![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by jonh kimble on April 4, 2003, at 11:40:47
Hi I have big time problems with motivation, anhedonia, social withdrawl and inability to sustain a conversation etc... (i believe low dopamine is to blame) and this is just the normal me. I have been diagnosed bp 2 and put on serquel 500 mgs at night to sleep and stabilize mood but when i wake up, all those problemslisted above are worse than ever. it is difficult for me just to utter the word hi to someone. i am wondering if seroquels da blocking ability is to blame. has this happened to others? does it indicate anything about me? whats a good med to combat these symtoms? thanks for your time
Posted by xjs7 on April 4, 2003, at 12:43:30
In reply to soooooo unmotivated. seroquel?, posted by jonh kimble on April 4, 2003, at 11:40:47
Hi,
Have you had any psychotic symptoms? Your problems with "motivation, anhedonia, social withdrawl" sound like the negative symptoms of schizophrenia to me. Perhaps this is why your doctor put you on Seroquel. Seroquel is supposed to help these "negative symptoms" just like it helps the positive symptoms. My AP helps me with my negative symptoms, although I still have problems with social withdrawl. Perhaps the Seroquel hasn't kicked in yet. I hope this helps.
xjs7
Posted by zeliva on April 4, 2003, at 17:40:16
In reply to Re: soooooo unmotivated. seroquel?, posted by xjs7 on April 4, 2003, at 12:43:30
That also happens to me, and I only take 50mg. I take 100mg Provigil in the morning to get rid of the yucky Seroquel hangover feeling. It helps. Why does your doc have you on so much? What is the reason he put you on it to begin with and how long have you been taking it?
jill
Posted by Ron Hill on April 4, 2003, at 18:34:12
In reply to soooooo unmotivated. seroquel?, posted by jonh kimble on April 4, 2003, at 11:40:47
> Hi I have big time problems with motivation, anhedonia, social withdrawl and inability to sustain a conversation etc... (i believe low dopamine is to blame) and this is just the normal me.
Jon,
I had the same symptoms as you and I agree that it is a dopamine problem. The good news is that an OTC product called Enada NADH (coenzyme 1) is doing a remarkable job in treating these symptoms (which I refer to as the atypical depressive phase of my BPII disorder). This is the tenth week of my Enada NADH trial so it is too early for me to report on the long-term efficacy.
For the finer details, read one of my prior posts at the following link:
http://www.dr-bob.org/babble/20030306/msgs/206934.html
As an update to this previous post, I currently take 2.5 mg every fourth day (Take 2.5 mg on day one; skip days two, three, and four; take 2.5 mg on day five). As stated in my previous post, 10 mg/day was a good dose during the acute treatment phase.
Since you are BP II, I'd ditch the AP and get on a first-line moodstabilizer (Depakote or lithium). I don't like the TD risk of an AP, but that's just me. Why does your pdoc have you on an AP instead of a MS?
If you have questions, just ask. I'd bet dollars-to-donuts that Enada NADH will snap you out of your atypical depression (low motivation, etc) within hours of taking the supplement. However, what I don't know is if it will cause irritability for you or if it will poop-out over time. I hope it helps long-term.
-- RonHere are some of the links discussing Enada NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10047,00.html#Cautions
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
Posted by Ron Hill on April 4, 2003, at 18:57:58
In reply to soooooo unmotivated. seroquel?, posted by jonh kimble on April 4, 2003, at 11:40:47
Jon,
I forgot to mention that I also take 600 mg/day of Lithobid (blood level of 0.4 mEq/L). When I first took the Enada NADH I felt like it might have pushed me into hypomania if it were not for the fact that I had a moodstabilizer fully in place beforehand.
-- Ron
Posted by cybercafe on April 4, 2003, at 20:46:04
In reply to Re: soooooo unmotivated. seroquel? » jonh kimble, posted by Ron Hill on April 4, 2003, at 18:34:12
> Since you are BP II, I'd ditch the AP and get on a first-line moodstabilizer (Depakote or lithium). I don't like the TD risk of an AP, but that's just me. Why does your pdoc have you on an AP instead of a MS?
hey question for you ron
how are depakote and lithium for causing sleepiness during the day?i find that zyprexa at 5 mg makes it hard to wake up but once i'm out of bed i am totally awake (at 2.5 mg i get no sedation at all)
Posted by Ron Hill on April 4, 2003, at 21:27:43
In reply to Re: soooooo unmotivated. seroquel?, posted by cybercafe on April 4, 2003, at 20:46:04
> hey question for you ron
> how are depakote and lithium for causing sleepiness during the day?
>
> i find that zyprexa at 5 mg makes it hard to wake up but once i'm out of bed i am totally awake (at 2.5 mg i get no sedation at all)Cybercafe,
At 600 mg/day of Lithobid (which is admittedly a low dose), I don't experience any sleepiness during the day. Years ago when I took 750 mg/day of Depakote, it caused depression, irritability, hair loss, weight gain, and rash, but I don't recall that it caused sleepiness during the day.
-- Ron
Posted by Rainbowlight on April 4, 2003, at 23:21:48
In reply to soooooo unmotivated. seroquel?, posted by jonh kimble on April 4, 2003, at 11:40:47
If there was ever a med that made me unmotivated it was Seroquel. All it took was a small dose, and I wouldn't be able to get off the couch. It never did go away, so I quit the med.
Posted by cybercafe on April 5, 2003, at 18:13:43
In reply to Re: Moodstabilizers or antipsychotics for BP II? » cybercafe, posted by Ron Hill on April 4, 2003, at 21:27:43
> > i find that zyprexa at 5 mg makes it hard to wake up but once i'm out of bed i am totally awake (at 2.5 mg i get no sedation at all)
>
> Cybercafe,
>
> At 600 mg/day of Lithobid (which is admittedly a low dose), I don't experience any sleepiness during the day. Years ago when I took 750 mg/day of Depakote, it caused depression, irritability, hair loss, weight gain, and rash, but I don't recall that it caused sleepiness during the day.did you find that depakote gave you a cyst or increased your cholesterol?
Posted by Krissy P on April 6, 2003, at 0:34:44
In reply to soooooo unmotivated. seroquel?, posted by jonh kimble on April 4, 2003, at 11:40:47
Whooaaaaaaaa 500mg of Seroquel? May I ask how long you've been on it? I cannot take more than 300 mg and even then I get the feelings you speak of here.(just my experience)
Can you ask your doc about the med Cogentin? It sometimes helps people with side effects of other meds.
Keep me posted, and hang in there.
I care!
Kristen
--------------------------------------------------------------------------------------------------
has this happened to others? does it indicate anything about me? whats a good med to combat these symtoms? thanks for your time
> Hi I have big time problems with motivation, anhedonia, social withdrawl and inability to sustain a conversation etc... (i believe low dopamine is to blame) and this is just the normal me. I have been diagnosed bp 2 and put on serquel 500 mgs at night to sleep and stabilize mood but when i wake up, all those problemslisted above are worse than ever. it is difficult for me just to utter the word hi to someone. i am wondering if seroquels da blocking ability is to blame. has this happened to others? does it indicate anything about me? whats a good med to combat these symtoms? thanks for your time
Posted by Krissy P on April 6, 2003, at 0:39:48
In reply to Re: Moodstabilizers or antipsychotics for BP II? » cybercafe, posted by Ron Hill on April 4, 2003, at 21:27:43
Hey Ron,
My pdoc said yes-try Lithium-a month ago. I saw her last week and she said Nooooooo
why do docs do this?? I'm still taking 50mg Lamictal. So far so good for the mood swings but (I won't even go there) my depression landed me in the ER and hospital for 2 days.
I was *puzzled* as to why my pdoc acted this way about Lithium?
Any ideas?
thanks, Kristen
--------------------------------------------------------------------------------------------------> > hey question for you ron
> > how are depakote and lithium for causing sleepiness during the day?
> >
> > i find that zyprexa at 5 mg makes it hard to wake up but once i'm out of bed i am totally awake (at 2.5 mg i get no sedation at all)
>
> Cybercafe,
>
> At 600 mg/day of Lithobid (which is admittedly a low dose), I don't experience any sleepiness during the day. Years ago when I took 750 mg/day of Depakote, it caused depression, irritability, hair loss, weight gain, and rash, but I don't recall that it caused sleepiness during the day.
>
> -- Ron
>
>
Posted by Ron Hill on April 7, 2003, at 1:16:06
In reply to Re: Moodstabilizers or antipsychotics for BP II?, posted by cybercafe on April 5, 2003, at 18:13:43
Cybercafe,
> did you find that depakote gave you a cyst or increased your cholesterol?
Not to my knowledge, but I did not have my cholestrol tested while on Depakote. So I really don't know the answer to this question.
-- Ron
Posted by Ron Hill on April 7, 2003, at 1:48:06
In reply to Re: Moodstabilizers or antipsychotics for BP II?-R, posted by Krissy P on April 6, 2003, at 0:39:48
Kristen
> My pdoc said yes-try Lithium-a month ago. I saw her last week and she said Nooooooo. why do docs do this?? I'm still taking 50mg Lamictal.
So what changes, if any, did your pdoc make in your medications? What did she say about Trileptal? Clearly you have been having trouble. What did she say about that? Are you still taking the Effexor? If I recall correctly, you were taking 50 mg Lamictal, 75 mg Effexor, 100 mg seroquel, and some benzo. What changes were made?
> So far so good for the mood swings but (I won't even go there) my depression landed me in the ER and hospital for 2 days.
Were you in the hospital last week while you were blocked? I'm sure you read all the posts on this board regarding concern for your well being after somebody received an e-mail from you last week in which you expressed a less-than-eager outlook on life. I knew you would not hurt yourself because you are too bright for that. Did you miss class? Stay caught up in school Krissy. You did so well last semester! Now you need to do it again.
Posted by Krissy P on April 8, 2003, at 0:57:17
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Krissy P, posted by Ron Hill on April 7, 2003, at 1:48:06
okay. My doc added Trileptal but only because I brought it up. My insurance doesn't cover it so I had to stop it after only 3 days.
No, I am OFF of Effexor as of a week ago. She said it was not helping my mood swings and this:"Most BP's do not do well on AD's"
So she took me off of Effexor, but put me on Celexa-a med that has helped me in the past.
She said to stay on 50 mg of Lamictal still.
so right now I am taking:
10mg Celexa (2nd night-increase to 20 in a week)
2mg Klonopin
200mg Seroquel
50mg Lamictal
ya know, when I told her what was going on, she didn't say much. I told her I have been cycling BAD, and she honestly didn't say much except what I said here and that I could Trileptal-but thanks to insurance I'm not taking it-I cannot afford it. What do you think????
Please get back to me when you are able.
Sooooooo, that's where I stand.
And, yes, I went to the ER because I took an overdose :0( Thank you so much for saying that I am too bright for hurting myself-you're not the only one who has said that in my lifetime. I just need to reinforce it to myself every day. I am so pushing to finish school and keep going-I know I can do it-I just trip myself up a lot and self-sabotage my dreams. I also looked into "Curves For Women" lol it's an exercise place, small, not a meat market, and I can afford it. I want to do it for me and my health. I miss exercise so bad I cry. I went from track to tennis, to gymnastics, to dance, etc then stopped. Gained a good 80 Lbs :0(
Anyway, thank you so much for your post and support sooooo much :0)
Thanks, Kristen
--------------------------------------------------------------------------------------------------
Kristen
So what changes, if any, did your pdoc make in your medications? What did she say about Trileptal? Clearly you have been having trouble. What did she say about that? Are you still taking the Effexor? If I recall correctly, you were taking 50 mg Lamictal, 75 mg Effexor, 100 mg seroquel, and some benzo. What changes were made?
Were you in the hospital last week while you were blocked? I'm sure you read all the posts on this board regarding concern for your well being after somebody received an e-mail from you last week in which you expressed a less-than-eager outlook on life. I knew you would not hurt yourself because you are too bright for that. Did you miss class? Stay caught up in school Krissy. You did so well last semester! Now you need to do it again.
Posted by Ron Hill on April 8, 2003, at 11:32:41
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Ron Hill, posted by Krissy P on April 8, 2003, at 0:57:17
Kristen,
> My doc added Trileptal but only because I brought it up. My insurance doesn't cover it so I had to stop it after only 3 days.
How did the Trileptal make you feel during the three days you were on it?
I'm assuming that your insurance won't cover it because it is an off-label use of the medication? If this is the reason, they might change their determination if your pdoc sends them a letter spelling out the usefulness of this particular anti-epileptic drug for the off-label treatment of bipolar disorder. Your insurance company pays for Lamictal but not Trileptal? That seems weird. If I were you, I'd appeal the insurance company's determination.
> I am OFF of Effexor as of a week ago. She said it was not helping my mood swings and this:"Most BP's do not do well on AD's"
If she really believes this then why did she, in her next breath, put you back on Celexa?
> What do you think????
It’s dangerous to ask me what I think because I'm likely to tell you.
1) Commit yourself to a consistent exercise program. Track your workouts in your daily log (you are keeping a log, right?).
2) Go to class EVERYDAY and get your homework done. Your future depends on you doing well in school.
3) In my opinion, you still need to add more mood stabilization to your cocktail. Try to get your insurance company to pay for the Trileptal. If they won't, talk your pdoc into a low dose trial of a slow release lithium product.
4) I'm not a pdoc, so all of this is just a layman's opinion. However, if I were in your shoes, I would want to work toward the following cocktail:
Establish a therapeutic dose level of a first or second-line moodstabilizer (e.g.; lithium, Depakote, or Trileptal). Since you did poorly on Depakote, this leaves the other two.
Slowly ramp up the Lamictal dose and simultaneously discontinue the SSRI.
Once stabilized on the moodstabilizer and Lamictal, slowly try to remove the AP.
If the ramped-up dose of Lamictal does not provide enough antidepressant effect, then it may be necessary to add an MAOI or, perhaps, an OTC supplement that will treat the depressive side of your BP II.
Lastly, I would then try to discontinue the benzo.
Therefore, the target cocktail that I would shoot for, if I were in your shoes, would be a good moodstabilizer plus a ramped-up Lamictal dose with the possible need to add-on an MAOI or an OTC supplement to treat any residual depression. The difficult part, however, is getting from where you are now (medication-wise) to the target cocktail without getting your brainchemistry all jumbled up during the transition.
This is merely my opinion, and opinions are like butt holes; everybody's got one.
All my best to you Kristen.
-- Ron
Posted by Krissy P on April 8, 2003, at 13:59:16
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Krissy P, posted by Ron Hill on April 8, 2003, at 11:32:41
Ron, thank you for this info.
Ok, I felt depressed the 3 days I was on Trileptal, and my ankles swelled up something horrible. Now get this, my damn doc has had a week to get a C-Pass to my insurance company regarding the Trileptal, NO WORD.
I also had to get the Lamictal approved.
Yes, then why did she put me back on Celexa when a second before she took me off Effexor???
I am so sick of this, really, I mean do I need to find a new pdoc, do I stop all meds? I really wonder at this point!
Thanks again and take care Ron,
Kristen
--------------------------------------------------------------------------------------------------
> 1) Commit yourself to a consistent exercise program. Track your workouts in your daily log (you are keeping a log, right?).
>
> 2) Go to class EVERYDAY and get your homework done. Your future depends on you doing well in school.
>
> 3) In my opinion, you still need to add more mood stabilization to your cocktail. Try to get your insurance company to pay for the Trileptal. If they won't, talk your pdoc into a low dose trial of a slow release lithium product.
>
> 4) I'm not a pdoc, so all of this is just a layman's opinion. However, if I were in your shoes, I would want to work toward the following cocktail:
>
> Establish a therapeutic dose level of a first or second-line moodstabilizer (e.g.; lithium, Depakote, or Trileptal). Since you did poorly on Depakote, this leaves the other two.
>
> Slowly ramp up the Lamictal dose and simultaneously discontinue the SSRI.
>
> Once stabilized on the moodstabilizer and Lamictal, slowly try to remove the AP.
>
> If the ramped-up dose of Lamictal does not provide enough antidepressant effect, then it may be necessary to add an MAOI or, perhaps, an OTC supplement that will treat the depressive side of your BP II.
>
> Lastly, I would then try to discontinue the benzo.
>
> Therefore, the target cocktail that I would shoot for, if I were in your shoes, would be a good moodstabilizer plus a ramped-up Lamictal dose with the possible need to add-on an MAOI or an OTC supplement to treat any residual depression. The difficult part, however, is getting from where you are now (medication-wise) to the target cocktail without getting your brainchemistry all jumbled up during the transition.
>
> This is merely my opinion, and opinions are like butt holes; everybody's got one.
>
> All my best to you Kristen.
>
> -- Ron
>
Posted by mags on April 8, 2003, at 14:18:47
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Ron Hill, posted by Krissy P on April 8, 2003, at 13:59:16
Hi Krissy, Thought I would add my two cents here. I haven't been on this board much since I spent most of last year in and out of hospital. One time for three months in a row. I was there in this Pyschiatric facility to try and get my meds adjusted and babysit me while we tried. This was after unsuccessful ECT's. I am BPII and am presently on:
Lithium 300 MG
Depakote 750MG
Seroquel 100MG
Wellbutrin 150 MG
Eltroxin 5MG (Thyroid med)
Ritalin SR 20 MGThis is after many many different med trials and I am seeing my doc tomorrow and will have to change them as they are not working.
I have tried the same drugs as you and many more and I agree with Ron, most docs don't like to give AD's if you are BP....however, I find without them I am totally flat....kinda like looking at life with the glass half empty instead of half full.
The only words of wisdom I can pass on to you is:
DON"T go off your meds cold turkey...it can be really a bad experience (I know!)
Read and read what others say here on this board and elsewhere.
Then go to your doc armed with lots of info. Altho' they try to help as much as they can, they are shootin in the dark as far as I am concerned. We all react so different to meds....the only thing I know for sure is there is no "magic pill"....but there may be a magic combo if you just keep working on it......
Good Luck
Marg
Posted by Ron Hill on April 8, 2003, at 15:10:00
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Ron Hill, posted by Krissy P on April 8, 2003, at 13:59:16
Krissy,
> I felt depressed the 3 days I was on Trileptal, and my ankles swelled up something horrible.
That does not sound very promising, but maybe these side effects are only short-term.
> I am so sick of this, really, I mean do I need to find a new pdoc, do I stop all meds? I really wonder at this point!
I agree with Meg. Do your own research and then take your ideas to your pdoc. Meet with your pdoc frequently until you get something figured out that works. Do not self-medicate and do not discontinue your meds without your pdoc's approval.
There is a cocktail out there somewhere that will work for you, Kristen. Your job (along with your pdoc) is to find it.
Best wishes.
-- Ron
Posted by Ron Hill on April 8, 2003, at 15:13:05
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Ron Hill, posted by Krissy P on April 8, 2003, at 13:59:16
This is the end of the 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.