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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by rovers95 on August 17, 2019, at 4:50:08
Okay so I'm starring to believe my bipolar diagnosis (bipolar 2 perhaps). I've been mildly depressed with periods of mild hypomania for years, but a combination of a light box, jet lag, and some life stress early this year put me into a hypomanic/mixed state, followed by depression.
In hindsight whenever I drink alcohol now I go hypomanic for about 24 hours, the crash and. Last weekend I drank on the ami and I went really hyper - read excessive confidence and hypersexuality. I gradually fell back down and by Thurs I was feeling very down. But now I'm starting to recover again (or am I coming back up?!).
I'm currently on 100mg amitriptyline and 600mg lithium. What I can't fathom is whether the improvement in my mood is towards hypomania or whether I'm recovering from the depression. So basically am I getting better or am I just making my illness worse down the line?
Posted by linkadge on August 17, 2019, at 7:28:03
In reply to Amitriptyline and bipolar... Playing with fire?, posted by rovers95 on August 17, 2019, at 4:50:08
Bipolar is possible. However, alcohol is a drug that could induce behavioral shifts.
If you are able to stop drinking for (even 2 weeks) and make a diary to see how your moods are (say 3x a day) it could assist a doctor in making that diagnosis.
Sometimes (IMHO) hypomania doesn't need to be treated. Sometimes, like you say, hypomania is a precursor to a good recovery.
When I was on amitriptyline I noticed a substantial improvement in my energy. As a past runner, I was able to start running again and, for a while, I thought I was running too much. However, it never posed any long term issues.
SSRIs tend to bottle up emotions (IMHO) sometimes the older antidepressants allow for a greater range of emotions / experiences. At least, that's my experience.
I'm on Effexor / Remeron and lithium and, while not depressed, I am somewhat numb. I may ask my doctor about switching back to amitriptyline instead of Remeron.
Linkadge
Posted by PeterMartin on August 17, 2019, at 15:15:34
In reply to Amitriptyline and bipolar... Playing with fire?, posted by rovers95 on August 17, 2019, at 4:50:08
I'd recommend searching Pub Med for studies on using tricyclics w/ bipolar: https://www.ncbi.nlm.nih.gov/pubmed/
I'm BP1 and I've always been told that of the different classes TCAs are the most likely to cause a manic switch.
I currently take Nardil. Took Marplan before for 7yrs. No probs.
Posted by SLS on August 18, 2019, at 11:25:03
In reply to Re: Amitriptyline and bipolar... Playing with fire?, posted by PeterMartin on August 17, 2019, at 15:15:34
Hi, Peter.
My doctor once said that there are no effective antidepressants that are not capable of producing mania in some percentage of people. Traditionally, it has been thought that tricyclics are the worst offenders. Interestingly, there were a few research doctors in the 1980s who thought that Wellbutrin might prevent mania rather than cause it. This turned out to be wrong. Still, some still regard Wellbutrin to be less apt to cause mania than other antidepressants.
Why did you stop taking Marplan? How would you compare it to Nardil with respect to efficacy and side effects? Weight gain?
Thanks.
- Scott
> I'd recommend searching Pub Med for studies on using tricyclics w/ bipolar: https://www.ncbi.nlm.nih.gov/pubmed/
>
> I'm BP1 and I've always been told that of the different classes TCAs are the most likely to cause a manic switch.
>
> I currently take Nardil. Took Marplan before for 7yrs. No probs.
Posted by PeterMartin on August 20, 2019, at 8:43:13
In reply to Re: Amitriptyline and bipolar... Playing with fire? » PeterMartin, posted by SLS on August 18, 2019, at 11:25:03
>
> Why did you stop taking Marplan? How would you compare it to Nardil with respect to efficacy and side effects? Weight gain?
>Stopped Marplan (for the moment at least) and went back to Nardil due to the cost. $650 a month. The US manufacturer/distributor still hasn't begun making their own again ("shortage") so theyre importing and selling a Danish version. Insurance won't even count the cost toward my deductible since the Danish brand isn't FDA approved.
Im not sure if the Danish version wasn't as effective as it should have been or something has changed w me, but I didn't do fantastic on it the 5 months or so I tried it (paying that extreme price). The US company will eventually make their own again so I decided to switch back to Nardil (which I still had a lot of) and avoid over spending. It's been almost a month now and I'm feeling pretty good.
I hope to not go above 60 on Nardil this time.
My doctor was very cool in letting me try adding Ritalin along w Marplan (final month) and now Nardil. Id taken Ritalin off and on a few years in the late 00s but generally had issues w chest pressure and elevated bp. I've monitored myself with a home bp cuff and there is practically zero change in BP before/after taking 10mg of Ritalin. If anything the Ritalin has helped the initial hypotension issues w Nardil & prevented the usual sugar cravings (I can almost get by eating just a heart breakfast).
We'll see what happens but I'm liking the Ritalin/Nardil combo so far.
My biggest problem still seems to be deciding on a lamictal generic to stick with. Anytime I have a mood crash I blame the type of Lamictal and try one of the other kinds I have. I need to stick w one as I respond differently to all of them. Sadly none seem to give me the consistency that TEVA (now discontinued) and brand did.
Metformin is still good. Doesn't give me weight loss but it helps prevent weight gain. I also really think it helps in other areas including mania risk.
So that's me right now....tried splitting Nardil mornign/night yesterday instead of all in the morning and I'm waking up nicely right now. Maybe that's a good change.
Hope you are well. Love when you post.
Posted by porkpiehat on September 10, 2019, at 8:01:17
In reply to Re: Amitriptyline and bipolar... Playing with fire?, posted by PeterMartin on August 20, 2019, at 8:43:13
Glad you're doing well on the Nardil. The Marplan thing was such a roller coaster.
You think the Metformin is helpful with the manic tendencies? I know this sounds really weird, but when I switch Lamictal brands or lower my doses, I tend to get very labile throughout the day and the only thing that temporarily fixes it is a large meal or coffee....Now I'm wondering if there's a metabolic component to all of this.
Can you get a pre-authorization for brand Lamictal for your insurance? that's what I got once TEva became unavailable.
This is the end of the thread.
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