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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on February 19, 2012, at 20:14:33
In reply to Lou's response-Dr John Breeding » sigismund, posted by Lou Pilder on February 19, 2012, at 17:30:45
Lou you were doing good don't go backwards okay? Phillipa
Posted by Phillipa on February 19, 2012, at 20:16:27
In reply to Lou's response-bohguzlehybulz » bleauberry, posted by Lou Pilder on February 19, 2012, at 18:23:52
Lou I was so hopeful Really I was can you openly apologize? Please. Phillipa
Posted by SLS on February 19, 2012, at 21:13:33
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
- Scott
Posted by SLS on February 19, 2012, at 21:25:54
In reply to Re: Desperate » Solstice, posted by SLS on February 19, 2012, at 21:13:33
> Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
Mixed states are not pleasant for the sufferer.
- Scott
Posted by Solstice on February 19, 2012, at 22:14:21
In reply to Re: Desperate » Solstice, posted by SLS on February 19, 2012, at 21:13:33
> Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
>
>
> - Scott
I want to understand it better.She has never had what we normally think of as 'depression' - in that she has never been shut down, or in bed, or sad, or feeling hopeless.
On the contrary, her self-image is either what I would consider fairly balanced, or it's inflated. She could never be accused of thinking poorly of herself. She's not at all self-conscious. She's generally sensitive to and compassionate toward the suffering of others. She has a reputation of being the champion of the underdog.
The elevation that gets my attention is where her self-expectations get markedly unreasonable, talking incessantly and randomly, being intense and excessively 'hyper,' and is unable to sleep for extended periods.
What makes it especially difficult is that her perceptions of things (during her current state) are really off, and somewhat paranoid. Her rapid and random thinking and talking means she doesn't *really* hear what the other is saying - so she jumps to crazy conclusions to fill in the gaps, I guess. Anyway, that's what I've been observed as contributing to her reactivity. She will have these intense and out-of-proportion reactions to things. It's very unpredictable. I can be having a fairly normal conversation with her (despite her intensity, etc.), and she'll suddenly completely misinterpret something and fly off the handle - and get really crazy. Any attempts to diffuse it seems to further agitate her. She can't be reasoned with, and her ideas about what's going on just get more and more illogical. All that can happen in a flash - and once she escalates like that, she gets really intense about how impossible her life is and it takes on a desperate quality.
I want to understand what goes with what. I don't know which symptoms fall into which category. I've felt blessed that her bipolar has been more hypomania alternating with a normal state - except that I think she spent the first 14 years of her life in a perpetual hypomania that got difficult enough to get our attention when she hit puberty. It was an unbelievable experience to 'meet' the real *her* when the Geodon diminished the hypomania. I remember her telling me how weird it was for her to realize that she was feeling 'feelings.' Before Geodon, her head was spinning so fast all the time that she never genuinely 'felt' a range of emotions. She liked a lot of stuff and was real excitable, but it wasn't until the Geodon settled the hypomania that she started to get to know herself, and feel moved by things, or concerned about things - the more moderate range of emotions that are felt deeply.
Sorry - I'm getting sidetracked - but I've read a lot of things that made it sound like the irritability/anger explosions are related to the hypomania.. but that didn't make sense to me. Is the irritability a feature of hypomania, or is it really a version of depression? I just don't understand how it works, which makes it kind of hard to discuss with her doctor, and even with my daughter.
Appreciate the help, Scott.
Solstice
Posted by Solstice on February 19, 2012, at 22:22:24
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
> One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
>Is Topamax typically used in conjunction with anything else?
What kind of cognitive side effects does it have? I know I can look it up online, but it'll be very generalized and be the same as all the other same-class medications. My daughter would be distressed if something made her feel cognitively dull.. so if there's a way to avoid that it would be important to avoid it.
> Mixed states are not pleasant for the sufferer.I know... it is so hard for me to watch. It's very disruptive for her. She told me the other day that she felt 'trapped' in the cycle - and feels desperate about feeling like she'll never break out of it. She has not been herself at all, and it's painful.
Solstice
Posted by papillon2 on February 19, 2012, at 22:50:27
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
> Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects.
I always thought the cognitive side effects of Topamax were a foregone conclusion. It's good to know they can be avoided by slow titration, kind of like Lamictal and SJS.
Thanks Scott.
Posted by Solstice on February 19, 2012, at 23:22:53
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
>
> One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
Scott -I read some patient dialogue about Topamax, and they discussed whether slow titration serves to minimize cognitive side effects. Some thought that slow titration did not minimize cognitive impairment, but rather masked it because it was less noticeable when the decline built more slowly.
I cannot judge the validity of their statements, but I am very interested in what you think about the merits.
Also - one of them said they switched to Zonegran, which supposedly did not have the cognitive impairment side effect. We just need to be careful about trying anything that is known to make irritability/agitation worse.
Solstice
Posted by SLS on February 19, 2012, at 23:39:42
In reply to Re: Desperate - tell me more, Scott » SLS, posted by Solstice on February 19, 2012, at 22:14:21
Hi Solstice.
A mixed-state is difficult to characterize and even more difficult to diagnose properly.
Hypomania can involve mixed-states.
Mixed states are described as being a combination of mania and depression, but this really doesn't say very much about what these states actually look like in real life.
In your daughter's case, I would characterize her current state as being a dysphoric hypomania, which is a type of mixed-state.
http://www.bipolarmixedstates.com/bipolarmixedstates.html
"A dysphoric mania consists of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms (MMDT). Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation. Alcohol, drug abuse, and some antidepressant drugs may trigger dysphoric mania in susceptible individuals."
I have suffered several dysphoric manic episodes that were associated with antidepressant drug treatment. Depakote and Zyprexa have each worked extremely well to dissolve the mania. It took less than 48 hours for each drug to put out the fire.
These are some of the things I experienced:
- Racing thoughts.
- Reduced need for sleep - 3 hours.
- Irritability.
- Rage attacks.
- Impatience for people who were too slow.
- Flight of ideas.
- Grandiose or expansive ideas and plans.
- No euphoria.
- Inflated self-esteem.
- Distractability
- Inability to complete tasks.
- Manufacturing associations between unrelated things.
- Pressured, rapid, and loud speech.
- Scott
Posted by SLS on February 19, 2012, at 23:46:05
In reply to Re: Desperate » SLS, posted by papillon2 on February 19, 2012, at 22:50:27
> > Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects.
>
> I always thought the cognitive side effects of Topamax were a foregone conclusion. It's good to know they can be avoided by slow titration, kind of like Lamictal and SJS.Yes. I was able to get to 200 mg and actually had an improvement in my clarity of thought with no problems finding words or slowed rate of speech. It actually improved my depression somewhat. I found it somewhat energizing.
It seems that once triggered, cognitive impairments persist. The key is not to trigger them in the first place. I started at 25 mg. It took me a month or so to reach 200 mg.
- Scott
Posted by SLS on February 19, 2012, at 23:55:41
In reply to Re: Desperate - another question, Scott » SLS, posted by Solstice on February 19, 2012, at 23:22:53
> I read some patient dialogue about Topamax, and they discussed whether slow titration serves to minimize cognitive side effects.
This has been the observation of my doctor. This was my experience as well.
> Some thought that slow titration did not minimize cognitive impairment, but rather masked it because it was less noticeable when the decline built more slowly.
In the end, how do you mask stupefaction?
> I cannot judge the validity of their statements, but I am very interested in what you think about the merits.
I can't guarantee anything. If I were a doctor, and observed this in many of my patients and in those of my colleagues, I could be more confident in saying such things.
> Also - one of them said they switched to Zonegran, which supposedly did not have the cognitive impairment side effect.
I found Zonegran to be pretty "clean" cognitively. Weight gain was not a problem. It just didn't work at all to improve my depression. I have no idea what track record it has for mania or mixed-states.
I did see Topamax 100 mg totally wipe out a raging mixed-hypomania within a week.
- Scott
Posted by Twinleaf on February 20, 2012, at 1:17:10
In reply to Re: Desperate » sigismund, posted by Solstice on February 19, 2012, at 17:20:51
I think it's wonderful that you are able to understand your daughter so well, and describe her symptoms so clearly, despite the enormous distress her condition must be.causing you. I think you are getting some very good suggestions from people who know a lot about bipolar illness; I hope at least one of them really helps her.
One thing caught my attention: how, under stress, she begins to distort her feelings about others' motives. Do you think this is something that psychotherapy might help her with? In addition, if you found a really good therapist, it would be an additional source of support, which might make things a bit easier for you. I realize that she has two neurologically based illnesses, but the interpersonal stresses resulting from them might be helped considerably by a caring therapist.
Posted by sigismund on February 20, 2012, at 1:23:45
In reply to Lou's response-Dr John Breeding » sigismund, posted by Lou Pilder on February 19, 2012, at 17:30:45
Actually I misspoke.
It is not the diagnoses so much I have problems with so much as the treatment.
So long as the treatment is not worse than the disease.
ADHD is so obviously culturally mediated.
I must look up the stats from different countries for ADHD. Including non western countries.
I read today that a change in the DSM led to a 200% increase in treatment in a very short time here.
These are my concerns as a parent. (Speaking personally, I would like some amphetamine treatment for myself.) Also as a parent I can imagine how appallingly difficult this is for Solstice.
Posted by Lou Pilder on February 20, 2012, at 5:09:33
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
> > Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
>
> One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
>
> Mixed states are not pleasant for the sufferer.
>
>
> - ScottFriends,
Just because someone posts concerning their promotion of a drug for children to take, their promotion could be short of the full understnding of the drug that they are promoting. If all of the facts about a drug were known before it was taken or given to a child, then I think that the person making the decision to institute the drug for a child to take could have a better understnding of the drug and then make a more informed decision as to give the drug to a child or not.
Now Topomax is the drug being promoted for a child to take here. But is that all there is to making a decision as to give it to a child, that someone on an internet site promotes it? If a parent went to the doctor and said that they wanted their child to take Topomax because someone on an internet site was promoting it, do you think that the doctor then would change his/her treatment because of that?
Let's look at a little about this drug, Topomax. The drug has the ability to act on the brain to lower the threshold in relation to seizures, which is used to treat epilepsy. The chemical structure of the drug and its history, I am prohibited here from showing in an exposition due to the prohibitions to me from Mr. Hsiung. His prohibition to me is based on that it {might not} be conducive to civic harmony, whatever that could mean. But if it {might} not, then it could also {might be}? So if usiing Mr. Hsiung's thinking in relation that topics that {might not be}, then could not it then be considerd that {NO} topic could be posted here because is it not a fact that any topic {MIGHT NOT BE} conducive to civic harmony, whatever that could be?
Now it is important for me to tell you this because what I could say without the prohibitions could IMHHO save lives and prevent someone from getting a life-ruining condition from these drugs. Because of the prohibitions, someone could die because they were not allowed to know educational material from me here. This is in tune with Mr. Hsiung's TOS here? Is it not that his TOS states that teh forum is for support and education? when I came here, I saw his TOS and I took him a his word. Yet today, the education that I could gie you is prohibited here by the nature of Mr. Hsiung posting to me prohibitions of what I can post or not based upon that someone {might} be {civically unharmonized}?, whatever that could mean, and I do not know.
Here is a video that I think could help in this discussion about the drug, Topomax. There is much more to this drug besides what is in the video.
Lou
to see this video:
A. Pull up Google
B. Type in:
[youtube,Topamax Lawyer-A Historical Timeline of Topomax Side Effects]
Posted by Lou Pilder on February 20, 2012, at 5:43:36
In reply to Re: Desperate » SLS, posted by papillon2 on February 19, 2012, at 22:50:27
> > Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects.
>
> I always thought the cognitive side effects of Topamax were a foregone conclusion. It's good to know they can be avoided by slow titration, kind of like Lamictal and SJS.
>
> Thanks Scott.papallon2,
You wrote,[...it's good to know ...].
Are you accepting the claim in question as fact here? If so, what way do you have to substantiate the claim a fact? If you have some citation other than the claim made here, could you post that citation here now?
Lou
Posted by Lou Pilder on February 20, 2012, at 5:47:19
In reply to Re: Desperate, posted by Twinleaf on February 20, 2012, at 1:17:10
> I think it's wonderful that you are able to understand your daughter so well, and describe her symptoms so clearly, despite the enormous distress her condition must be.causing you. I think you are getting some very good suggestions from people who know a lot about bipolar illness; I hope at least one of them really helps her.
>
> One thing caught my attention: how, under stress, she begins to distort her feelings about others' motives. Do you think this is something that psychotherapy might help her with? In addition, if you found a really good therapist, it would be an additional source of support, which might make things a bit easier for you. I realize that she has two neurologically based illnesses, but the interpersonal stresses resulting from them might be helped considerably by a caring therapist.Tl,
You wrote,[...a really good therapist.would be an additional source of support...].
Thanks, I think that's good.
But what criteria constitute a therapist being {a really good therapist} or not?
Lou
Posted by Lou Pilder on February 20, 2012, at 5:51:21
In reply to Re: Lou's response-Dr John Breeding, posted by sigismund on February 20, 2012, at 1:23:45
> Actually I misspoke.
>
> It is not the diagnoses so much I have problems with so much as the treatment.
>
> So long as the treatment is not worse than the disease.
>
> ADHD is so obviously culturally mediated.
>
> I must look up the stats from different countries for ADHD. Including non western countries.
>
> I read today that a change in the DSM led to a 200% increase in treatment in a very short time here.
>
> These are my concerns as a parent. (Speaking personally, I would like some amphetamine treatment for myself.) Also as a parent I can imagine how appallingly difficult this is for Solstice.Sig,
YOu wrote,[...so long as the treatment is not worse than the disease...].
Thanks, I think that's good.
Lou
Posted by Lou Pilder on February 20, 2012, at 6:32:23
In reply to Re: Lou's thanks-thyroid » Lou Pilder, posted by Phillipa on February 19, 2012, at 20:11:55
> Lou I must congratulate you that you are now posting Thank you's and positive stuff. So appreciative of your comments keep it up. But remember Solstice did ask you not to post on this thread. But since then very nice. Phillipa
Phillipa,
You wrote,[...Lou I must congratulate you...positive stuff..So appreciative of your comments keep it up...].
I would like you and others that think that what I am posting is positive to view the following video.
Lou
To see this video:
A. Pull up Google
B. Type in:
[youtube, CCHR: Drugging Our Children-Side Effects]
usually first
Posted by SLS on February 20, 2012, at 7:02:21
In reply to Re: Desperate, posted by Twinleaf on February 20, 2012, at 1:17:10
> I think it's wonderful that you are able to understand your daughter so well, and describe her symptoms so clearly, despite the enormous distress her condition must be.causing you. I think you are getting some very good suggestions from people who know a lot about bipolar illness; I hope at least one of them really helps her.
I agree with this very strongly.
> One thing caught my attention: how, under stress, she begins to distort her feelings about others' motives. Do you think this is something that psychotherapy might help her with? In addition, if you found a really good therapist, it would be an additional source of support, which might make things a bit easier for you. I realize that she has two neurologically based illnesses, but the interpersonal stresses resulting from them might be helped considerably by a caring therapist.
I agree with this very strongly.
You're good.
- Scott
Posted by SLS on February 20, 2012, at 7:13:53
In reply to Re: Lou's response-Dr John Breeding, posted by sigismund on February 20, 2012, at 1:23:45
> Actually I misspoke.
>
> It is not the diagnoses so much I have problems with so much as the treatment.
>
> So long as the treatment is not worse than the disease.This is a very difficult issue to address. I have little doubt that many psychotropic drugs affect the young, maturing brain in ways we cannot fully understand. When treating more severe case of ADHD, there is a balance scale of assessing risk versus benefit. You can either let the the child fail at everything in life or risk future untoward effects that are not yet known. Untreated pediatric ADHD often morphs into adult ADHD, so there is no "growing out of it".
> ADHD is so obviously culturally mediated.
I am baffled by this. What do you mean?
> I must look up the stats from different countries for ADHD. Including non western countries.
Oh. You mean reporting practices and diagnostic criteria vary. There might also be a difference in treatment practices. I don't know. What do you think?
Do you believe that the disease itself is culturally mediated?
- Scott
Posted by SLS on February 20, 2012, at 7:18:12
In reply to Lou's response-dhawerpsr » sigismund, posted by Lou Pilder on February 20, 2012, at 5:51:21
> Sig,
> YOu wrote,[...so long as the treatment is not worse than the disease...].
> Thanks, I think that's good.Thanks. I think that's good that you think that's good.
- Scott
Posted by Solstice on February 20, 2012, at 7:34:21
In reply to Lou's reply-postvpstuph » Phillipa, posted by Lou Pilder on February 20, 2012, at 6:32:23
You are causing me so much pain. I can hardly go to my own thread without dissolving into tears because of what you are doing. You have shamelessly hijacked my thread with your own agenda, and there is nothing 'caring' or constructive about it. It just speaks so much hatred toward me.
It really hurts me that this is being allowed to continue. People need to be protected from the harm you cause.
Solstice
Posted by SLS on February 20, 2012, at 7:37:51
In reply to Lou's request-phahct? » papillon2, posted by Lou Pilder on February 20, 2012, at 5:43:36
> > > Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects.
You excised this line from the following post.
http://www.dr-bob.org/babble/20120212/msgs/1010913.html
My words included the following:
"I can't guarantee anything. If I were a doctor, and observed this in many of my patients and in those of my colleagues, I could be more confident in saying such things."
Be careful not to post my words out of context. I will not tolerate it.
> Just because someone posts concerning their promotion of a drug for children to take, their promotion could be short of the full understnding of the drug that they are promoting."
You are not aware of the extent of my education, both in and post schooling. I believe you are intimating that I am not to be considered seriously because I "could be short of the full understnding of the drug" Using the term "could be" doesn't immunize you from incivility for your using the words that follow. I feel accused and put-down.
> ...the drug that they are promoting.
What do you mean by "promoting"? Do you think I have motives to suggest the efficacy of drugs for reasons that are not altruistic? I feel accused and put-down.
I have decided to not report your post to administration this time. Please be careful in your treatment of my words in the future.
- Scott
Posted by Solstice on February 20, 2012, at 7:42:43
In reply to Re: Desperate, posted by Twinleaf on February 20, 2012, at 1:17:10
> I think it's wonderful that you are able to understand your daughter so well, and describe her symptoms so clearly, despite the enormous distress her condition must be.causing you. I think you are getting some very good suggestions from people who know a lot about bipolar illness; I hope at least one of them really helps her.
>
> One thing caught my attention: how, under stress, she begins to distort her feelings about others' motives. Do you think this is something that psychotherapy might help her with? In addition, if you found a really good therapist, it would be an additional source of support, which might make things a bit easier for you. I realize that she has two neurologically based illnesses, but the interpersonal stresses resulting from them might be helped considerably by a caring therapist.
Hi Sigi.. thanks for stopping by.Yes, my daughter has a marvelous therapist that played a very large role in stabilizing my daughter three years ago. She's been involved with this situation, but it gets more difficult because my daughter has these distortion problems going on, and she vasscillates between wanting to see T, and crying out that no one is listening to her. My observation is that her treatment providers listen with tremendous caring and are very responsive, but my daughter gets these paranoid ideas and thinks they only listen to me. It's not true - I haven't even been involved in her therapy sessions other than when I'm called in at her request, but her mind is just not working 'with' her right now. That said, the therapist is fabulous and it helps me a lot to know I'm not holding this thing together on my own, for sure.
Solstice
Posted by Lou Pilder on February 20, 2012, at 8:03:16
In reply to Lou's reply-postvpstuph » Phillipa, posted by Lou Pilder on February 20, 2012, at 6:32:23
> > Lou I must congratulate you that you are now posting Thank you's and positive stuff. So appreciative of your comments keep it up. But remember Solstice did ask you not to post on this thread. But since then very nice. Phillipa
>
> Phillipa,
> You wrote,[...Lou I must congratulate you...positive stuff..So appreciative of your comments keep it up...].
> I would like you and others that think that what I am posting is positive to view the following video.
> Lou
> To see this video:
> A. Pull up Google
> B. Type in:
> [youtube, CCHR: Drugging Our Children-Side Effects]
> usually firstFriends,
If you are considering being a discussant in this thread, I am requesting that you read the following.
The following is about the fallacy of {false dilemma}. This is usually concerning giving only two choices when there could be more than just two. It is sometimes called the {either/or} fallacy.
In the link here, there are other fallacies mentioned also and I would like for you to look at the {straw man} fallacy , for I intend to post more about this as long as the rule of three does not apply.'
Lou
http:///grammer.about.com/od/fh/g/falsedilterm.htm
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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
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