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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 42. Go back in thread:
Posted by SLS on October 12, 2010, at 7:36:53
In reply to Re: going back to bipolar medications, posted by morgan miller on October 11, 2010, at 21:55:42
> There really is not a "true" bipolar. The spectrum is wide and varied and each individual is different. Heck, in 20 years they may not be calling some of us bipolar anymore.
Hopefully, it will be within man's ability to diagnose bipolar disorder using biological markers.
"True" bipolar disorder is sometimes referred to as manic depression, and was first described by Emil Kraeplin a hundred years ago, noting the recurrent course of the illness. The classically described bipolar I is sometimes referred to as Cade's Disease.
How common is bipolar I? Probably 1.5 - 3.0 percent of the population. My guess is that the higher number begins to reflect the inclusion of bipolar II and bipolar NOS.
- Scott
Posted by SLS on October 12, 2010, at 7:57:08
In reply to Re: going back to bipolar medications, posted by bleauberry on October 12, 2010, at 5:36:52
> I'm not a fan at all of lamictal. It seldom seems to lead to any of kind of lasting benefit,
not even in clinical trials,How do you account for the people who do respond well to lamotrigine treatment for depression, especially in polypharmacy? That would include me. Are the antidepressant effects of lamotrigine limited to bipolar disorder? Perhaps not. I think there needs to be more study in this area to characterize lamotrigine therapeutically, and to elucidate its mechanisms of action. Whenever I try to lower the dosage or discontinue lamotrigine, I feel significantly worse. In other words, repeated challenges with the higher dosages of lamotrigine procuced therapeutically measurable improvements in my depression. It is difficult to completely ignore real-life anecdotal experiences.
I would like to see how well unipolar depressives respond to a combination of lamotrigine with either Wellbutrin or Parnate.
- Scott
Posted by Dr. Bob on October 12, 2010, at 14:42:27
In reply to Re: going back to bipolar medications » stargazer2, posted by morgan miller on October 10, 2010, at 23:56:11
> what a bunch of ... a-ss-holes we were back then
Please don't use language that could offend others.
But please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person, and I'm sorry if this hurts you.
More information about posting policies is in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by linkadge on October 12, 2010, at 14:55:30
In reply to Re: going back to bipolar medications, posted by morgan miller on October 11, 2010, at 21:55:42
>As far as seroquel or any other AP is concerned, >I think there is far more potential for insulin >resistance and other metabolic issues than most >SSRIs.
The atypical with the most pronounced metabolic side effects is olanzapine. There is some evidence that seroquel can have similar effects, but the evidence is much less clear.
For some people, seroquel is a lifesaver. As noted in the studies of seroquel for GAD, seroquel provided relief from core symptoms within one week. This was in contrast to the SSRI arms which needed about 6 weeks for effects to become pronounced.
Metabolic concerns are just one side effect, are are probably minimal with doses below 75mg. All medications have side effects. If paxil makes you an insomniac that just wants to veg out all day, this too will take a metabolic toll.
For me, seroquel (an antipsychotic) produced much less apathy than any SSRI. On paper, this should not happen, but its really an individual balanace of benefits and risks.
I have a suspicion that TCAs like doxapin and amitriptyline probably have a very similar metabolic risk (weight gain, hyperlipidemia, glucose issues) (as most potent 5-ht2c antagonists seem to have), but they have not been studied as closely as the atypicals.
Linkadge
Posted by linkadge on October 12, 2010, at 15:07:00
In reply to Re: going back to bipolar medications, posted by SLS on October 12, 2010, at 7:36:53
The reason things like mood stabilizers, magnesium, omega3 etc. are appealing (to me) is because some of the mounting evidence that recurrent mood disorders are more than just disorders involving neurotransmitters.
With first episode disorders, perhaps there is enough neuronal integrety that a simple neurotransmitter boost is able to get things going.
For me now, SSRI's just produce the opposite effect to what they once did (massive excitory effect rather than inhibitory). Mind you, citalopram worked for about a year and a half with no major problems.
The anticonvulsants, benzos, mangesium and lithium seem like the only things that can help tame down the anxiety and hyperemotional moods.
Linkadge
Posted by morgan miller on October 12, 2010, at 15:23:13
In reply to Re: going back to bipolar medications, posted by linkadge on October 12, 2010, at 14:55:30
Seroquel at 25 mg put me into a acid trip like coma for 3 or 4 hours, then just left me feeling agitated. I think you are one of the positive responders to Seroquel. I hear of many people feeling drained and lifeless on it. A customer at work was only taking 50 and he said it makes him sleep for 12 hours and leaves him incoherent for several hours after he wakes up. But you are right that many other people have benefited from Seroquel. I would personally prefer waiting 6 weeks to get relief than to get immediate relief from a drug that I and I know many others believe is more invasive than most SSRIs, specifically Lexapro and Zoloft. I think Paxil is poison, at least from me it was. It turned me into a zombie for 10 days before I decided I would rather be an unstable mess instead of take it.
Posted by linkadge on October 12, 2010, at 17:34:40
In reply to Re: going back to bipolar medications » linkadge, posted by morgan miller on October 12, 2010, at 15:23:13
>I think you are one of the positive responders >to Seroquel.
I'm not going to get into an argument about how many people do well on seroquel and who don't, thats beyond the scope of anybody here. With any psychiatric medication, there will be those who respond well and those who don't.
>I hear of many people feeling drained and >lifeless on it. A customer at work was only >taking 50 and he said it makes him sleep for 12 >hours and leaves him incoherent for several >hours after he wakes up.
Well, I personally don't recomend more than 25mg but, whatever works (or doesn't for ya).
>But you are right that many other people have >benefited from Seroquel. I would personally >prefer waiting 6 weeks to get relief than to get >immediate relief from a drug that I and I know >many others believe is more invasive than most >SSRIs, specifically Lexapro and Zoloft.
Well thats great. If you can manage to wait 6 weeks than you're not dealing with severe GAD IMHO.
There really are no safe meds. My neighbours endo said that zoloft long term use w. weight gain probably caused her diabetes. I didn't sleep more than 2 hours at a time for a month on zoloft. The relative safety margin is largely dependant on your own individual reaction to a medication.Linkadge
Posted by Phillipa on October 12, 2010, at 19:54:46
In reply to Re: going back to bipolar medications, posted by linkadge on October 12, 2010, at 17:34:40
That's why I like the benzos. I did a google search on them and only negatives could find was tolerance or falls in elderly. Could be more but didn't find any. Phillipa and the work right away. 12.5 of seroquel put me out and I almost fainted.
Posted by morgan miller on October 12, 2010, at 21:12:53
In reply to Re: going back to bipolar medications, posted by linkadge on October 12, 2010, at 17:34:40
I agree with everything you said. I do think there are things we can do on some of these meds that can reduce or maybe eliminate the risk of issues like diabetes developing, exercise and diet are the main ones.
Posted by Jay_Clockwork_Angels on October 13, 2010, at 1:09:05
In reply to going back to bipolar medications, posted by linkadge on October 10, 2010, at 18:29:52
> ok, so I don't know if I am bipolar or not.
>
> However, lately it seems that any kind of antidepressant just makes things worse --> ssris making anxiety worse, causing insomnia, TCAs just plain being intollerable etc. etc.
>
> mood stabilizers like lithium and tegretol have been helping me more than other treatments lately. They seem to be able to produce a calming effect without inducing all forms of insanity that I get from antidepressants. Basically, I just want something that will help my brain shut/calm down without a kazillion week "waiting period" of worsened symptoms, and all manners of akathesia.
>
> I guess the bottom line is that with antidepressants I just feel *much less* in control. I can't stand the feeling of being out of control. They are so unpredictable. Ritalin is predictable for me (just up and down --> not all around). Mood stabilizers are more predictable too.
>
> Linkadge
>
>
>
>Hey Link, I know what you mean, man. I also wanted to add my support to your above post about coming up with new *mixes* using old scripts and such. The only reason I ever got any better on medications is because I took some unconventional (but safe) moves and juggled around some of my meds.
But, about this post, I'd like to add a few things. A couple of meds you may have not tried...but most of these aren't covered by Trillium or most public health plans.
-Trileptal seems to be a very interesting med on it's own, as supposedly in it's formula (difference from Tegretol) it hits the dopamine in the brain. Good anti-anxiety, and anti-depressant. I've tried it, but it was too expensive for me way back when it first came out.
-Abilify. Though it is as expensive as hell here in Canada, I've been on it for awhile, and found it has a combo of mood-brightening and anti-anxiety properties. You still have to take all of the precautions as you do with other 3rd Gen AP's. The blood sugar risk seems to be as problematic as on any of these meds.
-Dexidrine (IR) This is the only version covered by public health plans, but I have found this med incredible. Soooooo smooth, as I had tons of ups and downs on Ritalin. But, I know Ritalin has been good to you.
-Lyrica Again it is pricey, but even after a year on it, I can still feel it's anti-anxiety effect.
Just some ideas....hope you are feeling better soon.
Jay
Posted by linkadge on October 13, 2010, at 16:26:51
In reply to Re: going back to bipolar medications » linkadge, posted by Jay_Clockwork_Angels on October 13, 2010, at 1:09:05
Yeah, thanks for the recomendations.
Some of the meds mentioned are in the pool of ones I'd like to try.
Something like, low dose perhpenazine and tegretol/trileptal might help.
Linkadge
Posted by Maxime on October 13, 2010, at 21:59:26
In reply to Re: going back to bipolar medications, posted by Phillipa on October 12, 2010, at 19:54:46
> That's why I like the benzos. I did a google search on them and only negatives could find was tolerance or falls in elderly. Could be more but didn't find any. Phillipa and the work right away. 12.5 of seroquel put me out and I almost fainted.
Hi Phillipa, I'm surprised that you didn't find anything about benzos causing depression to worsen or that congnitive functions are impaired.
Posted by Phillipa on October 13, 2010, at 22:06:57
In reply to Re: going back to bipolar medications » Phillipa, posted by Maxime on October 13, 2010, at 21:59:26
Not on the search engines I used. And I figure after 40 years I'd see it in me? Phillipa
Posted by Maxime on October 14, 2010, at 22:48:41
In reply to Re: going back to bipolar medications » Phillipa, posted by Maxime on October 13, 2010, at 21:59:26
Well Phillipa, I guess you are the lucky one with re. regard to taking Valium for so many years without of the side effects below.
ALEXANDER LERMAN, M.D.
Adult, Child & Adolescent Psychiatry
250 North Bedford Road | Chappaqua Ny 10514
TEL. (914) 238-0566 | FAX (914) 914/238-0567 | E-MAIL: AL75@COLUMBIA.EDURisks of Treatment
The principal risks of benzodiazepine treatment include
Sedation these drugs can make you sleepy, particularly if mixed with alcohol or other CNS depressants. Care should be taken driving late at night.Rebound Anxiety some people experience a rebound return of anxiety symptoms when the medication wears off. This reaction is rare with low doses of medication, and more likely to occur with Xanax (alprazolam) than other drugs.
Cognitive dulling and memory problems while rare at low doses, memory problems and confusion can occur during the use of these drugs. Such problems are particularly common in older people.
Impairment of coordination Benzodiazepines can cause coordination problems similar to those caused by alcohol. Great care should be taken driving and operating other machinery while these drugs have been taken. Elderly people have increased risk of falling_________________________________________________
Written by: Professor C Heather Ashton, DM, FRCP Emeritus Professor of Psychopharmacology School of Neurosciences, Division of Psychiatry, The Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, England, UKDepression, emotional blunting
Long-term benzodiazepine users, like alcoholics and barbiturate-dependent patients, are often depressed, and the depression may first appear during prolonged benzodiazepine use. Benzodiazepines may both cause and aggravate depression, possibly by reducing the brain's output of neurotransmitters such as serotonin and norepinephrine (noradrenaline).
Posted by Phillipa on October 14, 2010, at 23:56:46
In reply to Re: going back to bipolar medications » Maxime, posted by Maxime on October 14, 2010, at 22:48:41
Maybe I am lucky. But I don't consider myself elderly by any means. Never fell off my bike when daily ride my six miles. But I've always been on low doses. I'm continuing to lower them as the hormones make me tired as the hormone doc thought they would. Being relaxed allowed me to concentrate better and hence get great grades in school and develop my own cheographed aerobic dance program and do malpractice and testify in court for law firms for quite a few years. Sometimes I'd just stop them when didn't need them no withdrawal. My pdoc as I asked never heard of Heather Ashton. They just don't go by that here. I was in false labor with third child and the ob-gyn gave me two seconals in the hospital that night. She's fine no problem. So maybe it's luck or maybe they are safe??? Each has to find out for themselves. Hence I usually see don't operate machinery or vehicles on any prescription or even non prescription meds when read the directions and side effects which come with them. Phillipa ps how does the klonopin you're on effect you as that I admit depressed me greatly and immediately was taken off by the pdoc
Posted by floatingbridge on October 15, 2010, at 13:03:42
In reply to going back to bipolar medications, posted by linkadge on October 10, 2010, at 18:29:52
Depakote (valproate acid sp?) seemed very tolerable without cognitive impairment. (I used it through grad school.) Maybe it was a bit fatiguing...esp in conjunction with the zoloft. I don't remember my dose. Moderate, not high.
(I'm no longer considered BP nos, but was....sometimes in the fuzzy nos areas, it depends on who is diagnosing.)
Good luck.
Posted by Maxime on October 15, 2010, at 17:56:27
In reply to Re: going back to bipolar medications » Maxime, posted by Phillipa on October 14, 2010, at 23:56:46
I never questioned your age! The aricle said that is common, especially in the elderly. Not that only occurs it happens in the elderly.
Also, not to be mean but in the 2000s or so your posts made more sense. I am not trying to pick on you, but you must notice the way your mind has been working lately. You sign you posts right in the middle of your posts which I can't say what that means because I would get banned. Let's just say that I am worrried about your deterioation and i think you should see a doctor about it and not a psychologist.
Posted by Maxime on October 15, 2010, at 18:11:13
In reply to Re: going back to bipolar medications » linkadge, posted by floatingbridge on October 15, 2010, at 13:03:42
> Depakote (valproate acid sp?) seemed very tolerable without cognitive impairment. (I used it through grad school.) Maybe it was a bit fatiguing...esp in conjunction with the zoloft. I don't remember my dose. Moderate, not high.
>
> (I'm no longer considered BP nos, but was....sometimes in the fuzzy nos areas, it depends on who is diagnosing.)
>
> Good luck.Depokote put into a stage of sleep where it was almost comatose. It took 5 days to wear off, 5 days to be able to walk again without looking and feeling drunk.
Posted by Maxime on October 15, 2010, at 18:21:29
In reply to Re: going back to bipolar medications » Maxime, posted by Phillipa on October 14, 2010, at 23:56:46
Hence I usually see don't operate machinery or vehicles on any prescription or even non prescription meds when read the directions and side effects which come with them. Phillipa ps how does the klonopin you're on effect you as that I admit depressed me greatly and immediately was taken off by the pdoc
---------------
Sorry, I don't understand your last sentence here. :( Are you saying that you were depressed when you were taken off of the meds by your pdoc?
Posted by Phillipa on October 15, 2010, at 19:44:51
In reply to Re: going back to bipolar medications » Phillipa, posted by Maxime on October 15, 2010, at 18:21:29
Maxie your choice think as you wish I sign in the middle a lot because I then decide to add more. From now I'll make it a point to not do that. I skip from googling an item I'm posting on ebay, to facebook and back again and like to answer all my mail before bed. Klonopin was given once when it was the "rage" or popular in this part of the country. It immediately depressed me and called pdoc who talked out loud on his cell phone as he was in his car and stated " you are not depressed it's the klonopin don't take anymore. Go back to xanax. Now does this make more sense? Phillipa
Posted by floatingbridge on October 15, 2010, at 22:08:37
In reply to Re: going back to bipolar medications » floatingbridge, posted by Maxime on October 15, 2010, at 18:11:13
> Depokote put into a stage of sleep where it was almost comatose. It took 5 days to wear off, 5 days to be able to walk again without looking and feeling drunk.Wow Maxime, what was the dose? I titrated up to something moderate.
Posted by floatingbridge on October 15, 2010, at 22:14:15
In reply to Re: going back to bipolar medications » linkadge, posted by Jay_Clockwork_Angels on October 13, 2010, at 1:09:05
Jay, very informative post. Hadn't heard of trileptal. Lyrica has been mentioned to me for pain.
Has anyone mentioned neurontin in this thread? Does it have any minor BP effect?
I was wondering if it would take the edge off ptsd hyper-arousal.
Posted by Maxime on October 16, 2010, at 4:11:28
In reply to Re: going back to bipolar medications » linkadge, posted by Jay_Clockwork_Angels on October 13, 2010, at 1:09:05
Jay, at what dosage does Trileptal act as an antidepressant? I am taking it now as a mood stabiliser - 600 mg.
Posted by Maxime on October 16, 2010, at 7:27:27
In reply to Re: going back to bipolar medications » Maxime, posted by floatingbridge on October 15, 2010, at 22:08:37
Damn! I wrote a long message and then I didn't re-confirm it and I posted nothing. My brain ain't what it used to be!
Brief version, :) I took my first dose of 250 mg of depakote and my roommates couldn't wake me up. They thought I had taken an OD but then they checked the number of pills in the bottle and I had not taken an OD. Woke up, slurred all my words and walked like a drunk for 3-4 days. Obviously it wasn't the med for me. I sure you will have better luck than I did. I think it probably reacted with whatever other med I was taking at the time.
What is the starting dosage for you?
Posted by floatingbridge on October 16, 2010, at 11:58:22
In reply to Re: going back to bipolar medications » floatingbridge, posted by Maxime on October 16, 2010, at 7:27:27
Ha! I was trying to crack your code!
Don't take the blame--technology makes it easy. Remember my recent spell-check flub :) Then at some point I double posted--you, I think.
So, I think I started on 75 mg. I remember them being a nice light purple. I can't recall the increase, but 3x per day. Then the pills came in a new strength and color--yucky pale yellow. Not informative I know.
I don't think my starting dose was critical. I was neither hypomanic or
suicidal.So is trileptal (sp) is a med you want to
keep?What do you think of lyrica or neurontin as (mild?) mood stabilizers?
This is the end of the thread.
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