![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Peter on March 19, 2002, at 17:26:43
Hello all:
Well, after another trial with a new medication cocktail prescribed by my pdoc, I'm still miserable. Since 1997, this guy has had me on various combinations of depakote, neurontin, a slew of SSRI's, Wellbutrin, Effexor, dopamine agonists, stimulants, klonopin, and more. He had diagnosed me with mild bipolar, some panic, social phobia, and possible ADD. I still continued to have problems-bad mood swings and times when I just couldn't go outside because I was depressed/anxious. When I opened my cabinet and saw hundreds of pill viles, it dawned on me that I needed another opinion from a second pdoc. This just isn't working, I thought. So, it was suggested that I have a consultation with NYC-based Donald F Klein, supposedly one of the best. He came to the conclusion that I am in fact bipolar, and that my anxiety/panic/depression stems from my BP. He said I should taper off all the meds I'm on now (Neurontin, adderall, and klonopin), and begin a simple combo of Lithium and Depakote. I always thought Lithium was only prescribed for people with intense BP I, with acute manias and suicidal depressions. I've never had acute mania-in fact, I don't ever recall having a manic episode, but he thinks I am BP. Does anyone know if Lithium can be used for milder BP disorder? If so, does anyone have any succes stories? I would love to once and for all be stabilized without constantly switching from one cocktail to the next for the rest of my life! Finally, I'm aware of the need for monitering and blood checks while on Lithium, but is it safe and effective at the right dose? Does it help depressive states characterized by apprehension, social phobia, and irritability? Thanks,
Peter
Posted by Peter on March 19, 2002, at 17:41:40
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
Sorry, I forgot to add my last question. It seems that my main trouble with SSRI's was that they'd make me emotionally numb, which would in turn cause me to turn to alcohol and drugs to FEEL something. Likewise, depakote and neurontin stabilized me, but below the normal level, so I was as a result more depressed and withdrawn (what I call the 'wet blanket effect'). This doctor Klein told me that Lithium is different-that it really evens out the mood without unwanted sedation or emotional numbness. Has anyone seen this to be the case with Lithium?
Peter
Posted by Geezer on March 19, 2002, at 19:03:13
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:41:40
> Sorry, I forgot to add my last question. It seems that my main trouble with SSRI's was that they'd make me emotionally numb, which would in turn cause me to turn to alcohol and drugs to FEEL something. Likewise, depakote and neurontin stabilized me, but below the normal level, so I was as a result more depressed and withdrawn (what I call the 'wet blanket effect'). This doctor Klein told me that Lithium is different-that it really evens out the mood without unwanted sedation or emotional numbness. Has anyone seen this to be the case with Lithium?
>
PeterHi Peter,
Let me begin by saying my current treatment is at the same point as yours and my past drug history is very similar to yours. Drugs taken are very similar with a few additions and subtractions. I think Dr. Klien has hit the mark, although I can't give you any real positive news as yet. I have been on 1000mg. of Depakote since last Nov. and have worked up to 900mg. of Lithium over the past two weeks. The past week was the first week in 20 years I have not taken antidepressants. Will keep you posted
Posted by JohnX2 on March 19, 2002, at 20:37:50
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP, posted by Geezer on March 19, 2002, at 19:03:13
Hi Geezer,I may be jumping on the lithium train.
I can't seem to sustain an AD response without going hypomania. W/o the AD the lamictal wasn't
cuttin it though. You think the lithium will calm the seas?Best wishes
John
> > Sorry, I forgot to add my last question. It seems that my main trouble with SSRI's was that they'd make me emotionally numb, which would in turn cause me to turn to alcohol and drugs to FEEL something. Likewise, depakote and neurontin stabilized me, but below the normal level, so I was as a result more depressed and withdrawn (what I call the 'wet blanket effect'). This doctor Klein told me that Lithium is different-that it really evens out the mood without unwanted sedation or emotional numbness. Has anyone seen this to be the case with Lithium?
> >
> Peter
>
> Hi Peter,
>
> Let me begin by saying my current treatment is at the same point as yours and my past drug history is very similar to yours. Drugs taken are very similar with a few additions and subtractions. I think Dr. Klien has hit the mark, although I can't give you any real positive news as yet. I have been on 1000mg. of Depakote since last Nov. and have worked up to 900mg. of Lithium over the past two weeks. The past week was the first week in 20 years I have not taken antidepressants. Will keep you posted
Posted by Mr.Scott on March 19, 2002, at 21:10:49
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
MHO is to follow his advice blindly. What do you have to lose?
Scott
Posted by Ron Hill on March 19, 2002, at 21:27:11
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
Peter,
You and I have traveled similar roads. The good news is that, at long last, I've got a med combo that works great. Perhaps, you may find it worthwhile to look into it. I'm BPII and I take 600 mg/day Lithobid and 400 mg/day SAM-e. I'll respond to some of your questions and close by routing you to prior posts that explain my history and the solution my current pdoc found for me (i.e. SAM-e).
> Well, after another trial with a new medication cocktail prescribed by my pdoc, I'm still miserable. Since 1997, this guy has had me on various combinations of depakote, neurontin, a slew of SSRI's, Wellbutrin, Effexor, dopamine agonists, stimulants, klonopin, and more. He had diagnosed me with mild bipolar, some panic, social phobia, and possible ADD.
My ordeal started in 1996 when I was misdiagnosised as ADHD and put on ritalin. When I started to get moody a couple of months after starting ritalin, the idiot pdoc added Paxil. The ritalin and paxil combo pushed me (a BPII) into a full blown mania as any good pdoc would fully expect. Adding insult to injury, the two hundred dollar an hour pdoc did not recognize the mania but, instead, kept writing scripts for the pstim and AD (can you say malpractice?). Once a guy gets his brain chemistry so screwed up, it's hard to get it squared away. I will not bore you with all the details because it sounds like you know the road all too well. Again, the good news is that with the help of my current pdoc and many people on this board, I've got it solved. Now it’s my responsibility to help others, if I can.
>He said I should taper off all the meds I'm on now (Neurontin, adderall, and klonopin), and begin a simple combo of Lithium and Depakote.
Did you tell him about your "wet blanket effect" response to Depakote when you took it previously. Why not try lithium by itself first, with the option to add-on an AED latter if it turns out to be needed?
>I always thought Lithium was only prescribed for people with intense BP I, with acute manias and suicidal depressions.
Yes, the general rule is, as I understand it, Li for BP I's and AED's for BP II's. But there are, of course, many exceptions to the general rule. I fall into the exception category by default since I am allergic to the AED's. I liked the mood stabilizing effect of Lamictal but I got a severe rash (even using the low and slow dosing required with Lamictal). Depakote also caused a rash and a bunch of other stuff like weight gain, depression, hair loss, etc.
>I've never had acute mania-in fact, I don't ever recall having a manic episode, but he thinks I am BP. Does anyone know if Lithium can be used for milder BP disorder? If so, does anyone have any succes stories?
Yes, I'm BP II and I've been on Lithobid for almost three years. Lithobid is the only brand of lithium that I have tried. It is time-released and gentle on the stomach. It works well for me as a mood stabilizer, however, it does not help my depression. As a result, I have spent the past three years trying various AD's hoping to find one that would work long-term with minimal side effects and no poop-out. I discuss this AD issue more fully in my prior posts linked below, which I encourage you to read. The bottom line, however, is that what ends up being the answer for me is SAM-e (a prescription medication in Europe but an OTC in the US).
>I would love to once and for all be stabilized without constantly switching from one cocktail to the next for the rest of my life!
I hear ya! I had almost lost hope for this vision until my pdoc put me on SAM-e.
>Finally, I'm aware of the need for monitering and blood checks while on Lithium, but is it safe and effective at the right dose?
I think so. There are some data that support the position that Li is actually neuroprotective (i.e. it's actually good for the brain). For maintenance purposes, the desirable serum lithium levels of bipolar patients are 0.6 to 1.2 mEq/l. For BP II patients, my pdoc shoots for the 0.6 mEq/l level. I prefer these lower levels because patients unusually sensitive to lithium may exhibit toxic signs at serum levels around 1.0 mEq/l. That's not the usually case, of course, but I like to play it safe. As far as on-going monitoring goes, it’s not like you're running to the hospital vampire every other day. Once the pdoc gets your dose adjusted, your serum lithium levels typically do not change much provided your dose stays constant. You will want to monitor your thyroid (TSH, T2, T3, etc.) and it might be beneficial to get a baseline thyroid blood test for subsequent comparative purposes.
>Does it help depressive states characterized by apprehension, social phobia, and irritability?
>Sorry, I forgot to add my last question. It seems that my main trouble with SSRI's was that they'd make me emotionally numb, which would in turn cause me to turn to alcohol and drugs to FEEL something. Likewise, depakote and neurontin stabilized me, but below the normal level, so I was as a result more depressed and withdrawn (what I call the 'wet blanket effect'). This doctor Klein told me that Lithium is different-that it really evens out the mood without unwanted sedation or emotional numbness. Has anyone seen this to be the case with Lithium?
Read the linked posts below regarding the emotional blunting issue.
Here are the two prior posts I'd like you to read:http://www.dr-bob.org/babble/20020313/msgs/97982.html
http://www.dr-bob.org/babble/20020318/msgs/98710.html
Here are a couple more good articles I came across:http://www.iherb.com/same2.html
Posted by Janelle on March 19, 2002, at 22:51:24
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP » Peter, posted by Ron Hill on March 19, 2002, at 21:27:11
Posted by Ron Hill on March 19, 2002, at 23:13:34
In reply to What does AED stand for? (nm), posted by Janelle on March 19, 2002, at 22:51:24
Posted by Peter on March 19, 2002, at 23:22:27
In reply to What does AED stand for? (nm), posted by Janelle on March 19, 2002, at 22:51:24
Thanks for your feedback everyone. I'm not so terrified about starting Lithium now. I'm actually looking forward to it. What I'm not looking forward to is the difficult time of tapering what I'm on now-Neurontin, Adderall, and Klonopin. It's the klonopin I'm especially concerned with; although I'm taking a relatively small dose (1.25-1.5mg daily), I've been on it for @3 years. I really want to get off of it, because I'm pretty sure that it's been keeping my mood down. I'm sure when I'm once and for all off of it, I'll feel energized and more alive, but I'm not looking forward to the withdrawl that can occur. Anyway, that SAMe option looks very interesting, Ron. I'll bring it up tomorrow at my pdoc session. But first things first-getting off all the current stuff and starting lithium. It will probably be a few months until I'm stabilized on lithium and free of all this other medication-well, I've gotta get through it, even though I'm sure it'll be hard. WISH ME LUCK!! Thanks again to everyone for your input/advice/comfort.
Peter
Posted by Ritch on March 19, 2002, at 23:48:19
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
> Hello all:
> Well, after another trial with a new medication cocktail prescribed by my pdoc, I'm still miserable. Since 1997, this guy has had me on various combinations of depakote, neurontin, a slew of SSRI's, Wellbutrin, Effexor, dopamine agonists, stimulants, klonopin, and more. He had diagnosed me with mild bipolar, some panic, social phobia, and possible ADD. I still continued to have problems-bad mood swings and times when I just couldn't go outside because I was depressed/anxious. When I opened my cabinet and saw hundreds of pill viles, it dawned on me that I needed another opinion from a second pdoc. This just isn't working, I thought. So, it was suggested that I have a consultation with NYC-based Donald F Klein, supposedly one of the best. He came to the conclusion that I am in fact bipolar, and that my anxiety/panic/depression stems from my BP. He said I should taper off all the meds I'm on now (Neurontin, adderall, and klonopin), and begin a simple combo of Lithium and Depakote. I always thought Lithium was only prescribed for people with intense BP I, with acute manias and suicidal depressions. I've never had acute mania-in fact, I don't ever recall having a manic episode, but he thinks I am BP. Does anyone know if Lithium can be used for milder BP disorder? If so, does anyone have any succes stories? I would love to once and for all be stabilized without constantly switching from one cocktail to the next for the rest of my life! Finally, I'm aware of the need for monitering and blood checks while on Lithium, but is it safe and effective at the right dose? Does it help depressive states characterized by apprehension, social phobia, and irritability? Thanks,
> Peter
Wow, you have really been going through the mill. I agree to *some* extent with your new pdoc's opinions. I went through this myself about 15 years ago when I started college for the 2nd time. I was on Lithium monotherapy (600mg/day), but still was having breakthrough panic attacks. Well, the first thing that was thought of was..."The bipolar is not being controlled properly, we need to increase the lithium". Well, increasing the lithium created more GI distress, which was what was precipitating the panic attacks anyways. So, they *finally* gave me some Lomotil (opioid+anticholinergic), and voila! the panic attacks diminished. Well, that certainly seemed to throw a kink into their theories at the time. I wound up on *less* lithium+diazepam+lomotil, and things worked out much better. You could try the Depakote+lithium combo and see what happens. Hey, it is a trial.. If they are full of crap, you will be able to tell relatively quickly!Mitch
Posted by Saffron on March 20, 2002, at 9:25:34
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
Hey there,
I think I have the same situation that you do, also diagnosed recently, or within the last year or so. BPII- with the withdrawn distance, and i turn to alchohol to feel something. I have states where i get this depressed anxiety, not a mania, but a time where im depressed and yet i need some sort of action in order to pinch myself? i dont know if thats what you mean, but thats how they told me they knew i was in this boat. they suggested Lithium to me but it made me nervous and im girly about weight gain so i wanted to get away from depacote so I've been trying topamax and i really like it, it takes away all that depressed anxiety. you may want to give that a go, for a few weeks it made me feel really great.
however, its been slowing down and we've been having to up the dosage recently so i may be moving over to lithium or depacoat, please let me know how your trial works out, i think we may have the same disorder. sorry- iknow you asked for help and you got a bunch of people telling you to go for it and tell them what you find. do you have a therapist as well as a psychiatrist? meds are part of it, but my main thing is the therapy, actually.
Posted by Peter on March 20, 2002, at 14:33:10
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP, posted by Saffron on March 20, 2002, at 9:25:34
Hi Saffron:
>I have states where i get this depressed anxiety, not a mania, but a time where im depressed and yet i need some sort of action in order to pinch myself?
I know what you mean. This is similar to what I've experienced-that mixed anxiety/depression. With me, I usually don't want to be around anyone and I get irritable. So if I do have to go out, I feel like I need to drink in order to wash over that antisocial, depressed anxiety.
> I've been trying topamax and i really like it, it takes away all that depressed anxiety. you may want to give that a go, for a few weeks it made me feel really great.
I haven't discussed that one with my pdoc. I spoke to him today and informed him of the other doctor's opinion that I start lithium, and he said it sounds good- but first, for the next few days, he wants to increase my Neurontin dose to a more therapeutic level. He thinks Neurontin would be great for me, once we get the levels right: very few side-effects and anti-anxiety effects. He said he wouldn't prescribe it for a BPI person with intense mania, but he thinks it would be good for my mild, anxiety-laced mood swings.
> do you have a therapist as well as a psychiatrist? meds are part of it, but my main thing is the therapy, actually.
I was in therapy for years. Personally, I got sick of the intrusive nature of it and the fact that it got me more stressed out, over-analyzing myself all the time. But it was probably just the wrong therapist for me; I'm thinking of pursuing less psychodynamic therapy and more cognitive-behavioral therapy, which I've never tried and heard is good. Thanks for your input. I wish you the best.
Peter
Posted by Peter on March 21, 2002, at 2:26:31
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP » Saffron, posted by Peter on March 20, 2002, at 14:33:10
Ok, here's the deal. I went back to my normal pdoc today whom I've been seeing since 1997. He had already discussed everything with the other pdoc -Donald Klein- who I went to see for a second opinion. As a stated earlier, Dr. Klein recommended that I taper off everything and start Lithium and a little depakote. My pdoc today told me that we can do this if I want, and it might be good for me, but he reminded me that I have a very mild bipolar case (with some hypomania and depression), and that the reason he never put me on Lithium is because it is more effective for BPI patients with acute mania. So he always thought, since I have more mild, mixed states, that the anticonvulsants would be better for me, even though they have more sedating properties than Lithium. Depakote was too sedating for me, but he really thinks the drug I'm on now, Neurontin, would be great for me because it's 'lighter' than depakote, can even-out mild bipolar mood swings, and it targets anxiety, and I'm a really anxious person. In addition, it has a very low side-effect profile, and there are no excess precautions like with Lithium (looking out for dehydration, etc.) and no blood tests required, because it all goes straight out the urine, with no kidney retention. So before we discuss me going on lithium any further, he wants me to increase my neurontin dose to a more therapeutic level and see how I tolerate it for the next few days. I'm now on 700mg daily and he has me going up to 900mg daily. It would be great if such a generally mild drug works well for me, so I can stick with it. But what concerns me is I'm also on adderall (20mg XR in the a.m. and 10mg regular early p.m), which he prescribed me because I was falling into depression from the early sedating effects of the neurontin!! Not to mention my klonopin 1.5mg daily for anxiety. So I've really got a cocktail here of 'off label' uses (adderall for depression, etc.). And the adderall is wierd-it makes me feel good, gives me drive and motivation, but also sometimes makes me very withdrawn and obsessive. But I like it; it just disturbs me a bit because it sometimes makes me feel a bit 'high' and that reminds me of my drug addiction years, and the association makes me feel guilty and wierd. On the other hand, even though it's a complex, perhaps unconventional cocktail, it might work well once the Neurontin is stablized at a higher dose. It gets confusing, but do you think it's worth it to stick with this combo with a chance that Neurontin might be good for me, in which case I wouldn't have to do the big shift over to Lithium, which is obviously a more heavy-duty drug? I'm trying to weigh the pros and cons of both sides and I just get more and more confused. What's the better choice? Any advice? Sorry and thanks.
Peter D
Posted by judy1 on March 21, 2002, at 2:55:00
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
since your case is so mild, i think neurontin may be helpful. i agree with it's low side effects and lack of blood tests, it ceratinly is worth the try. 1.5mg klonopin/day isn't all that high (I take 6mg/day) for anxiety. sorry i'm not familiar with adderall (I am dxed bp1 and panic disorder) so it would probably do a real number on me. BTW I went over 2100 mg of neurontin and it wasn't helpful- i do need the heavier stuff. wish you the best (and don't worry about 3 drug, there are people on this board on 6 or 7 at a time. take care- judy
Posted by Peter on March 21, 2002, at 16:48:35
In reply to Re: Very upset and confused-please help » Peter, posted by judy1 on March 21, 2002, at 2:55:00
Thanks for your encouragement, Judy. I guess I'd just feel more comfortable if Neurontin works and I don't have to take Lithium. I can understand that Lithium works great for many people, but why take it if a milder drug works? The only other thing I'm considering is switching the adderall. It sometimes feels good (like a 'high'), but it also tends to make me very withdrawn and nervous in public. The addictiveness also bothers me. So I'm actually thinking of suggesting a replacement for the adderall-I'm thinking effexor might be a good idea. I know I stated that I tried alot of SSRI's and they made me emotionally numb and caused alcohol/drug cravings. But effexor is different, because it also effects nueropinephrine(sp?). I tried effexor once, but it was during a very unhealthy, crazy time in my life when I was taking ecstacy and getting drunk all the time, so I don't really know how it effected me compared to normal SSRI's. I'm thinking it might be a good drug for me to try now with the Neurontin and klonopin instead of continuing adderall or switching over to Lithium. Anyone have good experience with effexor XR?
Posted by Mr.Scott on March 21, 2002, at 22:12:57
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
Easier said than done, but try not to stress yourself out. This is a process and it's going to take some time. As long as you stay engaged and keep trying to find an answer, you will!
Better to fully explore one regimen than jump to another before it's fully explored lest you have to jump back again because your not sure you fully explored it.
I think there is some truth to the fact that Lithium is better for BPI, but everyone is different. Off label usage is good thing not a bad thing. Those huge sample studies conducted to get drugs like Paxil approved for GAD by the FDA are great until you get into a clinical setting with an individual for whom Paxil doesn't do anything except make them emotional numb, overweight, and impotent and maybe a little less anxious. Suddenly the whole one size fits all solution goes out the window. From the sound of it, you would not have been labeled Bipolar at all a few years ago. Only now is everyone suddenly bipolar whereas we were all ADD a few years back.
You'll get to the right place...But never as fast as you want I'm afraid.
Scott
Posted by Peter on March 21, 2002, at 22:40:09
In reply to Re: Very upset and confused-please help » Peter, posted by Mr.Scott on March 21, 2002, at 22:12:57
Never mind that whole idea about going on effexor-my doctor rejected it. So, it looks like I've just gotta try Lithium even though I'm not BP1. He's going to see how Lithium/Neurontin combo works since Neurontin has supposed anti-anxiety affects. I'm just so sick of all this. I realize it's alot of trial and error, but man, since 1997 I've been switching drug cocktails like a bat outta hell. Not to mention that everytime I switch meds I get completely stressed out, as you can probably tell from all my incessant ramblings on this post. Now I'm freaked out about the whole dehydration thing with Lithium and the need for all those blood tests. This sucks. Whatever. I'm gonna go stare at the wall and bask in my self-pity.
Peter
Posted by Ritch on March 21, 2002, at 22:40:39
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
> Ok, here's the deal. I went back to my normal pdoc today whom I've been seeing since 1997. He had already discussed everything with the other pdoc -Donald Klein- who I went to see for a second opinion. As a stated earlier, Dr. Klein recommended that I taper off everything and start Lithium and a little depakote. My pdoc today told me that we can do this if I want, and it might be good for me, but he reminded me that I have a very mild bipolar case (with some hypomania and depression), and that the reason he never put me on Lithium is because it is more effective for BPI patients with acute mania. So he always thought, since I have more mild, mixed states, that the anticonvulsants would be better for me, even though they have more sedating properties than Lithium. Depakote was too sedating for me, but he really thinks the drug I'm on now, Neurontin, would be great for me because it's 'lighter' than depakote, can even-out mild bipolar mood swings, and it targets anxiety, and I'm a really anxious person. In addition, it has a very low side-effect profile, and there are no excess precautions like with Lithium (looking out for dehydration, etc.) and no blood tests required, because it all goes straight out the urine, with no kidney retention. So before we discuss me going on lithium any further, he wants me to increase my neurontin dose to a more therapeutic level and see how I tolerate it for the next few days. I'm now on 700mg daily and he has me going up to 900mg daily. It would be great if such a generally mild drug works well for me, so I can stick with it. But what concerns me is I'm also on adderall (20mg XR in the a.m. and 10mg regular early p.m), which he prescribed me because I was falling into depression from the early sedating effects of the neurontin!! Not to mention my klonopin 1.5mg daily for anxiety. So I've really got a cocktail here of 'off label' uses (adderall for depression, etc.). And the adderall is wierd-it makes me feel good, gives me drive and motivation, but also sometimes makes me very withdrawn and obsessive. But I like it; it just disturbs me a bit because it sometimes makes me feel a bit 'high' and that reminds me of my drug addiction years, and the association makes me feel guilty and wierd. On the other hand, even though it's a complex, perhaps unconventional cocktail, it might work well once the Neurontin is stablized at a higher dose. It gets confusing, but do you think it's worth it to stick with this combo with a chance that Neurontin might be good for me, in which case I wouldn't have to do the big shift over to Lithium, which is obviously a more heavy-duty drug? I'm trying to weigh the pros and cons of both sides and I just get more and more confused. What's the better choice? Any advice? Sorry and thanks.
> Peter D
Hi Peter, What about leaving your Adderall the same, and your Neurontin the same and just add on a *little* Depakote. Maybe 125mg at bedtime and see what happens. I have just restarted dexedrine lately with Neurontin+Klonopin and adding on the 125mg of Depakote at bedtime improved my sleep and settled me down anxiety-wise the next day. I have tried 250mg Depakote at bedtime and I sleep just a *little* too much. But, I am only taking 5mg dexedrine a day. Maybe if I increased to 250mg depakote at bedtime and also increased the dexedrine to a 10mg spansule midday...Mitch
Posted by Ritch on March 21, 2002, at 22:44:30
In reply to Re: Very upset and confused-please help, posted by Peter on March 21, 2002, at 16:48:35
> Thanks for your encouragement, Judy. I guess I'd just feel more comfortable if Neurontin works and I don't have to take Lithium. I can understand that Lithium works great for many people, but why take it if a milder drug works? The only other thing I'm considering is switching the adderall. It sometimes feels good (like a 'high'), but it also tends to make me very withdrawn and nervous in public. The addictiveness also bothers me. So I'm actually thinking of suggesting a replacement for the adderall-I'm thinking effexor might be a good idea. I know I stated that I tried alot of SSRI's and they made me emotionally numb and caused alcohol/drug cravings. But effexor is different, because it also effects nueropinephrine(sp?). I tried effexor once, but it was during a very unhealthy, crazy time in my life when I was taking ecstacy and getting drunk all the time, so I don't really know how it effected me compared to normal SSRI's. I'm thinking it might be a good drug for me to try now with the Neurontin and klonopin instead of continuing adderall or switching over to Lithium. Anyone have good experience with effexor XR?
Peter,
Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
Mitch
Posted by judy1 on March 22, 2002, at 0:57:50
In reply to Thanks everyone but I'm just sick of it all, posted by Peter on March 21, 2002, at 22:40:09
first of all, you DON'T have to take a med that makes you uncomfortable- and lithium certainly falls in that category. i had better luck (like the last poster) with depakote. i also agree that bipolar is way too over-diagnosed. i have clear manic and depressed episodes (psychotic) and a family history and am most definitely bipolar. effexor is a very stimulating drug and anxiety sounds like your main problem. if klonopin helps, have you ever tried a higher dose or xanax instead? how long have you been off street drugs (i was on also for years and i truly believe it took my brain at least a year to 'normalize'. i know how difficult this is- i've stopped meds many times- but maybe in your case simpler is better, just use what has worked in the past - klonopin and adderal- and play with doses. i wish you the best- judy
Posted by Peter on March 22, 2002, at 1:37:58
In reply to Re: Thanks everyone but I'm just sick of it all » Peter, posted by judy1 on March 22, 2002, at 0:57:50
> if klonopin helps, have you ever tried a higher dose or xanax instead?
Hi Judy: Thanks for being such a great help to me. I'm really encouraged by all of you giving of your time to share your experience and help one another. To answer your question, I was originally prescribed klonopin @3 years ago and have always stayed below the 2mg threshold my doc set for me. When I first took it, it was a wonder drug for months; I had lots of social phobia and panic back then, and I noticed an immediate difference-I could socialize, go to museums by myself, and go to restaurants without panicking and losing my appetite. It was great! But as the years went on, klonopin lost its 'flare' and really became a preventative drug for me-I no longer felt the sense of elevated mood it had first given me, but it just worked to ward off panic attacks. I'm sure my SP would have been worse now had I not been on klonopin all these years, but it's still not so good. I usually avoid most parties and gatherings of people I don't know, and I still have some trouble meeting new people. The problem is, when I've tried to take more klonopin, it really sedates me, which in itself renders me more withdrawn and antisocial. I don't know if I'd want to switch to xanax, with it's shorter duration and all.
>how long have you been off street drugs (i was on also for years and i truly believe it took my brain at least a year to 'normalize'. i know how difficult this is- i've stopped meds many times- but maybe in your case simpler is better, just use what has worked in the past - klonopin and adderal- and play with doses. i wish you the best- judy
I've been off street drugs since '97, though I've relapsed 2-3 times since (the last time about two years ago) due to SSRI-induced emotional numbness and hypomania. My doc insists on me being on some sort of mood stabilizer (he thinks Neurontin) if I were to stick with the klonopin and adderal. But because the adderall, though it elevates my mood at times, seems to be making me a bit more withdrawn and causing me to hyperfocus on repetitive actions, its not on the whole beneficial for me. Also, it makes my hands freezing, which is a definite hindrance for a pianist! So, even though the thought of lithium makes me feel uncomfortable, I'm thinking it's really the last hope I have for a simple, effective drug that will keep me stable while helping my depressive episodes and the hypomania I've been told I portray (though I still don't see it-maybe I'm just in denial). My doc wants me to stay on klonopin for my constant anxiety/worry and he believes that even staying on Neurontin at the right dose with lithium can be a good combo for me. He has assured me that the isues about blood monitering and precautions about dehydration are not as bad as I think; he also said many people experience no side-effects at all, like they're just taking a mineral (which I guess, in essence, they are). If he thinks lithium is the best choice for me, I just want to get going with the blood tests and start it ASAP so I don't have to sit here agonizing over it for weeks. So, if he really thinks it's best for me, I might be able to start it next week, and we'll taper off the adderall as we find the right lithium blood level for me. That's it in a nutshell. I'm trying not to keep on stressing and your input has helped me tremendously, but it looks like Lithium is the only way to go at this point, according to my current pdoc and the other doc I saw for a consultation. BTW, what meds are you taking?
Peter
Posted by Peter on March 22, 2002, at 1:56:41
In reply to Re: Very upset and confused-please help » Peter, posted by Ritch on March 21, 2002, at 22:44:30
> Peter,
>
> Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
>
> Mitch
Hi Mitch:
Thanks for the input. I have heard about that whole l-isomer causing havoc in the adderall, and that plain dexedrine is smoother. I gotta tell you, the adderall is such a wierd drug for me-over a 10 minute period I'll feel good and then slightly aprehensive and nervous! It must be that l-isomer! Well, I'd like to see if my pdoc would let me try Dex. spansules, but he's made it quite clear to me that starting lithium and tapering off adderall is the best thing for me to do now. I'm overly stressing myself out about Lithium and the precautions necessary for those taking it, but he told me it's no where near as bad as I think. In fact, he said, combined with Neurontin (which has added anxiety-targeting effects) it could really help me feel better, even though I'm not a severe, classic BP1 candidate. I evidently have mild BPII, but he still thinks it's worth a try. I just gotta stop overthinking and go for it. Thanks for your help.
Peter
Posted by Peter on March 22, 2002, at 18:18:50
In reply to Re: Very upset and confused-please help » Peter, posted by Ritch on March 21, 2002, at 22:44:30
> Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
>
> Mitch:
I'm still wavering about the Lithium, even though I just posted what sounded like a final decision of trying it out. Well, I'm like that-indecisiveness and worry are my two middle names. You said you're on Neurontin+klonopin+dex. What dose of Neurontin and klonopin are you on and how do you divide the doses? If I don't switch to Lithium, I'd like to try dex spansules, but I heard they're shorter-acting than adderall XR. Is this true? Already, I have to take a 10mg normal adderall around 6pm in addition to my morning 20mgXR dose. Also, I like the idea that dex is smoother than adderall-already I have freezing hands all the time, a high heart- rate, and extreme dry mouth.
Posted by Ritch on March 22, 2002, at 23:21:55
In reply to Dex question » Ritch, posted by Peter on March 22, 2002, at 18:18:50
>
> > Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
> >
> > Mitch:
> I'm still wavering about the Lithium, even though I just posted what sounded like a final decision of trying it out. Well, I'm like that-indecisiveness and worry are my two middle names. You said you're on Neurontin+klonopin+dex. What dose of Neurontin and klonopin are you on and how do you divide the doses? If I don't switch to Lithium, I'd like to try dex spansules, but I heard they're shorter-acting than adderall XR. Is this true? Already, I have to take a 10mg normal adderall around 6pm in addition to my morning 20mgXR dose. Also, I like the idea that dex is smoother than adderall-already I have freezing hands all the time, a high heart- rate, and extreme dry mouth.
Peter,My current med trailmix is(for BPII, ADHD, SP):
Depakote, 125-250mg at bedtime
Klonopin, .5mg bedtime + up to .5mg daytime PRN
Neurontin, 100mg 3x daily
Dexedrine IR, 5mg mid-afternoon
Celexa, approx. 2mg every other day AM
Supplements (200mg SAMe AM, 1G flax oil at lunch, etcetera vitamins)
Diphenhydramine, 12.5mg PRN midday/evening for muscle spasms, dystonia.The next step for me is to try the Spansules (10mg). It doesn't really bug me to *crash* that much. In the morning, coffee works just fine with the SAMe and B12 stuff. I just need the dex. for work. Otherwise, every single freaking noise in the office stops me in my tracks and I lose my place and get frustrated and pissed. Tonite, we had the intercom playing rock muzac, and a coworker had a portable radio on with a basketball game *simultaneously* (WITH other people talking all around me!). I just typed away and didn't miss a lick! Yes, the dexedrine is much smoother than Adderall. I also had mild motor *tics* with the Adderall-I also was a little restless (but not as bad as SSRI's). When I take my dose in the afternoon and it starts to kickin I feel a simultaneous calming, alerting feeling with a little hike in my heartrate. I used to "freeze" around people on Adderall and Wellbutrin, but this doesn't happen to me. Watch out with taking it with other stuff, though. When I take my tiny dose of Celexa and I take the tiny dose of dexedrine in the afternoon I get really *wirey*. If I take much of the Celexa without the dex. I get wirey too-it just really boosts it a lot. However.. I found before that the SSRI triggers most of my mood cycling, and Adderall seemed to dampen it (without the AD). Since Dex. is only a portion of the Adderall one would think that it would do likewise. I am increasing the number of days without SSRI to see if any panic/social anxiety begins to return, and also to check my cycling.
good luck,
Mitch
Posted by katia on January 4, 2004, at 1:56:56
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP » Peter, posted by Ron Hill on March 19, 2002, at 21:27:11
HI Ron,
I noticed on one of your posts you said you developed the rash on Lamictal. I just developed a rash this morning. I'm on 200mg of lam for over a month and over four months on it total. I started Lithium 2 weeks ago and just upped the total dose to 900mg in the evening two days ago. This rash is sore and is like poison oak and is on my arms, inner thighs, stomach and chest. And it hasn't gone away upon awakening. My pdoc is taking me off of Lamcital but I'm wondering if it's not the Lithium???
You said severe? What is that? My rash is pretty much covering most of my body and I"m scared. Did you have a sore throat? Did the rash hurt and feel tight like? Were there tiny bumps? Did it itch? I'm worried this is the severe one. How long did it last?
Thanks.
Katia
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