![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 82. Go back in thread:
Posted by SLS on August 15, 2005, at 18:19:55
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 15, 2005, at 16:33:03
> Wow, this sounds exactly like me! Is she still currently not taking meds? Do you know if she had any successs with meds in the past? With the symptoms described above, was this a BPI or BPII diagnosis?BPII with possible BPD.
Currently, she is taking Topamax. In my estimation, it is doing very little for her. She probably would have done well on Risperdal were she not to develop akathisia. For the first week after discontinuing the Risperdal, she was perfectly normal. She then gradually entered the mixed state that she suffers with today. My guess is that another AP like Seroquel would have been helpful. I mentioned to her Trileptal, but her doctor is not terribly receptive to making any changes. She probably seems asymptomatic during her visits with him. Trileptal + Seroquel might be worth exploring.
- Scott
Posted by SLS on August 15, 2005, at 18:22:49
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by ed_uk on August 15, 2005, at 10:48:57
> >I restarted it yesterday at 37.5mg and will continue it at 75mg if I get enough of a boost from it.
>
> Any benefit so far?
A little. I'll probably decide on what to do with dosage over the next few days.
- Scott
Posted by theo on August 15, 2005, at 23:05:05
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 15, 2005, at 18:19:55
> Currently, she is taking Topamax. In my estimation, it is doing very little for her. She probably would have done well on Risperdal were she not to develop akathisia. For the first week after discontinuing the Risperdal, she was perfectly normal. She then gradually entered the mixed state that she suffers with today. My guess is that another AP like Seroquel would have been helpful. I mentioned to her Trileptal, but her doctor is not terribly receptive to making any changes. She probably seems asymptomatic during her visits with him. Trileptal + Seroquel might be worth exploring.
>
>
> - ScottTopamax made me look pale/gray and feel sickly. Also actually gave me avoidance behavior where I would avoid any dealings with people. Also lost about 8 pounds in a couple of weeks. Naturally, I'm 6', 180 pounds and don't need to lose any weight. My sister takes Topamax for migraines and is upset because it hasn't helped her lose a pound, amazing how these meds work so different even compared with a family member.
An AP might be worth a try for me. I've never tried one but would be willing. My doc even said, "it's hard to diagnose you because you seem so normal but from the symptoms you explain, I know you are suffering."
I'm to the point of almost feeling insecure about trying another med because of being let down again, but then take a deep breath and know I must be strong and continue my journey.
By the way, when I was taking Keppra it was when I went from 500mg daily to 750mg daily that I started to feel the positive effects so hopefully you will experience this soon. As I think I mentioned in a past post, my pdoc wanted me to be at 1000mg daily, but when I went from 750mg to 1000mg, I was overly aggressive and even had a little road rage. 250mg can make a big difference, at least with me.
You mentioned you are taking Keppra twice daily. Can you feel the first dose wearing off before it's time for your second dose? I'll be curious to see if you can take it twice daily versus three times daily. The PI says take twice daily (every 12 hours) but it also states the half life to be 6-8 hours which doesn't make much sense to me.
Posted by theo on August 15, 2005, at 23:31:12
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 15, 2005, at 9:53:36
> With bipolar disorder, some people display a paradoxical calming and anti-manic effect from stimulants.
Have you ever tried a stim? The only reason I stopped Concerta was fear of long term use and just did a 15 day trial. Do you know much about Concerta? I'm only talking about 18mg but wonder about long term stim use. Is Concerta suppose to be safer than amphetamines(Adderall)?
Posted by SLS on August 16, 2005, at 8:05:38
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 15, 2005, at 23:31:12
Hi Theo.
I hope today finds you well.
I can't say that I feel anything positive from Keppra at 500mg that I should notice a fluctuation throughout the day. If my doctor has me increase the dosaged today, I might take it three times a day. I have to take an afternoon dose of Parnate anyway, so it is not really an added inconvenience.
I think the appearance of agressiveness would be a good thing for me. Depression leaves me feeling passive, inhibitited, and submissive.
Dexedrine (amphetamine) helps me for a few days only. Ritalin (methylphenidate) has no effect. As far as long term use is concerned, I haven't seen a trend in the reporting of irreversible side effects for Dexedrine, Adderall, or methylphenidate. Linkadge would be a good person to ask about this. To my knowledge, it is only Desoxyn (methamphetamine) that represents a hazard to the integrety of nerve terminals.
- Scott
Posted by zeugma on August 16, 2005, at 15:17:27
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 16, 2005, at 8:05:38
> Hi Theo.
>
> I hope today finds you well.
>
> I can't say that I feel anything positive from Keppra at 500mg that I should notice a fluctuation throughout the day. If my doctor has me increase the dosaged today, I might take it three times a day. I have to take an afternoon dose of Parnate anyway, so it is not really an added inconvenience.
>
> I think the appearance of agressiveness would be a good thing for me. Depression leaves me feeling passive, inhibitited, and submissive.
Hi Scott.Ritalin definitely makes me more aggressive. If lack of aggression were my target symptom, then 30 mg Ritalin would be ideal, at least for half the day. Unfortunately it is not my only target symptom, so I have to find treatments more broadly effective and excessive inhibition is hardly my biggest problem, although a 'normal' person might well find it intolerable.
I don't think amphetamines or methylphenidate have more long-term effects than other classes of medication. Linkadge did mention a 'chromosome study' but did not elaborate on this. I myself would gladly take methylphenidate if it helped more of my ADHD symptoms, but it leaves too many untreated, although it does a good job at treating sleepiness. I am a walking set of DSM-IV disorders, and I have to go for optimal treatments, not ideal ones.
Lack of aggression is a real problem for males.
-z
>
> Dexedrine (amphetamine) helps me for a few days only. Ritalin (methylphenidate) has no effect. As far as long term use is concerned, I haven't seen a trend in the reporting of irreversible side effects for Dexedrine, Adderall, or methylphenidate. Linkadge would be a good person to ask about this. To my knowledge, it is only Desoxyn (methamphetamine) that represents a hazard to the integrety of nerve terminals.
>
>
> - Scott
Posted by SLS on August 16, 2005, at 16:15:18
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 16, 2005, at 15:17:27
Pemoline?
DA agonists?
Abilify?
- Scott
Posted by zeugma on August 16, 2005, at 16:34:41
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 16, 2005, at 16:15:18
> Pemoline?
Tried it, worked great, was taken off it because of drastic weight loss.
>
> DA agonists?
>
I brought up bromocriptine to my pdoc. Do you consider modafinil an indirect DA agonist?> Abilify?
Am I irrationally afraid of AP's? I've heard that Abilify in particular is bad for akathisia, which I have endogeneously. Modafinil actually works for this problem, not methylphenidate or anything else, except to a small degree nortriptyline, probably because of NOR's anticholinergic activity. >
>
-z
> - Scott
Posted by SLS on August 17, 2005, at 7:52:45
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 16, 2005, at 16:34:41
Hi Zeugma.
> > Pemoline?
>
> Tried it, worked great, was taken off it because of drastic weight loss.
> >
> > DA agonists?
> >
> I brought up bromocriptine to my pdoc. Do you consider modafinil an indirect DA agonist?I am still undecided. So far, this drug has demonstrated increases in glutamatergic neurotransmission in at least two structures: the thalamus and the hypothalamus. Excitation of the neurons in the thalamus might stimulate DA neurons elsewhere in the limbic system such as the nucleus accumbans to produce reward. In the hypothalamus, certain nuclei are encouraged to secrete a substance called hypocretin, which when it reaches the cortex produces wakefulness. These are not necesarily dopaminergic. Modafinil has not been shown to be effective in treating ADHD.
> > Abilify?
> Am I irrationally afraid of AP's?
It is not irrational to be concerned with the long-term risks of neuroleptics. I still have a few "irrational" cortical neural circuits that are uncomfortable with the idea, despite my decision to start taking them several years ago. I think there are subpopulations that are more vulnerable to the development of EPS with the atypicals. For instance, older persons, particularly those with dementia, are several times more liable.
> I've heard that Abilify in particular is bad for akathisia, which I have endogeneously.
The akathisia produced by Abilify is usually moderate and time-limited as a startup side effect. It could conceivably stabilize DA synapses by acting as a patial agonist rather than a full antagonist as does the other neuroleptics.
> Modafinil actually works for this problem,
That's interesting. Do you have any theories as to why?
Have you tried anticholinergic drugs like Akineton (biperidin)? They might suppress REM sleep.
Maybe you can take pemoline and Zyprexa together. That might help with the weight loss issue and confer anxiogenic effects and enhance "clarity of thought".
- Scott
Posted by zeugma on August 17, 2005, at 16:29:03
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45
Hi Scott.
>
> > > Pemoline?
> >
> > Tried it, worked great, was taken off it because of drastic weight loss.
> > >
> > >
> > >
> > Do you consider modafinil an indirect DA agonist?
>
> I am still undecided. So far, this drug has demonstrated increases in glutamatergic neurotransmission in at least two structures: the thalamus and the hypothalamus. Excitation of the neurons in the thalamus might stimulate DA neurons elsewhere in the limbic system such as the nucleus accumbans to produce reward. In the hypothalamus, certain nuclei are encouraged to secrete a substance called hypocretin, which when it reaches the cortex produces wakefulness. These are not necesarily dopaminergic. Modafinil has not been shown to be effective in treating ADHD.>It is effective for my disorder, whatever its etiology, although it treats different symptoms than Ritalin. For example:
Color perception:
Improves on Ritalin dose-dependently, no effect from modafinil.
Physical coordination: Improves on modafinil, no effect or worsened on Ritalin.
Reaction time: improved on Ritalin, slowed on modafinil.
Pattern perception: improved on both, but more so on modafinil.
Organization: improved on modafinil, no effect or only slightly improved on Ritalin, and any improvement on Rit HIGHLY dose-dependent.
Color perception is known to be dopaminergically mediated, and this argues against a strong role for modafinil as dopaminergic.
Hypothalamically mediated parameter:
Appetite: Modafinil is the only drug on which I have an appetite. Modafinil is the only drug on which I have demonstrated weight gain. Appetite is known to be orexinergically (aka hypocretin) mediated- the word 'orexin' means 'appetite' in Greek. I have narcoleptic as well as appetitive problems, and both are orexinergically mediated and localized in the hypothalamus.
> >
>
>
>
> > I've heard that Abilify in particular is bad for akathisia, which I have endogeneously.
>
> It could conceivably stabilize DA synapses by acting as a patial agonist rather than a full antagonist as does the other neuroleptics.Perhaps.
>
> > Modafinil actually works for this problem,
>
> That's interesting. Do you have any theories as to why?I think the hypothalamus is concerned with the processing of interoceptive, particularly autonomic, stimuli. I think the same dysfunction that causes me to have no appetite also causes spasticity, of which akathisia is a manifestation. Modafinil has been reported to reduce spasticity in cerebral palsy. I consider myself to have some kind of movement disorder, related to hypothalamic dysfunction.
>
> Have you tried anticholinergic drugs like Akineton (biperidin)? They might suppress REM sleep.
>
I was on high doses of Cogentin when treated with an AP. I experienced unusually vivid dreaming during this time, secondary to neuroleptic administration.
> Maybe you can take pemoline and Zyprexa together. That might help with the weight loss issue and confer anxiogenic effects and enhance "clarity of thought".
>That's an interesting idea. Do you think Zyprexa has cognotropic properties?
-z
>
> - Scott
>
Posted by zeugma on August 17, 2005, at 16:46:54
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45
What benefits have you had from the addition of Abilify?
Have you ever tried gabapentin?
-z
Posted by zeugma on August 17, 2005, at 17:33:47
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45
by the way, exhaustive info about Keppra is now available at http://crazymeds.org/
I hope Keppra helps you.
-z
Posted by SLS on August 17, 2005, at 18:46:16
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 17, 2005, at 16:29:03
Z.
It looks like you have established a hypocretin connection to your condition given the narcolepsy and appetitive depression you have observed and the way they are influenced by modafinil. You might want to begin looking at the way the X and Y clocks are synchronized and see if there is some way to cue or reset them using environmental stimuli like a light box or well-timed melatonin ingestion. From what I understand, depression can affect adversely the periodicity of hypocretin secretion.
As far as Zyprexa is concerned, many people on PB have described it as producing or enhancing "clarity" of thought or thinking more clearly. I myself experienced this when I added it to help control an antidepressant-induced mania. I think Zyprexa has a positive influence on executive function in areas that might also contain hypocretin neurons such as PFC.
For me, Abilify has increased motivation and mental energy. It has also protected me from suicidality by dissipating anxious catastrophic thinking.
- Scott
Posted by zeugma on August 18, 2005, at 7:16:39
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 18:46:16
>
>
> You might want to begin looking at the way the X and Y clocks are synchronized and see if there is some way to cue or reset them using environmental stimuli like a light box or well-timed melatonin ingestion.>>Interestingly I was prescribed a light box many years ago after my first sleep study. Let's say 'compliance' was an issue. It was impossible for me to wake up before 2 pm on a consistent basis, much less at 6 am as the sleep doc advised. I used it intermittently over the years and unsurprisingly got no major benefit from it.
I wake up now fairly regularly by 6 am. I could retry it, as the thing takes up half my apartment (!).
<From what I understand, depression can affect adversely the periodicity of hypocretin secretion.
>Do you have any thoughts then on why modafinil is not considered an effective AD? I seem to get an AD effect from it, but that could be because it reduces core symptoms of melacholia (agitation and lack of interest in food).
> As far as Zyprexa is concerned, many people on PB have described it as producing or enhancing "clarity" of thought or thinking more clearly. I myself experienced this when I added it to help control an antidepressant-induced mania. I think Zyprexa has a positive influence on executive function in areas that might also contain hypocretin neurons such as PFC.>
yes, that's on the right track. i have serious executive function issues. Notably, these are helped more by provigil than by ritalin, though I do derive some benefit from ritalin.
>
> For me, Abilify has increased motivation and mental energy. It has also protected me from suicidality by dissipating anxious catastrophic thinking.
>It's well worth it then.
-z
>
> - Scott
>
Posted by theo on August 18, 2005, at 16:41:57
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 16, 2005, at 8:05:38
Hey Scott,
What dose are you currently at with the Keppra? Are you feeling anything positive or negative?
Ted
Posted by SLS on August 19, 2005, at 8:39:33
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 18, 2005, at 16:41:57
> Hey Scott,
>
> What dose are you currently at with the Keppra? Are you feeling anything positive or negative?
>
> TedI began taking 500mg of Keppra on Sunday. I will be moving up to 1000mg today. So far, I haven't experienced any negative effects on mood or cognition. This alone is a positive outcome at this juncture. Keppra has been known to make depression worse in some people. One of the things I hate about starting a new drug is that I place so much hope in it so soon. I experienced a small improvement in energy over the past two days. So, my silly mind interprets this as evidence that the drug will ultimately bring me into complete remission. Why is that? After so many "false starts" and treatment-failures, you would think I should at least remain neutral in my outlook, if not demonstrate overt pessimism based on my treatment statistics.
I guess I really don't expect very much from Keppra. The NIMH hasn't seen it successfully treat severe depression. However, this was probably in the absence of antidepressants. My doctor doesn't think much of the drug. Ivan Goldberg wasn't terribly impressed either. No one here has reported a robust antidepressant response in the treatment of chronic depression. I had it on my list simply because it was so different from the other anticonvulsants I've tried. However, I haven't tried Topamax yet. I was hoping to stay away from that drug because of how easily these drugs affect negatively my cognition.
So, here I am.
Life is funny. The one Medline article that captured my interest was this one:
When I decided to go for a second opinion consultation, I was recommended to see Dr. Kaufman. I had no idea he was the author of this article. I really didn't know anything about him. When I asked him what he thought of the idea of using Keppra, he smiled at me and asked me why I was interested in it. When he showed me a copy of the article abstract, I said, "Yeah, I read this." LOL. It was his suggestion that I give it a try. If it works, he would like to write me up. Hopefully, he'll have good reason to.
- Scott
-------------------------------------------1: Epilepsy Behav. 2004 Dec;5(6):1017-20. Related Articles, Links
Monotherapy treatment of bipolar disorder with levetiracetam.Kaufman KR.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu
Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Publication Types:
Case ReportsPMID: 15582854 [PubMed - indexed for MEDLINE]
Posted by ed_uk on August 19, 2005, at 9:43:22
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
>No one here has reported a robust antidepressant response in the treatment of chronic depression.
.......but not many babblers have tried it.
~ed
Posted by willyee on August 19, 2005, at 13:16:38
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Please guy keep us updated,im still trying to get this med prescribed with no success.
Posted by theo on August 19, 2005, at 17:11:58
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Keppra does have unique mood lifting properties that you should experience soon after you bump your dose up passed 500mg. I actually felt a little slowed on 500mg, but once I went to 750-1000 it seemed to make me more alert/assertive. It's one of those meds that seems to pick up speed with higher doses.
One thing about Keppra, you will know in a few days if you need to adjust up or down.
Posted by Nickengland on August 19, 2005, at 17:29:36
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Hello Scott,
I wish you the best of luck with Keppra ~ seems like you're stepping into new territory so to speak, and with that, like with all medication we try we're always taking some kind of risk on whether or not the effects of the drug will hold out or work to the extent we need them too.
I really do hope levetiracetam gives you success, i'm sure your keep us up-dated and i'll look out for your posts when they come up...it will be great to hear that its working well and i hope it is so far...
Kind regards
Nick
Posted by theo on August 19, 2005, at 23:38:22
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Forgot to ask, is he saying methylphenidate did not precipitate manic features while taking Keppra?
I was at work earlier and just re-read your post. Interesting you actually spoke with Dr. Kaufman?
I am at a weird phase in my battle. I've been off meds for a while and know I can make it through the day, but realize I'm not happy and life seems overwhelming. Sometimes I wish my symptoms were extreme so I could at least be more easily diagnosed. I've been off meds long enough where I almost feel weak, like I'm giving in to "drugs." To medicate or not to medicate, this battle is stressful in itself.
Keppra actually worked better in many ways than other meds I tried, but I got anxious and thought I needed to add this and that etc, etc. I always want "something better" and it can really make getting well difficult.
Keep me posted on your progress with Keppra. I really hope it works for you. I don't know if you ever check out the crazymed site, but the individual totally revamped the Keppra section and it's loaded with information.
Posted by theo on August 22, 2005, at 22:56:11
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Scott,
How is the increase in Keppra. Are you feeling anything positive (or negative) at all?
Ted
Posted by SLS on August 23, 2005, at 5:58:56
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 22, 2005, at 22:56:11
Hi Ted.
> How is the increase in Keppra. Are you feeling anything positive (or negative) at all?
I am not feeling anything negative.
:-)
This is a good thing.
I'll keep you posted.
- Scott
Posted by SLS on August 24, 2005, at 6:37:47
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 22, 2005, at 22:56:11
Yesterday was a good day. I had more energy than usual and accomplished more than I have in quite a while. No side effects.
- Scott
Posted by willyee on August 24, 2005, at 14:49:48
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 6:37:47
DO you feel the keppra might be poteintating the parnate so that its working more effectivly.
Or do you feel any benifits from keppra seem to pretain to keppras use soly?
I know it might be too early too tell,im confused i have to see my doc soon and i dont know whether to ask for topamx or keppra,theres no other AD im willing to go on also i get parnate free from a proram by its manufacturer so i just have to hope something can kick start this med again,its really seemms like a lost cause at this point,good luck!!
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.