![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 44. Go back in thread:
Posted by Kingfish on June 21, 2001, at 13:44:38
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by AMenz on June 21, 2001, at 11:48:31
Re: the posting - I've had that happen - I think having an extremely exciting subject line helps, though this one wasn't very exciting, was it? :)
I forget - what line of med does Zoloft fall under? Your comments about the AD's will be takent to heart. The only reason I don't think Celexa's a culprit is I just don't think it's done anthing. When I took it alone, a misguided year ago, all it did was cause sexual dysfunction.
I have been lucky to find a pdoc I like, but he is being stubborn about things now - wants to put me on Provigil to counteract the sedation, and I've been ansy about that from the start (see the current post from University), but I'm sorry you've had so much trouble in the pdoc field. It seems like so many have.
Why do you think the stabilizers didn't work for you in general?
Thanks for your advice.
- K.
Posted by Kingfish on June 21, 2001, at 13:51:36
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by gdog on June 21, 2001, at 12:02:06
gdog:
I think I have heard others mention what you're experiencing and if you're feeling like you're going into a hypomanic episode, I think you should call your pdoc, because it's a real danger with Wellbutrin.
I turned into a first rate bitch Immediately. I was irritable, and my thoughts started racing again, I couldn't think straight, my anxiety was SO high, my heart was racing. The main thing that was astounding was the irritability. I was so mean to my husband.
I know that side effects do subside - most of the side effects I had with Topamax did, but I just decided I couldn't handle those specific ones for six weeks while we waited to see.
It definitely has received a lot of great feedback here, too, though. But you should be on a stabilizer as well.
- K.
Posted by Kingfish on June 21, 2001, at 13:56:08
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » Kingfish, posted by Mitch on June 21, 2001, at 12:03:40
Mitch:
Thank you so much for your suggestion! I've thought about it but am nervous because I seem to need it this high to feel stabilized. That's why I was wondering about adding another stabilizer such as Lamictal, and then lowering the Top some, but not quitting it all together. What do you think?
What classes are Klonopin and Zoloft? How have they worked for you? Are you tired all the time? (I feel like I could handle a New side effect as long as it wasn't sedation - just woke up, very grudgingly, from a 3 hour nap).
Thanks again.
- K.
Posted by Sulpicia on June 21, 2001, at 23:00:22
In reply to What's worked 4 folks 4 BP II or other maladies?, posted by Kingfish on June 21, 2001, at 10:32:20
> Lamictal 450
wellbutrin 400
adderall 20
bipolar II teenager, with *severe* refractory depression.
valproic acid did nothing, lithium rendered her unconscious.
washing out wellbutrin at present bcuz it's not doing enough AD stuff.
Needless to say, if hypomania or mania is an issue for you, avoid this
regime.
S
Posted by Mitch on June 21, 2001, at 23:10:56
In reply to Re: Mitch, posted by Kingfish on June 21, 2001, at 13:56:08
> Mitch:
>
> Thank you so much for your suggestion! I've thought about it but am nervous because I seem to need it this high to feel stabilized. That's why I was wondering about adding another stabilizer such as Lamictal, and then lowering the Top some, but not quitting it all together. What do you think?
>
> What classes are Klonopin and Zoloft? How have they worked for you? Are you tired all the time? (I feel like I could handle a New side effect as long as it wasn't sedation - just woke up, very grudgingly, from a 3 hour nap).
>
> Thanks again.
>
> - K.K.
The *combination* of Neurontin and Topamax could be really the trouble. Could you stay stable with just the Neurontin and Celexa? Or could you just back off the Topamax a little at a time and see if you still feel ok? I wonder, because sometimes docs jack the dose up really rapidly and you *pass* a *sweet-spot* with the med without really knowing it.
The Zoloft is in the same class of med the Celexa is-I doubt if switching to it would help much-although it tends to be more activating. Klonopin is a benzodiazepine like Valium, if you are OK with exception to excess sedation I doubt that it that would help you any.
On the other hand-your Neurontin dose might be just a little higher than you need (with the TOP). If you really feel the Topamax is giving you more benefit than the Neurontin you could try backing off the Neurontin dose a bit at a time and keep your TOP dose the same.
You wouldn't really want to add a *third* med or switch one of them if you don't need to. I would investigate dosage adjustments of what you are currently taking FIRST.
Just suggestions,
Mitch
Posted by chloe on June 22, 2001, at 10:14:06
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » Kingfish, posted by Mitch on June 21, 2001, at 12:03:40
Be careful of the Trileptal or Lamictal they can trigger hypomania, though.
>
> I am taking Neurontin/Klonopin/Zoloft.
>
> MitchBTW, Kingfish, this is a great topic!!!
Mitch,
You mentioned that Trileptal can be activating. I think you told me before in another post that Trileptal can cause hypomania, but I guess I wasn't ready to hear it. I have been cylcing more, since Trileptal (and I felt agitated, wired and racy on Lamictal). I just can't imagine that an AC would be activating! Live and learn!Anyway, my point is, that since I switched from Tegretol to Trileptal, I have constantly been having to adjust and add things to my cocktail. The lastest being Neurontin, which was nice and calming in the beginning and helped my sleep. But now I am not sleeping well, but tired alot during the day. So I don't know if going up on the Neurontin would be helpful, but I am only on 600mgs.
I take Trileptal/Neurontin/Celexa (one and a half mgs!)/Valium which for the moment is keeping the lid on things. The addition of Neurontin has decrease the cycling greatly.
BP II and the treatment, for me is constantly evolving. So I am always needing to make adjustments and switches. Has anyone found a regime that has worked well and lasted for more than a few months???
Best wishes to all
Chloe
Posted by AMenz on June 22, 2001, at 16:56:43
In reply to Re: What's worked 4 folks 4 BP II » Mitch, posted by chloe on June 22, 2001, at 10:14:06
If you are cycling you should go off anti depressants altogether. That was the answer for me after cycling (mixed state) for a number of months while on 100 mg of Zoloft. At 50 mg I have stopped cycling. I keep taking it for whatever residual social anxiety effect it may have.
But it is for a fact that cycling that does not remit while on mood stabilizer and anti depressant spell take off anti depressant. Otherwise (like me) you'll go from one mood stabilizer to the next with no success.
It's been my experience that although mypsychiatrists were aware of the above, if you are depressed they will continue to augment and fiddle the mood stabilizer before they take the step of taking off the AD. I think that really sucks specially if they don't tell you that's what's happenning.
I am stable on 560 mg of lithium 50 zoloft, 50 tegretol and 1 mg of lorezapam. However, I have had a relapse on social anxiety. This is a separate issue that at present I can't resolve.
> Be careful of the Trileptal or Lamictal they can trigger hypomania, though.
> >
> > I am taking Neurontin/Klonopin/Zoloft.
> >
> > Mitch
>
> BTW, Kingfish, this is a great topic!!!
>
> Mitch,
> You mentioned that Trileptal can be activating. I think you told me before in another post that Trileptal can cause hypomania, but I guess I wasn't ready to hear it. I have been cylcing more, since Trileptal (and I felt agitated, wired and racy on Lamictal). I just can't imagine that an AC would be activating! Live and learn!
>
> Anyway, my point is, that since I switched from Tegretol to Trileptal, I have constantly been having to adjust and add things to my cocktail. The lastest being Neurontin, which was nice and calming in the beginning and helped my sleep. But now I am not sleeping well, but tired alot during the day. So I don't know if going up on the Neurontin would be helpful, but I am only on 600mgs.
>
> I take Trileptal/Neurontin/Celexa (one and a half mgs!)/Valium which for the moment is keeping the lid on things. The addition of Neurontin has decrease the cycling greatly.
>
> BP II and the treatment, for me is constantly evolving. So I am always needing to make adjustments and switches. Has anyone found a regime that has worked well and lasted for more than a few months???
>
> Best wishes to all
> Chloe
Posted by susan C on June 22, 2001, at 17:57:47
In reply to What's worked 4 folks 4 BP II or other maladies?, posted by Kingfish on June 21, 2001, at 10:32:20
> Hello,
I am on depakote, from my understanding, a long time mood stabilizer/anti seizure med. If it means anything, Dr. Dunner at University of Washington (state)and expert on BPII confirmed my pdoc's dx. They both explained the challenge is not to deal with the lows, but to control the highs. So, once the highs are not so high, the lows are not so low. They both agree (and many pdocs donot-sigh) that AD and SSRI agravate BPII manic and should be avoided. This was my experience. After flying high on prozac (and trazadone to put me to sleep) for 6 years I crashed worse than when I first started treatment. WHen I changed pdoc and diagnosis from depression to BPII, I came down off of serzone, it was terrible. I was so depressed. Med trials took me to depakote, which is the best so far. At this point I am feeling more even.
Posted by MM on June 22, 2001, at 18:50:23
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by susan C on June 22, 2001, at 17:57:47
I'm recently (like a month ago) diagnosed with BPII, and I'm still not sure it's right (I know a lot of people feel that way), but I feel like there should be tests done, like one for ADD, (concentration is one of the main things I'm having trouble with) and anxiety is the biggest thing. Will I know for sure it's BPII when I get on a mood stabilizer (I'm not on any AD's, tho I've tried them, or mood stabilizers, only taking 25mgs seroquel to sleep). Like will I feel really different or something to make it clear that I have BPII?
The past DX's were major depression/anxiety/panic.
Posted by MM on June 23, 2001, at 0:02:53
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 22, 2001, at 18:50:23
I guess you can't edit on here. Is one one hour session with me and one with a family member enough for this diagnosis?
Posted by Mitch on June 23, 2001, at 10:17:06
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 23, 2001, at 0:02:53
> I guess you can't edit on here. Is one one hour session with me and one with a family member enough for this diagnosis?
Well, if you have met the "criteria" for a hypomanic episode just *once* then according to the current DSM-IV (the book that the APA considers their diagnostic bible) then you are bipolarII. They used to differentiate (I think) however between people that only were hypomanic due to an antidepressant or alcohol/street drugs. But they don't any more. I think some pdocs may still not consider bipolar diagnosis if it is due to alcohol/street drugs/antidepressants.
Mitch
Posted by MM on June 23, 2001, at 14:32:42
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Mitch on June 23, 2001, at 10:17:06
Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
Posted by Mitch on June 23, 2001, at 17:13:23
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 23, 2001, at 14:32:42
> Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
That's a tough one. So, whatever the *episode* was it occured while on AD's right? I *think* the definition for hypomanic episode is at least four days of elevated mood-racing thoughts, impulsivity or hostility, difficulty sleeping, agitation, etc. But, didn't require hospitalization and you didn't get psychotic.
If I go off of antidepressants entirely my mood cycling settles down and don't have any problem with hypomania. But, I get panic attacks/depression. It is a "sticky" problem.
I don't know just how to solve the dilemma.
Mitch
Posted by MM on June 23, 2001, at 19:58:35
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Mitch on June 23, 2001, at 17:13:23
> > Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
>
> That's a tough one. So, whatever the *episode* was it occured while on AD's right? I *think* the definition for hypomanic episode is at least four days of elevated mood-racing thoughts, impulsivity or hostility, difficulty sleeping, agitation, etc. But, didn't require hospitalization and you didn't get psychotic.
>
> If I go off of antidepressants entirely my mood cycling settles down and don't have any problem with hypomania. But, I get panic attacks/depression. It is a "sticky" problem.
> I don't know just how to solve the dilemma.
> MitchThat's kind of why I was wondering if other people had doubts about their BP dx before going on mood stabilizers, but after they tried them they KNEW it was the right or wrong dx. Thanks for replying Mitch.
Posted by chloe on June 24, 2001, at 11:12:06
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 23, 2001, at 19:58:35
Hi MM
I wouldn't get to hung up about the label or "diagnosis". Some pdocs will put a bipolar label on a patient just so insurance will cover them. Finding the right medicine is what is important. AND just because you respond to a mood stabilizer, doesn't necessarily mean you are BP or not BP. It means you are responding well to that medication. Each person is different, and each person needs a certain type of medication(s) to give them relief from their pain.
I hope you find the right treatment regime for you. Whatever your particular "diagnosis" may be.BTW, I not convinced I am BP II but that is the stamp on me! God only knows I guess!
All the best
Chloe
>
> That's kind of why I was wondering if other people had doubts about their BP dx before going on mood stabilizers, but after they tried them they KNEW it was the right or wrong dx. Thanks for replying Mitch.
Posted by AMenz on June 24, 2001, at 15:00:00
In reply to Re: What's worked 4 folks 4 BP II or other maladies? » MM, posted by Mitch on June 23, 2001, at 17:13:23
I have always cycled too frequently to have 4 days of anything, yet have BPII dx. Are severe periods of irritability hypomania? I think they are acompanied by racing thoughts etc but not euphoric at all. Is this really hypomania? Is it a mixed state. And how can I be sure of diagnosis.
This BTW is the diagnosis I've had for over 10 years. I do cycle on AD's and get into mixed states.
Like you anxiety (social not panic) kicks up when on mood stabilizers and very low AD's (so I can keep from cycling). I'm beginning to think that behavioral therapy which seems to work for some anxiety disorders with no BPII comorbidity might be the way to go.
> > Well I'm not sure I've had a hypomanic episode, but if I did, it was because of anti-depressants. How do I know if it was a hypomanic episode, or just antidepressants helping with depression and anxiety?
>
> That's a tough one. So, whatever the *episode* was it occured while on AD's right? I *think* the definition for hypomanic episode is at least four days of elevated mood-racing thoughts, impulsivity or hostility, difficulty sleeping, agitation, etc. But, didn't require hospitalization and you didn't get psychotic.
>
> If I go off of antidepressants entirely my mood cycling settles down and don't have any problem with hypomania. But, I get panic attacks/depression. It is a "sticky" problem.
> I don't know just how to solve the dilemma.
> Mitch
Posted by Chris A. on June 24, 2001, at 18:01:55
In reply to Re: What counts as hypomania Mitch, posted by AMenz on June 24, 2001, at 15:00:00
Mitch,
July L. just shared this link on another thread that addresses your concerns. Registration is required, but worth it.
http://www.medscape.com/Medscape/CNO/2001/APACME/Story.cfm?story_id=2248 >
Chris A.
Posted by Mitch on June 24, 2001, at 18:42:57
In reply to Re: What counts as hypomania - Mitch, posted by Chris A. on June 24, 2001, at 18:01:55
Chris, Went there and checked it out, very interesting. I actually had it wrong (in my mind). The DSM-IV excludes diagnosis of hypomania (BPII) if it is a result of antidepressants. The article below in the link believes that even if AD's cause hypomania-then that persons *should* be diagnosed with BPII.
In my case I have had hypomania in the past without antidepressants so there is not question of my BPII diagnosis. However it apears that *technically* speaking if AD's are the only trigger that is present then BPII should not be considered the diagnosis.Here is the American definition of hypomanic episode:
Hypomanic Episode
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.
Mitch> Mitch,
>
> July L. just shared this link on another thread that addresses your concerns. Registration is required, but worth it.
>
> http://www.medscape.com/Medscape/CNO/2001/APACME/Story.cfm?story_id=2248 >
>
> Chris A.
Posted by Chris A. on June 25, 2001, at 13:04:21
In reply to Re: What counts as hypomania - Mitch » Chris A., posted by Mitch on June 24, 2001, at 18:42:57
Not all American psychiatrists and researchers are satisfied with the DSM 1V R bipolar classificaltions. They believe that they are too arbitrary, provide clear categories for easy answers to research, but don't serve those of us who are ill very well. On a technicality I am diagnosed BP I, but don't really fit that category at all because I've never been truly manic. Prozac caused hypomania followed by a horrible crash that I've never fully recovered from. Since I have mixed symptoms and was hospitalized in the midst of that I am considered BPI. My experience always seems to be closer to BP II, though. Some, like Askidal would say BP III since hypomania initially occurred in response to an AD. In all the screening tests I don't even qualify for bipolar. Even so my moods shift suddenly. I'll be doing fair one day and suicidal the next. Hence, I won't fight the BP diagnosis so that I can get the right treatment. ADs make the depressions worse, so I'll stick to the mood stabilizers.
Blessings,
Chris A.
Posted by judy1 on June 25, 2001, at 22:03:52
In reply to Re: What counts as hypomania - Mitch, posted by Chris A. on June 25, 2001, at 13:04:21
Chris,
At the recent BP conference in Pittsburgh, one of the shrinks from the Stanley Foundation said that mood stabilizers turn BP1's into BP2's- that is get rid of the mania and have predominantly depressive symptoms (which seems to be your case). I think my hormones are really kicking in here, it's a great feeling. Take care, judy
Posted by Chris A. on June 25, 2001, at 23:47:26
In reply to Re: What counts as hypomania - Mitch » Chris A., posted by judy1 on June 25, 2001, at 22:03:52
Dear Judy,
I would agree that the researcher at the Stanley Foundation is right. Hopefully more research will be focused on bipolar depression and more interventions will be available for those of us who can't take ADs. Geodon seems to be promising towards that end. If I could only tolerate the akithisia.
I am very happy that you are feeling well during your pregnancy. You deserve it after all of the struggles you have been through. Those were the most euthymic times in my life.
Take good care of the baby and yourself.Blessings,
Chris A.
Posted by Cece on June 27, 2001, at 14:11:02
In reply to Re: What counts as hypomania - Mitch » Chris A., posted by judy1 on June 25, 2001, at 22:03:52
Hi Judy-
Very interesting re BPI to BPII.
I haven't seen your posts re being pregnant. I'm curious, if you don't mind saying, what your diagnosis is, and what meds you are able to take during pregnancy? Also, what are your and your pdoc's thoughts re the possibilities of post-partum depression in a person with an affective disorder?
Thanx, and best wishes,
Cece
> Chris,
> At the recent BP conference in Pittsburgh, one of the shrinks from the Stanley Foundation said that mood stabilizers turn BP1's into BP2's- that is get rid of the mania and have predominantly depressive symptoms (which seems to be your case). I think my hormones are really kicking in here, it's a great feeling. Take care, judy
Posted by judy1 on June 27, 2001, at 18:45:42
In reply to Re: Pregnancy and meds in BP's » judy1, posted by Cece on June 27, 2001, at 14:11:02
Hi Cece,
I'm dxed bp1, rapid cycling and panic disorders. I think my shrink is leaning towards PTSD though, because I have a lot of dissociation problems. Thank you for the best wishes. This was an unexpected pregnancy and as soon as I found out I went off lamictal, risperdal and one other (can't remember). I did stay on klonopin (and still am) with xanax prn. Recently I've been taking zyprexa because I developed TD with risperdal, but I plan on tapering off that also. My pdoc basically treats 'fires' with me, and uses a great deal of psychotherapy. I see him weekly and e-mail him a lot (we have a very good relationship that took a good year to develope). I did have a psychotic depressive episode after my son was born and he and I are aware that there is a strong probability that I will have it again. So I guess we are working on maintaining a strong therapeutic relationship- my biggest problems are lack of insight when manic, and taking each day as it comes (never dull in bipolar disorder!) Hope this answers your questions. Take care, judy
Posted by Cece on June 28, 2001, at 5:10:32
In reply to Re: Pregnancy and meds in BP's » Cece, posted by judy1 on June 27, 2001, at 18:45:42
Thanx for replying. I was curious because post-partum psychosis seems to run in my family (both my mother and sister had it). My mom was probably undiagnosed BP, my sister tends toward anxiety and some depression (rarely admitted to).
I am past the age where pregnancy is an issue (52), and never found the right person to do it with, so never had to deal with the issues. I think that partly I subconsciously held back because of fear re post-partum (I didn't get right diagnosis and good tx. until about 8 years ago). I tried to do some research in my 30's, but couldn't find much.
My neice is BPI and young enough to still hope to have kids, so I wanted to get your info for her.
Thanx again- you sound well-prepared, with your feet on the ground and good support. I'm sure that you will make it just fine!
Cece
P.S. My mother and sister both had PPP with only one of their children: my mother with her second (me), and my sister with her first (my neice). Hopeful news for you.
> Hi Cece,
> I'm dxed bp1, rapid cycling and panic disorders. I think my shrink is leaning towards PTSD though, because I have a lot of dissociation problems. Thank you for the best wishes. This was an unexpected pregnancy and as soon as I found out I went off lamictal, risperdal and one other (can't remember). I did stay on klonopin (and still am) with xanax prn. Recently I've been taking zyprexa because I developed TD with risperdal, but I plan on tapering off that also. My pdoc basically treats 'fires' with me, and uses a great deal of psychotherapy. I see him weekly and e-mail him a lot (we have a very good relationship that took a good year to develope). I did have a psychotic depressive episode after my son was born and he and I are aware that there is a strong probability that I will have it again. So I guess we are working on maintaining a strong therapeutic relationship- my biggest problems are lack of insight when manic, and taking each day as it comes (never dull in bipolar disorder!) Hope this answers your questions. Take care, judy
Posted by Ron Hill on June 28, 2001, at 11:12:44
In reply to Re: What's worked 4 folks 4 BP II or other maladies?, posted by MM on June 22, 2001, at 18:50:23
> I'm recently (like a month ago) diagnosed with BPII, and I'm still not sure it's right
MM,
Use the link below to bring up a good (and free) dx test. It was accurate in my case (BP II). I found it helpful to have someone that knows me well sit with me as I took the test so she could add her perspective regarding the answer most applicable for my behavior.
http://www.mentalhealth.com/fr71.html
-- Ron
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.