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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Spriggy on March 1, 2005, at 15:43:55
If I had $10 for every question I've asked lately, I'd be RICH by now. I know.. My regards to all of you who have been kind of enough to indulge me and answer my questions.SLS- I've said it before but you seem to know your stuff.. Maybe you can give me some insight here.
I see the dr. tomorrow. it's not a pdoc- like I said before, unless you admit yourself into the psych ward, you can't see a pdoc around here for at least 3 months.
Probably if I would run naked through the freeway, I could get in sooner, but because my husband wouldn't approve, I'll refrain from that step.
Now.. onto the question.
I assume you know my situation by now since you always are kind enough to respond to my posts.
The pdoc in the psych ward told me a few things (forgive me if you already know this- you smart man you):
1) I had akathasia and need NOt to be on an SSRI again. EVER. He was pretty emphatic about that one.
2) We could try out a SNRI like Cymbalta but he said, " there's a possibility you will have a similar reaction."
Okay.. saying that to me is like asking me if I wouldn't mind trying to die and burn in Hades for a few days. So I am terrified to even attempt Cymbalta. What I experienced on Wellbutrin and Lexapro was horrific and would rather poke needles into my eyeballs.
So.. pdoc said:
1) There is a possibility you have Bipolar 2 (dad with bp) and you may need mood stabilizer.
He said this in "passing" while looking at his watch probably thinking about his turkey sandwich waiting for him.
I said, " so what would you do for that then?"
Once again looking at his watch he says, " well there's depakote but you will gain weight and I knwo you're a woman who wouldn't want that. There's a few other options.. lamictal but there's a rash risk."
Then he left. I mean he just got up, said " gotta go" and that was it.
I was discharged and told to see my dr. when I got home.
My dr. is more clueless than I am. If I asked my dr. for a horse traquilizer, I would get it.
I have an appointment tomorrow with this doctor.
I am still on low dose Klonopin ( today am actually skipping the morning dose to see how I do without it until bedtime).
I am still feeling a bit strange, having some minor agitation/restlessness.
I *think* at times I feel normal and then I suddenly feel that old dark depression hang over me. It doesn't last like it did before. It comes and goes.
It is apparent to me I am cycling. I ain't talking about exercise bike either.. I mean going from feeling good, to normal, to anxious, to depressed, to starting this all over again.
I am losing weight despite the fact that I am actually eating again. I suppose it's because my body is under such stress my metabolism thinks i"m running a 25k.
ANYWAY (am I rambling? maybe that's another symptom?), WHAT would you suggest?
Would Lamictal alone be beneficial for the mood instability and depression?
Should I take a risk and try the Cymbalta??
Should I just stay on the Klonopin and pray to God I get "normal" one day again soon?
Another thing pdoc mentioned was neurontin. I don't understand what that would be for- my dad takes it for diabetic neuropathy and it makes him hallucinate. So I'm not a big fan of that route either.
Somebody who has a clue tell me what I should tell my doctor tomorrow..
Thanks!
Posted by Phillipa on March 1, 2005, at 16:36:01
In reply to SLS? yooo hooo..., posted by Spriggy on March 1, 2005, at 15:43:55
I don't like the pdoc you had in the hospital. All he did was make you afraid and not offer any answers. Why couldn't he refer you to a pdoc as aftercare? Is it that there are no pdocs in your area? I don't know what to tell you about the meds, but I feel for you. I know Scott will reply to you. Fondly, Phillipa
Posted by SLS on March 1, 2005, at 17:21:41
In reply to SLS? yooo hooo..., posted by Spriggy on March 1, 2005, at 15:43:55
Can you describe in a bit more detail what are the symptoms of your illness? How do you sleep? How is your appetite? Do you feel worse in the morning? Anything you describe would be helpful.
> 1) I had akathasia and need NOt to be on an SSRI again. EVER. He was pretty emphatic about that one.
> 2) We could try out a SNRI like Cymbalta but he said, " there's a possibility you will have a similar reaction."Very possibly
> What I experienced on Wellbutrin...
Did you try Wellbutrin without Lexapro? What were the results?
> 1) There is a possibility you have Bipolar 2 (dad with bp)
What are the symptoms of your father's illness? What was it about his symptoms that led his doctor to diagnose him as bipolar?
> and you may need mood stabilizer.
If your father truly is bipolar, you probably should proceed under the premise that you fit somewhere along the bipolar spectrum. Mood stabilizers might be helpful.
Lamictal is known to possess antidepressant properties, and might be the right place to start. I would not worry too much about the rash. Starting low and increasing gradually provokes a reaction very infrequently. Although the titration schedule recommended can be frustratingly slow, it can be well worth the wait. You might want to make 200mg your target dosage.
> I am still on low dose Klonopin ( today am actually skipping the morning dose to see how I do without it until bedtime).
How much are you taking? In what ways does Klonopin help you?
> I am still feeling a bit strange, having some minor agitation/restlessness.
How do you account for this?
> It is apparent to me I am cycling.
How long do you spend in each of the phases of your cycle?
> ANYWAY (am I rambling? maybe that's another symptom?), WHAT would you suggest?
Have you tried Remeron?
If you are intolerant of the SRIs, perhaps it is time to explore either a tricyclic antidepressant (TCA) like nortriptyline or a monoamine oxidase inhibitor (MAOI) like Nardil.
> Would Lamictal alone be beneficial for the mood instability and depression?
Lamictal can help improve depression and reduce rapid-cycling. However, it is not a good drug to treat mania. I doubt it would prevent an antidepressant-induced switch into mania. If you were to add Depakote, you would need to reduce the dosage of Lamictal by half.
- Scott
Posted by Spriggy on March 1, 2005, at 18:00:21
In reply to Re: SLS? yooo hooo... » Spriggy, posted by SLS on March 1, 2005, at 17:21:41
Thanks Phillipa and Scott..
for whatever it's worth, if either of you were here, I'd offer you some of this banana cream pie.Okay.. now for the answers for Scott:
*** Can you describe in a bit more detail what are the symptoms of your illness? How do you sleep? How is your appetite? Do you feel worse in the morning? Anything you describe would be helpful.***
Well, I feel a very weird "head" feeling. Kind of like my head is full of cotton ( I know this makes no sense). It's a bizarre feeling- it's uncomfortable. Kind of like what you would feel like if you had a fever (but I don't!). Almost like there's a magnet in the center of my brain or a weight there.. Trust me, I know how bizarre this sounds because even saying it our typing it to myself looks sooo strange.I am sleeping fine becuase I am on 30 mg's of Restirol a night. Before that, I had a hard time "winding" down to sleep. I am having a bit of racey thoughts-- I almost feel like I have taken a boat load of caffeine or something similar (but I haven't). I wake up with this inner jitterness in the pit of my stomach. I suppose it could be "anxiety" but I've not experienced it before. Yes, I seem to feel worse in the morning. I think it's becuase I wake with this jittery feeling in my gut!
I also notice that I get depressed easily/daily. I think about death quite often. VERY unusual for me.
****Did you try Wellbutrin without Lexapro? What were the results?***
I was on Wellbutrin alone. I only took it a few days and could not sleep, could not eat, and felt even worse as far as this jittery/anxious/restless feeling goes. But I did have that same weird "head heavy" feeling on it.***What are the symptoms of your father's illness? What was it about his symptoms that led his doctor to diagnose him as bipolar?**
My father is the "typical" bipolar, I suppose. His mother was also bp and committed suicide so there is that whole "family history" thingy going on.
My dad gets euphoric mania (which I have never had, unfortunately!), he will go days and days without sleep (without even feeling the need for it). He spends money he does not have on things he does not need. He gets super happy/hyper, etc. He tends to go off on drug binges during these stages; drug of choice has been cocaine. These days it seems to be pain killers or marijuana but he is also dying and in chronic pain so that could be some of the reason for drug abuse at this point.
He doesn't seem to have to low depressive states. he gets depressed after these episodes but it's more the "blah's" than the deep down dirty pit depression like I've been experiencing.
***How much are you taking? In what ways does Klonopin help you?***
I am taking .25 Klonopin twice a day. Actually, today I skipped the morning dose to see how I would feel.
I suppose the Klonopin is making me a bit less anxious. I still feel jittery and shakey but maybe not quite as bad?? I don't even know if I think it's helping or just making me sleepy.
> I am still feeling a bit strange, having some minor agitation/restlessness.
***How do you account for this?
Well, I'm not sure exactly what you mean by that question.. It's the same feelings as described above. Weird head heavy feeling, uncomfortable, agitated, depressed, not like myself, etc..
I'm under a lot of stress; my father is dying (already mentioned), my son is severely autistic, my husband is a pastor, etc..
Could this all just be stress??? I exercise daily, take multi vitamins, eat healthy, pray, etc.. I can't imagine what else I can do in the natural to help myself.
My only conclusion is that all this stress has triggered bipolar that has already been there and never surfaced. I have no idea.
> It is apparent to me I am cycling.
****How long do you spend in each of the phases of your cycle?
I would say a few hours in each cycle daily. I feel good for a few hours, feel agitated/anxious a few hours, feel depressed/low a few hours, etc.. This goes on until I fall asleep at night when at last, I find some peace. Although, I will say I am dreaming a TON lately- like 5 dreams a night which is also weird for me.
Maybe my brain is acting like a 4 year old at Chuck E Cheeses.
> ANYWAY (am I rambling? maybe that's another symptom?), WHAT would you suggest?
***Have you tried Remeron? No, but if Remeron messes with seratonin, won't I be up a creek again?
***If you are intolerant of the SRIs, perhaps it is time to explore either a tricyclic antidepressant (TCA) like nortriptyline or a monoamine oxidase inhibitor (MAOI) like Nardil.
I will suggest this to doctor tomorrow but don't want anything that will cause weight gain. Even if I go insane, I would like to stay thin. Priorities, ya know?
> Would Lamictal alone be beneficial for the mood instability and depression?
***Lamictal can help improve depression and reduce rapid-cycling. However, it is not a good drug to treat mania. I doubt it would prevent an antidepressant-induced switch into mania. If you were to add Depakote, you would need to reduce the dosage of Lamictal by half.
Well, I don't think I'm "manic". At least not in the terms of mania that my father has in his bipolar. I am not spending money, talking too fast, calling people on the phone, having affairs, doing cocaine, or feeling euphoric.
is that what I would feel like manic? Because if so... I am really not at that place.
I don't feel euphoria at all. I feel moments of "normal" but nothing grand.
I REALLY, truly appreciate all your input.
I don't know if you are a pdoc but you should be. You know more than the ones around here do and I didn't have to wait on your list for 3 months or run around the freeway naked.
LOL
Posted by ed_uk on March 2, 2005, at 7:07:54
In reply to Re: SLS? yooo hooo..., posted by Spriggy on March 1, 2005, at 18:00:21
Hi,
I'm sorry I'm not SLS but I think Trileptal is another drug that might be worth considering. I think you might find it very stabilising.
Ed.
Posted by SLS on March 2, 2005, at 7:44:23
In reply to Re: SLS? yooo hooo..., posted by Spriggy on March 1, 2005, at 18:00:21
> My only conclusion is that all this stress has triggered bipolar that has already been there and never surfaced.
I think you hit the bullseye.
Because of your family history, the odds are rather high that you are also bipolar.
In adults, depression usually shows up first. It is somewhat difficult to say whether or not your agitation represents a bipolar mixed-state or atypical depression with anxiety, but that really isn't terribly important at the moment. Among other things, you are probably experience the "brain-fog" that many people describe as being a part of their depressions. For some people, the depressive state can become chronic without being interrupted by mania. They lie along a part of the bipolar spectrum that is different from where your father is situated. Your bipolarity might never look anything like your father's, but nonetheless, it might be a good idea to treat the two as having a common diathesis (biology). This would include the use of a mood stabilizer. A mood stabilizer has the potential to enhance the effects of an antidepressant, should one be necessary, and prevent a switch into mania that antidepressants can sometimes induce.
The anxiety you experience is probably a part of the bipolar depression rather than being a separate disorder. That it comes and goes several times a day is not really evidence of a rapid-cycling presentation. The true cycling of discreet bipolar states several times a day is exceedingly rare.
I think you might want to discuss with your doctor a trial of Lamictal. Lamictal is a mood stabilizer with antidepressant properties. 200mg a day seems to be the average effective dosage. If it doesn't work on its own, you can then consider adding lithium or an antidepressant. I suspect that the lithium would be helpful because it is very effective for bipolar I, which is what your father suffers from. Members of the same family very often respond to the same medication.
Weight gain is not an issue with Wellbutrin. Wellbutrin often produces anxiety/agitation/irritability/anger early in treatment, but there is a good chance they will disappear within a few weeks. In the meantime, you might be able to minimize these things by raising the dosage of Klonopin temporarily. Wellbutrin is thought to be an effective drug for treating bipolar depression.
Remeron is one of the drugs that will not act on you like the SSRIs, but often produces weight gain at the lower dosages. This tends to disappear at the higher dosages that are routinely prescribed for depression. I don't know the success rate of Remeron in treating bipolar disorder.
Parnate is the MAO inhibitor (MAOI) thought to be most effective for bipolar depression. Weight gain is unusual with this drug. The negative aspects of this drug is that you must remain on a special diet and be careful which drugs you take along with it. I am currently taking Parnate 70mg. I am not afraid of this drug. I have been on and off it since 1982. You can ask for more information from your doctor or here on Psycho-Babble. If your doctor is one who refuses to use Parnate under any circumstances, you might have to find another doctor who will if you exhaust treatment alternatives. Although tricyclics antidepressants (TCA) have a reputation to induce switches from depression into mania, I would still consider them as an alternative. Desipramine or nortriptyline are the two most often chosen because their side effects are milder than the others and are least like the SSRIs. I'm currently taking nortriptyline 100mg.
For what it is worth, my guess is that you are bipolar in a state of depression with anxiety and not in a mixed-state, nor hourly rapid-cycling. When the depression disappears, so will the anxiety and agitation/irritability. This is only a guess based on what little you have described. A more extensive interview with a doctor might reveal prior manic or hypomanic episodes and a true rapid cyclicity that occurs over the course of months (not hours).
- Scott
Posted by SLS on March 2, 2005, at 7:47:42
In reply to Re: SLS? yooo hooo..., posted by ed_uk on March 2, 2005, at 7:07:54
> Hi,
>
> I'm sorry I'm not SLS but I think Trileptal is another drug that might be worth considering. I think you might find it very stabilising.
>
> Ed.
I agree.My thought is that Lamictal + lithium would be particularly effective if there is a bipolar I diathesis.
How do you feel about the comparative usages of Depakote versus Trileptal and Tegretol?
- Scott
Posted by Spriggy on March 2, 2005, at 10:54:59
In reply to Re: SLS? yooo hooo... » ed_uk, posted by SLS on March 2, 2005, at 7:47:42
Thanks ed and Scott..
I'm off to the doc right now and will update you all on how it goes.
I think my request will likely be to start out on a low dose of Lamictal.
I suppose it will be safe to take along with this Klonopin??
We shall see.I'll update soon. Thanks a bunch.
Posted by Spriggy on March 2, 2005, at 13:37:47
In reply to Re: SLS? yooo hooo..., posted by Spriggy on March 2, 2005, at 10:54:59
Doc put me on Depakote; 250 mg's 2 times a day.
I'll start another post so I can find out more about this drug.
Posted by Phillipa on March 2, 2005, at 16:11:49
In reply to Re: SLS? yooo hooo..., posted by Spriggy on March 2, 2005, at 13:37:47
Scott, From what I've read from other Posters, remeron doesn't cause wt on low doses but does on higher doses. Could you clarify it for me as I take l5mg of remeron at bedtime. Thanks, Phillipa
Posted by Spriggy on March 2, 2005, at 18:21:23
In reply to Re: SLS? yooo hooo..., posted by Phillipa on March 2, 2005, at 16:11:49
Philippa my friend,
I'm not Scott but when Remeron was suggested to me by a nurse practicioner, she mentioned weight gain was a side effect. When I asked the pdoc, he said, " It can be but only at higher doses and only for some people."So maybe that answers that question for ya.
Posted by Phillipa on March 2, 2005, at 19:09:25
In reply to Re: SLS? yooo hooo..., posted by Spriggy on March 2, 2005, at 18:21:23
That's what I thought. Thanks, Phillipa
Posted by SLS on March 3, 2005, at 10:09:47
In reply to Re: SLS? yooo hooo..., posted by Phillipa on March 2, 2005, at 16:11:49
> Scott, From what I've read from other Posters, remeron doesn't cause wt on low doses but does on higher doses. Could you clarify it for me as I take l5mg of remeron at bedtime. Thanks, Phillipa
Actually, it is the reverse. Weight gain seems to be less of a problem at the higher dosages than at the lower dosages. Remeron is extremely antihistaminergic beginning at low dosages. This increases hunger, among other things. At higher dosages, some noradrenergic effects become more prominent and seem to reduce hunger.
- Scott
Posted by dove on March 4, 2005, at 13:04:23
In reply to Re: SLS? yooo hooo... » Phillipa, posted by SLS on March 3, 2005, at 10:09:47
It is the higher doses of Remeron (mirtazapine) that become weight neutral, and the lower doses that tend to cause weight gain. For the exact reasons Scott stated in the previous post.
dove
This is the end of the thread.
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