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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by lorelai on September 14, 2002, at 22:25:12
A little background: I was misdiagnosed early on (the docs tagged me with the dx "clinical depression" and no one noticed the full blown manic attacks complete with text book psychosis, etc., till much later--I'd had them for years and enjoyed the creative productivity, heightened sexuality and extreme shopping sprees--well, at least till I had to file bankruptcy). The first medication I was put on was Prozac. This of course threw me into even worse manic episodes (nearly got into a terrible car accident, lost a good friend whose husband insisted she stop seeing "that lunatic," and I spent money like it was water). Only positive thing was I lost 15 lbs.). From there I've been on Serzone, Effexor SR, Depakote and just lately had a terrible bout with Wellbutrin. The only good experience I've had with meds is the Ativan I take (occasionally) for anxiety attacks. Everything else has caused me no end of problems. Serzone and Effexor caused horrible memory loss. Serzone also caused me to gain weight and itch like crazy. Depakote seemed to work for a while and mellowed my moodswings, I guess, but then started to NOT work anymore as well as pack on more pounds. I also started losing handfuls of hair and my eyelashes on Depakote, which was scary! Wellbutrin was wonderful at first, as I lost weight. But then I experienced terrible, nonstop ringing in the ears, so bad I wanted to take a sledgehammer to my head! So now I'm back to taking nothing (except my occasional Ativan) and I'm worried because I've just gotten over a terrible depression (set off by the suicide of a friend in July). I know the manic stuff is eventually going to rear its head and then I'll have all sorts of problems. I'm one of those people who tends to make major life changing decisions while in the height of mania (my pdoc wants me to go back on Depakote. I've refused. She mentioned Lithium and I refused that too). I have to figure out something to take that's not going to cause me to gain weight again. I'm not even 5 ft. 1 and even a few extra pounds is too much. Not to mention the severe depression the weight gain sets into motion. I guess what I'm asking here is--are there any people with bipolar disorder out there who've had success with certain meds that DON'T cause weight gain??? My pdoc said something about neurontin the last time I saw her. Does anyone have any neurontin experiences they might share? Also, any idea on whether Topamax might be worth a shot? I'm just grasping at straws here, as you can tell. I'm tired of being a guinea pig for modern medical science, yeah, but if I could find something that works and doesn't cause me to go bald or lose my ability to have an orgasm or make my head ring like it's going to explode, then I'd be willing to give it a try. Thanks in advance.
Best,
Lorelai
Posted by Ritch on September 15, 2002, at 11:38:12
In reply to Need advice: meds for bipolar rapid cycling, posted by lorelai on September 14, 2002, at 22:25:12
> A little background: I was misdiagnosed early on (the docs tagged me with the dx "clinical depression" and no one noticed the full blown manic attacks complete with text book psychosis, etc., till much later--I'd had them for years and enjoyed the creative productivity, heightened sexuality and extreme shopping sprees--well, at least till I had to file bankruptcy). The first medication I was put on was Prozac. This of course threw me into even worse manic episodes (nearly got into a terrible car accident, lost a good friend whose husband insisted she stop seeing "that lunatic," and I spent money like it was water). Only positive thing was I lost 15 lbs.). From there I've been on Serzone, Effexor SR, Depakote and just lately had a terrible bout with Wellbutrin. The only good experience I've had with meds is the Ativan I take (occasionally) for anxiety attacks. Everything else has caused me no end of problems. Serzone and Effexor caused horrible memory loss. Serzone also caused me to gain weight and itch like crazy. Depakote seemed to work for a while and mellowed my moodswings, I guess, but then started to NOT work anymore as well as pack on more pounds. I also started losing handfuls of hair and my eyelashes on Depakote, which was scary! Wellbutrin was wonderful at first, as I lost weight. But then I experienced terrible, nonstop ringing in the ears, so bad I wanted to take a sledgehammer to my head! So now I'm back to taking nothing (except my occasional Ativan) and I'm worried because I've just gotten over a terrible depression (set off by the suicide of a friend in July). I know the manic stuff is eventually going to rear its head and then I'll have all sorts of problems. I'm one of those people who tends to make major life changing decisions while in the height of mania (my pdoc wants me to go back on Depakote. I've refused. She mentioned Lithium and I refused that too). I have to figure out something to take that's not going to cause me to gain weight again. I'm not even 5 ft. 1 and even a few extra pounds is too much. Not to mention the severe depression the weight gain sets into motion. I guess what I'm asking here is--are there any people with bipolar disorder out there who've had success with certain meds that DON'T cause weight gain??? My pdoc said something about neurontin the last time I saw her. Does anyone have any neurontin experiences they might share? Also, any idea on whether Topamax might be worth a shot? I'm just grasping at straws here, as you can tell. I'm tired of being a guinea pig for modern medical science, yeah, but if I could find something that works and doesn't cause me to go bald or lose my ability to have an orgasm or make my head ring like it's going to explode, then I'd be willing to give it a try. Thanks in advance.
> Best,
> LorelaiHi, Lorelai,
Topamax tends to cause some weight loss, and you can get away with once nightly dosing (which is what I like the best about it), BUT, the cognitive side-effects are kind of nasty for some folks, but many have reported them to slowly fade over weeks (once you reach a target dose). I got up to just 50mg/day and couldn't wait out the cog sfx because of my job (I was taking TOP for probably a couple of months total-and titrating the dose upwards, too). It seemed to be a pretty powerful antimanic agent, though. I slept like a log on it after a nightime dose, too. Maybe you could start 25mg at nightime and see how it goes? Neurontin didn't seem to cause weight gain or loss. It worked the best for anxiety associated with dysphoric hypomania/agitated bipolar depression. I don't like needing to take something 3-4x daily, though. If you take it less often than 3x daily, you may notice some agitative rebound/OCD-like effects when the med is leaving your system. If you don't crank the dose up too high at first-the cognitive sfx from it were fairly mild in my experience. It didn't adversely effect my work performance unless I was above 1200mg/day. You might find that going back on Depakote and adding thyroid hormone might prevent weight gain (but that's just a theory). I have a super-conservative thyroid-doc who doesn't like the idea (because of paranoia over bone-density loss), and my pdoc doesn't want that conflict with my internist, so no T4 for me. So, I have got to swap Tdocs. I rapid cycle every 3 weeks chronically, no full blown manias. I think it would be helpful.
hope this has been of some help,
Mitch
Posted by judy1 on September 15, 2002, at 19:03:47
In reply to Need advice: meds for bipolar rapid cycling, posted by lorelai on September 14, 2002, at 22:25:12
Sorry, Lorelai, unfortunately depakote is the most effective anti-manic agent for rapid cyclers, also zyprexa (but that packs on the pounds). The first thing I noticed was the ADs you were on- they are definitely contraindicated in BP 1. So, hopefully, since you stopped them the cycling will slow. Klonopin is probably better than ativan for you- it's also a benzo but is often used as an adjunct mood stabilizer in bipolar disorder. neurontin is useless, lamictal is good for depression but not mania, and like the other poster said topomax has cognitive side effects. how trusting are you with your pdoc? I ask, because after 2 years with mine, I've been able to take depakote on a prn basis- when he starts seeing a manic swing he insists i take it. at first i blew him off, but i would have the psychotic episodes that landed me in the hospital and all the financial difficulties you mentioned. now i work with a therapist and shrink and we monitor (even my husband and son!) my moods so we're able to catch an episode early. i need to stress this will only work if you have an excellent partnership with your shrink, and really understand the danger a manic episode presents. so for now, i just take klonopin (i have panic and ptsd) and see my shrink and therapist once a week. best of luck- judy
Posted by Lorelai on September 16, 2002, at 9:00:14
In reply to Re: Need advice: meds for bipolar rapid cycling » lorelai, posted by Ritch on September 15, 2002, at 11:38:12
Hi, Lorelai,
>
> Topamax tends to cause some weight loss, and you can get away with once nightly dosing (which is what I like the best about it), BUT, the cognitive side-effects are kind of nasty for some folks, but many have reported them to slowly fade over weeks (once you reach a target dose). I got up to just 50mg/day and couldn't wait out the cog sfx because of my job (I was taking TOP for probably a couple of months total-and titrating the dose upwards, too). It seemed to be a pretty powerful antimanic agent, though. I slept like a log on it after a nightime dose, too. Maybe you could start 25mg at nightime and see how it goes? Neurontin didn't seem to cause weight gain or loss. It worked the best for anxiety associated with dysphoric hypomania/agitated bipolar depression. I don't like needing to take something 3-4x daily, though. If you take it less often than 3x daily, you may notice some agitative rebound/OCD-like effects when the med is leaving your system. If you don't crank the dose up too high at first-the cognitive sfx from it were fairly mild in my experience. It didn't adversely effect my work performance unless I was above 1200mg/day. You might find that going back on Depakote and adding thyroid hormone might prevent weight gain (but that's just a theory). I have a super-conservative thyroid-doc who doesn't like the idea (because of paranoia over bone-density loss), and my pdoc doesn't want that conflict with my internist, so no T4 for me. So, I have got to swap Tdocs. I rapid cycle every 3 weeks chronically, no full blown manias. I think it would be helpful.
>
> hope this has been of some help,
>
> Mitch
**Mitch,
Thanks for the reply--I appreciate it! My pdoc's having a tough time with me, I think, because I seem to have such adverse reactions to everything we try. I don't get this, really, because as a teen I did a wide range of drugs on a near-daily basis (trying to self-medicate, I suppose the shrinks would say, though at the time I thought I was just having fun) and was always one of those people who could maintain control, drive a car, function in school, etc., no matter what drug I was on. So it doesn't make sense to me that as an adult my system is so delicate. Neurontin is my pdoc's latest suggestion, but I hadn't realized I'd have to take it 3 or 4 times a day??? Guess I'd better do some indepth digging, reading around. The idea of bone density loss might be a big problem for me since I'm of Asian descent (more prone to osteoporosis, or so I've heard), so the Depakote/thyroid hormone route doesn't sound like an option. I'm just starting a new job tomorrow and don't like the idea of anything messing with my ability to think (I have bad memories of starting out a new job and having my boss think I was some sort of moron because a couple of weeks into the job I was starting a new med--and I guess I SEEMED like a moron. I stopped the med and she probably thought I'd suddenly grown some brains, lol), so that seems to rule out Topamax, though maybe if I take tiny increments and let my system build up to it slowly...Well, I'll discuss all this with my pdoc on the 24th and see if she has any other ideas. It'd be ideal, of course, to simply not take anything. But, as I'm finding, pretty unrealistic. *sigh*
Best,
Lorelai
Posted by Lorelai on September 16, 2002, at 9:16:50
In reply to Re: Need advice: meds for bipolar rapid cycling » lorelai, posted by judy1 on September 15, 2002, at 19:03:47
> Sorry, Lorelai, unfortunately depakote is the most effective anti-manic agent for rapid cyclers, also zyprexa (but that packs on the pounds). The first thing I noticed was the ADs you were on- they are definitely contraindicated in BP 1. So, hopefully, since you stopped them the cycling will slow. Klonopin is probably better than ativan for you- it's also a benzo but is often used as an adjunct mood stabilizer in bipolar disorder. neurontin is useless, lamictal is good for depression but not mania, and like the other poster said topomax has cognitive side effects. how trusting are you with your pdoc? I ask, because after 2 years with mine, I've been able to take depakote on a prn basis- when he starts seeing a manic swing he insists i take it. at first i blew him off, but i would have the psychotic episodes that landed me in the hospital and all the financial difficulties you mentioned. now i work with a therapist and shrink and we monitor (even my husband and son!) my moods so we're able to catch an episode early. i need to stress this will only work if you have an excellent partnership with your shrink, and really understand the danger a manic episode presents. so for now, i just take klonopin (i have panic and ptsd) and see my shrink and therapist once a week. best of luck- judy
**Judy, Thanks! I did have one shrink, back in the Chicago area, who allowed me to take Depakote only when I felt my mood going up. I didn't know him very well (I saw him only for med checks and had a therapist I saw on a weekly basis). The problem was (at that time) I enjoyed my manic episodes so much I wasn't honest with them or myself when I felt one coming on. Now, though, the mania often turns--dysphoric, I guess is the term. And the episodes seem worse as I grow older (this has caused me no end of personal problems--I'm 43, have two kids, and have been married and divorced 3 times and my last two longterm relationships have been rollercoaster rides: my last boyfriend told my current boyfriend, "Brace yourself!!!" Then went on to warn him about my manias and depressions). I'm a writer and SO prolific/creative during mania that it's tough to give that up. But I've got my kids to consider and though in the past I seemed to have more of a handle on things, I don't seem to have that control anymore. I'm currently working with a pdoc I'd avoided in the past because I thought she'd be too tough on me. Turns out she's really great and I trust her and feel comfortable with her. I don't know if Depakote would work for me again since I haven't taken it in nearly a year. When it worked, it worked well. Then it just seemed to peter out and around that time I went into a deep depression. Well, sorry to go on and on. I appreciate the input more than you know. And it's nice to know I'm not alone.
~Lorelai**
Posted by Ritch on September 16, 2002, at 9:42:28
In reply to Re: Need advice: meds for bipolar rapid cycling » Ritch, posted by Lorelai on September 16, 2002, at 9:00:14
> **Mitch,
> Thanks for the reply--I appreciate it! My pdoc's having a tough time with me, I think, because I seem to have such adverse reactions to everything we try. I don't get this, really, because as a teen I did a wide range of drugs on a near-daily basis (trying to self-medicate, I suppose the shrinks would say, though at the time I thought I was just having fun) and was always one of those people who could maintain control, drive a car, function in school, etc., no matter what drug I was on. So it doesn't make sense to me that as an adult my system is so delicate. Neurontin is my pdoc's latest suggestion, but I hadn't realized I'd have to take it 3 or 4 times a day??? Guess I'd better do some indepth digging, reading around. The idea of bone density loss might be a big problem for me since I'm of Asian descent (more prone to osteoporosis, or so I've heard), so the Depakote/thyroid hormone route doesn't sound like an option. I'm just starting a new job tomorrow and don't like the idea of anything messing with my ability to think (I have bad memories of starting out a new job and having my boss think I was some sort of moron because a couple of weeks into the job I was starting a new med--and I guess I SEEMED like a moron. I stopped the med and she probably thought I'd suddenly grown some brains, lol), so that seems to rule out Topamax, though maybe if I take tiny increments and let my system build up to it slowly...Well, I'll discuss all this with my pdoc on the 24th and see if she has any other ideas. It'd be ideal, of course, to simply not take anything. But, as I'm finding, pretty unrealistic. *sigh*
> Best,
> Lorelai
>
>
Hi again,I forgot to mention Tegretol (carbamazepine) or Trileptal (oxcarbazepine). They aren't as good for rapid-cycling (generally) as Depakote, but pretty close. The good thing about them is they aren't very sedative and have a lower incidence of cognitive side-effects compared to some other antimanic agents. Also, twice daily dosing is usually sufficient. Weight gain isn't a big trouble with them either. I found Trileptal to be too nauseating for me, however (rats, the *only* thing that I couldn't tolerate about it!). But, everybody's different. The more options the better. You might bring those two up at your next visit.
good luck,
Mitch
Posted by Lorelai on September 16, 2002, at 18:36:59
In reply to Re: Need advice: meds for bipolar rapid cycling » Lorelai, posted by Ritch on September 16, 2002, at 9:42:28
> Hi again,
>
> I forgot to mention Tegretol (carbamazepine) or Trileptal (oxcarbazepine). They aren't as good for rapid-cycling (generally) as Depakote, but pretty close. The good thing about them is they aren't very sedative and have a lower incidence of cognitive side-effects compared to some other antimanic agents. Also, twice daily dosing is usually sufficient. Weight gain isn't a big trouble with them either. I found Trileptal to be too nauseating for me, however (rats, the *only* thing that I couldn't tolerate about it!). But, everybody's different. The more options the better. You might bring those two up at your next visit.
>
> good luck,
>
> Mitch
**Thanks Mitch--I'll definitely add these to the list of meds to discuss with my pdoc. I have to agree with you that the more options, the better! I looked these particular meds up today. I'm sure hoping to find something I can tolerate well. Would be great (and about time!). Appreciate all the info!
~Lorelai
This is the end of the thread.
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