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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 Mr.Scott on September 18, 2004, at 22:21:27
I have a bipolar disorder. I also have a psychiatrist who is wishy washy and ambivalent to say the least.I am far more frequently depressed (like 85-90% of the time I'm unhappy but I believe some of that is due to the consequences of my mood disorder rather than the disorder itself), and I have never had a full blown Mania. My hypomania's have only been induced by antidepressants and stimulants and rarely debilitating except for the inevitable crash. It was hard to sleep and I was euphoric or agitated and impulsive on Nardil and Prozac and a little bit on Ritalin as well for a few weeks until they stopped working or actually made my depression worse! Tricyclics may me want to kill myself immediately. I may have experienced more pure maniclike symptoms when I was younger and then my first clinical depression was at age 16. I also have a seasonal component.
After years of drugs (now in recovery) and meds my response to Antidepressants is generally a very quick hypomanic reaction (within 1 day for sure every time) followed in a few days by an enduring mixed state (lots of agitation, mood shifts, irritability, grandiosity, being a dick, and still being depressed and tired).
The disappointing thing about all this is my doctor's essential throwing up of his hands. I can't take Lamictal due to rash. I currently take 25mg of Zoloft and .75mg clonazepam and when I tell you I suffer I'm not lying.
Wouldn't straight lithium or maybe Depakote + Antidepressant make sense here?
I'm asking for help with this matter because I can't seem to get it fixed on my own, and I don't really know what I want from my doctor, but obviously I'm not getting it.
Surely someone who has had an unconventional or misdiagnosed bipolar disorder can share there experience with me...I hope.
Scott
Posted by HappyGirl on September 18, 2004, at 23:59:59
In reply to Bipolar Disorder Question. Can You Help Me?, posted by Mr.Scott on September 18, 2004, at 22:21:27
Hi:
It sounds to me like you have Bipolar II with mixed state (or 'rapid cycler'). For this form of Bipolar II, it's not easy to find a right med. combo. due to the complexity involved. However, Depakote is one of 'best meds' for this type of Bipolar, since Depakote is good both manic and depressive episodes. Lithium is a sort better for 'manic' side, not really helping 'depressive side' of Bipolar. But, Lithium is a well-known med. which is exclusively designed for Bipolar. Sometimes, Lithium and Depakote combo. is better than mono therapy, Depakote or Lithium alone therapy. Also, a newer form of anti-psycho. med., Zyprexa along with mood-stabilizer and anti-depressant might be more beneficial effect on your Bipolar.
H.G.
Posted by catmint on September 19, 2004, at 2:22:36
In reply to Re: Bipolar Disorder Question. Can You Help Me?, posted by HappyGirl on September 18, 2004, at 23:59:59
>>>>Depakote is one of 'best meds' for this type of Bipolar, since Depakote is good both manic and depressive episodes.
I have to disagree with this. Depakote alone will not relieve the depression in a Bipolar person who is primarily depressed, like Scott. In fact it can make it worse.
It is the first line of defense against acute mania. But since Scott has never had full-blown mania, it probably won't do anything for his depression.
I have been on this board for over 3 years and have never heard of a Bipolar II person on Depakote alone. There always has to be an anti-depressant along with it.
As for personal experience, I am Bipolar, have experienced full blown mania, and suicidal depression in the past, when I was in my mid-twenties. I am now 38 and doing much, much better, although I continue to have low-grade depression about 80% of the time.
I have tried Depakote, it is great for irritability, and helped me sleep, but did absolutely nothing for my depression.
What has been the best med for my depression is, hands down, Lamictal. I too had a rash in the beginning and stopped but I was so impressed by the anti-depressant effect that I gave it another go, this time titrating very slowly, like 12.5 mg. to start. Lamictal comes in very small doses for children.
Scott, could you by any chance give Lamictal another try. How did you start last time? You really do have to start with a very low dose.
Many people on this board have had great results from it.
Posted by Emme on September 19, 2004, at 8:34:03
In reply to Bipolar Disorder Question. Can You Help Me?, posted by Mr.Scott on September 18, 2004, at 22:21:27
>
> I have a bipolar disorder. I also have a psychiatrist who is wishy washy and ambivalent to say the least.
>
> I am far more frequently depressed (like 85-90% of the time I'm unhappy but I believe some of that is due to the consequences of my mood disorder rather than the disorder itself), and I have never had a full blown Mania. My hypomania's have only been induced by antidepressants and stimulants and rarely debilitating except for the inevitable crash. It was hard to sleep and I was euphoric or agitated and impulsive on Nardil and Prozac and a little bit on Ritalin as well for a few weeks until they stopped working or actually made my depression worse! Tricyclics may me want to kill myself immediately. I may have experienced more pure maniclike symptoms when I was younger and then my first clinical depression was at age 16. I also have a seasonal component.
>
> After years of drugs (now in recovery) and meds my response to Antidepressants is generally a very quick hypomanic reaction (within 1 day for sure every time) followed in a few days by an enduring mixed state (lots of agitation, mood shifts, irritability, grandiosity, being a dick, and still being depressed and tired).
>
> The disappointing thing about all this is my doctor's essential throwing up of his hands. I can't take Lamictal due to rash. I currently take 25mg of Zoloft and .75mg clonazepam and when I tell you I suffer I'm not lying.
>
> Wouldn't straight lithium or maybe Depakote + Antidepressant make sense here?
>
> I'm asking for help with this matter because I can't seem to get it fixed on my own, and I don't really know what I want from my doctor, but obviously I'm not getting it.
>
> Surely someone who has had an unconventional or misdiagnosed bipolar disorder can share there experience with me...I hope.
>
> ScottI agree with the above poster- sounds like BPII. Or BPIII. If your pdoc is throwing up his hands, you need a different doc. Badly. There are many options you haven't exhausted:
- MAOIs and Wellbutrin are not known for inducing cycling. Include a mood stabilizer.
- Try an AD plus Li.
- I'd be a bit surprised if Li or depakote alone did it for you. But, you never know.
- Consider the anticonvulsant Trileptal.
- Sooshi has great success with Zonegran, a newer anticonvulsant.
- Lamictal: Depending on what your rash was like and how quickly it resolved, you might think about a retrial. You can use 5 mg tabs for an ultra-slow titration. Not to be done w/o much thought, but if you can't find anything else that helps, at least discuss it. Don't be discouraged if you need extra AD on top of Lamictal.
- I have mostly depression, but like occasional seroquel for highly anxious states. I doubt you'd use it alone, but it might be helpful in combo w/ something else.
- Consider dopaminergic drugs for bipolar depression. My pdoc has had good luck with Mirapex. I think the jury's still out on memantine, but it's worth thinking about.
- If you're sluggish, a little provigil or selegiline might perk you up. Even a low dose of selegiline (5-10 mg) is good for some people. Other need higher doses.
- Consider swapping the clonazepam for xanax, which is supposed to have some AD properties.
Good luck.
Emme
Posted by HappyGirl on September 19, 2004, at 10:25:54
In reply to Re: Bipolar Disorder Question. Can You Help Me? » Mr.Scott, posted by Emme on September 19, 2004, at 8:34:03
Hi:
>>> I'd be a bit surprised if Li or depakote alone did it for you. But, you never know.<<<--- At the beginning of my Bp II therapy, my pdoc. put me 'Depakote' med. alone, ... from 750 mg. to 1250 mg. Back, six years ago, it seems to me this, Depakote alone was acceptable, although I, myself agree with other posters that Depakote or Lithium alone does NOT offer a good relief. However, I had 'ultra rapid cycler' on top of Bp II, then it seems to me that my pdoc. made 'extra' cautious NOT to put me any of A.D. in the fear of causing 'manic' episodes, although again, ... I needed A.D. so BADLY. Then, there is difference between Bp II and Bp II with ultra rapid cycler, like mine.
When I read Scott's plea in regard to med., I just felt his diagnose was somehow identical to mine, 'mixed state' or 'ultra rapid cycler' on top of Bp II. Also, all of med. regimen are based on my 'personal' experience. Since three and a half years ago, I've been on Zyprexa 5 mg., Lithium 900 mg. and two A.D.s to get my Bp stabilized. It was a VERY long and hard road to find this combo. But, in the end, I feel now it(patience) is well-worth, as knowing that my Bp II has somehow complexity to deal with. At least, I found a good pdoc. who is finally dxed appropriately and rxed a right med. combo.
H.G.
Posted by Mr.Scott on September 20, 2004, at 0:13:37
In reply to Re: Bipolar Disorder Question. Can You Help Me?, posted by catmint on September 19, 2004, at 2:22:36
I can definately try Lamictal again. I had a very mild rash.Scott
Posted by Mr.Scott on September 20, 2004, at 0:45:22
In reply to Bipolar Disorder Question. Can You Help Me?, posted by Mr.Scott on September 18, 2004, at 22:21:27
Thanks Ladies!
I feel like I'm in a boat that's taking on water and I'm constantly throwing buckets overboard trying to stay afloat.
I've been seeing the same doctor for 3+ years and every day it's a pinch of this or a pinch of that and there's 'a problem' with every med I take. If it doesn't cause my face to swell or my muscles to twitch, it will give me a feeling of drivenness to go and do something real stupid or make me feel comatose, agitated, whatever.
I wish I had an 'actual' community of people instead of a 'virtual' community of people to interact with (like AA for bipolars or something), because I feel like I'm on the borderline. I feel like I'm too normal to feel as sick as I do and yet I'm too sick to pretend like I'm normal all the time (it's so draining). It's like half my life is in the closet and I'm constantly trying to claw my way through life with a pocket full of pills. I need other nuts to talk to like alcoholics need other alcoholics!
Sorry for rambling. I deeply appreciate your responses to my post.
Scott
This is the end of the thread.
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