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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by JohnX2 on March 26, 2002, at 4:29:25
I am going to ask my doctor about adding Lithium to my cocktail.I would like to know if people think I could tolerate switching ADs back to Wellbutrin?
I have problems with anergic/atypical depression and many people believe I have ADD like symptoms too. In the past Wellbutrin gave me the nicest AD responses but pooped out and occasionaly made me almost psychotic.
Do you think I could tolerate a Wellbutrin add in with Lithium on board?
Thanks,
John
Posted by SLS on March 26, 2002, at 20:09:47
In reply to Lamictal + lithium + Wellbutrin ? Advice Needed, posted by JohnX2 on March 26, 2002, at 4:29:25
Hi John.
> I am going to ask my doctor about adding Lithium to my cocktail.
> I would like to know if people think I could tolerate switching ADs back to Wellbutrin?I'll throw your own advice back at you and suggest that you make one change at a time. I should talk, though.
If you can think of no reason not to do so, why don't you add lithium first for a week or two, followed by the addition of Wellbutrin and without the discontinuation of Serzone. It would save time on exploring permutations of the three.
- Scott
Posted by JohnX2 on March 26, 2002, at 20:39:21
In reply to Re: Lamictal + lithium + Wellbutrin ? Advice Needed, posted by SLS on March 26, 2002, at 20:09:47
> Hi John.
>
> > I am going to ask my doctor about adding Lithium to my cocktail.
>
> > I would like to know if people think I could tolerate switching ADs back to Wellbutrin?
>
> I'll throw your own advice back at you and suggest that you make one change at a time. I should talk, though.
>
> If you can think of no reason not to do so, why don't you add lithium first for a week or two, followed by the addition of Wellbutrin and without the discontinuation of Serzone. It would save time on exploring permutations of the three.
>
>
> - ScottThanks. That sounds like a good plan. Plus its a few more weeks off work potentially. ;)
Why is it so hard to give good advice to oneself? I know it is stupid not to have tried Li by now and it is dumb to switch 2 meds at once.
John
Posted by JohnX2 on March 26, 2002, at 21:24:13
In reply to Re: Lamictal + lithium + Wellbutrin ? Advice Needed » SLS, posted by JohnX2 on March 26, 2002, at 20:39:21
> > Hi John.
> >
> > > I am going to ask my doctor about adding Lithium to my cocktail.
> >
> > > I would like to know if people think I could tolerate switching ADs back to Wellbutrin?
> >
> > I'll throw your own advice back at you and suggest that you make one change at a time. I should talk, though.
> >
> > If you can think of no reason not to do so, why don't you add lithium first for a week or two, followed by the addition of Wellbutrin and without the discontinuation of Serzone. It would save time on exploring permutations of the three.
> >
> >
> > - Scott
>
> Thanks. That sounds like a good plan. Plus its a few more weeks off work potentially. ;)
>
> Why is it so hard to give good advice to oneself? I know it is stupid not to have tried Li by now and it is dumb to switch 2 meds at once.
>
> JohnFuck it. now I feel like I have dopamine shooting out of my ear. Send me a self-addressed stamped envelope and I'll send you some. ;)
I think this Li is going to be paydirt since I've held out for so long. Wellbutrin is a pipedream of mine. I think it is just a hypomanic addiction thing.
So how do you do these days? Screw the meds, go out and shoot a round of golf!
I have been on disability since January. Really screwed up my job on a bad manic episode. I need to be in really good shape when I go back.
Fucked up my car too. Any thoughts on a good car?
My Maxima crapped out. Seems it needed more oil changes than my trusty old honda accord. The oil light came on and I thought I was low on oil, so I put in a few quarts as a stop gap, then the light went off and BIG smoke came out the rear (put in too much oil). Thought I was in a James Bond film trying to divert the cars behind me.oh well I'm rambling.
John
Posted by Janelle on March 27, 2002, at 0:18:30
In reply to Re: dopamania? -- SLS, posted by JohnX2 on March 26, 2002, at 21:24:13
Ah-ha, JohnX2, I read in this thread that you are out of work on disability - I'm just curious is this disability insurance you have through your job or did you manage to get Social Security disability? Just curious.
Posted by JohnX2 on March 27, 2002, at 0:47:07
In reply to JOHNX2: a revelation! » JohnX2, posted by Janelle on March 27, 2002, at 0:18:30
My company's medical insurance provider is covering me. I became very Manic in January and needed to take a medical leave. Fortunately I collect almost full benefits during this time off. I haven't done this before; it is the 1st time. I should return to work shortly.
John
> Ah-ha, JohnX2, I read in this thread that you are out of work on disability - I'm just curious is this disability insurance you have through your job or did you manage to get Social Security disability? Just curious.
Posted by Janelle on March 27, 2002, at 0:55:40
In reply to Re: JOHNX2: a revelation! » Janelle, posted by JohnX2 on March 27, 2002, at 0:47:07
John, You're fortunate that 1) your company's medical insurance provider is covering you and 2) that you have an employer who apparently understands this kind of illness and allowed you to take a medical leave because of it. (that you're on leave also explains why you're up late posting on here, even if you live in the western US, it's getting late!)
You mentioned that you took the leave because you became "very manic" (in January) -- could you describe some of the symptoms/behaviors you were exhibiting that brought you to the point of having to take a leave from work?
I ask because there is uncertainty between my pdoc and a therapist about whether or not I have BPII - I know that I cycle, but it's back and forth from depression with anxiety to feeling good/okay (NOT manic, from what I understand about that condition). So, I'm quite interested in what kinds of behaviors you were exhibiting that were "manic" (and that apparently interfered with your job performance to the point of your taking a leave). Thanks very much.
Posted by JohnX2 on March 27, 2002, at 1:45:01
In reply to JOHNX2: all the best 2 U, more: » JohnX2, posted by Janelle on March 27, 2002, at 0:55:40
> John, You're fortunate that 1) your company's medical insurance provider is covering you and 2) that you have an employer who apparently understands this kind of illness and allowed you to take a medical leave because of it. (that you're on leave also explains why you're up late posting on here, even if you live in the western US, it's getting late!)
>My work situation is not good. Getting the medical leave was a coupe. The insurance provider is jerking me around (I'm still dealing with them). I live in TX. Lately I have been keeping a very late schedule. I make yours look quite whimpy!
> You mentioned that you took the leave because you became "very manic" (in January) -- could you describe some of the symptoms/behaviors you were exhibiting that brought you to the point of having to take a leave from work?
>I was rediagnosed Bipolar I in January by my pdoc. This is the more sever mania type. It was very debilitating and dangerous. I listed my symptoms for someone in a link. It dissipated over Jan/early Feb. I mostly have BP II type symptoms now. I'd describe them more in detail later.
These were my Jan symptoms:
http://www.dr-bob.org/babble/20020131/msgs/92857.html> I ask because there is uncertainty between my pdoc and a therapist about whether or not I have BPII - I know that I cycle, but it's back and forth from depression with anxiety to feeling good/okay (NOT manic, from what I understand about that condition). So, I'm quite interested in what kinds of behaviors you were exhibiting that were "manic" (and that apparently interfered with your job performance to the point of your taking a leave). Thanks very much.
Well Janelle, there is euphoric hypomania and agitated or dysphoric hypomania. The euphoric kind is when you feel good. This is not common for me. I have experienced this twice.
The last time was after a major depressive episode when I was 14. I pinged into a euphoric hypomanic state. I actually became much more extroverted as a result too. I was very shy and introverted as a child. This major cycle of depression/hypomania dissipated after a few years.
I guess since then I was a more mild BPII according to my pdoc.3 yrs ago (I'm 29) I slipped back into major depression, as I came out of this I again experienced some euphoric hypomania. Sometimes this was really wild. But in those intermittent 13 yrs it was mostly this mild mixed / dysphoric / agitated hypomania. This hypomania is generally less easily diagnosed (as you don't feel the euphoria).
With mixed/agitated/dysphoric hypomania I may feel very agitated, unable to sit still, depressed yet have racing thoughts, easily angered, confrontational, etc. Mood cycles easily.
The ADs poop out or make me cycle on-off.
Sorry I can't go into more on this blurb, I'm a bit tired.
Regards,
John
Posted by Janelle on March 27, 2002, at 2:15:56
In reply to Re: JOHNX2: all the best 2 U, more: » Janelle, posted by JohnX2 on March 27, 2002, at 1:45:01
John,
I appreciate your openness and willingness to share.
Thank you for the link to the thread where you mentioned your manic and hypomanic symptoms. After reading that, I'm seriously doubting that I have even Hypomania (BPII) -- I have maybe one or two of those symptoms you listed, if that.
I cycle in and out of anxious depression and feeling okay/good/functional. I guess I'm more unipolar depression.
Anyway, first I just have a couple of computer questions for you - how were you able to provide a URL for your thread about your symptoms? And how did you remember it - or did you jot it down at the time so you could refer to it?
Now, getting to the meat of the matter, you mentioned that there is "euphoric hypomania" and agitated or dysphoric hypomania, and you also mentioned mixed hypomania -- are these last three words - agitated, dysphoric, mixed all referring to one kind of hypomania (presumably the opposite of the euphoric kind?
Also, were you exhibiting the symptoms and *getting into trouble* so to speak, at work, where co-workers were witness to some of your hypomanic behaviors?
Posted by Janelle on March 27, 2002, at 2:19:49
In reply to JOHNX2: wow, thanks, more: » JohnX2, posted by Janelle on March 27, 2002, at 2:15:56
Posted by JohnX2 on March 27, 2002, at 3:11:29
In reply to JOHNX2: what is ''pressured speech?'' (nm), posted by Janelle on March 27, 2002, at 2:19:49
Hi Janelle,pressured speech is a hard to control urge to keep talking.
BTW, here is a link to the official DSM-IV
diagnostic criteria for hypomania.
You need to follow the flowchart carefully.
Note the uses of the word "irritable", etc.Note, there are other forms of related mood disorders like cyclothymia, soft bipolar, medication induced etc.
Criteria for Hypomanic Episode
A. 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.
B. 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:
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
(7) 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)C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. 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.
F. 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
This is the end of the thread.
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