![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 55. Go back in thread:
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
Posted by SLS on March 21, 2016, at 12:32:18
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 21, 2016, at 8:10:04
Hi Linkadge.
I would be curious to know what are the pharmacological properties currently ascribed to cyproheptadine. I am aware only of its 5-HT2a/b/c and H1 receptor antagonism.
What properties of cyproheptadine are responsible for its sleep-promoting effects?
- Scott
Posted by B2chica on March 21, 2016, at 15:01:15
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 21, 2016, at 12:24:39
i am considered bipolar mixed, but i've always called it agitated depression because i dont get euphoric or grandiose. i feel horrible filled with disdain and contempt for myself and my world, i also can have illusions (which put me in place for psychotic depresssion dx once). right now i am dealing with severe psycho motor agitation. it is cycling though. one day horrible physical and mental depression, today mood good but horrible physical aggitation. a few days ago felt both simultaneously, it was Horrible.
Good News is that i just called my pdoc to update him on my condition and he liked the idea of adding a TCA but he wanted time to think on it. hes actually out of town this week but he is calling in a rx for topamax and agrees to cut down pristiq.
and i'm going to get an ativan now.
thanks for all your help scott!
dare i see a possibility of hope?
b2
> 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
Posted by linkadge on March 21, 2016, at 18:21:35
In reply to Re: Tricyclics and bipolar depression » linkadge, posted by B2chica on March 21, 2016, at 9:42:45
Cyproheptadine is an antihistamine which is OTC (at least in Canada). It may require a prescription in the US, I don't know.
It acts primarily as a histamine and serotonin antagonist. It primarily blocks 5-ht2a/c receptors without effects on dopamine. Blocking 5-ht2 receptors can induce melatonin relase and help sleep. Drugs blocking 5-ht2 receptors can be helpful for hallucinations (maninly visual).
Linkadge
Posted by linkadge on March 21, 2016, at 18:27:13
In reply to Re: Tricyclics and bipolar depression » linkadge, posted by SLS on March 21, 2016, at 12:32:18
Drugs which block 5-ht2 receptors are known to improve sleep. Blocking 5-ht2 receptors blocks the serotonin induced supression of melatonin, and may help offset the circadian shifts associated with excessive nighttime light. 5-ht2 receptors appear to interact with GSK-3.
For instance, 5-ht2 blockers can improve disrupted sleep patterns in mice lacking monoamine oxidase.
Also, the histamine and calcium channel blocking effects of cyproheptadine can also improve sleep.
Linkadge
Posted by linkadge on March 21, 2016, at 18:39:39
In reply to Re: Tricyclics and bipolar depression » SLS, posted by B2chica on March 21, 2016, at 15:01:15
The problem is that we are all likely aflicted by different combinations and degrees of genetic abnormalities which contribute to our unique symtpoms.
Perhaps the addition of one gene turns typical depression into a more agitated one.
I think in 50 years, medicine will recognize that it was an error to try and fit patients into a handful of discrete categories.
Spring can be a bad time for cycling. I find that I need to darken my room around 7:00 this time of year. Sometimes a midday nap (1 hour of lights out) can help a lot.
Extra magnesium can help lower the threshold for mania (or hyperexcitable neurons) too.
Linkadge
Posted by B2chica on March 21, 2016, at 19:16:54
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by linkadge on March 21, 2016, at 18:39:39
thnx link. very true.
i was hoping pdoc would call in rx tonight, i havent heard anything yet...
Posted by SLS on March 22, 2016, at 2:48:50
In reply to Re: Tricyclics and bipolar depression, posted by B2chica on March 21, 2016, at 19:16:54
> thnx link. very true.
>
> i was hoping pdoc would call in rx tonight, i havent heard anything yet...
Good luck, B2chica.:-)
Linkadge is one smart guy, isn't he?
- Scott
Posted by B2chica on March 22, 2016, at 10:01:22
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 22, 2016, at 2:48:50
both of you are the best.
-when i talked with pdoc yesterday and mentioned tca i didnt specify and sure enough he picked amitriptyline. will take that tonight.
*****
on a side note. i had a little...um 'incident' last night. and i want to say it here because i want to lie to everyone else.eventhough the possibility of med change and potential hope was on the horizon, last night was again so bad. anxiety through the roof. i wanted to go for a walk, but my niece came over so i waited until she left... i had taken my nightly combo right before...
i ended up walking along a very busy street a long ways. i was purposefully walking near the street. got to a store, went in got a drink of water and came back out. ready to walk home....without the desire to reach home. i purposefully walked on the curb of the very busy street, partly to chicken to go out to the street, but also just hoping some car would mess up and jump the curb. not keeping my balance that great.. i didnt fall into the street though i did loose my balance a couple times..
well about 3/4 way home a cop pulled over. he told me he had gotten many calls and kept thinking i was drunk. i insisted twice not only was i not drunk i dont drink. he finally askee me if i had taken any pills. i admited that i had sleeping pills and was just so SO terribly tired i just needed some exercise to help me sleep.
well, i was about to continue walking home when it all hit me and i started bawling. i couldnt even continue on so he came over and insisted he give me a ride home (though still not that nice). i apologized profusely in between overwhelming waves of crying.so anyway... for the rest of the world, it was the sleep meds that made me wobbly and stupid and tired. for you folks.. i took a risk that at the time i wished would by some chance end my suffering. it did not. today i am glad.
http://mikejmoran.typepad.com/files/pedestrian-by-bradbury-1.pdf
too similar!b2
> > thnx link. very true.
> >
> > i was hoping pdoc would call in rx tonight, i havent heard anything yet...
>
>
> Good luck, B2chica.
>
> :-)
>
> Linkadge is one smart guy, isn't he?
>
>
> - Scott
>
>
Posted by Phillipa on March 22, 2016, at 11:50:53
In reply to Re: Tricyclics and bipolar depression, posted by B2chica on March 22, 2016, at 10:01:22
B2chica did your husband know you had left the house? Are you sure you are safe to be at home. I'm concerned about you. Very concerned. Phillipa
Posted by B2chica on March 22, 2016, at 14:19:37
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by Phillipa on March 22, 2016, at 11:50:53
he knew, i was after all going for a walk not unlike every other night... but i think between my mood, my exhaustion both physically and emotionally and the sleep meds... i should not have taken the meds and then left the house...however. my intent was there, i knew exactly what i was doing. i was just to..wavering to actually do anything. but i think my compassion is too strong, i cant imagine now how that person would have felt that would have hit me.. that alone is too much for me to think about right now.
im not really that safe emotionally, but hospital is not a solution...med change is. and i have that, tonight i start augment AD. i pray it helps me sleep..i just need to f-ing sleep.
Posted by baseball55 on March 22, 2016, at 19:08:56
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by linkadge on March 21, 2016, at 18:39:39
> I think in 50 years, medicine will recognize that it was an error to try and fit patients into a handful of discrete categories.
>
> I have had severe, vegetative depression with frequent periods of agitation and suicidal thoughts and plans. My psychiatrist said once, we know this is not typical depression. Call it bipolar 3-c or whatever you want. I liked that. We all experience things differently and are sometimes hard to fit in a particular DSM diagnosis. Of course, you need to pick a DSM category for the insurance companies.
I don't think it is correct to assume that, if Ads make you agitated, you are bipolar. It may just be that a reduction in depressive symptoms uncovers underlying problems, like anger or suicidality.
>
>
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