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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by JohnSky on July 31, 2007, at 9:15:11
Over the last 1.5 years I have been trying to gain ground on my depression and anxiety.
I am on Lithium, Seroquel, and ativan. I have been on Lithium about 3 months. Over the last year I have tried so many anti-depressants. They are only a few I have not tried.
Each one I try makes me very anxious and agitated. I keep on the medication for around six weeks but the anxiety never backs down and then I just can’t take any more and I get off the medication. I’m very frustrated because I am still depressed and I am hoping an anti-depressant will help with depression and anxiety. I have been diagnosed bipolar so maybe the anti-depressants are just causing problems by antagonizing the bipolar aspects. I guess at this point I am hoping the Lithium will do the trick in a couple months or so and help more with depression and anxiety. I sure am exhausted and frustrated with the endless trials of anti-depressants. Any thoughts on what might be going on?John
Posted by Netch on July 31, 2007, at 9:35:12
In reply to Why do all anti-depressants make me anxious, posted by JohnSky on July 31, 2007, at 9:15:11
Have you tried Lamictal or Remeron?
Posted by Phillipa on July 31, 2007, at 11:35:17
In reply to Re: Why do all anti-depressants make me anxious, posted by Netch on July 31, 2007, at 9:35:12
Can't lamictal also be used as an antidepressant and mood stabalizer all in one? Love Phillipa
Posted by dewdropinn on July 31, 2007, at 12:11:10
In reply to Why do all anti-depressants make me anxious, posted by JohnSky on July 31, 2007, at 9:15:11
Hey John,
As I may have mentioned in a previous post, your response to antidepressants is 100% consistent with the bipolar diagnosis -- even if you are predominantly depressed, your response to antidepressants almost definitively confirms your doctor's suspicions. I would highly recommend picking up a copy of "Why am I Depressed?" by Jim Phelps -- it provides incredible insights into this phenomena and also details options for treatment.
As Phillipa noted, Lamictal does have antidepressive properties when you get up to the higher doses (e.g. 200mg+), and is definitely worth exploring. I experienced profound benefits at 400mg. Lithium has antidepressant properties as well, and may prove effective once you get into the therapeutic range. Doctor's frequently combine Lamictal and Lithium for added mood stabilization and antidepressant oomph -- so this is certainly an option if Lithium alone proves insufficient. All mood stabilizers can be augmented by atypical anti-psychotics, which pose their own share of problems, but may be a viable options. I would view your agitation and anxiety as a good thing, even though it's absolutely frustrating right now, because it suggests long sought after answers. I think that you're closing in on a viable course of treatment for long-term recovery.
Drew
> Over the last 1.5 years I have been trying to gain ground on my depression and anxiety.
> I am on Lithium, Seroquel, and ativan. I have been on Lithium about 3 months. Over the last year I have tried so many anti-depressants. They are only a few I have not tried.
> Each one I try makes me very anxious and agitated. I keep on the medication for around six weeks but the anxiety never backs down and then I just can’t take any more and I get off the medication. I’m very frustrated because I am still depressed and I am hoping an anti-depressant will help with depression and anxiety. I have been diagnosed bipolar so maybe the anti-depressants are just causing problems by antagonizing the bipolar aspects. I guess at this point I am hoping the Lithium will do the trick in a couple months or so and help more with depression and anxiety. I sure am exhausted and frustrated with the endless trials of anti-depressants. Any thoughts on what might be going on?
>
> John
Posted by linkadge on July 31, 2007, at 12:24:40
In reply to Re: Why do all anti-depressants make me anxious, posted by Phillipa on July 31, 2007, at 11:35:17
Were you were diagnosed as bipolar because you were experiencing manic episodes, or was the diagnosis based on an agitated response to antidepressants?
Antidepressants are far from perfect. Certain animal models suggest that they can cause anxiety agitation and akathesia. Some people adapt to such effects, but other people do not.
Even some unipolar people cannot tollerate antidepressants for their agitating types of effects. Sometimes SSRI's are administered with antipsychotics (which block certain serotonin receptors) to ofset the agitation they can cause.
People who get such agitated responces to antidepressants may have different underlying biochemical abnormalities. Perhaps their serotonin is high but their dopamine is low. Driving this imballence even further in the wrong direction might be the cause.
I would tend to think that if the drug was exaserbating your own underlying bipolar disorder, then the activation might more resemble your own underlying disorder. If, however, you feel that the drug is superimposing a whole different set of symptoms, then it might more be a side effect of the drug itself.
I think that opiate based drugs would ulitmately come closer to the type of antidepressant that some personalities need.
Linkadge
Posted by JohnSky on July 31, 2007, at 13:30:05
In reply to Re: Why do all anti-depressants make me anxious, posted by dewdropinn on July 31, 2007, at 12:11:10
Thanks for the ideas everyone.
Drew you really keep on top of these posts. I tried Lamictal around 6 months ago and it made me worse for some reason... but my doc realized later he may not have moved me up to a high enough dose... so maybe I will go back to that option. But first I think I should give Lithium a fair chance as it has helped my Brother a great deal. Based on his results I have another month or two before the Lithium really kicks in for me... maybe for a change things will happend faster.
Off and on when my Brother and I talk he will tell me he felt "wonderful". I'd love to honestly say that.
Thanks for the encouragement... I think I am closing in a LT solution as well. I pray the Lithium works for me... and maybe I will need an add-on to help.
John
Posted by saturn on July 31, 2007, at 18:33:14
In reply to Re: Why do all anti-depressants make me anxious, posted by dewdropinn on July 31, 2007, at 12:11:10
>
>>>As I may have mentioned in a previous post, your response to antidepressants is 100% consistent with the bipolar diagnosis.Anxiety/agitation caused by antidepressants does not equal bipolar disorder (nor does it exclude it).
Posted by polarbear206 on July 31, 2007, at 21:05:07
In reply to Re: Why do all anti-depressants make me anxious, posted by JohnSky on July 31, 2007, at 13:30:05
> Thanks for the ideas everyone.
>
> Drew you really keep on top of these posts. I tried Lamictal around 6 months ago and it made me worse for some reason... but my doc realized later he may not have moved me up to a high enough dose... so maybe I will go back to that option. But first I think I should give Lithium a fair chance as it has helped my Brother a great deal. Based on his results I have another month or two before the Lithium really kicks in for me... maybe for a change things will happend faster.
>
> Off and on when my Brother and I talk he will tell me he felt "wonderful". I'd love to honestly say that.
>
> Thanks for the encouragement... I think I am closing in a LT solution as well. I pray the Lithium works for me... and maybe I will need an add-on to help.
>
> JohnJohn,
It is very likely that the lithium will work for you because your brother is having a good therapeutic response. If you are having some lingering depression and want to try an AD again, keep the dosage low to prevent anxiety and agitation. Lamictal is also a great drug, I take 200mg. Depending on how far to the right you are in the bipolar spectrum, some people need to take another mood stabilizer with the lamictal if it is too activating. It is used for bipolar II and those with soft bipolar as myself. Lithium and Lamictal have a good track record used in combo with or without a antidepressant.
Polarbear
Posted by Netch on August 1, 2007, at 8:02:43
In reply to Re: Why do all anti-depressants make me anxious, posted by polarbear206 on July 31, 2007, at 21:05:07
>
> John,
>
> It is very likely that the lithium will work for you because your brother is having a good therapeutic response. If you are having some lingering depression and want to try an AD again, keep the dosage low to prevent anxiety and agitation. Lamictal is also a great drug, I take 200mg. Depending on how far to the right you are in the bipolar spectrum, some people need to take another mood stabilizer with the lamictal if it is too activating. It is used for bipolar II and those with soft bipolar as myself. Lithium and Lamictal have a good track record used in combo with or without a antidepressant.
>
> Polarbear
>Totally agree Polarbear.
What are your side effects from Lamictal?
Was it difficult to titer up?
Does it impair your sleep or memory?Netch
Posted by JohnSky on August 1, 2007, at 9:25:31
In reply to Re: Why do all anti-depressants make me anxious, posted by linkadge on July 31, 2007, at 12:24:40
I was diagnosed bipolar after effexor set off a manic episode that started as a flame and grew to a roaring fire after a couple months. We stopped the effexor but the mania continued. When I look back in my past I think I was a touch manic alot of the time.
Posted by JohnSky on August 1, 2007, at 9:28:37
In reply to Re: Why do all anti-depressants make me anxious, posted by polarbear206 on July 31, 2007, at 21:05:07
I wondered about keeping the anti-depressant dose low as to not create anxiety and aggitation... my concern was would a anti-depressent work at lower doses than the marketed targeted dose. I am on EMSAM and I'm wondering if a 3mg level would help me instead of the minimum suggested dose of 6mg.
John
Posted by Netch on August 1, 2007, at 9:55:13
In reply to Re: Why do all anti-depressants make me anxious, posted by JohnSky on August 1, 2007, at 9:28:37
> I wondered about keeping the anti-depressant dose low as to not create anxiety and aggitation... my concern was would a anti-depressent work at lower doses than the marketed targeted dose. I am on EMSAM and I'm wondering if a 3mg level would help me instead of the minimum suggested dose of 6mg.
>
> JohnSince your depression has not lifted I think you need to ask your psych.
Personnally I think you should ask your psych for another drug to combine with lithium. Maybe lamictal or remeron, since you have problems with agitation and anxiety.
Posted by Bonnie_CA on August 1, 2007, at 12:08:39
In reply to Why do all anti-depressants make me anxious, posted by JohnSky on July 31, 2007, at 9:15:11
> Over the last year I have tried so many anti-depressants. They are only a few I have not tried.
> Each one I try makes me very anxious and agitated. I keep on the medication for around six weeks but the anxiety never backs down and then I just can’t take any more and I get off the medication. I’m very frustrated because I am still depressed and I am hoping an anti-depressant will help with depression and anxiety. I have been diagnosed bipolar so maybe the anti-depressants are just causing problems by antagonizing the bipolar aspects. I guess at this point I am hoping the Lithium will do the trick in a couple months or so and help more with depression and anxiety. I sure am exhausted and frustrated with the endless trials of anti-depressants. Any thoughts on what might be going on?
>Aww! I've so been there. (You need a hug.) I've tried pretty much all of the SSRIs (except Luvox, but why would I take that?), and never found relief until Lamictal. I was about at wit's end myself. If your anxiety is still bad, maybe using a different benzo would help. Some people with really bad anxiety find relief with Klonopin, because it's longer acting. I use xanax myself. I'm on Lexapro right now, but my doc wants to get me off of it for the reason you stated, that it could be antagonizing my anxiety. That'd be awesome if I could be off of SSRIs, because then I might lose the SSRI weight too! :D
-Bonnie
Posted by Oppycat on August 1, 2007, at 12:11:17
In reply to Re: Why do all anti-depressants make me anxious, posted by JohnSky on August 1, 2007, at 9:28:37
> I wondered about keeping the anti-depressant dose low as to not create anxiety and aggitation... my concern was would a anti-depressent work at lower doses than the marketed targeted dose. I am on EMSAM and I'm wondering if a 3mg level would help me instead of the minimum suggested dose of 6mg.
>
> JohnJohn,
Like you, virtually all antidepressants can hyperanxiety for me at the therapeutic dosage or below. The only exceptions to that are MAO's. When Parnate finally pooped out on me after many years, I experimented with other AD's at low doses. Currently, I am taking 15mg Remeron and 10mg Lexapro. I am doing pretty well on that combo along with 1mg Ativan, 900mg Trileptal, and 40mg Adderall XR. Incidentally, I am not bipolar. Perhaps a combo of 2 AD's at low doses will work for you, too.
Posted by dewdropinn on August 1, 2007, at 12:32:08
In reply to Re: Why do all anti-depressants make me anxious, posted by JohnSky on August 1, 2007, at 9:28:37
Experimenting with the lower dose of EMSAM makes a lot of sense -- it's incredibly easy to do (simply a matter of cutting the patch in half and slapping it on), and it will give you the definitive answer as to whether or not EMSAM play a role in your future treatment regiment.
I would not concern yourself with the recommended dosage guidelines -- if you were dealing with unipolar major depression, then those target numbers will be of benefit, but since you are contending with something more complicated, the published dosage parameters aren't necessarily relevant. With bipolar patients, doctors will commonly prescribe miniscule doses of antidepressants, so as to provide mood elevation without worsening the underlying condition -- I know one doctor who prescribes the 75mg instant release Wellbutrin tablets (the original drug formulation), and instructs patients to cut the pills into quarters -- so the starting dose is almost 1/10 the lowest "effective" dose of the drug. So, don't worry about the published guidelines -- they probably don't apply to your situation in any way, and your experience seems to validate this.
You are actually really lucky -- you have a familial precedent to guide your future treatment, and it seems that you're already heading in the right direction. I would suggest talking to your brother about his dosage -- your doctor may want to keep you dose low so as to avoid side effects, but your brother's dose will probably be highly suggestive of the dose that will be effective for you.
I would check out the website below -- it's really the ultimate source on just about everything related to bipolar disorders -- great info on drugs and treatment options, lots of studies and analysis, a great questions and answers section, and the site author, Jim Phelps, is one of the true experts on the subject. I have a suspicion that, if you poke around (the site isn't particularly well organized), you should find answers to most of your queries.
http://www.psycheducation.org/
Drew
> I wondered about keeping the anti-depressant dose low as to not create anxiety and aggitation... my concern was would a anti-depressent work at lower doses than the marketed targeted dose. I am on EMSAM and I'm wondering if a 3mg level would help me instead of the minimum suggested dose of 6mg.
>
> John
Posted by polarbear206 on August 1, 2007, at 14:44:31
In reply to Re: Why do all anti-depressants make me anxious, posted by Netch on August 1, 2007, at 8:02:43
>
> >
> > John,
> >
> > It is very likely that the lithium will work for you because your brother is having a good therapeutic response. If you are having some lingering depression and want to try an AD again, keep the dosage low to prevent anxiety and agitation. Lamictal is also a great drug, I take 200mg. Depending on how far to the right you are in the bipolar spectrum, some people need to take another mood stabilizer with the lamictal if it is too activating. It is used for bipolar II and those with soft bipolar as myself. Lithium and Lamictal have a good track record used in combo with or without a antidepressant.
> >
> > Polarbear
> >
>
> Totally agree Polarbear.
>
> What are your side effects from Lamictal?
> Was it difficult to titer up?
> Does it impair your sleep or memory?
>
> NetchNetch,
I don't even know I am taking a mood stabilizer. Lamictal has been a life saver for me. I had no difficulty going up to 200mg. No side effects, maybe an occasional headache. This is very common while titrating dosage. I occasionally need to take klonopin for sleep. Sometimes before my monthly visitor my sleep pattern is off course.
Polarbear
Posted by polarbear206 on August 1, 2007, at 15:01:36
In reply to Re: Why do all anti-depressants make me anxious » JohnSky, posted by Netch on August 1, 2007, at 9:55:13
> > I wondered about keeping the anti-depressant dose low as to not create anxiety and aggitation... my concern was would a anti-depressent work at lower doses than the marketed targeted dose. I am on EMSAM and I'm wondering if a 3mg level would help me instead of the minimum suggested dose of 6mg.
> >
> > John
>
> Since your depression has not lifted I think you need to ask your psych.
> Personnally I think you should ask your psych for another drug to combine with lithium. Maybe lamictal or remeron, since you have problems with agitation and anxiety.
>
>I agree with Netch. IMOP, EMSAM would not be the drug of choice. From what I gather, EMSAM would exacerbate your bipolar. Is your brother on an AD? Need a little more history. Are you able to function well and hold down a job? How do your moods play on a day to day basis? Sleep cycle, etc....
Polarbear
Posted by JohnSky on August 1, 2007, at 17:11:31
In reply to Re: Why do all anti-depressants make me anxious)), posted by polarbear206 on August 1, 2007, at 15:01:36
My brother is on a small dose of Paxil that he has been on for a few years and is slowly getting off of it. Once he started Lithium 6 months ago he noticed the drugs "battled each other".
I work full time. I am down most of the time but manage to get things done. Life and work is hard but that will change some day. I sleep OK... but this higher dose of EMSAM has me concerned. As I said somewhere in one of these posts if the higher dose pushes my anxiety up I am done with the drug.
John
Posted by linkadge on August 1, 2007, at 19:21:38
In reply to Re: Why do all anti-depressants make me anxious)), posted by JohnSky on August 1, 2007, at 17:11:31
>My brother is on a small dose of Paxil that he >has been on for a few years and is slowly >getting off of it. Once he started Lithium 6 >months ago he noticed the drugs "battled each >other".
Yeah, I have noticed that. I was on celexa and lithium. It seemed that the combination made me more bipolar than either alone! I acutally had psychedellic hallucinations on the combination. Ie cars faces looking real. Every object taking on a personality, cars, phones, trees, everything. I felt the emotions of objects such as lampshades and sat there trying to describe the emotions. I had time speeding up and slowing down too.
lithium can somtimes greatly enhance the serotonergic effects of the SSRI's. Somtimes it can enhance the neurotoxicity of lithium.
I personally felt that the combination of SSRI's and lithium did some really strange things. Of all the drug combinations I've taken, I feel that I am still altered as a result of those ones.
They certainly can fight with eachother. I found that there were side effects I got from the combination that neither drug gave me alone.
Lithium kindof wants to be the master. It does't really like other drugs telling it what to do.
Linkadge
Posted by Netch on August 2, 2007, at 9:14:50
In reply to Re: Why do all anti-depressants make me anxious » Netch, posted by polarbear206 on August 1, 2007, at 14:44:31
>
> Netch,
>
> I don't even know I am taking a mood stabilizer. Lamictal has been a life saver for me. I had no difficulty going up to 200mg. No side effects, maybe an occasional headache. This is very common while titrating dosage. I occasionally need to take klonopin for sleep. Sometimes before my monthly visitor my sleep pattern is off course.
>
> PolarbearI'm glad it has worked for you.
I definitely will have to try this drug.
I know it has helped many and I guess the only way to find out if it's my drug of choice is to try it.Netch
Posted by dewdropinn on August 2, 2007, at 10:46:12
In reply to Re: Why do all anti-depressants make me anxious)), posted by linkadge on August 1, 2007, at 19:21:38
I experienced a similarly wacky reaction to lithium, but it actually provided valuable insights. I've experienced night terrors for most of my life -- they occur in a programmed fashion, almost precisely 45 minutes after falling asleep. Lithium induced absolutely vicious night terrors, and they would occur several times throughout the evening -- I also had all kinds of bizarre hypogagic hallucinations, thoughts, really psychedelic, but in a bad trip kind of way.
As you may be aware, Lithium lowers the seizure threshold, and my experience with the drug alerted doctors to the fact that my night terrors were not related to any kind of anxiety disorder, but rather a low grade epileptic condition. It provided definitive proof that anti-convulsants would be essential to my treatment.
One of the truly exciting aspects of on-going bipolar research and the disorder itself is the fact that it touches on all mood disorders and it links mood disorders to neurological conditions that were once only tangentially linked to mental illness. It also touches on one of the basic principles involved with electronic systems. When most people think about electronics, they primarily think about wattage (e.g. power) -- but in reality, all complex electronic equipment requires capacitors and resistors to limit current and make the system function in an efficient manner. The brain is of course infinitely more complex than electronics equipment, but it is an electrical system -- so many of the same principals apply. This explains in part the broad utility of anti-convulsants -- they modulate and limit the flow of electricity which in turn allows current to flow efficiently and prevents the electrical system from going haywire.
Bringing this all back to lithium -- lithium is a critical component in many of the most efficient and powerful batteries. So, it makes perfect sense that this mineral can play a valuable role in modulating electrical transmition within the infinitely complex electrical system known as the human brain.
Drew
> >My brother is on a small dose of Paxil that he >has been on for a few years and is slowly >getting off of it. Once he started Lithium 6 >months ago he noticed the drugs "battled each >other".
>
> Yeah, I have noticed that. I was on celexa and lithium. It seemed that the combination made me more bipolar than either alone! I acutally had psychedellic hallucinations on the combination. Ie cars faces looking real. Every object taking on a personality, cars, phones, trees, everything. I felt the emotions of objects such as lampshades and sat there trying to describe the emotions. I had time speeding up and slowing down too.
>
> lithium can somtimes greatly enhance the serotonergic effects of the SSRI's. Somtimes it can enhance the neurotoxicity of lithium.
>
> I personally felt that the combination of SSRI's and lithium did some really strange things. Of all the drug combinations I've taken, I feel that I am still altered as a result of those ones.
>
> They certainly can fight with eachother. I found that there were side effects I got from the combination that neither drug gave me alone.
>
> Lithium kindof wants to be the master. It does't really like other drugs telling it what to do.
>
>
> Linkadge
>
>
>
Posted by linkadge on August 2, 2007, at 15:20:06
In reply to Re: Why do all anti-depressants make me anxious)), posted by dewdropinn on August 2, 2007, at 10:46:12
I was going to mention that. Ie the proconvulsant aspects of lithium. Lithium and pilocarpine are combined to mimic an animal model of temporal lobe epilepy. You'd likely want to be carefull combining lithium with any kind of nootropic or agent which enhances cholinergic function.
Somtimes lithium AD combinaitons have cause seizures. You also want to be carefull when combining it with other drugs which lower the seizure threshhold.
I had one strange reaction when I combined lithium and celexa. RAGE. I never had rage on either celexa or lithium alone, but when I combined them I started to have these bouts of INTENSE rage. Mainly an extreme pissedoffness at God. It lasted untill either drug left the system.
Linkadge
This is the end of the thread.
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