![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by floatingbridge on September 9, 2011, at 0:57:55
Topamax has been brought up for consideration.
What I have read about cognitive effects is not encouraging. I experienced enough of that on Lyrica. I have also read that Topamax has a nasty withdrawal. That effect usually hits me hard.
(Topamax and Lyrica are unrelated, correct?)
I suspect the suggestion was made because Topamax is
weight neutral and reduces anxiety. My doctor does not want to increase risperidone past .5mg because I am 'higher functioning'. This makes no sense at all, and I just about wept.But after looking at reviews of Topamax, I think I'd likely take an even worse cognitive hit. I can't afford anything like that.
So, if I pursue a stabilizer, lamictal is out.
Seroquel and abilify are out.Trileptal?
It really, really needs to be a bit mood brightening.
Or I am just saying forget it.
If I sound bitter and unhappy right now, it's because I am.
Posted by sigismund on September 9, 2011, at 2:14:32
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
What's this mood stabiliser thing?
The logic is (and I'm not disputing it, at least not yet) .......you are bipolar and in a mixed state (I made that up) or maybe you are just down all the time and...something something something....and you need mood stabilisers.....and Lamictal gave you the rash (but did you go up too quickly, and was the rash serious?).......where does that leave us?
You haven't been around. I have missed you. In the good old days there was none of this bipolar nonsense. You were either manic, depressed or schizophrenic.
I just kind of doubt that this kind of stuff will make you well.
Something a bit mood brightening for sure. I can see that.
Posted by sigismund on September 9, 2011, at 2:20:51
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
How's your sleep (such as it is)?
Where are you up to with Emsam?
I took 300mg gabapentin last night and some TCM herbs when I woke at midnight and I slept until 4am. I felt quite euphoric this morning.
Yesterday and today no curcumin and whatever else which may have been implicated in my insomnia.
Posted by SLS on September 9, 2011, at 6:28:57
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
> Topamax has been brought up for consideration.
>
> What I have read about cognitive effects is not encouraging.Start at 25mg and move up slowly to 100-200mg. The slower you increase the dose of Topamax, the less trouble you will have with cognitive side effects. It seems that if triggered by rapid titration, these side effects linger. With slower titration, you might not suffer any cognitive impairments at all.
> I experienced enough of that on Lyrica. I have also read that Topamax has a nasty withdrawal.
How so? I had none on two occasions?
> That effect usually hits me hard.
>
> Topamax and Lyrica are unrelated, correct?)
>
> I suspect the suggestion was made because Topamax is
> weight neutral and reduces anxiety. My doctor does not want to increase risperidone past .5mg because I am 'higher functioning'. This makes no sense at all, and I just about wept.I have seen Topamax 100mg work well to treat a mixed-state mania with rage. She looked somewhat BPD, as her mood and behavior was very labile during the courses of the day. I think she was more BD than BPD.
> So, if I pursue a stabilizer, lamictal is out.
> Seroquel and abilify are out.
>
> Trileptal?If you have tried Tegretol to no avail, I doubt Trileptal would work. Trileptal is a good drug, though. It can help with mania, impulse control, and rage.
Posted by floatingbridge on September 9, 2011, at 7:20:04
In reply to Re: Topamax, mood stabilizers? » floatingbridge, posted by SLS on September 9, 2011, at 6:28:57
>
> Start at 25mg and move up slowly to 100-200mg. The slower you increase the dose of Topamax, the less trouble you will have with cognitive side effects. It seems that if triggered by rapid titration, these side effects linger. With slower titration, you might not suffer any cognitive impairments at all.Did you have cognitive impairments at all? I an already a space cadet by nature.
>
> > I experienced enough of that on Lyrica. I have also read
that Topamax has a nasty withdrawal.
>
> How so? I had none on two occasions?
>Do you mean the withdrawal or the Lyrica? The withdrawal was explained as rebound anxiety and neuopathic pain, tingling in the extremities, even migraines.
>
> I have seen Topamax 100mg work well to treat a mixed-state mania with rage. She looked somewhat BPD, as her
mood and behavior was very labile during the courses of the day. I think she was more BD than BPD.
>I'm really not rageful. A lot less than many drivers on the roads here it seems. Anxious and dysphoric, yes, more so.
> > Trileptal?
>
> If you have tried Tegretol to no avail, I doubt Trileptal would work. Trileptal is a good drug, though. It can help with mania, impulse control, and rage.I haven't tried tegretol nor trileptal. Trileptal seems lighter (which sounds much better to me),
I am concerned that so many of these meds being proposed control rage. That is not my biggest concern. Maybe I misunderstand, but it's the dyshporia I want under control.
Posted by floatingbridge on September 9, 2011, at 7:32:19
In reply to Re: Topamax, mood stabilizers?, posted by sigismund on September 9, 2011, at 2:20:51
Hi sigi.
Four hours of sleep? We are evenly matched today :-). I was up at four myself, having fallen asleep near midnight.
It's like the S&P 500 regarding meds. Emsam is temporally down, risperdone up, benzo usage continues at a steady all time high with no advantage.
I really am not sure what to do. I don't understand my pdoc's strategy. I guess that question comes next week.
I haven't felt good enough to post much :-/
Posted by B2chica on September 9, 2011, at 7:58:01
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
Topomax is actually a migrane medication. funny that it actually gave me headaches when i first started off.
it didnt work for me as i dont do well it seems on mood stabilizers but for those that do i think it works well? all i can say for sure is that i dont recall any cognitive blunting caused by this medication. i seemed to stay pretty clear.
it is weight neutral. id say give it a try.id say its worth a try.
Triliptal on the other hand i had a horrible experience on.
So i cant comment unbiased.Best wishes
b2c.
Posted by floatingbridge on September 9, 2011, at 8:35:13
In reply to Re: Topamax, mood stabilizers? » floatingbridge, posted by B2chica on September 9, 2011, at 7:58:01
B2c, I am compelled to ask about your biased triliptal experience, what was not right?
Posted by Phillipa on September 9, 2011, at 11:27:57
In reply to Re: Topamax, mood stabilizers? » B2chica, posted by floatingbridge on September 9, 2011, at 8:35:13
150mg of trileptal was fine although noticed nothing I'm aware of. Stopped as was expensive. Phillipa
Posted by creepy on September 9, 2011, at 11:29:44
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
topamax isnt a really good mood stabilizer. Its effects on anxiety might depend on what 'kind' you have. The kind with physical arousal like PTSD seems to respond well to it, for me anyhow.
I couldnt tolerate it over 50mg since I started rapid cycling and getting awful anxiety. But then again even lamictal is destabilizing for many until they hit 200mg or so. a PRN add-on might be needed.
The startup might be harsh, it depends on the person. I had a lot of tingling in the hands and feet, and the carbonic anhydrase effects made soda taste bad. Maybe a little uncoordinated for awhile.
Food? This was the ultimate diet drug for me.. I didnt want to eat anything. But thats not what I go to a pdoc for, lol.
Posted by floatingbridge on September 9, 2011, at 11:45:20
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
Any one successes with trilpetil?
I read side effect profilevas ceing benign, relatively.
thanks :S
fb
Posted by Christ_empowered on September 9, 2011, at 12:26:12
In reply to What about trileptil? Better profile ?, posted by floatingbridge on September 9, 2011, at 11:45:20
Trileptal w/ Klonopin and occasional Ambien helped me stay on an even keel for a while, until I developed psychotic depression.
It does kind of make you stupid, but in this really subtle way that you're not aware of until after you're off of it. Kind of creepy.
Have you ever tried Zyprexa? Even PRN, it can knock out the crazy and the dysphoria for some people. It can also help sleep. The downside would be weight gain and metabolic disorders; some doctors have used metformin to counteract this. I also read some studies that used high doses of alpha lipoic acid and green tea extract, and that seemed to curb weight gain.
I hope you feel better soon.
Posted by SLS on September 9, 2011, at 12:47:10
In reply to Re: Topamax, mood stabilizers? » SLS, posted by floatingbridge on September 9, 2011, at 7:20:04
> >
> > Start at 25mg and move up slowly to 100-200mg. The slower you increase the dose of Topamax, the less trouble you will have with cognitive side effects. It seems that if triggered by rapid titration, these side effects linger. With slower titration, you might not suffer any cognitive impairments at all.
>
> Did you have cognitive impairments at all?None at 200mg.
> I am concerned that so many of these meds being proposed control rage. That is not my biggest concern. Maybe I misunderstand, but it's the dyshporia I want under control.
Don't try to exclude diagnoses and their treatments by the presence or absence of specific symptoms. You don't have to have rage to be BPD or BD. With some illnesses, certain symptoms must be present. Unfortunately, a single illness can have a multitude of symptoms that emerge and occur, often with great interindividual variation.
I hope this is helpful.
- Scott
Posted by floatingbridge on September 9, 2011, at 13:21:54
In reply to Re: Topamax, mood stabilizers? » floatingbridge, posted by SLS on September 9, 2011, at 12:47:10
Well, I also read a warning in fine print about topamax and risperdal that my pdoc missed :-(
Not sure how imortant the caution was....
I hear you about symptoms. It's just after awhile I wonder by looking at the symptom list if I these meds were best indicated for the Hulk.
Posted by sigismund on September 9, 2011, at 14:03:25
In reply to Re: Topamax, mood stabilizers? » sigismund, posted by floatingbridge on September 9, 2011, at 7:32:19
And then I thought you do have a brother who is properly bipolar. I have known two people who had bipolar which was not severe but certainly real, and they both had a floaty quality in some way, and then I wondered why you chose floatingbridge as your name.
I get a bit worried when I see people working their way through the pharmacopoeia. I have never tried mood stabilisers. Sometimes get these intense down contagious moods. I might have profited from them for all I know.
Posted by floatingbridge on September 9, 2011, at 14:29:52
In reply to Re: Topamax, mood stabilizers? » floatingbridge, posted by sigismund on September 9, 2011, at 14:03:25
Yeah, I get concerned too.
I am of two minds as usual: all or nothing.
I am trying to hit the middle ground.
I really don't know, sigi. Neurtonin gets nixed. Some other things I might be more comfortable with get nixed.
At least Emsam is still here, though the anxiety :-/
Yeah, the floating thing. Thought to change my name, but that felt a little nutty to me....
Thanks, sigi.
Posted by mellow on September 9, 2011, at 14:32:35
In reply to Topamax, mood stabilizers?, posted by floatingbridge on September 9, 2011, at 0:57:55
Was wondering where you had been for the last few days.
I did trilepal for about 3 years and was pretty stable despite some rage and soft cycling. Pdoc pushed topomax several appointments in a row and I finally bit on the idea. Dropped trileptal immediately, started 25mg topomax and went up 25mg per week until I hit 100mg. Felt great for about 6 weeks. Could go all day without eating. Stopped bingeing on fast food, but then the cognitive stuff set in. He dropped my celexa and topomax in half both at the same time and the withdrawal was hell. (All while on my honeymoon!)
Now I am reasonably stable on Lamictal and 50mg of topomax which is like barely any topomax at all, but apparently that is a common anticonvulsant combo. All in all I think it is a pretty crummy drug and I wish it were out of my cocktail, but pdoc won't budge on it and he gets grumpy when I make suggestions so I just take my script and leave. Seriously considering a second opinion at this point.
mellow
Posted by sigismund on September 9, 2011, at 14:34:31
In reply to Re: Topamax, mood stabilizers? » sigismund, posted by floatingbridge on September 9, 2011, at 14:29:52
Neurontin is as good as anything for my sleep. But it is pretty silly stuff and I reserve it for that. Just 300mg. Sometimes I stay in bed from 8pm to 4am, which is excellent. So much better than waking at midnight with a jolt.
Nice to see you around.
Posted by B2chica on September 9, 2011, at 15:30:19
In reply to Re: Topamax, mood stabilizers? » B2chica, posted by floatingbridge on September 9, 2011, at 8:35:13
no prob. i dont mind sharing at all. but it was the worst experience to date on medications. i later found out that part of the problem of reaction was the way the doc put me on the meds and i could have stroked out.
i was on symbyax and sonota and straterra i think, cant remember that far back. i think there were three that i was on. anyway, since i was in the hospital two weeks with no change (cuz pdoc was not changing my meds per my suggestion -practically screaming this-)anyway, another pdoc finally came in. first thing i told him was i wanted off and i read that mood stabilizers are good for bipolar, i wanted a new regimine. He said absolutely.
that night i took no symbyax but took zyprexa, seroquel, that next morning i took triliptal (high dose cant remember what exactly), wellbutrin and one other thing cant remember exactly. (this was in march of 04)So took pills about 9:00 (still in hospital) went outside for smoke -we used to be able to do that. Then went in for group so id say about 10-10:30 i started to have a reaction, i started to feel funny, my eyes got all blurry, i started to feel tingly all over and it was physically hard for me to move i started to try to talk and i couldnt. a girl i was hanging out with started to tell nurse something was wrong with me. nurse didnt believe her as she was kinda a trouble maker. she kept interrupting nurse and telling her about 5 times...FINALLY the girl next to me asked me if i was ok. i was able to slowly move my head and groan at her. i remember she touched my arm and my arm had posturing reaction. and i groaned and stared again at my friend.
FINALLy the nurse quickly got other nurses and came and got me. by that time i was trying to walk as there was a nurse under each arm.
all i wanted to do was tell the nurse it felt like my head was on fire...HOT is what i wanted to say and i couldnt get that one word out. i heard it in my head but i couldnt get it out, by the time i reached the door of the room i could no longer help walk, they had to drag me the rest of the way to my room.
i was "locked-in" for about 12 hours.
locked in is a brain injury term used for folks who are cognitively aware of everything but physically cant move anything. you are literally 'locked within your body'.
anyway. i told pdoc after that i still wanted to stay on triliptal, i figured that was as bad as it got. why not stay on it after initial crap happened.
So i was on it for about 6 months till i finally switched pdocs and he truly disliked my whole regimine and took me off most of what i was on.anyway. i remember having mood swings on it. after that ordeal.
but the wellbutrin alone was fantastic. till that pooped out.but again. this horrible experience was in part due to the way the gave me the medication.
they did a QUICK one day switch in meds. no titration. it was probably part from going off some meds instantly, and going on several and decent high dosages rather than going up slowly.so i dont want to scare anyone off the drug itself.
but now you know why i'm such an advocate of SLOW titration of medication either off OR on.
also my pdoc now (and after that incident) is a perfect match for me in that he is VERY cautious with titration both ways.
Best wishes! fb
b2c.
Posted by B2chica on September 9, 2011, at 15:34:40
In reply to Re: Topamax, mood stabilizers? » floatingbridge, posted by B2chica on September 9, 2011, at 15:30:19
ps. the nurses kept giving me strattera at night...not helpful for sleep! then they complained i was up half the night.
also, one of the side-effects of the triliptal was ataxia, which is what happened to my gait.
and also since this is an anticonvulsive it explains what happened to me.
Posted by floatingbridge on September 9, 2011, at 15:42:36
In reply to ps... » B2chica, posted by B2chica on September 9, 2011, at 15:34:40
Worst meds for me:
1. Strattera
2. Lyrica
3, abilify
4. SeroquelB2c. What ever did strattera work for you for?
Thanks for the honest assessment.
I am beginning to really feel that since lamictal was a no-go, and if pdoc won't budge ( he may have good reasons for this) I will look at other options. None of these AES is feeling too appealing.
I don't know.
Posted by floatingbridge on September 9, 2011, at 15:56:55
In reply to Re: Topamax, mood stabilizers?, posted by mellow on September 9, 2011, at 14:32:35
Mellow, I just lost a perfectly good note to you. Drat.
Do you hate the topamax on principle? Do you feel it is a do nothing tag-on?
How is the caffiene thing going?
I've been busy mom-ing, going to the doctors, fighting and enduring med changes, balh, blah, blah.
Thanks for noticing my absence. :-)
Posted by B2chica on September 9, 2011, at 16:03:24
In reply to Re: ps... » B2chica, posted by floatingbridge on September 9, 2011, at 15:42:36
strattera was a joke. it was basically a really good appetite suppressant. thats it.
Posted by floatingbridge on September 9, 2011, at 16:07:10
In reply to Re: ps..., posted by B2chica on September 9, 2011, at 16:03:24
It did much worse for me, triggered a pain cascade. Was supposed to be for add and energy. I could not think straight or focus on it.
Posted by Phillipa on September 9, 2011, at 19:30:00
In reply to Re: Topamax, mood stabilizers? » floatingbridge, posted by sigismund on September 9, 2011, at 14:03:25
Sigi you really don't like meds a lot do you? I don't either. Seems like we should be able to handle our own stuff doesn't it? Too many cooks spoil the broth sort of PJ
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.