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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Krazy Kat on November 15, 2001, at 15:26:02
Well, I can't leave 'well enough' alone. Am off Topamax as I've mentioned, dropped Prozac from 60 mg to 40 mg (have not noticed a change in the past week or so), and am up to 1500 mg Depakote.
The Depakote has definitely helped, but I'm questioning:
1. How much in the long term?
2. What am I going to do about the sedation?The sedation didn't seem this bad at 1000 mg, but now it's almost as intolerable as it was when I took Topamax. Sleeping 12 hours at night, 3-4 hours during the day. I can't get anything done. Other side effects have increased, too.
And it helped me get out of my depression, but I am still cycling with hypomania, and a lot of anxiety is back.
I'm wondering if I should be on a lighter regimine (regime - which word is correct?) for awhile? And keep Depakote as a stand-by when another major depression occurs (it worked very quickly for me).
Have any other Bipolars done this? Have you all found relief with something that is more of an anti-anxiety medication? Is there a med that can be taken when mania sets in, that doesn't have to be taken all the time? I'm wondering about taking a small amount of an AD, then augumenting with, I don't know, a benzo? Depakote in depressive emergencies?
I'm close to chucking all the meds again and know I should stay on something.
Also, considering starting a family soon, so anything "not as invasive" as Depakote would be good.
Sorry, this is a really rambling piece.
Thanks!
- Kelly
Posted by Krazy Kat on November 15, 2001, at 16:18:45
In reply to Boy,quiet today-? for Bipolars not on Stabilizer, posted by Krazy Kat on November 15, 2001, at 15:26:02
Posted by judy1 on November 15, 2001, at 17:11:34
In reply to Boy,quiet today-? for Bipolars not on Stabilizer, posted by Krazy Kat on November 15, 2001, at 15:26:02
You didn't mention what your blood level is- that piece of info is more important than actual doseage. If you are bp2 you can get by on less than bp1s. To show you the huge variation in people with bipolar disorder- I only use depakote when manic it makes me depressed within 2-3 days of oral loading (I am bp1 and I'm talking about in hospital high doses) I really think you are one of the few who is helped by depakote for depressions although most bp specialists would cringe before they prescribe prozac unless you are not rapid cycling and bp2 (and maybe that's why your depakote is so high). Klonopin is a good benzo for anxiety and a secondary mood stabilizer- you may want to ask your pdoc about that. Also I'm pregnant and would be happy to answer any questions you have- judy
Posted by Krazy Kat on November 15, 2001, at 21:04:50
In reply to Re: Boy,quiet today-? for Bipolars not on Stabilizer » Krazy Kat , posted by judy1 on November 15, 2001, at 17:11:34
Judy:
Thanks so much for your reply. I remember you had said that Depakote made you depressed in an earlier thread.
I just got a second set of tests done for my blood level - don't know what it is, yet, but the last test, when I was at 1000 mg, was apparently quite low according to my pdoc. I am a rapid cycling, BPII by diagnosis.
Anyhoo, in general, do you stay on anything in between taking the Depakote for mania? I realize it is probably different when pregnant - but maybe not. I think you are our residential mother-to-be. :)
Did you find that you needed to end any treatment after becoming pregnant? What do you plan on once the baby is born? Going back to your old med plan?
Have you taken Klonopin? If so, was it sedating for you? That seems to be my downfall...
Well, there 'er a few ?'s. Thanks!
- K.
Posted by dreamer on November 15, 2001, at 22:05:49
In reply to Boy,quiet today-? for Bipolars not on Stabilizer, posted by Krazy Kat on November 15, 2001, at 15:26:02
> Well, I can't leave 'well enough' alone. Am off Topamax as I've mentioned, dropped Prozac from 60 mg to 40 mg (have not noticed a change in the past week or so), and am up to 1500 mg Depakote.
>
> The Depakote has definitely helped, but I'm questioning:
>
> 1. How much in the long term?
> 2. What am I going to do about the sedation?
>
> The sedation didn't seem this bad at 1000 mg, but now it's almost as intolerable as it was when I took Topamax. Sleeping 12 hours at night, 3-4 hours during the day. I can't get anything done. Other side effects have increased, too.
>
> And it helped me get out of my depression, but I am still cycling with hypomania, and a lot of anxiety is back.
>
> I'm wondering if I should be on a lighter regimine (regime - which word is correct?) for awhile? And keep Depakote as a stand-by when another major depression occurs (it worked very quickly for me).
>
> Have any other Bipolars done this? Have you all found relief with something that is more of an anti-anxiety medication? Is there a med that can be taken when mania sets in, that doesn't have to be taken all the time? I'm wondering about taking a small amount of an AD, then augumenting with, I don't know, a benzo? Depakote in depressive emergencies?
>
> I'm close to chucking all the meds again and know I should stay on something.
>
> Also, considering starting a family soon, so anything "not as invasive" as Depakote would be good.
>
> Sorry, this is a really rambling piece.
>
> Thanks!
>
> - KellyI take a ad (one that sedates)then benzo when the world implodes.
Difficult regime if you work -non creatively or have routine, does work for me up to a point....
Then....... my life aint the norm . Oh tis tricky deciding which escolator (sp?) 2 takedreamerandy frisky molester
Posted by Mitch on November 15, 2001, at 23:46:28
In reply to Boy,quiet today-? for Bipolars not on Stabilizer, posted by Krazy Kat on November 15, 2001, at 15:26:02
> Well, I can't leave 'well enough' alone. Am off Topamax as I've mentioned, dropped Prozac from 60 mg to 40 mg (have not noticed a change in the past week or so), and am up to 1500 mg Depakote.
>
> The Depakote has definitely helped, but I'm questioning:
>
> 1. How much in the long term?
> 2. What am I going to do about the sedation?
>
> The sedation didn't seem this bad at 1000 mg, but now it's almost as intolerable as it was when I took Topamax. Sleeping 12 hours at night, 3-4 hours during the day. I can't get anything done. Other side effects have increased, too.
>
> And it helped me get out of my depression, but I am still cycling with hypomania, and a lot of anxiety is back.
>
> I'm wondering if I should be on a lighter regimine (regime - which word is correct?) for awhile? And keep Depakote as a stand-by when another major depression occurs (it worked very quickly for me).
>
> Have any other Bipolars done this? Have you all found relief with something that is more of an anti-anxiety medication? Is there a med that can be taken when mania sets in, that doesn't have to be taken all the time? I'm wondering about taking a small amount of an AD, then augumenting with, I don't know, a benzo? Depakote in depressive emergencies?
>
> I'm close to chucking all the meds again and know I should stay on something.
>
> Also, considering starting a family soon, so anything "not as invasive" as Depakote would be good.
>
> Sorry, this is a really rambling piece.
>
> Thanks!
>
> - Kelly
Hi K.K.IMO, the Prozac could be *creating* enough instability (you said you were *still* cycling-I am BPII as well and SSRI's cause the WORST hypomania for me) to require 1.5G of Depakote to control. I think that you are just trapped in a Catch-22. Yes, "lighter regime is better"-bumper stickers should be issued!:-)
WHAT IF: You could get by on 10mg of Prozac and 500mg of Depakote??, AND if you are still anxious (that is if the SSRI is not *causing* the agitation) you could just add a little Klonopin??The bottom line: 12+ hrs of sleep every day-NOT good (don't care what's wrong with ya).
Mitch
Posted by Daisy on November 16, 2001, at 7:48:16
In reply to Boy,quiet today-? for Bipolars not on Stabilizer, posted by Krazy Kat on November 15, 2001, at 15:26:02
I've had major problems with sedation, depression, and irritability with every mood stabilizer I've tried (with the exception of Tegretol, which just plain didn't work).
Right now I'm doing well on Wellbutrin SR (150 mg) and Risperdal (0.5 mg). I can't tolerate SSRI's; Wellbutrin is the first AD I've been able to tolerate without becoming manic and agitated, and even it I can't take without the Risperdal.
This controls most of my cycling. I still have some minor depressions and mild hypomanias. If I start to become seriously manic, I increase the risperdal and add in a pile of Xanax, and that seems to do the trick. I'm supposed to be taking a low dose of xaxax all the time, but I usually only take it when I'm extra anxious because I find it doesn't work well for me if I take it every day.
I did have some problems with the Risperdal in that I gained about 10 pounds over the year that I've been taking it, which made me want to stop taking it (which I found difficult because my symptoms intensified even when I switched to a different neuroleptic while weaning off it), but recently the weight has started coming off, so I've decided to keep with it. It's made a huge difference in my stability.
Daisy
Posted by Krazy Kat on November 16, 2001, at 10:14:42
In reply to Re: Boy,quiet today-? for Bipolars not on Stabilizer » Krazy Kat , posted by Mitch on November 15, 2001, at 23:46:28
Mitch:
I was going to bother you. :)
I know you've listed it several times before, but would you mind telling me what your regime is again?
I've been interested that you're BP and have had a "good enough" (that's what my pdoc always asks - are you "good enough"?) time with Neurontin and no other stabilizer.
Thanks for your comments - I believe you are correct, which is partly why I dropped the Prozac myself. Pdoc doesn't seem inclined to think it could be adding to my anxiousness, though, even though other AD's definitely have in the past.
- K.
Posted by Krazy Kat on November 16, 2001, at 10:16:17
In reply to Re: Boy,quiet today-? for Bipolars not on Stabiliz, posted by Daisy on November 16, 2001, at 7:48:16
> Daisy:
Thanks! What is Risperdal?
- K.
Posted by Mitch on November 16, 2001, at 13:38:25
In reply to Re: Boy,quiet today-? for Bipolars not on Stabilizer » Mitch, posted by Krazy Kat on November 16, 2001, at 10:14:42
> Mitch:
>
> I was going to bother you. :)
>
> I know you've listed it several times before, but would you mind telling me what your regime is again?As of *now* (since pdoc visit of yesterday):
Neurontin 100mg 3x daily.
Klonopin .5-1.0mg total daily
Zoloft 12.5mg divided over a week (yes that's right-exceptionally sensitive to SSRI's)
Wellbutrin 1/4 of a 75mg IR tab 3x daily.dx-BPII rapid cycling, adult ADHD, social phobia, seasonal recurrent major depression.
>
> I've been interested that you're BP and have had a "good enough" (that's what my pdoc always asks - are you "good enough"?) time with Neurontin and no other stabilizer.During April/May and late September-late Nov. (about now) I sometimes need 125mg of Depakote sprinkled here and there to keep my highs from getting a little *wacky*.
>
> Thanks for your comments - I believe you are correct, which is partly why I dropped the Prozac myself. Pdoc doesn't seem inclined to think it could be adding to my anxiousness, though, even though other AD's definitely have in the past.
>
> - K.Prozac I liked (for attentiveness+sociability), but it could get very agitating at times. I had a "free-floating" panic attack after a dose increase on it once and I have had maybe 2 or 3 of those over 30 years.
good luck
Mitch
Posted by Daisy on November 16, 2001, at 13:47:04
In reply to Re: Boy,quiet today-? for Bipolars not on Stabiliz » Daisy, posted by Krazy Kat on November 16, 2001, at 10:16:17
Risperdal is a neuroleptic (anti-psychotic, originally developed to treat schizophrenia). I've never had psychotic symptoms, but for me this works really well to keep the agitation and manic symptoms at bay, much better than mood stabilizers have and with far fewer side effects -- the only side effects I've had from it were sleepiness for the first few weeks and the 10-pound weight gain. I tend to gain weight easily, though, and have to struggle to stay in the slightly-overweight range. From what I understand, it's not as likely as, say, Zyprexa to cause weight gain. I think Zyprexa is the only anti-psychotic that's specifically approved in the US to treat mania, but I've heard of most all of the newer ("atypical") anti-psychotics being used for it.
The first time I ever took it it had astonishing results: I was wildly manic, to the point where the dr wanted to hospitalize me if this didn't work, and within an hour of taking a 1 mg dose I was myself again. For me it's pretty much been a wonder drug.
Posted by judy1 on November 16, 2001, at 17:00:13
In reply to Re: Boy,quiet today-? for Bipolars not on Stabilizer » judy1, posted by Krazy Kat on November 15, 2001, at 21:04:50
Hi,
I read Mitch's reply and really agree with his outlook on Prozac- if you reduce or get off I'm sure you could lower the depakote, the first time I took it I was hospitalized with a psychotic manic attack (in 2 days!) Klonopin is the only med that I have continued on throughout my pregnancy, in the 2nd trimester I did use depakote for a manic episode (after having a normal amnio) and then just a few days. I also use opiates for depresssion but I'm tapering now. I cannot take AD's without becoming manic. I think everyone is waiting for the other shoe to drop after birth- I had a psychotic depresion when my son was born. Despite some serious symptoms, I will always keep my regime simple- heavy psychotherapy (so I trust my pdoc enough to contact him when manic), klonopin for bipolar/panic- I got used to sedation after about a month and I take 6mg/day and treat episodes when they occur- depakote for mania, opiates for depression. I keep it simple now- after years of being on 6+ meds. Take care- judy
Posted by judy1 on November 16, 2001, at 17:01:51
In reply to Re: Boy,quiet today-? for Bipolars not on Stabilizer » Krazy Kat , posted by judy1 on November 16, 2001, at 17:00:13
I also take risperdal or zyprexa if I have psychotic symtoms; again just until they resolve- judy
Posted by Krazy Kat on November 16, 2001, at 18:42:59
In reply to P.S., posted by judy1 on November 16, 2001, at 17:01:51
Judy:
Thanks so much for your input. Can you tell me what falls in the "opiate" category?
Also, was it difficult for you to get your pdoc to give you this much room, i.e. mine doesn't seem to want me to have control over dosages based on episodes - he wants it to be consistent. But, especially with rapid cycling, I just don't see how that is beneficial.
Thanks again.
- K.
Posted by judy1 on November 17, 2001, at 11:15:03
In reply to Re: P.S. » judy1, posted by Krazy Kat on November 16, 2001, at 18:42:59
Hi,
Opiates are narcotics, they were used as AD's before modern ones were found. There are several threads going on here where treatment resistant people with depression take them- shelliR, Lorraine, others look through the board. It is VERY difficult to get a dr. to prescribe them for that reason. I have been through over a dozen pdocs and learned a few things- first they work for me since I pay them, I do as much research as possible so many times I'm better informed then they are (there's lots of good info on this board), and it's my body so I'm very particular what goes in. There are very few pdocs that would work with someone like me (extremely treatment resistant) but my pdoc just wants me well and has a healthy enough ego to listen to me. I wish you well- judy
This is the end of the thread.
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