![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by b2chica on February 6, 2015, at 15:03:34
i've expereienced the worst mixed episode that i have had to date.
i cant even believe i'm alive right now. my problem is... its not over.they lowered all of my meds. i'm now only on pristiq 50, and zyprexa 5mg.
i just spent 5 minutes crying while writing an email to my T BEGGING her to help me. though i know there is not much she can help with.
******************
so here's what i'm asking from babble folk. i am willing to go on either an Atypical Antipsychotic OR mood stabilizer (or quite frankly almost anything). However i will list the ones i've been on in the past that have either not worked or gotten severe side effects from.AAP
zyprexa (they lowered to 5 + brand has been $150 week.)
Abilify (severe anger/aggitationg)
Haldol (low dose but gave me headaches)
seroquel (gave me severe cog blunting)
risperdal (no effect)
geodon (psychosis)
perphenazine (have only used low dose, worked well)
Saphris (worked lightly... wasn't enough)
MS
gabapentin (has worked well in the past, but they took me off it right now)
trileptal (ataxia and locked in syndrome)
topamax (headaches and Rapid cycling)
lamictal (rapid cycling)
please med guru's give me a couple ideas to present to doc as soon as possible. i'm hoping i can get resolved sooner rather than later.b2
Posted by Louisiana Sportsman on February 6, 2015, at 15:40:58
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
Thanks for being open and honest about your feelings on the forum and sharing your med history without prompting.
I believe you're on too much AD with nothing to back it up. I highly suggest Latuda 40mg. for an AAP. It requires no initial dose titration at this dose and you can break it in half if needed.
In terms of MS, Lyrica could help since you responded well to gabapentin. Lyrica is a gabapentinoid.
What about Depakote?
Posted by ed_uk2010 on February 6, 2015, at 16:23:03
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
> gabapentin (has worked well in the past, but they took me off it right now)
> trileptal (ataxia and locked in syndrome)
> topamax (headaches and Rapid cycling)
> lamictal (rapid cycling)Hi B2,
Sorry to hear you're so unwell. Mixed episodes are most commonly treated with Depakote and antipsychotics, sometimes with lithium as an adjunct. The drugs you list above are anti-epileptics but not necessarily mood stabilisers. Gabapentin is useful for some types of anxiety - it has no proven role in bipolar disorder. Topamax has no proven role in bipolar disorder. Trileptal is possibly useful in mania, based on limited evidence. Lamictal is often of some use in bipolar depression only. Pregabalin (Lyrica) is useful in focal epilepsy, neuropathic pain and some types of anxiety, like gabapentin - it is not a mood stabiliser as such. In fact, I believe Pfizer were fined for inappropriately promoting gabapentin as a mood stabiliser.
Established mood stabilisers include Depakote and lithium. For a mixed state, combinations are often needed. Lithium alone is rarely sufficient.
I think you should start by considering Depakote. You could continue Zyprexa alone or add a little perphenazine if you've responded well to it before. Lithium also needs to be considered, especially if you're having a lot of suicidal thoughts.
Let us know how you get on.
Posted by Phillipa on February 6, 2015, at 17:44:49
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
B2Chica why did pdoc lower all your meds? Until they were all lowered were you doing better? Why all at once and one at a time? Phillipa
Posted by Linkadge on February 6, 2015, at 19:14:53
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
Add some frolic acid and omega 3. Choline can also help mixed / rapid cycling
Linkadge
Posted by SLS on February 6, 2015, at 21:19:32
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
I like what Ed has to say. If you do try Depakote, make sure you get a blood test *before* you start treatment to establish your baseline liver enzyme levels. Then, go for the same test at 2 weeks and once a month for 6 months. It is just a precaution as Depakote can affect the liver. After six months, the risk of liver toxicity decreases markedly.
I'll also mention Navane (thiothixene) as an antipsychotic. It might quiet your mind without producing brain fog. However, I would try Depakote first.
Good luck.
- Scott
Posted by burial on February 7, 2015, at 1:31:45
In reply to Re: worst mixed episode » b2chica, posted by SLS on February 6, 2015, at 21:19:32
i too think that Depakote can be very beneficial in mixed states. I had those from time to time and Depakote worked great to reduce agitation
Posted by Christ_empowered on February 7, 2015, at 6:18:01
In reply to Re: worst mixed episode, posted by ed_uk2010 on February 6, 2015, at 16:23:03
Depakote+an AP/AAP you can tolerate. In terms of supplements, I take taurine to help my moods. It seems to boost my anticonvsulants (I take Trileptal and Lamictal). High dose niacinamide has helped reduce my anxiety+agitation levels, too.Good luck!
Posted by Zyprexa on February 7, 2015, at 8:09:40
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
Are you stabilizing on the zyprexa now?
Try costco pharmacy. 10mg z for $20. You could cut them for half of what you are paying.
Posted by ed_uk2010 on February 7, 2015, at 12:47:30
In reply to Re: worst mixed episode, posted by Linkadge on February 6, 2015, at 19:14:53
>Add some frolic acid
Cute typo ;)
Posted by linkadge on February 7, 2015, at 17:44:30
In reply to Re: worst mixed episode » Linkadge, posted by ed_uk2010 on February 7, 2015, at 12:47:30
Typo? Haven't you heard of frolic acid? Its a newly discovered substance found in high levels in in toads, grasshoppers and unusually high spirited humans. Injections of frolic acid (@ 5, 10 and 15 mg/kg) into test subjects typically results in a significant boost in generalized merriness as well as a tendency to leap sideways, arm first, over mud puddles. As a potent, selective agonist for the CB1, 5-ht1 and newly discovered frolicoid receptors, frolic acid is though to hold potential for the treatment of clinical depression, through a specific reduction in NO synthase and IL-6 inflammatory pathways.
This is the real deal, my friend.
Linkadge
Posted by ed_uk2010 on February 7, 2015, at 18:11:15
In reply to Re: worst mixed episode » ed_uk2010, posted by linkadge on February 7, 2015, at 17:44:30
> Typo? Haven't you heard of frolic acid?
Haha :)
But seriously, you should be involved in biomedical research, if you aren't already!
Posted by phidippus on February 10, 2015, at 16:40:51
In reply to worst mixed episode, posted by b2chica on February 6, 2015, at 15:03:34
Sounds like you need a mood stabilizer bad. I would recommend Tegretol or Lithium for your brand of crazy. Plus I'd increase the Zyprexa to 10 mg.
Eric
Posted by b2chica on February 10, 2015, at 23:27:56
In reply to Re: worst mixed episode » b2chica, posted by phidippus on February 10, 2015, at 16:40:51
I'm not even sure I can describe in words where I was at mentally. Combine Maximum frustration, desperation, hopelessness, throw in a 'given up', and a pinch of severe anger and that was me at last pdoc appt. Pdoc Still wasn't going to change anything. She kept talking about "wanting me 'stable' on the meds before we added/ changed anything". Ok anyone else see the paradox there??????? I can't get stable on those meds cuz they dont work, she thinks they weren't working yet because I wasn't stable??
Anyway, I looked her straight in the eye, with tears streaming down and told her " I CAN NOT continue to live like this. I have been asking for help since before the holidays. The level of meds don't work...This IS as good as I get. I have leveled off. It may not be what u predicted, but I am patternistc for the last three days. I KNOW my body and I know how this works. Also, my T agrees. This Is It."After she started talking I went on to partially dissociate (which hasn't happened in a YEAR). I came back and started to leave and completely dissociated.
I dont remember it all...bits annnd pieces... But I know from my gut what I must have told her was All my stops are out... Every last card played, used up all my bag of tricks DONE.I do know I left there with zyprexa increased back to 10 And samples of Deplin. To be honest I dont care if I never remember/recover what I said, because I just know my life was saved yesterday by that med change.
I took first Deplin today. I Actually feel 90% better. I feel weak, a little vulnerable but Soooo much better. And I dont care if its placebo or upstart effect. Its like a reprieve... A LONG needed one.
Just to breathe...
Posted by phidippus on February 11, 2015, at 13:41:41
In reply to Re: worst mixed episode, posted by b2chica on February 10, 2015, at 23:27:56
I can understand why your pdoc's stance is frustrating. What does she have you on currently?
Are you familiar with 'distress tolerance'? Its a DBT trick that helps people through rough spots.. You kind of have to accept you might feel like sh*t for awhile until all gets straightened out. Look it up.
I think the increase in the Zyprexa is what helped you most - Deplin is the primary biologically active form of folic acid used at the cellular level for DNA reproduction, the cysteine cycle and the regulation of homocysteine. All it does is boost your other medications.
Eric
Posted by ed_uk2010 on February 11, 2015, at 17:46:45
In reply to Re: worst mixed episode, posted by b2chica on February 10, 2015, at 23:27:56
Hi B2,
Glad to hear you're feeling somewhat better. People usually dissociate when they've reached a level of distress and anxiety which is no longer tolerable. I think the adjustment to your meds helped you get out of this state.
I agree that increasing Zyprexa probably made a big difference, but do continue with Deplin - it could be helpful.
You were only taking 5mg of Zyprexa before, which is lower than the minimum effective dose for most people in a mixed state. The majority need 10mg or more. 5mg-7.5mg does sometimes work but it's not reliable. And many people need more than 10mg. You have plenty of room to adjust. I think you're absolutely right that a change was needed.
Hopefully, Zyprexa (at an adequate dose) and Deplin will help to keep you stable. If not, you still have lithium and Depakote to consider. Tegretol is less well-established as a mood stabiliser than Depakote so I'd always suggest Depakote first for a mixed state.
Hope you're feeling OK.
Posted by burial on February 14, 2015, at 9:08:25
In reply to Re: worst mixed episode » b2chica, posted by ed_uk2010 on February 11, 2015, at 17:46:45
> You were only taking 5mg of Zyprexa before, which is lower than the minimum effective dose for most people in a mixed state. The majority need 10mg or more. 5mg-7.5mg does sometimes work but it's not reliable. And many people need more than 10mg. You have plenty of room to adjust. I think you're absolutely right that a change was needed.
>
> Hopefully, Zyprexa (at an adequate dose) and Deplin will help to keep you stable. If not, you still have lithium and Depakote to consider. Tegretol is less well-established as a mood stabiliser than Depakote so I'd always suggest Depakote first for a mixed state.
>
> Hope you're feeling OK.
I think so too. It took me 20mg zyprexa and 1500mg Depakote to feel stable. I've seen studies of zyprexa, where they used 60-90mgs for treatment-resistant schizophrenia. Not saying you need those doses, but the point is you still have choices
Posted by Zyprexa on February 14, 2015, at 20:41:34
In reply to Re: worst mixed episode, posted by b2chica on February 10, 2015, at 23:27:56
How are you doing now? Still taking z? Is it still brand?
If you are having good results from deplin, you probably have a B vitamin deficiency. Particularly folic acid, which happens from drinking usualy. thats what I had a while back. I found that taking high doses of folic acid was cheeper and worked better than deplin, they are mostly the same thing. You might also try a B-complex, like B-50 or B-100.
I'm glad they uped the z to 10mg!
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.