![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 26 to 50 of 59. Go back in thread:
Posted by barbaracat on March 22, 2005, at 17:45:19
In reply to Re: Dysphoric Mania » barbaracat, posted by ed_uk on March 22, 2005, at 16:33:10
Not according to some recent lab work I have in front of me showing .5 - 2.0 as the range, with anything over 2 as toxic. But this is only one lab's opinion, albeit from one of the largest HMO's in the US. However, in doing a web search, typical ranges are .6 - 1.2 to 1.5. Recently, lower range of .4 are recommended.
> I thought the 'standard' upper limit was 1.2 in the US?
>
> Here, we usually say >1.5 is toxic and >2.0 requires emergency treatment!
>
> Kind regards,
> Ed.
Posted by ed_uk on March 22, 2005, at 17:55:53
In reply to Re: Dysphoric Mania, posted by barbaracat on March 22, 2005, at 17:45:19
Hi B!
0.5 - 2.0
>1.2 sounds extreme!
Ed.
Posted by barbaracat on March 22, 2005, at 18:17:16
In reply to Re: Lithium: to barbara and carebear » barbaracat, posted by ed_uk on March 22, 2005, at 15:57:53
>
> His pdoc appeared to be following the guidelines for the treatment of mania!**Ummm, unipolar/bipolar, depression/mania - pretty clear difference to me...
>
> >Why can't pdocs have patience and monitor the response at a less than 'therapeutic range'?
>
> I don't know, they seem to work by a 'one size fits all' strategy eg. everyone should be on 20mg Prozac etc.
>
**Less work for them, I guess. I find the same cookie cutter approach to conventional women's hormone therapy. I came down with a precancerous uterine condition because in my case, the cookie was too heavy with the estrogen ingredients.
>
> Do you think your 'requirements' have decreased with time as you've been on the Li??
>
**Good question. I don't know if the length of time (2 years) is a factor, but I am taking other things that are purported to be mood stabilizers, i.e., the amino acid L-taurine and 12 grams fish oil, so these could be potentiating things. I also take myo-inositol ocassionally which some say helps bipolars, others say is not good. I'm not sure it's doing anything one way or the other.It's possible I'm not even true bipolar, that something else is going on and lithium is calming an inflamed brain and I don't need as much as a 'true bipolar' would. But whoo boy, some of those manias were corkers and seem like classic BP-1 to me. More fun by far than the mixed states hells. Sigh. If only I had half the money now that I spent on those grand schemes and expensive projects...
Lithium is such an amazing substance. At the correct dose it's being prommoted as an alzheimer's treatment! It apparently inhibits the enzyme that contributes to amyloid plaque, it also increased brain derived neurotropic factor which increases dendrite growth. I haven't found anything definitive that states what dosages are recommended for neuroprotection as opposed to mania, but much less, I'm sure. Why can't we treat the mania, but reduce to neuroprotective maintenance levels afterwards?
I'm almost considering dropping my dose down no lower than 300mg 'just to see'. There are reports all over the web of bipolars benefitting from this small maintenance dose, but definitely not stopping altogether and raising it as needed. I like the idea of this. Something to carefully consider, given my hell with mixed states, but something to consider if it will work as well but without those toxicity issues. - Barbara
Posted by ed_uk on March 22, 2005, at 18:35:52
In reply to Re: Lithium: to barbara and carebear » ed_uk, posted by barbaracat on March 22, 2005, at 18:17:16
Hi B!
>cookie cutter approach
LOL I've never heard that one before, I like it!
> But whoo boy, some of those manias were corkers and seem like classic BP-1 to me.
Yes, I've read your posts where you describe your manias, it certainly seems like classic BP-I to me too.
>I'm almost considering dropping my dose down no lower than 300mg 'just to see'.
Are you sure you want to take the risk? I wouldn't want you to get ill again. It could be worth it if you've got some major side effects though.
Ed.
Posted by barbaracat on March 22, 2005, at 21:23:50
In reply to Re: Lithium » barbaracat, posted by ed_uk on March 22, 2005, at 18:35:52
>
> Yes, I've read your posts where you describe your manias, it certainly seems like classic BP-I to me too.**I've never been sure if I had BP-II or I but what's in a name? The treatment is the same.
>
> >I'm almost considering dropping my dose down no lower than 300mg 'just to see'.
>
> Are you sure you want to take the risk? I wouldn't want you to get ill again. It could be worth it if you've got some major side effects though.**No, no obvious side effects except that my thyroid has a hard time remaining stable. I also had some metabolites in my urine that concerned my doctor - said diabetes incipidus showed those metabolites, an condition unfortunately induced by lithium. I don't have it, luckily, but it did scare me.
But you're so right. There's nothing that would make me want to bring on a worsening of my condition. I just got out of the hospital 6 weeks ago because of a stressful event that was too much for lithium or any med. Life gets like that sometimes.
We forget so easily how bad it was when things start improving. Perhaps it's too soon to start tinkering because I'm just starting to feel stable physically and mentally for the first time in years - good in fact. Why would I want to fix something (lithium dose) if it ain't broke? But at some point I may inch on downward and see if things hold. I've never gone down lower than 600mg so who knows? The fact that 10 pellets out of a Cymbalta capsule is working so well still amazes me. My newest soapbox is my growing suspicion that we take too many meds at too high a dose. But I'll leave that lithium experiment for when I'm reallllly stable for a good long time. Thanks for your encouraging words of wisdom, Ed.
Are you a health professional, BTW, a fellow sufferer - or both? if you don't mind my asking. - Barbara
>
Posted by ed_uk on March 23, 2005, at 6:32:44
In reply to Re: Lithium » ed_uk, posted by barbaracat on March 22, 2005, at 21:23:50
Hi B!
>I've never been sure if I had BP-II or I but what's in a name?
In the European ICD-10 we just call it bipolar affective disorder, there is no I or II :-)
>my thyroid has a hard time remaining stable...
I wonder if a dose reduction would help this? - Especially since your level is only 0.3. Has your thyroid condition become easier to manage when you've reduced the dose previously?
>Why would I want to fix something (lithium dose) if it ain't broke?
Good point!
>But at some point I may inch on downward and see if things hold.
Perhaps you could reduce the dose gradually in very small steps- with careful monitoring for relapse. I think it would be useful to see your pdoc very regularly if you were doing this, depression can feel very much like reality if you know what I mean. If you relapse you could immediately go back up to 0.3.
>But I'll leave that lithium experiment for when I'm reallllly stable for a good long time.
I think that's a good idea. Don't rush into anything, your current stability is precious- hang on to it!
>Are you a health professional?
No, I'm a pharmacy student atm.
>a fellow sufferer...
Yes: anxiety, OCD, depression etc.
Kind regards,
Ed.
Posted by barbaracat on March 23, 2005, at 11:59:17
In reply to Re: Lithium » barbaracat, posted by ed_uk on March 23, 2005, at 6:32:44
>
> In the European ICD-10 we just call it bipolar affective disorder, there is no I or II :-)**I think we're up to Bipolar V in the US. Seems like splitting hairs but it does seem useful to distinguish cases that of mania that were brought on primarily by SSRIs (I think that's BP-IV) from genetic or other biochemistry.
> >my thyroid has a hard time remaining stable...
>
> I wonder if a dose reduction would help this? - Especially since your level is only 0.3. Has your thyroid condition become easier to manage when you've reduced the dose previously?**I'm not sure about 'easier to manage' but my TSH is affected by lowering/increasing the dose. At this point, I assume that my thyroid is toast anyway, has been problematic for a long time. Reducing or eliminating lithium is not going to restore healthy thyroid function and I'm resigned to needing thyroid hormone forever.
What is interesting is that I had some tests done late last year and earlier in this year that showed my TSH to be hovering around 8.0 and my reproductive hormones to be almost nil. I was seeing a clueless 'holistic' doctor who basically took tests but did nothing about them. I hit a wall of stressful events early February and crashed and had to be hospitalized for 10 days in the psych unit.
Since then, I've seen a very savvy OB/GYN who specializes in hormones and has increased my thyroid and changed it from the natural one I was taking to Synthroid and Cytomel. I resisted because I was brainwashed on the 'natural is better', but the synthetic T4/T3 is more consistent with less jaggy T3/T2 spiking.
She's put me on SUBLINGUAL bioidentical sex hormones and it has made all the difference. I had been on bioidentical hormones all the time but they were apparently not being adequately absorbed (transdermally). She said my cortisol levels were quite low indicating my adrenal function was exhausted.
This hormonal support has been crucial to all the other things working and getting in sync. My digestion and elimination has improved (thyroid). My fibromyalgia symptoms (fatigue, muscle pain, insomnia) have cleared up (fibro symptoms are EXACTLY the same as hypothyroid symptoms and some schools of thought believe it's an malfunction in cellular mitochondria and an inability to uptake T3). Thyroid has been the big player, but the total endocrine hormonal balance is necessary and all interrelated. Menopause can be a bitch, but doesn't have to be. And it doesn't matter what age or sex you are. Hormonal imbalance happens.
My new doc said "I can't believe you're up and walking about with levels like these". No wonder everything was so difficult. I was depleted. I try to stress on this board how important it is to get a baseline full hormone panel and go from there. So few doctors test for this - a thyroid panel is about as far as they go and you're lucky if you get that. Vitamin D deficienty is another one that's receiving alot of attention for mood disorders. I'm awaiting my prescription for high dose Vitamin D and looking forward to seeing how it goes.
So once my cellular sparkplugs are firing like they should and my energy and stamina and ability to manage stress are in good shape, I may be able to reduce the lithium. Lithium augments the other neurotransmitters and smooths electrical impulses - but so do the endocrine hormones! Lithium may have been keeping me together while my other hormones were non-functioning.
Why all the hormonal malfunction is what I ask myself and what to do about it. Stress, of course, early life stress damage to the HPA-axis. So that's my focus now - what heals, supports limbic structures. Can the hippocampus be regenerated? Is that really the problem?
>> >Are you a health professional?
>
> No, I'm a pharmacy student atm.
>
> >a fellow sufferer...
>
> Yes: anxiety, OCD, depression etc.
>
**Pharmacy - how interesting! Right there on the cutting edge of new developments. It's poignant how so many of us are in these specialized fields because of the need to understand our own condition. I go to the my pharmacies and usually look into the eyes of the pharmacist and sure enough, I recognize someone who's been through it.If you don't mind my asking, is there anything that's helping you with your symptoms? I realize that that combo of OCD, anxiety and depression are tricky to manage. How are you doing with it? - Barbara
Posted by Spriggy on March 23, 2005, at 15:21:24
In reply to Re: Lithium: to barbara and carebear » ed_uk, posted by barbaracat on March 22, 2005, at 18:17:16
Whoever that was up there that described their state when they are dysphoric, that is exactly how i feel as well.
I suppose the only difference is that I've never done that on my own; only when given an anti depressent.
Lexapro was the worst- it got me stuck in that HORRIBLE, HORRIFIC place of internal restless, hell, agitated, crawling out of my skin, racing thoughts, suicidal, and every other bad and dark thing of the mind you can think of.
But then, in a split second, I would go from that experience, and swing waaaaaaay over and feel almost euphoric (which only lasted 10 minutes at the most).
It was horrible.
Now, I'm dealing mostly with cycling from feeling "normal", to anxious, to semi depressed (but not that deep, dark depression).
The brain is so weird. Our bodies are just so complex. God's design was so intricate and when it gets messed up in the least bit, we go nuts and haywire.
I really appreciated this post on dysphoric mania because it really described in words how I felt on Lexapro (and the weeks after discontinuing) in ways I could not explain.
Posted by ed_uk on March 23, 2005, at 16:23:18
In reply to Re: Lithium » ed_uk, posted by barbaracat on March 23, 2005, at 11:59:17
Hi Barbaracat!
>She's put me on SUBLINGUAL bioidentical sex hormones and it has made all the difference.
That's interesting, there aren't any sublingual hormones on the market here, we do have hormones in the form of a nasal spray though! (Aerodiol)
>Synthroid and Cytomel.
Have you ever taken Synthroid on its own? In your experience, is it more effective to take Synthroid and Cytomel in combination?
When I've worked in pharmacies in the UK, we get trillions of prescriptions for T4 every day. I've never once seen a prescription for T3 though!
>How are you doing with it?
>.....is there anything that's helping you with your symptoms?I'm not doing too badly at the moment thank you, I don't have any severe symptoms right now.
I'm just on lofepramine 140mg. It's quite similar to desipramine- which isn't marketed here. I often taken an SSRI for my OCD, not at the moment though. My symptoms come in 'episodes,' they always have done. I don't have OCD atm but I may do in the future. If so, I'll need to go back on an SSRI, probably citalopram. I've never tried sertraline though, I might try that next time. SSRIs don't do much for my depression, if I get really depressed in future I'd like to try an MAOI. Lofepramine is ok for my depression but not great.
Regards,
Ed.
Posted by CareBear04 on March 23, 2005, at 18:12:01
In reply to Re: dysphoric mania, posted by Spriggy on March 23, 2005, at 15:21:24
spriggy-- i had the same experience on lexapro. it was the first psych med i ever took, and i never wanted to take another.
Posted by barbaracat on March 23, 2005, at 20:19:21
In reply to Re: Lithium » barbaracat, posted by ed_uk on March 23, 2005, at 16:23:18
> That's interesting, there aren't any sublingual hormones on the market here, we do have hormones in the form of a nasal spray though! (Aerodiol)
>
**I don't think we have the nasal. Sounds interesting. Regular pharmacies don't carry the sublinguals or the creams. We have them made up by a compounding pharmacy. Probably the biggest and most well known one in the US is Women's International Pharmacy. They've done alot of pioneering hormone compounding.
>
> Have you ever taken Synthroid on its own? In your experience, is it more effective to take Synthroid and Cytomel in combination?**Yes, I've taken straight T4 alone before and it didn't work as well. I only take 5mg of Cytomel which is pretty small, but it seems to kick start the T3 conversion. When I was on Armour, a natural T4/T3 dessicated hormone the T3 was too high and gave me jitters.
>
> When I've worked in pharmacies in the UK, we get trillions of prescriptions for T4 every day. I've never once seen a prescription for T3 though!**It's fairly common over here. Theory is that some people don't convert T4 to the active form as well as they should.
>
I've never tried sertraline though, I might try that next time. SSRIs don't do much for my depression, if I get really depressed in future I'd like to try an MAOI. Lofepramine is ok for my depression but not great.**I was on sertraline for years and liked it better than most of the SSRI type meds. It worked well for my depression, but would lose potency after a while and had to keep bumping it up. Never tried an MAOI but have heard that it really helps some people where everything else failed. I think the idea is to get a reversible one that lessens the side effect. I believe moclobemide is one but I don't think we have it here in the states. I remember hearing about it on the Babble board some time back. It's interesting how meds are different in the UK and US.
>
I hope you continue to feel good and that nasty depression doesn't return.>
>
>
>
Posted by barbaracat on March 23, 2005, at 23:59:33
In reply to Re: dysphoric mania, posted by Spriggy on March 23, 2005, at 15:21:24
I think that was I, BarbaraCat, who described mixed states. I know it so well. My Bette Noir.
Are you on any kind of mood stabilizer? I think you've by-passed the part where you're taking an anti-bipoloar med. Is anything working for you? Lithium is the one that calms my demons, although they are forever present, just not so... pesky.
> Whoever that was up there that described their state when they are dysphoric, that is exactly how i feel as well.
>
> I suppose the only difference is that I've never done that on my own; only when given an anti depressent.
>
> Lexapro was the worst- it got me stuck in that HORRIBLE, HORRIFIC place of internal restless, hell, agitated, crawling out of my skin, racing thoughts, suicidal, and every other bad and dark thing of the mind you can think of.
>
> But then, in a split second, I would go from that experience, and swing waaaaaaay over and feel almost euphoric (which only lasted 10 minutes at the most).
>
> It was horrible.
>
> Now, I'm dealing mostly with cycling from feeling "normal", to anxious, to semi depressed (but not that deep, dark depression).
>
> The brain is so weird. Our bodies are just so complex. God's design was so intricate and when it gets messed up in the least bit, we go nuts and haywire.
>
> I really appreciated this post on dysphoric mania because it really described in words how I felt on Lexapro (and the weeks after discontinuing) in ways I could not explain.
Posted by ed_uk on March 24, 2005, at 12:51:40
In reply to Re: Lithium » ed_uk, posted by barbaracat on March 23, 2005, at 20:19:21
Hi!
>I was on sertraline for years and liked it better than most of the SSRI type meds.
In what way did you prefer it to other SSRIs?
>I hope you continue to feel good and that nasty depression doesn't return.
Thank you :-) I hope you stay well too.
/Ed
Posted by B2chica on March 24, 2005, at 13:12:49
In reply to Re: Dysphoric Mania, posted by MoparFan91 on February 22, 2005, at 21:05:21
agree completely! it's like reading a bio. i'm really glad someone started this thread. my doctors have been scratching their heads kinda not sure where my symptoms are-cuz many 'slip through the cracks' on different meds. it's nice to know i'm not making all that up. and that this dysphoric mania is real. (i mean it's real to me but didn't know if i was alone in this or not)
-my last bout was pretty tough, lots of what you listed below. i wouldn't take my pills cuz i thought 'they' were trying to kill my kindred spirit, i had TONS of creative ideas but soon became scattered and angered. i was then convinced i needed to cut off my left hand, started to but didn't, luckily got off with only needing 5 stitches.) i think i'm going to try zyprexa again. 10mg. anyone on higher than that?depression on speed...interesting description.
B2c.> According to my experience, my mixed states present the following symptoms:
> Self-hatred
> Self-rage and damaging my own belongs
> Wailing/Crying
> Loneliness
> Extremely agitated and wanting to jump out of my skin
> Self-injury and cutting
> Things and people occasionally having a nightmarish quality to them
> Being anxiety-ridden, tense, and scared
> Suicidal impulses
> Certain kinds of music (whether from my stereo or in my head) makes me go crazy and bang my head on the table or wall
> Paranoia or thinking that others are against me
> Feelings that no one likes me
> Feeling removed from everyone and lost in a bad world
> Mental torturing with bad, scary thoughts in part due to the OCD
>
> I have problems with OCD along with the Bipolar, and when OCD symptoms happen during a mixed state, it can turn real ugly real fast. It's like my mind is 'sticking' and 'locking on' to certain bad thoughts, and they push me down further in the abyss and make me more anxious/agitated. It's next to impossible to get out of this state because of this.
>
> > i used to have purely "white" manias-- high energy, euphoric, magnetic, energizer bunny states that lasted months. i'd get so much done and feel so great, and people would inquire whether i was on amphetamines or wonder how i got everything done and didn't sleep.
> >
>
> I tend to get hypomanias where I feel boundless energy, elated, and laugh at about even the silliest things. I put a funny twist on everything. It's like feeling a little high (on some nitrous acid, or 'laughing gas'). I talk and talk and talk. I've acted obnoxious at times in this state.
>
> > when i had my first really serious depressive episode and was put on lexapro, it put me in a really bad place. the depression was blacker than ever, but while it had been the lethargic sort before, it became super-agitated akathisia like depression. this was nyc, and i used to go up to the roofs of high buildings with strong urges to throw myself off, partly from depression, and partly just because i felt so much agitation that i couldn't get away from myself. i had psychotic symptoms-- paranoid delusions that my room was bugged and people on the street would shoot me; visual hallucinations of blood and body parts; auditory hallucinations telling me to hurt myself. was this a dysphoric mania or a mixed state or an agitated depression? antidepressants in general tend to do bad things to me, especially without a strong mood stabilizer. the SSRIs are the worst, like for you.
> >
>
> I'm sorry to hear what you went through. It's a really bad feeling. I hope you're doing better.
>
> What you had above was definitely a mixed state. A mixed can feel like a form of akathisia to me. It's like wounded in a cage trying to get out but can't.
>
> Even on mood stabilizers, I became (hypo)manic on them. Eventually, I got to mood cycling faster and more fiercely on them, though the depression was better overall.
>
> > finally, i've recently had high energy states where i've felt cabin fever and had to keep moving and cleaning and doing. i couldn't sit still but wasn't doing anything that productive. it wasn't a white mania; i was definitely irritable, which isn't like me. i couldn't sleep, but unlike mania, where i don't feel the need to sleep, this was like depression where i wanted to sleep but couldn't. my energy level was high, but it was too much for my mood to handle in a way. is this dysphoric mania?
> >
>
> This is more like Dysphoric HypoMania to me. Irritability is a main component.
>
> > these are some of the states i've had. thoughts?
>
> Your agitated depression experience sounded very similar to what I went through before. Many times, I've felt like driving off a bridge in these states. Mixed States are more like impulsive depression or depression on Speed.
Posted by barbaracat on March 24, 2005, at 13:21:23
In reply to Re: Lithium » barbaracat, posted by ed_uk on March 24, 2005, at 12:51:40
> >I was on sertraline for years and liked it better than most of the SSRI type meds.
>
> In what way did you prefer it to other SSRIs?**It was smoother. I started taking it in 1986. Started out with Prozac after having taken some TCA's and trazodone. Prozac switched me into a nasty mixed state mania. Sertraline was noticeably easier, although I had to start out with a very small dose (I think 25mg instead of the standard 50mg) and work up slowly. I went through some typical bipolar/SSRI upheaval for about 2 weeks and then it calmed down and provided a good AD response for a number of years.
During the 9 years I was on it, off and on, it fizzled out and the dose kept rising. At one point I was taking 300mg for almost 2 years, which is way too high. Kept getting panic attacks and typical mixed states symptoms, but didn't know that I was bipolar and pdoc kept raising the dose of sertraline to handle 'depressive disorder'. I tried most of the other SSRI/SNRI type meds (again not knowing I was bipolar) as well but kept coming back to sertraline because of it's relatively mild ride.
I am currently taking Cymbalta (duloxetine) and am very happy with it's AD response. Don't know if it's out in the UK yet, as it's very new here, although sometimes you get them first. It has a very strong immediate NE response and is purported to address pain syndromes (like my fibromyalgia condition). I think it targets different receptor sites than the usual SS meds. But I have to go extremely slowly with this one.
I believe I mentioned the bizarre psychedelic effects I got with 30mg. I took alot of bravery to even consider ramping down to a new starting dose of 3 pellets. I'm now up to 12 pellets out of a capsule of 30mg, probably less than .5mg.
A few others on this board are experiencing similar effects at miniscule dosing. So far, this is the best AD I've been on. Effective lifting of a severe depression, doesn't cause mania, no sx (not at this dose at least) - and talk about cost effective! One capsule has lasted over 2 weeks. Since it's such a new med (put out by Lilly) and being heavily marketed, there must be a way as a pharmacy student to obtain some if you wanted to give it a try. - Barbara
>
> >I hope you continue to feel good and that nasty depression doesn't return.
>
> Thank you :-) I hope you stay well too.
>
> /Ed
Posted by CareBear04 on March 24, 2005, at 13:53:29
In reply to Re: Dysphoric Mania » MoparFan91, posted by B2chica on March 24, 2005, at 13:12:49
haha, depression on speed! that's so accurate. i hadn't read that before you mentioned it again in your post.
i'm so glad your hand is okay. that's really scary what happened!
i've only had zyprexa at 2.5mg, and that was too much. i grew fat and laid around all day. 10mg is ambitious. let us know how it turns out. have you tried any of the other atypicals?
Posted by ed_uk on March 24, 2005, at 14:01:49
In reply to Re: Lithium » ed_uk, posted by barbaracat on March 24, 2005, at 13:21:23
Hi Barbaracat!
>Started out with Prozac after having taken some TCA's and trazodone...
How did trazodone affect you? Which TCAs did you try? Did they induce manic/mixed states?
>'depressive disorder'
When did you eventually get diagnosed with bipolar disorder?
>Don't know if it's out in the UK yet, as it's very new here, although sometimes you get them first.
We got it several months after you did. Here, duloxetine is marketed as Cymbalta for depression and as Yentreve for stress incontinence. I guess they don't want the people with stress incontinence to know they're taking a psych drug!!!
http://www.pharmj.com/Editorial/20050129/products/p107products.html#cymbalta
>I believe I mentioned the bizarre psychedelic effects I got with 30mg.
Yes, you mentioned the LSD-like effects!
>So far, this is the best AD I've been on. Effective lifting of a severe depression, doesn't cause mania, no sx (not at this dose at least) - and talk about cost effective! One capsule has lasted over 2 weeks.
I think it's great that you're doing so well :-)
I was worried about you reducing the lithium because you seem so healthy at the moment :-)
Kind regards,
Ed.
Posted by B2chica on March 24, 2005, at 15:39:40
In reply to Re: Dysphoric Mania » B2chica, posted by CareBear04 on March 24, 2005, at 13:53:29
tried
-risperdal (didn't seem to do anything for me) and -seroquel [mostly for sleep-which it worked like a charm but ended up with bad side effects (effecting cognition)] so stopped that.
-zyprexa at 10 worked for me before but my GP Rx it for me (initial Dx) then i went to see pdoc and he took me off it (that guy wouldn't listen to me either) then switced pdocs, now have a great one, but i was in the hospital for depression recently and had a 'freak out' day...(i don't think the nurses new what to make of it) i just needed to let it run it's course...anyway the pdoc there put me on 5mg of zyprexa, that just made me eat constantly and still didn't help 'up' feeling so i took myself off it, 4 days later i cut...smart huh. well, alls well that ends well. i'm healing physically and see pdoc tomorrow to discuss this wacky cr@p that's going on in my head.
later
B2c.> haha, depression on speed! that's so accurate. i hadn't read that before you mentioned it again in your post.
> i'm so glad your hand is okay. that's really scary what happened!
> i've only had zyprexa at 2.5mg, and that was too much. i grew fat and laid around all day. 10mg is ambitious. let us know how it turns out. have you tried any of the other atypicals?
Posted by barbaracat on March 24, 2005, at 15:59:23
In reply to Re: Cymbalta » barbaracat, posted by ed_uk on March 24, 2005, at 14:01:49
> How did trazodone affect you?
**I liked it at first because it felt so calllmmm. I was bouncing around with moderate mixed-states so it was a nice change from the constant anxiety. It helped me sleep well at higher doses. The major drawback was getting up in the morning, never my strong point. It would take about 2 hours to get the cotton out of my head and I felt lethargic all day. I believe I was taking around 200mg for around 2 years and got tired of fighting off the lethargy. That's when Prozac came on the scene and my pdoc switched me over to it. Lasted about 1 month and then switched to sertraline, as we talked about. I think traz is a decent sleeping med at 50mg or so (still grogginess at that dose in the a.m. and feels like a histamine blockade effect). I now take Ambien for sleep instead. I don't believe many are using it for first-line AD relief but it could be a good adjunct.
>>Which TCAs did you try? Did they induce manic/mixed states?
**In my experience, no. When I first agreed I needed meds it was a big admission since this was the late '70s and I was the quintessential Ms. Natural. Didn't even wash my floors with anything non-organic. So the only things back then were the old standards, Elavil, Tofranil. I HATED the side effects. One did help, however, Surmontil, which I don't think they make anymore. But then, trazadone and then SSRIs came on the scene and most pdocs pretty much abandoned TCAs.
Recently, after my Mom died, I had to do something and went on Nortriptyline for about 6 months. I loved it, absolutely loved how I felt on it. As you can imagine, I was totally wigged out from losing my beloved Mom right around Christmas from a car hitting her while out on a walk. I was losing it, even on lithium and lamictal. So my pdoc, knowing my bad history with SSRIs suggested nortrip. It brought me out of that desperate place in 2 weeks and allowed me to deal with the grief normally. No, it did not induce mania, in fact brought me out of a severe mixed states depression in a gentle, light manner.
I'd be on it today if it weren't for two side effects that were intolerable - constant dry mouth and thirst, and constipation. I felt like it was dehydrating me no matter how much water, electrolytes, whatever I took. So I eased off taking it pretty rapidly. Very easy to stop, none of that nonsense like you get with SSRI discontinuation.
>
> When did you eventually get diagnosed with bipolar disorder?**About 2-1/2 years ago, mainly from researching on my own and the help of this board. It had actually been suggested to me years ago by an astute pdoc but I totally rejected the concept of it. I thought it meant 'really crazy' and meant either depressed or grandiose madcap manias and euphoria. Looking back now, I can see that I had more symptoms than I would admit, and many hypomanias which were too much fun, but major symptoms were wretched mixed states bipolar depression which was not classic anything - just scary and weird for everyone. Someone said 'depression on speed'. I'd add 'depression on speed AND bad acid'. Every one of my many docs were baffled by my symptoms and stuck me in the 'treatment resistant major depressive disorder with comorbid anxiety' slot. Mixed states was not recognized as even possible (up and down together?) until recently so I kept getting higher doses of SSRIs as I continued to get worse.
I followed a Babble poster's link to www.psycheducation.org, read about mixed states, and with great relief thought to myself 'I'm not alone! That's me!', suggested this to my pdoc who put me on lithium and the rest is history. But I can't help lamenting how traumatized my receptors were for so many years and wondering how things would be now if this had been caught sooner. I'm just grateful it was.
>
> Cymbalta for depression and as Yentreve for stress incontinence. I guess they don't want the people with stress incontinence to know they're taking a psych drug!!!**Or smokers knowing they're taking wellbutrin.
>
> I was worried about you reducing the lithium because you seem so healthy at the moment :-)**'Oh, I can reduce my meds!' Isn't this a common misperception we make when we're feeling better? I think I'll stick with my 600mg lithium for now.
Really, Ed, if you're thinking of an AD, consider low dose Cymbalta before settling on sertraline. IMHO, as long as you don't start out too high, there's no comparison. Be well, my friend. - Barbara
>
> Kind regards,
> Ed.
Posted by ed_uk on March 24, 2005, at 18:23:00
In reply to Re: Cymbalta TCAs mixed states » ed_uk, posted by barbaracat on March 24, 2005, at 15:59:23
Hello!
>Elavil...
I only lasted one day on amitriptyline. I was almost unconscious for 24 hours- couldn't keep my eyes open!! Dothiepin (Prothiaden) was bad too. Very bad dry mouth with these drugs. Urination was VERY difficult.
>Elavil, Tofranil. I HATED the side effects.
What side effects did you have?
>One did help, however, Surmontil, which I don't think they make anymore.
It's still available here :-)
>Nortriptyline
I'm sorry to hear about your mother. It's strange how pdocs sometimes say that TCAs are more likely to induce mania than SSRIs and yet patients often find the opposite.
>About 2-1/2 years ago....
I'm surprised your pdocs didn't spot it earlier- it sounds like you've had some quite 'classic' manias as well as the mixed states and depressions.
>I think I'll stick with my 600mg lithium for now.
:-)
Regards,
Ed.
Posted by barbaracat on March 24, 2005, at 19:39:43
In reply to Re: Cymbalta TCAs mixed states » barbaracat, posted by ed_uk on March 24, 2005, at 18:23:00
> I only lasted one day on amitriptyline. I was almost unconscious for 24 hours- couldn't keep my eyes open!!
>
> >Elavil, Tofranil. I HATED the side effects.
>
> What side effects did you have?**Same as you - walking around unconscious and with strange stiffness in my fingers and peripheral skeletal muscles. Couldn't pee.
> >
> It's strange how pdocs sometimes say that TCAs are more likely to induce mania than SSRIs and yet patients often find the opposite.**Yes, that seems unfortunate.
>
> >About 2-1/2 years ago....
> I'm surprised your pdocs didn't spot it earlier- it sounds like you've had some quite 'classic' manias as well as the mixed states and depressions.
>
**I don't think mixed states are an easy marker for a dx of bipolar, but certainly, something else was obviously going on with me than just depression. My mixed states depressions were so severe and psychotic I don't think my docs knew what to do with me. Antipsychotics were tried but didn't help. I strongly resisted the label 'bipolar' and bipolars can be pretty persuasive, don't keep appointments when they're flying high. But to be honest, I think pdocs miss the obvious far too often and a really good one is a rare thing.**BTW, what kinds of MAOIs are you considering, Ed? I hear good things about Nardil.
Posted by ed_uk on March 24, 2005, at 20:03:07
In reply to Re: Cymbalta TCAs mixed states » ed_uk, posted by barbaracat on March 24, 2005, at 19:39:43
Hello!
>I don't think mixed states are an easy marker for a dx of bipolar, but certainly, something else was obviously going on with me than just depression....
I thought you'd had some euphoric manias as well as the mixed states?
>BTW, what kinds of MAOIs are you considering, Ed?
I'd like to try Parnate. I've tried moclobemide (Manerix, Aurorix) but it didn't help- it doesn't seem to help many people to be honest!
Ed.
Posted by barbaracat on March 25, 2005, at 0:47:37
In reply to Re: MAOI » barbaracat, posted by ed_uk on March 24, 2005, at 20:03:07
> I thought you'd had some euphoric manias as well as the mixed states?
**Yes indeed. Some wild and crazy times but part of it was the times and just part of my nature growing up. I think bipolar takes whatever is naturally there and super-fuels the energy to extremes. The euphoric states were no doubt manias too but so sublime, so close to Spirit, more real than here. I've always been drawn to that place, my foot in both worlds, but mania fuels it to the point of exhaustion. Like, c'mon angels, quit with the heavenly choir so I can sleep.
But who can say what's going on? I suspect that there's some gate that opens, a chemical antenna that is sensitive to other frequencies. Maybe it's the consolation for the rest of it. Kay Redfield Jamison said she wouldn't trade it, even with all the hell. I think I agree, but ask me during the hell and I definitely would not.
>
>
> I'd like to try Parnate.**I believe that's Nardil in the US? Well, I wish you the best with it but hope you won't need it. A question for you. You say you're a student in pharmacy. How do you manage it when you're going through a difficult time? I'm thinking of going back to school but am concerned about the stress.
Posted by ed_uk on March 25, 2005, at 10:40:49
In reply to Re: MAOI » ed_uk, posted by barbaracat on March 25, 2005, at 0:47:37
Hi!
>I believe that's Nardil in the US?
Phenelzine (Nardil in the UK and the US)
Tranylcypromine (Parnate in the UK and US)>How do you manage it when you're going through a difficult time?
I didn't manage at all well last semester I'm afraid. I didn't sit my January exams, I'll be doing them in August with the people who've got resits. Oh well....
Kind regards,
Ed.
Posted by barbaracat on March 25, 2005, at 12:37:55
In reply to Re: MAOIs » barbaracat, posted by ed_uk on March 25, 2005, at 10:40:49
> I didn't manage at all well last semester I'm afraid. I didn't sit my January exams, I'll be doing them in August with the people who've got resits. Oh well....
>
**I'll be rooting for you. With all your personal experience, you'll bring alot to the profession, and we sure need it. There should be special universities for 'wounded healers' - less stress, more time, more understanding. - Barbara
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