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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SLS on February 20, 2014, at 20:47:05
I don't wish to be mean or scolding, but I don't see that you are working with your doctor closely enough to come up with a plan and stick to it. You petition people on Psycho-Babble to give you answers to questions that you should be asking a doctor.
You are all over the place with drugs and diagnoses.
I mentioned to you hyponatremia. Did you follow up with your doctor about this?
What about providing a list of antipsychotics that you have tried and how you reacted to them? Did you decide against doing this?
Did you not like the Topamax idea? Did you present it to your doctor?
Have you tried Remeron?
What about giving Latuda a chance to work for depression? I actually found it good for sleep, even though it didn't provide me with the desired effect on mood.
You need to be more focused. In your present state, this is very difficult. Try to remain calm and relaxed. I think that it is inevitable that you will find the right treatment for your affective illness. You remain responsive to both anti-manic and anti-depressant drugs. In other words, you are not completely treatment resistant. It is quite possible that you could have been closer to finding an answer if you hadn't gone around in circles with Trileptal and Geodon.
I have seen people with bipolar mixed-states do well with a variety of treatments. I think you will do well with either a single antipsychotic or a combination of an antidepressant with a mood stabilizer or anti-manic.
You have so much to look forward to. Just don't sabotage the treatment plan that you and your doctor have chosen for you.
Does your doctor take your phone calls?
- Scott
Posted by Sheilac on February 21, 2014, at 6:25:54
In reply to Shielac, posted by SLS on February 20, 2014, at 20:47:05
You're so right Scott. I'm going to try to see my doc Monday, if not I won't be able to get in until March 10th.
Yes, Geodon works for my depression. Seroquel worked in the past for sleep, but left me irritable in the morning. I haven't tried Remeron. Right now, Klonopin and melatonin give me great sleep.
Since tapering off Trileptal, the pain and swelling have gone away, but the anxiety has spun out of control. I've been taking a lot more Klonopin to deal with the anxiety and am trying Depakote to see if it will bring relief without the swelling.
I feel like I've tried so many drugs with so many side effects and I'm so frustrated.
I have spun out of control and I need to get a grip and be more medicated.
I will place a call today to my doc to see if I can squeeze in on Monday.
I'm just not sure what to take anymore.
Posted by SLS on February 21, 2014, at 8:36:56
In reply to Re: Shielac » SLS, posted by Sheilac on February 21, 2014, at 6:25:54
> I'm just not sure what to take anymore.
That's why it would be helpful to create a list of what medications you have tried in the past and how you reacted to each one of them. Give a copy to your doctor. He has too many clients to remember everyone's treatment history. You should be a participant in deciding your treatment plan, but not the sole decision maker.
Did your doctor prescribe Depakote without ordering a blood test?
It may be that Tegretol (a cousin drug of Trileptal) would help with the irritable mixed-state hypomania without producing hyponatremia and pain symptoms.
For now, Depakote may not be a bad idea to control the manic aspects of your mental illness. Depression is a possible side effect of Depakote, but it isn't usually severe. Although Depakote might leave you moderately depressed, I think that, in your case, this might be part of your illness rather than a side effect. You will probably need an antipsychotic with antidepressant properties like Geodon or Latuda. (Latuda enhanced the quality of my sleep, although sleep disruption is also possible). You might even need to add an antidepressant like Wellbutrin. Wellbutrin can sometimes produce anxiety and anger, but it is less likely to produce mania at normal dosages compared to other antidepressants. You won't know until you try it. Wellbutrin can be energizing.
Edema (swelling) is a possible side effect of Depakote. However, it occurs infrequently and usually after taking Depakote for an extended period of time. Depakote is good for anxiety. Liver toxicity can occur during the first 6 months of treatment. This is why having blood tests is a good idea.
* What are the main symptoms of your depression in the absence of mania?
* Have you ever taken a stimulant?
I would try to avoid antidepressants for now. It is unfortunate that you react badly to Lamictal. You might consider using minocycline as a replacement. Like Lamictal, it suppresses glutamate hyperactivity. It works for bipolar depression. It would be nice if one drug could treat your condition. Perhaps Latuda or Saphris could do this.
ONE STEP AT A TIME!!!
(Do as I say and not as I do).
:-)
- Scott
Posted by Phillipa on February 21, 2014, at 8:55:15
In reply to Re: Shielac » Sheilac, posted by SLS on February 21, 2014, at 8:36:56
Sheila good advise from Scott. Phillipa
Posted by Sheilac on February 21, 2014, at 9:28:03
In reply to Re: Shielac » SLS, posted by Phillipa on February 21, 2014, at 8:55:15
At this point in time, I'm having extreme anxiety and no depression. Depression seems to come on after I've been on a mood stabilizer.
I can't reach any of my docs and am very frustrated.
Ironically, the foot doc said that I should have been getting blood work to check my sodium and liver function while being on Trileptal. Neither the neurologist nor the pdoc mentioned this! This really could have helped get to the bottom of the swelling issue.
I feel so desperate right now, I just want to throw in the towel, go back to the 600mg Trileptal and Geodon and after a week when I'm so crippled with swelling with pain go to the doc and demand blood work. At least I would have some mental relief until the physical pain set in! But then it would mean weaning down off Trileptal.
My doc only gave me 125mg of Depakote - not enough.
I have hesitated to go back to a Geodon, but I know if I take 80mg tonight I will be free tomorrow from the severe anxiety state I'm in now. I'll have sexual problems, but I will feel more stable.
The bad part is when you can't reach your doc and you have to wing it. Shouldn't be this way.
Posted by Sheilac on February 21, 2014, at 11:04:37
In reply to Re: Scott - Shielac, posted by Sheilac on February 21, 2014, at 9:28:03
Ok, I slept great last night with melatonin & Klonopin. Great.
This morning I had anxiety that I couldn't tell if it was akathesia from being off Trileptal or just pure anxiety.
I took 1mg Klonopin, 1 Benadryl and 125mg of Depakote, then out of desperation I took 150mg Trileptal. Yesterday morning I took the same thing minus the Trileptal. And as yesterday, I now feel great. No more anxiety.What gives?
Maybe I'm not taking enough Depakote (dose 2x a day?) or maybe I just need to dose the Trileptal bedtime and morning and that will zap the anxiety?
Or maybe, is this anxiety I feel a mixed episode? I'm not acting too crazy. If it were a mixed episode I feel, why would, Benadryl, Klonopin, low dose Depakote work? Plus, no swelling and pain from 600mg Trileptal and no dull unmotivated blah feelings.
I hate to go back to large doses of Geodon for treating sleep and daytime anxiety issues.
But when my anxiety is so bold in the morning it has to be treated.
I just struggle with over medicating myself for anxiety issues.
Posted by SLS on February 21, 2014, at 16:00:31
In reply to Re: Scott - Shielac, posted by Sheilac on February 21, 2014, at 11:04:37
> Ok, I slept great last night with melatonin & Klonopin. Great.
That's good to hear.
> This morning I had anxiety that I couldn't tell if it was akathesia from being off Trileptal or just pure anxiety.
People are often under the mistaken impression that akathisia is the same thing as treatment emergent anxiety. I very much doubt that what you experience is akathisia. It is more likely a simple withdrawal symptom for coming off the Trileptal too quickly and too often.
An effective dosage of Depakote will lie somewhere between 500 mg/day and 1500 mg/day. For me, 1000 mg/day was ideal to treat a dysphoric mania. Combining Depakote with Geodon, Abilify, or Latuda might be an ideal solution.
Gotta go...
- Scott
> I took 1mg Klonopin, 1 Benadryl and 125mg of Depakote, then out of desperation I took 150mg Trileptal. Yesterday morning I took the same thing minus the Trileptal. And as yesterday, I now feel great. No more anxiety.
>
> What gives?
>
> Maybe I'm not taking enough Depakote (dose 2x a day?) or maybe I just need to dose the Trileptal bedtime and morning and that will zap the anxiety?
>
> Or maybe, is this anxiety I feel a mixed episode? I'm not acting too crazy. If it were a mixed episode I feel, why would, Benadryl, Klonopin, low dose Depakote work? Plus, no swelling and pain from 600mg Trileptal and no dull unmotivated blah feelings.
>
> I hate to go back to large doses of Geodon for treating sleep and daytime anxiety issues.
>
> But when my anxiety is so bold in the morning it has to be treated.
>
> I just struggle with over medicating myself for anxiety issues.
>
>
>
>
This is the end of the thread.
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