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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 54. Go back in thread:
Posted by platinumbride on April 25, 2005, at 22:43:34
In reply to Re: Keppra » platinumbride, posted by theo on April 25, 2005, at 12:15:13
You are most welcome.....
I really wish you all good things. I see recovering addicts a lot and I just can't believe that they are managing to confront life, unaided by substance, day after day...especially after many years of substance making everything "all right".
Be well,
Diane
> Thank You! It's tough to hold on when confronting situations like this and not see immediate results, but hopefully in the near future it will be worth it.
Posted by SLS on April 26, 2005, at 7:28:28
In reply to Re: Keppra » SLS, posted by theo on April 24, 2005, at 9:37:59
Hi Theo.
I'm still thinking...
:-)
I want to reiterate what Diane said. I have an enormous amount of respect for the strength you have shown to maintain your sobriety in the face of other adversities.
My knee-jerk reaction after reading your post is that you might benefit most from CBT (cognitive-behavioral therapy). This does not obviate the need for pharmacotherapy, but would address true psychological issues that a medication will not be able to help with.
- Scott
Posted by theo on April 26, 2005, at 8:29:12
In reply to Re: Keppra » theo, posted by SLS on April 26, 2005, at 7:28:28
> Hi Theo.
>
> I'm still thinking...
>
> :-)
>
> I want to reiterate what Diane said. I have an enormous amount of respect for the strength you have shown to maintain your sobriety in the face of other adversities.
>
> My knee-jerk reaction after reading your post is that you might benefit most from CBT (cognitive-behavioral therapy). This does not obviate the need for pharmacotherapy, but would address true psychological issues that a medication will not be able to help with.
>
>
> - ScottI agree, but since I quit taking meds, my interest to go to therapy or do anything for that matter is pretty flat. It's like I need something (med) to bridge the gap and help me "feel" like going forward.
I'm a dealer for a high end furniture company and was awarded a bid yesterday for about decent commission. I didn't even feel good about that!!! This worries me because I can't seem to feel excited about anything it seems.
Posted by SLS on April 26, 2005, at 18:34:04
In reply to Re: Keppra » SLS, posted by theo on April 26, 2005, at 8:29:12
> > Hi Theo.
> >
> > I'm still thinking...
> >
> > :-)
> >
> > I want to reiterate what Diane said. I have an enormous amount of respect for the strength you have shown to maintain your sobriety in the face of other adversities.
> >
> > My knee-jerk reaction after reading your post is that you might benefit most from CBT (cognitive-behavioral therapy). This does not obviate the need for pharmacotherapy, but would address true psychological issues that a medication will not be able to help with.
> >
> >
> > - Scott
>
> I agree, but since I quit taking meds, my interest to go to therapy or do anything for that matter is pretty flat. It's like I need something (med) to bridge the gap and help me "feel" like going forward.
>
> I'm a dealer for a high end furniture company and was awarded a bid yesterday for about decent commission. I didn't even feel good about that!!! This worries me because I can't seem to feel excited about anything it seems.
That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.How did you respond to Parnate?
- Scott
Posted by theo on April 26, 2005, at 23:12:43
In reply to Re: Keppra » theo, posted by SLS on April 26, 2005, at 18:34:04
>
> That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.
>
> How did you respond to Parnate?
>
>
> - ScottActually, I've never tried Parnate, Nardil or any TCA's, only SSRI's and anticonvulsants. So now's the big question, what to try. Not only what class but then which med within that class?
Posted by SLS on April 27, 2005, at 8:26:02
In reply to Re: Keppra » SLS, posted by theo on April 26, 2005, at 23:12:43
> >
> > That sounds like a bona-fide biological depression to me. Loss of interest, motivation, and reward. You are right in thinking that it would be more productive to engage in CBT without the depression getting in the way. Therefore, it is logical to attack the depression first. If you hit the bullseye, you can move forward. However, if you don't hit the bullseye, you might benefit from trying to move forward with the CBT anyway. Progress would be slow, but it would still help to chip away at your fears and inhibitions.
> >
> > How did you respond to Parnate?
> >
> >
> > - Scott
>
> Actually, I've never tried Parnate, Nardil or any TCA's, only SSRI's and anticonvulsants. So now's the big question, what to try. Not only what class but then which med within that class?Don't forget about Effexor or Cymbalta. Either of these are worth a try if you haven't tried them already.
From the land of TCA comes desipramine and nortriptyline. Both of these drugs have mild side effects compared to the others. I would give a small advantage to nortriptyline. However, one must be diligent in establishing blood levels in the beginning such that the dosage chosen results in values between 50-150 ng/ml. There are people, however, whom respond to desipramine and not to nortriptyline.
desipramine 150-300mg
nortriptyline 50-100mgFor MAOIs, it is difficult to choose whether to go with Parnate or Nardil. If lack of energy is not a problem, and there exists anxiety disorders or OCD, Nardil might be the best choice. However, there are some people who respond to Parnate who don't respond to Nardil, so you can't discount all MAO inhibitors based upon your non-response to only one of them.
Parnate 40-80mg
Nardil 60-90mgTheo, it seems to me that there are still quite a few avenues of treatment you have not explored yet. The odds are in your favor that you will find something that works well.
- Scott
Posted by theo on April 27, 2005, at 9:15:15
In reply to Re: Keppra » theo, posted by SLS on April 27, 2005, at 8:26:02
In you response to TCA's, you didn't mention imipramine. How does it compare to the other ones mentioned? Didn't you try it before?
I can usually get by with small doses, which also may be an advantage with some meds.
Posted by SLS on April 27, 2005, at 19:53:17
In reply to Re: Keppra » SLS, posted by theo on April 27, 2005, at 9:15:15
Imipramine is the "gold standard" by which other antidepressants have been measured. If you are not afraid of anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty in urination, etc.), you will probably enhance your chances of getting well by trying imipramine instead of desipramine.
- Scott
Posted by theo on April 27, 2005, at 22:42:59
In reply to Re: Keppra, posted by SLS on April 27, 2005, at 19:53:17
> Imipramine is the "gold standard" by which other antidepressants have been measured. If you are not afraid of anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty in urination, etc.), you will probably enhance your chances of getting well by trying imipramine instead of desipramine.
>
>
> - ScottSo between nortriptyline, desipramine and imipramine, nortriptyline would have the least side effects and imipramine the most? With TCA's are side effects dose related?
Posted by SLS on April 28, 2005, at 6:17:11
In reply to Re: Keppra » SLS, posted by theo on April 27, 2005, at 22:42:59
> > Imipramine is the "gold standard" by which other antidepressants have been measured. If you are not afraid of anticholinergic side effects (dry mouth, blurred vision, constipation, difficulty in urination, etc.), you will probably enhance your chances of getting well by trying imipramine instead of desipramine.
> >
> >
> > - Scott
>
> So between nortriptyline, desipramine and imipramine, nortriptyline would have the least side effects and imipramine the most? With TCA's are side effects dose related?The anticholinergic side effects of TCAs are dose related. I'm partial to nortriptyline right now because it is somewhat less selective than desipramine for amine uptake inhibition. I find nortriptyline to be a more pleasant drug to be on.
Years ago, an idea circulated that responses to desipramine and nortriptyline were mutually exclusive. If you responded to one, you would tend not to respond to the other and vice versa. Again, with antidepressants, it is important not to generalize your reaction to one drug to an entire class.
- Scott
Posted by platinumbride on April 28, 2005, at 8:46:50
In reply to Keppra, posted by SLS on April 21, 2005, at 19:50:04
Posted by theo on April 28, 2005, at 9:28:26
In reply to Re: Keppra, posted by SLS on April 28, 2005, at 6:17:11
Thanks for the input. I'll be speaking with my pdoc soon to discuss options.
Posted by SLS on April 29, 2005, at 8:43:29
In reply to Scott, have you started on keppra yet? (nm) » SLS, posted by platinumbride on April 28, 2005, at 8:46:50
Hi.
:-)
My doctor elected to try Trileptal first. That's ok with me. If it were necessary (wouldn't it be cool if it weren't?), I would then move to Keppra.
I continue to be interested in Keppra. My doctor has described some people becoming agitated or hypomanic while taking it. If you can get me manic, this is a good thing. I would welcome any drug that can shift my chemistry enough to punch a hole through my wall of depression. My rare drug-induced manias are easily controlled with Depakote or Zyprexa.
- Scott
Posted by theo on April 29, 2005, at 18:09:30
In reply to Re: Scott, have you started on keppra yet? » platinumbride, posted by SLS on April 29, 2005, at 8:43:29
> Hi.
>
> :-)
>
> My doctor elected to try Trileptal first. That's ok with me. If it were necessary (wouldn't it be cool if it weren't?), I would then move to Keppra.
>
> I continue to be interested in Keppra. My doctor has described some people becoming agitated or hypomanic while taking it. If you can get me manic, this is a good thing. I would welcome any drug that can shift my chemistry enough to punch a hole through my wall of depression. My rare drug-induced manias are easily controlled with Depakote or Zyprexa.
>
>
> - Scott
>Does the Trileptal have any AD properties? Let me know how your trial goes.
Posted by SLS on May 1, 2005, at 10:23:40
In reply to Re: Keppra » SLS, posted by theo on April 28, 2005, at 9:28:26
Has anyone had a manic reaction to Keppra?
Thanks.
- Scott
Posted by Ritch on May 1, 2005, at 11:47:56
In reply to Re: Keppra - causes mania?, posted by SLS on May 1, 2005, at 10:23:40
> Has anyone had a manic reaction to Keppra?
>
> Thanks.
>
>
> - ScottI noticed some irritability associated with using it. But it seems to be dose related and the irritability wasn't accompanied by increased psychomotor agitation and angry rumination. The "irritability" was more to do with increased assertiveness and a disinhibiting effect accompanied by being more aware of what's going on. Difficult to describe, but it seemed to work on my ADHD symptoms, especially short term working memory. Improved working memory makes it a little easier to become irritable in my case.
Posted by platinumbride on May 2, 2005, at 20:33:37
In reply to Re: Scott, have you started on keppra yet? » platinumbride, posted by SLS on April 29, 2005, at 8:43:29
Well, it's all a crap shoot anyway, right, so maybe trileptal will be of help.
I really hope so.Diane
> Hi.
>
> :-)
>
> My doctor elected to try Trileptal first. That's ok with me. If it were necessary (wouldn't it be cool if it weren't?), I would then move to Keppra.
>
> I continue to be interested in Keppra. My doctor has described some people becoming agitated or hypomanic while taking it. If you can get me manic, this is a good thing. I would welcome any drug that can shift my chemistry enough to punch a hole through my wall of depression. My rare drug-induced manias are easily controlled with Depakote or Zyprexa.
>
>
> - Scott
>
Posted by SLS on May 3, 2005, at 9:04:17
In reply to Re: Scott, have you started on keppra yet? » SLS, posted by platinumbride on May 2, 2005, at 20:33:37
> Well, it's all a crap shoot anyway, right, so maybe trileptal will be of help.
> I really hope so.Thanks, Diane. It would be quite a pleasant surprise. I'm currently taking:
Lamictal 150mg
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Trileptal 600mgThe doctor who recommended the Keppra (levetiracitam) wrote the following article:
Interesting. I had been an ultra-rapid cycler for a few years in my early 20s.
- Scott
Posted by platinumbride on May 3, 2005, at 9:52:00
In reply to Re: Scott, have you started on keppra yet? » platinumbride, posted by SLS on May 3, 2005, at 9:04:17
Wow Scott,You are taking what seems to be, a lot of good stuff.
I guess we have to keep trying, as you have said to me...I say this b/c i have seen your website and your "sweetie".
I have a sweetie too and a lot of love around me, so I really cannot stop trying either.
My dad, many years ago, was poorly diagnosed as a hopeless schizophrenic (he was really bipolarI in a big way....) He said that when he came down he couldn't be in the daylight for even 15 minutes....
If we can type and we can help each other on this board then we probably each have moments of contentment, and those are what we have to focus on.
god, I sound like Dr. friggnin Phil.....never mind all of that LOL
FIngers are crossed for the trileptal.........
Be well Scott,
Diane
> > Well, it's all a crap shoot anyway, right, so maybe trileptal will be of help.
> > I really hope so.
>
> Thanks, Diane. It would be quite a pleasant surprise. I'm currently taking:
>
> Lamictal 150mg
> Parnate 80mg
> nortriptyline 100mg
> Abilify 10mg
> Trileptal 600mg
>
> The doctor who recommended the Keppra (levetiracitam) wrote the following article:
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15582854
>
> Interesting. I had been an ultra-rapid cycler for a few years in my early 20s.
>
>
> - Scott
Posted by theo on May 3, 2005, at 11:18:12
In reply to Re: Scott, have you started on keppra yet? » platinumbride, posted by SLS on May 3, 2005, at 9:04:17
Scott,
If you try Keppra, have you looked into taking it twice daily or 3 times daily? I was just curious if you had seen any research on this.
The PI says twice daily (every 12 hours) then states a 6-8 hour half life. When I took it, I could feel my 7:00am dose wear off about 3:00pm. I tried it both ways but was just curious what your doc has said about dosing.
Posted by theo on May 3, 2005, at 11:59:56
In reply to Re: Keppra - causes mania? » SLS, posted by Ritch on May 1, 2005, at 11:47:56
> > Has anyone had a manic reaction to Keppra?
> >
> > Thanks.
> >
> >
> > - Scott
>
> I noticed some irritability associated with using it. But it seems to be dose related and the irritability wasn't accompanied by increased psychomotor agitation and angry rumination. The "irritability" was more to do with increased assertiveness and a disinhibiting effect accompanied by being more aware of what's going on. Difficult to describe, but it seemed to work on my ADHD symptoms, especially short term working memory. Improved working memory makes it a little easier to become irritable in my case.At what dose and what dosing schedule were/are you taking Keppra?
Posted by Ritch on May 3, 2005, at 22:24:12
In reply to Re: Keppra - causes mania? » Ritch, posted by theo on May 3, 2005, at 11:59:56
> > > Has anyone had a manic reaction to Keppra?
> > >
> > > Thanks.
> > >
> > >
> > > - Scott
> >
> > I noticed some irritability associated with using it. But it seems to be dose related and the irritability wasn't accompanied by increased psychomotor agitation and angry rumination. The "irritability" was more to do with increased assertiveness and a disinhibiting effect accompanied by being more aware of what's going on. Difficult to describe, but it seemed to work on my ADHD symptoms, especially short term working memory. Improved working memory makes it a little easier to become irritable in my case.
>
> At what dose and what dosing schedule were/are you taking Keppra?
>
>Theo, I started out with 250mg twice daily a couple of years ago (tried for several months with Depakote and low-dose Effexor and clonazepam). It seemed to make me irritable and that is why I stopped it. I restarted it at 125mg twice daily recently (after having been off all AD's, just Depakote and clonazepam now). I noticed an uptick of irritability again. But.. I don't notice an *explosive* irritability I had while on AD's, just an assertive grouchiness-readiness to complain and squawk, stuff like that. I've read your posts about dosing schedules.... I'm thinking of splitting into 125mg TID to see how that goes.
Posted by Maxime on May 3, 2005, at 22:30:46
In reply to Re: Keppra - causes mania? » theo, posted by Ritch on May 3, 2005, at 22:24:12
Hi Scott. My pdoc gave me 10 days worth of cortisone to try and bring on a hypomanic episode to break through the depression. It did on day 8 and by day 11 I crashed really hard.
Maxime
Posted by theo on May 3, 2005, at 22:38:22
In reply to Re: Keppra - causes mania? » theo, posted by Ritch on May 3, 2005, at 22:24:12
How's the Depakote working and what dose are you taking? Are you taking regular or ER? I think I've asked you before but can't remember.
Posted by SLS on May 4, 2005, at 5:26:12
In reply to Re: Cortisone?, posted by Maxime on May 3, 2005, at 22:30:46
> Hi Scott. My pdoc gave me 10 days worth of cortisone to try and bring on a hypomanic episode to break through the depression. It did on day 8 and by day 11 I crashed really hard.
>
> MaximeYou might want to try taking ketoconazole. It is a cortisol synthesis inhibitor used to treat Cushings Disease. If your CRH-ACTH-cortisol system is out of whack, it might help. Ketoconazole is also used as an antifungal.
- Scott
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