Posted by Ron Hill on September 14, 2007, at 11:18:41
In reply to Re: My Horrible Experience on Abilify » Ron Hill, posted by AnneL on September 12, 2007, at 13:41:40
Anne,
Here are several links to studies and information that you may find useful:
Studies and Documents Addressing the Issue of Antidepressant Induced Rapid Cycling in Bipolar Patients:
Anne, double click on a link, and then on the Internet Explorer menu bar, click Edit, and then Find on this Page. Enter into the search box a phrase like “rapid cycling”, or “switching”, or a similar term.
Once you find the relevant potion(s) of the document via your searches, decide if you want to give a copy of the document to your pdoc. If so, print the document and highlight the relevant section(s). When reading these documents, recall that venlafaxine is Effexor.
http://bjp.rcpsych.org/cgi/content/full/189/2/124
http://ajp.psychiatryonline.org/cgi/content/full/163/2/232
http://ajp.psychiatryonline.org/cgi/content/full/163/8/1337
http://apt.rcpsych.org/cgi/content/full/11/1/28
http://apt.rcpsych.org/cgi/content/full/11/1/19
http://www.jabfm.org/cgi/content/full/18/4/271#R33
Expert Consensus Guidelines™ Medication Treatment of Bipolar Disorder 2000
http://www.psychguides.com/gl-treatment_of_bp2000.html
(Rapid Cycling tx discussion starts on page 36; read all of the sections on rapid cycling)Expert Consensus Guidelines™ Treatment of
Bipolar Disorder 2004
http://www.psychguides.com/ecgs15.php
(As stated on the web page, the Main Document Costs $19.99; but the (1) Table of Contents and the (2) Patient-family guide are both free of charge. Scan through both free documents, and read the paragraph on page 5 of 8 at the top left column titled “Treatments for acute depression” in the Patient-family guide.)Substance Abuse Affects on Switch Rate
http://www.psychiatrysource.com/NewsItem/Substance-abuse-increases-antidepressantinduced-ma.aspx?l1=3PsychEducation.org
“Antidepressants That Aren't "Antidepressants"
(Written 10/2005; updated 2/2006)
http://www.psycheducation.org/depression/ADwithoutAD.htmPsychEducation.org
“Rapid Cycling and Mixed States as "Waves"
(April 2006)
http://psycheducation.org/depression/Waves.htmPsychEducation.org
“Dark Therapy”
(updated 8/2006)
http://psycheducation.org/depression/darkrx.htm
Anne, the link (above) is way cool. The graph shows that the patient (pt) slept an irregular amount on an on-going basis and he was also bipolar rapid cycling. So they put this guy in a dark room for 14 hours a night, (they reduced to 10 hours a few weeks into the trial).Almost immediately after they started tossing the guy in there every night, the data tape shows that the pt almost immediately began to sleep a consistent number of hours every night. No big news, in and of itself.
HOWEVER, as soon as the pt started sleeping a consistent number of hours per night, his rapid cycling stopped!! You’ve got to be kidding me!! Check out the graphs for yourself. Absolutely astonishing!!
Obviously, these data must be taken with a grain of salt since it was a one pt open study with no control group, etc. But still, the correlation of the graphs is so astounding that we need some high quality follow-up studies conducted.
In the meantime, we bipolar rapid cycling pts need to force ourselves to establish and maintain good sleep hygiene which includes a consistent bedtime, and getting up each morning at the same time. It’s all about keeping our circadian clock in sync with the day/night cycle of the rotating earth.
I say all this, and here I am typing this post to you in the wee hours of the night. I wanted to get this to you before your pdoc appointment on Friday.
When I am in my normal phase (which I am now), I start to get tired at about 10 pm. But at 11 pm, a switch goes off in my brain, and my energy, motivation, productivity and, clarity of thought rise to the highest levels of the day. With my current workload, I love to get as much work done as possible. You know, it’s the “strike while the iron is hot” and “Git-er-dun” line of thinking.
As I eagerly work into the wee hours, I periodically look at the clock and tell myself that I need to go to bed. And, I answer myself that, as soon as I’m done with my project, I’ll go to bed. But, I often keep working through the night. Not good.
Don’t misunderstand me, Anne. This is not hypomania. I’ve been at this game of bipolar disorder for a long time, and I know exactly what I feel like when I’m hypomanic.
I am definitely not hypomanic as I work during the wee hours. If that were the case, I’d just take an extra 300 mg of Trileptal to reel in the hypomania, and that would be the end of that.
Instead, my high productivity, energy, motivation, and enhanced clarity of thought in the wee hours are because I have my circadian clock out of whack. I get tired just shortly before the sun rises.
And, by the way, as the dawn breaks, then indeed I do begin to experience some hypomania due to sleep deprivation. But, as always, I can reel the hypomania in with some extra Trileptal.
With regard to getting my circadian clock back in sync, I have some LowBlueLight (LBL) yellow glasses, but I typically use them only during the SAD season. The LBL glasses do a good job of resetting my circadian clock when I wear them during SAD season. So, I will dig out my LBL glasses and begin the process of resetting my circadian clock.
But, shame on me! In the past, I had only skimmed over the Dark Therapy PsychEd webpage. But, I read it thoroughly tonight to decide if I should send the link to you. So, I owe you a thank you. By writing this post to you, I learned something very important.
The bottom line is that my irregular sleep pattern has my circadian clock all screwed up (and vice-versa), and this may be worsening my rapid cycling. Therefore, I need to do whatever it takes to get my clock back in sync.
When you have time, click the links that Dr Phelps has imbedded within the text and read some more information (if you want to). He is a good pdoc, but he writes poorly, and his website is chaotic, and very difficult to use. He needs to hire a good webmaster. The website contains some good information, if you can find what you are looking for. He does have a search function on the site now, and that helps.
PsychEducation – The Blog
“Yellow lenses at night for sleep: Not Such a Strange Idea”
http://www.psycheducation.com/2006/08/yellow-lenses-at-night-for-sleep-not.htmlWelcome to lowbluelights.com
“Products for a Healthier Life” (check out the way cool glasses)
https://www.lowbluelights.com/index.asp“Sleep” (click ALL links on this page, and read them all)
https://www.lowbluelights.com/sleep.asp“SAD” (click ALL links on this page)
https://www.lowbluelights.com/sad.asp
Anne, I have more that I can send you, but this is plenty for now.Just ask if you need something.
If it is okay with you, I need to follow this post up with another post because I need to ask you some questions about your bipolar symptoms.
Be well.
-- Ron
Bipolar II with ultra rapid cycling (15 day cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
----------
> Ron,
> Thank you, Thank you for your most informative and very compassionate post.
>
> I have been on Effexor for 7 years and my current pdoc did not prescribe it for me. Perhaps this is why I have cycled in and out for all of these years. My second pdoc added on Lamictal but this caused anger. Now, I don't know if I was really angry at work at the time (could be), but I did not seem to have a working "censor" button so it was hypothesized that the lamictal and the clonipin could have created a situation where I was "disinhibited". The lamital was stopped and I went on my merry way on Effexor.
>
> New pdoc and she listens to my symptoms of BPII and puts me on Abilfy low dose 5 mg. then 10 mg. daily and honestly I did not notice one bit of difference and continued to cycle. I had lowered my Effexor from 225 to 37.5 mg. daily and I was hitting a very depressive state and she said to up the Abilify to 15 mg. - one dose of 15 mg. and I thought I was going to end up in the ER with major, intense anxiety.
>
> Right now, I self-medicating at Effexor 75 mg. and this seems to have killed the major depressive feelings, but I know I am just waiting to cycle again. It's not a matter of will it, but when will it.
>
> I see my pdoc on Friday and will be discussing all the AED's with her. I am a little gun shy due to the Abilify - I could kick her in the shin for that one. Thank you again for all of your help and I will read Dr. Phelp's information.
> :) AnneL
poster:Ron Hill
thread:780264
URL: http://www.dr-bob.org/babble/20070911/msgs/782870.html