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Dr. Bob is Robert Hsiung, MD,
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Posted by cache-monkey on March 15, 2005, at 1:45:07
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by Phillipa on March 14, 2005, at 18:35:30
I guess it is a form of rebound anxiety, but not in the immediate classical Xanax sense. I think that Xanax worked to keep my anxiety/panic in check, and then slowly it crept back in after full discontinuation of Xanax and switch-over to Klonopin. Xanax XR is a a possibility. But, I've heard that (for whatever reason) Xanax is the hardest benzo to discontinue.
I'd been thinking about valium, and have seen you post on it in a variety of threads. Why do you like it so much? Do you find it sedating? How does it compare to any other benzos you've tried?
Any info would be greatly appreciated.
Best,
cache-monkey> Sounds like rebound anxiety. What about the long acting xanax? I've never taken it. I like valium. It's beginning to sound like my mantra. Fondly, Phillipa
Posted by cache-monkey on March 15, 2005, at 1:53:58
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by yxibow on March 14, 2005, at 20:27:27
<< Xanax is much more quicker acting and tends to give an immediate euphoria rather than Klonopin which is much more subtle, so that makes sense that you felt that on the spot. Three weeks should be enough for rebound withdrawal although if you've been taking it for a long time that may not be true. Some of the anti-benzo crowd claims months to years but that's not really scientifically proven from what I know. >>
I don't think this is withdrawal from the Xanax. It's like the constant anxiety from my pre-daily-benzo days came creeping back in and blossomed back into full-fledged near-panic-but-not-quite anxiety. I think it's just that the Klonopin isn't as effective for me, maybe due to the differences you mention below.
<< I would say any drug varies between individuals... a benzodiazepine is not always just a benzodiazepine, although they all act similarily with different half lifes, and different sub-bindings at GABA and can vary suchlike in their makeup: (hypnotic/sedative [strongly so, e.g. Dalmane, Halcion], anxiolytic [e.g. Xanax, Ativan], anticonvulsant/antitremor [e.g. Klonopin]). But as said before, all do hit all those sub-receptors, some may be better than others or more immediate. >>Hmm. Interesting to know. How does Valium fit into this spectrum?
Thanks for the info!
Best,
cache-monkey
Posted by cache-monkey on March 15, 2005, at 2:06:21
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Ritch on March 15, 2005, at 0:14:36
<< I'd feel averse to increasing K as well beyond 1.5mg. >>
That's what my gut's telling me. (Also because it's equivalent to 30 mg Valium.) But someone else said that one can go much higher...
<< I would consider switching to Ativan a try (since it is also an effective antimanic like K), and just keep some Xanax on hand PRN if it doesn't work out. >>
I'd actually been leaning toward Valium due to it's longer half-life. Any particular reason you suggest Ativan? Is it less sedating or something like that?
<< If a lot of your anx. is rooted in mixed bipolar, then Depakote would be a good add.. I've found a mix of benzo + Depakote + gabapentin to work rather well for anxious bipolar mixed stuff. >>
Still working out the source of my anxiety. A lot of it is early childhood/early adolescence stuff. But still part of my bipolarity. Good to know about the benzo+Depakote+Neurontin combo, although I hadn't heard such good things about Neurontin elsewhere on this board. Out of curiousity, which benzo did you end up using?
Thanks for all of the info!
Best,
cache-monkey
Posted by cache-monkey on March 15, 2005, at 2:10:21
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
Hey all,
Thanks so much for the input on my questions about benzos. I have another question: is there any consensus on which benzos tend to be more and less sedating? (E.g. I've heard that Valium tends to be more sedating than, say, Xanax.) Or, as with so many psychotropics, is this just something that depends on the person?
Thanks,
cache-monkey
Posted by Ritch on March 15, 2005, at 10:25:56
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » Ritch, posted by cache-monkey on March 15, 2005, at 2:06:21
> I'd actually been leaning toward Valium due to it's longer half-life. Any particular reason you suggest Ativan? Is it less sedating or something like that?
I was on lithium + Valium (or chlordiazepoxide) for nearly ten years. It's a good one, I never had to take more than 10mg a day. My dose was 5mg twice daily, sometimes just 2.5mg twice daily. I just found Valium a little depressogenic compared to Xanax, Klonopin, or Ativan. Even Librium (chlordiazepoxide) didn't feel as heavy. However, Valium is probably the best if you have a lot of muscle tension.
>
> << If a lot of your anx. is rooted in mixed bipolar, then Depakote would be a good add.. I've found a mix of benzo + Depakote + gabapentin to work rather well for anxious bipolar mixed stuff. >>
>
> Still working out the source of my anxiety. A lot of it is early childhood/early adolescence stuff. But still part of my bipolarity. Good to know about the benzo+Depakote+Neurontin combo, although I hadn't heard such good things about Neurontin elsewhere on this board. Out of curiousity, which benzo did you end up using?
>
> Thanks for all of the info!
>
> Best,
> cache-monkeyI'm on Depakote 250-375mg + Klonopin .5-1.0mg + tiny bit of Celexa every other day. The thing I like about the Klonopin is its slow "peakiness", and it slow accumulation and elimination. I can get panicky and I just double the dose for about two or three days then go back to the original dose and I seem to get this "coverage" of a week or so, and I don't notice the "return" to the original lower dose-it's kind of masked. I'm curious about pregabalin.. (low dose) in the mix.
Posted by cache-monkey on March 15, 2005, at 12:26:17
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Ritch on March 15, 2005, at 10:25:56
> I'm on Depakote 250-375mg + Klonopin .5-1.0mg + tiny bit of Celexa every other day. The thing I like about the Klonopin is its slow "peakiness", and it slow accumulation and elimination. I can get panicky and I just double the dose for about two or three days then go back to the original dose and I seem to get this "coverage" of a week or so, and I don't notice the "return" to the original lower dose-it's kind of masked. I'm curious about pregabalin.. (low dose) in the mix.
I'm curious about pregabalin, as well. Wonder when it'll finally be approved...Thanks for the info.
Peace,
cache-monkey
Posted by Phillipa on March 15, 2005, at 16:54:12
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 15, 2005, at 12:26:17
I don't think you would need such a high dose of valium. I didn't have any trouble switching from 2mg klonopin to a total of l5mg valium a day. I like it because I think it works better for anxiety for me anyways. The long half-life is good too. I was hoping for the aaaaah I used to feel on valium, and the instant relief of anxiety. That's not happened this time. Fondly, phillipa
Posted by cache-monkey on March 15, 2005, at 17:54:42
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?), posted by Phillipa on March 15, 2005, at 16:54:12
Thanks, Phillipa. Out of curiosity, did you find Valium any more sedating than Klonopin? (I feel like the K is keeping me sleepy a lot of the day...)
Best,
cache-monkey> I don't think you would need such a high dose of valium. I didn't have any trouble switching from 2mg klonopin to a total of l5mg valium a day. I like it because I think it works better for anxiety for me anyways. The long half-life is good too. I was hoping for the aaaaah I used to feel on valium, and the instant relief of anxiety. That's not happened this time. Fondly, phillipa
Posted by Phillipa on March 15, 2005, at 19:15:10
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 15, 2005, at 17:54:42
No, I thought klonopin made me feel dumb. Fondly, Phillipa
Posted by Maxime on March 15, 2005, at 20:03:08
In reply to Klono not nearly as effective as X? (Oth. Benzos?), posted by cache-monkey on March 14, 2005, at 14:18:42
I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
Just my 2 cents. ;)
Maxime
Posted by Phillipa on March 15, 2005, at 20:42:51
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Phillipa on March 15, 2005, at 19:15:10
I agree with you Maxime. It doesn't affect you the same either. Fondly, Phillipa
Posted by cache-monkey on March 15, 2005, at 22:26:59
In reply to Re: Klono not nearly as effective as X? (Oth. Benzos?) » cache-monkey, posted by Phillipa on March 15, 2005, at 19:15:10
I sort of feel the same way. Plus I've been feeling a little more depressed as of late. I've heard that's been a problem for other people on K. I'm definitely going to suggest Valium next time I see my pdoc.
Thanks,
cache-monkey> No, I thought klonopin made me feel dumb. Fondly, Phillipa
Posted by cache-monkey on March 15, 2005, at 22:32:26
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by Maxime on March 15, 2005, at 20:03:08
Thanks Maxime. That's the difficulty for me with this decision: I'm soft BP, and some of the anxiety might be "mixed state" sorts of stuff. But I feel like the Klonopin just isn't cutting down very much on the anxiety (esp. as compared to a "comparable" amount of Xanax). Plus it might be slowing me down/making me a little depressed.
So I think I'm going to try for Valium (or maybe Ativan) and keep the BP stuff in check with Lithium and/or Depakote.
Anyway, thanks for the input.
I hope that you start feeling well again soon. I know it's hard, but try not to let the posts by a certain (now blocked) babbler get to you. I mostly lurk on this board, and have read a lot of your posts. You're really helpful to a lot of people, me included.
Best,
cache-monkey> I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
>
> Just my 2 cents. ;)
>
> Maxime
Posted by SLS on March 16, 2005, at 5:55:41
In reply to Re: Klono not nearly as effective as X? (Oth. Benz, posted by Maxime on March 15, 2005, at 20:03:08
> I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
>
> Just my 2 cents. ;)
>
> Maxime
I sort of agree with you. Some of the things I encountered over the years hint that Klonopin can modulate serotonergic activity.
- Scott
Posted by Maxime on March 16, 2005, at 17:42:40
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » Maxime, posted by cache-monkey on March 15, 2005, at 22:32:26
Cache-Monkey it is almost 7 pm and you made me smile for the first time today. Thank you.
I hope the valium helps.
Hugs,
Maxime> Thanks Maxime. That's the difficulty for me with this decision: I'm soft BP, and some of the anxiety might be "mixed state" sorts of stuff. But I feel like the Klonopin just isn't cutting down very much on the anxiety (esp. as compared to a "comparable" amount of Xanax). Plus it might be slowing me down/making me a little depressed.
>
> So I think I'm going to try for Valium (or maybe Ativan) and keep the BP stuff in check with Lithium and/or Depakote.
>
> Anyway, thanks for the input.
>
> I hope that you start feeling well again soon. I know it's hard, but try not to let the posts by a certain (now blocked) babbler get to you. I mostly lurk on this board, and have read a lot of your posts. You're really helpful to a lot of people, me included.
>
> Best,
> cache-monkey
>
> > I think Kolonopin should be in a class of its own because it is NOT like other BENZOS. It is an anti-convulsant first and foremost which is why it used for bipolar illness.
> >
> > Just my 2 cents. ;)
> >
> > Maxime
>
>
Posted by barbaracat on March 18, 2005, at 1:05:35
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » mattw84, posted by cache-monkey on March 15, 2005, at 1:35:46
Dear C_Monkey,
I hope Depakote works for you. Unfortunately it did not for me. I have severe mixed-states bipolar depression, probably Bipolar I, and do well on lithium, as long as I can reasonably manage worry and stress. I'm also hypothyroid so my docs ocasionally insist on trying something besides lithium, but I always return to it. Depakote turned me into a drooling stumbling lethargic depressive which then escalated into mixed-states anyway. Not enough mood stabilization. Seroquel was a constant fog - a strong antihistamine effect which did nothing for me.Anyhoo, I definitely will take Xanax when the panic threatens, have never had a problem with dependence and can take it PRN. Klonopin does not have the same effect, just doesn't. Ativan is a good runner up, as is Valium. I like Gabapentin alot but it does lose efficacy quickly. I take a break from it and need only 300-600mg to produce a nice smooth feeling - for a couple days at least. When I need to really chill, I'll take 1/2 Ambien (usually take it only for sleep). But it sometimes leaves me feeling depressed when it wears off and memory impaired. Better than creepy anxiety, however.
What works best for me on a long-term basis are some nutritional remedies. The amino acid L-Taurine at 1000mg twice a day (up to 2000mg twice a day) has been very effective. It stabilizes electrical potential of smooth muscle and has antiseizure properties. Calcium, Magnesium, Zinc, B6 and Folic Acid are necessary for me as well. Help relax the muscles and promote serotonin production.
Also worth a try is taking 1/2 teaspoon of baking soda and a pinch of sea salt in water or juice (I use cranberry juice). Tastes awful but works to alkalynize the blood pH and carbon dioxide/oxygen and electrolyte balance. These tend to be off during panic attacks and an acidic condition seems to go along with disregulated cortisol production. It's better to be slightly alkaline. I take this concoction on a regular basis before bed and feel it's helping to rebalance my system.
Be aware of your breathing too. Disordered breathing is guaranteed to bring on anxiety. Unfortunately, years of tension and armouring cause tightness in our chest and diaphragm and it's not easy to retrain the breath. There's a good website, www.breathing.com that's devoted to this topic. I got his material and it's pretty good. Stay in the present moment, as well as you can. What's happening in the right now is usually just fine and we forget this. And exercise. This is the best anti-anxiety agent going. We all know this, but it's so damn hard to stir the stumps.
Good luck, fellow mixed-stater. Such an interesting state it is. It ain't easy, but I'm finding my way through this with natural and conventional methods and if I can, anyone can. - BarbaraCat
Posted by SLS on March 18, 2005, at 6:05:17
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » cache-monkey, posted by barbaracat on March 18, 2005, at 1:05:35
Hi BarbaraCat.
> I hope Depakote works for you. Unfortunately it did not for me. I have severe mixed-states bipolar depression, probably Bipolar I, and do well on lithium, as long as I can reasonably manage worry and stress. I'm also hypothyroid so my docs ocasionally insist on trying something besides lithium, but I always return to it.
If you are inclined to attempt to replace lithium again, you might want to give Lamictal a try. You can begin taking it and wait a few months at a therapeutic dosage (200mg) before removing the lithium very, very gradually. Doing this over the course of months might prevent triggering a relapse and establish a propylaxis with Lamictal.
Be well.
- Scott
Posted by barbaracat on March 18, 2005, at 10:30:00
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » barbaracat, posted by SLS on March 18, 2005, at 6:05:17
>
Hi Scott,
Tried Lamictal and it worked well on 75mg for about 6 months and then pooped. As I ramped up I developed early symptoms of The Rash and stopped, as it appeared to have pooped even at higher doses. I eventually developed Stevens Johnson Syndrome, full-blown rash, from an allergic reaction to another drug. I believe Lamictal created an SJS prodromal inflammatory condition that has now become an ongoing allergic sensitivity. It has plagued me with every skin sensitive med I've taken since, antibiotics and such that I've never been allergic to before.Long story short, thanks for the advice, but even on Lam I needed lithium. I seem to require the particular mood stabilizing properties it provides that no other med seems able to and other than the thyroid thing (which I'm handling with thyroid hormone), it's a wonderful med for me. I like the fact it's also a neuroprotective agent too. I'm doing well on teensy dose Cymbalta, low dose lithium, L-Taurine and other aminos. I take benzos as needed because I've become a fervent believer that by not spinning into a high stress/anxiety state I can maintain pretty well. - Barbara
>
> If you are inclined to attempt to replace lithium again, you might want to give Lamictal a try. You can begin taking it and wait a few months at a therapeutic dosage (200mg) before removing the lithium very, very gradually. Doing this over the course of months might prevent triggering a relapse and establish a propylaxis with Lamictal.
>
> Be well.
>
>
> - Scott
>
>
Posted by cache-monkey on March 18, 2005, at 13:43:50
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » cache-monkey, posted by barbaracat on March 18, 2005, at 1:05:35
Hi BarbaraCat,
I'm actually not going for the Depakote just yet. I'll wait until my Li level gets into the therapeutic window. (Just started at 1200 mg, and crossing my fingers that this will do the trick.) Did you find that you got thirsty on higher doses, but that this subsided over time?
If and when I try the Depakote, I'm shooting for a very low dose (e.g. 500 mg/day). It sounds like you replaced Li with the Depakote. Have you ever tried it as an add-on? Also, does the Li alone seem to help with your mixed states?
After meeting with my pdoc, we ended up settling on Xanax XR for a while. I am concerned about the dependency factor. I'm not familiar with Taurine... I suppose I'll go over to the alternative board to find out more, but if you can give me a little more information on it, I'd be much obliged.
In the meantime, I'll check out the website you recommend. I do feel like a chunk of my mixed-states/anxiety comes from breathing issues. And I definitely agree that regular exercise (whether from better breathing or extra endorphins) helps quite a bit.
Thanks for all the info!
Best,
cache-monkey> Dear C_Monkey,
> I hope Depakote works for you. Unfortunately it did not for me. I have severe mixed-states bipolar depression, probably Bipolar I, and do well on lithium, as long as I can reasonably manage worry and stress. I'm also hypothyroid so my docs ocasionally insist on trying something besides lithium, but I always return to it. Depakote turned me into a drooling stumbling lethargic depressive which then escalated into mixed-states anyway. Not enough mood stabilization. Seroquel was a constant fog - a strong antihistamine effect which did nothing for me.
>
> Anyhoo, I definitely will take Xanax when the panic threatens, have never had a problem with dependence and can take it PRN. Klonopin does not have the same effect, just doesn't. Ativan is a good runner up, as is Valium. I like Gabapentin alot but it does lose efficacy quickly. I take a break from it and need only 300-600mg to produce a nice smooth feeling - for a couple days at least. When I need to really chill, I'll take 1/2 Ambien (usually take it only for sleep). But it sometimes leaves me feeling depressed when it wears off and memory impaired. Better than creepy anxiety, however.
>
> What works best for me on a long-term basis are some nutritional remedies. The amino acid L-Taurine at 1000mg twice a day (up to 2000mg twice a day) has been very effective. It stabilizes electrical potential of smooth muscle and has antiseizure properties. Calcium, Magnesium, Zinc, B6 and Folic Acid are necessary for me as well. Help relax the muscles and promote serotonin production.
>
> Also worth a try is taking 1/2 teaspoon of baking soda and a pinch of sea salt in water or juice (I use cranberry juice). Tastes awful but works to alkalynize the blood pH and carbon dioxide/oxygen and electrolyte balance. These tend to be off during panic attacks and an acidic condition seems to go along with disregulated cortisol production. It's better to be slightly alkaline. I take this concoction on a regular basis before bed and feel it's helping to rebalance my system.
>
> Be aware of your breathing too. Disordered breathing is guaranteed to bring on anxiety. Unfortunately, years of tension and armouring cause tightness in our chest and diaphragm and it's not easy to retrain the breath. There's a good website, www.breathing.com that's devoted to this topic. I got his material and it's pretty good. Stay in the present moment, as well as you can. What's happening in the right now is usually just fine and we forget this. And exercise. This is the best anti-anxiety agent going. We all know this, but it's so damn hard to stir the stumps.
>
> Good luck, fellow mixed-stater. Such an interesting state it is. It ain't easy, but I'm finding my way through this with natural and conventional methods and if I can, anyone can. - BarbaraCat
Posted by barbaracat on March 18, 2005, at 18:52:36
In reply to Re: Klono not nearly as effective as X? (Oth. Benz » barbaracat, posted by cache-monkey on March 18, 2005, at 13:43:50
Hi CM,
>
> I'm actually not going for the Depakote just yet. I'll wait until my Li level gets into the therapeutic window. (Just started at 1200 mg, and crossing my fingers that this will do the trick.) Did you find that you got thirsty on higher doses, but that this subsided over time?**Yes, definitely thirstier. It increases peeing and makes the kidneys work hard. It goes away if you drink extra water and increase salt intake. But definitely NOT table salt which simply causes bloat. You need to replenish electrolytes and minerals that are from a bioavailable source and a good salt will do that.
The best salt I've come across is from a deep mine in the Himalayas and tastes wonderful. I'm totally spoiled on this lovely pink salt. I order it from www.americanbluegreen.com. The website has alot of info on the its benefits. It's expensive, however, around $30 for 2lbs, but I think of it as a necessary medicine. You can get it from other sources which might be slightly less spendy, but this stuff is da kine.
**Another side effect that happened when I increased Li was hand tremors. It was very annoying. It started to subside after 2 months but I went back down to 600mg anyway, which seems to be good enough for me, although far below my therapeutic window.
>
> If and when I try the Depakote, I'm shooting for a very low dose (e.g. 500 mg/day). It sounds like you replaced Li with the Depakote. Have you ever tried it as an add-on?**No, I didn't do both although I've heard it can be a good combo. I didn't do well on Dep, made me very lethargic, hair started falling out (yes, this is a sx) and did nothing to prevent mania, like racing thoughts in a lethargic body. I was also taking Seroquel for a while with it which made the lethargy worse. I wanted to just stay in bed all day paralyzed with racing thoughts.
>>Also, does the Li alone seem to help with your mixed states?
**That's difficult to say, I don't think so entirely. However, if I don't do lithium, I'm guaranteed one. Stress is my big trigger and if I let anxiety get out of hand it will escalate into a mixed state depression. But as I recall, those were also times when for one reason or another I stopped or reduced Li. Yes, I'd say Li does prevent the bleak awful mixed-states, but I can still get seriously depressed from stress and exhaustion, but it's a different animal from mixed states frenzy. There are times when I do fine on Li alone and other times when I need an AD, which is tricky for BPs. These days I seem to be maintaining on low dose Cymbalta to handle depression and doing what I can to minimize stress - benzos, breathing, walking, keeping on top of my hormones, trying to stay in the moment.
Lamictal is a good combo with Lithium for mixed states. I personally needed Lithium with it, but for some bipolars with depression Lamictal alone is enough. It was pretty activating but I never felt like I was careening off into anything too manic. Unfortunately, it eventually pooped and raising the dose caused an allergic reaction so I can't take it. But it's a good one to keep in mind.
I probably could use to increase the Li but I'm concerned about the thyroid thing and the fact that it makes it real hard to lose weight. All of them do that, unfortunately. My body can't handle complicated metabolic burdens any more and so I'm trying to manage with a minimal number of meds at the lowest doses. It's a lesson in learning to tolerate discomfort and being OK with good enough instead of perfect. A real challenge for me. Besides, I must admit that I like to dance around the edge of hypomania. As long as I can nip the axiety and bring myself down from a hypo buzz, I can still enjoy the many benefits of being bipolar.
>
> After meeting with my pdoc, we ended up settling on Xanax XR for a while. I am concerned about the dependency factor.**Try not to stress about dependency right now while you're finding the right chemical balance. I know this has been a concern of yours in the past, but I truly think that dependency is more of a problem when your biochemistry is out of whack. When you get to a point where you're stable with the right meds, working on the breathing and exercise and supporting things nutritionally, you'll probably do fine with taking the Xanax only ocasionally. Until then, you gotta do what you can to manage anxiety and trust that you'll be able to wean off when you're ready. IMHO, Xanax XR is as good as a benzo gets, so consider it a helping friend and enjoy.
>>I'm not familiar with Taurine... I suppose I'll go over to the alternative board to find out more, but if you can give me a little more information on it, I'd be much obliged.**Sure. Here's an article by Margot Kidder about amino acids in bipolar with a good explanation of L-Taurine: http://www.alternativementalhealth.com/articles/aminobipolar.htm
>
> In the meantime, I'll check out the website you recommend. I do feel like a chunk of my mixed-states/anxiety comes from breathing issues. And I definitely agree that regular exercise (whether from better breathing or extra endorphins) helps quite a bit.**Ah yes, lovely endorphins. Wish there was a pill for that. Guess it's called exercise. The breathing is important. Amazing how disordered breathing contributes to all this misery. Try the 1/2 tsp baking soda thing and some extra calcium. If you have uneven shallow breathing, your blood pH is most likely skewed towards acidic - a big player in panic disorder.
>
> Thanks for all the info!
>
**Sure thing, it's been enjoyable! Good luck and keep me posted. - BCat
Posted by cache-monkey on March 19, 2005, at 13:29:43
In reply to Benzos and other stuff » cache-monkey, posted by barbaracat on March 18, 2005, at 18:52:36
Wow, BarbaraCat! Thank you so much for all the information and counsel.
A couple of brief follow-ups below...
<<Yes, definitely thirstier. It increases peeing and makes the kidneys work hard. It goes away if you drink extra water and increase salt intake. But definitely NOT table salt which simply causes bloat. You need to replenish electrolytes and minerals that are from a bioavailable source and a good salt will do that.
The best salt I've come across is from a deep mine in the Himalayas and tastes wonderful. I'm totally spoiled on this lovely pink salt. I order it from www.americanbluegreen.com. The website has alot of info on the its benefits. It's expensive, however, around $30 for 2lbs, but I think of it as a necessary medicine. You can get it from other sources which might be slightly less spendy, but this stuff is da kine.>>
Hmm. So this is different than NaCl? I'll check out the website. Dehydration is definitely a concern for me. (Even as a child, I would dehydrate very easily.) Are there other sources of electrolytes that you might recommend? E.g. is it possible to go into a GNC and buy some sort of electrolyte powder or pill?
<< Another side effect that happened when I increased Li was hand tremors. It was very annoying. It started to subside after 2 months but I went back down to 600mg anyway, which seems to be good enough for me, although far below my therapeutic window. >>
Luckily, I've escaped this so far. I've always had shaky hands and haven't noticed an appreciable increase. In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.
<< I didn't do well on Dep, made me very lethargic, hair started falling out (yes, this is a sx) and did nothing to prevent mania, like racing thoughts in a lethargic body. I was also taking Seroquel for a while with it which made the lethargy worse. I wanted to just stay in bed all day paralyzed with racing thoughts. >>
Yuck on the side effects. I know what you mean about staying in bed. When the racing thoughts come, I just want to curl up in a ball and reduce all sensory input.
<< Lamictal is a good combo with Lithium for mixed states. I personally needed Lithium with it, but for some bipolars with depression Lamictal alone is enough. It was pretty activating but I never felt like I was careening off into anything too manic. Unfortunately, it eventually pooped and raising the dose caused an allergic reaction so I can't take it. But it's a good one to keep in mind. >>
Yeah, I've heard good things about Lamictal. But, I also found it too activating. It actually set off a full-fledged panic attack for me. Plus it had some annoying side effects. Too bad, although I've heard that poop-out is not uncommon with it...
<< I probably could use to increase the Li but I'm concerned about the thyroid thing and the fact that it makes it real hard to lose weight. All of them do that, unfortunately. My body can't handle complicated metabolic burdens any more and so I'm trying to manage with a minimal number of meds at the lowest doses. It's a lesson in learning to tolerate discomfort and being OK with good enough instead of perfect. A real challenge for me. Besides, I must admit that I like to dance around the edge of hypomania. As long as I can nip the axiety and bring myself down from a hypo buzz, I can still enjoy the many benefits of being bipolar. >>
Yeah, I know what you mean about keeping the hypomania. I've been feeling a little "flat" on the lithium and think this is partially due to losing the hypomanic edge. My pdoc is adamant about getting into the therapeutic range, though, and I figure I'll give it a try for a little while.
<< After meeting with my pdoc, we ended up settling on Xanax XR for a while. I am concerned about the dependency factor.**Try not to stress about dependency right now while you're finding the right chemical balance. I know this has been a concern of yours in the past, but I truly think that dependency is more of a problem when your biochemistry is out of whack. When you get to a point where you're stable with the right meds, working on the breathing and exercise and supporting things nutritionally, you'll probably do fine with taking the Xanax only ocasionally. Until then, you gotta do what you can to manage anxiety and trust that you'll be able to wean off when you're ready. IMHO, Xanax XR is as good as a benzo gets, so consider it a helping friend and enjoy. >>
Thanks. That's a very comforting perspective. Have you used Xanax XR? If so, I'm wondering if you found that once-daily dosing was enough or whether you had to supplement with a little IR toward the end of the day.
<< Here's an article by Margot Kidder about amino acids in bipolar with a good explanation of L-Taurine: http://www.alternativementalhealth.com/articles/aminobipolar.htm >>I'll check this one out, too. Thanks!
<< Ah yes, lovely endorphins. Wish there was a pill for that. Guess it's called exercise. The breathing is important. Amazing how disordered breathing contributes to all this misery. Try the 1/2 tsp baking soda thing and some extra calcium. If you have uneven shallow breathing, your blood pH is most likely skewed towards acidic - a big player in panic disorder. >>
Mmmmm. Endorphins. I will try the baking soda thing.
Again, thanks for all the input. It's most appreciated.
All the best,
cache-monkey
Posted by barbaracat on March 19, 2005, at 16:22:36
In reply to Re: Benzos and other stuff » barbaracat, posted by cache-monkey on March 19, 2005, at 13:29:43
>
> Hmm. So this [Himalayan salt] is different than NaCl? I'll check out the website.**The website describes it well. It is NaCl but because it's source is a millions year old ocean salt bed, it has most of the minerals our bodies require in a crystalline form that is bioavailable. Many mineral salts besides simple Sodium. Some claims are made for the energetic properties as well. Also, the mine is very deep in the mountain and has never been exposed to any of the pollutants that are present in most other salts that are collected above ground. This goes for Celtic Sea Salt which is far less superior, in my opinion. The Himalayan has a fantastic taste and texture, almost 'sparkly'. I guess you can tell I love the stuff.
>>Dehydration is definitely a concern for me. (Even as a child, I would dehydrate very easily.) Are there other sources of electrolytes that you might recommend? E.g. is it possible to go into a GNC and buy some sort of electrolyte powder or pill?
**The electrolytes we need are:
sodium (Na+)
potassium (K+)
chloride (Cl-)
calcium (Ca2+)
magnesium (Mg2+)
bicarbonate (HCO3-)
phosphate (PO42-)
sulfate (SO42-)The only one not prevalent in the salt is bicarbonate, but that's where the baking soda comes in. So, a great electrolyte drink would be to make up a sole which is a saturated solution of the Himalayan salt (you order the large crystals and simply put a bunch in a jar and add water until the crystals no longer dissolve. This is a 28% saturated solution that is basically the reconstituted original seawater.) One teaspoon of this sole and 1/4 teaspoon baking soda in a quart of diluted juice is vastly superior to any sports drink out there. I like cranberry juice and dilute it 1/2 and 1/2 with water, it masks the baking soda somewhat. It doesn't hurt to supplement with extra minerals, but get them in an ionic form for assimilation. A few grains of this salt in drinking water allows it to filter through cell membranes easier. You can drink plenty of water, but if you're 'osmotically challenged', it has a hard time getting into the cells.
If you want a something premixed, a product called 'Hydralyte' is great. You can order it at www.gookinaid.com. I think the Fruit Punch tastes the best. It's a great site that explains all about the horrors of dehydration. Something we Lithium users have to take seriously. By all means, stay away from those crappy commercial sports drinks. No good. It's amazing they get away with that marketing bullsh*t.
>
> In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.**Well, good. Hopefully you're one of the lucky ones that can benefit from lithium, as I do. I've found it very smooth and calming. It's a very interesting drug. Do a Google search on neuroprotective+lithium or neurogenesis+lithium and you'll be pleased at how good it actually is for the brain. Life extention folks use it for anti-aging.
>
>
> Yeah, I know what you mean about keeping the hypomania. I've been feeling a little "flat" on the lithium and think this is partially due to losing the hypomanic edge. My pdoc is adamant about getting into the therapeutic range, though, and I figure I'll give it a try for a little while.**That therapeutic window is getting lower all the time. Used to be in times of old that at least 1400-1800mg was the starting dose producing dull drooling zombies with kidney problems. Now, they're looking at more like 900-1200 as the average max to produce enough of a therapeutic benefit without the high dose problems.
My pdoc was frustrated with my refusal to ramp up to the therapeutic window, but I didn't like how I felt at those doses and figured it was my body, not his. He finally came around to being OK with it.
Between 600 and 900mg is my therapeutic dose, no matter what the 'window' dictates. But I'm also taking a small dose of an AD which keeps the depression demon at bay. Lithium will augment most antidepressants, so I think the combo is working synergistically. I don't know if a higher dose of Lithium would provide more AD benefits or not for me.
Like I mentioned, managing my anxiety and making sure my metabolic systems are in balance seems to be the key. Lithium keeps me from the extremes of up and down. Some existential angst keeps me honest, I welcome productive hypomanias and I certainly don't want to flatline. Those therapeutic ranges are based on an average control population and everyone's chemistry is different. You have to play with it until you know what's right for you.
>
Have you used Xanax XR? If so, I'm wondering if you found that once-daily dosing was enough or whether you had to supplement with a little IR toward the end of the day.**I recently had a sample pack of it and liked it very much. My doctor didn't want to prescribe it just yet because I had a big Klonopin prescription filled and I think she'd feel more comfortable waiting. They're like that. Once a day worked fine for me, but I don't usually take benzos on a daily schedule, just as needed. But if I need another later on in the day, then why suffer?
>
**Are you taking fish oil, BTW? I don't think we've talked about that, but it's a big piece in my recovery. It seems to be so important to cellular health in general. The one I take is Carlson's Fish Oil, 2 Tbl a day. I get it from www.iherb.com. Pills aren't such a good idea because you have to take a handful to get the optimal amount (9-12G) and the oil is frequently rancid in pills. The Carlson's is lemon flavored and actually tasty. I'll tell you, though, all this mixing potions and stuff takes time. And money.Well, this has been a nice way to spend a lovely rainy day in Oregon. I love the rain, luckily. So do those big fir trees outside my window. It's helped me to put my regimen down on paper and appreciate everything this wild journey has taught me. - Barbara
Posted by cache-monkey on March 20, 2005, at 19:00:55
In reply to Re: Benzos and other stuff » cache-monkey, posted by barbaracat on March 19, 2005, at 16:22:36
<< The electrolytes we need are:
sodium (Na+)
potassium (K+)
chloride (Cl-)
calcium (Ca2+)
magnesium (Mg2+)
bicarbonate (HCO3-)
phosphate (PO42-)
sulfate (SO42-)
The only one not prevalent in the salt is bicarbonate, but that's where the baking soda comes in. So, a great electrolyte drink would be to make up a sole which is a saturated solution of the Himalayan salt (you order the large crystals and simply put a bunch in a jar and add water until the crystals no longer dissolve. This is a 28% saturated solution that is basically the reconstituted original seawater.) One teaspoon of this sole and 1/4 teaspoon baking soda in a quart of diluted juice is vastly superior to any sports drink out there. I like cranberry juice and dilute it 1/2 and 1/2 with water, it masks the baking soda somewhat. It doesn't hurt to supplement with extra minerals, but get them in an ionic form for assimilation. A few grains of this salt in drinking water allows it to filter through cell membranes easier. You can drink plenty of water, but if you're 'osmotically challenged', it has a hard time getting into the cells. >>Quite a cocktail. Alright, I'll check out the Himalayan salt, already! Sheesh.
<< If you want a something premixed, a product called 'Hydralyte' is great. You can order it at www.gookinaid.com. I think the Fruit Punch tastes the best. It's a great site that explains all about the horrors of dehydration. Something we Lithium users have to take seriously. By all means, stay away from those crappy commercial sports drinks. No good. It's amazing they get away with that marketing bullsh*t. >>
That actually seems quite cheap, or comparable to Gatorade in price, at least. Is Gatorade one of the "crappy" drinks to stay away from? How come?
<< > In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.
**Well, good. Hopefully you're one of the lucky ones that can benefit from lithium, as I do. I've found it very smooth and calming. It's a very interesting drug. Do a Google search on neuroprotective+lithium or neurogenesis+lithium and you'll be pleased at how good it actually is for the brain. Life extention folks use it for anti-aging. >>
Yeah, so this last dose adjustment has been a little less smooth. I've been noticing some definite polyuria action. I posted further down the board about this, but my bladder and prostate actually feel a little sore right now. It's kind of annoying, and I hope it subsides with time. If it doesn't, I'll have to push for a "sub-clinical" dose of Li with my pdoc. He won't be happy, though, since he (like your pdoc) is fixed on a magical number for for the lithium serum level. Anyway, time will tell, I suppose.
[...]
<< Are you taking fish oil, BTW? I don't think we've talked about that, but it's a big piece in my recovery. It seems to be so important to cellular health in general. The one I take is Carlson's Fish Oil, 2 Tbl a day. I get it from www.iherb.com. Pills aren't such a good idea because you have to take a handful to get the optimal amount (9-12G) and the oil is frequently rancid in pills. The Carlson's is lemon flavored and actually tasty. I'll tell you, though, all this mixing potions and stuff takes time. And money. >>I tried fish oil for about three, with the goal of getting 1000 mg EPA (and, based on the formulation I was using, 200 of DHA). I think that it might have been making me more anxious and discontinued about two weeks ago. I rechallenge with it at some point, but for now I want to figure out what the Lithium is doing.
<< Well, this has been a nice way to spend a lovely rainy day in Oregon. I love the rain, luckily. So do those big fir trees outside my window. It's helped me to put my regimen down on paper and appreciate everything this wild journey has taught me. - Barbara >>
It's been definitely good for me to get feedback from someone who's a bit ahead of me in the game. You've definitely provided me a number of avenues to explore, as well as a comforting voice in the middle of all my mental health anxiety. Rain's on the way out here, now (New England), which always makes me feel a little bluer. Luckily I'm moving to slightly clearer skies in a few months. Hopefully I'll be taking a clearer, healthier head with me.
All the best,
cache-monkey
Posted by barbaracat on March 21, 2005, at 2:36:35
In reply to Re: Benzos and other stuff, posted by cache-monkey on March 20, 2005, at 19:00:55
Hey, I lived in New England for 5 years. Loved it. Some more thoughts. The start of lithium therapy can be a rollercoaster while your therapeutic levels are being established. I doubt if any doctor will risk tampering with toxicity on one hand or a sub therapeutic weak response on the other and must go by set rules. I got up to the therapeutic range but did not like how I felt and knew it would not be long before I was 'uncomplying'. My main concern was that my thyroid could not hold a stable level, I felt shaky and clumsy. I backed off slowly, noticing very carefully my response and asking my husband to monitor me for extra weirdness while I reduced. I was able to halve my dose from the therapeutic 1200mg to 600mg and luckily, this seems to be the magic number for me. It could be that with all the other stuff I take I'm synergistically affecting the mood stabilizing properties and thereby need less lithium, but maybe I just need less to do the job - not perfectly, but well enough so that I'm not veering too far off center line.
Perhaps when you get to a therapeutic level you'll even off with fewer side effects. This frequently happens after a few weeks. A time-released brand can help with sx's (but not with polyuria). Hopefully you can maintain a stable response at a level where, despite the numbers, it works for you. This is the point where my pdoc said 'oh OK, it shouldn't be working, but I guess it is' and no longer insisted on that window.
My situation is that I've had disastrous and near fatal reactions to health-care and I'm not bloody likely to take anyone's word for anything if it doesn't feel right. I've had to advocate for myself and become my own test case, but I don't advise this for anyone not prepared to put alot of time, effort and risk-taking into it.
With that caveat, I will say this: if you're having uncomfortable and potentially unhealthy effects from lithium, the question is are you in a crisis that warrants ramping up so quickly? Can the dose increase be more gradual? Some recent articles state that 600-900mg is proving to be as effective and the current therapeutic window and dosages should be reevaluated. Perhaps your doctor is aware of these studies. Can you live with 'skirting the edge of hypomania', and find healthy lifestyles methods as enhancers to lithium's efficacy?
My case has been quite serious, resistant, and confounding to most health practitioners I've been to. They do what they can based on what they've learned, but I most definitely do not attribute the gains in my physical and mental health to their limited protocols. As I said, if I can get better, ANYONE can and I hope that gives some measure of hope. But I admit it took alot of tweaking. Enuff said on that.
>
About hydration:
> [Hydrlite] actually seems quite cheap, or comparable to Gatorade in price, at least. Is Gatorade one of the "crappy" drinks to stay away from? How c**Yeah, Gatorade ranks pretty low. Drink it if you like it, but not for its hydrating properties. Too much sugar or fructose - don't you feel the stickiness afterwards? - not enough minerals and hardly any bicarbonate. Plus the artificial flavors and colors. Ick. Most of the sports drinks are in this category.
Hydralite tastes quite good and you're correct, compared to store bought brands, very cost effective. I heard about it when I was hiking in Idaho and got sick from high elevation dehydration. Cured the muscle and stomach cramps within the first day of taking it.
The only think I can think of to watch for is the sugars. He uses glucose and this is a good thing since as sugars go since glucose gets converted immediately to energy and metabolizes cleanly. But lithium can raise insulin levels (yet another reason to not bulk up on it) and I don't know how glucose affects this. As a sport drink/rehydrator, glucose is a necessary ingredient, along with the rest of the ingredients in their proper balance. Hydralite contains much less sugar than the others. I like it alot, but don't drink it all the time and depend more on the salt and bicarb to deal with the lithium/kidney thing.
>
> << > In fact the ride up Li has (knock wood) been remarkable smooth. Hopefully the dose increase (which should get me to therapeutic levels) will be alright.
>
> **Well, good. Hopefully you're one of the lucky ones that can benefit from lithium, as I do. I've found it very smooth and calming. It's a very interesting drug. Do a Google search on neuroprotective+lithium or neurogenesis+lithium and you'll be pleased at how good it actually is for the brain. Life extention folks use it for anti-aging. >>
>
> Yeah, so this last dose adjustment has been a little less smooth. I've been noticing some definite polyuria action. I posted further down the board about this, but my bladder and prostate actually feel a little sore right now. It's kind of annoying, and I hope it subsides with time. If it doesn't, I'll have to push for a "sub-clinical" dose of Li with my pdoc. He won't be happy, though, since he (like your pdoc) is fixed on a magical number for for the lithium serum level. Anyway, time will tell, I suppose.
>
> [...]
> << Are you taking fish oil, BTW? I don't think we've talked about that, but it's a big piece in my recovery. It seems to be so important to cellular health in general. The one I take is Carlson's Fish Oil, 2 Tbl a day. I get it from www.iherb.com. Pills aren't such a good idea because you have to take a handful to get the optimal amount (9-12G) and the oil is frequently rancid in pills. The Carlson's is lemon flavored and actually tasty. I'll tell you, though, all this mixing potions and stuff takes time. And money. >>
>
> I tried fish oil for about three, with the goal of getting 1000 mg EPA (and, based on the formulation I was using, 200 of DHA). I think that it might have been making me more anxious and discontinued about two weeks ago. I rechallenge with it at some point, but for now I want to figure out what the Lithium is doing.
>
> << Well, this has been a nice way to spend a lovely rainy day in Oregon. I love the rain, luckily. So do those big fir trees outside my window. It's helped me to put my regimen down on paper and appreciate everything this wild journey has taught me. - Barbara >>
>
> It's been definitely good for me to get feedback from someone who's a bit ahead of me in the game. You've definitely provided me a number of avenues to explore, as well as a comforting voice in the middle of all my mental health anxiety. Rain's on the way out here, now (New England), which always makes me feel a little bluer. Luckily I'm moving to slightly clearer skies in a few months. Hopefully I'll be taking a clearer, healthier head with me.
>
> All the best,
> cache-monkey
Posted by cache-monkey on March 21, 2005, at 12:43:27
In reply to Re: Benzos and other stuff » cache-monkey, posted by barbaracat on March 21, 2005, at 2:36:35
Hey,
<< Some recent articles state that 600-900mg is proving to be as effective and the current therapeutic window and dosages should be reevaluated. Perhaps your doctor is aware of these studies. >>
I'm not aware of these studies, and my doctor for sure doesn't know about them. (He claims that below a level of 0.6, Lithium will do nothing.) If you have any references, could you please pass them along?
<< Can you live with 'skirting the edge of hypomania', and find healthy lifestyles methods as enhancers to lithium's efficacy? >>
I might just have to. The whole thirst/dehydration/urination thing is really hard to live with right now.
<< The only think I can think of to watch for is the sugars. He uses glucose and this is a good thing since as sugars go since glucose gets converted immediately to energy and metabolizes cleanly. But lithium can raise insulin levels (yet another reason to not bulk up on it) and I don't know how glucose affects this. As a sport drink/rehydrator, glucose is a necessary ingredient, along with the rest of the ingredients in their proper balance. Hydralite contains much less sugar than the others. I like it alot, but don't drink it all the time and depend more on the salt and bicarb to deal with the lithium/kidney thing. >>
Interesting about the insulin. Again something I wasn't aware of. You really have done your research on this!
Thanks again,
cache-monkey
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