![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Mr.Scott on July 16, 2001, at 17:43:27
New doc with new DX same old drugs...
It is possible that I suffer from a mixed bipolar II state, although until now I have always thought of myself as a chronically anxious depressive. Lithium and Depakote are out of the question for me as I find them to have obnoxious side effects. Does anyone know where I might turn next after these options? I am interested in Topamax and lamictal but have no experience or knowledge about them.
If anyone has a moment to post let me know which I might try first.
A bit more about me first..
I am almost always depressed and anxious SSRI's help a little as do benzos but SSRI's also have many side effects for me and cause agitation and restlessness, had a history of childhood conduct disorder (possible ADHD). I have a normal to HIGH sex drive, if anything I overeat and oversleep, but would not if I wasn't on SSRI's and benzo's. My mind is NEVER at rest always filled with activity and often agony. I am extremely tired and am highly obsessive. A part of my brain is CLEARLY overactive. While my body feels as though it has been run over by a truck. I have tried to commit suicide seriously once about 5 years ago, and I frequently think about it. Every once in while I wake up feeling great then I begin to worry about bipolar disorder and my day is again ruined in a matter of hours. I have never had ANY florid MANIC symptoms (ie. Feeling godlike, and thinking I'm Jesus). I been been depressed for about 10 years now with several periods of feeling good. I did have a SERIOUS cocaine problem at one time.I currently hate my life, my girlfriend of 5 years and I broke up 8 weeks ago, I don't much care for my job, and I spend too much money (no discipline/impulsive).
Please help me find some direction. I'm thinking anticonvulsants but these docs aren't half as good as their patients I'm finding..
Mr.Scott
Posted by Zo on July 16, 2001, at 18:33:46
In reply to Best Tolerated Anti-Convulsant for BP, posted by Mr.Scott on July 16, 2001, at 17:43:27
Did you see my post on the other BPII thread about the Omega-3 regiment my pdoc wants to try before we go on to, I suppose, Lamictal. . .since I've already bombed out on Zyprexa, Geodon and Risperdol.
Having read widely on all three, it looks like best tolerated is as individual as we are. Neurontin is a very mild AC, anti-anxiety and pain med, which provides a good background for BP, but doesn't seem to be enough alone. It is very calming, and not sedating after initial side-effects, calms all those over-excited GABA receptor sites. Zyprexa causes weight gain for many, manuf. now saying that is mediated with Axid twice a day, an $$ OTC antacid. . .not for me! But wow, was it a great med.
Klonopin is the only benzo that is actually helpful, not just a bandaid - not that we don't need bandaids! sometimes for years! - but Klonopin has antiseizure and mood-stabilizing properties. Most benzos actually diminish Stage 4 sleep, which is so important to not activating mood swings.
OmegaBrite is online, post if you want the regimen repeated. My pdoc is definitely a med guy, this is the only "supplement" he's ever put me on.
Topamax seems to vary; I'd go on either T and Lamictal verrry gradually, and may. . .See Cece's posts.
Good luck,
Zo
Posted by Janelle on July 16, 2001, at 19:36:40
In reply to Best Tolerated Anti-Convulsant for BP, posted by Mr.Scott on July 16, 2001, at 17:43:27
Mr. Scott - a lot of what you mention also describes my symptoms.
I just started on an anti-convulsant, Lamictal. My pdoc suggested either that one or Depakote, and fear of possible hair loss kept me from trying Depakote (my hair is thin as it is and sheds a lot as it is; I don't need to be on a med that could make it worse!).
Because of the rash issue, I'm starting on microdose/pediatric dose of Lamictal so I can't tell anything yet.
Don't know if you've tried Zyprexa (that's an anti-psychotic, but don't let the class of med alarm you) that works on anxious depression. It has worked WONDERS for me thus far, although the drowsy/spacey feeling side effect has yet to wear off (has gotten better tho!). It also gives me the munchies, but having lost a lot of weight recently, I am determined not to give in and not to have to take another med to counteract this.
I feel like a walking pharmacy as it is.I've been on Klonopin for years, but it is inconsistent in helping with my anxiety.
I'd suggest that if you go the a-c route, you try Lamictal or Neurontin, the latter sounds like it is mild and perhaps the "most tolerable", but then again we are all so DIFFERENT in our reactions to these meds - what works for one person often does not work for another.
Sounds like with all your stuff going on, you are in better shape than I am because at least you are able to WORK. I'm not. :-(
I agree with your finding that many of the pdocs aren't half as good as their patients. This board is a wonderful source of good, accurate, intelligent and informative material.
-Janelle
Posted by Mitch on July 16, 2001, at 23:53:16
In reply to Best Tolerated Anti-Convulsant for BP, posted by Mr.Scott on July 16, 2001, at 17:43:27
Mr. Scott,
You didn't mention Neurontin in your post. Have you tried that?? It has been found to be good for anxiety/depression/OCD/ADHD problems. Topamax might be helpful for the OCD-like symptoms too, but can cause a lot of cognitive dysfunction. From what you mentioned below-it sounds a lot like limbic ADHD. Have you tried a non-SSRI like Wellbutrin?? Or a secondary-amine TCA like Nortriptyline or Desipramine? Serious past coke trouble could be self-medication for ADHD.I can't handle Li due to GI disturbance and Depakote is easier to handle, but does practically zero for my depression. Haven't tried Lamictal yet.
This is a super long-shot, but what if you combined Neurontin (say 600mg/day)for obsessiveness/mood stabilization/attentiveness with Gabitril (say 4-8mg bedtime), which I have found to be activating/mood elevating-but don't go high on dose (esp. during the day) or you can get some cognitive trouble. Try that with NO ad's or benozs.??? If you still feel bummed-try 100mg Wellbutrin SR in the mornings. Just suggestions,
Mitch
> New doc with new DX same old drugs...
>
> It is possible that I suffer from a mixed bipolar II state, although until now I have always thought of myself as a chronically anxious depressive. Lithium and Depakote are out of the question for me as I find them to have obnoxious side effects. Does anyone know where I might turn next after these options? I am interested in Topamax and lamictal but have no experience or knowledge about them.
>
> If anyone has a moment to post let me know which I might try first.
>
> A bit more about me first..
> I am almost always depressed and anxious SSRI's help a little as do benzos but SSRI's also have many side effects for me and cause agitation and restlessness, had a history of childhood conduct disorder (possible ADHD). I have a normal to HIGH sex drive, if anything I overeat and oversleep, but would not if I wasn't on SSRI's and benzo's. My mind is NEVER at rest always filled with activity and often agony. I am extremely tired and am highly obsessive. A part of my brain is CLEARLY overactive. While my body feels as though it has been run over by a truck. I have tried to commit suicide seriously once about 5 years ago, and I frequently think about it. Every once in while I wake up feeling great then I begin to worry about bipolar disorder and my day is again ruined in a matter of hours. I have never had ANY florid MANIC symptoms (ie. Feeling godlike, and thinking I'm Jesus). I been been depressed for about 10 years now with several periods of feeling good. I did have a SERIOUS cocaine problem at one time.
>
> I currently hate my life, my girlfriend of 5 years and I broke up 8 weeks ago, I don't much care for my job, and I spend too much money (no discipline/impulsive).
>
> Please help me find some direction. I'm thinking anticonvulsants but these docs aren't half as good as their patients I'm finding..
>
> Mr.Scott
Posted by Elizabeth on July 17, 2001, at 0:34:22
In reply to Best Tolerated Anti-Convulsant for BP, posted by Mr.Scott on July 16, 2001, at 17:43:27
> New doc with new DX same old drugs...
Isn't it always that way? Well, almost.
> It is possible that I suffer from a mixed bipolar II state, although until now I have always thought of myself as a chronically anxious depressive. Lithium and Depakote are out of the question for me as I find them to have obnoxious side effects.
Lithium isn't really indicated for mixed states, anyway. You could try Tegretol, or its newer and gentler cousin, Trileptal (oxcarbazepine). Lamictal and Neurontin also have pretty good reputations; Topamax might be something to try if those don't work.
Another approach, if mood stabilisers don't seem to be helping, would be to try psychostimulants. The AD Wellbutrin is stimulant-like and is considered to be preferable to other ADs for bipolar disorder (along with the MAO inhibitors).
Alternatively, consider just going on benzos. You might simply have generalised anxiety disorder.
> I have tried to commit suicide seriously once about 5 years ago, and I frequently think about it.
Some people find that atypical antipsychotics in low doses (Zyprexa 2.5-5 mg, for example) help with obsessive suicidal thoughts. (You just take it when the obsessions are bad, you don't have to be on it all the time.)
> I did have a SERIOUS cocaine problem at one time.
What did cocaine do for you?
-elizabeth
Posted by Kingfish on July 17, 2001, at 11:10:34
In reply to Re: Best Tolerated Anti-Convulsant for BP » Mr.Scott, posted by Elizabeth on July 17, 2001, at 0:34:22
Mr. Scott:
Here's my experience.
Diagnosed BP II, I think I'm BP I, due to psychotic symptoms. Whatever.
Some of your symptoms are similar to mine. Topamax stopped the racing thoughts, and obsessive/compulsive qualities. It did not help my depression. Prozac seems to be helping my depression but it has brought the OCD, BIG TIME, and added anxiety to the mix.
Topamax has been extremely sedating for me, but I haven't seen others complain of that. The cognitive side effects went away for me, but for some, they stay.
I also take Neurontin - it is calming, but did not work on its own, and I don't think it usually does.
I am currently fighting with my pdoc to start Lamictal because it is activating (he doesn't want to switch from the Topamax because it has worked).
So, in answer, I don't know which has less side effects. I don't think the Neurontin alone will help, but combined with one of the other two, it should.
But, the Topamax made a huge difference in my life as far as calming my mind, helping me to think more literally, and finally giving me some sense of peace.
- K.
Posted by Mr.Scott on July 17, 2001, at 12:22:24
In reply to Re: Best Tolerated Anti-Convulsant for BP, posted by Kingfish on July 17, 2001, at 11:10:34
Thank you all for replying to my post.
No one else understands.. Friends and family think I'm nuts which is true, but they cannot offer anything in the way of advice. And every doctor has a new opinion. The last doc thought my condition was "neurological" and certainly not bipolar. The new one says it must be bipolar. The famous child psychiatrist Bennet Leventhal said it was not bipolar, while another insisted It was (about 13 years ago).So it sounds like most of you think the new Dx of bipolar could be a real possibility. I know categories and labels really aren't that important, and a couple people suggested either GAD or Limbic ADHD. Regardless, of the name the case for anticonvulsants for me seems pretty compelling.
I want to formulate a list of anticonvulsants and give it to my doc and say "here, I want to try all these until I find one that is tolerable and effective."
Mr.Scott
Posted by MM on July 17, 2001, at 12:33:03
In reply to so it seems, posted by Mr.Scott on July 17, 2001, at 12:22:24
Three new anti-epileptics are out:
Zonisamide
Tiagabine
LevitiracetamThere's also the standard ones, which I can probably find a list of if you need it.
Posted by Mitch on July 17, 2001, at 13:21:02
In reply to Re: so it seems, posted by MM on July 17, 2001, at 12:33:03
Hey, has anybody tried these? The two newest ones are zonisamide and levitiracetam. They are marketed in the U.S. as Zonegran and Keppra.
I posted a Zonegran thing once before, but got no replies. My pdoc mentioned Zonegran a few months ago, but I was wary about switching/adding anything at that time.
> Three new anti-epileptics are out:
> Zonisamide
> Tiagabine
> Levitiracetam
>
> There's also the standard ones, which I can probably find a list of if you need it.
Posted by MM on July 17, 2001, at 13:34:35
In reply to Re: Levitiracetam Zonisamide anybody tried them? » MM, posted by Mitch on July 17, 2001, at 13:21:02
There's a poster on another board who's on Tiagabine (Gabatril) and likes it a lot. If I find any other info i'll post it.
Posted by MM on July 17, 2001, at 14:14:46
In reply to Re: Levitiracetam Zonisamide anybody tried them?, posted by MM on July 17, 2001, at 13:34:35
http://www.mhsource.com/pt/p990564.html
(article about meds in the works)http://home.borism.net/pmbrig/BP_pharm.html#ZNS
(lots of info, scroll down to investigational meds)Sorry, I'm not finding much.
clinical class: anticonvulsant
--------------------------------------------------------------------------------
The term anticonvulsant describes the category of drug whose original or most common use and intended therapeutic effect is to control or prevent epileptic seizures or convulsions.
carbamazapine | Celontin | Cerebyx | clonazepam | clorazepate | Depakene | Depakote | dephenylhydantoin | diazepam | Dilantin | ethosuximide | ethotoin | Felbatol | felbamate | fosphenytoin | gabapentin | Gabitril | Klonopin | lamotrigine | Lamictal | Mebaral | mephobarbital | methosuximide | Mogadon | Mysoline | Neurontin | nitrazepam | Peganone | phenacemide | phenobarbital | Phenurone | phenytoin | primidone | Sabril | Tegretol | tiagabine | Topamax | topiramate | Tranxene | Valium | valproate | vigabatrin | Zarontin | Zonegran | zonisamide
There's one list I found of anti-convulsants.
http://www.bipolarnetwork.org/new_site/Clinical/
(site about med trials)
Posted by susan C on July 17, 2001, at 14:21:41
In reply to Re: Levitiracetam Zonisamide anybody tried them? » MM, posted by Mitch on July 17, 2001, at 13:21:02
http://www.bipolarnetwork.org/new_site/Clinical/ on this site, is Levitiracetam study. My pdoc mentioned it as something up and coming to investigate. I haven't taken it.
> Hey, has anybody tried these? The two newest ones are zonisamide and levitiracetam. They are marketed in the U.S. as Zonegran and Keppra.
> I posted a Zonegran thing once before, but got no replies. My pdoc mentioned Zonegran a few months ago, but I was wary about switching/adding anything at that time.
>
>
> > Three new anti-epileptics are out:
> > Zonisamide
> > Tiagabine
> > Levitiracetam
> >
> > There's also the standard ones, which I can probably find a list of if you need it.
Posted by AnnieC on July 17, 2001, at 14:35:09
In reply to Re: Levitiracetam Zonisamide anybody tried them? » MM, posted by Mitch on July 17, 2001, at 13:21:02
I have epilepsy and have taken both Zonegran and Keppra. I was part of the Stage 4 clinical trials for Keppra. So far as seizures were concerned, both helped me for a short period of time, but like most of the anti-convulsants I've taken they've made my depression much worse. It amazes me that they're prescribed for depression when one of the side effects is depression as well as a number of other behavioral and cognitive side effects. I currently take Topamax for the seizures (doesn't work that well, but is better than nothing) and EffexorXR for depression. Good luck if you try them. They both made me somewhat sleepy and affected me cognitively.
Posted by Mitch on July 18, 2001, at 0:05:10
In reply to Re: Levitiracetam Zonisamide anybody tried them?, posted by AnnieC on July 17, 2001, at 14:35:09
AnnieC,
Thanks for the reply. I have also noticed that when neuros push up AC doses you tend to get a lot of somnolence, depression, etc. But, for us bipolar folks, I wonder if *lower* doses than those usually used for seizure control would be adequate to control our illness without the side effects? I have read a post once from someone with TLE that mentioned that *reduced* seizure control (reduced dosages of AC's) sometimes is allowed by neuros to spare their patients mental health (depression/cognitive problems). The thing that fascinates me is MM's post about Keppra's supposed memory-enhancement effects upon animals in studies.
Mitch
> I have epilepsy and have taken both Zonegran and Keppra. I was part of the Stage 4 clinical trials for Keppra. So far as seizures were concerned, both helped me for a short period of time, but like most of the anti-convulsants I've taken they've made my depression much worse. It amazes me that they're prescribed for depression when one of the side effects is depression as well as a number of other behavioral and cognitive side effects. I currently take Topamax for the seizures (doesn't work that well, but is better than nothing) and EffexorXR for depression. Good luck if you try them. They both made me somewhat sleepy and affected me cognitively.
Posted by Mitch on July 18, 2001, at 0:19:36
In reply to Re: Levitiracetam Zonisamide anybody tried them?, posted by susan C on July 17, 2001, at 14:21:41
SusanC,
Thanks for the info! I got confused clicking around as to who posted it. It seems Keppra appears to have fewer cognitive adverse effects than Zonegran. The animal studies with enhanced-memory-well I will have to look into that one a little closer. I also found a medscape article that was discussing the mechanisms of AED's and mentioned that Keppra almost was excluded because it *failed* the "maximal electroshock test" that triggers generalized (grand mal) seizures and is commonly used to screen new AED meds, however it does *abolish* seizures brought on by a newer test (designed and modeled for partial seizures) that is a "6Hz corneal stimulation model of pharmacoresistant partial seizures". Anyway, here is a link for anyone who can get into Medscape-it is an interesting article!
http://pharmacotherapy.medscape.com/CMECircle/Neurology/2001/CME02/CME02-17.htmlMitch
> http://www.bipolarnetwork.org/new_site/Clinical/ on this site, is Levitiracetam study. My pdoc mentioned it as something up and coming to investigate. I haven't taken it.
>
> > Hey, has anybody tried these? The two newest ones are zonisamide and levitiracetam. They are marketed in the U.S. as Zonegran and Keppra.
> > I posted a Zonegran thing once before, but got no replies. My pdoc mentioned Zonegran a few months ago, but I was wary about switching/adding anything at that time.
> >
> >
> > > Three new anti-epileptics are out:
> > > Zonisamide
> > > Tiagabine
> > > Levitiracetam
> > >
> > > There's also the standard ones, which I can probably find a list of if you need it.
Posted by MB on July 18, 2001, at 2:11:29
In reply to Best Tolerated Anti-Convulsant for BP, posted by Mr.Scott on July 16, 2001, at 17:43:27
> New doc with new DX same old drugs...
>
> It is possible that I suffer from a mixed bipolar II state, although until now I have always thought of myself as a chronically anxious depressive. Lithium and Depakote are out of the question for me as I find them to have obnoxious side effects. Does anyone know where I might turn next after these options? I am interested in Topamax and lamictal but have no experience or knowledge about them.
>
> If anyone has a moment to post let me know which I might try first.
>
> A bit more about me first..
> I am almost always depressed and anxious SSRI's help a little as do benzos but SSRI's also have many side effects for me and cause agitation and restlessness, had a history of childhood conduct disorder (possible ADHD). I have a normal to HIGH sex drive, if anything I overeat and oversleep, but would not if I wasn't on SSRI's and benzo's. My mind is NEVER at rest always filled with activity and often agony. I am extremely tired and am highly obsessive. A part of my brain is CLEARLY overactive. While my body feels as though it has been run over by a truck. I have tried to commit suicide seriously once about 5 years ago, and I frequently think about it. Every once in while I wake up feeling great then I begin to worry about bipolar disorder and my day is again ruined in a matter of hours. I have never had ANY florid MANIC symptoms (ie. Feeling godlike, and thinking I'm Jesus). I been been depressed for about 10 years now with several periods of feeling good. I did have a SERIOUS cocaine problem at one time.
>
> I currently hate my life, my girlfriend of 5 years and I broke up 8 weeks ago, I don't much care for my job, and I spend too much money (no discipline/impulsive).
>
> Please help me find some direction. I'm thinking anticonvulsants but these docs aren't half as good as their patients I'm finding..
>
> Mr.ScottYou just described *my* problems to the "t" including the cocaine (although I used other illicit substances too). Let me know what works for you. The fatigue, feeling like you've been "hit by a truck," depressed most of the time with periods of seeming normalcy, no obvious manic phases, agitation with the SSRIs...these symptoms are the same that I'm dealing with. Good luck to you! Let me know what helps you...it might help me also. After 10 years of being on the psych-med merry-go-round, I don't think I could cope being a pdocs guinnea pig another time. If I knew a general direction in which to go, it might be a different story. Do you think the bipolar II label fits you? I don't think it fits me: I've never had a decreased need for sleep, no euphoria. Just a gut-wrenching, heart-pounding, obsessive anxiety marked by malaise and fatigue, alternating with deep periods of depression where I stay in bed for days.
Posted by Mr.Scott on July 18, 2001, at 17:18:38
In reply to Re: Best Tolerated Anti-Convulsant for BP » Mr.Scott, posted by MB on July 18, 2001, at 2:11:29
You know something.. I couldn't agree with you more about questioning the BPII Dx. I really think I have something that crosses several boundries in the DSM. Has anything worked for you? I guess Benzos and low dose SSRI's seem to be my best hope to date, but they are far from perfect. Have you tried Remeron? My teeth are always clenched from prozac, but without it I fall off into hell rather quickly. The Anxiety is a staple in my life with obsessive thinking even when I do feel okay. Stress clearly aggravates my condition, but is not the sole cause. Also, Let me know if anything has Definately NOT worked. I tried to commit suicide on a combo of Prozac and Wellbutrin 5 or six years ago, So I can't recommend that one. What is your response to caffiene? I need it stay awake, but it causes me great misery. What is your most recent Dx.. I am very curious to find someone else who has such similar qualities.
Mr.Scott
Posted by MB on July 18, 2001, at 21:37:19
In reply to Re: Best Tolerated Anti-Convulsant for BP » MB, posted by Mr.Scott on July 18, 2001, at 17:18:38
> You know something.. I couldn't agree with you more about questioning the BPII Dx. I really think I have something that crosses several boundries in the DSM. Has anything worked for you? I guess Benzos and low dose SSRI's seem to be my best hope to date, but they are far from perfect. Have you tried Remeron? My teeth are always clenched from prozac, but without it I fall off into hell rather quickly. The Anxiety is a staple in my life with obsessive thinking even when I do feel okay. Stress clearly aggravates my condition, but is not the sole cause. Also, Let me know if anything has Definately NOT worked. I tried to commit suicide on a combo of Prozac and Wellbutrin 5 or six years ago, So I can't recommend that one. What is your response to caffiene? I need it stay awake, but it causes me great misery. What is your most recent Dx.. I am very curious to find someone else who has such similar qualities.
>
> Mr.ScottWell, as far as my last diagnosis goes, it's been "major depression," but this was before bipolar II became popular amongst diagnosing pdocs. I imagine there would be some pdocs out there wanting to diagnose me as BPII. I say this because of the similarity of my symptoms to other people (like yourself) who have been DXed as BPII.
Wellbutrin drove me out of my mind. I could handle it with large doses of Xanax, however. SSRIs seem to alleviate the depression at first and then poop out...all the while creating "racing" thoughts, restlesness, anxiety, etc. As with you, SSRIs and a benzo has been the best legal treatment I've recieved. However, my history of drug abuse precludes most pdocs from even going *near* benzos where I am concerned.
Strangly, speaking of the obsession you mentioned above, the SSRIs made it *much* worse. Was that you're experience? Can obsessions be due to anxiety and not due to obsessive compulsive disorder? I think mine are just due to anxious worry. I guess "worry" and "obsession" might be differnt...I get them confused with one another.
About caffeine: it makes me miserable: anxiety, racing thoughts, facial tics, and diaphragmatic tics (like little, barely-audible coughs). I can tolorate two cups, max, separated by no fewer than five hours. I've tried to quit a million times, but the suicidal depression that ensues is unbearable.
Are you going to try anti-convulsive medication? I found neurontin to be a very easily tolorated one. I took it for restless leg symptoms, and can't remember what it did to my mood.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.