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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 JennyR9306 on October 17, 2008, at 9:34:48
i am having a really hard time right now wit hmeds. Pdoc put me on Depakote eight weeks ago to see how it would work with current meds. I am on Seroquel 800mg and Klonopin. It seemed to work fine. The only side effect she mentioned was weight gain. She DID NOT mention the issues regarding me being of child bearing age and PCOS or risk to the baby if I became pregnant. I addresed this with her on my next visit. I have been unable to afford meds since I'm unemployed and have no insureance. I went off Depakote for a bit because i was concerned about the pregancy thing (probably a bit of paranoia there) had a major meltdown last night and went back on. THEN I find out today that doc wants me off of it. Where do I go from here? I've tried Lamictal and Lithium - Lamictal I maxed out on with little success and lithium i couldn't get to a therapeuitic level- too many side effects. Please help! Hubby is at work all day and I'm scouring the internet about what else there is to try.
Posted by Phillipa on October 17, 2008, at 11:16:06
In reply to Medication help please!, posted by JennyR9306 on October 17, 2008, at 9:34:48
What is your diagnosis or symtoms are you trying to treat? Phillipa
Posted by JennyR9306 on October 17, 2008, at 11:47:27
In reply to Re: Medication help please! » JennyR9306, posted by Phillipa on October 17, 2008, at 11:16:06
I am bipolar dx'd in 2000.
Posted by azalea on October 17, 2008, at 12:54:04
In reply to Medication help please!, posted by JennyR9306 on October 17, 2008, at 9:34:48
Depakote is not a good choice for a woman of childbearing age. But you shouldn't stop it cold turkey. What dosage are you taking?
What symptoms were you having that prompted you pdoc to add Depakote to your Seroquel + Klonopin combo?
Rest assured there are other options for treating bipolar disorder. First, I'd like to know whether you're having residual depression, mania, or mixed. Let us know in a post.
> i am having a really hard time right now wit hmeds. Pdoc put me on Depakote eight weeks ago to see how it would work with current meds. I am on Seroquel 800mg and Klonopin. It seemed to work fine. The only side effect she mentioned was weight gain. She DID NOT mention the issues regarding me being of child bearing age and PCOS or risk to the baby if I became pregnant. I addresed this with her on my next visit. I have been unable to afford meds since I'm unemployed and have no insureance. I went off Depakote for a bit because i was concerned about the pregancy thing (probably a bit of paranoia there) had a major meltdown last night and went back on. THEN I find out today that doc wants me off of it. Where do I go from here? I've tried Lamictal and Lithium - Lamictal I maxed out on with little success and lithium i couldn't get to a therapeuitic level- too many side effects. Please help! Hubby is at work all day and I'm scouring the internet about what else there is to try.
Posted by JennyR9306 on October 17, 2008, at 13:13:43
In reply to Re: Medication help please! » JennyR9306, posted by azalea on October 17, 2008, at 12:54:04
P doc added Depakote ER 500 because I was experiencing what I would say are mixed episodes. Just prior to the Depakote I was getting depressed so Lexapro was added. After a few weeks it seemed as if I was heading the other direction so the Lexapro was stopped and Depakote was added. I was/ am taking 500 ER once a day. I am worried about other meds because I can handle a lot of things but nausea is the worst for me. My pdoc gave me a "low dose" of depakote since she said I was "med phobic". I tend to be on the depressive side. ALthough since being on Depakote that has dminished somewhat. I had a major episode of hormonal/PMS last nigth with crying and feeling fat and awful etc. I *hate* the weight gain with all these meds. But I'd rather be heavier and stable than thin and suicidal.
Posted by greywolf on October 17, 2008, at 21:52:59
In reply to Re: Medication help please!, posted by JennyR9306 on October 17, 2008, at 13:13:43
I would investigate a course of Abilify 10mg along with an SSRI (if you get any relief from them). Try something like Pristiq (or its predecessor), then see if your doctor will add in something light for anxiety (alprazolam .5mg) because it sounds like you have a fair amount of anxiety. On the other hand, Remeron/Seroquel will knock you on your butt, too, but with the weight gain issue.
Greywolf
Posted by JennyR9306 on October 18, 2008, at 9:07:49
In reply to Re: Medication help please!, posted by greywolf on October 17, 2008, at 21:52:59
My pdoc will not put me on an AD because of the potential for mania. Does anyone know anything about zonegran?
Posted by azalea on October 18, 2008, at 14:23:52
In reply to Re: Medication help please!, posted by JennyR9306 on October 18, 2008, at 9:07:49
Zonegran (zonisamide) is an anticonvulsant with mood stabilizing properties. It is not FDA-approved for bipolar disorder, but shows promise in research. It typically causes weight loss, in contrast to many other meds for bipolar.
J Affect Disord. 2008 Jan;105(1-3):311-4. Epub 2007 Jun 21.
Is adjunctive open-label zonisamide effective for bipolar disorder?
Ghaemi SN, Shirzadi AA, Klugman J, Berv DA, Pardo TB, Filkowski MM.
Bipolar Disorder Research Program, Department of Psychiatry, Emory University, Atlanta, GA 30322, United States. nghaemi@emory.eduOBJECTIVE: To assess the effectiveness and safety of zonisamide in bipolar disorder. METHODS: A chart review was conducted of naturalistic treatment with zonisamide in 35 outpatients meeting DSM-IV criteria for bipolar disorder (9 males, 26 females; mean +/- SD age = 29.2 +/- 12.7; 14 with bipolar disorder type I, 6 with bipolar disorder type II, and 14 with bipolar disorder not otherwise specified). Patients received zonisamide adjunctive therapy between January 1994 and December 2004. Treatment response was defined as a Clinical Global Impressions - Improvement (CGI-I) scale score of +2 (much improved) or + 3 (very much improved). RESULTS: Zonisamide was moderately to markedly effective in 9 subjects (26%). Indication for treatment included depressive (34.3%, [12/35]), manic/hypomanic (28.6%, [10/35]), or mixed (31.4%, [11/35]) symptoms. The mean zonisamide dose was 130 mg/d for a mean duration of treatment of 27.0 +/- 32.3 weeks. Sedation (25%, [4/16]) was the most common side effect; 19/35 (54.3%) reported no side effects. 17/35 (49%) patients terminated early, mostly due to adverse effects (6/35). Using a multivariable model, predictors of response, concurrent mood stabilizers, dose and bipolar subtype (bipolar type I > type II/NOS), were controlled for in this sample. CONCLUSIONS: In 35 persons with bipolar disorder taking standard mood stabilizers and other psychotropic agents, adjunctive zonisamide appears to have modest benefit in global improvement when added to a pre-existing complex medication regimen in patients with bipolar spectrum disorder. These pilot data support the need for larger studies to test the potential efficacy of zonisamide for treatment in mood disorders.
> My pdoc will not put me on an AD because of the potential for mania. Does anyone know anything about zonegran?
Posted by JennyR9306 on October 22, 2008, at 14:58:02
In reply to Re: Medication help please! » JennyR9306, posted by azalea on October 18, 2008, at 14:23:52
This is rediculous. My pdoc wasnts me off Depakote but is not willing to put anything in its place. The annoying thing is that since I'm stuck in a county mental health clinic til I get insurance, I have to go through my case manager who relays info to the doc and then from her to me etc in a huge circle. I've only got a few days of Depakote left although it is seriously messing up my hormones..no period yet although a neg hpt. Called the obgyn to get a prescription for bc pills so pdco will feel better about the zonegran. sheesh. I'm getting insurance in January and I'm getting a new doc...one I can actually communicate with on a one on one basis. This is enough to drive anyone nuts.
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