![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 55. Go back in thread:
Posted by SLS on March 19, 2016, at 16:41:17
In reply to Re: Tricyclics and bipolar depression *Trigger* » J Kelly, posted by B2chica on March 19, 2016, at 16:06:06
I wish I knew what to say. I don't.
All I can say is that I have been in a similar place. For me, caring for my grandmother was enough of a responsibility to prevent me from leaving this world. However, I did have my release valve. I just couldn't use it. I promised myself that I would not kill myself while my grandmother was still alive. She lived to age 99. By this time, I was feeling somewhat better.
I hope you can hold on tight to your memories of remission, as brief as they may have been. Your brain is still capable of working. You know that life can be a grand experience, and that your outlook can change quickly when you respond to treatment.
You must feel extremely alone. You aren't.
- Scott
Posted by B2chica on March 19, 2016, at 16:52:33
In reply to Re: Tricyclics and bipolar depression, posted by SLS on March 19, 2016, at 16:19:53
very helpful. so could i add nortriptyline (or the like) to pristiq?
i would like to lower pristiq as i know that has shifted me into this mixed state, thats why previous doc put me on 10 zyprexa before sending me for second opinion.
my pdoc has mentioned topamanx, though i've been on it before, who knows..i was worried at first as i thought it sort of made my cycle a bit, but hell to be honest im already cycling so wht the heck right?
i would like to try abilify again, but at the time i was also on klonipin and i just remember the terriby anger/rage i got. my T got some of that backlash. anyway, i still thought it was the klonipin.so maybe if i lowered pristiq a bit, added nortriptyline and added topamax...
i can at least suggest this see what he says..yes hope does incredible things. thought i may not have a lot right now, it is only the little bit that is enough.
thank you scott.
Posted by J Kelly on March 19, 2016, at 16:59:16
In reply to Re: Tricyclics and bipolar depression *Trigger* » J Kelly, posted by B2chica on March 19, 2016, at 16:06:06
> thank you for your caring.
I like to think that's why we are here.
> i am absolutely sick and tired of hospital. i just cant do that again.I get this. Three times for me, one forced. Its never fun.
>
> the thing is Jade, i have suicidal thoughts and believe me many of them are tempting. but the truth also is that my pull and desire to remain here for my small children is too strong.
> honestly i was just going to post about this, how somehow this makes things worse. because before kids i felt like i had this 'release valve' of the Option of suicide.
> now that i am actively choosing not to has taken away that 'release valve' and seems to make this pain even more unbearable.I'm so sorry you are feeling this way. I understand. I believe I am still here because of my children. Abandoning them is simply not an option. You are doing the right thing by choosing to remain here for them.
>
> i am utterly exhausted from 'feeling'. i feel such a terribl disappointment of who i am these days.. but i know i need to do everything to stay alive. at least that is how i feel for now. i dont know what the future holds for me.This is so true. Staying alive is the most important goal. We don't know what the future holds but I like to think if we hang on and be brave good things will come to us.
>
> it did not help that i just recently lost a cousin to suicide, about a month ago.. he was in his 50's. so a lot of the responses were 'he held on for a long time', he's at peace now'...
>
> how does that relate to me? cant i be at peace, arent i holding on? and the never ending possibility that it could just as easily have been me... alas it was not.
> i am here.
> in pain, but here.I have more to say about this but not here. Please feel free to babblemail me anytime.
I wish you health and happiness :)
Jade
Posted by SLS on March 19, 2016, at 18:04:10
In reply to Re: Tricyclics and bipolar depression » SLS, posted by B2chica on March 19, 2016, at 16:52:33
> very helpful. so could i add nortriptyline (or the like) to pristiq?
Yup. If in doubt, just be sure to use blood tests for nortriptyline as a guideline to find the right dosage.
With Topamax, it is important to start low and increase the dosage very gradually. You could start at 25 mg/day and move up by 25 mg every week. That may seem ridiculous, but doing so is likely to help you avoid cognitive impairments altogether. You might end up responding to 100 mg/day rather than the 200 mg/day most often targeted. Also, the risk of kidney stones is dosage-dependent. I witnessed a woman in a mixed-state hypomania respond completely to Topamax 200 mg/day. At some point, her dosage was reduced to 100 mg/day and she was fine.
> i would like to lower pristiq as i know that has shifted me into this mixed state
That was my initial thought.
I'm still wondering if Trileptal would help with the manic component of your mixed-state *and* reduce your cycling.
I don't know. Don't exclude Saphris from consideration. Latuda sucks.
Brintellix?
- Scott
Posted by linkadge on March 19, 2016, at 18:15:18
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 19, 2016, at 18:04:10
There is some evidence that TCAs are more effective than SSRIs in terms of core symptoms of depression.
If I was experiencing severe depression, I would take amitriptyline over any SSRI.
That being said, they can induce rapid cycling in some individuals. However, if you are experiencing more mood lability related to severe depression, than I would not hesitate to give a TCA a try. If significant insomnia / anxiety is present, I would start with amitriptyline.
Linkadge
Posted by B2chica on March 19, 2016, at 19:19:45
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 19, 2016, at 18:04:10
good to know about the topamax. i;ll try to remember that and blood tests for nortrip. i think i'll write some notes to take to next appt as i doubt my memory will hold.
trileptal is just not an option. after taking it i had a severe reaction that i thank God i was already in the hospital. i ended up being locked-in for about 10 hours.Saphris helped but only minor and the eating really wasnt too bad as i took it in the afternoon so i just had a decent (or extra) with lunch. at least not at 10 at night.
Yes! Latuda sucks... depression worse.early last year other pdoc chose Fetzima instead of Brintellix... not sure why but that's what she chose. i have not been on brintellix yet so yes, i did forget about that one.
....
as a note, i have had a little reprieve from the exhaustion of feeling everything simultaneously, today was more of a cycle. most of the day extreme langour and about 5-ish i felt that twinge in the pit of my stomach and energy bursts throughout my veins... i've been on three walks. the walks help but only for short time.
all i can think now is another 20 min and i'm going to take my sleep meds. its early but they didnt really work last night so ill take early in hopes that i can get to sleep before 2.i do truly appreciate suggestions. its hard when you dont know what i've been on and that my list of failed meds is so extensive.
i wish there was more research on this stuff.
thanks
scott.
Posted by B2chica on March 19, 2016, at 19:23:00
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 19, 2016, at 18:15:18
yes severe insomnia (both in depressive phase and if mixed mania) and anxiety.
thank you link.
its good to see you and scott are still around here. there arent many names i recognize these days.
b2
> There is some evidence that TCAs are more effective than SSRIs in terms of core symptoms of depression.
>
> If I was experiencing severe depression, I would take amitriptyline over any SSRI.
>
> That being said, they can induce rapid cycling in some individuals. However, if you are experiencing more mood lability related to severe depression, than I would not hesitate to give a TCA a try. If significant insomnia / anxiety is present, I would start with amitriptyline.
>
> Linkadge
Posted by B2chica on March 19, 2016, at 19:24:27
In reply to Re: Tricyclics and bipolar depression *Trigger* » B2chica, posted by J Kelly on March 19, 2016, at 16:59:16
i cant seem to respond, agree much to say...another time.
but thank you for kind words.
b2
Posted by B2chica on March 19, 2016, at 21:43:21
In reply to Re: Tricyclics and bipolar depression *Trigger* » B2chica, posted by SLS on March 19, 2016, at 16:41:17
i think my last pdoc has thoroughly quashed my hope...the small tinder of hope i have left is this new pdoc. he has been with me (a bit off and on) since my dx back in 2003. he is highly intelligent.
but when i sat in my last meeting i had a sense of him perplexed and not sure how anything can really help right now... of course he didnt say that. and to be honest i need to put out there that if there is any pdoc in the nation that can help me...it is this dear one. he is not afraid of medications and not afriad to do 'off label' etc. and i am grateful to him... my heart just dropped alittle at his silence and expression of concern on how to move.i do feel alone, but not in the normal sense with my depression isolating from others. i feel alone in that no one seems to kno2 how to treat me, and in the mean time even waiting that week for the next appt where i clutch despearately to a glimmer of hope, is hell. even one day...today feels like it was about 2 and half days of living sh*t.
but right now, right here. my babies are in bed. even my DH went to bed. me alone time on laptop. i am writing a short fiction novel and have pressured myself as my timelines are getting messed up due to my sickness.
but i digress, that is another diatribe.again, with graciousness, thank you for the help.
b2but i will remember suggestions with adding to and lowering pristiq.
thnx u
Posted by Phillipa on March 19, 2016, at 22:31:36
In reply to Re: Tricyclics and bipolar depression *Trigger* » SLS, posted by B2chica on March 19, 2016, at 21:43:21
B2chica, I know what your girl's mean to you. You will get through this I know you will. I don't post here much but when you you I reach out to you hoping to give you some hope. And with the daylight savings time do you feel this could have triggered this? Among the other things. Phillipa
Posted by B2chica on March 19, 2016, at 23:36:42
In reply to Re: Tricyclics and bipolar depression *Trigger* » B2chica, posted by Phillipa on March 19, 2016, at 22:31:36
thanks P.
no i have been having this trouble for months, i think all of it started (as usual) the first part of november. and to be honest, if my pdoc would have listened to me and approached my sleep issues first instead of messing with the rest ofmy meds, i dont think i'd be in this place now.however about a month ago we had a cousin die, suicide. and i think that really tipped the barrel... he could do it, he had kids, he was bipolar...
the connections and parallels were terribly hard to ignore. i did manage to go to the funeral and i am very glad i did. i think it helped a bit with some closure. But it is still in the forefront of my mind. As his method was same as a coworker/student i lost several years ago...i also lost a family friend last december, she just dropped it was an brain aneurysm, she survived through thanksgiving, but soon after passed. she was a year younger than my husband. she had a child not to much older than my oldest.
and a coupld months before that, a lady in my church group passed away. though with that it was her second bout with cancer. she had one child in one of my childs class.
yes, and one of my husbands uncles died a few months ago as well. though we hadnt seen him in years, i still remember his kindness to me well.So over all, i have had too many funerals as of late.
which, i think i need to stop talking about this as it is triggering me quite badly.
thnx
b2
Posted by SLS on March 20, 2016, at 0:40:38
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 19, 2016, at 18:15:18
Would you suggest a TCA for someone who is in a mixed-state? You might be very right, but conventional wisdom is to avoid TCA in bipolar disorder. I suppose it is possible that the "mixed-state" in B2chica's case is actually a melancholic depression with psychomotor agitation. A TCA would work well if this were the case.
- Scott
Posted by Tomatheus on March 20, 2016, at 2:55:28
In reply to Re: Tricyclics and bipolar depression » SLS, posted by B2chica on March 19, 2016, at 15:57:44
> -wellbutrin was the one AD that was amazing, unfortunately it pooped out. i have revisited it twice and still no go.
B2chica,
You might already know this, but data from studies that had been ordered by the U.S. Food and Drug Administration have found that two bupropion products that were previously on the market were not therapeutically equivalent to their brand-name Wellbutrin counterparts. The two bupropion products in question were the 300-mg Budeprion XL tablets (but not the 150-mg Budeprion XL tablets) that were manufactured by Impax Laboratories, Inc., and marketed by Teva Pharmaceuticals USA, Inc., and the 300-mg bupropion HCl ER tablets that were manufactured by Watson. More information regarding the FDA's reviews of various generic bupropion products is available here:
Do you remember if you were taking one of the generic bupropion products that was found to be not therapeutically equivalent to the brand-name Wellbutrin either when the medication seemed to poop out or during the two times when you tried the medication again after that point? Judging from the information in the above link from the FDA's Web site, generic versions of bupropion other than the two that I mentioned in my previous paragraph were found to be therapeutically equivalent to Wellbutrin, but the 300-mg Budeprion XL tablets and the 300-mg bupropion HCl ER tablets made by Watson were not therapeutically equivalent to Wellbutrin. If you took one or both of the generic versions of bupropion that were found to not be therapeutically equivalent to the brand-name version of the medication during the periods when the medication didn't seem to work for you, it might be possible that either the brand-name Wellbutrin or one of the therapeutically equivalent generics could still work for you.
Of course, if you were taking the brand-name version of Wellbutrin or one of the therapeutically equivalent generic versions of the medication when the medication didn't seem to be helping you, then trying Wellbutrin again probably wouldn't make a whole lot of sense, but I just thought that I'd make you aware that two of the generic versions of bupropion that were once available were found to not be therapeutically equivalent to regular brand-name Wellbutrin, just in case you might have been taking one of those versions of the medication that wasn't therapeutically equivalent.
At any rate, I'm pulling for you, and I hope that you'll find something that will work out for you.
Tomatheus
Posted by Lou Pilder on March 20, 2016, at 8:45:05
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
> Are tricyclics any good with bipolar depression?
>
> I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> I think it's pristiq just isn't going to work for me annymore.
> But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
>
> b2
Friends,
It is written here,[...I am in the middle of hell...].
It has been revealed to me how to be released from the prison of hell. And what you all here that are contributing to this member staying in the midst of hell, could also lead this person to her death.
Friends, be not deceived. The chemicals that the pack of members here are advocating to the member that is in the midst of hell could cause her to kill herself of be killed by the drugs. The psychiatrist that would give these concoctions of death to her knows or should know that fact. You see, when these drugs are combined their effects are increased exponentially. That means that the drugs that could decrease heart or respiration such as central nervous system depressants, could cause heart or respiratory depression to cause death as just one way these drugs kill. By allowing Scott to defame me here and post anti-Semitic propaganda against me here with impunity and promote these drugs with impunity, others could follow him with advocating more drugs. By Mr. Hsiung not interceding here and allowing Scott to defame me and stigmatize me here, Scott could be seen as the leader of the pack that could bring addiction, life-ruining conditions and death here all under the guise of being supportive, for support takes precedence according to Mr. Hsiung.
Who will you follow today? Do you also want to be led to the midst of hell?
Lou
Posted by stan_the_man70 on March 20, 2016, at 9:17:43
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
Why not try something else?
> Are tricyclics any good with bipolar depression?
>
> I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> I think it's pristiq just isn't going to work for me annymore.
> But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
>
> b2
Posted by Phillipa on March 20, 2016, at 9:41:57
In reply to Re: Tricyclics and bipolar depression *Trigger* » Phillipa, posted by B2chica on March 19, 2016, at 23:36:42
B2chica, I do know how you are feeling about the triggers as many have been lost in my life lately. My Husband's youngest Brother 51 died after a long illness last week. And where I live a lot of other people. And I have lost my youth which I can never gain back. And I agree it's time for both of us to stop dwelling on the past. Please move forward you have always been an inspiration to me. Such a wonderful Mother and wife and truly gifted. With friendly love Phillipa
Posted by B2chica on March 20, 2016, at 13:55:46
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by Tomatheus on March 20, 2016, at 2:55:28
i was on two different generics (i cant tolerate any of the teva mfg generics, i know that was one of them) but then i did go back on name brand too, to no avail.
i appreciate your support.
thanks
b2
Posted by B2chica on March 20, 2016, at 23:20:56
In reply to Lou's response-the leader of the pack » B2chica, posted by Lou Pilder on March 20, 2016, at 8:45:05
Lou.
i have never responded to one of your benighted comments before, but tonight i think i will.
Lou You wrote: [you all here that are contributing to this member staying in the midst of hell, could also lead this person to her death.]-First that is an illogical and improbably comment. althought i love and graciously appreciate the support and suggestions here on the board, i always go with my knowledge of medication and my body, as well as other physicians i have tending to me which i trust as they are expereinced, intelligent and proven to truly have my best interest at heart. so stating that memebers on an online forum could even slightly contribute to my death is highly improbably, and harmful and i am astounded how you can create such a statement unless it is only created as a 'shock-value' statement, which again would prove what you wrote is more about you than about me.
-Lou, your next statement
["he chemicals that the pack of members here are advocating to the member that is in the midst of hell could cause her to kill herself of be killed by the drugs. The psychiatrist that would give these concoctions of death to her knows or should know that fact. You see, when these drugs are combined their effects are increased exponentially. That means that the drugs that could decrease heart or respiration such as central nervous system depressants, could cause heart or respiratory depression to cause death as just one way these drugs kill."]-i dont know of any single pharmaceutically produced 'medication' that does NOT have the potential to cause severe side effect, permanant damge or even death. and that includes the bottle that almost every american has in their cabinet 'tylenol'.
as a note, i am in my 40's and always read the side effects portion of the meds i get. i also know my body, and if something isnt write, i get help even if that means going to emergency room. i am VERY aware of all the dangers and hazards these psychopharmacological meds have. HOWEVER, with my knowledge, understanding and trained/experienced doctors i make an informed concent to be treated with these meds. SO for you to state the obvious, once again seems more like a tirad of scare tactics and bulling rather than a dignified response meant to help.Lou, your next statement:
[ "By allowing Scott to defame me here and post anti-Semitic propaganda against me here with impunity and promote these drugs with impunity, others could follow him with advocating more drugs. By Mr. Hsiung not interceding here and allowing Scott to defame me and stigmatize me here, Scott could be seen as the leader of the pack that could bring addiction, life-ruining conditions and death here all under the guise of being supportive, for support takes precedence according to Mr. Hsiung"]-it sounds to me that you have hi-jacked MY thread where i am asking for help and support for you to go off on another user of this site. i find that inconsiderate, and childish. it is unfortunate that you cannot find more appropriate ways to express your concerns, and it is also unfortunate that you seem to target the one user that has a lot of experience and gives all the users here on this board lots of emotional support. SO by tearing him down you are only making yourself to look (to me) as juvenile, self-centered, discourteous, and a bit myopic.
Lou, your next statement:
["Who will you follow today? Do you also want to be led to the midst of hell?"]-Lou, i can assure you, and i am going to go ahead and assume i speak for many others on this site. Nobody wants to be on these medications, nobody wants the horrible side effects or risks of harm to their bodies. But the fact that so many ARE on these meds and do suffer (and i mean really suffer) from horrible and sometimes lasting side effect...well doesnt that say anything to you lou? you mention being led to the midst of hell, yet if you would have read even ONE of the posts you spew your distressing editorials to, you will notice we are all ready in the midst of hell. Yes Lou, we are already there, not because of the meds, but because of our biology. we are all fighting to stay alive... and quite frankly, as i speak for myself, if that means i shorten my life by 10 years because of a certain med that i'm on...if that med gives me even 1 year of lucidity and peace... i say to hell with those extra 10 years. because if my disease makes it so my life is so horrible that i am not even aware of life and others around me, if it prevents me from spending time or holding and loving my family and friends. than i dont want those extra 10 years.
-and another note, if someday. one of the meds i take happens to end my life.. well than my epitaph will read: "She died trying!" and eveyone here will know, finally i will be at peace.
so that is just fine by me.
-a note about your comments. They are uneducated blatherings of data your are clearly uneducated in. your comments seem to me to be ill-advised, and ill-considered. as well as presumptious and imperceptive
****
Lou, i have one last thing to say.
i am pretty sure (knowing your online personality) that you will immediatly go on the 'defensive' and try to retort -though i'm sure unsuccessfully-a retort filled iwth backlash and pejorative remarks- but i would like to tell you.. dont bother to direct any toward myself as i wont read it, nor will i read any other posts you have. and i hope no one else does either, as they will not recieve what they are looking for here.
The way you write, your notes show all of the above that i mention, but never include helpful critism or respect for others, not to mention you do not add any information or support of value. so overall i am not sure why you post, other than to get on your 'soap-box' of hating pharmaceuticals. i stronly urge you to alter your writing skills. although, understanding a little of your online personality i do not believe that either will occur.So last i say my goodbye.
i wish you luck in the future and hope that you can become one more member of support here. If that does not happen, you can be assured, if a line is from Lou Pilder i will not read any of it.i hope you have read it all, as i think they are all things that have needed to be said.
Best Wishes to you
-b2> > Are tricyclics any good with bipolar depression?
> >
> > I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> > I think it's pristiq just isn't going to work for me annymore.
> > But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
> >
> > b2
> Friends,
> It is written here,[...I am in the middle of hell...].
> It has been revealed to me how to be released from the prison of hell. And what you all here that are contributing to this member staying in the midst of hell, could also lead this person to her death.
> Friends, be not deceived. The chemicals that the pack of members here are advocating to the member that is in the midst of hell could cause her to kill herself of be killed by the drugs. The psychiatrist that would give these concoctions of death to her knows or should know that fact. You see, when these drugs are combined their effects are increased exponentially. That means that the drugs that could decrease heart or respiration such as central nervous system depressants, could cause heart or respiratory depression to cause death as just one way these drugs kill. By allowing Scott to defame me here and post anti-Semitic propaganda against me here with impunity and promote these drugs with impunity, others could follow him with advocating more drugs. By Mr. Hsiung not interceding here and allowing Scott to defame me and stigmatize me here, Scott could be seen as the leader of the pack that could bring addiction, life-ruining conditions and death here all under the guise of being supportive, for support takes precedence according to Mr. Hsiung.
> Who will you follow today? Do you also want to be led to the midst of hell?
> Lou
Posted by ClearSkies on March 21, 2016, at 1:04:08
In reply to Re: Lou's response-'my expressive editorial on Lou, posted by B2chica on March 20, 2016, at 23:20:56
Brava!
And - good luck with it!
You're a strong, smart woman. You will get through this.
Posted by linkadge on March 21, 2016, at 8:00:07
In reply to Re: Tricyclics and bipolar depression » linkadge, posted by B2chica on March 19, 2016, at 19:23:00
Yeah,
Amitriptyline would be worth trying. You could also try doxepin or trimipramine as they tend to promote sleep. Trimipramine *may* be better for mixed symptoms.
I assume you have tried seroquel? It can be good for bipolar and has a metabolite with antidepressant effects (norquetieptine is a norepinephrine reuptake inhibitor). It generally has a positive effect on anxiety / sleep.
For mixed symptoms you may try adding a higher dose DHA supplement ~500mg of DHA. I find that can be great for cycling / anxiety / insomnia.
You may also look into cyproheptadine + melatonin. This is absolutely killer for insomnia (especially if mixed with a benzodiazepine - just not with an antidepressant).
Linkadge
Posted by linkadge on March 21, 2016, at 8:10:04
In reply to Re: Tricyclics and bipolar depression » linkadge, posted by SLS on March 20, 2016, at 0:40:38
I think you really need to listen to the specific symptoms that are involved.
There can be a fine line between "mixed states" and "agitated depression". I would say that if symptoms are predominantly negative (anxiety, depression, sadness, irritability, insomnia, pain) then antidepressants can help. Of course, start with a very low dose. It also helps to have a mood stabilizer in place.
If more classic symptoms of mania are present(pressure of speech, impulsivity, recklessness, euphoria, grandiosity, flight of ideas etc), then I would not suggest using an antidepressant until those symptoms are fully controlled.
My mother is "bipolar" but symptoms like irritability surprisingly respond much better to a low dose antidepressant than to more mood stabilizer.
I personally take lithium, but still find that Effexor can often do more for my anxiety / irritability.
Linkadge
Posted by B2chica on March 21, 2016, at 9:37:35
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 21, 2016, at 8:10:04
this is interesting, i would much more describe my symptoms as agitated depression, way more than mania.
in general i dont get euphoric, it is always irritibility, psychomotor aggitation, depressive and suicidal thoughts, can go to auditory and even visual illusions at times.
thank you for this information> I think you really need to listen to the specific symptoms that are involved.
>
> There can be a fine line between "mixed states" and "agitated depression". I would say that if symptoms are predominantly negative (anxiety, depression, sadness, irritability, insomnia, pain) then antidepressants can help. Of course, start with a very low dose. It also helps to have a mood stabilizer in place.
>
> If more classic symptoms of mania are present(pressure of speech, impulsivity, recklessness, euphoria, grandiosity, flight of ideas etc), then I would not suggest using an antidepressant until those symptoms are fully controlled.
>
> My mother is "bipolar" but symptoms like irritability surprisingly respond much better to a low dose antidepressant than to more mood stabilizer.
>
> I personally take lithium, but still find that Effexor can often do more for my anxiety / irritability.
>
>
> Linkadge
>
>
>
>
>
>
Posted by B2chica on March 21, 2016, at 9:42:45
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 21, 2016, at 8:00:07
i cant really make any educated suggestions right now. i fully trust my pdoc (now that i have old one back). so i will suggest TCA and mention a few and se what he says.
i did try seroquel, back in the day it was INCREDIBLE for sleep. but after a few weeks i got cognitive blunting..pretty severe.
what is cyproheptadine? can it get it at pharmacy store? i have taken melatonin in the past, worked 2-3 days but then nothing, but i think i still have some. and i still have both xanax and ativan at home.
again, thx link
Posted by Lou Pilder on March 21, 2016, at 10:34:36
In reply to Re: Lou's response-'my expressive editorial on Lou, posted by B2chica on March 20, 2016, at 23:20:56
> Lou.
> i have never responded to one of your benighted comments before, but tonight i think i will.
>
>
> Lou You wrote: [you all here that are contributing to this member staying in the midst of hell, could also lead this person to her death.]
>
> -First that is an illogical and improbably comment. althought i love and graciously appreciate the support and suggestions here on the board, i always go with my knowledge of medication and my body, as well as other physicians i have tending to me which i trust as they are expereinced, intelligent and proven to truly have my best interest at heart. so stating that memebers on an online forum could even slightly contribute to my death is highly improbably, and harmful and i am astounded how you can create such a statement unless it is only created as a 'shock-value' statement, which again would prove what you wrote is more about you than about me.
>
> -Lou, your next statement
> ["he chemicals that the pack of members here are advocating to the member that is in the midst of hell could cause her to kill herself of be killed by the drugs. The psychiatrist that would give these concoctions of death to her knows or should know that fact. You see, when these drugs are combined their effects are increased exponentially. That means that the drugs that could decrease heart or respiration such as central nervous system depressants, could cause heart or respiratory depression to cause death as just one way these drugs kill."]
>
> -i dont know of any single pharmaceutically produced 'medication' that does NOT have the potential to cause severe side effect, permanant damge or even death. and that includes the bottle that almost every american has in their cabinet 'tylenol'.
> as a note, i am in my 40's and always read the side effects portion of the meds i get. i also know my body, and if something isnt write, i get help even if that means going to emergency room. i am VERY aware of all the dangers and hazards these psychopharmacological meds have. HOWEVER, with my knowledge, understanding and trained/experienced doctors i make an informed concent to be treated with these meds. SO for you to state the obvious, once again seems more like a tirad of scare tactics and bulling rather than a dignified response meant to help.
>
> Lou, your next statement:
> [ "By allowing Scott to defame me here and post anti-Semitic propaganda against me here with impunity and promote these drugs with impunity, others could follow him with advocating more drugs. By Mr. Hsiung not interceding here and allowing Scott to defame me and stigmatize me here, Scott could be seen as the leader of the pack that could bring addiction, life-ruining conditions and death here all under the guise of being supportive, for support takes precedence according to Mr. Hsiung"]
>
> -it sounds to me that you have hi-jacked MY thread where i am asking for help and support for you to go off on another user of this site. i find that inconsiderate, and childish. it is unfortunate that you cannot find more appropriate ways to express your concerns, and it is also unfortunate that you seem to target the one user that has a lot of experience and gives all the users here on this board lots of emotional support. SO by tearing him down you are only making yourself to look (to me) as juvenile, self-centered, discourteous, and a bit myopic.
>
>
> Lou, your next statement:
> ["Who will you follow today? Do you also want to be led to the midst of hell?"]
>
> -Lou, i can assure you, and i am going to go ahead and assume i speak for many others on this site. Nobody wants to be on these medications, nobody wants the horrible side effects or risks of harm to their bodies. But the fact that so many ARE on these meds and do suffer (and i mean really suffer) from horrible and sometimes lasting side effect...well doesnt that say anything to you lou? you mention being led to the midst of hell, yet if you would have read even ONE of the posts you spew your distressing editorials to, you will notice we are all ready in the midst of hell. Yes Lou, we are already there, not because of the meds, but because of our biology. we are all fighting to stay alive... and quite frankly, as i speak for myself, if that means i shorten my life by 10 years because of a certain med that i'm on...if that med gives me even 1 year of lucidity and peace... i say to hell with those extra 10 years. because if my disease makes it so my life is so horrible that i am not even aware of life and others around me, if it prevents me from spending time or holding and loving my family and friends. than i dont want those extra 10 years.
> -and another note, if someday. one of the meds i take happens to end my life.. well than my epitaph will read: "She died trying!" and eveyone here will know, finally i will be at peace.
> so that is just fine by me.
>
>
> -a note about your comments. They are uneducated blatherings of data your are clearly uneducated in. your comments seem to me to be ill-advised, and ill-considered. as well as presumptious and imperceptive
> ****
> Lou, i have one last thing to say.
> i am pretty sure (knowing your online personality) that you will immediatly go on the 'defensive' and try to retort -though i'm sure unsuccessfully-a retort filled iwth backlash and pejorative remarks- but i would like to tell you.. dont bother to direct any toward myself as i wont read it, nor will i read any other posts you have. and i hope no one else does either, as they will not recieve what they are looking for here.
> The way you write, your notes show all of the above that i mention, but never include helpful critism or respect for others, not to mention you do not add any information or support of value. so overall i am not sure why you post, other than to get on your 'soap-box' of hating pharmaceuticals. i stronly urge you to alter your writing skills. although, understanding a little of your online personality i do not believe that either will occur.
>
> So last i say my goodbye.
> i wish you luck in the future and hope that you can become one more member of support here. If that does not happen, you can be assured, if a line is from Lou Pilder i will not read any of it.
>
> i hope you have read it all, as i think they are all things that have needed to be said.
> Best Wishes to you
> -b2
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> > > Are tricyclics any good with bipolar depression?
> > >
> > > I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> > > I think it's pristiq just isn't going to work for me annymore.
> > > But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
> > >
> > > b2
> > Friends,
> > It is written here,[...I am in the middle of hell...].
> > It has been revealed to me how to be released from the prison of hell. And what you all here that are contributing to this member staying in the midst of hell, could also lead this person to her death.
> > Friends, be not deceived. The chemicals that the pack of members here are advocating to the member that is in the midst of hell could cause her to kill herself of be killed by the drugs. The psychiatrist that would give these concoctions of death to her knows or should know that fact. You see, when these drugs are combined their effects are increased exponentially. That means that the drugs that could decrease heart or respiration such as central nervous system depressants, could cause heart or respiratory depression to cause death as just one way these drugs kill. By allowing Scott to defame me here and post anti-Semitic propaganda against me here with impunity and promote these drugs with impunity, others could follow him with advocating more drugs. By Mr. Hsiung not interceding here and allowing Scott to defame me and stigmatize me here, Scott could be seen as the leader of the pack that could bring addiction, life-ruining conditions and death here all under the guise of being supportive, for support takes precedence according to Mr. Hsiung.
> > Who will you follow today? Do you also want to be led to the midst of hell?
> > Lou
>
> Friends,
Be not deceived. Thousands of people are killed by these drugs every month. They are killed taking these drugs as prescribed. The prescriber gave the drugs to those that were killed by the drugs. Many of the deaths were suicides caused by the drugs as the drugs could increase suicidal thoughts. The drugs were prescribed to people even though the person was suicidal. This means that the psychiatrist giving the drug had the choice to prescribe a drug that could kill the person or not to.
Here the subject person is suicidal and there are members advocating drugs that could increase suicidal thoughts. And the subject person here could go to her psychiatrist, get a script, head for the dance at the pharmacy, take the drug advocated by the member here, and kill herself. This is supportive here as Mr. Hsiung says that support takes precedence. This could lead you or your child to their deaths.
Take heed that no man deceive you. For a liar could be in a white coat.
Lou.
Posted by SLS on March 21, 2016, at 12:24:39
In reply to Re: Tricyclics and bipolar depression » linkadge, posted by B2chica on March 21, 2016, at 9:42:45
As I mentioned above, you may very well have a unipolar depression with psychomotor agitation that resembles the melancholic subtype. People with this kind of depression usually feel worse in the morning and experience more early morning awakenings. If this is indeed the case, a tricyclic antidepressant would be a good choice. I would choose nortriptyline. It is not usually activating and has mild anticholinergic side effects compared to amitriptyline. Amitriptyline is better for insomnia, though.
If you are bipolar and will ultimately respond to a TCA, I would avoid those drugs that are serotonin reuptake inhibitors. The TCAs that are not SRIs include desipramine, nortriptyline, and trimipramine. Linkadge's suggestion of using doxepin is an interesting one. It tends to promote sleep and reduce anxiety. It is strongly antihistaminic. However, doxepin is not quite as effective for depression as are the other TCAs in my opinion. Still, it might work for you. Interestingly, trimipramine improves sleep architecture in depression, but I don't know how well it works for severe insomnia. I tried trimipramine and found it to be very tolerable. I think you are going to need to have a conversation with your doctor about trying a TCA either with or without adding Zyprexa, even if only temporarily.
If you find amitriptyline to be effective for depression but intolerable, you can move to nortriptyline and perhaps employ Linkadge's strategy to combine cyproheptadine (Periactin) with melatonin for insomnia.
- Scott
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