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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by cb on August 14, 2001, at 18:07:03
My bipolar son has been very anxious and depressed. Dr has taken him off synthroid, neurontin, and klonopin. He is currently on lithobid (1200 mg) and zyprexa (10 mg) and Wellbutrin (400 mg). Previously he was on zoloft, paxil and celexa while taking depakote. His doctor is considering putting him back on an SSRI and upping his lithium. SSRIs have always made him manic before (while on the Depakote). Does anyone have experience with the SSRIs and lithium. I think someone who answered me before mentioned taking prozac and a mood stabilizer after having gotten manic from the SSRI? I would really appreciate input. We are a little nervous about the SSRI since the SSRI manias were aggressive and violent. Unfortunately, they seem to have been the only thing that has helped the depression. Thank you, thank you, thank you - anxious mom
Posted by Mitch on August 15, 2001, at 0:27:43
In reply to Bipolar meds/anxiety-follow up from anxious mom, posted by cb on August 14, 2001, at 18:07:03
> My bipolar son has been very anxious and depressed. Dr has taken him off synthroid, neurontin, and klonopin. He is currently on lithobid (1200 mg) and zyprexa (10 mg) and Wellbutrin (400 mg). Previously he was on zoloft, paxil and celexa while taking depakote. His doctor is considering putting him back on an SSRI and upping his lithium. SSRIs have always made him manic before (while on the Depakote). Does anyone have experience with the SSRIs and lithium. I think someone who answered me before mentioned taking prozac and a mood stabilizer after having gotten manic from the SSRI? I would really appreciate input. We are a little nervous about the SSRI since the SSRI manias were aggressive and violent. Unfortunately, they seem to have been the only thing that has helped the depression. Thank you, thank you, thank you - anxious mom
AnxMom,
So, given the lithium, Wellbutrin, and Zyprexa your son is still showing mixed anxiety and depression but the manic symptoms are currently being controlled, right? Given the prominent anxiety he has displayed and sensitivity to SSri's I would wonder if the Wellbutrin dosage may be much too high (he could be experiencing primary anxiety/agitation that is feeding the depression).
First, I would consider dropping down the Wellbutrin and see if his anxiety falls off and given the reduction of anxiety his mood *improves*. I mean, you haven't seen him depressed without being anxious and agitated, correct?
Another thing to consider after that, would be the possibility that the Zyprexa could be causing agitation as well.
I wouldn't be surprised if he could be on lithium+ a low-dose of Remeron or Serzone (something somewhat sedative and anxiolytic) and respond quite well.
Mitch
Posted by stjames on August 15, 2001, at 1:25:17
In reply to Re: Bipolar meds/anxiety-follow up from anxious mom » cb, posted by Mitch on August 15, 2001, at 0:27:43
To treat depression in BP you have to use the antidepressants. All AD's tend to cause mania in BP. It is common practice to counter this with anti-mania meds, finding a correct balance with the 2.
j
Posted by cb on August 15, 2001, at 7:23:42
In reply to Re: Bipolar meds/anxiety-follow up from anxious mom » cb, posted by Mitch on August 15, 2001, at 0:27:43
> > >
> So, given the lithium, Wellbutrin, and Zyprexa your son is still showing mixed anxiety and depression but the manic symptoms are currently being controlled, right?
yes.
Given the prominent anxiety he has displayed and sensitivity to SSri's I would wonder if the Wellbutrin dosage may be much too high (he could be experiencing primary anxiety/agitation that is feeding the depression).
>
> First, I would consider dropping down the Wellbutrin and see if his anxiety falls off and given the reduction of anxiety his mood *improves*. I mean, you haven't seen him depressed without being anxious and agitated, correct?Actually, we have only seen the mania in response to the AD. His predominant problem is the depression - the anxiety is a pretty new symptom (last 3 months).
>
> Another thing to consider after that, would be the possibility that the Zyprexa could be causing agitation as well.
>
> I wouldn't be surprised if he could be on lithium+ a low-dose of Remeron or Serzone (something somewhat sedative and anxiolytic) and respond quite well.
>
Thanks, we'll ask the dr about this.He's getting pretty frustrated since he hasn't felt "good" in 6 mos. (including 3 in the hospital), and senior year of high school starts in 3 weeks!
Posted by Mitch on August 15, 2001, at 10:09:42
In reply to Re: Bipolar meds/anxiety-follow up from anxious mom, posted by cb on August 15, 2001, at 7:23:42
> > So, given the lithium, Wellbutrin, and Zyprexa your son is still showing mixed anxiety and depression but the manic symptoms are currently being controlled, right?
> Actually, we have only seen the mania in response to the AD. His predominant problem is the depression - the anxiety is a pretty new symptom (last 3 months).
You are in one of those dilemmas where you can get the highs under control, but there is lingering depression, but adding an antidepressant provokes breakthrough manic symptoms. I am bipolar and have fought with that for a long time. It looks as though his doc is looking to adding/switching to an SSri (since he had an AD response to it previously). I was on lithium+Prozac for about 7 years. It worked ok, but I had to keep the Prozac dose very low or it would set off very pronounced hypomania. If he adds an Sri I would suggest a low dose of Paxil (5mg/day) and watch him closely to see how he reacts to it. If he gets a *little* high-I wouldn't get real concerned as long as doesn't become irritable or hostile and he is sleeping a reasonable amount. The main reason I mentioned Paxil is that it tends to be anxiolytic and it has a short half-life, so if it "boomerangs" on you, it will get out of his system rapidly if you withdraw it.
> He's getting pretty frustrated since he hasn't felt "good" in 6 mos. (including 3 in the hospital), and senior year of high school starts in 3 weeks!
The anxiety in some part could be the pressure to "get well" before school starts and some anticipatory anxiety about the atmosphere there given his recent problems (how classmates are going to treat him). Does he ruminate about and feel apprehensive about returning to school?
Posted by AMenz on August 18, 2001, at 22:55:29
In reply to Bipolar meds/anxiety-follow up from anxious mom, posted by cb on August 14, 2001, at 18:07:03
I'm on lithium and a very low dosage of SSRI because I get into mixed mania with SSRI
For years before I was on parnate which gave me tachichardia and other symptoms but lifted depression withou producing mania.
However, supposedly bipolar once they stabilize on lithium will feel less depressed. Adding antidepressants is like adding fuel to the fire.
The child needs some time to reach mood stability. I think frequent changes in medication are themselves contributing to mood instability and should be avoided unless the side effects are intolerable and create need for change.
I think most psychiatrists do not follow the accepted algorith for bipolar disorder and wind up starting with things like neurontin, lamictal, instead of the lithium or depakote base for treatment.
Support etc if he is depressed but no in danger (i.e., suicidal) might get him through until lithium effects mood stability.
Stabilizing his circadian routine, sleep at same time, meals at same times, exercise at same time, has also a powerful effect in promoting mood stabilization, and is now recommended I believe, by Mass General Hospital which has an excellent bipolar program.
Verbal therapy can only help deal with the symptoms specially for a young person first encountering this frightening experience.
The good news is that after the first episodes in teens, bipolars tend to stabilize for up to 5 years.
There is a light at the end of the tunnel.
Good luck. I'm an agnostic but have gotten to the point where I pray regularly to whoever or whatever is out there. I'll include you.
> My bipolar son has been very anxious and depressed. Dr has taken him off synthroid, neurontin, and klonopin. He is currently on lithobid (1200 mg) and zyprexa (10 mg) and Wellbutrin (400 mg). Previously he was on zoloft, paxil and celexa while taking depakote. His doctor is considering putting him back on an SSRI and upping his lithium. SSRIs have always made him manic before (while on the Depakote). Does anyone have experience with the SSRIs and lithium. I think someone who answered me before mentioned taking prozac and a mood stabilizer after having gotten manic from the SSRI? I would really appreciate input. We are a little nervous about the SSRI since the SSRI manias were aggressive and violent. Unfortunately, they seem to have been the only thing that has helped the depression. Thank you, thank you, thank you - anxious mom
Posted by judy1 on August 21, 2001, at 23:40:56
In reply to Bipolar meds/anxiety-follow up from anxious mom, posted by cb on August 14, 2001, at 18:07:03
I'm another one who ALWAYS gets psychotic manic episodes on SSRI's no matter what mood stabilizer(s) are in place. I can't believe your son's docs are still giving him AD's with his history. I agree 100% with AMenz's post- get the mood stabilizer in place and unless he is suicidal load on the therapy and all the other known stability modes- sleep, exercise, etc. I loathe this polypharmacy approach, it doesn't work and you turn into a treatment resistant rapid-cycler (like me). Does he have a really GOOD therapist?- judy
Posted by Zo on August 22, 2001, at 1:33:05
In reply to Re: Bipolar meds/anxiety-follow up from anxious mom » cb, posted by judy1 on August 21, 2001, at 23:40:56
Hey!
(she says in Civil tones)I owe my *life* to polypharmacy!
Of course, YMMV.
:) Zo
Posted by cb on August 22, 2001, at 8:36:26
In reply to Re: Bipolar meds/anxiety-follow up from anxious mom » cb, posted by judy1 on August 21, 2001, at 23:40:56
> Thanks for your input - it's nice to hear from someone with the same reaction to SSRIS (nice for us, not nice for you).
He does have a good therapist - he is comfortable going to him and they have a good relationship (he is going 2x/wk these days) - not an easy thing for a 16 yr. old male!!
We saw a psychopharmocologist yesterday who is recommending adding tegretol to the lithium, wellbutrin and zyprexa that he is on now - then eliminating the zyprexa (possible cause of anxiety) and lowering the wellbutrin. We always come back to the depression though. Dr says that the tegretol has some antidepressant qualities. We have our fingers crossed!
Posted by cb on August 22, 2001, at 8:38:04
In reply to Re: Bipolar meds/anxiety-follow up from anxious mom » cb, posted by judy1 on August 21, 2001, at 23:40:56
> Thanks for your input - it's nice to hear from someone with the same reaction to SSRIS (nice for us, not nice for you).
He does have a good therapist - he is comfortable going to him and they have a good relationship (he is going 2x/wk these days) - not an easy thing for a 16 yr. old male!!
We saw a psychopharmocologist yesterday who is recommending adding tegretol to the lithium, wellbutrin and zyprexa that he is on now - then eliminating the zyprexa (possible cause of anxiety) and lowering the wellbutrin. We always come back to the depression though. Dr says that the tegretol has some antidepressant qualities. We have our fingers crossed!
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