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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by fuchsia on October 23, 2005, at 5:04:01
How long did it take for your rapid cycling to stop? If it took a long time was it clear which regime it was that did it?
What was the 'stopping' like? Did the cycles gradually get longer?
I am trying to stop my own rapid cycling at the moment and I think I'm getting there but for me it's fairly slow. As I am very gradually increasing my lamictal (monotherapy) I don't think I'll know what dose is responsible for stopping the cycling if indeed it does stop.
So far I've been going for 12 weeks and I've been getting a marked reduction in the amplitude of the cycles but not much change in the frequency.
Posted by SLS on October 23, 2005, at 7:37:16
In reply to Anyone who had rapid cycling and got it to stop?, posted by fuchsia on October 23, 2005, at 5:04:01
Hi Fuscia.
Unfortunately, I can't offer you a personal anecdote to be able to answer your questions. However, rapid cyclicity is often treated more successfully by combining mood stabilizers. Lithium + Lamictal seems to be emerging as the treatment of choice for rapid cycling bipolar I. I don't know how much it has been studied for bipolar II. I would expect the lithium to limit the amplitudes of both phases of the illness. There are several other options.
- Scott-------------------------------------------
> How long did it take for your rapid cycling to stop? If it took a long time was it clear which regime it was that did it?
>
> What was the 'stopping' like? Did the cycles gradually get longer?
>
> I am trying to stop my own rapid cycling at the moment and I think I'm getting there but for me it's fairly slow. As I am very gradually increasing my lamictal (monotherapy) I don't think I'll know what dose is responsible for stopping the cycling if indeed it does stop.
>
> So far I've been going for 12 weeks and I've been getting a marked reduction in the amplitude of the cycles but not much change in the frequency.
>
>
>
>
Posted by fuchsia on October 23, 2005, at 9:39:57
In reply to Re: Anyone who had rapid cycling and got it to stop? » fuchsia, posted by SLS on October 23, 2005, at 7:37:16
Hi Scott
Thanks for answering!
I have bipolar II. I did try lithium before but couldn't tolerate even a tiny amount which was a shame because it felt like it was doing wonders for my depression (for the short time I took it).
Maybe depakote would be something to add? I'm not sure about it because the lamictal has taken away most of the manic type symptoms (agitation, racing thoughts, hypomania, extreme crossness) but I still have bad repeating depressions (somewhat cushioned as compared to before).
Fuchsia
Posted by SLS on October 23, 2005, at 10:50:36
In reply to Re: Anyone who had rapid cycling and got it to sto » SLS, posted by fuchsia on October 23, 2005, at 9:39:57
Hi again.
> Thanks for answering!
>
> I have bipolar II. I did try lithium before but couldn't tolerate even a tiny amount which was a shame because it felt like it was doing wonders for my depression (for the short time I took it).
>
> Maybe depakote would be something to add? I'm not sure about it because the lamictal has taken away most of the manic type symptoms (agitation, racing thoughts, hypomania, extreme crossness) but I still have bad repeating depressions (somewhat cushioned as compared to before).Depakote is certainly a good drug to consider for helping with your cycling into depression. It is extremely important to note that you must reduce your dosage of Lamictal by 50%. Depakote elevates levels of Lamictal.
1. Before beginning Depakote, get a blood test for baseline liver enzymes.
2. Introduce the Depakote while reducing the Lamictal.
3. Get blood test for liver enzymes after two weeks.
4. Get blood tests for Depakote to insure therapeutic levels.
5. Get blood test for liver enzymes every month or two until you have been on Depakote for 6 months.
Two other drugs that are worthy of consideration are Trileptal and Abilify. These are really substitutes for Tegretol and Zyprexa respectively, as they have reduced side effects.
- Scott
Posted by blueberry on October 23, 2005, at 15:40:54
In reply to Anyone who had rapid cycling and got it to stop?, posted by fuchsia on October 23, 2005, at 5:04:01
Depakote extended release can work as early as the first day, and usually within six days. For me, it worked on the first day. The waves diminished bigtime. I still have some mild depressive issues. I am only on 500mg, which is the smallest dose. More common doses are 1000mg to 1500mg. The extended release version is the way to go for smoother blood levels and smoother side effects.
I was in severe rapid cycling, often with severe depression and severe mania and then both overlapping each other at the same time. Depakote put a stop to that on the first day. Side effects are nill, other than increased appetite. Not sure what side effects would be at a higher dose.
Posted by MoparFan91 on October 23, 2005, at 22:07:15
In reply to Anyone who had rapid cycling and got it to stop?, posted by fuchsia on October 23, 2005, at 5:04:01
I have Bipolar-NOS and usually cycle rapidly throughout the day every ~8 hours or so untreated. This is referred to as Ultradian cycling. I have mixed states as well.
I took Depakote before. I took it starting in adolescence but it mainly helped a lot with real bad temper and anger issues that I had in my early teens at puberty. When I got in my very late teens, it didn't really hit the bipolar symptoms.
Around 2 years ago, I was having severe mixed state depression Hells when on 1,000mg of Depakote per day. I was rapid cycling and having bad depression.We added 10mg (then 20mg) of Lexapro to the Depakote to help with depression. Basically, that was the only doing anything for the bipolar.
Depakote (the mood stabilizer) was already doing nothing at all before taking the Lexapro.
This was like taking an SSRI w/o a mood stabilizer.
Anyway, Lexapro was wonderful. It lifted me out of depression and got me thru the holidays undepressed (usually, I sink a bit during that time). It kept me out of 'depression' Hell. I felt positive overall and less obsessive-compulsive. I was more socially appropriate, too. I was able to share feelings with others better.
I still had some mood cycling and anxiety, though, but they weren't as bad when taking the Lexapro. I started cycling bad back into depression, though, when I stopped Lexapro cold turkey.Anyway, I'm on Topamax (250mg) and Lamictal (400mg) right now.
My cycles thru the day don't last as long. The higher I've gone up on the doses of each, the shorter my cycles have been. When something triggers a cycle, my mood returns to baseline sooner than before.
Also, the amplitudes of my mood cycles have gone down a bit as well especially when the Topamax was added. My Mixed State Hells are basically gone but the depression (sadness/tearfulness) part is still masked thru it sometimes.I'm now actually on mood stabilizers "that work". Topamax works well to keep anxiety, agitation, and irritability at bay, and Lamictal keeps me out of only 'severe' depressions.
However, I stay moderately depression, at baseline, much of time still, so I might still need some SSRI (maybe some Lexapro again). I do have fairly good amount of energy, though.Lamictal is a pretty weak anti-depressant at the best.
Posted by mizloopy on October 24, 2005, at 2:01:36
In reply to Re: Anyone who had rapid cycling and got it to stop? » fuchsia, posted by SLS on October 23, 2005, at 7:37:16
> Hi Fuscia.
i'm a rapid cycler and i think i've been one my whole life. i've had luck with depakote, but had to reduce my dose because of weight gain. it has also helped with controling my chronic headaches. and at first i had a lot of hair loss , but than calmed down too in time.
much luck to you....
Posted by UgottaHaveHope on October 24, 2005, at 3:54:11
In reply to Re: Anyone who had rapid cycling and got it to stop? » SLS, posted by mizloopy on October 24, 2005, at 2:01:36
My mind would race and race and race, my body ravaged with nervous energy.
Then I got shot with an elephant dart called Seroquel. Actually I was on Lamictal, too, at the time. But once I felt the effects of Seroquel, I dropped off on the Lamictal.
Posted by fuchsia on October 24, 2005, at 22:57:38
In reply to Re: Anyone who had rapid cycling and got it to stop?, posted by blueberry on October 23, 2005, at 15:40:54
Hi Blueberry
From your posts I think that your symptoms were similar to mine. My cycle length is probably longer though; usually about 2 weeks or so. I think I would need at least 3 or 4 weeks to tell if I had stopped cycling.
It's great that you had such a good response to the depakote and reassuring that you had so few side-effects on that dose.
When you say 'depressive issues' do you think that the depressions are cyclic?
I think my cycles are related to my lamictal dose increases now. If I stay on the same dose I would maybe just be depressed a lot of the time; I guess I'll see when I stop increasing it.
Posted by fuchsia on October 24, 2005, at 23:29:36
In reply to Re: Anyone who had rapid cycling and got it to stop? » fuchsia, posted by MoparFan91 on October 23, 2005, at 22:07:15
Hi MoparFan91
Thanks for describing your history.
I had SSRIs some years ago and I think they were what triggered the cycling for me initially. At the worst point I had ultraradian cycling (brought on by other factors) then things leveled out into cycles of about 2 weeks or so.
I do still get really depressed on the lamictal but it is definitely less 'hellish'. Before I took it they were like being in a different place; sort of like a hell place, a long way under the ground. Now it's like I am at least in the normal world only I just feel incredibly bad.
I am wondering now how much protection mood stabilisers can offer against the effect of the antidepressants on the cycling. I would be scared to take them myself now.
Posted by fuchsia on October 24, 2005, at 23:48:35
In reply to Re: Anyone who had rapid cycling and got it to sto » fuchsia, posted by SLS on October 23, 2005, at 10:50:36
Hi Scott
I think I will have to wait a bit before I add something along the lines of your suggestion. Right now I am pregnant (32 weeks) and it was a tough call deciding to take the lamotrogine. The obstetrician insisted it was worth the risk so I hope she was right. I couldn't have gone on much longer the way I was anyway.
In another post of yours you mentioned the abilify didn't go into the movement part of the brainstem. Like so many others I am totally paranoid about EPSs; I got them from SSRIs and I got an occulogyric crisis from maxolon so I'm scared I'm susceptible. It can still cause them, can't it?
Posted by fuchsia on October 24, 2005, at 23:53:01
In reply to Re: Anyone who had rapid cycling and got it to stop? » SLS, posted by mizloopy on October 24, 2005, at 2:01:36
Thanks mizloopy
I'm thinking I like the sound of these lower doses of depakote.
Posted by fuchsia on October 25, 2005, at 0:00:14
In reply to Re: Yes, it was Seroquel, posted by UgottaHaveHope on October 24, 2005, at 3:54:11
Wow UHH - sounds like it was effective.
Do you know how long your cycles were?
Posted by SLS on October 25, 2005, at 7:38:18
In reply to Re: Anyone who had rapid cycling and got it to sto » SLS, posted by fuchsia on October 24, 2005, at 23:48:35
> Hi Scott
>
> I think I will have to wait a bit before I add something along the lines of your suggestion. Right now I am pregnant (32 weeks) and it was a tough call deciding to take the lamotrogine. The obstetrician insisted it was worth the risk so I hope she was right. I couldn't have gone on much longer the way I was anyway.
>
> In another post of yours you mentioned the abilify didn't go into the movement part of the brainstem. Like so many others I am totally paranoid about EPSs; I got them from SSRIs and I got an occulogyric crisis from maxolon so I'm scared I'm susceptible. It can still cause them, can't it?Hi.
My reading of the literature indicates that "theroretically", the potential for Abilify to produce abnormal movements is very low because it does not bind to dopamine D2 receptors in the striatum, the brain region responsible for the translation of movement commands from higher brain structures. However, the risk of akathisia seems to be higher with Abilify than with other APs, although an akathisia-like startup side effect often resolves on its own within the first week or two.
I take Abilify 10mg to help prevent suicidal states. It also helps with mental energy and motivation. For me, the degree of relief is very small, but I need all the help I can get just to survive. These illnesses are such pains in the...
I find Abilify to be a very clean drug. However, like so many other drugs that have not been around for 50 or more years, it is difficult to make any absolute guarantees regarding long-term use.
- Scott
Posted by Chairman_MAO on October 25, 2005, at 22:18:12
In reply to Re: Anyone who had rapid cycling and got it to stop? » fuchsia, posted by SLS on October 23, 2005, at 7:37:16
For such severely agitated states, I have a lot of faith (purely intellectual, that's what I say "faith"; you'll never find this in clinical use here for some reason--perhaps that's because I kinda made it up myself & kinda took some of it from obscure Russian literature) in high-dose (5-20mg/day) clonazepam (barbiturates along with or in lieu of BZDs for extreme cases) + galantamine 2-24mg/day. If necessary, small amounts of lithium, lamotrigine, other mood stabilizers, or minute amounts of a DA blockers (haloperidol, molindone (I think this one has been forgotten for some reason), or atypicals) would get it under control. Alternatively, a new "atypical" DA agonist such as pramipexole or ropinirole could work in place of the antagonist. Abilify might be really useful here as well. If you understand how ACh counterbalances DA, what the BZD receptors do, how galantamine mitigates cognitive impairment/myorelaxation of BZDs, etc, you will see how, for all the cool or "novel" treatments we seem to have, there are tons more with relatively few side effects that no one ever gets to even try.
I'd like to hear comments on my theory.
Posted by SLS on October 26, 2005, at 8:40:28
In reply to Re: Anyone who had rapid cycling and got it to sto » SLS, posted by Chairman_MAO on October 25, 2005, at 22:18:12
> For such severely agitated states, I have a lot of faith (purely intellectual, that's what I say "faith"; you'll never find this in clinical use here for some reason--perhaps that's because I kinda made it up myself & kinda took some of it from obscure Russian literature) in high-dose (5-20mg/day) clonazepam (barbiturates along with or in lieu of BZDs for extreme cases) + galantamine 2-24mg/day. If necessary, small amounts of lithium, lamotrigine, other mood stabilizers, or minute amounts of a DA blockers (haloperidol, molindone (I think this one has been forgotten for some reason), or atypicals) would get it under control. Alternatively, a new "atypical" DA agonist such as pramipexole or ropinirole could work in place of the antagonist. Abilify might be really useful here as well. If you understand how ACh counterbalances DA, what the BZD receptors do, how galantamine mitigates cognitive impairment/myorelaxation of BZDs, etc, you will see how, for all the cool or "novel" treatments we seem to have, there are tons more with relatively few side effects that no one ever gets to even try.
>
> I'd like to hear comments on my theory.I like Klonopin. It did a better job of controlling my first iatrogenic dysphoric mania than lithium did.
I think your ideas are interesting, but it is sometimes difficult to test radically different strategies without risking for a decompensation of someone's condition. I don't know if one can simply consider a low dose of a DA agonist the mirror image of a higher dose of a DA antagonist such that the same result is obtained. It still might be psychotomimetic. Of course, reaching the end of the rainbow might not be without a journey of risk.I understand that there is an ACh - DA balance in certain brain regions and functions, however, I don't know specifically which ones you are referring to. As far as BZD receptors and their facilitation of GABA neurotransmission, I am again a bit puzzled by where you are going with this.
I'll try to check in with you later.
Take care.
- Scott
Posted by Chairman_MAO on October 26, 2005, at 10:53:38
In reply to Re: Anyone who had rapid cycling and got it to sto » Chairman_MAO, posted by SLS on October 26, 2005, at 8:40:28
Dopamine agonists over time drastically **REDUCE DA release** due to their actions at the autoreceptors. Their steady-state level also probably regulates the frequency, etc. of the release.
I believe that is why they are mood-stabilizing.
Due to the location of BZD receptors (im thinking of their projections through the limbic system) they are uniquely suited as antipsychotic (and antimanic, which is so obvious I do not see why I have to justify it; back in the 50s they used pentobarbital all the time for "manic psychosis" or 'manic agitation") medications--at least my neuropsych theory tells me so. Ever taken LSD and then put 10mg diazepam under the tongue? You can go from nirvana to normal in 10 minutes or less. The BZD receptors specifically inhibit ego-dissolving, overwhelming "psychotic" experiences (which I believe are correlated with excessively repetative neural firing in key areas of the brain, such as a specific region I forget where NE neurons carry sensory data elsewhere for processing. This is why NE uptake inhibitors/releasers drastically potentiate LSD trips). It is my belief that psychosis is the mind's attempt to rearrange all of reality to hide a key fact or several key facts from itself, or at least the result of its attempt to keep an ego glued together at all costs, even delusions and hallucinations.
Posted by Chairman_MAO on October 26, 2005, at 11:51:36
In reply to Re: Anyone who had rapid cycling and got it to sto » Chairman_MAO, posted by SLS on October 26, 2005, at 8:40:28
As you can see, it is reasonable of me to assert that clonazepam would treat positive symptoms. However, it worsens, negative symptoms. So, read on after this abstract ...
1: Int J Psychosom. 1991;38(1-4):17-20.
Adjunctive clonazepam in the treatment of chronic schizophrenia.
Herrera JM, Alvarez WA, Freinhar JP, Lawson WB, Sramek JJ.
Mount Sinai School of Medicine, Elmhurst Hospital Center, N.Y.
Clonazepam was added to the neuroleptic regimen of 3 treatment-resistant
schizophrenic patients with schizoaffective features. Manic symptoms improved
but returned following discontinuation of clonazepam. The drug appears to
benefit positive psychotic symptoms but worsens negative symptoms.OK. So we need to work on the negative symptoms? Let us add galantamine:
1: Clin Neuropharmacol. 2002 Sep-Oct;25(5):272-5.
Adjuvant galantamine administration improves negative symptoms in a patient with
treatment-refractory schizophrenia.Rosse RB, Deutsch SI.
Mental Health Service Line, Department of Veterans Affairs Medical Center,
Washington, DC 20422, USA.Because of the demonstration of a selective alpha nicotinic receptor abnormality
in patients with schizophrenia, galantamine was added to the stable regimen of
atypical and other antipsychotic medications in a 43-year-old man manifesting
severe and persistent positive and negative symptoms, as well as mood
disturbance and cognitive dysfunction. Galantamine is an inhibitor of
acetylcholinesterase and a positive allosteric modulator of nicotinic
cholinergic receptors (with a FDA-approved indication for the treatment of
patients with mild to moderate Alzheimer disease (AD) under the trade name
Reminyl). Galantamine HBr was initiated at a dose of 4 mg po BID, which was
maintained for the first week of adjuvant therapy, and eventually was increased
to 12 mg po BID during the final weeks of his 2-month trial. Remarkably, within
1 week of its initiation, there was a dramatic and clinically significant
decrease of negative symptoms, as reflected in formal ratings on the Scale for
the Assessment of Negative Symptoms. Moreover, within a few days of galantamine
discontinuation, negative symptoms worsened, returning to the baseline level of
severity. In addition to targeting memory dysfunction in AD,
acetylcholinesterase inhibitors may have an expanded range of targets and
clinical indications, including behavioral and psychotic symptoms. Galantamine
is distinguished from other acetylcholinesterase inhibitors by its positive
allosteric modulatory properties, improving the efficiency of transduction of
the acetylcholine signal at nicotinic receptors. This latter property may have
contributed to the observed improvement in negative symptoms observed in this
patient. Importantly, positive symptoms were unchanged during this 2-month
trial.(7)Keep in mind galantamine alleviates cognitive impairment/myorelaxation from high-dose clonazepam. and that clonazepam will mediate the agitation/discomfort that galantamine could cause in high doses. This combination is a baby of mind that I hope to somehow see through to use in the clinic someday, either by me or someone else.
Comments, please.
Posted by Chairman_MAO on October 26, 2005, at 11:53:40
In reply to Evidence for my treatment protocol » SLS, posted by Chairman_MAO on October 26, 2005, at 11:51:36
In the previous post, I meant "baby of mine", and I also meant to say that galantamine's mechanism for improving benzo-induced cognitive dysfunction I believe is prevention of BZD-induced decrease of acetylcholine release.
Posted by Chairman_MAO on October 26, 2005, at 11:57:31
In reply to Re: Evidence for my treatment protocol, posted by Chairman_MAO on October 26, 2005, at 11:53:40
Furthermore, if this formula were compounded into a single tablet, the two drugs would partially mitigate the effects of the other in overdose, as well.
Posted by ed_uk on October 26, 2005, at 14:51:39
In reply to Re: Evidence for my treatment protocol, posted by Chairman_MAO on October 26, 2005, at 11:53:40
>galantamine.......improving benzo-induced cognitive dysfunction......
LOL, you stole my idea!
~ed ;-)
This is the end of the thread.
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