Psycho-Babble Medication Thread 1116072

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paradoxical effects on mood stabilizers and atypic

Posted by porkpiehat on July 23, 2021, at 21:01:07

Sadly, my mom is back in trouble again since they put her on topomax. She complained about the apathy, weight gain, and bad thoughts she has been having on Celexa. They added topomax 50-100 mgs and she got very manic and confrontational.

She is like a different person to me. A lot of the confrontationalism is her getting agency for the first time and she sounds like a proper adult rather than a kicked dog. But it is overboard and it is accompanied by slurred speech and she is confused. she is super excited about doing stupid things and particularly aggressive.

It seems like every time they have given her an atypical antipsychotic or some of the mood stabilizers, this behavior comes out. She doesn't see it and she thinks we are all "challenging" her.

I have similarly paradoxical responses on the atypicals and feel uncomfortably dissociated from people, after a brief period of agency and lack of paranoia.

Her mother was schizophrenic and she has a complex trauma history and occasional borderline dx. I'm trying so hard to help her and help direct her meds. The ER docs all assume she is bipolar and want to pile up the mood stabilizers, but I think she is more trauma/personality disorder/destabilized.

I feel over my head and my heart is breaking, but I can't leave her to her own devices or the medicare/clinic doctors that won't give her proper considerations.

What are everyone's thoughts on this paradoxical response to mood stabilizers and atypicals?

thanks so much!

 

Re: paradoxical effects on mood stabilizers and atypic

Posted by linkadge on July 24, 2021, at 11:42:33

In reply to paradoxical effects on mood stabilizers and atypic, posted by porkpiehat on July 23, 2021, at 21:01:07

Hey.

As I have mentioned before, my mother is going through a difficult time too. We are looking at long term care. She had a very abrupt relapse in her psychiatrics symptoms last summer which landed her in the hospital. Unfortunately, she has been deteriorating. I disagree with what the psychiatrists are doing, but ...

To your situation...

First off, Topomax is not (in my opinion) a mood stabilizer. There is scant evidence that it really helps prevent mania or depression and it is not approved for either of these.

Topomax raises GABA. Raising GABA can sometimes cause disinhibition. SSRIs by themselves can cause disinhibition (via reducing activity in the prefrontal cortex). Sometimes older people (or those with psychiatric disorders) already have prefrontal hypofunction (hence the apathy).

Antidepressants and anticonvulsants don't always mix well together. Interestingly, I feel that the noradrenergic drugs sometimes mix better with anticonvulsants.

If citalopram is causing apathy then change it. I would recommend trying nortriptyline. I would drop the topomax. If there is clear evidence of bipolar then use a real mood stabilizer. Otherwise try a different antidepressant.

Linkadge

 

Re: paradoxical effects on mood stabilizers and atypic » porkpiehat

Posted by jay2112 on July 24, 2021, at 15:56:13

In reply to paradoxical effects on mood stabilizers and atypic, posted by porkpiehat on July 23, 2021, at 21:01:07

Hi:

Just one little observation I have made for myself. At normal doses, both atypicals and mood stabilizers cause what I now realize was acute, agitated depression. Yes, depression can INCREASE manic-type symptoms. It is called dysphoric mania. I had that problem for years. It is almost paradoxical to our current traditional thinking.

https://pubmed.ncbi.nlm.nih.gov/2930331/
https://pubmed.ncbi.nlm.nih.gov/27866502/

Those are just some basic introductions to the term and illness. They are really dynamic and unique to, again, the ideas that mania is only some semi-euphoric state, and that depression is just some apathetic, run-down state...or something like that. (I am using generalizations just to be concise) The term seems to share SOME similarities to 'mixed state', but it still is a very different concept.

Hope that helps..and best to your Mom
Jay

 

Thank you!

Posted by porkpiehat on July 28, 2021, at 13:21:22

In reply to Re: paradoxical effects on mood stabilizers and atypic » porkpiehat, posted by jay2112 on July 24, 2021, at 15:56:13

Thank you both for your input. I think the gaba-related disinhibition is spot on regarding my mom. It would make sense that I thought she was drunk at first with her slurring and body language.

Now what to do with it? They've added lithium to calm her down and it has worked, but she's back to oversleeping and overeating which is why they moved her to topomax in the first place.


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