![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by cockeyed on August 1, 2005, at 23:33:58
today my t told me that I should get a 2nd op. on whether or wht my condition is in. I've been diagnosed as Bipolar II but she suspects that when I start feeling "nomal" I'm considered manic. trouble is, I suspect that when I'm normal, I'm a little bit nuts: like to have fun, boogie, that sort of crap.
But I'm confused re drugs. I'm taking tranxene and, sometimes, less lately, gabepentin. also 40 mgs. prozac, daily. Trouble is this drug shell game is starting to ...well, confuse me. So I think I'll get a second opinion. I very much like being manic, but screw the depression. If you've been depressed you know what i mean. Right now I'm up and down....self-medicating with vodka. But how long does he shell game go on. And what happens if I say f*ck it, civilly of course, and decide to do what does okay by me...but not my family. So I'm drug shopping. I know vodka works for a while but I'm well behind he learning curve on the latest drugs for BPII. Also I question whether I'm bipolar. I suspect I'm grimly depressive and once in a while emerge into a real world that is not filled with pri-mordial menace.
So, any drug solutions. I've decided to see a 2nd pdoc to get a better fic on where I might be on the nut spectrum.. In the meantime I'll hit some vodka and start working out more...and take my regular dose of meds. Oh what fun, cockeyed.
Posted by med_empowered on August 2, 2005, at 3:15:06
In reply to second opinion, posted by cockeyed on August 1, 2005, at 23:33:58
hey. I'm kind of in a similar boat..I've been dx'd as BP II, BP I, BP NOS, and (once, by an incompetent dufus) schizophrenic. What really sucks about bipolar treatment, as I think you've noticed, is that shrinks seem to mostly care about mania--I think the energy and the craziness that go along with it scares them, so they really focus on that to the exclusion on adequately treating the depressive symptoms, which are more frequent and, for me at least, more severe. I've been on all kinds of meds (stimulants, anti-depressants, benzos, sleeping pills, anti-psychotics, mood-stabilizers, etc.) and I gotta say-- getting balanced on meds is tough. Right now I dont take anything, and I'm in the midst of a pretty rough depressive patch (atypical: I respond to whats going on around me, which gives me a temporary break). NOW...it sounds like when you feel "normal" you seem kind of "hypomanic". "Hypomania" is a symptom of bipolar disorder, but its really not a big problem for most people; usually its mania, which often includes psychosis, spending sprees, promiscuity, and other problems that really is a problem. Hypomania can be pretty pleasant, actually...in my own experience, I have a tendency to become kind of anxious while hypomanic; if you're taking Tranxene or other anti-anxiety meds, that will help a lot. The bad news is that its much, much harder to adequately treat the depressed phase of bipolar illness. The treatment for depression in BP II is pretty much taken out of the treatment for BP I; you can increase the mood-stabilizer dosage, add a mood-stabilizer, add an antidepressant, rarely add a stimulant, or do electroshock. I think we may have similar issues...I tend to be get seriously depressed, move up a bit, then move down. From my own experience, I can only say that your medication should reflect your *current* mood (this is why its good to see your doc often if you have these kinds of issues; meds sometimes need constant updating). I kind of think in your case a good place to start with the meds would be to taper or at least reduce the 40mgs of Prozac you're taking; of all the SSRIs, Prozac probably has the *worst* reputation when it comes to making people crazy. And...any antidepressant without a mood-stabilizer (or possibly with a mood-stabilizer) can make the "cycling"--movement up or down the mood chart-- considerably faster and more intense for those with bipolar disorder. I think you mentioned gabitril or gabapentin...these meds are OK, sometimes, but they're really not very good mood-stabilizers for most people. I personally prefer mood-stabilizers that don't require blood tests--the idea of some med ruining my liver or pancreas is just a bit too much for me to take. So, I'd recommend Trileptal--a modified version of Tegretol--as a 1st line candidate. Basically, Trileptal is like other mood-stabilizers in the sense that its mostly "anti-manic"--its good at bringing the mood down a bit and preventing manic craziness, but it isn't all that great at fixing the depressed phase of bipolar disorder...at best, it slices off the worst of the depression; in the worst case scenario, it can just dampen your mood without having any real anti-depressant effects. The other main option would be Lamictal. Lamictal seems good at treating and preventing the depression that you find in bipolar disorders, but it really isn't so good at treating or preventing mania. Some people get hypomanic while taking Lamictal, so some docs only RX it mixed with Depakote or Lithium. Based on your history and your desire to treat the downs more aggressively than the ups, it would seem that using Lamictal might be a good idea. But..Lamictal can cause a possibly fatal skin reaction in some people, so beware of that...your doc will adjust your dose gradually, and the med is usually stopped at any sign of a rash. There's also Tegretol (similar to Trileptal, but with blood tests and toxicity problems), Depakote, and Lithium. Depakote can be useful if you have problems with panic disorder or excessive anxiety, tend to "cycle" rapidly, or have a problem with psychosis when you move up or down in terms of mood. It also can cause hair loss, cognitive problems, weight gain, and hormonal weirdness; because of the possibility of damage to the liver and pancreas, you'll need to do blood tests. Lithium is the classic bipolar remedy...it can cause tremor, cognitive problems, hair loss, acne/skin problems, and weight gain, among other things. It has an anti-suicide effect, but I wouldn't call it an antidepressant per se..its really best used as an anti-manic agent. Like with Depakote, periodic blood tests are a must...you'll also need to watch fluid intake and avoid dehydration. Then...there are the antipsychotics. Atypicals are now being used not just to treat acute mood episodes or control psychotic episodes, but also for maintenance. I personally dont really like antipsychotics, but some people love them, so its a personal thing. Abilify is the newest and the one I like the most. You can take anywhere from 5mgs-30mgs daily, usually as one dose at night. It tends to be pretty much non-drowsy; mixed with antidepressants, it can be "activating," mildly stimulating, and very effective against depression. Its also pretty weight neutral; odds are you won't gain or lose weight on abilify. The downsides are start up anxiety, plus the usual problems with antipsycohtics--akathisia, tremor, possible tardive dyskinesia. Geodon is a less-frequently used antipsychotic...its more or less weight neutral, but it does tend to be sedating (its a 2X daily med) and it has induced mania when mixed with antidepressants. Then there's seroquel...great for sleep, also a 2X daily med..can cause weight gain, diabetes, etc....can have antidepressant effects, but they seem much less pronounced than the other atypicals. Zyprexa is the reigning champ of the atypicals; it can cause diabetes and weight gain, but it can also zap some depressive episodes (especially when mixed with antidepressants--hence Symbyax, the zyprexa+prozac combo) and is pretty good at controlling mood long-term. Risperdal and clozapine are also options, but I think those are best used when other options fail. Treatment of bipolar disorder or severe depressive disorders usually involves a mood-stabilizer + WHATEVER. Antidepressant, benzos, stimulants, etc. are all possible add-ons, depending on what exactly your problems are. Good luck!
Posted by Squiggles on August 2, 2005, at 6:27:31
In reply to second opinion, posted by cockeyed on August 1, 2005, at 23:33:58
Trying to medicate your depression with
alcohol is much riskier than accepting
your doctor's opinion. Alcohol can only
exacerbate the depression and maybe even
make you unaware of the swings you fall
into in bipolar illness.It may be safer to work with your doctor
on getting the right dose or kind of
medication to get you stable. They
all read the same books after all and
in serious mental disorders, the facts
are shared pretty well all around the
medical community.Squiggles
Posted by partlycloudy on August 2, 2005, at 10:45:56
In reply to Re: second opinion, posted by med_empowered on August 2, 2005, at 3:15:06
Great post but hard to read!! Who-ee, please consider those of us who are slightly dyslexic! I'm going to copy and paste your post and put in a few paragraphs so I can appreciate it better :-)
I'm bipolar II and at this point I *never* trust my Good Moods as they swiftly become agitation and irrational thinking. Like this morning I was at the gym and I felt pretty good - well, proud of myself for working out, frankly, as I am a darn good couch potato. Then I start looking around the room and think: Hmm... that sign should be printed, not hand written; and that other one looks tacky put up with tape, it should be laminated and neat. Stupid stuff like that. I ended up fairly certain I could manage the whole place so much better than anyone else could, LOL.
By the time I got done with grocery shopping I was yelling at my husband to Let Me Put the G*dam Groceries Away (so they'd be in the "right" places, of course). I really, really don't like this, and it feels so utterly beyond my control.
Posted by Nickengland on August 2, 2005, at 13:48:41
In reply to second opinion, posted by cockeyed on August 1, 2005, at 23:33:58
Best thing I would suggest is coming to terms that Vodka is a depressant drug in itself....Although obviously it provides short-term relief to problems, longterm its not going to help the medication work, its probably going to increase the side effects and possibly make the whole condition worse...
>So, any drug solutions.
The best start if your bipolar would be beginning with a mood stabiliser. Be it lithium or anticonvulsant.
As for the "latest drugs" The general feeling within psychiatry is that these are the best ones to try first or first-line.
Lithium - (gold standard)
Sodium Valproate (depakote)
Carbamazepine (Tegretol)
They are considered the main 'big 3' Ironically they're the oldest of the 'latest' but still the best place to start (and hopefully finish)
Afterwards you have..
Oxcarbazepine (Trileptal)
Lamotrigine (lamictal)
Topiramate (Topamax)
Plenty to choose from and even after that you have antipsychotics. (I have little knowledge of those) but i've tried all the above.
Sounds a wise idea getting a second opinion - If your bipolar the last thing you want to be taking sometimes is an anti depressant. (i noticed your on prozac) this could be why your going up and down all the time. Plus I know for sure how bad those depression are....and so I came to the conclusion, 'what goes up'...must eventually 'come back down' - i.e depression.
I'm not sure what tranxene is?...but I'm pretty sure prozac and neurontin isn't going to do anything for bipolar...prozac could well be making it worse.
Posted by Nickengland on August 2, 2005, at 13:57:44
In reply to Re: second opinion, posted by med_empowered on August 2, 2005, at 3:15:06
Great description!.....you forgot Topamax though..lol
I know it hasn't got the 'best' reputation but I can definately speak good words of Topamax...as for feeling stupid on it, as that seems to be the worst complaint - I can actually think clearer. I can honestly say I've had far, far worse side effects on carbamazepine, valproate, lithium and lamotrigine.
Only one I say for myself that ranks well with topamax is trileptal in terms of effectiveness and side effects.
I guess its the same old story though that truely everyone reacts so differently to different medication even though there is still a general side effect profile.
Kind regards
Nick
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.