![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by Viridis on December 26, 2003, at 2:41:07
In reply to Best Approach for Bipolars, posted by Mr. Scott on December 23, 2003, at 23:33:47
I don't have an "official" diagnosis of BP, but it's pretty obvious to me that I fall into the "BP II" part of the spectrum. My pdoc chooses not to diagnose me this way (instead I'm ADD with major depression and panic disorder), but he agrees that many others would treat me as bipolar II.
SSRIs are awful for me and promote rapid cycling and anxiety at any dose, Wellbutrin was a disaster, and Strattera just stopped working after a promising start. Provigil was somewhat helpful and I may try it again. I used Neurontin for quite a while and it simply stopped having any effect after the first few doses. I refuse to try Depakote or lithium. I do quite well with daily Klonopin and occasional Xanax, plus daily Adderall, so these are my current maintenance meds.
On my next visit, I'm going to ask for Lamictal (which I know he'll be willing to prescribe; we've already discussed it), and also cautiously test the waters with opiates. These work extremely well for mood stabilization for me, but I really doubt I can get a prescription for psychiatric purposes (even though dentists etc. have given me lots for pain management, and the mood stabilization benefits have been dramatic).
I'll keep you posted on how this all works out.
Posted by Mr. Scott on December 26, 2003, at 9:00:54
In reply to Re: Best Approach for Bipolars » Mr. Scott, posted by Viridis on December 26, 2003, at 2:41:07
Thanks! You sound like me.
Posted by HappyGirl on December 26, 2003, at 13:23:50
In reply to Can Depression be made worse by AD's in bipolars?, posted by Mr. Scott on December 25, 2003, at 22:04:40
Hi Scott:
In answer to your few questions below;
>>> As bipolars go...Is it generally the manic/hypomanic side of things that gets worse or de-stabilized by taking antidepressants? Or is it posible they actually 'worsen' depression by taking them.<<<
In Bipolar, you should/can not take mono-therapy, 'Anti-Depressant' only. It has to be done always with mood-stabilizer, such as Lithium, Depakote and any other reputable M.S.>>> I feel like sometimes they work to euthymia, other times they bring on hypomania, and sometimes they make depression worse, perhaps by not doing anything except creating side effects.<<<
Anti-Depressants brings up mania, in your case, 'hypomania' if your Bp is II spectum. Some of folks saying that an SSRI is NOT good for Bipolar, because SSRI such as Zoloft is notorious to bring up mania, even causing 'rapid cycler.' So, be cautious!>>> I have a hard time accepting that I can jump completely from an SSRI to Lamictal seemlessly and not experience a black depression. <<<
Your concern/worry on this is very understandable. However, Lamical has both properties, one for depression and the other for mood-stabilizer. Especially, Lamical is quite reputable as one of best ADs among Bp community. However, in my personal opinion, Lamical is not as strong as SSRI that is primarily designed for depression. On the otherhand, Lamical is originally designed for 'epilepsy,' ... but there is still a good proof/evidence to work VERY WELL on Bp depression.
>>>Currently i take Trileptal (900mg daily), Tranxene (7.5mg daily), and Lexapro (1mg daily). <<<
Trileptal, M.S. is a newer version of Tegretol, (came around 2001-2002?,' and a fairly common use as for M.S. Also, anti-dep. Lexapro is, in my knowledge, a good AD. Just the dosage, you need to test, because lower dosage doesn't do any good on your depression, if your is fairly severe.
One more med. Tranxene is anti-anxiety that also might be good for 'sleep well' throughout night. But, I have no good clue on this med.>>>I doc wants me to add Lamictal and eventually simplify.<<<
Your pdoc. may paln to add 'Lamical,' if your depression does not lift by taking only one AD, Lexapro, because Bp II is mostly 'major depression' with hypomania and dysphoric(rage/anger mix.). Then, it needs stronger AD's effect, for that you may need two different form of AD approach to combat the depressive side of your Bp.
H.G.
Posted by Mr.Scott on December 26, 2003, at 15:18:12
In reply to Re: Can Depression be made worse by AD's in bipolars?, posted by HappyGirl on December 26, 2003, at 13:23:50
Thank You H.G. for your experience and wisdom!
Some days (like today) I feel bad agitation. I wonder if drinking too much coffee/caffeine to overcome the Trileptal/Tranxene/depression isn't such a good idea either! Maybe my expectations are too high too. I've never heard anyone on this board mention digestive side effects from Lamictal, but who knows!
Thanks Again.
Scott
Posted by HappyGirl on December 26, 2003, at 21:25:55
In reply to Re: Can Depression be made worse by AD's in bipolars? » HappyGirl, posted by Mr.Scott on December 26, 2003, at 15:18:12
Hi Scott:
In my knowledge along with my personal experience, any of caffein has negative effects on Bp symptoms. Especially, too much coffee including too much chocolate just aggrevate your symtoms further/irritable and even rageous moods, because caffein is 'stimulant.' Then, you need to cut down those caffein drink/food.Also, as you might know already, Bipolar takes quite a while to get under control. The most important thing is you need a lot of patience and determination to get well/recovery. There is no such word 'Quick Fix,' rather this is to be 'life-long committment, ... in other words, you can say, ... 'struggle' to make you feel well.
Besides med. regimen, there might be a good idea for you to invest 'psycho-therapy'/counselling especially if you have some personal problems to tackle.
Keep reading and also posting whenever you have a question. Because, knowledge is a power once come to M.I., like Bp and other significant M.I.
H.G.
Posted by Lyrical13 on December 27, 2003, at 7:13:08
In reply to Can Depression be made worse by AD's in bipolars?, posted by Mr. Scott on December 25, 2003, at 22:04:40
I fret about med matters too. Will it make me worse? Are the side effects horrible? Will I have a reaction to the med or be a zombie? What's teh best thing to do? I've had reactions to meds before so I think it's only natural that I worry a bit. That's why I do as much research on a med before I decide to take it. I know what to expect that way. It helps a little bit. And when you think about it, we are all basically human guinea pigs when it comes to meds. It's a lot of trial and error to see which meds or combos will work for you. Our docs (hopefully) are making their best educated guesses based on past hx and symptoms so hopefully that will shorten the duration of the "experiment" and reduce the number of combos we have to try before we get it right. My doc (new to me in the last few months but so far I really like him and he has been very helpful) wants me to go off Seroquel and Synthroid and go on Lamictal along with my Effexor...he thinks (and I do to) that I'm BP2 rather than depressed/anxious. I wish I knew this 10 years ago...but each year we get a little better at catching the downward spiral sooner and getting help before it gets any worse. Sometimes it works, sometimes it doesn't. DEfinitely helps when your doc listens to you.. which my old doc really didn't... it seemed like he did, but he really wasn't there for me when I was in a crisis (not good at returning phone calls)
Anyway, don't worry or feel bad about worrying about meds...I think it's only natural given our situation.
Lyrical13
Posted by Lyrical13 on December 27, 2003, at 7:18:26
In reply to Re: Can Depression be made worse by AD's in bipolars? » HappyGirl, posted by Mr.Scott on December 26, 2003, at 15:18:12
I avoid caffeine for several reasons..it aggravates a couple of other medical things I have and it worsens anxiety. Think about it. Caffeine is a stimulant..it stimulates the adrenal gland and other areas. Overstimulation can cause anxiety. I avoid all caffeine (including chocolate most of the time) and I've found that it helps. I also notice that when I do have a little caffeine I get jittery and anxious/hyped up.
Lyrical13
Posted by ramsea on December 27, 2003, at 15:15:52
In reply to Can Depression be made worse by AD's in bipolars?, posted by Mr. Scott on December 25, 2003, at 22:04:40
For me the ADs can do both---as a BP 1 I can move into euphoric highs which can feel really wonderful after a lethargic depression, or I can get mixed states which give me all the energy and buzzing brain of mania with all the negativity and horror of depression. It is the worst state I can imagine. I can understand being worried, as this is a dead serious health issue. You have every reason to fret. I hope you get ease of mind soon and figure you probably will as the meds settle. For me Lexapro was a real downer, so getting rid of it was like getting rid of an aching rotten tooth. My pdoc also is adamant that in my case it is impt to simplify the meds. You might find that the Lamictal will be antidepressant enough and having lexapro would just be overkill. Also Lamictal seems to work best when not combined with too many other meds. Try to contradict the negative thoughts about your treatment, as your pdoc sounds involved and up to date and you sound intelligent. So you are in good hands, you need time and space to settle into a more solid recovery. Time takes time. Please don't get mad at me if I say something dumb like try to go with the flow and relax into your recovery.
Posted by Mr. Scott on December 27, 2003, at 18:20:28
In reply to Re: depression bipolar » Mr. Scott, posted by ramsea on December 27, 2003, at 15:15:52
Thank you all for posting. Sincerely.
You have helped me to accept my situation and realize that maybe a little patience and acceptance will go a long way. I'm scared...and grasping for straws that don't exist. I'm so anxious right now that it's difficult to even see all the complex variables at play ranging from relationships to meds to controversial diagnoses and several others. I think maybe if I just let go of some of it, I'll be better off and have a better understanding of the big picture as it unfolds.
Thanks,
Scott
Posted by leopard on December 28, 2003, at 2:40:43
In reply to Best Approach for Bipolars, posted by Mr. Scott on December 23, 2003, at 23:33:47
>
> Do most of you find the best approach to be Mood Stabilizer and Antidepressant (ie, Depakote + SSRI), or Mood Stabilizers alone (ie, Depakote + Lamictal).
>
> ScottI have recently been diagnosed with BPII. I never did well with SSRI's...I also wasn't diagnosed with BPII yet, so it was a disaster for me and I didn't know why. I would take them and was either sleeping 18 hours a day or a horrible rageaholic making risky decisions. I still didn't know my diagnosis when I tried Effoxor. It seemed to make a world of difference for me initially but topped out and really didn't address the crazy negative ruminations and paranoia I had. I added Geodon and the results were amazing!!!! I don't see a lot of stuff about Geodon on this board in general but I am willing to talk about this drug to anyone who will listen. From what I understand, there aren't weight gain issues with this drug. Hope this info helps.
Posted by Mr. Scott on December 28, 2003, at 12:32:13
In reply to Re: Best Approach for Bipolars, posted by leopard on December 28, 2003, at 2:40:43
Really? Your description of your ills fits me quite well. Tell me more about your success with Geodon.
Scott
Posted by leopard on December 28, 2003, at 18:30:32
In reply to Re: Best Approach for Bipolars » leopard, posted by Mr. Scott on December 28, 2003, at 12:32:13
I am so glad I found this web site...I feel a lot less insecure about my diagnosis...I am finally able to stop labeling myself as inadequate and recognize that the negative, obsessive ruminations, paranoia, perceived slights, anxiety, unfounded jealously, "reading into things", constantly feeling suspicious of people and their motivations are the pinging of chemicals in my brain that need to be redirected...this is not my character. This realization came through tons of therapy, EMDR, and now finally medication. I have been on Geodon for about two months now...I never knew what it was like to feel balanced...I liken it to a warm bath after a lifetime of cold showers. A really warm calm inside. I am able to listen to people without a running negative dialogue interfering with the moment; I am so much more tolerant of people, family, coworkers and life in general. I do not have "brain fog", I do not feel like I am changed...just better. In fact, when I look back at my behavior…literally, my interactions with the world out there, I am abhorred. Instead of beating myself up, I am recognizing how sick I was and how thankful I am to have found a way to move forward in a much less complicated manner. I am slowly weaning myself off of Effexor, I was on the lowest dosage, to see if Geodon can handle it alone. Again, Manic Depression and the accompanying behaviors...or flavors ;)... make diagnosing this disease so difficult and fine tuning the meds near impossible...lots and lots of hard work to be sure! I have had no bouts with insomnia, sexual dysfunction, weight gain, rashes, mania, nothin'...just a nice calm wonderful feeling. I am unfamiliar with a lot of the terminology used on this board. I hope my layman's terminology will help anyone reading this thread.
~Shannon
Posted by ramsea on December 29, 2003, at 5:29:53
In reply to Re: Best Approach for Bipolars (geodon for me) » Mr. Scott, posted by leopard on December 28, 2003, at 18:30:32
Shannon, it's refreshing to hear such a positive message. I look forward to your posting in future. I don't think anyone is here under the guise of expert, except as we are experts of ourselves. Some people clearly have more studied opinions than other people, and can be a great help. But I find everyone helpful, and I am not always interested in a professional take on a subject, but just true human experience. Anyway, I am glad for your newfound sense of well-being. Long may it last.
Posted by Mr.Scott on December 29, 2003, at 18:55:32
In reply to Re: Best Approach for Bipolars (geodon for me) » Mr. Scott, posted by leopard on December 28, 2003, at 18:30:32
well...
In summation, you have effectively described exactly everything that I and probably many others suffer from. SSRI's and Effexor are bad news for me, so with your inspiration I'll be seeking out a sample pack of Geodon in a week and a half when I see my doc. I've rarely heard anyone describe so succintly exactly the same cluster that causes me so much misery on a day in day out basis. I hope I find some relief as you have. May I ask how much you are taking?
Thanks for a new medical hope!
Scott
Posted by leopard on December 29, 2003, at 20:21:19
In reply to Re: Best Approach for Bipolars (geodon for me) » leopard, posted by Mr.Scott on December 29, 2003, at 18:55:32
I hope you find success in your journey to wellness...lots and lots of trial and error. I take 20mg at lunch time. That's it. The shelf life of Geodon is 6.5 hours....and yes you can definitely feel it wearing off...nothing bad but I noticed my agitation/tolerance level starts to rise...I am 5'4" and weigh 110lbs...not sure if ht/wt will determine your strength though...I may begin to take one in the am and one in the pm but for now I will stay where I am...I think there are too many pdocs who start or titrate meds way too high and way too fast...just my opinion...I feel like, I have had this problem for so long, let's take it nice and easy to really determine what is best for my brain...if I started at 40 mg (which is what he suggested) I would never know that 20 is pluggin' along just fine for right now...be your own best advocate! Also, try and clean the slate, as it were, and be as close to med free when you begin new meds...this is what I have been doing...I really want to observe and isolate which drugs are affecting what. Know what I mean? Also, take your vitamins and try to walk 15 to 30 minutes per day...it's not a lot of effort but the results are amazing...I don't get crazy with working out but the walking seems to help...on the beach is best! (all those neg ions are supposed to do wonders for our poor little brains). I take 2 teaspons of merc free fish oil per day as well...Hmmm, what else? I have also read the vit D is a big help in combatting depression. Good Luck and keep me posted!!!!!
~Shannon
well...
>
> In summation, you have effectively described exactly everything that I and probably many others suffer from. SSRI's and Effexor are bad news for me, so with your inspiration I'll be seeking out a sample pack of Geodon in a week and a half when I see my doc. I've rarely heard anyone describe so succintly exactly the same cluster that causes me so much misery on a day in day out basis. I hope I find some relief as you have. May I ask how much you are taking?
>
> Thanks for a new medical hope!
>
> Scott
Posted by Lyrical13 on December 30, 2003, at 7:37:35
In reply to Re: Best Approach for Bipolars (geodon for me) » Mr.Scott, posted by leopard on December 29, 2003, at 20:21:19
there are too many pdocs who start or titrate meds way too high and way too fast...just my opinion...I feel like, I have had this problem for so long, let's take it nice and easy to really determine what is best for my brain...if I started at 40 mg (which is what he suggested) I would never know that 20 is pluggin' along just fine for right now...
I agree. I am sensitive to meds and I ALWAYS bring this up when a doc (any kind) is getting out the Rx pad to prescribe something. I ask for the lowest dose available and sometimes will even start with half of that dose if possible. I've found that starting low and slowly working my way up to a therapeutic dose works best. It's often much less than a doc would have considered.
I really want to observe and isolate which drugs are affecting what. Know what I mean?
Exactly! I was supposed to start Seroquel and Synthroid at the same time but I wanted to see what did what...which one produced which side effects etc. I started the Synthroid a few days before the Seroquel. I chose that one first because it was supposed to have very little in terms of side effects. Also it was the middle of the week and I was afraid to start an AP then.. I've never taken one and didn't know what it would do to me. I started the Seroquel on Friday night so I would have the weekend to see what happened and my husband would be around to help if it went badly. I was supposed to increase the dose on both of the meds but I did it one at a time. I did one after 2 weeks and the other after 3 weeks (I don't remember which one went first now) The next time I went to my pdoc he was thinking of upping the Seroquel more but I told him I wasn't going to go any higher (I was at 50mg) because the morning after I upped it I fell down the last 3 steps as I was coming downstairs because I was so groggy. He was cool with that. (somewhat off-topic: It seems like my pdoc is often skeptical of what I tell him...like that steps thing...he raised his eyebrows like he thought I was making it up.. also I have low blood sugar and he was looking at my lab work and said my fasting was 98. Well, that's wonderful..usually it's around 70...but either way it doesn't mean anything. People with LBS often have normal fasting blood sugar readings. It's when you're up and about and haven't had anything to eat for a couple hours that you run into problems or when you eat sugar and your pancreas goes into overdrive...but I digress....)
Also, take your vitamins and try to walk 15 to 30 minutes per day...it's not a lot of effort but the results are amazing...I don't get crazy with working out but the walking seems to help...on the beach is best! (all those neg ions are supposed to do wonders for our poor little brains). I take 2 teaspons of merc free fish oil per day as well...Hmmm, what else? I have also read the vit D is a big help in combatting depression.
I too find that exercise makes a BIG difference. I really started doing it regularly this fall and it made a big difference...esp with the anxiety. When I was feelng really anxious I couldn't wait to exercise because I knew I was going to feel a lot better afterward. I take a multivitamin that's high in antioxidants, B vitamins and minerals that are supposed to be good for LBS (chromium, manganese, molybdenum (?), biotin, selenium) and extra C to help with immune system (esp since I work at a school... cold and flu central!) I didn't know about the Vit D and fish oil. Will have to try that. Getting enough rest, getting fresh air & sunshine also help as well as having a good support network.Helpful resource:
"The Antidepressant Survival Guide"
Info on how to make diet and lifestyle changes to improve effectiveness of meds and decrease side effects. Includes many of the above suggestions and more.
Question: What kind of med is Geodon? mood stabilizer?
I'm also on Effexor and we plan to start backing it down once I d/c Seroquel and start Lamictal. How are you doing it so that you don't have the nasty side effects? (rate, dose) I'm on the max dose of 225mg.
thanks
L13
Posted by Patient on December 30, 2003, at 16:49:58
In reply to Re: Best Approach for Bipolars, posted by leopard on December 28, 2003, at 2:40:43
Hi,
I found this string of messages interesting concerning meds. for bipolar disorder, due to my own experiences and frustrations with antidepressants. I've been seeing a psychiatrist every few months since 2000. I've been on Zoloft, Celexa, Wellbutrin for a very short period, Celexa, Prozac, Celexa, Lexapro with not the best results. The first time I tried Zoloft, which was when I went to my GYN complaining of Premenstrual Syndrome symptoms, she put me on Zoloft. I started on 25mg and within 2 days I felt great. This is usually how I react to SSRI's and then after a month or two I go down hill or feel that drug-poop out is occuring.
My doctor has loosely diagnosed me with Borderline Personality Disorder, but main diagnosis is moderate depression with extreme anxiety. Last Feb. I started on Lexapro with carbamazepine (Tegretol) anticonvulsant, to see if it would help stabilise my moods, especially before that time of the month. It didn't help, and I couldn't tolerate the dose he wanted me to go up to (400mg a day). So then I was on just the Lexapro 5mg and after a while it wasn't helping-increasing the dose only gave me anxiety. I added Wellbutrin SR to it and it helped very much, but the combo. was too pricey for us-my husband and I are currently having severe money problems due to lack of income from lack of job (engineer)f--(" One of these days you're gonna have to decide between heartworm medicine for the dog, or your brain candy!". Anyway, I decided to stop taking Lexa. and Wellb. to save money-well that only brought out all my terrible self in full force, so back on it. Then I decided to stop Lexa. and go on Prozac. I already had lots of leftovers of this med. At the very first it was fine, then by the end of the second week I was doing badly (I was ready to take the family dog to the Humane Society or dump him some where). So, after 2 1/2 weeks of Prozac I switched to trazodone and only a low dose during day, higher dose at bedtime. I feel calmer, but I am still depressed as well as a bit irritable. I have recently upped the dose of traz. (trazodone does cause lightheadedness and a drugged feeling, but otherwise no complaints, and just yesterday I started taking Lexapro again-I took 5mg in morn. and 5mg at noon for 10mg is too anxiety producing for me. I feel much better than just the trazodone alone. So, now I wonder where I go from here and look forward to talking this over with my doctor next month. so I am seriously taking an overview of myself and my meds.--my doctor isn't real good at this, and I only see him every two or three months-once again, to save money. Geodon is classed as a tranquiliser, as is Abilify (sp?). I've heard of Zyprexa as well, but don't if this is a tranquiliser as well.
So, you are taking how much Effexor and how much Geodon? I've avoided Effexor because of all the bad withdrawal complaints I have read.
All this leads me to an interest in medicines for Bipolar illness. I understand that Bord.P.D.'s have some similar symptoms to B.D. and sometimes a person can have both. I don't like the idea of taking Depakote or Depakene, lithium, or Lamictal, etc.- these anticonvulsants that are the usual standby for B.D. They can have serious side effects. It sounds like Geodon has 5-HT and NE reuptake inhibition-sounds like it would work very well for depression. Thanks for your input (as well as the others) about Geodon. I will bring this drug to my doctor's attention. I'm desperate for help. I hate this rollercoaster drug ride!
This is from http://www.rxlist.com/cgi/generic2/ziprasidone_cp.htm
ziprasidone pharmacodynamics
Ziprasidone exhibited high in vitro binding affinity for
the dopamine D 2 and D 3 , the serotonin 5HT 2A , 5HT
2C , 5HT 1A , 5HT 1D , and (alpha) 1 -adrenergic
receptors (K i 's of 4.8, 7.2, 0.4, 1.3, 3.4, 2, and 10 nM,
respectively), and moderate affinity for the histamine H
1 receptor (K i =47 nM). Ziprasidone functioned as an
antagonist at the D 2 , 5HT 2A , and 5HT 1D receptors,
and as an agonist at the 5HT 1A receptor. Ziprasidone
inhibited synaptic reuptake of serotonin and
norepinephrine. No appreciable affinity was exhibited
for other receptor/binding sites tested, including the
cholinergic muscarinic receptor (IC 50 >1 µM).The mechanism of action of ziprasidone, as with other
drugs having efficacy in schizophrenia, is unknown.
However, it has been proposed that this drug's efficacy
in schizophrenia is mediated through a combination of
dopamine type 2 (D 2 ) and serotonin type 2 (5HT 2 )
antagonism. Antagonism at receptors other than
dopamine and 5HT 2 with similar receptor affinities
may explain some of the other therapeutic and side
effects of ziprasidone.Ziprasidone's antagonism of histamine H 1 receptors
may explain the somnolence observed with this drug.Ziprasidone's antagonism of (alpha) 1 -adrenergic
receptors may explain the orthostatic hypotension
observed with this drug.
Posted by leopard on December 30, 2003, at 19:01:15
In reply to Re: Geodon talk (ziprasidone) , posted by Patient on December 30, 2003, at 16:49:58
Hi there,
I am so glad I found this board and found others like me...in terms of looking for answers and discussing symptoms and not giving up in our search to feel mentally well. Thank you for the link and the RX info on Geodon...I lack knowledge in this area and it is fascinating to know what receptors are affected by what meds. I am not a doc, but from what you are describing; you may very well be BP...probably BPII...which is very hard to diagnose AND it is often confused with BPD. Please go to BP websites and find a pdoc in your area that specializes in BP...PLEASE...unipolar meds suck for BP people...I tried 90% of the meds you listed...Wellbutrin was OK and I liked Effexor for a while...there is always the honeymoon period but then they tend to make me feel like I have hit a plateau...I eventually phased out the much maligned Effexor...it was not pleasant but the Geodon, I believe, made it a lot less traumatic...I was also in Maui for 10 days when I did this so I was able to walk for miles on the beach and this helped immensely. I am only taking Geodon right now and I am one happy customer...no prolactin problems, no weight gain, no brain fog and cool as a cucumber. ;) I don't know where you live but if you are not working, then you do qualify for disability if you live in the US...have a pdoc write a note for you and try to get a Medi-cal card...this will pay for your RXs. I am not sure, but I believe there are programs out there to get meds to people who cannot afford them...PLEASE look into this...you are worth it! Can anyone else help out with suggestions to get RXs for free?
Best to all!
~Shannon
Posted by leopard on December 30, 2003, at 19:10:05
In reply to Re: Geodon talk (ziprasidone) , posted by Patient on December 30, 2003, at 16:49:58
Opps, I forgot! I am taking 20 mgs of Geodon. I take it at lunch time. It has a shelf life of 6.5 hours...some say 7...I wish I could take 10 mg 2x p/d but 20 mg is the lowest dose...maybe I'll split them up....dunno... I was taking 37.5 of Effexor 2x p/d.
I do notice when this stuff starts to where off...my agitation increases...when this happens I make a cup of chamomile tea or hot cocoa and try to chill and curl up with a book...or screw the tea...I hit the road for a walk...15 to 30 minutes does it for me. I try to take the minimum amount of meds whenever I begin a new one...if I increase my doseage I will post this fact...along with how I am feeling...
Posted by platinumbride on December 31, 2003, at 9:47:19
In reply to Re: Geodon talk (ziprasidone) , posted by Patient on December 30, 2003, at 16:49:58
I was without insurance for a very long time and can relate to your dilemna about not taking meds for money reasons, but there is free medication available. Try this website, or check sites of makers of the specific meds you need. There is usually a patient assistance program or an indigent program. Your healthcare provider has to become your "advocate", and there is documentation involved, but it is a good thing to know about and take advantage of when you have to....especially if you are in a situation where you do not qualify for public assistance, as I was
Best of luck.....
Posted by Patient on January 1, 2004, at 16:59:16
In reply to Re: Geodon talk (ziprasidone) » Patient, posted by platinumbride on December 31, 2003, at 9:47:19
Thank you both so much! Your replies give me hope.
Leapord, I'm a dependant, so I don't qualify for disability, but boy, sure seems like I'm disabled for I haven't worked in ten years and have had panic attacks/cried the two times I had applied (vet tech)for a job. My plan is to try low cost meds. and trazodone as well as Ativan benzo meet this criteria. We have private insurance since my husband is self-employed (computer design) and works at home, but he only has one client and the work is like being a carpenter, but even less stable. Thanks Leapord for the medicine dosages you are taking. I too like and need to start at a low dose, sometimes below the average starting dose.
I have often wondered if I am BP2 for my biggest problem is with anger/aggession/irritability. A couple years ago after being on Zoloft for several months, I lost my temper with a young bratty dog we had adopted-I just about beat him up-I was on the ground with him hitting him-we were both on the ground-I was so shaken by this that I panicked and had to get him away from me before I killed him, or so I thought I was capable of doing-out of desperation I took him away in the truck and dumped him. I'm so ashamed to tell this, but this is the kind of temper problem I have. I have lost my temper in this way before I ever started on any medicines. Usually it involved dogs disobeying me. I get easily frustrated. I look back on all of these terrible things I have done because of my mood swings and feel horrible about them, but once my temper goes that's it. I have always liked animals, so for me to do this was quite shocking. I also have spending spree problems. My brothers have temper problems-some much worse than others. Two brothers besides my Dad, have SEVERE tempers. My Dad is dead, though. My brothers have told me that when we were little he used to stand with his hands on his hips and tell us kids (7 total) that he hated us, this would be when he had lost his temper and his countenance would change and his veins would pop out of his head. He used to joke that the only reason he had us is because we were a tax write-off. I have an older brother that is schizophrenic, otherwise there is no known relatives with BP1, though one cousin committed suicide in his teens when he started dabbling into Nazism in Michigan. I'd certainly guess that a few of them have indiagnosed BP2. My grandfather was a "mean drunk" and an alcoholic. The only thing that would classify me as BPD is that I am self-injurous in that I would hit my head with my fists, sometimes would use a hard object, but I've never cut or burned myself like most BPD's do. My hitting myself is great anger at me, almost as if I were trying to murder me-does that make sense? I often have images of several guns pointed at my head and they shoot away at me-like the scene from the Daffy Duck cartoon where Daffy is in the lake surrounded by several duck hunters and they all blow away at him at once. I think these thoughts when I'm in a self-hate mood. After each loss of temper I go into a deep depression. Plus, I had bulemia in the past for many years. Okay, enough of the shock talk.
I better stop here before I go on and on about myself-I can be so self-centered when it comes to my problems-always thinking about me. I guess I go into give personal details hoping there will be someone that shares the same problems and can relate, though I wouldn't wish my problems on my worst enemy.
I appreciate the link and the information about patient assistance for low cost meds. When I find a medicine that works pretty good, I usually order it from Canaada if they have it-it's always much less expensive there. This, though, is the reason I end up with so many left over medicines because they stopped working or gave me problems after a few months, and when you order from Canada, it's usually in bulk. I finally threw away the Prozac, BuSpar, and carbamazepine.
I've always wondered why SSRI's can cause mania or hypomania-is it because of their high selectivity to reuptake serotonin? I've read the two meds. approved for bipolars depression is Effexor and Wellbutrin. These aren't as selective of serotonin, so it seems to me, anyway, that serotonin isn't a good thing for bipolars. I have to mention that I am no longer taking the Lexapro with trazodone-I could only handle it for two days-it caused a stimulant-type anxiety and insomnia-even 50 mgs. of trazodone wasn't helping me to sleep. So, I've upped the trazodone to 25mg 4 times a day. It has a relaxing effect on me-read somewhere, I think Canada, uses traz. for aggression.
Thanks again for your replies and well wishes and knowing there are others out there with some similar experiences. May my next visit to my doc be successful! We'll certainly talk Geoden.
Posted by Patient on January 1, 2004, at 17:14:19
In reply to Re: Geodon talk -Platinumbride and Leapord, posted by Patient on January 1, 2004, at 16:59:16
Hi again,
I was just thinking about something I read a few years ago about SSRI's effects on neurotransmiiters. I don't know where I read it, but it was something about selective serotonin reuptake inhibitors can cause a down regulation of dopamine, which can lead to such things as jaw clenching, and I think sweating--not sure about the sweating. But, if this is true, that SSRI's cause dopamine to be depleted, then what normally happens when dopamine levels go down, is that choline levels increase. Dopamine and choline balance each other-when one is low the other increases.
Low dopamine can also result in increase in prolactin levels which can cause some woman to have milk leakage from their breasts.
Thinking about the choline/dopamine balancing act, I remembered where I read in the book "Prescription for Nutritional Healing", under the chapter for manic depression/bipolar disorder, that one who suffers from BP illness should not take supplemental choline for it can induce mania.
Hmmm-just a thought that this is what might be going on with SSRI's and any drug that increases serotonin. Any other ideas,or corrections, out there?
Posted by leopard on January 2, 2004, at 7:45:29
In reply to Re: Geodon talk -Platinumbride and Leapord, posted by Patient on January 1, 2004, at 16:59:16
Hi again,
You're welcome and I hope whatever info you may find on this board somehow helps you or points you in the right direction. I am not 100% sure but I think you still qualify for disability. Being married doesn't change your status...you aren't a dependent...just married and this should have no bearing on you disability claim...please check it out. From what you have posted...you seem pretty much a poster child for BPII if not BPI...with a little mix of BPD thrown in for good measure. ;) I am not a doc, but your symptoms are just like my mother's...no kidding. I also have a brother who was diagnosed with schizphrenia but somehow this diagnosis didn't sit well with me...after much trial and error, his correct diagnosis is BPI with schizo-affective thrown in. BP is the most misdiagnosed mental disease. I am sure if you look into the disability thing, you will find that you still qualify...get to a pdoc ASAP!!! You need to get you anger under control so you can feel good about yourself and move on with life. :) Best, best, best, luck in your journey to peace (of mind).
Posted by Patient on January 8, 2004, at 14:27:59
In reply to Re: Geodon talk -Platinumbride and Leapord » Patient, posted by leopard on January 2, 2004, at 7:45:29
Thanks so much!
That shows you how little my husband and I know about the disability situation. I guess we always thought that with government help it's all or nothing-that you have to be flat broke and own nothing of value (like a house/property) in order to qualify. I have to look into it more when I can get more time on the internet.
I've gone to Dr. Bob's Psychopharmacology Tips and there are some helpful pointers on anger and choice of mood stabilisers. If not Geoden, then valproic acid (Depakote).
I mentioned I have been taking trazodone, a 5-HT2 antagonist-type antidepressant, sorta like a tricyclic. I've been taking it since Dec. 9, and eventually found out it doesn't help with my anger problem, or depression which was getting worse as premenstrual syndrome time-of-the-month got nearer. That's why I started taking Lexapro, but after two days stopped it due to extreme anxiety, insomnia, as well as I started picking at my fingers and chewing my fingers again--at least I wasn't depressed, but I couldn't handle these other effects, so I stopped the Lex. Then the depression and anger/irritability came back and I lost my temper. This hasn't happened in some time. Since I had some leftover Celexa, I decided to take 10mg for I was desperate for something. By the second day I was no longer depressed or angry-what a difference! I'm still taking trazodone (Desyrel) 3 times a day-it helps me sleep, and keeps me calm in early evenings when I tend to get anxious and unable to relax. It's either traz. or a benzo-type drug-I'd rather take trazodone. Celexa SSRI has always been the one SSRI I go back on when the others don't work for me. It causes the least unwanted side effects for me.
Well, the psychiatrist's office messed up rescheduling my appointment from mid-Dec. to mid-Jan. and looks like I will be seeing him at the end of this month instead. It is okay, though, for when I couldn't get a hold of them (answering machine was off), out of panic I called my gyn. doc. and had the nurse get me a temporary prescription for Celexa for I am just about out of one year old leftovers.
When I finally do see my psychiatrist, I will be talking to him about mood stabilisers-and whether or not I should be on an SSRI, or take some other type of antidepressant, or just be on moodstabilisers, whatever. I hope I can take a small tiny dose of Celexa with a stabiliser for I do like the way I feel on it. Is it SSRI-induced hypomanic euphoria? Maybe. It could also be the stimulating start-up effects that all of the SSRI's as well as other antidepressants share-they've all had this effect on me when I first take them, then after about a month or so it goes away. Anyway, I just had to keep you updated-my husband gets sick of hearing about it so I've stopped telling him what I am going through-at least I can write it down here and it makes me feel better.
Thanks for an ear to hear! Take care and the best to you!
Posted by Patient on March 11, 2004, at 17:37:35
In reply to Re: Geodon talk-Leapord, posted by Patient on January 8, 2004, at 14:27:59
Over a month later and I'm doing much better. I went from 10mg. to 20mg. Celexa and found the increase to help relieve the stimulation I was experiencing at the lower dose. I had started to take carbamazepine again (I hadn't gotten rid of all of this med. as I'd thought), taking 200mg a day, but it only gave me false-hunger pangs and reacted to anything I ate that contained enzymes, such as grapefruit or bananas-making my stomach feel like it was stuffed with cotton and making me feel agitated.
I went to see my psychiatrist at the end of January. I never got around to talking to him about other mood stabilizers such as lamotrigine or even talk to him about Geoden, but I did show him some information I had for treatment for borderline personality disorder from Dr. Bob's Psychopharmacological Tips. The doctor asked me what I wanted to do, for he knew I was on a tight budget and so couldn't afford just any medicine treatment. He wanted me to try increasing Celexa to 40mg. We agreed on that, and he agreed to let me try a months trial of Depakote as well. He didn't have samples for an entire month, but I said I'd try it anyway. So, I started taking 40mg Celexa in morning, and 250mg Depakote controlled-release in late afternoon. Within a few days increased Depakote C-R to mid. aft. and mid. eve. dosing. I was able to laugh again and make my husband laugh-something I haven't done in a long time. The one thing I noticed was when I'd wake up to go pee or let a cat outside, that I could smell a smell of cheese in my nostrils, like Limburger cheese or Valerian herb. This peculiar odor has diminished somewhat, but I found it an interesting side effect. I haven't become apathetic, or had any hair loss, or hair changes, or weight gain. I do become sleepy about two hours after taking Celexa, but that is the only side effect that I can think of that would be a nuisance. I can still have orgasms, though mainly in the mornings. At first I was taking 50mg trazodone to help me sleep, then down to 25mg. which worked just as well as 50mg. Now I find I don't need it-I sleep very well.
I still experience agraphobia and have long-simmering internal problems that I haven't worked out-which is why almost nightly I have disturbing dreams where I am lashing out at family, such as hitting my Mom, being belligerent towards my family or my husband's family (my husband's family is as different from mine as night is from day), or dreaming of filthy bathrooms, especially a messy commode, or dreaming of tornado(es) where I am warning others around me to seek cover, or viewing USA military jet manuevers with a feeling of dread, wondering if World War lll has begun, or of traveling with my Mom or Dad or both, many travels on steep mountainous roads, or of losing my purse. My husband does not like to hear me tell him my dreams for they do not make sense to him for there is no start or beginning, or someone turns into someone else. I tell him, "If only I could plug my dream into a television to show you what I dream".
The lack-of-job-for-my-husband situation is still hanging over us, and we are so thankful for his one client that still has dribs and drabs of work for him so that we live paycheck to paycheck now. He has taken some rainy day money out of his IRA's to help pay some bills-he is very frugal and has saved much money in the past while he was working for the aerospace industry, otherwise we'd really be in a bind and probably living with his parents.
Speaking of his parents-the golden agers (yes, I envy them-they live the perfect retirement life compared to what my parents have due to my parents past irresponsible ways)-over a week ago they asked my husband if they could stop by for a visit this spring on their car trip to the Ozarks. My husband told them he couldn't guarantee it, but that he'd asked me. They know how tempermental I can be, and that I can be rude if I do not want someone over to visit-which means we never have anyone over to visit, especially relatives, especially my husband's side of the family. He asked me, I panicked, started shaking, and said no, nope, no way. So, I'd failed that test and felt horrible for the next several days. Husband said that since I won't allow his family over to visit, that he will not allow my family over to visit, and added, that will probably never happen anyway since my Mother (my Dad is dead) is too afraid and worried to leave her house and come visit me. She lives 800 away.
So, now I have another reason to never want to see my in-laws again, for I've shamed myself in their eyes as well as my husband's, again. I was doing well up to that point. Hubby said, "Sure you are when you live in a box". He doesn't understand that I was not raised by his parents and their rules, and was raised irresponsibly and spoiled, a Mom that still refers to us as her babies who never asked us to do anything, and a Father full of anger and resentment, bigotted, aloof, hardly ever home due to lay-offs and getting an engineering job in some other state while living in a cheap apartment. And me, with no confidence and no self-esteem. I do regret marrying him, because we are so different and I am bringing him down and ruining, if not already ruined his life. I should have said no, and I should have stayed single-not even a boyfriend-I just am not a people person-not in an intimate, compassionate, caring sort of way-it's difficult to change.
Other than that, the higher dose of Celexa and the Depakote have done wonders for me-I haven't gotten irritable over little things and feel more at ease and no side effects to complain of. I'm not a zombie, though the memory still suffers. I can't afford to take more than 500mg of Depakote with the Celexa. I don't feel I need a higher dose.
Thanks to Doctor Bob's web site for all of the information shared as well as others that have contributed. My doctor needs all the help he can get!
Gotta go plant some Bibb lettuce seed and feed our small flock of chickens. Thanks for lending an ear. The best to all of you. Thanks again Doctor Bob!
This is the end of the thread.
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