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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Jimmyboy on January 8, 2007, at 19:52:59
Well went to a new pdoc today, a highly trained Columbia U type, was hoping for some new groundbreaking ideas, but no. She said I was bipolar II, Lamictal didn't do jack as well as everything else .. Basically told me to stay on Serzone ( even though I told her I am already exhausted/tired all the time , and Serzone is very sedating ) and to add a high dose of Lithium ( which is also sedating and dulls your cognative abliities).
I was on Lith for over 2 years at 900 mg/day. and had no benefit or side effects .. she said if you don't get to theraputic level, it is no help at all , zilch and that it magically kicks in at theraputic level ( apparently 900 mg is not theraputic level? ) - so my questions are this :
1. What is the general dose of Li to reach the .08 - 1.2 " theraputic levels) . I am a pretty big guy, if that matters.
2. Has anyone been helped by kicking the Li level up higher , when it didn;t help at a lower dose?
JB
Posted by Phillipa on January 8, 2007, at 21:13:46
In reply to Bipolar II - it really sucks, posted by Jimmyboy on January 8, 2007, at 19:52:59
Everyone is an individual and has to find their own dose to get lithium to a theuraputic one. Love Phillipa
Posted by cgd092 on January 8, 2007, at 21:25:34
In reply to Bipolar II - it really sucks, posted by Jimmyboy on January 8, 2007, at 19:52:59
You wrote, " Lamictal didn't do jack "
How much did you get up to? Did it even give you side effects, like a headache? I'm starting a trial of it and hope to feel something positive soon; I'm only up to 50mg. I'm unipolar, but my pdoc wants to try this. If you can share any Lamictal experiences, I'd like it hear. Thanks! --Katy
Posted by Phillipa on January 8, 2007, at 21:37:39
In reply to Re: Bipolar II - it really sucks, posted by cgd092 on January 8, 2007, at 21:25:34
I got up to 50mg too unipolar and got excess salivation disgusting tried twice and had to quit. And I found that I got angry. Didn't realize till stopped the med. Love Phillipa
Posted by med_empowered on January 8, 2007, at 22:06:59
In reply to Re: Bipolar II - it really sucks » cgd092, posted by Phillipa on January 8, 2007, at 21:37:39
you'll need to do bloodowork pretty regularly to see how you're doing with Li levels...it could be that lithium just isn't for you. Docs seem to love it for BP II, but really its best for BP I, with classic features (euphoric mania, so on so forth).
BP II is a completely different animal. Some people w/ BP II can actually do an antidepressant w/o a mood stabilizer...some manage to go off psychotropics altogether. I did read on yahoo news or something a while back that they had worked out ideal depakote dosages/blood levels for both BP I and II..however, with so much individual variation, and the low quality of psychiatric studies in general, I don't know how helpful those guidelines would be.
Why wasn't the lamictal helping? did you still have (hypo)mania or mixed episodes or depression? Or did you have anxiety and attention issues remaining? Personally, Trileptal worked well for me...there's no mandatory blood work (checking blood sodium is probably a good idea, though) and its pretty tolerable. Supposedly its a bit weaker than Tegretol.
Are you on any benzos? Those help a lot of people with mood issues.
Good luck
Posted by Phillipa on January 8, 2007, at 22:14:13
In reply to Re: Bipolar II - it really sucks, posted by med_empowered on January 8, 2007, at 22:06:59
Med since you're here my pdoc prescribed trileptal for me last time with the luvox, valium and .5xanax and lunesta and said the trileptal would help with anxiety is that true and and what dose if it does and at what time of day. Thanks love Phillipa
Posted by Jimmyboy on January 8, 2007, at 23:11:28
In reply to Re: Bipolar II - it really sucks, posted by med_empowered on January 8, 2007, at 22:06:59
Honestly, the Lamictal just didn;t do "anything" , I still had dark depressions come just as bad and just as often.. basically I felt like I was taking nothing. Thats why I quit it, not b/c of side efects or anything.
Posted by blueberry1 on January 9, 2007, at 4:44:10
In reply to Bipolar II - it really sucks, posted by Jimmyboy on January 8, 2007, at 19:52:59
What are you primary symptoms? If you are bipolar II then you must get some kind of hypomanias, or agitated states, or something like that? How would you describe it? How often do they happen? Is depression the primary thing? Is there a lot of fatigue?
The reason I ask is because answers to those questions will make a huge difference in drug selection. Just because someone is BPII doesn't mean a mood stabilizer is the way to go. Like was already stated, an antidepressant and/or benzo is fine with some top notch pharmacologists. And other things like Provigil should be explored. I disagree with what the doctor said about lithium not doing anything until the blood level is right. If it was going to do anything for you, it is my hunch you would have at least felt a hint of something from it at 900mg.
It's so frustrating when you go with high hopes to a new doctor and they basically preach out of a textbook like you are some statistic or something.
Posted by med_empowered on January 9, 2007, at 5:28:59
In reply to Re: Bipolar II - it really sucks » Jimmyboy, posted by blueberry1 on January 9, 2007, at 4:44:10
phillipa--trileptal kind of helped my anxiety (more of a general relaxation thing; it didn't reduce panic attacks or greatly improve my social phobia), but it didn't really show up until 600mgs/day, and it was pronounced @ 1200mgs/day. Those dosages made me stupid, though, which is why I don't take Trileptal any more.
Jimmy--I think maybe you should try something other than the traditional "mood stabilizer" route. Its worth noting that most "mood stabilizers" are good anti-manics (most sedatives are), but they don't do so well for depression (lamictal maybe, but apparently the study design made its results seem alot more impressive). You could try an atypical neuroleptic, but if your symptoms don't include psychosis or mania, that strikes me as overkill. I read a study where some Bipolar and schizoaffective patients did quite well with Wellbutrin, combined with benzos and/or low-dose neuroleptics. Some people w/ bipolar disorders find straterra and edronax to be helpful for their depressions.
Also, psychotherapy can be very helpful.
Posted by Jimmyboy on January 9, 2007, at 9:18:51
In reply to Re: Bipolar II - it really sucks » Jimmyboy, posted by blueberry1 on January 9, 2007, at 4:44:10
Hi Blueberry ,
I appreciate you taking the time to answer. Basically my depression is major fatigue/hypersomnia, brain fog, loss of short term memory, absoluteluy zero motivation to do anything or to socialize, and absolutely no emotions whatsoever.
But yeas, it has been depression 99.9% of the time, has been pretty much constant and recurring for most of my life. Have had limitd and short lived success on anti-depressants, etc. I have had 1 full blown manic episode about 12 yrs ago ( drug induced - zoloft + yohimbe, + street drugs) and a hypomanic episode 2 years ago. Other than that , no mania, hypomania.
Oh yeah, my mother had a severe case of bipolar I , mostly mania.
Thanks for any suggestions,JB
Posted by becksA on January 9, 2007, at 9:35:06
In reply to Re: Bipolar II - it really sucks, posted by med_empowered on January 8, 2007, at 22:06:59
Phillipa was correct, I'm 6'7" 220, but despite that, the smallest dose of Lith could work for me. Although I am now on 1200mg daily. Bare in mind I have always been EXTREMELY tolerant to meds. I'm coming down off of 14mg Klonopin (The only thing that helped my anxiety, but the dose was so high I began to become WAY too impulsive). In any case, I've come down to 8mg of klonopin and am surprised to notice that the anxiety isn't nearly what I expected. There is almost no change whatsoever...Hard to tell. I think (and hope) the Lithium is playing that role.
About the Lamictal, I maxed that out and it did nothing for me except increase my anxiety, I also did Depakote at a high dose and seemed to do nothing but depress me a bit if anything.
Posted by blueberry1 on January 9, 2007, at 16:10:29
In reply to Re: Bipolar II - it really sucks, posted by Jimmyboy on January 9, 2007, at 9:18:51
The description you gave points fairly strongly in the direction of stimulants. Have you tried Adderall? Have you tried Provigil? Maybe go to remedyfind.com and see how other users have rated their experiences with these. Provigil in particular looks very impressive in the real world, either on its own or often combined with a ssri. In any case, I doubt any antidepressant is going to address your symptoms very well. One exception is wellbutrin, but it is fairly weak finnicky. To take a gamble and go where the odds are best in your favor...stimulants. Having a LOW dose antidepressant onboard with them is a good thing. This according to the doctor's website from Harvard that was suggested on my recent thread asking about stimulants. Check that out.
> Hi Blueberry ,
>
> I appreciate you taking the time to answer. Basically my depression is major fatigue/hypersomnia, brain fog, loss of short term memory, absoluteluy zero motivation to do anything or to socialize, and absolutely no emotions whatsoever.
>
> But yeas, it has been depression 99.9% of the time, has been pretty much constant and recurring for most of my life. Have had limitd and short lived success on anti-depressants, etc. I have had 1 full blown manic episode about 12 yrs ago ( drug induced - zoloft + yohimbe, + street drugs) and a hypomanic episode 2 years ago. Other than that , no mania, hypomania.
>
> Oh yeah, my mother had a severe case of bipolar I , mostly mania.
>
>
> Thanks for any suggestions,
>
> JB
Posted by Phillipa on January 9, 2007, at 17:57:45
In reply to Re: Bipolar II - it really sucks, posted by med_empowered on January 9, 2007, at 5:28:59
Med so 300mg would do absolutely nothing at all? How bout for the anxiety associated with depression? Love Phillipa
Posted by med_empowered on January 9, 2007, at 21:27:44
In reply to Re: Bipolar II - it really sucks, posted by blueberry1 on January 9, 2007, at 16:10:29
I tend to agree w/ blueberry here. Personally, low-to-moderate adderall helped stabilizer my moods. There's also ritalin, dexedrine, desoxyn, and Provigil to conside.
Posted by Jimmyboy on January 10, 2007, at 8:42:53
In reply to Re: Bipolar II - it really sucks, posted by med_empowered on January 9, 2007, at 21:27:44
I have tried stimulants and they definitely help with the brain fog and concentration, the problem with them seems to be that I get a lot of anxiety/social anxiety and tend to overfocus on things and become even worse with social interaction. Is there anything that can mellow that out?- like adding an anti-depressant, or using super low doses, benzo's? Thanks for the infoJB
Posted by linkadge on January 10, 2007, at 13:22:16
In reply to Re: Bipolar II - it really sucks)blueberry)med emp, posted by Jimmyboy on January 10, 2007, at 8:42:53
Lithium levels are indivudual. Its not like the brain isn't affected by levels that are above or below "theraputic".
Lithium was terrable for my anhedonia.
Tegretol, and trileptal made me feel posessed.
Low dose depakote + omega-3 worked fairly well.
Linkadge
Posted by med_empowered on January 10, 2007, at 16:00:20
In reply to Re: Bipolar II - it really sucks)blueberry)med emp, posted by linkadge on January 10, 2007, at 13:22:16
Jimmyboy--I hear you on the anxiety from even low doses of stims. A LOW dose of an AD might work; I read an article where a doc recommended 37.5mgs/day Effexor, or 1/2 the usual minimum therapeutic dose. BuSpar+Stims might help, but buspar is a bid/tid med and it kind of sucks for a lot of people so....
For Bipolar, Wellbutrin (and Edronax and Straterra) seem helpful; they're kind of stimulant-ish, and there's a lower risk of inducing mania. With BP II (which overlaps a lot w/ forms of unipolar depression docs used to recognize in the pre-Prozac years), I think you kind of have to see how you react. If stims helped, maybe add in a low-dose, clean, tolerable AD...my vote would be celexa/lexapro at tiny doses, or maybe sub-therapeutic amounts of cymbalta (like 20mgs or so). I imagine an ADD doc would be more familiar with this than mood-disorder focused docs. Since there's so much overlap between ADD and some forms of bipolar (mood lability, anxiety, sometimes OCD, periods of irritability, so on and so forth), you might want to see if treating your problem from more of a "complicated ADHD" standpoint is more productive than treating it as a less-severe form of BP I, which is what it seems your doc is doing now.
Good luck!
Posted by polarbear206 on January 10, 2007, at 18:06:22
In reply to Re: Bipolar II - it really sucks, posted by Jimmyboy on January 9, 2007, at 9:18:51
> Hi Blueberry ,
>
> I appreciate you taking the time to answer. Basically my depression is major fatigue/hypersomnia, brain fog, loss of short term memory, absoluteluy zero motivation to do anything or to socialize, and absolutely no emotions whatsoever.
>
> But yeas, it has been depression 99.9% of the time, has been pretty much constant and recurring for most of my life. Have had limitd and short lived success on anti-depressants, etc. I have had 1 full blown manic episode about 12 yrs ago ( drug induced - zoloft + yohimbe, + street drugs) and a hypomanic episode 2 years ago. Other than that , no mania, hypomania.
>
> Oh yeah, my mother had a severe case of bipolar I , mostly mania.
>
>
> Thanks for any suggestions,
>
> JBWe have much of the very same symptoms in common. If your bipolar is depression dominated, you probably need to be on an ad in combination with a mood stablizer. I went the stimulant route and it caused mixed states to surface. I tried Lithium, depakote, and have had great success with 200mg of lamictal and effexor. lamictal has a narrow therapeutic window. Vegetated depressions (atypical) respond well to MAOI's. Have you tried any? Were you ever on a mood stabilizer and an ad at the same time? Light therapy can be very helpful in your case as an add on. Costco has the "Golite" which is portable Go to psycheducation.org bipolar II diagnosis and treatment.
Posted by ClearSkies on January 10, 2007, at 19:40:25
In reply to Re: Bipolar II - it really sucks, posted by polarbear206 on January 10, 2007, at 18:06:22
I'm currently tapering off of Lamictal as it has not shown any benefits for my hypomanic episodes. I'm full-blown right now. Breezed through euphoria sometime yesterday and I'm back to shuddering and not being able to hold a thought for more than a few moments... which is why I'm posting, I guess.
My hypomania is so shortlived, and so infrequent, that I really question whether a mood stabilizer is the right treatment for me. Goodness knows, this med isn't doing anything for my current frenzy. My anxiety is way up as the Lamictal is going down, that much is apparent.
So, I'm thinking, Depakote or Lithium are on the horizon. Though considering my infrequent periods of hypomania, I think I'd do ok with sticking with my current AD - Cymbalta, 60mg - and a low dose of a benzo if I need it to get through the next skip through crazy-land. My pdoc has been informed that I consider her dismissive of my opinions. I print out loads of anecdotal evidence and she handed the last batch back at me. "No studies, no double-blind, no references, these mean nothing." Charming woman. Then I pointed out that my experiences are anecdotal, by definition. And that if she didn't respond to my anecdotal symptoms, that I'd find a pdoc who would.
It's been contentious. I'm thrashing against a doctor who wants to ADD rather than SUBTRACT. When I reported my problems with Lamictal - that it isn;t working for me - her response was to recommend an additional AD to help. I started bawling my eyes out, right there, I swear. (I usually leave my pdoc's office in tears, come to think of it.)
So, where was I?
Yes, BP II sucks. Some people don't accept that it's a bonafide dx. Some people think you should work this stuff through for yourself and get off all the meds.
I think that I need a fairy godmother who will wave her magic wand over my head, and pronounce me Fixed.
Ain't that a nice thought?Forgive me for rambling,
ClearSkies
Posted by Phillipa on January 10, 2007, at 20:16:22
In reply to Re: Bipolar II - it really sucks, posted by ClearSkies on January 10, 2007, at 19:40:25
Wow that's fast. So does hubby still think you don't need meds? Send a bit my way. Love Phillipa
Posted by med_empowered on January 11, 2007, at 0:13:44
In reply to Re: Bipolar II - it really sucks » ClearSkies, posted by Phillipa on January 10, 2007, at 20:16:22
wow. I've never experienced a p-doc quite as self-absorbed and mean as yours. I think you should get a new one--F*A*S*T! I had one I really didn't get a long with...I said I'd feel more comfortable with another doc, and asked for a list. I also told her I'd need her to write my RXs for a while, max 3 months, while I found someone else. She agreed.
Remember: you are paying these people. You aren't under court-order to go to her; you're going b/c she's supposed to help. She isn't. Tell her this, and tell her you will need her to handle any problems that come up in the next couple months as you find someone who will be helpful.
Posted by ClearSkies on January 11, 2007, at 8:34:52
In reply to To ClearSkies..., posted by med_empowered on January 11, 2007, at 0:13:44
> wow. I've never experienced a p-doc quite as self-absorbed and mean as yours. I think you should get a new one--F*A*S*T! I had one I really didn't get a long with...I said I'd feel more comfortable with another doc, and asked for a list. I also told her I'd need her to write my RXs for a while, max 3 months, while I found someone else. She agreed.
>
> Remember: you are paying these people. You aren't under court-order to go to her; you're going b/c she's supposed to help. She isn't. Tell her this, and tell her you will need her to handle any problems that come up in the next couple months as you find someone who will be helpful.Thanks for your ideas, med_empowered! I have a couple of leads on pdocs from my therapist, and I've scheduled an appointment with my regular GP for his take too.
I do think my relationship with this pdoc is beyond repair. Getting a 3 month supply of my current Rx's is a great idea, and I'll bring it up at my next appointment.Thanks again - I really appreciate your opinions!
CS
Posted by cgd092 on January 11, 2007, at 10:47:18
In reply to Bipolar II - it really sucks, posted by Jimmyboy on January 8, 2007, at 19:52:59
I hope you find something that works. I was on Serzone for at least a year and I liked it. It worked, and it didn't have bad sexual side effects. But it did eventually poop out on me.
Posted by Jimmyboy on January 12, 2007, at 13:47:59
In reply to Re: Bipolar II - it really sucks, posted by cgd092 on January 11, 2007, at 10:47:18
Thanks, I pretty much have given up on anything working.. Serzone used to work, at least keep me semi functional , but its been 6 weeks and nothing.. I just started Lithium and I think I am going to try a MAOI , because I literally have tried everything else and nothing has worked. So , I guess thats sort of the last road for me.
Good luck to you,
JB
Posted by nolegirl23 on January 14, 2007, at 19:23:03
In reply to Re: Bipolar II - it really sucks)blueberry)med emp, posted by Jimmyboy on January 10, 2007, at 8:42:53
I was recently hospitalized for anorexia/bulima, major depression, panic disorder, OCD...
I've been out for about 4 months, and I went through a phase where I just HAD to get a second full time job (because one wasn't enough), I felt like I had to immediately get out of debt (all of it..), go back to school.. So I got a second job, was sleeping less, (no biggie), started doing crazy things like Drinking and driving, drinking at work (I work in law enforcement....), and I'm not even a drinker really.
I recently started cutting, and last week I REALLY cut my arms up badly..I told my psych. all of the above, and how my mind is constantly racing and how i feel like I always have to be doing something because I have all of this mental energy that I can't do anything with..
He then tells me that my initial diagnosis of Major Depression may have been incorrect. He said that I probably have Bipolar II disorder..
I cried as if I was told I had cancer or something. I am never manic, (I don't think...) I just get really really depressed at times.. Then he explained hypomania to me, and I'm still confused.Anyways, to make a long story a little longer, he added Lamictal to my medicinal regimen. I am on 40 mg.s per day of Lexapro, 4 mg's of Xanax, Vistaril (for sleep) and now Lamictal.
Has anybody had any experience with lamictal, bipolar II, and how bipolar II differs from BPI?
thanks a million,
and best wishes to you all
Nolegirl
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