![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by catmint on November 18, 2002, at 14:24:05
I have read a lot on this board about benzodiazipenes and I have no idea what they do, what the side effects are, what are the differences between say, Klonopin and Valium, and why they are addictive, etc.
Any comments appreciated,
Amy
Posted by Mr.Scott on November 18, 2002, at 16:14:53
In reply to What do Benzo's do exactly?, posted by catmint on November 18, 2002, at 14:24:05
> I have read a lot on this board about benzodiazipenes and I have no idea what they do, what the side effects are, what are the differences between say, Klonopin and Valium, and why they are addictive, etc.
>
> Any comments appreciated,
>
> AmyHello Amy,
Benzodiazepine drugs bind to a specific receptor in the brian called (believe it or not) the Benzodiazepine receptor. The Benzodiazepine receptor sits adjacent to the GABA receptor and its ionophore channel. It is believed that benzodiazepines alter GABA receptor sensitivity, and so the receptors are more sensitive their own GABA. GABA is the brains main inhibitory neurotransmitter and is present at 40% of all synaptic junctions in the brain (places where neurons meet eachother). Most of the benzodiazepines available with the exception of Ambien and the other new sleeping pill of which I cannot remmber it's name are full benzodiazepine agonists. Ambien and the other new pill are partial benzodiazepine agonists. As it turns out there are subtle differences among the benzodiazepine receptors in the brain. Some are more reponsible for inducing sleep, some more for anxiety, others still for anticonvulsant effects, some for muscle relaxation. Others still are involved in learning and memory. Each of the marketed full agonist benzodiapines has slightly different affinities for these recptors. Valium is touted as the best for muscle relaxation. Klonopin for Anti-convulsant, etc. Restoril for sleep. At equal dosing however they can all substitute fairly well for one another. Ambien only hits the benzodiazepine sleep receptor and not the others. Benzodiazepines are not really addictive in the sense of say cocaine. Almost no one develops an intense preoccupation with benzodiazepines where they need more and more of them to get the desired effect. The are habituating in the sense that they do relieve stress and emotions that are unpleasant so that people can get into the habbit of taking them innappropriately. More important however is that they cause physical dependence. The body gets used to their presence and attempts in part to compensate. Withdrawing benzodiazepines results in an abstinence syndrome of which the severity is dependent mainly on two criteria. 1)how powerful the drug binds to the receptors and 2)the drugs half life.
Drugs like Xanax and Ativan are the hardest to withdraw from because they have short half-lives and very tight receptor binding. Drugs like Tranxene and Valium which are weakly bound to recptors and have a very long-half life are easier to taper off of. Finally, a third criteria exists when taking into account benzodiazepines and their abuse potential. That is 3)How euphoric they are. In this category Valium and Xanax are far favored over the others amongst addicts while others such as Klonopin, Tranxene and Serax, are not sought after by addicts with the same tenacity. Benzodiazepines are far from perfect drugs. However, long-term use can be effective for many people suffering from several disorders including anxiety and other disorders worsened by stress. I would definately think of benzos as a third line med. I would try antidepressants, anticonvulsants first such as Neurontin, and therapy first. In the end however doctors who believe science has advanced so far as to never prescribe benzodiazepines for people who suffer are foolish and unwise. Not wanting to create a second problem is understandable, however unwillingness to treat the initial problem effectively is not.
Posted by Alan on November 18, 2002, at 20:06:17
In reply to Re: What do Benzo's do exactly? » catmint, posted by Mr.Scott on November 18, 2002, at 16:14:53
I would definately think of benzos as a third line med. I would try antidepressants, anticonvulsants first such as Neurontin, and therapy first. In the end however doctors who believe science has advanced so far as to never prescribe benzodiazepines for people who suffer are foolish and unwise. Not wanting to create a second problem is understandable, however unwillingness to treat the initial problem effectively is not.
=============================================
Dear Mr. Scott,In light of the recent report by the World Health Organisation regarding the frequency of complaints surrounding AD's (especially in relation to the bzds), in the case of anxiety disorders, why would you not think that bzds shouldn't be offered by the physician on an equal footing with the aforementioned AD's and AC's?
The efficacy rates comparatively speaking are not close to those of the anxiolytics - the bzds far ahead by every credible published report I and my pdoc have seen, even comparing the AD manufacturer's own published reports (30 - 50% - barely above placebo*)?
With discontinuation syndrome/poop out euphemistically used interchangeably with the tolerance/withdrawl effect of bzds, isn't the issue about the superiority of AD's in this regard at the very best a comparative wash?
Best,
Alan
*"Significantly better" than placebo refers only to statistical significance, i.e. validity of the conclusion. The difference between 10% success on placebo and 11% success on Lexapro for instance could make Lexapro "significantly better" than Celexa in statistical terms if the sample were large enough.
This glossing over of success rates that often are in fact less than 50% is all too common. For several SSRIs, an ordinary doc with poor info-search skills may be unable to find actual success rates. And IMO that's no accident.
Posted by Mr.Scott on November 18, 2002, at 21:28:02
In reply to Re: What do Benzo's do exactly? » Mr.Scott, posted by Alan on November 18, 2002, at 20:06:17
Hello Alan,I am not at all anti benzo, and I wouldn't work with a physician who had an anti-benzo agenda. I do feel however that if a celexa, or zoloft worked for anxiety it's better in many ways than are benzos. If SSRI's don't work, than go to the benzos by all means. If Celexa or Zoloft stop working they can be easily withdrawn in most people. Xanax or Ativan cannot be easily removed for most people. Klonopin isn't that much easier either. I think it's important to take into account everyones individual differences which no study can effectively do. I would use what is easiest to use first and then whatever is necessary. Thats my take on the situation..
Scott
Posted by catmint on November 18, 2002, at 21:38:54
In reply to Re: What do Benzo's do exactly? » catmint, posted by Mr.Scott on November 18, 2002, at 16:14:53
Posted by Alan on November 19, 2002, at 0:53:03
In reply to Re: What do Benzo's do exactly? » Alan, posted by Mr.Scott on November 18, 2002, at 21:28:02
>
> Hello Alan,
>
> I am not at all anti benzo, and I wouldn't work with a physician who had an anti-benzo agenda. I do feel however that if a celexa, or zoloft worked for anxiety it's better in many ways than are benzos. If SSRI's don't work, than go to the benzos by all means. If Celexa or Zoloft stop working they can be easily withdrawn in most people. Xanax or Ativan cannot be easily removed for most people. Klonopin isn't that much easier either. I think it's important to take into account everyones individual differences which no study can effectively do. I would use what is easiest to use first and then whatever is necessary. Thats my take on the situation..
>
> Scott
===============================================
Then how would one explain this:http://www.guardian.co.uk/Archive/Article/0,4273,4201752,00.html
Especially the 2 paragraphs citing the World Health Organisation's findings?Alan
Posted by Mr.Scott on November 19, 2002, at 19:09:49
In reply to Re: What do Benzo's do exactly? » Mr.Scott, posted by Alan on November 19, 2002, at 0:53:03
Thats a good article! Thanks for sharing it.
I still believe that the balance of information is in favor of SSRI's over Benzo's as first line drugs. Now admittedly that may be because SSRI's are newer and less negative info that is credible is published, but there is literally entire forests of literature on the evils of benzos. Ranging from impairment of learning to aggravation of depression and not the least of which includes self administering across multiple species. Even brain shrinkage has been linked to high potency benzos (although it remains unproven as to whether or not co-administered alcohol might have contributed).
There is no perfect drug. They all have risks and benefits. I advocate only the best way to alleviate suffering, and from my point of view if you can do it with Lexapro or Prozac thats probably (although not necessarily) going to cause less problems than Ativan or Xanax. Also, SSRI's are more versatile than Benzo's for psychiatric illness in general, and I have met very few people who have anxiety and no obsessiveness or depression. But hey... if all someone needs is a benzo I'd say they are a very lucky psychiatric patient!
Scott
Posted by Alan on November 19, 2002, at 22:45:42
In reply to Re: What do Benzo's do exactly? » Alan, posted by Mr.Scott on November 19, 2002, at 19:09:49
I think that my point was that the bzds should be offered by physicians on an equal footing with the other two medications mentioned considering the organisation's report and the myths that have flown around about the unsubstantiated evils of bzds.
Some do well on AD's - some on bzds. Why shouldn't one of the AD's and one of the bzds be offered to the patient in two seperate clinical trials to see which works better then? Conforms to your theory, no?
Otherwise the commercially driven AD's will always take away choice for the doctor and the patient.
Alan
Posted by Mr.Scott on November 20, 2002, at 1:23:50
In reply to Re: What do Benzo's do exactly? » Mr.Scott, posted by Alan on November 19, 2002, at 22:45:42
The commercially driven aspect you mentioned is terrible. I can't think of a better way than capitalism, but then I haven't really had too much time to think of alternatives having to spend 8-12 hours a day making money and all. I'm not a big fan of governement intervention and regulation per se, but when it comes to people's healthcare the marketing really does more harm than good...But thats a whole nother thread..
Scott
Posted by Jefff on November 20, 2002, at 19:40:02
In reply to Re: What do Benzo's do exactly? » Alan, posted by Mr.Scott on November 20, 2002, at 1:23:50
Im just curious about when I read that Benzos are sought after for their euphoric effects. Ive been on Klonopin for about two moths now (2mg/day) and have also taken Xanax... both have been great for calming, soothing/anti anxiety and whatnot but I dont find I feel any euphoria at all? Am I missing something? Ive taken Vicodin and Codeine and these drugs definitely gave me a numbing body sensation and some mind numbing, but I wouldnt call any of it euphoric.
So why do people call Benzos euphoric producing? Or is the calmness/anti anxiety feeling supposed to be this euphoria? Im confused...
any thoughts anyone,
Thanks, Jeff
Posted by FredPotter on November 20, 2002, at 21:37:30
In reply to What is this supposed Benzo euphoria like??, posted by Jefff on November 20, 2002, at 19:40:02
Thanks Jeff Search me. I've never found them pleasurable. AA say they're "solid alcohol". What a joke. Would that they were. When I had a big anxiety/depression crash a year ago, complicated by alcohol, I went to hospital, where they stopped Xanax dead, substituting Valium at a very low dose for about 2 days. I ended up with a seizure, for whatever reason.
Doctors were clamouring to stop the Xanax, even though 3 years ago they were encouraging me to take it.
This isn't being unwilling to start someone on Xanax. I can sort of understand that. In my case I've been taking benzodiazepines on and off, mostly on, for 38 years. At first doctors coerced me into taking them (Librium then, then Valium, then Serax, then Xanax). I feel a bit pushed around, but I'm still alive and my brain works pretty well I'd say
Peace
Fred
Posted by viridis on November 21, 2002, at 2:03:34
In reply to What is this supposed Benzo euphoria like??, posted by Jefff on November 20, 2002, at 19:40:02
For me, benzos are nothing like alcohol or other recreational drugs. At the appropriate doses, benzos alleviate anxiety and have an antidepressant effect; above this I just feel sleepy. So, I have no incentive to increase the dose, any more than I would exceed the recommended dose of aspirin for a headache.
It's hard for me to understand the abuse potential of benzos, but I do have friends who really get off on them, so for certain people they can hit the spot. This doesn't seem to be the case for those with genuine anxiety disorders, who (based on the available data) need benzos to facilitate GABA binding at key receptor sites, i.e., just normalize brain function, no more.
Posted by Ritch on November 21, 2002, at 7:49:51
In reply to What is this supposed Benzo euphoria like??, posted by Jefff on November 20, 2002, at 19:40:02
> Im just curious about when I read that Benzos are sought after for their euphoric effects. Ive been on Klonopin for about two moths now (2mg/day) and have also taken Xanax... both have been great for calming, soothing/anti anxiety and whatnot but I dont find I feel any euphoria at all? Am I missing something? Ive taken Vicodin and Codeine and these drugs definitely gave me a numbing body sensation and some mind numbing, but I wouldnt call any of it euphoric.
> So why do people call Benzos euphoric producing? Or is the calmness/anti anxiety feeling supposed to be this euphoria? Im confused...
> any thoughts anyone,
> Thanks, Jeff
Of the people I have known over 25 years who have abused benzos, I would say 90% of them were attempting to treat *untreated* depression (usually "mixed" anxiety/depression). They also had other substance abuse issues. In their case, it seems they weren't becoming *euphoric* on BZD's, they were using them as a *numbing* device. Sometimes the "abuse" is the result of an improperly treated or undertreated anxiety disorder. One person I knew had PTSD (from a shooting incident), and was "abusing" Valium and Nembutal to prevent recurrent nightmares. When she got on Elavil (this was 1979) and into some decent therapy she improved dramatically.
Posted by joy on November 21, 2002, at 20:56:22
In reply to Re: What is this supposed Benzo euphoria like?? » Jefff, posted by Ritch on November 21, 2002, at 7:49:51
Posted by Mr.Scott on November 22, 2002, at 0:08:12
In reply to Re: What is this supposed Benzo euphoria like?? » Jefff, posted by Ritch on November 21, 2002, at 7:49:51
Benzo's are a strange breed lets face it. They are hard to categorize in terms of their abuse liability. I agree with the poster above who said people who abuse them are trying to treat something else. I would also add many hard core druggies use it to smooth over the edges of alcohol withdrawal and cocaine jitters or to amplify heroin. Benzo's are nowhere near those drugs in terms of abuse potential in and of themselves.
I think the euphoria benzo's provide is subtle and is more about quick relief and removal of negative feelings than actually eliciting good feelings on their own. If you are chronically stressed out anxious and unhappy and you take 10mg of valium, believe me you'll feel very different and much better in 20 minutes. For some people I believe that can be a problem, for others it's not.
If you're looking for therapeutic relief it's best to start with a low dose and climb as needed to avoid the immediate feelings. Also Klonopin and many others that take longer to get into the brain don't provide the immediate sense of relief that is reinforcing like valium does.
Scott
Posted by Ritch on November 22, 2002, at 9:49:39
In reply to Benzo Euphoria, posted by Mr.Scott on November 22, 2002, at 0:08:12
> Benzo's are a strange breed lets face it. They are hard to categorize in terms of their abuse liability. I agree with the poster above who said people who abuse them are trying to treat something else. I would also add many hard core druggies use it to smooth over the edges of alcohol withdrawal and cocaine jitters or to amplify heroin. Benzo's are nowhere near those drugs in terms of abuse potential in and of themselves.
>
> I think the euphoria benzo's provide is subtle and is more about quick relief and removal of negative feelings than actually eliciting good feelings on their own. If you are chronically stressed out anxious and unhappy and you take 10mg of valium, believe me you'll feel very different and much better in 20 minutes. For some people I believe that can be a problem, for others it's not.
>
> If you're looking for therapeutic relief it's best to start with a low dose and climb as needed to avoid the immediate feelings. Also Klonopin and many others that take longer to get into the brain don't provide the immediate sense of relief that is reinforcing like valium does.
>
> Scott
Hi, Scott. The *time* factor is the main thing for sure. The time it takes for the med to take effect and the duration of action. Of all the stimulant trials I have been through, only Adderall was something that I could take just once a day (at the same time every day), and just forget about it. All of the others would leave my system in just a few hours. I would yawn or something, and find myself looking at my watch. The AD's that have major withdrawal problems are the short half-life ones (Effexor, Paxil). Xanax is troublesome due to its brief half-life.
Posted by HIBA on November 22, 2002, at 23:55:08
In reply to Re: What do Benzo's do exactly? » Alan, posted by Mr.Scott on November 19, 2002, at 19:09:49
Dear Mr. Scott,
<<I advocate only the best way to alleviate suffering, and from my point of view if you can do it with Lexapro or Prozac thats probably (although not necessarily) going to cause less problems than Ativan or Xanax>>
Less problems than ativan or xanax ? I have experienced both type of withdrawals. Xanax withdrawal gave me some bouts of anxiety and dysphoria which I could easily manage with intensifying social activity. Things were not the same with zoloft. Obsessive rumination and consequent depression led me to the psychiatric clinic and only the answer was prozac. (which I am still on). I was a stranger to obsession prior to zoloft.
I agree with you, if a person can do with benzos alone he is the luckiest psychiatric patient. Isn't that what you meant ?
HIBA
Posted by viridis on November 23, 2002, at 1:42:40
In reply to Benzo Euphoria, posted by Mr.Scott on November 22, 2002, at 0:08:12
Hi Ritch and Mr. Scott (and everybody),
I think you're right -- the great majority of people who "abuse" benzos are actually trying to medicate themselves for a real (usually undiagnosed) disorder, not get high. But there is a small subset of people who do seem to get a genuine high from certain benzos. I've known a few who used Valium and Xanax recreationally, often in combination with alcohol (obviously a dangerous mix).
My pdoc told me that for the vast majority of his patients to whom he prescibes benzos, they're very safe and effective both short and long term. However, he added that occasionally, he's had patients who repeatedly "lose", "spill" etc. their prescriptions and request frequent replacements, then (sometimes) admit to bingeing on these drugs (usually Xanax; Klonopin doesn't seem to be a problem). He's quite willing to adjust doses as appropriate, but said that when he sees any evidence of misuse, he insists on a switch to a different class of meds. Again, he emphasized that this is a very small subset of the patients for whom he prescribes benzos, but he is very alert to signs that a patient is enjoying the meds and escalating doses beyond those needed for anxiety relief.
The first few times I took Xanax, I experienced what might almost be called a "high", but really it was more a sense of tremendous relief from unrelenting anxiety. I wasn't "stoned"; I just felt positive and able to deal with stress. Now, with daily use of Klonopin, I'm able feel this way much of the time, and I can't imagine going back to the way I was.
Posted by Mr.Scott on November 23, 2002, at 1:45:57
In reply to Re: What do Benzo's do exactly? » Mr.Scott, posted by HIBA on November 22, 2002, at 23:55:08
Hello Mitch,
Can we exchange current cocktails?
Currently I'm taking:
2.5 mg of Lexapro (am)
200mg Caffeine (am)
.25 mg of clonazepam (pm) or 3.75mg Tranxene (pm)
3000mg EPA (OmegaBrite)(pm)I would like to try 1)another soothing anticonvulsant, 2)back to more benzos or else 3)I may have to add some lithium back in, which is fine at the low end. Neurontin which I enjoy very much is highly side effect laden believe it or not for some reason. hmmm... perhaps 100mg only might work though. Stimulants are magic at first for me, but always degenerate into a sickening dysphoria. Doesn't seem to matter if it's Cylert, Cocaine, Ritalin, or Amphetamine. Only Caffeine can I tolerate...
What magic recipe helps keep you sane and productive these days?
Scott
Posted by Squiggles on November 23, 2002, at 6:51:34
In reply to Re: Benzo Euphoria, posted by viridis on November 23, 2002, at 1:42:40
I'm glad your doctor emphasized the "subset"
portion of the benzo usage you describe.My doctor practically had the shove the pill
down my throat when raising the Rivotril.Some people belong to the subset of "drugphobia",
others to the type you describe.As for euphoria, i find it interesting that
a CNS depressant or "downer" as the slang term
goes, can produce such an effect. But i suppose
since benzos are so much like alcohol, perphaps
the first time does do that.If there is abuse, the pill bottle will tell,
and neither the pharmacist nor the doctor will
miss that. An attempt on the part of the patient
to abuse these, may indicate the first signs
of addiction. So, it would be something for the
doctor to watch for.Squiggles
Posted by Ritch on November 23, 2002, at 9:57:03
In reply to Mitch!!!, posted by Mr.Scott on November 23, 2002, at 1:45:57
> Hello Mitch,
>
> Can we exchange current cocktails?
>
> Currently I'm taking:
>
> 2.5 mg of Lexapro (am)
> 200mg Caffeine (am)
> .25 mg of clonazepam (pm) or 3.75mg Tranxene (pm)
> 3000mg EPA (OmegaBrite)(pm)
>
> I would like to try 1)another soothing anticonvulsant, 2)back to more benzos or else 3)I may have to add some lithium back in, which is fine at the low end. Neurontin which I enjoy very much is highly side effect laden believe it or not for some reason. hmmm... perhaps 100mg only might work though. Stimulants are magic at first for me, but always degenerate into a sickening dysphoria. Doesn't seem to matter if it's Cylert, Cocaine, Ritalin, or Amphetamine. Only Caffeine can I tolerate...
>
> What magic recipe helps keep you sane and productive these days?
>
> Scott
>
>Hi Scott, Currently:
1) Effexor XR 4 mg (yes that's right) A.M. and 4mg afternoons (approximate of course). That's just enough to "dust" the 5-HT transporters and relieve some anxiety (also helps with muscle aches/pains). I had a sleepwalking episode after taking it all at bedtime as an experiment-ain't doing that again! I will push the Effexor XR up to a max of 18.75mg per day (again approx.)when (and IF) I get depressive symptoms (during about 3-6 days of my 3-week cycle). I will back off to just the tiny 4mg AM dose when I get a little on the high side (2-4 days of my 3-week cycle). I have to keep it VERY low or I will get hypomanic big time.
2) Sublingual B-complex and fish oil (1G cap) and 150mg of Trileptal with lunch (along with a single multivitamin). I also am going to add on 500mg of L-tyrosine for a few days if I hit a low spot. It seems to really help, but only for a *few* days, then it poops.
3) A second fish oil capsule with food in the late afternoon with the 4mg of Effexor XR (if I think I need it).
4) Depakote 125mg + Klonopin .5mg at bedtime. This time I got the sprinkle Depakote. I thought they screwed up and gave me Prozac! No vanilla smell and they are green and white-odd. I also got a script for 250mg Depakote to take instead of the 125mg SPR if I am a little high.
5) Off stimulants. Feel much better. My mood was fairly stable on them, but like you I tend to get "icky" on them after awhile and would prefer a little distractability. Incidentally, the Trileptal addition is an experiment to see if I can get *improved* cognitive function with it without needing an ADD med. I must say it is working fairly well. I went to a 3-hr meeting the other day and actually sat in ONE chair and listened throughout the presentation. Something else too-I've noticed that tastes and smells seem "normal", they don't seem flat or nasty like they evidently have been for some time. I swear I have got some kind of temporal lobe problem. I don't want to go up on the Trileptal any more just yet. I almost barfed on it the last time I went to 300mg, but I was also on an SSRI (Zoloft), that triggers a lot of nausea anyhow.
Hey, I have got one question for you: Does your mood cycling follow a D-M-E or a M-D-E pattern? Mine follows a clearcut DME pattern. I tend to "bounce" out of depression with hypomania and then the hypomania just fades, then I crash out of 'normality' into depression rather suddenly.
Mitch
Posted by Mr.Scott on November 23, 2002, at 11:42:57
In reply to Re: Mitch!!! » Mr.Scott, posted by Ritch on November 23, 2002, at 9:57:03
Hey Mitch,
Thanks for that in depth response! I will surely try some of your methods.
Actually come to think of it...I did come out of a nasty and lengthy depressive episode 3-4 weeks into a clear cut 2-3 day hypomania (induced by antidepressant change) and now I am kind of mixed I guess. It might be the recently substituted Lexapro for Effexor XR however that is 'jacking me around' where I might be otherwise euthymic.
I'm irritable, and I awoke this AM feeling like a truck had run me over. I know not what happened to my alarm clock...I swear I set it though. I'm not sure if this is euthymic and anxious or mildly hypo and irritable. It all starts to get confusing...
Scott
Posted by Ritch on November 23, 2002, at 13:09:02
In reply to Re: Mitch!!! » Ritch, posted by Mr.Scott on November 23, 2002, at 11:42:57
> Hey Mitch,
>
> Thanks for that in depth response! I will surely try some of your methods.
>
> Actually come to think of it...I did come out of a nasty and lengthy depressive episode 3-4 weeks into a clear cut 2-3 day hypomania (induced by antidepressant change) and now I am kind of mixed I guess. It might be the recently substituted Lexapro for Effexor XR however that is 'jacking me around' where I might be otherwise euthymic.
>
> I'm irritable, and I awoke this AM feeling like a truck had run me over. I know not what happened to my alarm clock...I swear I set it though. I'm not sure if this is euthymic and anxious or mildly hypo and irritable. It all starts to get confusing...
>
> Scott
>Scott, so you probably have a DME pattern too. My 3-week (actually about 20 day) cycles are burned in really well as far as peak to peak timing goes. What changes is the *duration* and *intensity* of the hypomanias and depressions and those changes are seasonal. The depressions lengthen in Nov/Dec to the point where they hit 14-days out of 20 and I technically have a major depressive episode, and I will get a hypomanic spell suddenly but just for a day or two at most and it is fairly mild. The "normal" or euthymic days dwindle down to nil as well. The next depressive spell is due next week right at Thanksgiving and then the next one (which usually is a whopper) will be before Christmas, but I should have a mild hypomanic spell the day before and Christmas Day, so that's a relief. I guess I will put this new med regime to a test. OH, the easiest way I can predict these things it to make a mark on the most remarkably hypomanic day (during a period of relative hypomania), and then look exactly 20 days forward and then make a question mark. The depressions are harder to predict but I know I will be depressed the most the few days before the highpoint. I noticed you aren't taking any mood stabilizer except Klonopin and Fish Oil. Have you considered a little Depakote? The ONE thing it seems to work the best on for me is grouchiness for sure.
Mitch
Posted by Peter S. on November 23, 2002, at 22:53:28
In reply to Re: cycling » Mr.Scott, posted by Ritch on November 23, 2002, at 13:09:02
Ritch,
You have an amazing regimen! How did you decide on all of it? I've tried fish oil and Omega 3 but never saw any real results. Can you tell when you drop a med or substance?
I have intense cycling which seems to be about 3 days in duration. It has especially increased since I've been taking meds. It's driving me crazy. For the last 2 days I've been in an incredibly deep hole. 3 days ago I felt great.
I really don't know what to do anymore. I've tried every med under the sun. I'm now taking Lamictal and Neurontin and have just added Lithium.
Posted by Ritch on November 24, 2002, at 10:38:36
In reply to Re: cycling, posted by Peter S. on November 23, 2002, at 22:53:28
> Ritch,
>
> You have an amazing regimen! How did you decide on all of it? I've tried fish oil and Omega 3 but never saw any real results. Can you tell when you drop a med or substance?
>
> I have intense cycling which seems to be about 3 days in duration. It has especially increased since I've been taking meds. It's driving me crazy. For the last 2 days I've been in an incredibly deep hole. 3 days ago I felt great.
>
> I really don't know what to do anymore. I've tried every med under the sun. I'm now taking Lamictal and Neurontin and have just added Lithium.
>
>Hi Peter, it was arrived at by LOTS of trial and error over years. Also, it is always evolving, so it is by no means final. The basic conclusions that I have found through going through lots of med trials and mood charting (that's a very good idea BTW), is that (for me) Depakote works the best for hostility and hypomania, and Clonazepam simply prevents panic attacks period (I haven't had ONE full-blown panic attack while I stay on a low dose maintenance). Now that leaves bipolar depression and ADHD symptoms that are relatively unaddressed. Serotonin reuptake inhibitors (currently low-dose Effexor), help with generalized anxiety and can reasonably pull me out of BP depression, BUT they trigger intense hypomania like nothing else I have ever taken. Stimulants don't trigger hypomania, but they make anxiety worse. I've tried several and tried to manage anxiety in different ways while trying them to no avail. So they are off the table. Wellbutrin didn't help the ADHD symptoms very well and also caused lots of anxiety, so it is out. So.... now we are trying fish oil, L-tyrosine (intermittently), and oxcarbazepine as an atypical antidepressant to see if I can get by. So far so good, but I won't know until I get through a full cycle on it (middle or end of next week).
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Dr. Bob is Robert Hsiung, MD,
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