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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by NKP on November 11, 2008, at 14:47:44
-- but your doctor thinks you have bipolar depression, and treats you with a medication regime intended for bipolar depression.
Could that make unipolar depression worse?
Thanks.
Posted by desolationrower on November 11, 2008, at 15:40:24
In reply to Suppose you have unipolar depression --, posted by NKP on November 11, 2008, at 14:47:44
I think some of the anticonvulsants could make one's depression worse - the ones like carbazepine, valproate, topiramate, that are mainly used against mania. Same thing for the (ugh) antipsychotics.
Probably just as important, not taking a real antidepressant means your (potential) unipolar isn't being treated.
What does your doc think indicates bipolar that you disagree about?
-D/R
Posted by Phillipa on November 11, 2008, at 18:04:06
In reply to Re: Suppose you have unipolar depression --, posted by desolationrower on November 11, 2008, at 15:40:24
Benzos, lamictal and trileptal are all okay taken them all at low doses. Why do you say uni and doc say bipolar no mania? Love Phillipa
Posted by yxibow on November 11, 2008, at 19:43:58
In reply to Re: Suppose you have unipolar depression --, posted by desolationrower on November 11, 2008, at 15:40:24
> I think some of the anticonvulsants could make one's depression worse - the ones like carbazepine, valproate, topiramate, that are mainly used against mania. Same thing for the (ugh) antipsychotics.
Lithium actually is one of the fastest agents against suicide. But there are definite side effects, monitoring salts, weight gain, etc.
And antipsychotics, at a low and sensible dose and one of the less harsh ones like Seroquel (MED, minimum effective dose) do augment antidepressants (and anxiolytics).
That doesn't mean one needs to go down that road right now unless they have TRD (treatment resistant depression)
I would disagree about anticonvulsants -- AEDs such as Lamictal are actually antidepressants in their own right. And they help augment antidepressants (and anxiolytics), its just finding the right one sometimes.However of the panoply of them Trileptal is preferable to Tegretol which has some "unclean" side effects.
This is going to sound contrite to those with BP but small touch of mania might not hurt someone with deep unipolar depression, they could use the stimulation.
> Probably just as important, not taking a real antidepressant means your (potential) unipolar isn't being treated.
Most likely true unless you have dysthymia and you can worth through it in therapy without an antidepressant, but its hard.
-- tidings
Jay
Posted by Phillipa on November 11, 2008, at 20:04:00
In reply to Re: Suppose you have unipolar depression -- » desolationrower, posted by yxibow on November 11, 2008, at 19:43:58
Jay seriously need a bit of hypomania how do I get it any ideas? Love Phillipa
Posted by bleauberry on November 11, 2008, at 20:23:58
In reply to Suppose you have unipolar depression --, posted by NKP on November 11, 2008, at 14:47:44
Anything can make depression worse, regardless whether so-called bipolar or unipolar, and that includes antidepressants, mood stabilizers, stimulants, benzos, antibiotics, antipsychotics, herbs, vitamins, anything. The potential is always there. Few studies reveal the percentage of patients that deteriorate and get worse shortly after starting a treatment, but the ones I have found show it happens in about 5 out of any random hundred people up to 16 out of any random hundred people, on any random given psych med, regardless of diagnosis.
Posted by NKP on November 12, 2008, at 2:20:05
In reply to Suppose you have unipolar depression --, posted by NKP on November 11, 2008, at 14:47:44
Thank you all for your responses.
I do not want anyone who may be emotionally fragile to get upset, so if that is the case, you may not want to read further.
The person in question is not me, but someone I know. The diagnosis made by her first pdoc was unipolar depression. She was treated with various combinations of SSRIs, APs, and benzodiazepines.
During this period, she attempted suicide twice by overdose. On both occasions she ended up in hospital for several days. The second time was extremely serious. She very nearly died.
After the second attempt, she spent two weeks in a psychiatric clinic receiving extensive counseling and therapy. In this clinic she was assigned one of their pdocs, who she has since stayed with for treatment. She has not gone back to her old pdoc.
The new pdoc diagnosed her with bipolar disorder.
Initially he put her on a variety of meds including lamotrigine. After a few weeks, she developed a bad rash on her arms and legs, so he took her off the lamotrigine and replaced it with lithium. She is still titrating the lithium dose.
Her current med regime is:
8 AM:
60 mg fluoxetine (Prozac)
10 mg buspirone (Buspar)
0.5 mg clonazepam
200 mg lithium6 PM:
10 mg buspirone (Buspar)
0.5 mg clonazepam8 PM:
200 mg lithium9 PM:
200 mg quetiapine (Seroquel)
11.25 mg zopicloneAfter she left the clinic, there was a dramatic improvement for a few weeks, but these last few days (especially since dropping the lamotrigine) it seems she is getting worse, not better. Considering her history, this is of great concern for me.
Any thoughts?
Thanks.
Posted by Phillipa on November 12, 2008, at 18:37:57
In reply to Re: Suppose you have unipolar depression --, posted by NKP on November 12, 2008, at 2:20:05
Wow I'm sure it is. Sorry the lamictal didn't work out for her. Are you absolutely positive she's taking her meds? If so a call to maybe both pdocs is in order. The old one knows her better was she suicidal when on the meds he had her on? Must have been as the suicide attemps. Any personality traits that triggered the attempts? Gee definitely let the new one know. So sorry for you both. Love Phillipa
Posted by azalea on November 12, 2008, at 22:27:04
In reply to Re: Suppose you have unipolar depression --, posted by NKP on November 12, 2008, at 2:20:05
Sounds like stopping the lamotrigine caused a turn for the worse. While the rash is concerning, perhaps an option would be to retry lamotrigine, but start at a lower dose and titrate more slowly this time. Dr. Phelps (psychiatrist in Oregon and creator of psycheducation.org) recommends starting at 12.5mg lamotrigine and increasing by 12.5mg weekly. This is more conservative than the manufacturer recommendation. He has noticed a decrease in rash incidence with the more gradual titration.
> After she left the clinic, there was a dramatic improvement for a few weeks, but these last few days (especially since dropping the lamotrigine) it seems she is getting worse, not better. Considering her history, this is of great concern for me.
>
> Any thoughts?
>
> Thanks.
Posted by emme on November 12, 2008, at 23:17:43
In reply to Re: Suppose you have unipolar depression -- » NKP, posted by azalea on November 12, 2008, at 22:27:04
> While the rash is concerning, perhaps an option would be to retry lamotrigine, but start at a lower dose and titrate more slowly this time.
If rash is an issue, one can go very very slowly if needed. After my first try (titration schedule starting at 12.5 mg) caused a rash, I restarted at 2 mg and increased by about 5 mg per week for a few weeks. I was then gradually able to increase the increments. YMMV.
emme
Posted by yxibow on November 13, 2008, at 1:26:47
In reply to Re: Suppose you have unipolar depression -- » NKP, posted by azalea on November 12, 2008, at 22:27:04
> Sounds like stopping the lamotrigine caused a turn for the worse. While the rash is concerning, perhaps an option would be to retry lamotrigine, but start at a lower dose and titrate more slowly this time. Dr. Phelps (psychiatrist in Oregon and creator of psycheducation.org) recommends starting at 12.5mg lamotrigine and increasing by 12.5mg weekly. This is more conservative than the manufacturer recommendation. He has noticed a decrease in rash incidence with the more gradual titration.
>
> > After she left the clinic, there was a dramatic improvement for a few weeks, but these last few days (especially since dropping the lamotrigine) it seems she is getting worse, not better. Considering her history, this is of great concern for me.
> >
> > Any thoughts?
> >
> > Thanks.
>
>Its a possibility, but rechallenging something that may already have caused a sensitivity is something not to be taken lightly. Going slowly, its a very long titration, and you can run the possible rare risk of SJS more perhaps this time. I don't know the studies on this, so I can't confirm this.
As far as the other medications are concerned, I hope she responds to BuSpar but probably less than 1/3 see some significant results.
I would have the doctor consider upping the Lithium. Lithium is one of the fastest ways to stop suicidality.
Possibly go up slightly on the Seroquel, carefully, monitoring for side effects, and only using the MED (minimum effective dose.
If you have to post something, I think its important to not mince words. Suicide is a common thought in a number of mental illness disorders and is one of the major causes of death in schizophrenia and other related illnesses.
The aunt I never knew, as mental illness runs on my mothers side, 99% likely killed herself, I wont go into the ugly details, she had a not so great psychiatrist and a not so great boyfriend. This affected my grandfather and my grandmother greatly not to mention her two sisters. But that was the 70s and only the beginning of medications for BP-II.
I nearly attempted it myself, because I saw what was a tic coming and also because I had hopelessness in my future -- I was seen several times but never admitted (fortunately, because of HIPAA rules) to the hospital. But perhaps it was right by my caretakers that this provided some insight into my feelings and what was going on.
I still have thoughts, I think people with low self-esteem and the lack of hope for hope, yes, that's a curious statement but there's a point to it, but at the same time I cling on to some hobbies and I know that there isn't infinite time to get me to where I want or as much as possible (we all I think would like to be "normal" but what is that really ?)
I have some rather difficult symptoms that in my mind especially separate me from life and the "normal" things that people do even if they are feeling bad, bugged out bored, etc... with my orphan disorder, visual problems, I don't think at this point I still could enjoy, understand a movie in the theater (24fps) or be in a crowded bar with disco lights and all or watch TV for hours like I used to, especially on a regular old TV.
But I repeat parts of my disorder, this isn't about me, this is about your friend... I'm going on tangents.
I think some of those minor changes might help. And perhaps Depakote, if she hasn't already tried it.
Of course the increased Lithium means increased monitoring salts and weight issues and various other side effects.
However, weighing the issues that have gone on before versus side effects -- I don't know, that's a very personal thing for her and her relations.
-- best wishes
Jay
-- Jay
Posted by desolationrower on November 13, 2008, at 7:53:27
In reply to Re: Suppose you have unipolar depression -- » azalea, posted by yxibow on November 13, 2008, at 1:26:47
in a hospital you get a lot of contact with professionals, sometimes thats more important than the medicine they are giving...is your friend seeing a therapist regularly?
SJS is very serious, but it is also a very slow disease, so with careful monitoring it is not a big danger. Especially if the lamotragine was helpful and reducing suicidal feelings, i think it would be worth the risk to try, again going slowly.
-d/r
This is the end of the thread.
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