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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by cyban on April 22, 2011, at 21:10:34
I am a Bi Polar type 1, ADD, Alcoholic.
I am currently on: Lithium Benz, Trileptol, Celexa, Abilify, Ativan, Requip, and Ambien.
My Psychiatrist is at a loss, we have tried a lot of other medications whose names I forget but nothing has helped the Mania. I twitch so much I have blisters on my feet, I hallucinate visually and audibly, and get very aggressive.
Any suggestions would be appreciated.Worry if I double post, I am not sure how to use the site yet.
Posted by Phillipa on April 23, 2011, at 0:09:46
In reply to Nothing Works, posted by cyban on April 22, 2011, at 21:10:34
That's fine and welcome to babble but didn't you post celexa as your ad above and now requip here? Could you check your meds as different. Phillipa
Posted by bleauberry on April 23, 2011, at 5:09:37
In reply to Nothing Works, posted by cyban on April 22, 2011, at 21:10:34
I'm sorry you have to endure what you do.
When I see stories like yours, I immediately conclude that we are barking up the wrong tree. In other words, when symptoms aren't helped by a wide variety of meds, and the doctor runs into a brick wall, it is simply a way of sayjing, "it's something else, you're focusing on the wrong stuff".
There are some common things that have your symptoms as an earmark. I can name off half a dozen, but Lyme disease is just one example. In a hypothetical example, which is actually a real example repeated daily all over the world, when the Lyme disease is treated, the psychiatric symptoms get better and eventually are gone. Without psych meds.
The psych meds are missing the target. The problem isn't the brain....the problem is something else that is impacting the brain. It just so happens that whatever it is, it is too powerful or too all-encompassing for psych meds to target or to compete with.
That's how I see it anyway. If you were a friend or a neighbor and we were sitting around chatting, I would be strongly nudging you to do some experimentation with the following:
antibacterial meds
antifungal meds
antimicrobial herbs
detox substances (DMSA< ALA< NAC)
diet....hugely important...there are things you should not have in your grocery cart.In terms of med choices, I'm not sure I like the ones you are on. That's a bizarre mix. And they are obviously doing you some physical harm. Since I don't know you and I don't know your history, I can only speculate. My speculation says zyprexa plus prozac have a lot more potential than the current meds.
Bipolar type 1....ADD...these are just names that really don't mean anything. A cluster of symptoms they had to give a name to, a cluster of symptoms that can easily overlap with something else that isn't either of those, a cluster of symptoms with a findable and treatable cause.
Unfortunately psychiatrists are sometimes the worst ones to treat psychiatric symptoms, because their view of treatment has such a narrow vision. They are not usually very knowledgable on the rest of the body, where the symptoms are likely coming from. There are only a handful of pdocs for example who have experience in treating Lyme psych patients....who are distinctly different than your average garden variety psych patient. In those cases, either extremely small doses or extremely high doses are needed, and the number of meds needed is usually only one or two. Entire cocktails are not needed, but instead the right dosing of the right meds.
The Lyme examples here are just that....examples. There are others. Don't count on your pdoc to walk you through it though. Most patients learn their options and take control of their own destiny by doing their own research on the web. But I can save you a lot of time. Look no further than chronic low level pathological chronic infection of some kind (likely not diagnosable for a host of reasons so don't even try to do that), detox issues as in heavy metal accumulation, and careful choice of foods including challenge tests to find out if any of your normal foods are causing problems.
All of the above lead to widespread inflammation including the brain, widepspread immune dysfunction which is closely tied with everything in the nervous system, and widespread bizarre imbalances of neurotransmitters that are not constant, but rather in motion. Kind of hard to hit so many targets, especially when they are constantly in motion not static, with a mere pscyhiatric medicine prescription. I think in cases like yours a much broader more comprehensive plan is needed.
I am not at all saying ditch your meds or your pdoc. I am saying, keep the best, try new ones, throw out the duds, especially throw out the ones making other problems, and broaden the horizons outside of the psychiatric toolbox. There is where healing is.
> I am a Bi Polar type 1, ADD, Alcoholic.
> I am currently on: Lithium Benz, Trileptol, Celexa, Abilify, Ativan, Requip, and Ambien.
> My Psychiatrist is at a loss, we have tried a lot of other medications whose names I forget but nothing has helped the Mania. I twitch so much I have blisters on my feet, I hallucinate visually and audibly, and get very aggressive.
> Any suggestions would be appreciated.
>
> Worry if I double post, I am not sure how to use the site yet.
Posted by Christ_empowered on April 23, 2011, at 5:18:30
In reply to Re: Nothing Works, posted by bleauberry on April 23, 2011, at 5:09:37
What dose of the Abilify are you taking? If you're not at 30 (or higher, I guess), increasing it might help. Supplements can help, too--6grams/taurine daily has really helped stabilize my mood w/o side effects.
I would think that if you're manic dropping the celexa might help, or increasing the Ativan, but I'm not a doctor.
Posted by linkadge on April 23, 2011, at 8:35:23
In reply to Nothing Works, posted by cyban on April 22, 2011, at 21:10:34
I think you're taking too much.
I had visual hallucinations on the combination of lithium and celexa (normal objects taking on human or animal form)
I would cut back. If mania is the main problem come off the celexa!!! You might also want to come off the abiify (as I don't think its great for mania or agression)
Have you tried valproate. Valpraote likely packs a better punch than trileptal for mania.
I did well on lithium + valproate + high dose fish oil.
Linkadge
Posted by Cyban on April 23, 2011, at 8:48:09
In reply to Re: Nothing Works, posted by Christ_empowered on April 23, 2011, at 5:18:30
I am a Bi Polar type 1, ADD, Alcoholic.
I am currently on: Lithium Benz, Trileptol, Celexa, Abilify, Ativan, Requip, and Ambien.My Psychiatrist is at a loss, we have tried a lot of other medications whose names I forget but nothing has helped the Mania. I twitch so much I have blisters on my feet, I hallucinate visually and audibly, and get very aggressive.
Any suggestions would be appreciated.
Worry if I double post, I am not sure how to use the site yet.
Thanks for the replies; I am reading them all carefully.I will do some research on Lyme. Would it cause manic swings? I do go from severely depressed to severely manic in about 6 month swings with little bumps in-between.
I did try dropping the Lithium which didnt help, but I increased Abilify which helped. For some reason my pdoc didnt like the increased dosage of Abilify.
I eat pretty healthy as we have a CSA in our back yard, cook most of our meals (My wife wont buy a Microwave) but do eat out Sushi a lot.
This has been an ongoing issue for a few years; it started in my teens, went away in my twenties, and came back in my thirties.
Posted by SLS on April 23, 2011, at 9:28:34
In reply to Re: Nothing Works, posted by linkadge on April 23, 2011, at 8:35:23
> Have you tried valproate. Valpraote likely packs a better punch than trileptal for mania.
I can't compare valproate versus Trileptal for severe mania. However, valproate is a remarkable anti-manic for me. It works very fast, especially if you begin taking it using loading doses.
> I did well on lithium + valproate + high dose fish oil.
I will be adding fish oil to my treatment regime. Can you describe what your experience with it was?
Thanks.
I have already added phosphatidylserine, a substance that is supposed to work with fish oil to help support neurotrophism.
- Scott
Posted by Cyban on April 23, 2011, at 9:32:55
In reply to Re: Nothing Works » linkadge, posted by SLS on April 23, 2011, at 9:28:34
> > Have you tried valproate. Valpraote likely packs a better punch than trileptal for mania.
>
> I can't compare valproate versus Trileptal for severe mania. However, valproate is a remarkable anti-manic for me. It works very fast, especially if you begin taking it using loading doses.
>
> > I did well on lithium + valproate + high dose fish oil.
>
> I will be adding fish oil to my treatment regime. Can you describe what your experience with it was?
>
> Thanks.
>
> I have already added phosphatidylserine, a substance that is supposed to work with fish oil to help support neurotrophism.
>
>
> - ScottI havent tried Valproate yet, the Trileptol seems to do very little, just takes a bit of the edge off so im not breaking things. I am writing down people sugguestions and going to talk to my pdoc next week.
Posted by linkadge on April 23, 2011, at 15:21:14
In reply to Re: Nothing Works » linkadge, posted by SLS on April 23, 2011, at 9:28:34
Well, when I took the combination of lithium + epival + fish oil, I noticed I needed less of either to feel stable and normal.
I was taking something like lithium 450, epival 250 and omega 3 (approx 600mg of EPA and 600 DHA).
Basically, adding the omega 3 made me feel more human, a bit more motivated / in control and a bit more ability to eperience joy.
Linkadge
Posted by cyban on April 23, 2011, at 22:04:49
In reply to Re: Nothing Works, posted by Cyban on April 23, 2011, at 9:32:55
anhedonia is one of my symptoms as well, I forget because my wife is more the one to remind me.
I have also tried Topomax, Cojentin, and Prozac in the past
Posted by Ben on April 24, 2011, at 2:03:06
In reply to Re: Nothing Works » cyban, posted by Phillipa on April 23, 2011, at 0:09:46
1) What about Seroquel/Quetiapine. It should help against mania and depression - so its probably also a mood stabilizer.
2) Did you tried the MAOI Parnate/Tranylcypromine?
good luck
Posted by Cyban on April 24, 2011, at 6:30:33
In reply to Re: Nothing Works, posted by Ben on April 24, 2011, at 2:03:06
> 1) What about Seroquel/Quetiapine. It should help against mania and depression - so its probably also a mood stabilizer.
>
> 2) Did you tried the MAOI Parnate/Tranylcypromine?
>
> good luckI didnt find any gemeric name for Tranylcypromine that I have taken.
I will write them down and talk to my Pdoc about them, thank you.
Posted by Ben on April 24, 2011, at 8:54:06
In reply to Re: Nothing Works, posted by Cyban on April 24, 2011, at 6:30:33
Hi Cyban
Seroquel is the brand name for the drug quetiapine an atypical antipsychotic. Tranylcypromine is an antidepressant which inhibits the monoaminooxidase enzyme in the brain. Brand names are Parnate or Jatrosom.
Posted by Hombre on April 24, 2011, at 11:21:05
In reply to Nothing Works, posted by cyban on April 22, 2011, at 21:10:34
Seroquel might let you get off Ativan and Ambien. You can just take it at the same time every night and you'll be out like clockwork. It really can help with racing thoughts and anxiety all day long, too. You may need a high enough dose, and it might take a few weeks to get over the heavy sedation, but it is workable.
Posted by Ben on April 24, 2011, at 12:00:12
In reply to Re: Nothing Works, posted by Hombre on April 24, 2011, at 11:21:05
I took Seroquel at night and my sleep was fine. Most of all feel a hangover effect the next day and during the day what concerns the sedation. In my case I didnt feel tired the next day but it may depend of the dose.
Posted by desolationrower on April 30, 2011, at 4:47:11
In reply to Re: Nothing Works » linkadge, posted by SLS on April 23, 2011, at 9:28:34
> I will be adding fish oil to my treatment regime. Can you describe what your experience with it was?
>
> Thanks.
>
> I have already added phosphatidylserine, a substance that is supposed to work with fish oil to help support neurotrophism.
>
>
> - ScottSomeone already mentioned taurine as well, which is also abundant in seafood. If possible, i would suggest eating fish as opposed/addition to fish oil, as it contains the w-3 oil, taurine, as well as other things. Of course, a fish oil pill is better than nothing, and high dose w-3 might be useful, at least to try. There is less evidence that i've seen for dose for mental health, but for other aspects the benefits taper off quickly after about .5g/day of EPA/DHA (which is still more than the standard american diet provides), and i think for most people some fish, and avoiding 'vegetable oil' is enough for proper metabolism re:polyunsaturated fats & their metabolites. THere might be interesting interactions with COX inhibitors (aspirin/ibuprofen) which are beneficial for mental health - cox turns long-chain w-3 and w-6 fatty acids into signaling molecules. So it might either antagonise or synergise with high dose fish oil, which may or may not be better than the normal amount. some stuff to think about or try, i guess. w-3s have effects beyond just the eicoisinoids. (for both scott and cyban, actually)
for the OP, that is a long list of things to take, some stuff looks like its working at odds. And i agree about diet etc, perhaps yours it good, but are you generally in good health and is there anything that changed when you changed to bp again? also, i would recommend (actually, i'd rec it for everyone) to go to http://cronometer.com/ and put in your usual meals and see if you are getting enough of everything. CSA veggies are great, but there still could be something missing or that you are out on the far edge of the bell curve as far as how much you need. All kinds of crazy genetic weirdnesses are possible.
MAOI: I would suggest phenelzine aka nardil as the much better choice for someone with prominent mania, agitation, etc.
N acetyl cysteine or riluzole both work on glutamate, and have *some but not great evidence they might help with substance use and mood disorders.
How is your sleep? have you had a sleep test? I would suggest some melatonin, maybe some sleep drugs too. your symptoms sounds like how i feel when i don't sleep...
-d/r
Posted by cyban on April 30, 2011, at 6:19:05
In reply to Re: Nothing Works, posted by desolationrower on April 30, 2011, at 4:47:11
Well I talked to my Pdoc and asked about some of the medications in the replies if not all of them.
He gave me some reasons he didnt want to switch, some of them being they were similar medications to what I am on and said the MAOI was more for anxiety but my Ativan dose is so high he didnt believe those would even help so he increased my meds to:
Trileptol 1,500 MG Day
Ambien 10 MG Day
Ativan 20 MG Day
Celexa 40 MG Day (I have still been having depressed swings even when manic, which really sucks)
Abilify 20MB Day
Lithium Card 1,200 MG DayIt seemed to help a little.
I don't sleep much, 11PM-3AM, but I do get a lot of fish in my diet (I love Sushi) so I am reluctant to try fish oil.
Posted by desolationrower on April 30, 2011, at 18:32:49
In reply to Nothing Works, posted by cyban on April 22, 2011, at 21:10:34
Well, if what you are taking isn't working, and your pdoc doesn't want to change things, you might want to consider a new doctor.
-d/r
Posted by Phillipa on April 30, 2011, at 20:27:20
In reply to Re: Nothing Works, posted by desolationrower on April 30, 2011, at 18:32:49
I agree with d/r 20mg of ativan or was that a typo? Phillipa
Posted by cyban on May 1, 2011, at 8:26:13
In reply to Re: Nothing Works, posted by Phillipa on April 30, 2011, at 20:27:20
> I agree with d/r 20mg of ativan or was that a typo? Phillipa
No, didnt typo - is that high?
Posted by cyban on May 1, 2011, at 8:29:33
In reply to Re: Nothing Works, posted by cyban on May 1, 2011, at 8:26:13
I was wondering, because I dont know any other Bipolar people, do the meds usually bring you back down to stable, or only decrease the mania a little?
Posted by Phillipa on May 1, 2011, at 21:29:01
In reply to Re: Nothing Works, posted by cyban on May 1, 2011, at 8:26:13
I feel 20mg of ativan is extremly high. Your doc is aware of the dose and prescribes it right? Phillipa
Posted by cyban on May 2, 2011, at 7:40:26
In reply to Re: Nothing Works » cyban, posted by Phillipa on May 1, 2011, at 21:29:01
> I feel 20mg of ativan is extremly high. Your doc is aware of the dose and prescribes it right? Phillipa
Sorry, sorry all, that was a typo... I need to stop replying to posts when I wake up (at 3AM)
It's 20mg Abilify
I only take 3mg Ativan maybe twice a day.Too bad there is no way to edit posts.
Posted by cyban on May 2, 2011, at 7:42:11
In reply to Re: Nothing Works, posted by cyban on April 30, 2011, at 6:19:05
> Well I talked to my Pdoc and asked about some of the medications in the replies if not all of them.
> He gave me some reasons he didnt want to switch, some of them being they were similar medications to what I am on and said the MAOI was more for anxiety but my Ativan dose is so high he didnt believe those would even help so he increased my meds to:
> Trileptol 1,500 MG Day
> Ambien 10 MG Day
> Ativan 4 MG Day
> Celexa 40 MG Day (I have still been having depressed swings even when manic, which really sucks)
> Abilify 20MB Day
> Lithium Card 1,200 MG Day
>
> It seemed to help a little.
>
> I don't sleep much, 11PM-3AM, but I do get a lot of fish in my diet (I love Sushi) so I am reluctant to try fish oil.Typo'd Ativan
Posted by desolationrower on May 2, 2011, at 14:12:48
In reply to Re: Nothing Works » cyban, posted by Phillipa on May 1, 2011, at 21:29:01
heh, good catch
-d/r
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