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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by sam K on September 25, 2008, at 15:35:40
I took some provigil today and Im pretty sure it makes me manic. I become out of focus, yet so focused at the same time. Like a spacy focus. Ill zone out yet Im still thinking really fast. Caffeine may do this to me too.. I was wondering, is there such thing as being stimulated and not having racing thoughts?
Im taking Lamictal and Im getting used to it, so Im a wee bit tired. My heart rate seems to go down and I feel understimulated. I get very afraid when this happens because I start to feel fat.. whenever my heartrate/bloodpressure goes down I feel fat and lazy. What would help this without making me get racing thoughts?
This month Ive been noticing these moments I get racing thoughts and rage. So I think Im bipolar in ways. My cousin is very bipolar.
So again, is there such thing as being stimulated without racing thoughts?
Posted by med_empowered on September 25, 2008, at 16:12:16
In reply to mania, posted by sam K on September 25, 2008, at 15:35:40
There's a big difference between mania--which is severe and I think has to last at least 1 week and/or result in hospitalization--and drug-induced stimulation, which is what you're experiencing.
Its possible that your brain is more bipolar-ish so you react to stimulants differently, but...I don't think that's really a good "test" for bipolarity. You're Bipolar I if you end up significantly impaired and/or hospitalized b/c of mania (and also have depressive spells); you're bipolar II if you have significant depression with oocasional bouts of hypomania.
What you're having is a drug reaction. People react differently to psych meds. People without a personal or family history of mania/psychosis can go psychotic/manic on antidepressants, stimulants, and (less commonly) other meds, such as anticonvulsants or even antipsyhotics. Having an unsual or undesired reaction to a psychiatric med doesn't indicate bipolarity; it probably just means you should watch out for the drug in question and drugs with similar mechanisms of action (which in your case I guess would mean avoid provigil and be careful with stimulating antidepressants).
Are you still seeing the doctor who thinks you have (prodromal) Schizophrenia? How's your life going overall? What's the Provigil for?
Have a good day.
Posted by Phillipa on September 25, 2008, at 20:29:41
In reply to Re: mania, posted by med_empowered on September 25, 2008, at 16:12:16
I've always thought it would be stimulating. Paradoxical reaction? Love Phillipa
Posted by Tony P on September 27, 2008, at 23:07:01
In reply to mania, posted by sam K on September 25, 2008, at 15:35:40
Provigil can both cause overstimulation and/or trigger a manic/hypomanic episode.
In my experience, it can certainly tip me over into hypomania, which is just a milder form -- sub-clinical, you might say. There's still some controversy, I believe, but Bipolar III has been proposed as a diagnosis for people who are depressed and experience manic (or hypo-manic) episodes only when they take antidepressant or stimulating meds (of which I would consider Provigil to be one). So there seems to be a clearly definable class of us who react this way.
On the other hand, a large dose of Provigil (depending on how sensitive you are to it) will certainly make you overstimulated, pretty similar to too much caffeine. How much Provigil did you take? E.g. 200 mg is quite a lot if you're not accustomed to it.
As med_empowered says, what you're experiencing sounds more like drug-induced overstimulation than mania, although I sometimes find it hard to tell the two apart myself, from the inside, so to speak. But Provigil can produce either or both of these effects, depending on the individual, what else you're taking, etc.
One way to distinguish mania from overstimulation (although there are some uncommon mixed states to confuse the issue) is that on the whole mania feels g-o-o-d. If I'm manic, I may be behaving irrationally, (as others will notice), babbling nonsense, going on shopping sprees, working for hours on something completely unimportant, but I _feel_ calm, in control, creative and expansive.
If I'm overstimulated on the other hand I feel anxious, irritable, I have racing thoughts and a feeling that I am NOT OK. Also, overstimulation gives me insomnia which I _experience_ as MISSING needed sleep, whereas hypomania causes me to sleep less and feel just fine -- a subtle but very real distinction.
Med_empowered also mentioned that you've had a tentative schizophrenia diagnosis? Are you taking any neuroleptics (major tranqs, anti-psychotics or whatever) for that? If so, does it help with the reaction to the Provigil? I find Seroquel will bring me down very quickly from a hypo-manic episode, but if instead I'm anxious or overstimulated it just makes me feel overstimulated AND sleepy (not very nice, but it does draw a distinction between the two states).
The Lamictal may also be a factor. How long have you been taking it, and what dose are you at? Despite its being generally slightly sedating, I found myself a few years ago when I was titrating up the dose of Lamictal that at about 100 mg/day I suddenly experienced quite severe general anxiety, that lasted for several weeks. I have read other people on Lamictal describe a similar experience.
Do post again and tell us how you are doing.
Tony P
Posted by sam K on September 28, 2008, at 1:46:46
In reply to Re: mania » sam K, posted by Tony P on September 27, 2008, at 23:07:01
tony and med
Im doing quite well lately. I am taking my medicine consistantly and am at 125 mg of Lamictal. I am becoming pretty stable and calm. I use caffeine sometimes because I think Im still getting used to the Lamictal.Whats been bothering me lately is my lowered heart rate. My tiredness and lethary that I get after exercising. A mild depression. Im starting to think I have some adrenal fatigue? Im taking b6 lately for it and it really works!! But I dont want to take too much because it can be bad. Seriously, does anyone know about this lack of adrenaline throughout the day. Its not even all from Lamictal, Ive had this for a while. Ive had palpitations for so LONG and I have no idea why!!
Please help!! Im just so curious
Posted by Tony P on September 28, 2008, at 4:25:37
In reply to thanks, posted by sam K on September 28, 2008, at 1:46:46
Sam,
Tiredness and lethargy are a normal response to exercise, as your body gets rid of waste products such as lactic acid. Some conditions, such as liver disease or poor circulation, can prolong this process. And others such as low thyroid can lead to constant tiredness. Have you had the bloodwork done to test for liver problems, hypothyroid & other common hormone deficiencies? That's an essential first step. Many physical/hormonal problems can lead to abnormal fatigue and heart rate. The fact that B6 helps suggests that you may have a physical or dietary problem. My MD regularly recommends B6 and a number of other supplements, both vitamins & herbals, for lack of energy. A full discussion of those really belongs on the Alternative board.
Please don't take it amiss if I'm covering what is old familiar territory for you or telling you stuff you already know by heart -- I don't know your history, or what you may already have tried.
A low heart rate after exercise is usually a _good_ thing in the absence of other symptoms such as dizziness or almost passing out when you stand up, or cold fingers and toes. It can also be paradoxically caused by _too much_ adrenaline/noradrenaline. See the articles on Norepinephrine (same as noradrenaline) & Reflex Bradycardia at wikipedia.org if you want some technical background.
Noradrenaline/norepinephrine is also one of the Big Three brain transmitter chemicals that are involved in depression. It's been the most popular one for development of new medical treatments for depression in the last few years: e.g. Effexor and Cymbalta, or any med. that is called an SNRI. Personally, I think the most important thing is to find the right _balance_ between the various brain transmitters for _you_.
Anxiety from any cause, often associated with excess NE & other "fight-or-flight" hormones, can cause palpitations. And caffeine is well-known for causing palpitations, although usually the heart beats faster too. Depression can often come mixed with anxiety; I have that type myself, and probably fit somewhere on the bipolar spectrum, as it's coming to be called.
So, not being a doctor, and not being there with you, all I can say is 1) if you haven't already done so, make sure you get a really thorough physical with bloodwork from your regular GP, and discuss your symptoms with him; 2) if the tests don't turn up any physiological causes for your lethargy and abnormal heart rhythms, then maybe you have mixed or treatment-resistant depression/bipolar spectrum, and Lamictal by itself, at the dose you're taking, is not enough to treat it.
As I said in my earlier post, Lamictal can sometimes _cause_ anxiety & palpitations. I had to take 2-4 mg/day of clonazepam to get me through that adjustment period. Lamictal can also cause a subtle kind of lethargy, a case of the "blahs", sometimes called anhedonia, although it's less likely to do that than other mood-stabilizers. Did your heart and fatigue problems start with the Lamictal, or did you already have them?
Are you seeing a psychiatrist? Lamictal at 125 mg/day is an OK mood stabilizer but a pretty mild antidepressant for some people, while others find 25 mg is as much as they need; Lamictal seems to have a very wide range of effective dose for different people. Although the manufacturer recommends 200 mg/day maximum, my former pdoc, who prescribed Lamictal a lot, said he found some patients benefitted from as much as 600 mg/day. Or maybe you need an SNRI along with it, or some other adjuvant or helper med such as Buspar. Is your pdoc open to discussing alternatives? Sometimes it takes a lot of trial-and-error to find the right treatment combination; one size definitely does NOT fit all.
Of course, I may be preaching to the converted; you may already have been through this whole process more than once. But there are so many different medications that can help one person and not another. See my post from earlier today on "Exotic Meds for Treatment Resistant Depression" for just a partial list of the non-standard or less common medications I have tried.
Have you been diagnosed as bipolar? If so, which subtype? (I, II, III or ???) My same former pdoc was convinced that bipolar comes in a variety of forms, degrees and disguises, not always recognized, including ultra-rapid-cycling (daily or worse), sometimes called cyclothymia. That's now becoming a much more widely accepted view of depression & bipolar. Here's an informative web page that I just discovered by Googling "racing thoughts and depression": http://www.psycheducation.org/depression/02_diagnosis.html#Anchor-What-41424
I have to say again, I'm not a doctor; I can only offer my own experience and limited knowledge. But it does sound like you and I have much in common. I'm definitely Bipolar III (some AD meds make me hypomanic), and I probably fit somewhere on the bipolar spectrum or graph. Going back & rereading your first post, I suspect that provigil is triggering _something_ in you; whether it's a bipolar III hypomanic episode or whatever, it sounds like it's not helping you any. The SNRIs are supposed to energize you while reducing anxiety (including "racing thoughts"), but everybody reacts differently. The search goes on; good luck, and keep posting.
Feel free to Babblemail me any time, too.
Tony P
Posted by sam K on September 29, 2008, at 11:53:37
In reply to Re: thanks » sam K, posted by Tony P on September 28, 2008, at 4:25:37
I feel like crap, Im having suicidal thoughts lately (but I know they will go away). Im just so messed up. If I told anyone the truth then they'd think I was crazy (which I am lol). So I probably shouldnt care. Here we go I will say whats going on in my head lately.
For some reason I get attatched to ideas very easily(why I dont know, help!). A few days ago I ran into a book at the library called "feeling fat, frazzled or" I don't know the rest. sorry. But anyways I have been having palpitations lately. My heart rate is low and I just feel fat and lazy. This is where it gets funky. When my heart rate is low I begin to worry that I will become fat. So I used stimulants to keep my heart rate at a decent rate. Then these stimulants in return cause me anxiety and irriability. So its a freakin shi**y day everyday. Everday.. god da**, is me trying to find a solution to my problems. And I never get it right.
Something else thats bothering me is my multivitamin. I first thought Lamictal was causing increased appetite but I noticed when I didnt take my vitamin I wasnt as hungry. So here I am obsessing about some stupid vitamin situation. If I take a vitamin I become tired, if I dont I fear I will become deficiant. WOW. Do I have OCD? probably. :(
So I avoid zinc, because I think it increases my appetite. Sounds crazy.. doesnt it.
I cant figure out a solution and Im drving myself crazy.
What do you think is going on? I will start revealing the truth and get opinions because Im very desperate.
Im on Lamictal 125 mg for depression and mood swings. I think I have some Bipolar issues and I have an eating disorder. Do I need an antidepressant? I find them hard to tolerate.And by the way, thank you Tony P, I feel like someone really cares, thank you!!!!!
Posted by Tony P on September 30, 2008, at 13:52:23
In reply to :(, posted by sam K on September 29, 2008, at 11:53:37
Yes, I care, Sam; I can identify with you. I'm going through much the same kind of mood swings and "damned if I do, damned if don't" dilemmas as you.
I realized the next day that it was really ironical my posting all that "good advice" to you under the original heading "mania" -- because I was in the middle of a mild manic episode myself, also triggered by modafinil, one of the symptoms being thinking that I know everything and am here to set everybody else right!! So I hope I didn't come across as "know-it-all", as I thought I might have afterward.
I haven't posted until now because I crashed Monday -- slept all day, despite taking some modafinil, and missed an evening rehearsal. Then stayed up too late, trying to write a piece of music that wasn't working. Consequently, even though I slept in a bit this AM, I still feel like crap, tired, depressed, and ready to call myself names and beat myself up with a big stick!
But I read a good little nugget of wisdom in my daily meditation book, which helps with that tendency to be hard on myself: We're human, so we will make mistakes and fall short of the goals we set for ourselves.... (here's the part I like) The mistakes we make are the signposts along the way we're supposed to follow. As a Taoist, that appeals to me.
I've been called in at the last minute to cover for someone this afternoon at my volunteer job, and I know I'll feel better after that. We'll chat some more.
Best,
Tony
Posted by sam K on September 30, 2008, at 23:49:39
In reply to Re: mania :( » sam K, posted by Tony P on September 30, 2008, at 13:52:23
This is the end of the thread.
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