![[dr. bob]](/dr-bob-sm.gif)
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 mellow on August 21, 2011, at 17:03:56
Having a real hard time with using too many stimulants lately. I think it is definitely playing into my anxiety, but I'm looking for some supplements that will give me good reserves of "calm energy" if that makes sense. I work night shift 3 nights a week so I feel draggy the other 4 days a week. Some days I stay in bed 12 hours. I do think some of it could be that I'm doped up on risperdal as an anti manic agent.
I'm probably in the range of 8-10 servings of caffeinated beverages if you count diet sodas and sometimes I smoke up to 3 cigars. Thank God I don't do cigarettes anymore although cigars are just as terrible for your mouth. I think if I could get down to one large coffee when I wake up and a cigar once a week when I go out to my favorite club I would be ok.
But getting there seems impossible. I'm thinking Niacinamide (what dose?) for the calm and maybe an adaptogen for the energy. Of course the shift work is probably my main problem but I have to deal with it until I finish my degree and get a day job. I think if I could get my "mojo" back with out being crazy manic I could deal with my insecurities and feel a little better.
Dx: Bipolar II (Cyclothymia)
Meds:
Lamictal 150
Risperdal 2
Topamax 50Sups:
High Energy Multi
D3 5000 (just started today)
Balanced B stress Complex
Omega Mood 2000Any thoughts?
mellow
Posted by Lao Tzu on August 23, 2011, at 4:18:03
In reply to Getting off coffee and nicotine, posted by mellow on August 21, 2011, at 17:03:56
Risperdal is a strong drug. I take 6mg of Risperdal a day for schizophrenia. I smoke 2 packs a day and have two regular size coffees each day. I think you naturally gravitate to stimulants to offset the sedating effects of the Risperdal. Plus the shift work is throwing your circadian rhythms out of balance. That's probably the biggest factor in how you are feeling. If your sleep cycle is unbalanced you're not going to feel 100% no matter what supplements you take. The best thing is to find a job with predictable hours and go to bed the same time each day. The supplements you take seem okay. You're getting a multi and fish oil, which definitely are good for you, but in my honest opinion, adding more supplements may not do much good unless you correct your shift work problem. In fact, taking anything else with stimulating properties might make the situation worse. However, that being said, perhaps some Chinese panax ginseng or ashwaghanda might help. They are both adaptogens and they seem to offer favorable results. Rhodiola rosea is another one, but rhodiola can cause insomnia and may interfere with your meds, so I don't recommend that one. I have had some success with ginseng, but I haven't tried ashawaghanda. As far as coffee and cigars, they are not really good for bipolars or schizophrenics for that matter, but I fully understand that getting off of them is difficult. I've been down that road many times. I say solve your shift work problem first by getting a job with more favorable hours, and I'm sure things will be better for you. A routine schedule of sleep and activity is necessary for bipolars and schizophrenics. When you stray from that routine you cause imbalances in your circadian rhythms and then you feel like crap and want to caffeinate yourself to death just to feel normal. There's no sense in doing this to yourself. I find, in my case, that if I have a set routine of sleep and activity seven days a week, I feel better. That means getting to bed the same time everyday of the week. Good luck to you!
Lao
Posted by floatingbridge on August 23, 2011, at 15:12:20
In reply to Getting off coffee and nicotine, posted by mellow on August 21, 2011, at 17:03:56
This may be left field, so I hope others step in.
I was thinking of trying this down the line.
http://en.wikipedia.org/wiki/Piracetam
I used to be on dexidrine. I know the stimulant crave very well :-/.
Nicotine I know less about. I do know it exerts a powerful effect in some that is often overlooked. Have you read up on wiki or maybe more reliable sources to see what it might be doing for you?
Maybe try getting off one at a time?
I think one thing the stimulant thing might do is increase NE levels (among the many things they do) and after some time, that creates anxiety. For me. As far as I have been able to understand to date.
I also have started, with mixed feelings, risperidone. I cannot, cannot take it during the day or I am zombified. My pdoc thinks in my case, given my symptoms (it is not used as an anti manic med) that once a day is fine.
Increase lamictal to 200 and decrease risperdal? Just ideas.... I imagine you have your meds steady and balanced.
Posted by floatingbridge on August 23, 2011, at 15:31:04
In reply to Getting off coffee and nicotine, posted by mellow on August 21, 2011, at 17:03:56
Well, I reread wiki on nicotine. Most flew over my head, but I did catch that nicotine has Mao-inhibition qualities.
Here's the wiki:
http://en.wikipedia.org/wiki/Nicotine
Rhodilia rosia leaps to mind. But I take care with herbs. I think this one can be activating and interfer with sleep.
Than there is http://en.wikipedia.org/wiki/Mucuna_prurienswhich contains, beside l-dopa, nicotine!
But I think one needs to use care with this as well.
Do you have access to a good, middle of the road herbalist?
Posted by mellow on August 24, 2011, at 0:24:39
In reply to Getting off coffee and nicotine, posted by mellow on August 21, 2011, at 17:03:56
Thanks for chiming in guys. Lao I think you are right with reaching for coffee to get through the sedation of the risperdal and the shift work is a killer. But both seem to be a necessary evil right now though. I think I could come down on the risperdal if I needed, but I hate tapering it. I take two 1mg tablets at bed. I might just try taking 1 tablet to see what happens. My doctor is encouraging less of the drug or a switch to a more stimulating atypical. Abilify has come up in conversation. Either way I can't stay in bed all day. I swear it's like I'm paralyzed when the alarm goes off. Literally can't move.
I am actually doing ok with cigars. I went out to the tobacco bar and smoked 1 last night, but didn't smoke today. That is a good reduction from 3 sometimes 4 a day. I feel ok. Mostly mental cravings. Coffee I cant help myself! Probably 7 cups today.
floating, I will read those links tonight. I hope you are having a better week. Is ensam done for?
mellow
Posted by floatingbridge on August 24, 2011, at 1:22:22
In reply to Re: Getting off coffee and nicotine, posted by mellow on August 24, 2011, at 0:24:39
Mellow, maybe cut back by .25mg or .5mg and see. You can always cut back more sooner if you feel o.k.
Abilify was more activating. I took it in the a.m.
I don't think a cigar every day or so is a terrible habit. I know about the mouth risks. But just my perspective. I used to keep my mouth distracted with gum....
Oh, Emsam is still around as per pdoc. Increased risperidone. Who knows...? I get twitchy about meds :-/. Thanks for asking. My apologies for the barrage of links. Seems like homework :-)
This is the end of the thread.
Psycho-Babble Alternative | 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.