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Re: Advice on which medication is best for my case » phidippus

Posted by kavinsky99 on February 24, 2014, at 19:08:14

In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by phidippus on February 24, 2014, at 18:01:55

> >I don't really obsess about anything else other than my traumas (the more severe ones), also. Don't know if that matters.
>
> All you kneed to have is one obsession (mine is suicide).
>
> >I still don't know if it's pure anxiety or a type of hypomania where anxiety is very present.
>
> It sounds more like hypomania, which can include high levels of anxiety.
>
> > Could be hypomania, or could be just stress induced brain changes.
>
> The area of the brain most susceptible to changes brought about by stress is the hippocampus-it can shrink, causing memory impairments, cognitive problems, etc.
>
> >It would explain why I never have euphoric mania
>
> I'm Bipolar I and rarely have euphoric manias.
>
> >I'm noticing that doing something concrete and real about it is making me feel better.
>
> Distraction and structure help alleviate OCD symptoms.
>
> > What I tried to describe is more like extreme anxiety/stress with depression being a consequence, that tends to be brief.
>
> You'r still describing a mixed state :) Bipolar II presents exactly the way you describe. The stress/anxiety component is the mania.
>
> >it makes me sad that I never had euphoric mania! haha
>
> Even when I had a euphoric state it was laced with god awful amounts of anxiety.
>
> > Sometimes I tend to have a really incoherent approach to things, a lot of confusion.
>
> Do you experience a lot of racing thoughts?
>
I do have true racing thoughts when I'm very anxious, specially during a panic attack. Other times, I don't have RACING thoughts per se, but very attention consuming, endless mind chatter that I can't control and often give up and just "dialogue" with. I have the odd day where I'm literally consumed by "flashbacks" and inner dialogue. I wouldn't say these thoughts are racing, as I actually feel my mind goes slower in those days (along with extreme fatigue), but they are intense and run on a chain, like my mind is on a track and all I can do is wait for the ride to be over (when I sleep or pop a benzo).

> >Even on the smallest doses, APs make this specific problem far, FAR worse.
>
> If you do have the slightest bit of ADHD, it could axplain why APs make these symptoms worse.
>
Yeah, APs are great for managing anxiety (in lower doses. higher doses seem to worsen it) and agitation, but create an specific kind of restlessness that is a lot like true ADHD. Nothing sinks in, nothing feels rewarding, nothing gets caught in my mind. So I keep doing random stuff and moving around.
>
>
> > That seems to happen more on the beginning of SSRIs. More or less the same between all of them:t They make me feel good the first 2 doses, then move to slight apathy and the host of physical side effects, then I get this boost in
> > energy and get way too confident. Then a more severe form of bluntness of emotion/though and apathy kicks in.
>
> Sounds like they destabilize your mood quite a bit. If you were on 1200mg of Lithium and say, 20 mg Lexapro, it wouldn't be such an issue.
>
Don't know if I could tolerate 1200mg of lithium well. 900mg was causing a few bothersome side effects. Now I'm at 600mg, but I do miss how well it worked at 900mg.
> > Think it's worth the shot to try again, to see if mania is triggered?
>
> What's worth trying is one of these antidepressants that worked for you .with the lithium.
>
Well, I'd have to go up to 1200mg then.
But I'm using tianeptine and feeling as stable as I have ever been, on 3mg to 6mg daily dose along with 600mg lithium.
> >Is there anything such as a "test for mania" in those who already might suffer from it?
>
> Not really. A manic response to any antidepressant is a good indicator you are truly bipolar
>
> > Mirtazapine at 45mg (more norepinephrine release) caused the same irritability as Effexor 150mg did, by the way (even concurrent with 900mg lithium).
>
> 900 mg of Lithium might not be enough.
>
> >
> >Lithium was prescribed for the effects it has on repairing damage caused by stress.
>
> Does it help with your anxiety?
>
It does, but not enough to keep it under control, specially when it gets too bad. I feels as if lithium is just "cementing" a solid layer of tranquility and overall good functioning in my mind. The more I use lithium, the less excitable I am in general. On or off the lithium, I can see severe changes on how I react to just about anything. For the best, in general. I do notice lithium "dulls" certain impulses and interests I used to have, that made me a more fun and outgoing person. Lithium is turning me into a more quiet person, that finds comfortable to just not care much about things.

> >I think lithium is my best bet.
>
> I think so, too and indicates to mee you are bipolar. HOWEVER, Lithium is not going to help with the intrusive and recurrent thoughts - you need an AD to treat those, so I encourage you to find an SSRI that works well with the lithium.
>
Actually, that's why my doctor prescribed me originally and it was the best medication I took regarding the never ending mind chatter and intrusive thoughts. Serotonergic ADs help too, of course. Sadly, I usually can't tolerate SSRI/SNRI side effects (really bad ones tend to appear after a few months), so I end up discontinuing them. Doctor suggested Clomipramine for the intrusive thoughts, I haven't tried it yet due to the anti-cholinergic effects being possibly harmful to my already bad cognition. What do you think of TCAs, at a low dose? Their side effect profile scares me, but their efficacy and how they can be helpful on neuropathic pain keep me curious.

> > However, I do need something else for anxiety and focus.
>
> You can always try Vyvanse, which will help with concentration and may even help your OCD/PTSD.
>
I think Vyvanse isn't available in my country yet. Isn't it a stimulant? Stimulants and other dopaminergic drugs aren't a good option for me, as they worsen the agitation and anxiety a lot.

> > I've read Seroquel might be good for bipolar depression and reversing cognitive dysfunction (that is more present in bipolar II). What do you think?
>
> Seroquel is not so good for cognitive dysfunction-it is more likely to cause it.
>
As will most APs, right? Damn you, dopamine...

> > > > I wish to see obliterated:
> > > >
> > > > Depression;
>
> Lithium helps depression.
>
> Any serotegenic antidepressant could help
>
> Wellbutrin
>
> Rilutek
>
Rilutek, did not know it could work for depression.
Wellbutrin worsened my anxiety and agitation a lot. I took 450mg for 2 years, and it slowly increased my symptoms of anxiety, depression and the possible bipolar II to a point where I was having anxiety attacks every 45 minutes (all of them were pretty negligible before it and I never had panic attacks before). So any doctor usually rule out dopaminergic drugs.

> > > > anxiety;
>
> TCAs, SSRIs, Gabitril, Benzodiazapines, Keppra, 5ht1a agonists, many APs can be helpful.
>
Never tried TCAs. What do you think of them? You think low dose of any of them could be effective for anxiety and neuropathic pain, without harm to cognition or other more bothersome side effects?

SSRIs are so unreliable. Every two weeks or so my mood and side effect profile seem to shift to something else.

Gabitril's description makes it sound a lot like Gabapentine. Gabapentine made me dumber than a box of rocks. Rocks with a relentless death wish, too. Same goes to Topamax. That's why I'm weary of trying any mood stabilizer (though I haven't touched the better ones for anxiety/depression/bipolar, like Lamictal, Tegretol, Trileptal). Keppra isn't very popular in my country, but I think we have it. i'm going to look into that one better before I comment on it.

APs make me apathetic, impulsive, ADHD, dysphoric (not in the dysphoric mania sense. just extremely miserable and angry/sad at life), dumb and obese. But they work for what they're intended, though! I'll try one of these again when I have the time to deal with serious side effects and sleep 12-15 hours a day.

> > > > negative critical thoughts that "talk to me" in my mind;
>
> APs are good for intrusive thoughts. If its an OCD thing, SSRIs can be helpful. CBT and DBT.
>
The intrusive, repeating thoughts are by far the worst symptom of all. I don't know if they're the cause of a symptom or both, but they literally cripple my ability to live. For all that I do, unwanted negative thoughts pop up.

900 Lithium + 30mg mirtazapine + 1mg risperidone or 600mg lithium + 50mg Zoloft + 6mg bromazepam were the best combos for that. However, Zoloft, risperidone, bromazepam and mitazapine tend to worsen my cognition.

> > > > intrusive flashbacks that pop up constantly;
>
> Prazosin
>
I never tried beta and alpha blockers. I'll look into it.

> > > > overall agitation;
>
> Lithium, APs, serotogenic drugs
>
> > > > insomnia;
>
> Gabitril, Seroquel, Rozerem, Lunesta, Ambien, Clonidine, Mirtazapine, Trazodone.
>
> > > > I wish to see improved:
> > > >
> > > > Overall cognition
>
> Keppra, LAtuda, MEmantine, Riluzole
>
Can these drugs and nootropic drugs cause an increase on intrusive thoughts? I'm scared of trying even choline supplements, and insted of finding more ability to memorize better and focus on studying, I'll just have more ability to bring back and focus on the garbage already on my mind.

> > > > focus
>
> Vyvanse, Concerta
>
Stimulants might not be a good idea for me.

> > > > ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen.
>
> Zen Buddhism
>
Not sure if you're joking, but it made me laugh.
hahahaha
> Eric


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poster:kavinsky99 thread:1060760
URL: http://www.dr-bob.org/babble/20140214/msgs/1061250.html