Psycho-Babble Medication Thread 135419

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Amateur Shrinks and experienced Patients needed!

Posted by Mr.Scott on January 11, 2003, at 20:34:05

Please help me evaluate my situation so when I see my doctor on Monday who insists on emphasizing psychotherapy and offers the well known to be ineffectual neurontin for my bipolar 2 disorder I have some ammo.

I am taking 2.5mg of Lexapro which painfully stiffens my muscles up. I also take 3.75mg of tranxene daily and 1500mg of EPA (fish oil). For the last few days I felt really good and revved up. I drank a good amount of coffee and was exercising like a champ. Going to classes and working and feeling anxious to but also about raising my hand in class. Was I normal or hypo? How would I know? Over the weekend I have crashed. My mood is irritable, negative, mildly dysphoric and I'm VERY tired. The muscle pain is now really a bother to me and I can't seem to push myself to do much even though I am forcing myself to go see a movie tonight anyways.

Is this a cycle or can it be explained as normal? And if you think it's a cycle what do I need to do to get my shrink to realize these hypomanic blips may be preventing me from ever getting stabilized across the board. He doesn't see them or think much of them when I mention them. Other times I've been revved and feeling good I've made some poor decisions usually involving substances of abuse.

I read a book on childhood bipolar disorder that in looking back I certainly could squeeze myself into. Once again it says AVOID ANTIDEPRESSANTS, and particularly if your not on Lithium, Depakote, or Trileptal/tegretol.

Should I try Lamictal since I am primarily depressed?

Once again folks..any input is appreciated..

Scott

 

Re: Amateur Shrinks and experienced Patients needed! Mr.Scott

Posted by jay on January 12, 2003, at 1:41:23

In reply to Amateur Shrinks and experienced Patients needed!, posted by Mr.Scott on January 11, 2003, at 20:34:05

Well...a couple of points, and don't forget...you don't have to take what your doctor suggests. Like me...you too also sound like you've been struggling with this for a long time, and I think with Bipolar Disorder, doctors still too often go by the 'classical' treatments offered in the DSM.

An important point, though, worth mentioning to your doctor is that Neurontin has been shown to be of very little use for *anything*. I can't recall the website, but the doctor on there mentions that after the makers of Neurontin where exposed with their half-arse 'studies', newer studies have even shown it to be less effective than placebo, and I know there must be a few around for Bipolar Disorder.

Another interesting, and tried and true, route is to try *two* mood stabalizers, along with a small amount of antidepressant. This, again, comes from the pdoc mentioned above...but I forget the website and his name.

I still am not convinced that BP2 and 3'ers *must* leave an antipressant out of their cocktail. I think the dose has to be carefully adjusted, but the depression has to be looked after as well. I know it is risky, and can complicate things, but I have *never* been satisfied with just a mood stabalizer.

So, I would at the very least, try to keep your antidepressant with a mood stabalizer, and *try* to get two prescribed if you can. I know there is some good literature supporting this, so you may want to try a medline search or something like that. Also, there is the angle to go with a antidepressant, an atypical ap, and a mood stabalizer. I also find benzodiazepines helpful in these cases, but I don't know if your doctor is anti-benzo, or what.

Good luck...and remember there *are* choices...no matter how many meds you've been through, and how many years as well. I recall reading it often takes 10 years to just find the right diagnosis and meds for BP'ers. I am into my second decade, and just *really* starting to experiment with meds
(as far as combos go, anyways), and notice that when you get feeling *well*...it is not something you have to worry about slipping away.

Sorry for the long post...but I thought it would help. Let us know how you make out...and be assertive, but of course not aggressive, with your pdoc. Best wishes...

Jay

 

Re: Amateur Shrinks and experienced Patients needed!

Posted by JohnL on January 12, 2003, at 8:17:36

In reply to Amateur Shrinks and experienced Patients needed!, posted by Mr.Scott on January 11, 2003, at 20:34:05

I am indeed an amateur. But I am a highly experienced patient. :-) You name it, I've probably tried it.

It's just an opinion, but I would suggest forgetting about traditional BP treatments such as Tegretol, Lithium, Neurontin, Lamictal, etc. Instead, go with 20mgProzac and 5mg to 10mg of Zyprexa. The two together are much stronger than either alone in wiping out the depression. And this combo oftens provides significant improvement in just one week. Zyprexa acts as a mood stabilizer and is even FDA approved for mania.

In the game of psychiatry, choosing the right meds is often like throwing darts blindfolded. So I tend to go with things that appear to have the highest potential for being successful for the largest amount of people. Zyprexa plus Prozac fits that description.

Again, it is just my opinion. But I have been on Lamictal, Lithium, Tegretol, etc etc. And I've been on all the ADs. I know what each feels like. Of them all, the combo of Zyprexa plus Prozac is far superior to anything else.

There is plenty of scientific research as well as anecdotal evidence to support these opinions.

> Please help me evaluate my situation so when I see my doctor on Monday who insists on emphasizing psychotherapy and offers the well known to be ineffectual neurontin for my bipolar 2 disorder I have some ammo.
>
> I am taking 2.5mg of Lexapro which painfully stiffens my muscles up. I also take 3.75mg of tranxene daily and 1500mg of EPA (fish oil). For the last few days I felt really good and revved up. I drank a good amount of coffee and was exercising like a champ. Going to classes and working and feeling anxious to but also about raising my hand in class. Was I normal or hypo? How would I know? Over the weekend I have crashed. My mood is irritable, negative, mildly dysphoric and I'm VERY tired. The muscle pain is now really a bother to me and I can't seem to push myself to do much even though I am forcing myself to go see a movie tonight anyways.
>
> Is this a cycle or can it be explained as normal? And if you think it's a cycle what do I need to do to get my shrink to realize these hypomanic blips may be preventing me from ever getting stabilized across the board. He doesn't see them or think much of them when I mention them. Other times I've been revved and feeling good I've made some poor decisions usually involving substances of abuse.
>
> I read a book on childhood bipolar disorder that in looking back I certainly could squeeze myself into. Once again it says AVOID ANTIDEPRESSANTS, and particularly if your not on Lithium, Depakote, or Trileptal/tegretol.
>
> Should I try Lamictal since I am primarily depressed?
>
> Once again folks..any input is appreciated..
>
> Scott

 

Re: Amateur Shrinks and experienced Patients needed! jay

Posted by Dr-Eamerz on January 12, 2003, at 8:17:57

In reply to Re: Amateur Shrinks and experienced Patients needed! Mr.Scott, posted by jay on January 12, 2003, at 1:41:23


>
> An important point, though, worth mentioning to your doctor is that Neurontin has been shown to be of very little use for *anything*. I can't recall the website, but the doctor on there mentions that after the makers of Neurontin where exposed with their half-arse 'studies', newer studies have even shown it to be less effective than placebo, and I know there must be a few around for Bipolar Disorder.
>

I'm an experienced ill person

Jaybabes.....
I take Neurontin with Depakote..as a stabiliser solo it's useless but if i take 600mg is a big difference with anxiety--better than benzos (that don't work for me)but can make you a bit stupid--like i am now : )
i THINK IT WOULD HAVE TO BE 600MG 4 TIMES A DAY FOR A GOOD EFFECT BUT THAT'S EXPENSIVE HERE IN UK.(OOPS naughty capslock)
I need alot of meds a big combo to be well but ...no can do.

 

Oppss..sorry 'bout dat! Dr-Eamerz

Posted by jay on January 12, 2003, at 9:05:59

In reply to Re: Amateur Shrinks and experienced Patients needed! jay, posted by Dr-Eamerz on January 12, 2003, at 8:17:57


Oooppss..my bad!!..:-) Sorry..I didn't mean to generalize. I just recall there was a really big Neurontin 'craze' a few years ago, and the makers got busted for touting it for everything they possibly could. But, isn't that what most drug companies do?..hehee.

I am sure it still has many uses, especially in the combos like you mentioned. I also too rely on a 'cocktail', and it has taken a long time to find what does and doesn't work. The more meds avaialble, the better it seems, just because I think it increases your 'odds' of finding ones that do work.

Anyhow,
May you be enchanted in light and a peaceable kingdom!

Jay

> >
> > An important point, though, worth mentioning to your doctor is that Neurontin has been shown to be of very little use for *anything*. I can't recall the website, but the doctor on there mentions that after the makers of Neurontin where exposed with their half-arse 'studies', newer studies have even shown it to be less effective than placebo, and I know there must be a few around for Bipolar Disorder.
> >
>
> I'm an experienced ill person
>
> Jaybabes.....
> I take Neurontin with Depakote..as a stabiliser solo it's useless but if i take 600mg is a big difference with anxiety--better than benzos (that don't work for me)but can make you a bit stupid--like i am now : )
> i THINK IT WOULD HAVE TO BE 600MG 4 TIMES A DAY FOR A GOOD EFFECT BUT THAT'S EXPENSIVE HERE IN UK.(OOPS naughty capslock)
> I need alot of meds a big combo to be well but ...no can do.

 

Re: Oppss..sorry 'bout dat! jay

Posted by Dr-Eamerz on January 12, 2003, at 9:25:46

In reply to Oppss..sorry 'bout dat! Dr-Eamerz, posted by jay on January 12, 2003, at 9:05:59


>
> Anyhow,
> May you be enchanted in light and a peaceable kingdom!
HEEheee..suppose at the moment I'm a Neurontin junkie..thing is my metabalism must be fast ..I need 600mg every 3hrs..I find I can concentrate much more and lengthens attention span(even though my spelling is kaput)and quietenz zee mind
Oh well I'd better go back to 300mg 3x day or doc will spank me (i wish : )

 

Re: Amateur Shrinks and experienced Patients needed! Mr.Scott

Posted by Ritch on January 12, 2003, at 10:54:50

In reply to Amateur Shrinks and experienced Patients needed!, posted by Mr.Scott on January 11, 2003, at 20:34:05

> Please help me evaluate my situation so when I see my doctor on Monday who insists on emphasizing psychotherapy and offers the well known to be ineffectual neurontin for my bipolar 2 disorder I have some ammo.
>
> I am taking 2.5mg of Lexapro which painfully stiffens my muscles up. I also take 3.75mg of tranxene daily and 1500mg of EPA (fish oil). For the last few days I felt really good and revved up. I drank a good amount of coffee and was exercising like a champ. Going to classes and working and feeling anxious to but also about raising my hand in class. Was I normal or hypo? How would I know? Over the weekend I have crashed. My mood is irritable, negative, mildly dysphoric and I'm VERY tired. The muscle pain is now really a bother to me and I can't seem to push myself to do much even though I am forcing myself to go see a movie tonight anyways.
>
> Is this a cycle or can it be explained as normal? And if you think it's a cycle what do I need to do to get my shrink to realize these hypomanic blips may be preventing me from ever getting stabilized across the board. He doesn't see them or think much of them when I mention them. Other times I've been revved and feeling good I've made some poor decisions usually involving substances of abuse.
>
> I read a book on childhood bipolar disorder that in looking back I certainly could squeeze myself into. Once again it says AVOID ANTIDEPRESSANTS, and particularly if your not on Lithium, Depakote, or Trileptal/tegretol.
>
> Should I try Lamictal since I am primarily depressed?
>
> Once again folks..any input is appreciated..
>
> Scott


Scott, I've found Neurontin to be somewhat helpful. True, it doesn't do much for my hostility and is only mildly antimanic. But, it definitely helped anxiety and had a mildly antidepressant effect. As far as your questions about cycles go, you need to chart the things. If you don't chart them (esp. if you are rapid-cycler), you won't get a sense of what pattern you are dealing with. I've been rundown and tired the last day or two and I thought I was coming down with a cold or flu or something. Well, I looked at my mood calendar and I'm in the depressive last few days of my current 20-day cycle. It can be as simple as getting one of those desk calendars and just put a plus or a minus based on how you feel when you first get up and then at the end of the day before you go to bed to judge how remarkably up or down you were. Then look at the patterns after a few weeks. THEN you can have something to show your doctor-they like charts! The anxiety could be the citalopram. I found citalopram to enhance my "startle response" more than the other SSRI's. As far as the muscle pain goes, maybe you could whack that dose in half? I also found with Celexa that I could get just as good a benefit from it by taking it every other morning (instead of every day). I don't know how long you have been taking the Lexapro, but it may be the result of it accumulating and your blood level of it is high enough to make you feel kind of foggy-headed and rundown. Flulike-symptoms are common with SSRI. The choice of "mood stabilizer", that's probably the toughest. My first idea would be to try lithium (since it is 1st line) first, but there have been many here that are very happy with Lamictal. Maybe a combo of Lamictal+Neurontin? The N. might help with the "activation" that might result from the Lamictal. hope this helps some--Mitch

 

Re: Amateur Shrinks and experienced Patients needed! Mr.Scott

Posted by ace on January 12, 2003, at 21:47:01

In reply to Amateur Shrinks and experienced Patients needed!, posted by Mr.Scott on January 11, 2003, at 20:34:05

> Please help me evaluate my situation so when I see my doctor on Monday who insists on emphasizing psychotherapy

What type of psychotherapy? It's funny, I doubt that any psychotherapy has ever cured any mental illness.

 

Re: Amateur Shrinks and experienced Patients needed! Ritch

Posted by Mr.Scott on January 13, 2003, at 17:24:51

In reply to Re: Amateur Shrinks and experienced Patients needed! Mr.Scott, posted by Ritch on January 12, 2003, at 10:54:50

I'm going to 'split the dose' as you suggest. If that doesn't help I think it's time to try L-tryptophan/5-HTP instead of these SSRI's. And maybe futz around more with Trileptal and benzos and finally stimulants if needed to undo the cognitive disturbance benzos will cause.

Thats for the input.

Scott

 

Re: Amateur Shrinks and experienced Patients needed! Mr.Scott

Posted by Ritch on January 13, 2003, at 23:33:25

In reply to Re: Amateur Shrinks and experienced Patients needed! Ritch, posted by Mr.Scott on January 13, 2003, at 17:24:51

> I'm going to 'split the dose' as you suggest. If that doesn't help I think it's time to try L-tryptophan/5-HTP instead of these SSRI's. And maybe futz around more with Trileptal and benzos and finally stimulants if needed to undo the cognitive disturbance benzos will cause.
>
> Thats for the input.
>
> Scott

Scott, hey no problem. I've tried upping my dose of Trileptal from 150mg/day to 225mg/day (again) and I am getting very nauseated once again with some exotropia (with worsened attentiveness/cognitive function). I am not sure whether to just drop back to 150mg/day and leave everything alone or flip back to low-dose Neurontin (and stop the OXC). It is like I have all of these "ceilings" with a lot of meds that are helpful. If I take more than 250mg/day of Depakote I swell up like a dog tick and can't stop eating. If I take more than 150mg/day of Trileptal I am fixing to hurl all of the time. If I take *any* lithium I've got diarrhea that strikes at any time of the day or night. Neurontin works well in many ways, but I get altered posture and strange muscle spasms (in my chest wall and eustachian tubes, etc.) at usual doses. Klonopin makes me stupid if I take it during the day. Stimulants make me panicky over time (probably because of HPA axis screwups). I can't take any AP's because of worsening dystonic reactions with time. Sorry, but I guess this has turned into a med intolerance rant. Gabitril at higher doses caused major cognitive dysfunction and depersonalization and facial numbness. Topamax did something similar to that. There ARE a few things I haven't tried yet: Thyroid augmentation, MAOI's, Lamictal, and verapamil. Only the verapamil has been brought up by my pdoc, perhaps I should try that next (flip from the OXC/Trileptal)??


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