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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 23 to 47 of 54. Go back in thread:
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
Posted by Ritch on May 4, 2005, at 10:07:28
In reply to Re: Keppra - causes mania? » Ritch, posted by theo on May 3, 2005, at 22:38:22
> 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.
Theo, I'm taking:
Depakote 250mg ER (sometimes 500mg for a day or two every few days)
Keppra 125mg BID
Clonazepam .5mg HSDepakote can really shut down the manic symptoms even at this low dose. While just on Dep+Clon. I had ZERO irritability and no racing thoughts. But, I was *still* cycling every three weeks.. it wasn't mood cycling like you normally think of it.. it was like a cyclic ADD thing where my energy would drop and my functional short term memory was just wiped out.. just thick headed, then it would go away and I felt sharp as a tack for several days in a row, then stupid and tired again for several days. Weird. I was "depressed" in an energy management sense of the word, but I didn't "feel" depressed in a miserable sense, or have negative ruminations, just sleepy and stupid. That would give way to feeling motivated and quick-witted, but without racing thoughts or hyperactivity. I am beginning to believe that this pattern is a "pseudo-depression" of sorts that is a result of what appears to be sleep disruptive aspects of the Depakote. While it improves a cluster of symptoms it makes the "pseudo-depression" worse (IMO) due to its sleep disruptive effects (I wake early-fragmented sleep-fatigued next day). So... the idea was bring in Keppra again to help with the sleep and cognition. But, I'm having this simmering (but non-explosive) irritation, cognition improved, but the Keppra doesn't help sleep unless I take 250mg HS. Taking 125mg HS as I'm doing right now actually seems to activate me and wake me up in the middle of the night more so than I did before I restarted it. Weird drug. Since it seems so dose-dependent with its actions.. I'm thinking of taking 125mg first thing in the AM, then 125mg in the afternoon and *skip* the nighttime dose and see what happens. Whew.. the complications..
Posted by theo on May 4, 2005, at 10:52:39
In reply to Re: Keppra - causes mania? » theo, posted by Ritch on May 4, 2005, at 10:07:28
If I try Depakote, it will probably be just 250mg of the ER.
Does this small dose cause any side effects like the thinning hair, gastrointestinal problems I read about. Also, do you have to get blood tests at this small of a dose?
Posted by Ritch on May 4, 2005, at 12:35:37
In reply to Re: Keppra - causes mania? » Ritch, posted by theo on May 4, 2005, at 10:52:39
> If I try Depakote, it will probably be just 250mg of the ER.
>
> Does this small dose cause any side effects like the thinning hair, gastrointestinal problems I read about. Also, do you have to get blood tests at this small of a dose?I never got any noticeable hair loss at all at 250mg. At a steady 500mg dose I did notice some, but it wasn't real bad. I take folic acid and L-Carnitine since Depakote can deplete these. Depakote never gave me any GI distress, unlike lithium. That's individual of course. I can't take Trileptal because of the nausea. However, other than what appears to be sleep disruptive effects, Depakote does cause me to have some twitching and some tremor. I got a blood pull recently (with a comprehensive metabolic panel, etc.). It depends on your pdoc. Some don't bother with it at low doses, others do. None of mine bothered except maybe once a year (along with other tests).
Posted by theo on May 4, 2005, at 23:01:50
In reply to Re: Keppra - causes mania? » theo, posted by Ritch on May 4, 2005, at 12:35:37
I forgot to ask, does Depakote ER 250mg cause any cognitive impairment?
Posted by Ritch on May 5, 2005, at 10:07:02
In reply to Re: Keppra - causes mania? » Ritch, posted by theo on May 4, 2005, at 23:01:50
> I forgot to ask, does Depakote ER 250mg cause any cognitive impairment?
All antimanic agents that have worked for me have caused some degree or type of cognitive blunting or dulling. However, some of the severity of depressions that have been prevented has to count against that to some extent when figuring that in. I would hate to think that I'm trading a nasty yo-yo for depression on the installment plan, but it is kind of like that it seems at times--:) As far as chronic day-to-day cognitive side effects of antimanics go.. lithium was easily the worst, Trileptal caused it too, and also Depakote. Particularly with Depakote (for me), the biggest trouble is transient word recognition difficulties (or delayed recognition).. it is a little like the epilepsy patients who have their corpus callosum (sp?) severed and when looking at a word with their left eye (only), they can't recognize it. There are rare occasions where I look directly at a common word and know that I know what it is, but I can't describe it-- it's pretty weird. I notice it the worst when I increase the dose, and it *does* settle down and fade somewhat with time.. with Trileptal (in my individual case).. it seemed to gradually worsen on the same dose. Keeping the dose of Depakote at a lower level mitigates a lot of that and overall I can tolerate it better than any of the others for the antimanic benefits that it provides (a good cost/benefit ratio). I think I would have little cognitive impairment at all if I could get my sleep architecture straightened out (and whatever med that is used to help that, if any doesn't make things worse the next day).
Posted by theo on May 5, 2005, at 11:59:29
In reply to Re: Keppra - causes mania? » theo, posted by Ritch on May 5, 2005, at 10:07:02
Thanks, the nurse just called and she is going to talk to the doc and I'll probably give it a try.
I can always try Keppra again, but I know it's limitations and thought I might try Depakote first.
Posted by SLS on May 5, 2005, at 18:13:26
In reply to Re: Keppra - causes mania? » Ritch, posted by theo on May 5, 2005, at 11:59:29
> I can always try Keppra again, but I know it's limitations and thought I might try Depakote first.
What limitations?
- Scott
Posted by theo on May 5, 2005, at 19:26:00
In reply to Re: Keppra - causes mania? » theo, posted by SLS on May 5, 2005, at 18:13:26
> > I can always try Keppra again, but I know it's limitations and thought I might try Depakote first.
>
> What limitations?
>
>
> - ScottLimitations in dosage mainly. If I go above 750mg I can get extremely impatient and angry on it, which can be fixed with a dosage adjustment down but to dose Keppra effectively, I have to take it 3 times daily which can also get old because it seems like all I'm thinking about is when to take my next dose.
Keppra is hard to explain. It's good in the way that it clears your mind, but at the same time I can get hostile and weak. I work out at the gym as much as possible and although Keppra doesn't make me feel tired, it can make me extremely weak at times. I also have a hard time reading, following words on a page, which can get frustrating.
If Depakote doesn't work, I will try Keppra again and just deal with the sides I guess. The only reason I quit Keppra was because my pdoc added Lamictal to help with depression and I starting getting mega side effects. I dropped the Keppra to get a true read on the Lamictal, which I eventually found was the true culprit for the side effects and dropped it. So here I sit.
Posted by Ritch on May 5, 2005, at 23:34:03
In reply to Re: Keppra - causes mania? » SLS, posted by theo on May 5, 2005, at 19:26:00
> > > I can always try Keppra again, but I know it's limitations and thought I might try Depakote first.
> >
> > What limitations?
> >
> >
> > - Scott
>
> Limitations in dosage mainly. If I go above 750mg I can get extremely impatient and angry on it, which can be fixed with a dosage adjustment down but to dose Keppra effectively, I have to take it 3 times daily which can also get old because it seems like all I'm thinking about is when to take my next dose.
>
> Keppra is hard to explain. It's good in the way that it clears your mind, but at the same time I can get hostile and weak. I work out at the gym as much as possible and although Keppra doesn't make me feel tired, it can make me extremely weak at times. I also have a hard time reading, following words on a page, which can get frustrating.
>
> If Depakote doesn't work, I will try Keppra again and just deal with the sides I guess. The only reason I quit Keppra was because my pdoc added Lamictal to help with depression and I starting getting mega side effects. I dropped the Keppra to get a true read on the Lamictal, which I eventually found was the true culprit for the side effects and dropped it. So here I sit.
>
>You seem to be experiencing some similar effects that I have and am experiencing with Keppra. There does seem to be a dose-dependent relationship (in my experience) with ability to help as a hypnotic (125mg doesn't work and actually worsens middle insomnia for me-but 250mg helps). Also, I have been getting significant relief from the anergic depressive symptoms, but with the trouble of increased grouchiness and impatience. I haven't had explosive temper episodes (which is good), but I don't feel too confident that they wouldn't happen at a higher dosage (say higher than 500mg total daily). I had the "asthenia" experience with Keppra if I took daytime doses higher than 125mg-felt like a rag doll. Good for psychomotor agiation... but the stumbly, wobbly feel is a bummer.
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