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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by JennyJen on June 16, 2002, at 6:54:25
Hey Everyone,
So I am back to parnate and still wondering if I have mild hypomania. I am more social ... talking alot at work (maybe inappropriately ... like to gossip!), cleaning my apartment alot, insomnia, return of sexuality. I think I maybe add low dose lithium to see what that feels like.
(by the way my pdoc says I am not hypomanic .... just normal for the first time in my life)My question is .... has anyone achieved a happy medium ... normal feeling and emotions? It seems like AD many bipolars hypomanic and Mood Stablizers make most depressed.
Thanks everyone!
Jenny
Posted by JohnX2 on June 16, 2002, at 7:57:12
In reply to JohnX2 or anyone else- Finding a happy medium!, posted by JennyJen on June 16, 2002, at 6:54:25
> Hey Everyone,
>
> So I am back to parnate and still wondering if I have mild hypomania. I am more social ... talking alot at work (maybe inappropriately ... like to gossip!), cleaning my apartment alot, insomnia, return of sexuality.
I'll order what you're having...do they take Visa? :-)
> I think I maybe add low dose lithium to see what that feels like.
> (by the way my pdoc says I am not hypomanic .... just normal for the first time in my life)
>
> My question is .... has anyone achieved a happy medium ... normal feeling and emotions? It seems like AD many bipolars hypomanic and Mood Stablizers make most depressed.
>
> Thanks everyone!
>
> JennyJenny, from your brief description it doesn't sound like you
are having bad hypomania. The insomnia may be an indicator, but this
is a notorious side effect of Parnate, so I would tend to rule that out.I felt "normal" a few fleeting times. But "normal" is very different
for many people. Some people are Type-A (leadership, extrospective, aggressive, whatever)
some Type-B (more laid back, introspective, whatever, etc). Who can define
"normal"?It doesn't seem surprising at all that an AD (especially Parnate)
may have a profound impact on your personality traits.
In fact a lot of people with depression who go on AD's discover
a part of themselves they never knew existed. Also antidepressants
can change one's pesonality profile altogether (like from Type-B
to A, etc). There is an interesting book on this subject called
"Listening to Prozac".Parnate from what I understand can have quite an initial kick that
is almost amphetamine like. I think this wears a bit as you get used to
the med.I would be worried about hypomania if you see yourself engaging in
activities that would have long term negative consequences on your life.
Like wild spending sprees (WELL beyond your means), many *inappropriate* sexual
indiscrections, grandious thoughts (we're talking big here, like you
are super-man and on top of the world and everyone else is shit).
Another indicator may be persistent racing thoughts.Remember you have to benchmark hypomania against normal. Its easy
to see the same symptoms (which when in check are euthymia) when
your mood is raised from low to normal.Btw, a low dose of lithium is unlikely to curtail
hypomanic symptoms. You need to get your blood levels
to a higher range to help with that. This is a time consuming
process. Maybe a depakote trial would be another suggestion
if you feel compelled to do a quick med run. A low dose of
depakote at night may well help with sleep.In regards to the mood stabilizer issue. I have not
found any stabilizer to make me feel depressed except
strong doses of Klonopin. Seems people starting a mood
stabilizer with mainly antimanic effects (like
Depakote) and no positive AD effect and depression
may feel more flat.BTW, if just the AD is working pretty steady-state, then
this is a flag on not being bipolar. Usually stand alone
ADs are disasters for bipolars (the work and crap out,
make the patient more depressed, or cause lots of mood
cycles). You seem to have indicated success reaching
a steady response on ADs which is good?Have Fun,
John
Posted by JennyJen on June 16, 2002, at 8:35:18
In reply to Re: JohnX2 or anyone else- Finding a happy medium! » JennyJen, posted by JohnX2 on June 16, 2002, at 7:57:12
Hey John,
Thanks for the great advice. It is so hard to figure out what is normal behavior when you have been shy and socially phobic your whole life. And, with my cousin experiencing bipolar I with wild mania episodes, I guess I am alway checking and worrying I might be going into a manic episode.
Luckly, no symptoms of mania you described. And I have been stable on parnate in the past for a couple of years. Well, I will probably always have one eye open for symptoms of hypomania!
Thank you so much! Your information and support is priceless! (How much do I owe you ... $100 per post .... HAHAHA) Please send me your bill.
Your Friend,
Jenny
Posted by JohnX2 on June 16, 2002, at 8:51:20
In reply to Please send me a bill! Thanks! » JohnX2, posted by JennyJen on June 16, 2002, at 8:35:18
> Hey John,
>
> Thanks for the great advice. It is so hard to figure out what is normal behavior when you have been shy and socially phobic your whole life. And, with my cousin experiencing bipolar I with wild mania episodes, I guess I am alway checking and worrying I might be going into a manic episode.
>
> Luckly, no symptoms of mania you described. And I have been stable on parnate in the past for a couple of years. Well, I will probably always have one eye open for symptoms of hypomania!
>
> Thank you so much! Your information and support is priceless! (How much do I owe you ... $100 per post .... HAHAHA) Please send me your bill.
>
> Your Friend,
>
> JennyPlease send donations care of.... just kidding ;-)
Yeah, it sounded like from your original posts and your
description of the social phobia that it made sense that
you responded well to the MAO inhibitor and not as well to
the other meds. This is a very common treatment trend for your
symptoms. Now we just need a med w/o all the dietary crud!Have fun being happy!
John
Posted by JennyJen on June 16, 2002, at 8:52:16
In reply to Please send me a bill! Thanks! » JohnX2, posted by JennyJen on June 16, 2002, at 8:35:18
Hey John,
Sorry for being a pest! I know I ask too many questions. But how about this.
With parnate .... I have difficult keeping organized because I try to do to much at once. (Right now I have 7 windows open on my computer ... going from psycho babble to alt.support.depression to amazon.com to new york times) And have difficult concentrating and reading ... like I have to read a line a couple of times to have it finally sink in. Is this mild hypomania?
Sorry! Thanks!
Jenny
Posted by JennyJen on June 16, 2002, at 9:00:18
In reply to Oh ..... one more question. Sorry. » JennyJen, posted by JennyJen on June 16, 2002, at 8:52:16
John,
By the way, even 300mg or 600mg of lithium flaten me out like a pancake ... make me really sad and apathetic. I don't know if that clearifies the diagnosis.
My pdoc still says depression and anxiety .... just hope we are not missing bipolar II or III.
Jenny
Posted by JonW on June 16, 2002, at 10:35:11
In reply to Re: Please send me a bill! Thanks! » JennyJen, posted by JohnX2 on June 16, 2002, at 8:51:20
> symptoms. Now we just need a med w/o all the dietary crud!
Just an FYI that there is some evidence that suggest Parnate + Reboxetine could be a beneficial combination in this regard. I'm curious why there haven't been any other studies since 1994, but here's the one to which I'm referring:
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7931221&dopt=Abstract)
--------------------------------------------------
Reboxetine prevents the tranylcypromine-induced increase in tyramine levels in rat heart.Dostert P, Castelli MG, Cicioni P, Strolin Benedetti M.
Farmitalia Carlo Erba, Research and Development, Erbamont Group, Milan, Italy.
This study aimed to examine whether the increase in heart radioactivity levels after intravenous injection of 14C-tyramine to rats pretreated with the irreversible MAO inhibitor tranylcypromine could be antagonized by reboxetine, a potent and selective noradrenaline uptake blocker. Reboxetine was found totally to abolish the effect of tranylcypromine. Heart radioactivity levels after reboxetine and tranylcypromine were very similar to those found when tyramine was injected after reboxetine only. These results suggest that reboxetine might be advantageously combined with tranylcypromine, or any MAO inhibitor, in depressed patients unresponsive of either treatment given alone.
PMID: 7931221 [PubMed - indexed for MEDLINE]
--------------------------------------------------Jon
Posted by oona on June 16, 2002, at 10:43:34
In reply to Re: JohnX2 or anyone else- Finding a happy medium! » JennyJen, posted by JohnX2 on June 16, 2002, at 7:57:12
JohnX2,
I was reading your message to JennyJen and had a question about my own meds and you seem to be quite knowledgable.
I had been on Zoloft for 7 years and actually did quite well on it but wanted to change to try to get the libido going again. Unfortunately, the Welbutrim was not for me and could not last through the trial, my blood pressure went sky high. Started on Celexa (10 to 20 now 30) with the Risperdal (.25 then .50).... While going up on the doses, I started getting sleepy and my depression did not lift much, actually, I believe it is worse now than in the past 7 years. The irritablilty is also bad and I have been on the defensive a lot lately.
Also, it has been really hot here and I do not think that I have been drinking enough water as I am getting dizzy spells that may be caused from dehydration.
The last thing is that I just am getting over a bout of bronchitis and am still congested, so some of this may be because of illness. One other symptom is that I feel a fluttery feeling in my heart like it is skipping or racing.
My questions are: should I stay with this and work with the pdocs or try and go back to the zoloft that I did so well on and forget about the libido thing. I am bipolar II.
ps: probably will see my med doc this week just to make sure that I do not have pnuemonia (sp) or worse. I obsess about my health so much that when I am really sick, I do not check out because I feel like I am crying wolf or it is just in my head.
thanks for any words,
oona
Posted by JonW on June 16, 2002, at 11:00:29
In reply to JohnX2, Can I add a question here? » JohnX2, posted by oona on June 16, 2002, at 10:43:34
> I had been on Zoloft for 7 years and actually did quite well on it but wanted to change to try to get the libido going again. Unfortunately, the Welbutrim was not for me and could not last through the trial, my blood pressure went sky
Hi oona,
If your doc is open to writing a prescription for moclobemide you might want to try this. It's more likely to increase libido if anything. It is also one of the safer ADs for bipolar disorder.
Jon
Posted by JohnX2 on June 16, 2002, at 11:38:46
In reply to Oh ..... one more question. Sorry. » JennyJen, posted by JennyJen on June 16, 2002, at 8:52:16
> Hey John,
>
> Sorry for being a pest! I know I ask too many questions. But how about this.
>
> With parnate .... I have difficult keeping organized because I try to do to much at once. (Right now I have 7 windows open on my computer ... going from psycho babble to alt.support.depression to amazon.com to new york times) And have difficult concentrating and reading ... like I have to read a line a couple of times to have it finally sink in. Is this mild hypomania?
>
> Sorry! Thanks!
>
> Jenny
Hey Jenny,How long have you been on the medicine and when did you
get a response?I really don't know for sure..
I'm guessing this is a start up effect from a Parnate
response that will subside.Was this a consistent problem the last time you took
Parnate?Also, do you not complete your tasks?
What you described is more like ADHD. The adhd symptoms
are often confused/mixed/hard to seperate from hypomania.I know if you don't have ADHD and you are given an ADD
med, the med may actually induce ADHD symptoms.Now Parnate from what I understand can have a very
zippy energizing start up effect (it can actually treat
ADD if you have it underlying).Is it possible that your new found zest for life and the
energizing effects of Parnate are causing some distractability?Take Care,
John
Posted by JohnX2 on June 16, 2002, at 12:07:26
In reply to Re: Last tid bit, posted by JennyJen on June 16, 2002, at 9:00:18
> John,
>
> By the way, even 300mg or 600mg of lithium flaten me out like a pancake ... make me really sad and apathetic. I don't know if that clearifies the diagnosis.
>
> My pdoc still says depression and anxiety .... just hope we are not missing bipolar II or III.
>
> JennyIt really depends on your blood levels, not the medicine dose.
Hmm, I don't know if I've seen a trend of whether bipolars are
ambushed by lithium or not?John
Posted by Denise528 on June 18, 2002, at 16:39:35
In reply to Re: Last tid bit » JennyJen, posted by JohnX2 on June 16, 2002, at 12:07:26
JohnX,
I don't understand this notion that if you are bi-polar the chances are that ADs won't work for you. AD's used to work great for me, no problems. Now they don't. Does this mean that at one time I was unipolar but I've now mutated into a bipolar.
Denise
Posted by JohnX2 on June 19, 2002, at 19:06:18
In reply to JohnX - Can you explain?, posted by Denise528 on June 18, 2002, at 16:39:35
> JohnX,
>
> I don't understand this notion that if you are bi-polar the chances are that ADs won't work for you. AD's used to work great for me, no problems. Now they don't. Does this mean that at one time I was unipolar but I've now mutated into a bipolar.
>
> DeniseI don't think this necessarily implies bipolar.
It possible for unipolar depression to mutate into
bipolar though.The bipolar 'no predictable AD response' is usually a symptom of a bipolar. But 'no predictable AD response' doesn't always imply bipolar.
I dunno, I think it is like saying if it rains out side, the sidewalk is wet. If the side walk is wet, it doesn't mean it is raining.
Sorry can't be more help.
Take Care,
John
Posted by Geezer on June 20, 2002, at 13:49:09
In reply to JohnX - Can you explain?, posted by Denise528 on June 18, 2002, at 16:39:35
> JohnX,
>
> I don't understand this notion that if you are bi-polar the chances are that ADs won't work for you. AD's used to work great for me, no problems. Now they don't. Does this mean that at one time I was unipolar but I've now mutated into a bipolar.
>
> DeniseHi Denise,
I think John X has given you the best answer to the Unipolar-Bipolar-AD question you will find at this point in time. I was treated for Unipolar for many years, off and on ADs with little success. Got on Prozac in 1998 and had the best year of my life, until it "pooped out". Rediagnosed Bipolar II in 2000, have been all thru the "mood stabilizers" and currently trying various "cocktails". It's all a roll of the dice - keep trying. I really like the rain and wet sidewalk comparison.
Geezer
Posted by JohnX2 on June 21, 2002, at 0:12:00
In reply to Re: JohnX - Can you explain?, posted by Geezer on June 20, 2002, at 13:49:09
> > JohnX,
> >
> > I don't understand this notion that if you are bi-polar the chances are that ADs won't work for you. AD's used to work great for me, no problems. Now they don't. Does this mean that at one time I was unipolar but I've now mutated into a bipolar.
> >
> > Denise
>
> Hi Denise,
>
> I think John X has given you the best answer to the Unipolar-Bipolar-AD question you will find at this point in time. I was treated for Unipolar for many years, off and on ADs with little success. Got on Prozac in 1998 and had the best year of my life, until it "pooped out". Rediagnosed Bipolar II in 2000, have been all thru the "mood stabilizers" and currently trying various "cocktails". It's all a roll of the dice - keep trying. I really like the rain and wet sidewalk comparison.
>
> GeezerThe sidewalk comparison is an old logic deduction
error know as Modus Ponen,Modus Tollen (Latin?).Basically:
if A implies B (Modus Ponen)
then it is false to assume B implies A (Modus Tollen)
In regards to the mood stabilizers, etc. My feeling is that
if you don't have clearcut bipolar symptoms like cycling, then
the mood stabilizers are a crapshoot.At this point I'm really not big into the whole label thing.
I think the brain is way to complicated to boil it down to a
few labels.My thing with a series of unresponsive AD trials (and say
you've tried the different classes), I see value in trying to
augment with stabilizers even if you don't have clear cut
ye 'ld bipolar symptoms. Basically I'm thinking these medicine
really just jolt your brain using educated guesses as to where
to do the jolting. If you administer an AED then this changes
the "picture of the brain" what have you that the antidepressants
have to look at before they start jolting. Who knows if this would
shake things up to get a response (irrespective of the damn labels)?Take Care,
John
Posted by JonW on June 21, 2002, at 16:27:55
In reply to Re: JohnX - Can you explain?, posted by JohnX2 on June 21, 2002, at 0:12:00
> Basically:
>
> if A implies B (Modus Ponen)
> then it is false to assume B implies A (Modus Tollen)Sound a lot like "correlation doesn't necessarily equal causation".
Jon
Posted by oona on June 22, 2002, at 8:45:21
In reply to Re: JohnX - Can you explain?, posted by JohnX2 on June 21, 2002, at 0:12:00
JohnX2:
In the previous post, what does "cycling" mean (definition) in relation to bipolar symptoms?
Thanks,
oona> "In regards to the mood stabilizers, etc. My feeling is that
> if you don't have clearcut bipolar symptoms like cycling, then
> the mood stabilizers are a crapshoot."
>
Posted by JohnX2 on June 22, 2002, at 14:47:11
In reply to Re: JohnX - Can you explain? » JohnX2, posted by oona on June 22, 2002, at 8:45:21
> JohnX2:
> In the previous post, what does "cycling" mean (definition) in relation to bipolar symptoms?
> Thanks,
> oona
>
> > "In regards to the mood stabilizers, etc. My feeling is that
> > if you don't have clearcut bipolar symptoms like cycling, then
> > the mood stabilizers are a crapshoot."
> >oona,
cycling is cyclical mood swings
John
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