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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by johnj on July 28, 2002, at 11:41:05
Hello
a few question for you all. What AD has helped you and what dose? Better yet, what has not helped? Thanks
Posted by Ritch on July 28, 2002, at 14:48:43
In reply to Bipolar II's and AD's, posted by johnj on July 28, 2002, at 11:41:05
> Hello
> a few question for you all. What AD has helped you and what dose? Better yet, what has not helped? ThanksHi,
I haven't tried MAOI's, just tricyclics, SSRI's, and the new ones. Tricyclics didn't work well by themselves. Wellbutrin is too sleep disruptive. Remeron/Serzone/Trazodone made me sleep all the time. Probably low-dose SSRI's and Effexor. It seems that the dosages that work the best are anywhere from 1/4 to 1/8 of the "standard" dose they make (2.5mg of Prozac/Celexa, 12.5mg of Zoloft/Effexor)
Mitch
Posted by cybercafe on July 28, 2002, at 20:07:35
In reply to Re: Bipolar II's and AD's » johnj, posted by Ritch on July 28, 2002, at 14:48:43
> I haven't tried MAOI's, just tricyclics, SSRI's, and the new ones. Tricyclics didn't work well by themselves. Wellbutrin is too sleep disruptive. Remeron/Serzone/Trazodone made me sleep all the time. Probably low-dose SSRI's and Effexor. It seems that the dosages that work the best are anywhere from 1/4 to 1/8 of the "standard" dose they make (2.5mg of Prozac/Celexa, 12.5mg of Zoloft/Effexor)
Hey Mitch do you have atypical or melancholic depression?
Posted by Ritch on July 28, 2002, at 20:48:32
In reply to Re: Bipolar II's and AD's, posted by cybercafe on July 28, 2002, at 20:07:35
> > I haven't tried MAOI's, just tricyclics, SSRI's, and the new ones. Tricyclics didn't work well by themselves. Wellbutrin is too sleep disruptive. Remeron/Serzone/Trazodone made me sleep all the time. Probably low-dose SSRI's and Effexor. It seems that the dosages that work the best are anywhere from 1/4 to 1/8 of the "standard" dose they make (2.5mg of Prozac/Celexa, 12.5mg of Zoloft/Effexor)
>
> Hey Mitch do you have atypical or melancholic depression?
>
My depressions are seasonal SAD-like episodes. I have two per year. One is in the summer and one is in late fall early winter. The summertime one tends to be more of a mixed bipolar depression with more anxiety and insomnia--also I feel more alert and OK in the morning with afternoon/evenings becoming lethargic and fatigued with rebound alertness later in the evening with insomnia/broken, reduced sleep. The wintertime one is associated with weight gain, carbohydrate cravings, and hypersomnia--sleeping late into the mornings and still not feeling rested. How that fits into "atypical" or not, I am not sure.Mitch
Posted by Jackd on July 28, 2002, at 23:22:25
In reply to Re: Bipolar II's and AD's » cybercafe, posted by Ritch on July 28, 2002, at 20:48:32
Well first thing's first, you need to be on a mood stabilizer (or two) if you aren't on one yet.
People, including me before I started, ask what exactly mood stabilizers do for you. Well with risk of sounding redundant, they balance you out, make you more controlled in action, emotion and thought, and they can really really help with anxiety and restlessness (if it stems from your mood disorder). Oh and you don't "burn" out as easily doing long tasks that involve weeks or months. That's just my experience.
Lamictal would be the one of choice for milder bipolar. From the literature I've read and posts I've seen that seems to be the general growing consensus. It works good, has virtually no side effects, and has a decent AD quality.
As for antidepressants... for me SSRI's are pathetically inadequate, just numbing me and making me less sharp. Atypical depression calls for atypical AD's, or so they say, and it seems to be true. I would recommend Remeron but many say it makes them feel drowsy. I would try a high dose (60-90mg) of it which is quite stimulating. Effexor is pretty effective, but it just makes a lot of people including me feel too wired, too medicated. Wellbutrin seems to have a good reputation but again, I felt it had too much of an edge to it.
I've probably said far too much, but that just about sums up any insight I would have. Just remember, mood stabilizers are KEY for any mood instability. Without one you're in for a long rollercoaster ride and dissatisfaction with most meds.
Posted by cybercafe on July 28, 2002, at 23:34:00
In reply to Re: Bipolar II's and AD's » cybercafe, posted by Ritch on July 28, 2002, at 20:48:32
>one is in late fall early winter. The summertime one tends to be more of a mixed bipolar depression with more anxiety and insomnia--also I feel more alert and OK in the morning with afternoon/evenings becoming lethargic and fatigued with rebound alertness later in the evening with insomnia/broken, reduced sleep. The
hmmm.. the summer depression sounds like it may respond better to a tricyclic than an SSRI, especially if it is not mood reactive
>wintertime one is associated with weight gain, carbohydrate cravings, and hypersomnia--sleeping late into the mornings and still not feeling rested. How that fits into "atypical" or not, I am not sure.... yeah the winter one (if there is mood reactivity especially) would be classified as atypical, and would respond better to SSRIs than the summer depression... but it would probably respond to an MAOI like Parnate best of all...
Posted by Shawn. T. on July 29, 2002, at 2:13:54
In reply to Bipolar II's and AD's, posted by johnj on July 28, 2002, at 11:41:05
Remeron makes you drowsy, and Wellbutrin makes you have insomnia. Remeron makes you gain weight, and Wellbutrin typically makes you lose it. I have bipolar II, and the combination works well for me. I seem to be the only person in the world that thinks having a ton of noradrenaline flowing through you isn't such a great thing, so I really don't recommend over 15mg of Remeron to anyone. Believe it or not, you will experience side effects if you take a large dose (I may be one of the few people around here who believes this to be true). Wellbutrin's noradrenaline reuptake mechanism is interesting because it actually decreases the firing rate of noradrenaline neurons. This is due to an increased activation of inhibitory somatodendritic alpha-2-adrenoceptors. Remeron blocks those receptors. So combining too much Remeron with Wellbutrin is a bad idea, but combining just a little (7.5-15mg/day) with it will do nicely. Individual reports have cited that this is an excellent combination for treatment resistant depression, and it should not switch you into a manic episode.
Throw in some fish oils and skip out on the mood regulators (Remeron has a certain level of mood regulation on its own). Whatever you do, do not under any circumstances take an SSRI.Shawn
Posted by colin wallace on July 29, 2002, at 4:03:38
In reply to Re: Bipolar II's and AD's, posted by Shawn. T. on July 29, 2002, at 2:13:54
>> Believe it or not, you will experience side effects if you take a large dose (I may be one of the few people around here who believes this to be true...
This is so very true (from a seasoned, 60mg vet.)
Posted by Ritch on July 29, 2002, at 9:06:38
In reply to Re: Bipolar II's and AD's, posted by Jackd on July 28, 2002, at 23:22:25
> Well first thing's first, you need to be on a mood stabilizer (or two) if you aren't on one yet.
>
> People, including me before I started, ask what exactly mood stabilizers do for you. Well with risk of sounding redundant, they balance you out, make you more controlled in action, emotion and thought, and they can really really help with anxiety and restlessness (if it stems from your mood disorder). Oh and you don't "burn" out as easily doing long tasks that involve weeks or months. That's just my experience.
>
> Lamictal would be the one of choice for milder bipolar. From the literature I've read and posts I've seen that seems to be the general growing consensus. It works good, has virtually no side effects, and has a decent AD quality.
>
> As for antidepressants... for me SSRI's are pathetically inadequate, just numbing me and making me less sharp. Atypical depression calls for atypical AD's, or so they say, and it seems to be true. I would recommend Remeron but many say it makes them feel drowsy. I would try a high dose (60-90mg) of it which is quite stimulating. Effexor is pretty effective, but it just makes a lot of people including me feel too wired, too medicated. Wellbutrin seems to have a good reputation but again, I felt it had too much of an edge to it.
>
> I've probably said far too much, but that just about sums up any insight I would have. Just remember, mood stabilizers are KEY for any mood instability. Without one you're in for a long rollercoaster ride and dissatisfaction with most meds.Hi Jack,
Oh, I have been on antimanics for 25 years now. Lithium, mostly, but recently Depakote and Neurontin. I agree with your assessment of them. Something I *hadn't* heard before is your statement--.."you don't "burn" out as easily doing long tasks that involve weeks or months." That is interesting, because that is where my ADHD and bipolar symptoms overlap the most. PLANS just never seem to get followed through on and that tends to make depression worse. "Prisoner of the present" would definitely be an accurate statement! Lamictal would probably be ideal for me especially since I have never had a full blown psychotic mania. I have had some mixed spells that came a little close though... I am keeping that one on the back burner because I am responding fairly well to what I am taking now and I fear the skin thing bigtime (even though it is quite rare). I am just taking Depakote 250mg+Klonopin .25mg with 12.5 mg of Effexor right now. When this lifts I will probably flip the Effexor back to a weaker AD at a low dose, like Celexa or Lexapro. Effexor has set off bad hypomania in the past, so it is just too powerful to take during periods of the year when I am prone to that.
Mitch
Posted by Ritch on July 29, 2002, at 9:15:41
In reply to Re: Bipolar II's and AD's, posted by cybercafe on July 28, 2002, at 23:34:00
> >one is in late fall early winter. The summertime one tends to be more of a mixed bipolar depression with more anxiety and insomnia--also I feel more alert and OK in the morning with afternoon/evenings becoming lethargic and fatigued with rebound alertness later in the evening with insomnia/broken, reduced sleep. The
>
> hmmm.. the summer depression sounds like it may respond better to a tricyclic than an SSRI, especially if it is not mood reactive
>
>
> >wintertime one is associated with weight gain, carbohydrate cravings, and hypersomnia--sleeping late into the mornings and still not feeling rested. How that fits into "atypical" or not, I am not sure.
>
> ... yeah the winter one (if there is mood reactivity especially) would be classified as atypical, and would respond better to SSRIs than the summer depression... but it would probably respond to an MAOI like Parnate best of all...
>
Hi,The summertime one *has* responded to nortriptyline+Zoloft before. But interestingly, nortripytline by itself didn't work. Also nortripytline is the only tricyclic that has worked worth a damn. The wintertime one thus far has responded the best to stimulants. I took just 5mg of Adderall in the morning for a wintertime episode once and I had NO depression at all. I couldn't stand the anxiety though! The last wintertime one I responded the best to a low-dose combo of Wellbutrin+Nortriptyline+Celexa. MAOI's would probably be the ideal med for me. Pdoc won't go for it, though. I tend to get hypertensive reactions from meds, so I am not going to argue. I was up to just 25mg of Effexor a couple of weeks ago and my BP went from about 130/75 > 160/90! Eeek. It has done that before on Effexor (but not that much), and I get significantly raised BP from Zoloft and Wellbutrin, too.
Mitch
Posted by cybercafe on July 29, 2002, at 12:47:52
In reply to Re: Bipolar II's and AD's, posted by Shawn. T. on July 29, 2002, at 2:13:54
>it. I have bipolar II, and the combination works well for me. I seem to be the only person
This is news right? When did you get diagnosed bipolar Shawn?
No need to comment if you don't want to -- but i was a little worried when you disappeared and thought you might like to share ...btw... have you ever considered lamictal?
>in the world that thinks having a ton of noradrenaline flowing through you isn't such a
certain noradrenergic receptors are known to precipitate mania.... which is why you never give a TCA to a bipolar ... (also because bipolars tend to have more atypical/vegetative depression, but that's another matter)
Posted by Shawn. T. on July 29, 2002, at 21:18:28
In reply to Re: What News Shawn ? , posted by cybercafe on July 29, 2002, at 12:47:52
I believe that I decided this about a week ago. I self diagnosed it; the evidence seems to be there. I have an appointment with my psychiatrist August 7, so I'll talk to him about it then. He accepted the diagnosis of my previous psychiatrist, which was dysthmia with comorbid anxiety. Bipolar II is one of the most difficult diagnoses in medicine to make; I have really started to show strong signs of it in the past two years (I realize now). I am lucky that I caught it early; it gets worse when untreated. Believe it or not, I am glad that I am bipolar; it has done me more good than harm.
Shawn
Posted by cybercafe on July 29, 2002, at 21:59:51
In reply to Re: What News Shawn ? , posted by Shawn. T. on July 29, 2002, at 21:18:28
> I believe that I decided this about a week ago. I self diagnosed it; the evidence seems to be there. I have an appointment with my
Hmmm... i know there is a mania rating scale -- but i find it much harder to fill out objectively than the hamilton depression scale -- perhaps because i have nothing to compare the h-mania to (what's normal?)
>previous psychiatrist, which was dysthmia with comorbid anxiety. Bipolar II is one of the most
yeah... did you find your dysthymia was constant mood or went up and down (cyclothymia)?
i know they both tend to start at an earlier age that most depressive disorders
>difficult diagnoses in medicine to make; I have really started to show strong signs of it in the
hmmm... i found it pretty easy to make... i mean... i was upset when my doc didn't accept my self-diagnosis .... it has always been pretty obvious that there were times i would talk faster and louder than others.... or get really excited in a situation where others just couldn't understand what i was so excited about...
.... i think i have a bit of a cluster B axis II disorder ... (narcissistic personality disorder perhaps) and that certainly has an underlying mood instability to it...>past two years (I realize now). I am lucky that I caught it early; it gets worse when untreated.
yeah... i wonder if that is grounds for a lawsuit?
>Believe it or not, I am glad that I am bipolar; it has done me more good than harm.
... i could sure use some of that h-mania right about now
Posted by Shawn. T. on July 30, 2002, at 18:09:13
In reply to Re: What News Shawn ? , posted by cybercafe on July 29, 2002, at 21:59:51
I don't think that I have cyclothymia. Like I said, I'll get a professional opinion about it. I never claimed to know anything about the diagnosis part of things, but I certainly know a thing or two about drugs. Hypomania never bothered me (I of course did not realize it was going on before); I am known by my friends as the person always in control (except on Paxil). Putting up with 2-4 month depression spells has been my primary problem; I have definitely had some spells where I completely lost my energy. I had an 8am calculus class my freshman year of college that I had to skip all of the time; it still amazes me that I managed to pass it (barely) with all of the quizzes and homeworks that I did not complete. I wasn't exactly going out and getting drunk every night before class either. If I had been medicated earlier, I would probably be well on my way to becoming a computer scientist by now.
Shawn
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