Psycho-Babble Medication Thread 64595

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

Tired of chronic BP II misery

Posted by loosmrbls on May 29, 2001, at 12:50:44

I simply am sick to death of all these different drugs, I truly think there will never be a good day again.

After a hospitalization from mid-April to early May for depression, I was sent home on Depakote and Zoloft. My pdoc quit the Zoloft after I told him it didn't seem to add any effect to the Depakote except give me a headache. Within two weeks, I was depressed again. Not as bad (no hospital needed) and a more withdrawn, dark, flat depression. I guess the Depakote was stopping severe swings and the anxiety.

As I mentioned in an earlier post, I quit all my meds and felt much better. For a few days. Then the depression came back, and the mood instability, and everything else.

A week ago, was re-started on Depakote and started on Remeron. Even with this AD, I am an irritable, short-tempered prick. I get mad/frustrated so easily, look for arguements (mostly with wife), and can't stand it. I've had this response with every AD. So it's not a switch into mania, I'd say. I mean, what are the chances of EVERY AD causing this reaction within 1-2 days of starting medication. Especially with stabilizer on board? Is it an "unmasking" of depressive irritability/anxiety? Or something else?

Any ideas? I can't stand it, neither can my wife. My doctor seems VERY hesitant to use any neuroleptics. I do have some suspiciousness/paranoia, but no delusions ro psychosis to speak of.

I feel a hospital trip may be in order soon if things don't calm down soon.

 

Re: Tired of chronic BP II misery

Posted by KarenK on May 29, 2001, at 20:33:42

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

> I simply am sick to death of all these different drugs, I truly think there will never be a good day again.
>
> After a hospitalization from mid-April to early May for depression, I was sent home on Depakote and Zoloft. My pdoc quit the Zoloft after I told him it didn't seem to add any effect to the Depakote except give me a headache. Within two weeks, I was depressed again. Not as bad (no hospital needed) and a more withdrawn, dark, flat depression. I guess the Depakote was stopping severe swings and the anxiety.
>
> As I mentioned in an earlier post, I quit all my meds and felt much better. For a few days. Then the depression came back, and the mood instability, and everything else.
>
> A week ago, was re-started on Depakote and started on Remeron. Even with this AD, I am an irritable, short-tempered prick. I get mad/frustrated so easily, look for arguements (mostly with wife), and can't stand it. I've had this response with every AD. So it's not a switch into mania, I'd say. I mean, what are the chances of EVERY AD causing this reaction within 1-2 days of starting medication. Especially with stabilizer on board? Is it an "unmasking" of depressive irritability/anxiety? Or something else?
>
> Any ideas? I can't stand it, neither can my wife. My doctor seems VERY hesitant to use any neuroleptics. I do have some suspiciousness/paranoia, but no delusions ro psychosis to speak of.
>
> I feel a hospital trip may be in order soon if things don't calm down soon.

***Here's an idea. My son has treatment resistant bp rapid cycling. I took him to Demitri Papolos. He wrote the book, "The BiPolar Child". Rather than use an AD, he suggested lamictal. It didn't work out for my son, but it has worked out well for a number of people on this board.

This is like the search for the Holy Grail!

KarenK


 

Re: Tired of chronic BP II misery » loosmrbls

Posted by SalArmy4me on May 30, 2001, at 1:07:30

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

Dr. Bob's colleagues talk about using Depakote to lessen irritability--but it takes a few weeks to work, as all psychotropic medications do:

Date: Sat, 1 Feb 1997 10:12:40 -0800 (PST)
From: Jaime Smith < evb@yknet.yk.ca >
Subject: Valproate for anger episodes

I've been following a fellow in the local prison where he is doing time on drug charges. I was asked to see him because of anger episodes in the prison setting a few months ago.

I started him on a trial of valproate 125 mgm QID the first week, 250 QID the second week. Amazing change after two weeks now -- he has been elected chairman of the inmate committee, sleeps well, writes poetry, and says it subjectively is a major change in his ability to exercise self control. He denies using drugs in prison -- and in the controlled milieu compliance with medication is ensured. This seems almost too good to be true.

From: cprice@mem.po.com (Charles Sowle Price, MD)
Date: Sat, 1 Feb 1997 14:38:29 -0500
Subject: Valproate for anger episodes

I use this strategy often. It works a high enough % of the time that I use it often early in my decision tree.

Date: Sat, 01 Feb 1997 18:14:38 -0800
From: "Deborah Pines, MD" < deborahp@erols.com >
Subject: Valproate for anger episodes

I haven't seen anything so dramatic, but I do see major improvements over time with my conduct disordered, explosive adolescents who have spent years in different settings and on different meds. The valproate seems to really help them control the magnitude of their aggression, outbursts and irritability. Some kids really think valproate has "changed their lives".

 

Re: Tired of chronic BP II misery » loosmrbls

Posted by Mitch on May 30, 2001, at 1:58:54

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

> I simply am sick to death of all these different drugs, I truly think there will never be a good day again.
>
> After a hospitalization from mid-April to early May for depression, I was sent home on Depakote and Zoloft. My pdoc quit the Zoloft after I told him it didn't seem to add any effect to the Depakote except give me a headache. Within two weeks, I was depressed again. Not as bad (no hospital needed) and a more withdrawn, dark, flat depression. I guess the Depakote was stopping severe swings and the anxiety.
>
> As I mentioned in an earlier post, I quit all my meds and felt much better. For a few days. Then the depression came back, and the mood instability, and everything else.
>
> A week ago, was re-started on Depakote and started on Remeron. Even with this AD, I am an irritable, short-tempered prick. I get mad/frustrated so easily, look for arguements (mostly with wife), and can't stand it. I've had this response with every AD. So it's not a switch into mania, I'd say. I mean, what are the chances of EVERY AD causing this reaction within 1-2 days of starting medication. Especially with stabilizer on board? Is it an "unmasking" of depressive irritability/anxiety? Or something else?
>
> Any ideas? I can't stand it, neither can my wife. My doctor seems VERY hesitant to use any neuroleptics. I do have some suspiciousness/paranoia, but no delusions ro psychosis to speak of.
>
> I feel a hospital trip may be in order soon if things don't calm down soon.

This is really weird, but I found even Remeron caused me to be bitchy too! (BP-II, as well-supersensitve to antidepressants-with ADHD). Even Buspar at 10mg/day caused me to get nearly physically violent.
Hey, this is a REAL long shot, but what about asking for some LOW-dose Dexedrine or Adderall to see what that does (NOT while you are taking ANY AD). Yor pdoc would probably freak, but I have taken it in the past (Adderall) and my cycling STOPPED! It *just might* work with the Depakote-who knows? If you are bitchy, picking fights, can't focus, getting frustrated-sounds a lot like ADHD as well. ..OR..
Also-I can't hack more than just tiny doses of AD's-but they do help. I am talking 2.5mg of Prozac for example. Maybe he can restart you on the Zoloft at just 12.5mg/day and let that go for a couple of weeks-see how you feel.

FWIW-
Mitch

 

Re: Tired of chronic BP II misery Mitch

Posted by loosmrbls on May 30, 2001, at 10:35:29

In reply to Re: Tired of chronic BP II misery » loosmrbls, posted by Mitch on May 30, 2001, at 1:58:54

Mitch, as I mentioned in an earlier post your course and response to drugs seems very similar to mine.

Two psychiatrists have told me I probably have ADHD, but I had horrible irritability to both Wellbutrin and high-dose Effexor XR -- both increase dopamine. So they both were very reluctant to start any ADD meds.

Right now, they think this is agitation/irritability related to the depression, now that the vegetation is starting to lift. They are giving me PRN Klonopin (.25mg every six hours as needed). It seems to help.

I have thought about ritalin/dexedrine, and may try it when not on AD's if things continue to decline.

Right now I am on Depakote 1500mg/day, Remeron 30mg/day (5-6 days, irritability was almost immediate), and now the Klonopin as needed every six hours.

My plan is to give the Remeron a fair shot (four weeks at least) with the Klonopin as-needed. If I am still irritable or depressed, I will ask for ECT. If they flat-out refuse, then I will refuse any medical therapies that do not include a mood stabilizer and an ADD med.

I feel better today. Guess the Klonopin is working on the agitation.

 

Re: Tired of chronic BP II misery » loosmrbls

Posted by Wendy B. on May 30, 2001, at 13:24:30

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

> Any ideas? I can't stand it, neither can my wife. My doctor seems VERY hesitant to use any neuroleptics. I do have some suspiciousness/paranoia, but no delusions ro psychosis to speak of.
>
> I feel a hospital trip may be in order soon if things don't calm down soon.


Hey Loosmrbls, Mitch & others,

I have been experiencing the same irritability lately, so there must be something in the air...
I'm not ADHD or ADD, so I don't even have the good excuses you have... My mood swings seem to go in the opposite direction (towards depression), not towards hypomania. And depressives are notoriously irritable, angry people.
But just to illustrate, last night, in a fit of anger & irritation, I threw a kitchen utensil known for its strength (a Copco food strainer, actually), on the floor, in the presence of my 9 yr-old, and it shattered into many pieces (!), and she ran to her room to hide... Good f***in' grief. Loss of control really has me scared sometimes, and I feel like a shitty parent.
Anyway, I apologized to her and she understands I'm trying to get a handle on it in therapy...
But back to meds: before trying a neuroleptic, since it's not really indicated (no hallucinations or move toward psychotic mania), have either of you (Loosmrbls or Mitch) done what Karen K. suggests & gone on an anti-convulsant/mood stabilizer, along with the Depakote? She suggests Lamictal (lamotrigrine), I would also mention Neurontin (gabapentin), and Topamax (topiramate). I have had good results with the Neurontn. And I have read about the value of combining the Depakote with these, so it seems worth a try? Maybe...
I wish you luck,

Wendy

 

Re: Tired of chronic BP II misery » loosmrbls

Posted by Ron Hill on May 30, 2001, at 14:35:26

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

Dear Mr. L.M. Bells:

I also am BP II. My current med combination is working extremely well. However, it was four years of pain and dysfunction until my doctor and I (i.e.; internet information) found a med combo that works. I will not bore you with the gory details associated with my prior woes, instead I want to encourage you to not give up in your research endeavors to find a med combo that is right for you personally. You are smart (all BP's are), so stay at it!

Regarding your irritable, short-tempered, mad/frustrated symptoms, as it happens I listened to an audio clip on the web this morning featuring a psychiatrist named Dr. Glen Mullen in which he said that about 2-3% of people taking an SSRI experience severe agitation/anxiety. Further, it is the Doctor's claim that, in such cases, augmentation of the SSRI with a tranquilizer may be effective. The primary focus of the clip is SSRI's, so he did not mention whether or not this severe side effect occurs in any fraction of the patients taking other classes of AD's.

The clip may be of some help, or maybe not. But it's probably worth a listen. The clip uses RealPlayer, so if you do not currently have this media player on your machine, go to the RealPlayer web site and download it for free. Here's the link directly to the audio clip:
http://members.fortunecity.com/siriusw/glenmullen.ram

Also, here is the link to the web page that contains this audio clip as well as other audio/video clips. Beware, however, the site is fanatically anti-SSRI's.
http://members.fortunecity.com/siriusw/prozac.html


Be Well, Happy, and Stable.

-- Ron

P.S. In case you are wondering, I take 600 mg Lithobid, 10 mg Paxil, and 100 mg Wellbutrin per day. :)
-------------------------------------------------


> I simply am sick to death of all these different drugs, I truly think there will never be a good day again.
>
> After a hospitalization from mid-April to early May for depression, I was sent home on Depakote and Zoloft. My pdoc quit the Zoloft after I told him it didn't seem to add any effect to the Depakote except give me a headache. Within two weeks, I was depressed again. Not as bad (no hospital needed) and a more withdrawn, dark, flat depression. I guess the Depakote was stopping severe swings and the anxiety.
>
> As I mentioned in an earlier post, I quit all my meds and felt much better. For a few days. Then the depression came back, and the mood instability, and everything else.
>
> A week ago, was re-started on Depakote and started on Remeron. Even with this AD, I am an irritable, short-tempered prick. I get mad/frustrated so easily, look for arguements (mostly with wife), and can't stand it. I've had this response with every AD. So it's not a switch into mania, I'd say. I mean, what are the chances of EVERY AD causing this reaction within 1-2 days of starting medication. Especially with stabilizer on board? Is it an "unmasking" of depressive irritability/anxiety? Or something else?
>
> Any ideas? I can't stand it, neither can my wife. My doctor seems VERY hesitant to use any neuroleptics. I do have some suspiciousness/paranoia, but no delusions ro psychosis to speak of.
>
> I feel a hospital trip may be in order soon if things don't calm down soon.

 

Re: Tired of chronic BP II misery Mitch » loosmrbls

Posted by Mitch on May 31, 2001, at 2:13:16

In reply to Re: Tired of chronic BP II misery Mitch, posted by loosmrbls on May 30, 2001, at 10:35:29

LM,

I also have had very intense hostility (and hypomanic) responses to *tiny* doses of Effexor, but NO hypomania and less grouchiness with Wellbutrin. I had NO HYPOMANIA and even *less* grouchiness with LOW-dose Adderall (with an obvious anti-cycling effect).

One AD that happened also to help attention and did't get me hypomanic or irritable was nortriptyline (Pamelor)-low-dose, 10-25mg/day. It helped me focus A LOT BETTER at work without making me uptight or bitchy. Just an FYI.

Have you ever tried any Neurontin? I find that (thus far) it is the only anti-convulsant med that seems to help my ADHD (at reasonable lower doses). I know that many pdocs are using it for that.

The "dopamine thing" is really odd. It is true that if I took a higher dose of Adderall-that there were times that I got a high autonomic response to a temper situation (challenge).

The "anti-cycling" thing about the Adderall was this: It created a relatively acceptable SAMENESS. I FELT much the same EVERY DAY/ALL DAY, got up at the SAME TIME every day, went to sleep at the SAME TIME everyday-NO SLEEP DISTURBANCES WHILE I WAS ASLEEP. I just woke up rapidly from being asleep, had the same FEELING (which wasn't very remarkable) most of the day, and then went to sleep quickly and slept (7-8hrs consistently), and repeated that pattern-very consistently.

When I am cycling (3-week cycles) all of that GOES TO HELL-sleeping a lot, sleeping a little, grouchy for a few days, depressed intensely for a few days, laughing and acting foolish for a few days, etc. That all came to a halt with the Adderall. (That is my *good* two-cents worth about it).

I also have two seasonal major depressive episodes and I was taking the Adderall during one of them and had NO depressive symptoms. The trouble is that I had discontinued an SSRI+benzo just a few weeks before I started the Adderall and I got real edgy/panicky at times from the stim. I wonder if that was mainly a withdrawal from them that I was experiencing.

I think you are going to do ok. When the Depakote starts really kicking in you are prob. going to settle down a lot, and they will prob. decrease the dosage a little at a time to get to a min. level that keeps you stable.

As far as ECT is concerned-I am completely unafraid of it. I am seriously considering it for my S.A.D. episodes (twice a year-just about the time they start).

You are going to do OK,
Mitch

> Mitch, as I mentioned in an earlier post your course and response to drugs seems very similar to mine.
>
> Two psychiatrists have told me I probably have ADHD, but I had horrible irritability to both Wellbutrin and high-dose Effexor XR -- both increase dopamine. So they both were very reluctant to start any ADD meds.
>
> Right now, they think this is agitation/irritability related to the depression, now that the vegetation is starting to lift. They are giving me PRN Klonopin (.25mg every six hours as needed). It seems to help.
>
> I have thought about ritalin/dexedrine, and may try it when not on AD's if things continue to decline.
>
> Right now I am on Depakote 1500mg/day, Remeron 30mg/day (5-6 days, irritability was almost immediate), and now the Klonopin as needed every six hours.
>
> My plan is to give the Remeron a fair shot (four weeks at least) with the Klonopin as-needed. If I am still irritable or depressed, I will ask for ECT. If they flat-out refuse, then I will refuse any medical therapies that do not include a mood stabilizer and an ADD med.
>
> I feel better today. Guess the Klonopin is working on the agitation.

 

Re: Tired of chronic BP II misery » Wendy B.

Posted by Mitch on May 31, 2001, at 2:18:51

In reply to Re: Tired of chronic BP II misery » loosmrbls, posted by Wendy B. on May 30, 2001, at 13:24:30

Hi, Wendy

Yep, AC's do seem to work the best and I have been the most stable on lower dose Neurontin than anything else. It is just that I do have attentional problems-NO DOUBT.

Mitch

>
>
> Hey Loosmrbls, Mitch & others,
>
> I have been experiencing the same irritability lately, so there must be something in the air...
> I'm not ADHD or ADD, so I don't even have the good excuses you have... My mood swings seem to go in the opposite direction (towards depression), not towards hypomania. And depressives are notoriously irritable, angry people.
> But just to illustrate, last night, in a fit of anger & irritation, I threw a kitchen utensil known for its strength (a Copco food strainer, actually), on the floor, in the presence of my 9 yr-old, and it shattered into many pieces (!), and she ran to her room to hide... Good f***in' grief. Loss of control really has me scared sometimes, and I feel like a shitty parent.
> Anyway, I apologized to her and she understands I'm trying to get a handle on it in therapy...
> But back to meds: before trying a neuroleptic, since it's not really indicated (no hallucinations or move toward psychotic mania), have either of you (Loosmrbls or Mitch) done what Karen K. suggests & gone on an anti-convulsant/mood stabilizer, along with the Depakote? She suggests Lamictal (lamotrigrine), I would also mention Neurontin (gabapentin), and Topamax (topiramate). I have had good results with the Neurontn. And I have read about the value of combining the Depakote with these, so it seems worth a try? Maybe...
> I wish you luck,
>
> Wendy

 

Re: Tired of chronic BP II misery

Posted by loosmrbls on May 31, 2001, at 9:29:56

In reply to Re: Tired of chronic BP II misery Mitch, posted by loosmrbls on May 30, 2001, at 10:35:29

My pdoc did mention adding Neurontin to the Depakote. I truly hope so because the weight gain is becoming an issue. Hopefully, it will allow me to lower the depakote dose. I've read that antidepressants destabilize mood in BP II patients, but I seem to crash into horrible depressions if I'm not on one. So I'm not sure if multiple mood stabilizers or keeping the Remeron on board is better. If the irritability is still there after 4 weeks, I will stop it. I'll keep you informed of what happens. Thanks for your input, it helps alot.

 

Re: Tired of chronic BP II misery » loosmrbls

Posted by Mitch on May 31, 2001, at 11:05:00

In reply to Re: Tired of chronic BP II misery , posted by loosmrbls on May 31, 2001, at 9:29:56

1) If your Depakote blood level is stable and well into the therapeutic range-he probably will want to maintain your present dosage on it(at least for a while). I would go ahead and add *some* Neurontin (say 300mg/2-3xdaily). Just a personal note: I have found Neurontin works a *lot* better for depression than Depakote.

2) If that noticeably helps-especially with depression and grouchiness, *then* *consider* either reducing the Remeron (which probably won't help much), ditching AD's altogether (probably not a good idea), or switching to a different AD (i.e, some low-dose Serzone-something lower potency, mellow and not likely to set you off, say 25-50mg twice daily).

3)Just a thought, if you do have ADD along with the bipolar, a really sedating AD like Remeron might not be a good choice and could be the culprit setting off the irritability (for different reasons). My theory is that it *fogs* up your head and makes it tough to think clearly and you get frustrated easier-hence the grouchiness. Sometimes really sedating AD's create a "pseudo-depression". You are just so knocked out.

4) If you find a different AD that works for you, and you are on your Depakote/Neurontin combo. BUT, you are gaining weight like it is going out of style-talk with your doc about a *gradual* taperdown of the Depakote (leaving everything else the same) and see how you respond.

I have been on Dep. before and I gained about 20lbs. Remeron will do it to you too. About 20lbs there. Buy some new pants and hang in there! When you get past all of this you will be able to lose most of it back.

Keep me posted on how you are doing. I am curious how this all works out.
good luck,
Mitch

> My pdoc did mention adding Neurontin to the Depakote. I truly hope so because the weight gain is becoming an issue. Hopefully, it will allow me to lower the depakote dose. I've read that antidepressants destabilize mood in BP II patients, but I seem to crash into horrible depressions if I'm not on one. So I'm not sure if multiple mood stabilizers or keeping the Remeron on board is better. If the irritability is still there after 4 weeks, I will stop it. I'll keep you informed of what happens. Thanks for your input, it helps alot.

 

Re: Tired of chronic BP II misery mitch

Posted by loosmrbls on May 31, 2001, at 11:17:03

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

Just spoke with pdoc over the phone. Because there is has been so much med-switching in the past, he is pretty insistent we keep things stable and see how it goes. I really can't argue against that. If we add or change a new med and things chenge, it will be impossible to lay the blame anywhere.
So right now I am staying on Remeron 30mg (no sedation at this dose, increased appetite), Depakote 1500mg (slight heartburn and increased appetite, but no sedation or tremor as other people complain about), and Klonopin 0.5mg as needed every 6 hours for agitation.

If, after 4-6 weeks, I still am requiring a lot of Klonopin due to agitation then I will call the AD trial a failure and probably add Neurontin. If my thinking is still off (and I know exactly what you are talking about with the "fogginess" and ADD adding to the frustration), then an amphetamine will be in order.
Right now, I want to address the bipolar disorder, especially the depressive aspect, because this can also cause loss of concentration and intellect. Have to eliminate this before figuring out if ADD characteristics are playing a role. I am convinced I have ADD.

 

Re: Tired of chronic BP II misery mitch

Posted by Mitch on May 31, 2001, at 13:15:47

In reply to Re: Tired of chronic BP II misery mitch, posted by loosmrbls on May 31, 2001, at 11:17:03

He is quite right. I have had a lot of troubles with switching stuff too quick or worse-changing more than one thing at a time. I am somewhat *lucky* though, I cycle so fast you usually see if something is working or not pretty quickly. I just mentioned adding the Neurontin as a *single* next step (when you see your pdoc next). He did offer to add some Neurontin at your last visit, right? The other stuff I wrote would have been possibilities over the course of months. If you aren't bothered too much with sedation from the Remeron then that is a good sign-your depression is probably lifting.

sounds good,

Mitch

> Just spoke with pdoc over the phone. Because there is has been so much med-switching in the past, he is pretty insistent we keep things stable and see how it goes. I really can't argue against that. If we add or change a new med and things chenge, it will be impossible to lay the blame anywhere.
> So right now I am staying on Remeron 30mg (no sedation at this dose, increased appetite), Depakote 1500mg (slight heartburn and increased appetite, but no sedation or tremor as other people complain about), and Klonopin 0.5mg as needed every 6 hours for agitation.
>
> If, after 4-6 weeks, I still am requiring a lot of Klonopin due to agitation then I will call the AD trial a failure and probably add Neurontin. If my thinking is still off (and I know exactly what you are talking about with the "fogginess" and ADD adding to the frustration), then an amphetamine will be in order.
> Right now, I want to address the bipolar disorder, especially the depressive aspect, because this can also cause loss of concentration and intellect. Have to eliminate this before figuring out if ADD characteristics are playing a role. I am convinced I have ADD.
>

 

Re: Tired of chronic BP II misery mitch

Posted by loosmrbls on May 31, 2001, at 13:30:17

In reply to Re: Tired of chronic BP II misery mitch, posted by loosmrbls on May 31, 2001, at 11:17:03

I hope it works out. Let me know how you do. Like I said, your experience has been a lot like mine on several meds. And I always love to hear about people doing better, and trying to help if they are doing worse

 

Re: Tired of chronic BP II misery mitch » loosmrbls

Posted by Mitch on June 1, 2001, at 0:11:22

In reply to Re: Tired of chronic BP II misery mitch, posted by loosmrbls on May 31, 2001, at 13:30:17

LM, All I know is that Neurontin works the best of the AC's for me for the bipolar II and ADHD. I know that AD's set off cyling, I have mood-charted and I know that SSRI's DO IT. But I am stuck taking one (Celexa) because if I dont' I get all panicky and gloomy! I am in the process of tapering it...very...slowly....Christ! how slow do you need to taper somethings?

Thanks for support and input,
Mitch

> I hope it works out. Let me know how you do. Like I said, your experience has been a lot like mine on several meds. And I always love to hear about people doing better, and trying to help if they are doing worse

 

Re: Tired of chronic BP II misery mitch

Posted by loosmrbls on June 1, 2001, at 8:13:59

In reply to Re: Tired of chronic BP II misery mitch » loosmrbls, posted by Mitch on June 1, 2001, at 0:11:22

My experience has been the same. I think all the SSRI's (or for that case, antidepressants) set off dysphoria, or I prefer "dysregulation." It is totally independant of "starting mania" or "starting cycling." I just know that every antidepressant I have been on (even those reknown for not staring mania) sparks off irritability, anger, rage, and dysphoria mixing together in various patterns at random times at rates. These have been the times my suicidality have been the worst.
This is ironic, because every article I have read, even those dealing with "personality disorders" that treat symptoms and not diseases (eg "anger" instead of "depression") list SSRI's as the first choice for mood stabilization. I know in my case the exact opposite is true. And I know it is not "mania" being unmasked, becasue within a day of being on an AD I become a short-tempered, irritable prick, and it takes significant doses of Klonopin to mask it.
But there's the dilemma, much like yours. Every time I've been completely off AD's, I slump into a dark, black, withdrawn, depression where I become a stone, cold and immobile.

Not sure what to do. I don't want to chronically be doped up on benzodiazepines, but scared to be off antidepressants.

 

Serotonin receptor downregulation???

Posted by Mitch on June 1, 2001, at 13:34:25

In reply to Re: Tired of chronic BP II misery mitch, posted by loosmrbls on June 1, 2001, at 8:13:59

I think the trouble LM may be that serotonin receptors get down-regulated (fewer of them) from taking SSRI's and then when you try to get off of it the receptor density starts going up and then you start getting all of the gloomy shit coming back. They have shown that suicidal people have excess serotonin receptors-I guess the question is if I am better off having fewer of them is there SOME OTHER WAY to get there??

Anybody, jump in on this

> My experience has been the same. I think all the SSRI's (or for that case, antidepressants) set off dysphoria, or I prefer "dysregulation." It is totally independant of "starting mania" or "starting cycling." I just know that every antidepressant I have been on (even those reknown for not staring mania) sparks off irritability, anger, rage, and dysphoria mixing together in various patterns at random times at rates. These have been the times my suicidality have been the worst.
> This is ironic, because every article I have read, even those dealing with "personality disorders" that treat symptoms and not diseases (eg "anger" instead of "depression") list SSRI's as the first choice for mood stabilization. I know in my case the exact opposite is true. And I know it is not "mania" being unmasked, becasue within a day of being on an AD I become a short-tempered, irritable prick, and it takes significant doses of Klonopin to mask it.
> But there's the dilemma, much like yours. Every time I've been completely off AD's, I slump into a dark, black, withdrawn, depression where I become a stone, cold and immobile.
>
> Not sure what to do. I don't want to chronically be doped up on benzodiazepines, but scared to be off antidepressants.

 

Re: Serotonin receptor downregulation???

Posted by loosmrbls on June 1, 2001, at 13:45:35

In reply to Serotonin receptor downregulation???, posted by Mitch on June 1, 2001, at 13:34:25

If the theory is that there is not enough serotonin in the synapses, I would expect an INCREASE in post-synaptic serotonin receptors to try and compensate for lack of neurotransmitter.

Than, all of a sudden you give a drug where there is an increase in serotonin in the synapse, and you still have an increase in receptors. It probably takes a few days for the receptors to decrease, so for a few days you actually have over-stimulation of the serotonin pathways.

However, I still can't figure it all out. I would think if you increase serotonin, the body would decrease it;s sensitivity to it as an adjustment and you'd be back at square one. However, as you know it gets much more complicated than that -- there are receptors on both sides of the synapse and I truly think it's all guesswork what will finally work.

For me, I think the Depakote does provide some stabilization by acting as a generalized nervous system depressant (calms it down). I'm not sure exactly what the antidepressant is doing positive, but it does bring about immediate agitation that is counter-acted by the benzo. Maybe I should stop these two.

However, lithium does not have an antidepressant effect on me. And I'm prone to depression if not on an antidepressant. So should I take Neurontin instead of Remeron/Klonopin?

Another problem is the Klonopin sometimes makes me feel goofy, almost works TOO well. I sure wouldn't mind stopping the Remeron. In combination with Depakote, I've gained some weight.

 

Re: chronic BP misery » loosmrbls

Posted by chloe on June 1, 2001, at 19:41:16

In reply to Re: Serotonin receptor downregulation???, posted by loosmrbls on June 1, 2001, at 13:45:35


> However, lithium does not have an antidepressant effect on me. And I'm prone to depression if not on an antidepressant. So should I take Neurontin instead of Remeron/Klonopin?
>

Hi LM
I doubt you could use Neurontin instead of your current combo.
I began Neurontin about 3 weeks ago to help with my aggitation from an SSRI. I am quite unimpressed with it's ability to help with irritability and aggitation. I feel it is rather a "light weight" for the symptoms of irritation you describe. It does help a little with anxiety, in that it makes me a bit sleepy.

However, if you have a benzo that is helping control your temper, etc, even when you are on an AD, I would celebrate! I have not found a benzo that can keep a lid on my AD induced hypomania and irritability.

Hang in there!
C

 

Re: Serotonin receptor downregulation??? » loosmrbls

Posted by Mitch on June 1, 2001, at 23:17:07

In reply to Re: Serotonin receptor downregulation???, posted by loosmrbls on June 1, 2001, at 13:45:35

FWIW, I think that bottom-line is getting the serotonin receptor density DOWN. I just wonder if there is a more complex method that is yet undiscovered (DNA-wise) that would reduce the serotonin receptor density *directly*, not *indirectly* as how the brain does it now as a response to AD's.

> If the theory is that there is not enough serotonin in the synapses, I would expect an INCREASE in post-synaptic serotonin receptors to try and compensate for lack of neurotransmitter.
>
> Than, all of a sudden you give a drug where there is an increase in serotonin in the synapse, and you still have an increase in receptors. It probably takes a few days for the receptors to decrease, so for a few days you actually have over-stimulation of the serotonin pathways.
>
> However, I still can't figure it all out. I would think if you increase serotonin, the body would decrease it;s sensitivity to it as an adjustment and you'd be back at square one. However, as you know it gets much more complicated than that -- there are receptors on both sides of the synapse and I truly think it's all guesswork what will finally work.
>
> For me, I think the Depakote does provide some stabilization by acting as a generalized nervous system depressant (calms it down). I'm not sure exactly what the antidepressant is doing positive, but it does bring about immediate agitation that is counter-acted by the benzo. Maybe I should stop these two.
>
> However, lithium does not have an antidepressant effect on me. And I'm prone to depression if not on an antidepressant. So should I take Neurontin instead of Remeron/Klonopin?
>
> Another problem is the Klonopin sometimes makes me feel goofy, almost works TOO well. I sure wouldn't mind stopping the Remeron. In combination with Depakote, I've gained some weight.

 

Re: Tired of chronic BP II misery mitch

Posted by KarenK on June 3, 2001, at 20:51:03

In reply to Re: Tired of chronic BP II misery mitch, posted by loosmrbls on June 1, 2001, at 8:13:59

>
> Not sure what to do. I don't want to chronically be doped up on benzodiazepines, but scared to be off antidepressants.

***LM, I had the same problem for years with prozac. I had to start with liquid prozac and taper up painfully slowly and it made me so hyper and racey that I had to take valium with it. Last June, I got off the valium and switched first to depakote and then to topamax and found I can now take an adult dose of prozac with topamax and I feel pretty good.

KarenK

 

Re: Tired of chronic BP II misery-loosemrbles

Posted by AMenz on June 4, 2001, at 15:18:44

In reply to Tired of chronic BP II misery, posted by loosmrbls on May 29, 2001, at 12:50:44

Also a BPII, rapid cyclers. I lowere myself the dosage on Zoloft (which is also an SSRI) to 50 from 100 mg. Mixed states of mania disappeared almost immediately. SSRI's do cause at least rapid cycles to cycle. Drs. seem to miss this. This might perhaps be your first line of attack. Obviously another AD might be needed. But I found that what I thought was depression was part of this mixed mania.

Consult with you doctor about this. I also saw an article in the internet by some psychopharmacologist regarding dropping AD's in cycling BP's. I'm sorry I don't have the address.

Anyway it took me over six months to discover that my symptoms were the SSRI even though both doctors and myself knew of such effects. (go figure). Maybe this may be the cause of your continued symptoms. Worth discussing with DR

> I simply am sick to death of all these different drugs, I truly think there will never be a good day again.
>
> After a hospitalization from mid-April to early May for depression, I was sent home on Depakote and Zoloft. My pdoc quit the Zoloft after I told him it didn't seem to add any effect to the Depakote except give me a headache. Within two weeks, I was depressed again. Not as bad (no hospital needed) and a more withdrawn, dark, flat depression. I guess the Depakote was stopping severe swings and the anxiety.
>
> As I mentioned in an earlier post, I quit all my meds and felt much better. For a few days. Then the depression came back, and the mood instability, and everything else.
>
> A week ago, was re-started on Depakote and started on Remeron. Even with this AD, I am an irritable, short-tempered prick. I get mad/frustrated so easily, look for arguements (mostly with wife), and can't stand it. I've had this response with every AD. So it's not a switch into mania, I'd say. I mean, what are the chances of EVERY AD causing this reaction within 1-2 days of starting medication. Especially with stabilizer on board? Is it an "unmasking" of depressive irritability/anxiety? Or something else?
>
> Any ideas? I can't stand it, neither can my wife. My doctor seems VERY hesitant to use any neuroleptics. I do have some suspiciousness/paranoia, but no delusions ro psychosis to speak of.
>
> I feel a hospital trip may be in order soon if things don't calm down soon.


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