Psycho-Babble Medication Thread 79893

Shown: posts 11 to 35 of 35. Go back in thread:

 

Re: Thanks all, very helpful! (nm)

Posted by chloe on September 30, 2001, at 19:59:52

In reply to Re: LITHIUM helping depression..., posted by Mitch on September 30, 2001, at 1:27:23

 

Re: Is the LITHIUM causing this?

Posted by SLS on October 1, 2001, at 8:11:46

In reply to Re: Is the LITHIUM causing this? chloe, posted by Sunnely on September 29, 2001, at 17:12:53

> SSRIs by themselves such as Prozac, Zoloft, Paxil, Luvox, and Celexa have been reported to induce akathisia. The exact mechanism is unclear. It is postulated that the enhanced serotonin effect of SSRIs mediate inhibition of dopamine in the brain leading to EPS such as akathisia.


Hi Sunnely.

By what mechanisms does lithium exert its pro-serotonergic effects?

Thanks.


- Scott

 

Re: Is the LITHIUM causing this? SLS

Posted by Sunnely on October 1, 2001, at 19:14:18

In reply to Re: Is the LITHIUM causing this?, posted by SLS on October 1, 2001, at 8:11:46

> Hi Sunnely.
>
> By what mechanisms does lithium exert its pro-serotonergic effects?
>
> Thanks.
>
>
> - Scott

Hi Scott,

Exactly, I don't know. It appears that lithium enhances tryptophan uptake and has various other indirect effects on serotonin metabolism.

Here's an excerpt from a book explaining lithium's pro-serotonergic effect.

Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT). Furthermore, it enhances the effects of serotonergic antidepressant drugs, particularly in cases of tricyclic-resistant depression. Although the number (Bmax) and function of 5-HT2A receptors are modulated by several antidepressant therapies, lithium's effects on this serotonin receptor subtype is not straightforward. The 5-HT2 family of serotonin receptors is of particular interest because it activates, through a guanine nucleotide binding protein (G protein) linkage, the hydrolysis of phospholipase C (PLC), which activates the diacyglycerol (DAG) and inositol 1,4,5-triphosphate (IP3) second-messenger systems. Lithium's involvement in modulating 5-HT2A receptor function is probably not a simple matter of it altering receptor number or affinity, because many investigations have failed to show a consistent effect. The functional consequences of lithium on 5-HT2A receptor activity, as measured by behavioral responses, are equally ambiguous.

Reference: Bipolar Medications: Mechanisms of Action, 2000. Edited by Husseini K. Manji, MD, Charles L. Bowden, MD, and Robert H. Belmaker, MD. American Psychiatric Press, Inc., Washington, DC.

 

Re: LITHIUM, as the sole AD?

Posted by chloe on October 1, 2001, at 20:04:46

In reply to Re: Is the LITHIUM causing this? SLS, posted by Sunnely on October 1, 2001, at 19:14:18

> >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)

Hi Sunnely.

Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.

I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?

Thanks
Chloe

 

Re: LITHIUM, as the sole AD? chloe

Posted by Sunnely on October 1, 2001, at 22:48:14

In reply to Re: LITHIUM, as the sole AD?, posted by chloe on October 1, 2001, at 20:04:46

> > >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)
>
> Hi Sunnely.
>
> Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.
>
> I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?
>
> Thanks
> Chloe

******************************

Hi Chloe,

The answer to your question will most likely depend on what exactly is your diagnosis. If you are treatment-resistant depression (unipolar depression), then the use of an antidepressant (most probably with an adjunctive treatment such as lithium), is beneficial in a number of cases. However, if you belong to the bipolar disorder spectrum (e.g., Bipolar I, Bipolar II), the use of a mood stabilizer (or combination of mood stabilizers) without antidepressant is more beneficial than with antidepressants.

Antidepressants may be necessary in acute bipolar depression, but it is recommended that they be tapered and discontinued once the response has been established over 1-3 months. For those patients who relapse into depression, it is appropriate that they be maintained on antidepressants for a longer period of time.

FYI, the trend in the US among bipolar researchers and some practitioners has been to limit antidepressant use. This view has also tended to be supported by bipolar specialists in some parts of Europe, especially in the more Mediterranean countries, while some bipolar researchers in the US and many researchers in other parts of Europe, particular in the UK and some in Germany, feel less concerned about the drawbacks of antidepressant use in bipolar disorder and are more concerned that bipolar depression will go untreated.

The risks of long-term use of antidepressants in bipolar depression is acute manic switch or rapid cylcing. In a review done by Goodwin and Jamison, the early literature on tricyclic antidepressants (TCAs) generally suggests a rather high rate of switches to acute mania (in the 30% - 60% range) with those agents. Monoamine oxidase inhibitors (MAOIs) do not have a lower mania switch rate, though they appear to be more effective than TCAs in bipolar depression. Recent clinical studies suggest that the acute manic or hypomanic switch rate with SSRIs in bipolar I and II is not minor - being 15% -27%, even despite concurrent mood stabilizer treatment.

A number of bipolar disorder experts recommend "aggressive" use of mood stabilizers and brief trials of antidepressants. By "aggressive" use of mood stabilizers they mean routine polypharmacy (multiple mood stabilizers) with two or three mood-stabilizing agents. Since FDA-indicated agents for mania are few, this approach entails frequently using other drugs with mood stabilizing effects that may not be FDA-indicated for mania, such atypical antipsychotics and novel anticonvulsants.

Bottom line is, in your case, whether to use an antidepressant or not will depend on what exactly your diagnosis is. Some patients initially diagnosed with unipolar depression turn out to be bipolar disorder. Natural history studies largely indicate that untreated bipolar depressive episodes are briefer (mean 3-6 months) than unipolar depressive episodes (mean 6-12 months). Recent data also link a higher likelihood of lithium response for depression to very brief, recent depressive episodes. Post partum depressive episodes are also more frequent in bipolar disoder than unipolar depression. Recently, the antidepressant "wear off" phenomenon or "pooping out" (in which patients exhibit acute, but not prophylactic, response to antidepressants) has been linked to bipolar disorder. Lastly, lack of response to three or more adequate antidepressant treatment trials has long been considered a reason for reassessment of the unipolar depression.

If your diagnosis is bipolar II, "aggresive" use of mood stabilizers and limited use of antidepressant (only if absolutely necessary) is probably the best treatment approach. Since lamotrigine (Lamictal) appears to be beneficial in patients with bipolar depression, the combined use of lithium and lamotrigine (without antidepressant) may not be a bad idea in your case.

 

Re: Is the LITHIUM causing this? - Thank you. Sunnely

Posted by SLS on October 2, 2001, at 13:59:44

In reply to Re: Is the LITHIUM causing this? SLS, posted by Sunnely on October 1, 2001, at 19:14:18

Thanks again, Sunnely.

Manji was at the NIMH during my time there. He was considered by my immediate research clinician to be brilliant. He and Robert Post made a good team. They were really into PKC at the time - 1992.

Who would have thought that a simple monovalent ion could have such diverse and profound effects?


- Scott


> > Hi Sunnely.
> >
> > By what mechanisms does lithium exert its pro-serotonergic effects?
> >
> > Thanks.
> >
> >
> > - Scott
>
> Hi Scott,
>
> Exactly, I don't know. It appears that lithium enhances tryptophan uptake and has various other indirect effects on serotonin metabolism.
>
> Here's an excerpt from a book explaining lithium's pro-serotonergic effect.
>
> Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT). Furthermore, it enhances the effects of serotonergic antidepressant drugs, particularly in cases of tricyclic-resistant depression. Although the number (Bmax) and function of 5-HT2A receptors are modulated by several antidepressant therapies, lithium's effects on this serotonin receptor subtype is not straightforward. The 5-HT2 family of serotonin receptors is of particular interest because it activates, through a guanine nucleotide binding protein (G protein) linkage, the hydrolysis of phospholipase C (PLC), which activates the diacyglycerol (DAG) and inositol 1,4,5-triphosphate (IP3) second-messenger systems. Lithium's involvement in modulating 5-HT2A receptor function is probably not a simple matter of it altering receptor number or affinity, because many investigations have failed to show a consistent effect. The functional consequences of lithium on 5-HT2A receptor activity, as measured by behavioral responses, are equally ambiguous.
>
> Reference: Bipolar Medications: Mechanisms of Action, 2000. Edited by Husseini K. Manji, MD, Charles L. Bowden, MD, and Robert H. Belmaker, MD. American Psychiatric Press, Inc., Washington, DC.

 

Re: LITHIUM, as the sole AD? Sunnely

Posted by susan C on October 3, 2001, at 19:00:51

In reply to Re: LITHIUM, as the sole AD? chloe, posted by Sunnely on October 1, 2001, at 22:48:14

> > > >Many studies have shown that lithium affects the synthesis, turnover, release, and uptake of the monoamine neurotransmitter 5-hydroxytryptamine (serotonin; 5-HT)
> >
> > Hi Sunnely.
> >
> > Your post was extremely informative. But do you have any experience or knowledge of how effective Li is as an AD? I have discontinued the Celexa, and after two days, feel so much calmer and quieter inside. But of course I am a little worried that I will not feel too well without a traditional AD. I only seem to respond to SSRIs. Things like tricyclics, remeron and serzone were not of much use to me. And wellbutrin causes awful night sweats, the drenching kind.
> >
> > I guess my question is, are there some folks (with treatment resistant depression, BP 2, BPD) who get AD effect from Li without a traditional AD on board? I know everyone is different, but does any one have any experience with this?
> >
> > Thanks
> > Chloe
>
> ******************************
>
> Hi Chloe,
>
> The answer to your question will most likely depend on what exactly is your diagnosis. If you are treatment-resistant depression (unipolar depression), then the use of an antidepressant (most probably with an adjunctive treatment such as lithium), is beneficial in a number of cases. However, if you belong to the bipolar disorder spectrum (e.g., Bipolar I, Bipolar II), the use of a mood stabilizer (or combination of mood stabilizers) without antidepressant is more beneficial than with antidepressants.
>
> Antidepressants may be necessary in acute bipolar depression, but it is recommended that they be tapered and discontinued once the response has been established over 1-3 months. For those patients who relapse into depression, it is appropriate that they be maintained on antidepressants for a longer period of time.
>
> FYI, the trend in the US among bipolar researchers and some practitioners has been to limit antidepressant use. This view has also tended to be supported by bipolar specialists in some parts of Europe, especially in the more Mediterranean countries, while some bipolar researchers in the US and many researchers in other parts of Europe, particular in the UK and some in Germany, feel less concerned about the drawbacks of antidepressant use in bipolar disorder and are more concerned that bipolar depression will go untreated.
>
> The risks of long-term use of antidepressants in bipolar depression is acute manic switch or rapid cylcing. In a review done by Goodwin and Jamison, the early literature on tricyclic antidepressants (TCAs) generally suggests a rather high rate of switches to acute mania (in the 30% - 60% range) with those agents. Monoamine oxidase inhibitors (MAOIs) do not have a lower mania switch rate, though they appear to be more effective than TCAs in bipolar depression. Recent clinical studies suggest that the acute manic or hypomanic switch rate with SSRIs in bipolar I and II is not minor - being 15% -27%, even despite concurrent mood stabilizer treatment.
>
> A number of bipolar disorder experts recommend "aggressive" use of mood stabilizers and brief trials of antidepressants. By "aggressive" use of mood stabilizers they mean routine polypharmacy (multiple mood stabilizers) with two or three mood-stabilizing agents. Since FDA-indicated agents for mania are few, this approach entails frequently using other drugs with mood stabilizing effects that may not be FDA-indicated for mania, such atypical antipsychotics and novel anticonvulsants.
>
> Bottom line is, in your case, whether to use an antidepressant or not will depend on what exactly your diagnosis is. Some patients initially diagnosed with unipolar depression turn out to be bipolar disorder. Natural history studies largely indicate that untreated bipolar depressive episodes are briefer (mean 3-6 months) than unipolar depressive episodes (mean 6-12 months). Recent data also link a higher likelihood of lithium response for depression to very brief, recent depressive episodes. Post partum depressive episodes are also more frequent in bipolar disoder than unipolar depression. Recently, the antidepressant "wear off" phenomenon or "pooping out" (in which patients exhibit acute, but not prophylactic, response to antidepressants) has been linked to bipolar disorder. Lastly, lack of response to three or more adequate antidepressant treatment trials has long been considered a reason for reassessment of the unipolar depression.
>
> If your diagnosis is bipolar II, "aggresive" use of mood stabilizers and limited use of antidepressant (only if absolutely necessary) is probably the best treatment approach. Since lamotrigine (Lamictal) appears to be beneficial in patients with bipolar depression, the combined use of lithium and lamotrigine (without antidepressant) may not be a bad idea in your case.

Hi all

Maybe, just maybe, I am beginning to understand some of what is being said here on this board. The final section of your post is exactly what a 'world famous researcher' diagnosed and recommended for bipolar 2, rapid cycling. If my insurance had not been part of a negotiated coverage, off the street, that advice would have been $400. Again, I am impressed, in general, and in you, Sunnely, Thank you.

Unfortunately I did not respond well to lamitical.
but, 'that's (not) all folks'

Susan C (often self-referred to as mouse)

 

Re: LITHIUM, as the sole AD? Sunnely

Posted by Chloe on October 3, 2001, at 22:06:45

In reply to Re: LITHIUM, as the sole AD? chloe, posted by Sunnely on October 1, 2001, at 22:48:14

Thank you Sunnely,
As usually, your post was most informative.
Now several days of being off of celexa, I am "crashing." My pdoc seems to think that Li alone can be my antidepressant/mood stabilizer. I hope she is right, but I am not optimistic.

It is not completely clear what my diagnosis it. I have had major depression since puberty and am now 35. When i was younger, it seemed more unipolar with psychotic features, and treated wtih tricyclics, ssris, traditional aps, stimulants, depakote.

Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.

I have been on every mood stabilizer it seems. Even Lamictal. That was extremely energizing to me. For the two weeks I was on it, I felt like sleep was optional. I really wasn't fond of that one, though it does have powerful AD properties.

Hum, I said all that to say that I am sticking with the lithium and hopefully will be able to find some AD that I can add to the mix that won't send me into the stratosphere. What ever it is, it seems I will only need a little bit...

One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???

Thanks for listening
chloe

 

Re: LITHIUM, as the sole AD? Chloe

Posted by SLS on October 3, 2001, at 23:38:40

In reply to Re: LITHIUM, as the sole AD? Sunnely, posted by Chloe on October 3, 2001, at 22:06:45

> Thank you Sunnely,
> As usually, your post was most informative.
> Now several days of being off of celexa, I am "crashing." My pdoc seems to think that Li alone can be my antidepressant/mood stabilizer. I hope she is right, but I am not optimistic.
>
> It is not completely clear what my diagnosis it. I have had major depression since puberty and am now 35. When i was younger, it seemed more unipolar with psychotic features, and treated wtih tricyclics, ssris, traditional aps, stimulants, depakote.
>
> Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
>
> I have been on every mood stabilizer it seems. Even Lamictal. That was extremely energizing to me. For the two weeks I was on it, I felt like sleep was optional. I really wasn't fond of that one, though it does have powerful AD properties.
>
> Hum, I said all that to say that I am sticking with the lithium and hopefully will be able to find some AD that I can add to the mix that won't send me into the stratosphere. What ever it is, it seems I will only need a little bit...
>
> One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???
>
> Thanks for listening
> chloe


Hi Chloe.

I just wanted to let you know that I'm listening too.

Have you ever tried Buspar?


- Scott

 

Re: LITHIUM, as the sole AD? Chloe

Posted by Mitch on October 3, 2001, at 23:46:47

In reply to Re: LITHIUM, as the sole AD? Sunnely, posted by Chloe on October 3, 2001, at 22:06:45

> Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
>
> One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???

Hi Chloe,
I am in a similar situation as yourself. I have the best response with SSRI's for non-seasonal (intra-cyclical) bipolar depression and anxiety, but they exacerbate hypomania more than any other AD's. I can't take ANY (conventional or atypical)AP's due to EPS symptoms. My question is: Have you ever had a trial of an MAOI? I feel strongly that I could have a positive response to one. Tranylcypromine is indicated for bipolar depression and there is supposed to be fewer "switch" rates with MAOI's generally than SSRi's as a class. My pdoc is afraid of them and the last pdoc I had (a few years ago) was afraid of them too. Personally, I think I just saw the word "lawsuit" reading backwards in their eyeglasses. I realize the current "thinking" is "aggressive" use of mood stabilizers w/o AD's, but I am also skeptical. I have comorbid anxiety disorders that aren't helped much by without an AD. Have you had a trial of any MAOI's?

Mitch

 

Re: LITHIUM, as the sole AD? Mitch

Posted by SLS on October 4, 2001, at 9:47:36

In reply to Re: LITHIUM, as the sole AD? Chloe, posted by Mitch on October 3, 2001, at 23:46:47

> > Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
> >
> > One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???
>
> Hi Chloe,
> I am in a similar situation as yourself. I have the best response with SSRI's for non-seasonal (intra-cyclical) bipolar depression and anxiety, but they exacerbate hypomania more than any other AD's. I can't take ANY (conventional or atypical)AP's due to EPS symptoms. My question is: Have you ever had a trial of an MAOI? I feel strongly that I could have a positive response to one. Tranylcypromine is indicated for bipolar depression and there is supposed to be fewer "switch" rates with MAOI's generally than SSRi's as a class. My pdoc is afraid of them and the last pdoc I had (a few years ago) was afraid of them too. Personally, I think I just saw the word "lawsuit" reading backwards in their eyeglasses. I realize the current "thinking" is "aggressive" use of mood stabilizers w/o AD's, but I am also skeptical. I have comorbid anxiety disorders that aren't helped much by without an AD. Have you had a trial of any MAOI's?
>
> Mitch


Hi Mitch.

There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.

I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.

I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.


- Scott

 

Re: LITHIUM, as the sole AD? SLS

Posted by Mitch on October 4, 2001, at 13:06:02

In reply to Re: LITHIUM, as the sole AD? Mitch, posted by SLS on October 4, 2001, at 9:47:36

> Hi Mitch.
>
> There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.
>
> I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.
>
> I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.
>
>
> - Scott

Thanks Scott, for the response. I suppose I would need to clarify some stuff. I am what my pdoc calls "hyperresponsive" to meds. There have been situations where 1.25mg of Celexa (i.e.), triggered a potent hypomanic episode (like smoking grass) for about 2-8hrs after taking it. Another incident that was far more intense was taking 37.5mg of Effexor which also triggered a robust hypomanic episode that was also quite intense and brief (about 5 hrs). But...those type of meds make me more sociable and settle down panic and reduce anxiety generally. I was on Adderall (5mgAM) with no AD's and my cycling STOPPED and my sleep/wake cycles normalized and I had NO depression (poof!), but...I was cool distant quiet unhumorous. Then I got a thyroid tumor! Could you share some insights into this?

Mitch

 

Re: LITHIUM, crashing, ADs, etc

Posted by Chloe on October 5, 2001, at 20:26:06

In reply to Re: LITHIUM, as the sole AD? Sunnely, posted by Chloe on October 3, 2001, at 22:06:45

Well, I have realized I cannot survive without an AD. Lithium is not enough. I got so depressed and agitated I had to resort to Seroquel to stop a very desperate spiraling down. (The AP's work so well, but I can't continue on it due to tongue movements. This truly infuriates me.)

I also had a Li level drawn and on 600 mgs I am shocked to find out that I only have a level of 0.4. I have this jazzy feeling all the time, so I thought for sure I was up around 0.8 or so. Could the low level be one of the factors that allowed my mood to get so low and agitated? I wanted to go DOWN on the Li, but with this low level, I am not sure that is wise if I want any mood stabilization out of it.

Also, I was told to add 1 mg of Celexa back in. It's been 12 hours, and I feel so "up" and wired. I have no idea how I am going to sleep. I wish there were a better AD for me, but no way on the MAOI's. Thanks for the thought Mitch. But I would not be safe on such a drug. And my pdoc does not like Buspar. She hasn't seen any success with it. I was wondering if I could keep the Celexa during the day, and add maybe 25 mgs of Serzone at night. Perhaps serzone would have the calming effect that might last into the next day...and not the emotional lability that comes along with the higher doses.

This is all so complicated. And I feel so awful calling my pdoc every few days with the next crisis. I just can't seem to get stabilized.

Does anyone have any thoughts on my li level. Is it too low for mood stabilization?

How about Celexa with a splash of Serzone? Is this a good combo?

Thanks all.
Chloe

 

Re: LITHIUM, crashing, ADs, etc Chloe

Posted by Mitch on October 5, 2001, at 22:04:15

In reply to Re: LITHIUM, crashing, ADs, etc, posted by Chloe on October 5, 2001, at 20:26:06

> Well, I have realized I cannot survive without an AD. Lithium is not enough. I got so depressed and agitated I had to resort to Seroquel to stop a very desperate spiraling down. (The AP's work so well, but I can't continue on it due to tongue movements. This truly infuriates me.)
>
> I also had a Li level drawn and on 600 mgs I am shocked to find out that I only have a level of 0.4. I have this jazzy feeling all the time, so I thought for sure I was up around 0.8 or so. Could the low level be one of the factors that allowed my mood to get so low and agitated? I wanted to go DOWN on the Li, but with this low level, I am not sure that is wise if I want any mood stabilization out of it.
>
> Also, I was told to add 1 mg of Celexa back in. It's been 12 hours, and I feel so "up" and wired. I have no idea how I am going to sleep. I wish there were a better AD for me, but no way on the MAOI's. Thanks for the thought Mitch. But I would not be safe on such a drug. And my pdoc does not like Buspar. She hasn't seen any success with it. I was wondering if I could keep the Celexa during the day, and add maybe 25 mgs of Serzone at night. Perhaps serzone would have the calming effect that might last into the next day...and not the emotional lability that comes along with the higher doses.
>
> This is all so complicated. And I feel so awful calling my pdoc every few days with the next crisis. I just can't seem to get stabilized.
>
> Does anyone have any thoughts on my li level. Is it too low for mood stabilization?
>
> How about Celexa with a splash of Serzone? Is this a good combo?
>
> Thanks all.
> Chloe

Chloe, I don't know if you caught one of my posts earlier but have you ever tried a smidge of Paxil or Luvox before? I think Celexa may just be too activating an SSRI for you. I found it was more *wirey* in some ways than Zoloft (although I can sleep on the Celexa better).
I don't necessarily think that the serum lithium level is that predictive when it comes to BPII and unipolar depression. I got by on 300mg a day for years-which certainly was less than .4. If I got into a dicey situation at work (lots of stress/anger) I would up to 450mg for a few days and I could tell a difference. I think if you stayed on 600mg/day for a solid month or so and it didn't get much better I would doubt if more of it would help that much for your particular situation.

So here's my ideas:
1) Substitute the Celexa with a very low dose of a more sedating SSRi such as Paxil or Luvox to your current lithium/diazepam regimen. (try that first before going to Serzone)

2) Ask your doctor about possibly adding some T4 (levothyroxine) thyroid hormone to try to settle down your cycling. I know you mentioned once that you were paranoid about fiddling with that-but they make a wide array or doses and you might try just 25mcgs/day to start and see if it helps. Also they use T4 to *reduce* thyroid nodules and goiters. Also lithium can make some people a little hypothyroid anyways. I wished my pdoc was willing to let me try that.
keep us informed,

Mitch

 

Re: LITHIUM, crashing, ADs, etc Chloe

Posted by Cam W. on October 5, 2001, at 22:09:17

In reply to Re: LITHIUM, crashing, ADs, etc, posted by Chloe on October 5, 2001, at 20:26:06

Chloe - I would say that you lithium level being that low could contribute to your agitation, depresssion, and elation. For lithium to work, you need to stay within the therapeutic window (0.8 - 1.2). If your level is lower than 0.8 you are at risk for a relapse; above 1.2 you need to worry about toxicity.

When lithium is used to augment antidepressants, blood level targets are lower (eg. 0.6).

Good luck in getting the level up. - Cam

 

Re: LITHIUM, as the sole AD? Mitch

Posted by SLS on October 5, 2001, at 23:41:59

In reply to Re: LITHIUM, as the sole AD? SLS, posted by Mitch on October 4, 2001, at 13:06:02

> > Hi Mitch.
> >
> > There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.
> >
> > I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.
> >
> > I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.
> >
> >
> > - Scott
>
> Thanks Scott, for the response. I suppose I would need to clarify some stuff. I am what my pdoc calls "hyperresponsive" to meds. There have been situations where 1.25mg of Celexa (i.e.), triggered a potent hypomanic episode (like smoking grass) for about 2-8hrs after taking it. Another incident that was far more intense was taking 37.5mg of Effexor which also triggered a robust hypomanic episode that was also quite intense and brief (about 5 hrs). But...those type of meds make me more sociable and settle down panic and reduce anxiety generally. I was on Adderall (5mgAM) with no AD's and my cycling STOPPED and my sleep/wake cycles normalized and I had NO depression (poof!), but...I was cool distant quiet unhumorous. Then I got a thyroid tumor! Could you share some insights into this?
>
> Mitch


Hi again.

Believe it or not, stimulants can sometimes help to stabilize mood when used in combination with other drugs and paradoxically act as an antimanic agent. So, too, can high dosages of T4 (not T3) thyroid hormone help to stabilize mood and encourage an improvement in depression when used as an adjunct.


- Scott

 

Re: LITHIUM, crashing, ADs, etc Cam W.

Posted by Chloe on October 6, 2001, at 16:17:02

In reply to Re: LITHIUM, crashing, ADs, etc Chloe, posted by Cam W. on October 5, 2001, at 22:09:17

Cam,

This is very useful information. Your conclusion is that my cycling and agitation could be due to this low lithium level? I wonder why the *heck* my pdoc doesn't think the level in important. I had to ask to have it drawn. And now that we have the information, she did not say increase the dose.

I do have this internal "jazziness" that is rather bothersome. Do you have any insight into if this buzzy feeling decreasing with time or with an increase in the level? Is this jazziness some serotinergic process, or a calcium ion thing in the cells?

As you have probably read, I am having a hard time trying to find an AD that can augment the li that doesn't increase this revved up feeling. I restarted 1 mgs of Celexa yesterday morning, and had instant remission from depression, but also listened to my heart thump away all night long. I am looking into a more sedating SSRi, perhaps Luvox. But for the time being, I feel I need to leave my pdoc alone for a day or so. It's been crisis after crisis.

Lastly, I am a soft BP 2, BPD with psychotic feature and a rapid cycler (who has a baseline of irritability). Do you think that getting my level to around .8 would really help? Or am I asking too much of the Li (neurontin, diazapam and a splash of Celexa)?
You thoughts and insights would be most appreciated.
Chloe

> Chloe - I would say that you lithium level being that low could contribute to your agitation, depresssion, and elation. For lithium to work, you need to stay within the therapeutic window (0.8 - 1.2). If your level is lower than 0.8 you are at risk for a relapse; above 1.2 you need to worry about toxicity.
>
> When lithium is used to augment antidepressants, blood level targets are lower (eg. 0.6).
>
> Good luck in getting the level up. - Cam

 

Re: LITHIUM, crashing, ADs, etc Mitch

Posted by Chloe on October 6, 2001, at 16:32:07

In reply to Re: LITHIUM, crashing, ADs, etc Chloe, posted by Mitch on October 5, 2001, at 22:04:15

Hey Mitch
I am curious about my Li level and what is a good target. I really need a time to sit down and meet with my pdoc. We have been having these crisis phone conversations, or emails and I always feel like something did not get said. It's not really a good time to make decisions when I am so desperate on the phone with her. God, I want this instability to end!

I like the luvox idea. I think Paxil is too short acting for me, and my give me some rebound troubles. I am very sensitive to that stuff. I do remember you mentioned it before, I just was hoping I could do without an AD and just take Li. Well, that was a crash and burn! For right now, I am taking a HALF a milligram of Celexa, and hopefully I will be able to sleep tonight. If this doesn't work, I will persue the Luvox.

In terms of the T4, well, I just know nothing about it. I guess I should inform myself more on the subject, esp if it decreases cycling. I also have to look into getting my menstrual cycle regulated. I am having very frequent irregular periods, that I know are adding to my rage and intolerance of everyday life. I have a gyn appointment on tuesday. So I hope something useful will come out of that.

Thanks for the great info, support and prompt replies. I hope you are still enjoying an emotional reprive with these cooler temps and shorter days.
Chloe

 

Re: LITHIUM, crashing, ADs, etc Chloe

Posted by Cam W. on October 6, 2001, at 17:25:34

In reply to Re: LITHIUM, crashing, ADs, etc Cam W., posted by Chloe on October 6, 2001, at 16:17:02

Chloe - Ask your doc why he/she doesn't want your lthium level within the normally recognized antimanic range. The antidepressant action of lithium at that level may result in your not needing the Celexa, either. Your doc may have a perfectly good explanation for not increasing your lithium dose, but he/she should let you in on it.

- Cam


 

Re: LITHIUM, crashing, ADs, etc Cam W.

Posted by Chloe on October 6, 2001, at 18:04:08

In reply to Re: LITHIUM, crashing, ADs, etc Chloe, posted by Cam W. on October 6, 2001, at 17:25:34

Thanks Cam,
I can answer some of the questions. I think my pdoc is so busy, being the head of the psych dept. at a major hospital, that she doesn't really have time to think things through. Though I know she does care, and is try to help. Also, I have never had a true manic phase. I just have horrible mood instability and disregulation. So frankly, I think she doesn't know how to treat me anymore.

I did complain of the internal jitteriness, and at that point she said I could decrease(!) the Lithium. That is just downright strange as we were trying to get lithium to be my primary AD. (I have had trouble tolerating the SSRi's of late. The agitation and irritability is really a problem.) But perhaps she feels I can't tolerate the Li if I am having the jitteriness...That is why I asked you if you knew if this buzzy feeling does abate over time.

And yes you are right, I do need to hear her explanation is about the lithium. Despite her busy agenda.
Thanks again
Chloe


> Chloe - Ask your doc why he/she doesn't want your lthium level within the normally recognized antimanic range. The antidepressant action of lithium at that level may result in your not needing the Celexa, either. Your doc may have a perfectly good explanation for not increasing your lithium dose, but he/she should let you in on it.


 

Re: LITHIUM, crashing, ADs, etc Chloe

Posted by Mitch on October 7, 2001, at 11:24:30

In reply to Re: LITHIUM, crashing, ADs, etc Mitch, posted by Chloe on October 6, 2001, at 16:32:07

> Hey Mitch
> I am curious about my Li level and what is a good target. I really need a time to sit down and meet with my pdoc. We have been having these crisis phone conversations, or emails and I always feel like something did not get said. It's not really a good time to make decisions when I am so desperate on the phone with her. God, I want this instability to end!
>
> I like the luvox idea. I think Paxil is too short acting for me, and my give me some rebound troubles. I am very sensitive to that stuff. I do remember you mentioned it before, I just was hoping I could do without an AD and just take Li. Well, that was a crash and burn! For right now, I am taking a HALF a milligram of Celexa, and hopefully I will be able to sleep tonight. If this doesn't work, I will persue the Luvox.
>
> In terms of the T4, well, I just know nothing about it. I guess I should inform myself more on the subject, esp if it decreases cycling. I also have to look into getting my menstrual cycle regulated. I am having very frequent irregular periods, that I know are adding to my rage and intolerance of everyday life. I have a gyn appointment on tuesday. So I hope something useful will come out of that.
>
> Thanks for the great info, support and prompt replies. I hope you are still enjoying an emotional reprive with these cooler temps and shorter days.
> Chloe

Chloe,

As far as the lithium goes "the therapeutic level" is simply a statistical generalization-*most* people get the *best* response in a range from x-z. I wouldn't get too hung up with the numbers. I really think your pdoc is looking for the *clinical* evidence that you are getting a good response and given you are super sensitive to side effects doesn't want you to ditch the lithum prematurely. Also you need to hold on to that dose for several weeks just to see what the full improvement actually could be at that dose. She might have the idea of possibly increasing it after she sees the full benefits of the dose you are currently at or she is using it solely as a low-dose augmentation strategy with Neurontin (I thought you were still taking 500mg/day?).

There was one time about 12 years ago where I went off meds entirely for over a year. NOT GOOD. I went through a bad depression, dropped out of college, started working construction jobs, got hypomanic and irritable-lost my job, got hit head-on by a drunk driver on the wrong-side of the road on the interstate doing 60mph, was temporarily disabled for months, allmost got kicked out of my parent's house and became homeless, good GRIEF! I finally started back on lithium during another major depression (600mg/day) and within about ten days I was a completely different person! I have stayed on meds ever since, thank God!

Yes, the weather is ideal for me brisk and bright-the perfect combination. You know, I went to a website on SAD and they mentioned that many people with SAD have brief hypomanias in the spring and autumn. Well, that is when I have mine! They also mentioned that SAD sufferers also can have major depressions in mid-summer because of the heat! They said this depression often can be marked by agitation and insomnia in contrast to the wintertime one. Well, that is when I experience mixed states. I also have noticed that stimulants or Wellbutrin are the only meds historically that have *completely* quashed these two seasonal depressions.(?)
Sorry for blathering on... I am a little high right now and I like it! :)

Mitch

 

Re: LITHIUM, crashing, ADs, etc Mitch

Posted by Chloe on October 7, 2001, at 19:35:44

In reply to Re: LITHIUM, crashing, ADs, etc Chloe, posted by Mitch on October 7, 2001, at 11:24:30

Hi Mitch,
Thanks for the reply. I enjoyed your *blathering* :) I am glad that Lithium was able to get you out of a rough time years ago. Clearly this drug does have it's merits. I am pleased with it so far, but darn, like all the rest it's not a miracle cure! I guess I am just too complicated for a one med magic fix. Oh, and yes I am still taking the neurontin, it also helps with that jazzy feeling I am having. Hopefully, in time, as you said, I will gain some stability and decrease my cycling with these two meds on board.

Enjoy your brief respite before hybernation season sets in! Though keep an eye out for *too high*! It's amazing that you have such predictable cycles. I can't predict how I will feel in the morning! ;-)
Chloe

 

Re: LITHIUM, crashing, ADs, etc Chloe

Posted by Mitch on October 7, 2001, at 21:39:29

In reply to Re: LITHIUM, crashing, ADs, etc Mitch, posted by Chloe on October 7, 2001, at 19:35:44

> Enjoy your brief respite before hybernation season sets in! Though keep an eye out for *too high*! It's amazing that you have such predictable cycles. I can't predict how I will feel in the morning! ;-)
> Chloe

Well, it (wintertime depression) usually starts to kick in anywhere from the last week of October to the week of Thanksgiving in November (unflinchingly predictable for 25+ years). I first just notice fatigue for a week or so. Then it becomes difficulty concentrating, and then I have trouble getting up in the morning. Then it just gets deeper and deeper and I start putting on some weight. By the time mid-December comes around (the deepest part of it) I can start crying for no apparent reason, I have difficulty getting to work (though I force myself to make it somehow), I have no interest in doing *anything* except SLEEP (I always call it "nuclear winter of the mind"). Then, if I am *lucky* there is a BIG BLIZZARD in early January and that snaps me out of the dangerous part of it. I have to get out into the snow to get groceries, and to be on foot instead of being in a car must expose me to more sunlight I think. Plus, the intense exercise of walking in and shoveling snow must release extra endorphins that helps me recover from it. I have such vivid memories of childhood of giant icicles along the roofline dripping in the intense sunlight with steam wafting off of them! Well, I see my pdoc again next month-right when it is going to start again-this time I am going to ask for some Wellbutrin-which worked last summer. I also am going to put together a light box (I like building things)with some spare parts from work and maybe with the WB and the light box I can make it through January!

Mitch

 

Re: LITHIUM, crashing, ADs, BP alternative

Posted by Mayhew on July 23, 2002, at 21:59:08

In reply to Re: LITHIUM, crashing, ADs, etc Chloe, posted by Mitch on October 5, 2001, at 22:04:15

i've been taking neurontin (a brand name mood stabalizer aka gabapentin) for BPD for over two years. i have not had any serious difficulties with BPD depression since being on it--until recently, which therapy is smoothing out. i have yet to use an AD while on neurontin.
i hope this might generate some discussion

mayhew

 

Re: LITHIUM, crashing, ADs, BP alternative

Posted by cybercafe on July 24, 2002, at 19:54:04

In reply to Re: LITHIUM, crashing, ADs, BP alternative, posted by Mayhew on July 23, 2002, at 21:59:08

> i've been taking neurontin (a brand name mood stabalizer aka gabapentin) for BPD for over two years. i have not had any serious difficulties with BPD depression since being on it--until recently, which therapy is smoothing out. i have yet to use an AD while on neurontin.
> i hope this might generate some discussion

hi, thanks for the info.. i am taking gabapentin also

can i ask what dose you are taking, if you are type I or type II, and if gabapentin was started in a manic or depressive phase?

i am taking parnate with gabapentin


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.