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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by olysi79 on February 3, 2005, at 11:28:14
Hello all,
I take Trileptal and Paxil for BP II, OCD, and panic disorder. Overall, I do ok. However, every couple of weeks, (sometimes I go for a month) I experience intense bouts of depression and anxiety that last about 3 to 4 days. I can't do anything, I'm in despair, and nothing is pleasureable. Then it seems to dissapate. I no longer have hypomanias, at least not highly noticeable ones as the trileptal eases that. Any suggestions? Would switching to another mood stabilizer help with this? I like the trileptal because it has some anti-anxiety properties but perhaps it is too mild. I also want something that increases dopamine to help with the lack of pleasure in daily activities. I use Zyprexa if I really start to head south, but am conservative with that. Should I be more willing to take it for depression as needed just like I use it for hypomania and racing thoughts?
Posted by med_empowered on February 3, 2005, at 12:51:12
In reply to BP- periodic bouts of depression - any advice?, posted by olysi79 on February 3, 2005, at 11:28:14
hey! I'm a former trileptal user myself (my meds are in the midst of yet another change)...what's your dosage? I too sometimes had those bouts of intense depsair, etc...sometimes it would hit just when I woke up, kind of like a panic attack. I found Klonopin helped these feelings and panic, as well; its THE benzo for bipolar, since it has mood-stabilizing properties...it seems to help some people with resistant depression, though it can cause/worsen depression in others. I also personally found that the SSRIs just didn't cut it for me. Although shrinks love cleaner drugs for bipolar, I found I needed something along the lines of Effexor, Tofranil, or Cymbalta for relief. A tricyclic is the ultimate defense against misery before ect or maois; getting a shrink to rx it for bipolars is hard (more likely to activate mania), but not impossible. Switching to lamictal might help, but I personally think switching your mood-stabilizer is a big deal in bp. As for zyprexa...if you want MORE dopamine, cut it out completely. Its a neuroleptic, and neuroleptics clamp down hardcore on dopamine. In addition, stopping a neurleptic leads to rebound of dopamine that can cause all kinds of problems if the drug was taken continuously, long-term. Plus, if you factor in the risks inherent in antipsychotic use (tardive dyskinesia, akathisia, cognitive impairment), I think you'll also come to the conclusion that you're better off antipsychotic-free. Good luck!
Posted by olysi79 on February 3, 2005, at 16:31:32
In reply to Re: BP- periodic bouts of depression - any advice?, posted by med_empowered on February 3, 2005, at 12:51:12
Hye, thanks for your input. I take 900 MGS, what did you take?
I don't like to think that i have "resistant depression" for the record, but it hits now and again VERY intensely, depending upon how much sleep I am getting, stress levels, and whether or not I am eating right. I have some friends who have this too. One in particular is BP and he has this happen to him, even though he is on wellbutrin, Lexapro, depakote, tegretol, and Klonopin. But I'd still say he's a far cry from resistant. When I think resistant I think frequent hospitalizations and ECT, just so we're on the same page.
I Don't think I'll give up SSRIS because they work for OCD. I have to be careful about hypomnias though. Luvox in particular has had this effect on me. I'd bounce between feeling like I was on speed to intense anxiety and despair, awful feeling.
Many people ahve what you have described, the searing anxiety in the morning. I keep Klonopin handy but since it is not a long term treatment option (in my opinion, with its addiction potential), I won't go with it in the long haul. I am going to add Wellbutrin to the mix to balance my dopamine/NE, keep my SSRI, and hold onto to the trileptal.
I use Zyprexa because it is a killer for irrational thinking. I think taking that occasionally with a regular dose of Wellbutrin to keep dopamine levels balanced may be good idea. Alot of people on the site actually use Zyprexa daily with Wellbutrin. EPS is definetely a factor, and akathisia is intensely unpleasant, so I hear that. With the Zyprexa dopamine blockage EPS can be hardcore, but perhaps augmenting with Wellbutrin would help to boost up the dopamine availablity and not make it so harsh.> hey! I'm a former trileptal user myself (my meds are in the midst of yet another change)...what's your dosage? I too sometimes had those bouts of intense depsair, etc...sometimes it would hit just when I woke up, kind of like a panic attack. I found Klonopin helped these feelings and panic, as well; its THE benzo for bipolar, since it has mood-stabilizing properties...it seems to help some people with resistant depression, though it can cause/worsen depression in others. I also personally found that the SSRIs just didn't cut it for me. Although shrinks love cleaner drugs for bipolar, I found I needed something along the lines of Effexor, Tofranil, or Cymbalta for relief. A tricyclic is the ultimate defense against misery before ect or maois; getting a shrink to rx it for bipolars is hard (more likely to activate mania), but not impossible. Switching to lamictal might help, but I personally think switching your mood-stabilizer is a big deal in bp. As for zyprexa...if you want MORE dopamine, cut it out completely. Its a neuroleptic, and neuroleptics clamp down hardcore on dopamine. In addition, stopping a neurleptic leads to rebound of dopamine that can cause all kinds of problems if the drug was taken continuously, long-term. Plus, if you factor in the risks inherent in antipsychotic use (tardive dyskinesia, akathisia, cognitive impairment), I think you'll also come to the conclusion that you're better off antipsychotic-free. Good luck!
Posted by Phillipa on February 3, 2005, at 17:08:56
In reply to Re: BP- periodic bouts of depression - any advice? » med_empowered, posted by olysi79 on February 3, 2005, at 16:31:32
Where do all of you "experts" get your knowledge. I thought I had some from being a former psych RN, but I sure was wrong! Here I am addicted to benzos after 30 some odd years. They didn't know back then I guess. But, why are the pdoc's using so many atypical antipsychotics for anxiety, sleep, etc.? I don't get it. Fondly, Phillipa
Posted by olysi79 on February 3, 2005, at 18:01:18
In reply to Re: BP- periodic bouts of depression - any advice?, posted by Phillipa on February 3, 2005, at 17:08:56
I have to chuckle at this Phillippa because in a way yoy're right... I wonder if people know too much, and it makes it difficult to treat. on the same end, knowledge is power.
> Where do all of you "experts" get your knowledge. I thought I had some from being a former psych RN, but I sure was wrong! Here I am addicted to benzos after 30 some odd years. They didn't know back then I guess. But, why are the pdoc's using so many atypical antipsychotics for anxiety, sleep, etc.? I don't get it. Fondly, Phillipa
Posted by Minnie-Haha on February 3, 2005, at 18:38:55
In reply to BP- periodic bouts of depression - any advice?, posted by olysi79 on February 3, 2005, at 11:28:14
I suppose you've already tried this, but have you tried keeping a log to see if there is something that triggers these bouts? Since they seem to happen every few weeks... Does it happen on certain dates or days of the month? Around certain events? Certain lunar cycles? Any pattern at all?
Posted by Phillipa on February 3, 2005, at 18:40:03
In reply to Re: BP- periodic bouts of depression - any advice? » Phillipa, posted by olysi79 on February 3, 2005, at 18:01:18
As my husband says "alittle bit is dangerous", but then some people just have faith in pdocs. My daughter-in-law takes anything and it works for her and then abuses to boot. I go "by the rules" for the most part, and nothing works for me. I also showed her the copied announcement about Lunestra and her first comment was "it didn't come from a medical journal and even the drug reps haven't told us about it yet." But, she had heard of it. I think it intimidates them. Fondly, Phillipa I showed it to the pdoc, forgot to add that.
Posted by olysi79 on February 3, 2005, at 18:40:42
In reply to Re: BP- periodic bouts of depression - any advice?, posted by Minnie-Haha on February 3, 2005, at 18:38:55
Hey Minnie-haha
I think I will try this, I have not kept a log. though stress may be a trigger, this is a great idea. You aren't by chance referring to Minnehaha falls are you? If so, hi fellow minnesotan
:)
> I suppose you've already tried this, but have you tried keeping a log to see if there is something that triggers these bouts? Since they seem to happen every few weeks... Does it happen on certain dates or days of the month? Around certain events? Certain lunar cycles? Any pattern at all?
>
Posted by olysi79 on February 3, 2005, at 18:42:06
In reply to Re: BP- periodic bouts of depression - any advice?, posted by Minnie-Haha on February 3, 2005, at 18:38:55
Hey Minnie-haha
I think I will try this, I have not kept a log. though stress may be a trigger, this is a great idea. You aren't by chance referring to Minnehaha falls are you? If so, hi fellow minnesotan
> I suppose you've already tried this, but have you tried keeping a log to see if there is something that triggers these bouts? Since they seem to happen every few weeks... Does it happen on certain dates or days of the month? Around certain events? Certain lunar cycles? Any pattern at all?
>
Posted by Minnie-Haha on February 3, 2005, at 18:44:26
In reply to Re: BP- periodic bouts of depression - any advice?, posted by olysi79 on February 3, 2005, at 18:40:42
> Hey Minnie-haha
> I think I will try this, I have not kept a log. though stress may be a trigger, this is a great idea. You aren't by chance referring to Minnehaha falls are you? If so, hi fellow minnesotanNo. It was one of my dad's many nicknames for me from when I was a kid. But I did spend my childhood in Wisconsin, so Hello! fellow Upper Midwesterner.
Posted by Minnie-Haha on February 3, 2005, at 18:54:00
In reply to Re: BP- periodic bouts of depression - any advice? » Minnie-Haha, posted by olysi79 on February 3, 2005, at 18:42:06
BTW: My DXs are mild BP2 and mild OCD, too. I am currently taking Trileptal (150mg am/pm) and Cymbalta (60mg about 5pm). I am feeling pretty good right now except for a little amotivation (which I may augment with Wellbutrin or Cytomel), a little increase in appetite (gained 2-3 pounds -- others report weight loss!), and a little increase in blood pressure. I may reduce the Cymbalta dose if the appetite/BP effects continue.
I tried 1/2 of a 7.5mg Zyprexa tablet one night at the height of my insomnia/anxiety (before I started on Cymbalta) and it sure turned off all the chatter in my head, but it scared the hell out of me. I was like a zombie the next day. It just didn't "feel" right. Plus, I read that it can cause tardive dyskinesia. I'm gonna stay away from APs as long as I can.
Posted by Maxime on February 3, 2005, at 21:33:00
In reply to BP- periodic bouts of depression - any advice?, posted by olysi79 on February 3, 2005, at 11:28:14
Have you noticed if it happens around the full moon or anything to do with the lunar cycle?
Maxime
Posted by olysi79 on February 6, 2005, at 1:42:39
In reply to Re: BP- periodic bouts of depression - any advice? » olysi79, posted by Maxime on February 3, 2005, at 21:33:00
Hi Maxime, I haven't noticed anything like that, but it would be interesting to watch and see. Do you have some of those bouts of depression as well?
> Have you noticed if it happens around the full moon or anything to do with the lunar cycle?
>
> Maxime
Posted by Maxime on February 6, 2005, at 19:26:48
In reply to Re: BP- periodic bouts of depression - any advice? » Maxime, posted by olysi79 on February 6, 2005, at 1:42:39
Hi - I am BP type 2 and right now all I have is depression. But I do go hypomanic three days before the full moon. I have charted it. For 6 months I did not look at a calendar to know when the moon would be at its fullest (yes, I realise one can look up in the sky). And I was consistently hypomanic 3 days before and then crash the day after the full moon. So I would decrease my anti-depressant (Parnate, extremely short half life) and increase my mood stabilisers and it helped a great deal.
But now I am going through a hellish depression and not even the moon can help!
Maxime
> Hi Maxime, I haven't noticed anything like that, but it would be interesting to watch and see. Do you have some of those bouts of depression as well?
>
> > Have you noticed if it happens around the full moon or anything to do with the lunar cycle?
> >
> > Maxime
>
>
Posted by Phillipa on February 6, 2005, at 19:39:47
In reply to Re: BP- periodic bouts of depression - any advice? » olysi79, posted by Maxime on February 6, 2005, at 19:26:48
And you sound so together and still can care about others. I admire you. Fondly, Phillipa
Posted by Maxime on February 7, 2005, at 19:01:00
In reply to Re: BP- periodic bouts of depression - any advice? » Maxime, posted by Phillipa on February 6, 2005, at 19:39:47
Thanks, but you don't see me when I am weeping, wanting to end my life, and shaking like I have "lost it".
Actually, I think I am going to have to quit my job. I have been escaping to the bathroom several times a day to break down in tears. The slightest bit of stress overwhelms me. It's so hard to live like this.
Is it living?
Maxime
Posted by Phillipa on February 7, 2005, at 19:14:10
In reply to Re: BP- periodic bouts of depression - any advice? » Maxime, posted by Phillipa on February 6, 2005, at 19:39:47
Gee, You sound like me, only I can't cry, or work. It's all internalized. I have empathy for you and I still admire you. Aren't you on a lot meds? Sorry, I can't keep track of everyones. Today I wonder if maybe all the new meds introduced so soon could have something to do with the way I feel. Are you on any new meds? Sorry if I had the answer we would both be happy and well. Fondly, Phillpa
Posted by olysi79 on February 7, 2005, at 23:49:04
In reply to Re: BP- periodic bouts of depression - any advice? » olysi79, posted by Maxime on February 6, 2005, at 19:26:48
Hi Maxime,
Thanks for the info on this, I'll have to watch over this to see. I hope you are doing better.
Best,
Chris> Hi - I am BP type 2 and right now all I have is depression. But I do go hypomanic three days before the full moon. I have charted it. For 6 months I did not look at a calendar to know when the moon would be at its fullest (yes, I realise one can look up in the sky). And I was consistently hypomanic 3 days before and then crash the day after the full moon. So I would decrease my anti-depressant (Parnate, extremely short half life) and increase my mood stabilisers and it helped a great deal.
>
> But now I am going through a hellish depression and not even the moon can help!
>
> Maxime
>
>
>
>
> > Hi Maxime, I haven't noticed anything like that, but it would be interesting to watch and see. Do you have some of those bouts of depression as well?
> >
> > > Have you noticed if it happens around the full moon or anything to do with the lunar cycle?
> > >
> > > Maxime
> >
> >
>
>
Posted by olysi79 on February 7, 2005, at 23:50:20
In reply to Re: BP- periodic bouts of depression - any advice? » Maxime, posted by Phillipa on February 6, 2005, at 19:39:47
Thanks for the kind words Phillipa! I hope you are doing better. Things will get better.
Best,
Chris
> And you sound so together and still can care about others. I admire you. Fondly, Phillipa
Posted by olysi79 on February 7, 2005, at 23:56:24
In reply to Re: BP- periodic bouts of depression - any advice?, posted by Maxime on February 7, 2005, at 19:01:00
Maxime, I have been through this and it was yucky. What I'd recommend is takign soem time off ASAP and getting help for this. A hospital stay may be in order if possible. have faith my friend, you'll see your way through this.
Best,
Chris> Thanks, but you don't see me when I am weeping, wanting to end my life, and shaking like I have "lost it".
>
> Actually, I think I am going to have to quit my job. I have been escaping to the bathroom several times a day to break down in tears. The slightest bit of stress overwhelms me. It's so hard to live like this.
>
> Is it living?
>
> Maxime
Posted by Maxime on February 8, 2005, at 21:00:21
In reply to Re: BP- periodic bouts of depression - any advice? » Maxime, posted by olysi79 on February 7, 2005, at 23:56:24
Chris, you are very sweet. I don't think I could get admitted into the hospital except for the fact that I am suicidal and have a history of attempts. But I am at the end of med line. I have tried everything (seriously, close to 40). ECT is all that is left and I will not go that route.
Maxime
> Maxime, I have been through this and it was yucky. What I'd recommend is takign soem time off ASAP and getting help for this. A hospital stay may be in order if possible. have faith my friend, you'll see your way through this.
> Best,
> Chris
>
> > Thanks, but you don't see me when I am weeping, wanting to end my life, and shaking like I have "lost it".
> >
> > Actually, I think I am going to have to quit my job. I have been escaping to the bathroom several times a day to break down in tears. The slightest bit of stress overwhelms me. It's so hard to live like this.
> >
> > Is it living?
> >
> > Maxime
>
>
Posted by Maxime on February 8, 2005, at 21:10:32
In reply to Re: BP- periodic bouts of depression - any advice? » Phillipa, posted by Phillipa on February 7, 2005, at 19:14:10
Phillipa, you don't have to apologize for not remember which meds I take! :)
I was on Parnate, Adderall XR, Trileptal, Clonazapam, Thorazine (for nights when I can't sleep or was hypomanic) and synthroid (for my thyroid not as a psych med).
Because I have been in a state of suicidal depression since the summer, I switched to Nardil and lasted a week and a half (I stopped it last week)because of the side effects.
I decided to stop everything but the Adderall and the clonazapam. I cannot go through a withdrawal of those two meds right now. But the plan is to be off all meds and let nature take its course and find a way out of this world because I cannot handle the pain.
Maxime
> Gee, You sound like me, only I can't cry, or work. It's all internalized. I have empathy for you and I still admire you. Aren't you on a lot meds? Sorry, I can't keep track of everyones. Today I wonder if maybe all the new meds introduced so soon could have something to do with the way I feel. Are you on any new meds? Sorry if I had the answer we would both be happy and well. Fondly, Phillpa
Posted by olysi79 on February 8, 2005, at 22:04:19
In reply to Re: BP- periodic bouts of depression - any advice?, posted by Maxime on February 8, 2005, at 21:00:21
Hi Maxime,
I'm sorry to hear that things are going so badly for you. Keep on playing with those medicine combos. There's lots of opportunities out there and as soon as things can get tweaked, you'll do ok.> Chris, you are very sweet. I don't think I could get admitted into the hospital except for the fact that I am suicidal and have a history of attempts. But I am at the end of med line. I have tried everything (seriously, close to 40). ECT is all that is left and I will not go that route.
>
> Maxime
>
>
> > Maxime, I have been through this and it was yucky. What I'd recommend is takign soem time off ASAP and getting help for this. A hospital stay may be in order if possible. have faith my friend, you'll see your way through this.
> > Best,
> > Chris
> >
> > > Thanks, but you don't see me when I am weeping, wanting to end my life, and shaking like I have "lost it".
> > >
> > > Actually, I think I am going to have to quit my job. I have been escaping to the bathroom several times a day to break down in tears. The slightest bit of stress overwhelms me. It's so hard to live like this.
> > >
> > > Is it living?
> > >
> > > Maxime
> >
> >
>
>
This is the end of the thread.
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