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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by bch on February 7, 2007, at 20:59:02
Hi,
this board has helped me so much over the last few weeks with med trials, but i never intended to post...
I hate to do it but all I know to do is give a short history.
I have been on prozac off and on for 15 years. It does the following for me:
*No suicidal or better of dead thoughts
*Keeps temper tantrums at bay (just yell at my kids, don't SCREAM at them)
*Gives a slight focus to thoughts,can usually decide which T.P. to buy in under an hour. foggier when not on prozac or on other ADsWhat it has NOT done for me:
* Has not given me more energy (sleep at every opportunity for hours on end)
* Has not Stopped compulsive binging (no purging) (15 years of docs saying "oh no, doesn't increase carb cravings,blah, weight neutral blah blah, excercise , blah blah dont blame the meds, blah blah..100 pounds later, oh BTW... of course this is not all the prozac, i could have managed on my own eventually)
* Has not made me feel HAPPY, just a little better than wanting to dieEvery so often I would try a NEW one, paxil, zoloft,ZZZZZZZ, lexapro but never felt better than the prozac, so like an abused child, I always went back to the prozac because at least I knew what to expect.
A few wks before Christmas, I got on the merry go round and decided I wanted to feel better and I would try whatever. Started with Cymbalta. I stayed on it for 1 month. I didn't feel better, just blah.
Finally went to a pdoc. She suggested adding klonepin to the Cymbalta, to see if eased anxiety would stop the oversleeping overeating. Nothing. I broke a .5 mg into 1/2 or 1/4 so as not to crash all night and day. My 15 yr. old finally asked me where my sense of humor had been for the last month or so..... I stayed on it because I had stopped binge eating, bloating, and thought I would eventually lose weight since I wasn't overeating. One month later, all my pants are 2 inches to tight.
Then went off cymbalta, thought I would die, or be killed by DH, and don't know what I would have done if I hadn't found all you wonderful people. (No withdrawl with my patients, blah, blah, you'll be fine, blah, base level, see how depressed you are w/o meds, blah, blah,,,,)
Went on emsam, with such hopes because I had such obvious symptoms of atypical depression. Other than all the typical stuff here on other posts about emsam, I am not depressed really, but I am a BITCH, I mean to say, "welcome home, how was your day?" and I say is "Why are you home???" I am po'd at everybody and just feel generally like a mean, hateful person. Now I am no doormat on any day, but I try to be at least not vicious. My apetite has come back but I am not sleeping as much. This is how I felt on a trial of Wellbutrin several years ago, not suicidal, I was fine,but made everyone ELSE feel like crap, very mean spirited.
Saw Pdoc today, she now think I am bipolar, no mania symptoms because I have developed such good skills at controlling them and they are masked/evidenced now by extreme anxiety/harm avoidance.
She prescribed topamax and will add prozac after emsam washout (she says two weeks...is that long enough?)
So after all this drivel (I AM SO SORRY) I am reading about bipolar and topamax here and on crazymeds and I just don't know... I am pretty avid about gathering info and have been for all the years with the major depression, and I have never felt I had any bipolar symptoms. Just always down or unhappy. Anyone out there have any brilliant thoughts about the need for the serotonin (prozac) and not liking the wellbutrin?Thanks so much for your patience, I would not say I am manic by any means, but all day I am talking and can't shut up!! HELP! a little wired. Took last patch of emsam off at noon.
Posted by med_empowered on February 8, 2007, at 1:02:39
In reply to need help with bipolar diagnosis, posted by bch on February 7, 2007, at 20:59:02
Its impossible to say "yes, you're bipolar" or "no, you're not bipolar" b/c there isn't a brain scan or blood test someone can give you--the illness really exists as a concept, a group of symptoms clustered together b/c lots of other people have similar clusters, and given a name--bipolar.
So, all you can really do is judge by what works, what doesn't, what makes your life easier and what makes things worse.
I don't know what to tell you about your antidepressant situation. Personally, I'd try another benzo if i were you--if klonopin's too much, maybe xanax (now available in xr and a dissolving wafer form, too) or ativan...even good-old fashioned valium can help people a lot.
Also, back to the topamax--the problem with a lot of doctors is that they confuse "sedated, lethargic, and flat" with "improved". This explains shrinks' ongoing love-affair with zombie-maker pills. Topamax could help, but it can also make people stupid,and there are other things to try--like lamictal, trileptal. Maybe Lyrica? Its related to neurontin and its a GABA drug, so its kind of benzo-ish...that might help you simmer down a little.
The ultimate chill pill of course would be an atypical antipsychotic, like zyprexa. I personally dislike these drugs, but some people like them for as-needed use or for continuous use at very low dosages (ex: most patients with psychosis take at least 5mgs of zyprexa, usually more like 10-20, but some with non-psychotic mood "issues" do well on 2.5mgs/day or less of zyprexa.) There's a combo pill, Symyax, that has zyprexa mixed with prozac. Zyprexa can cause diabetes and weight gain (both of which might be prevented by use of metformin and/or amantidine).Good luck.
Posted by bch on February 8, 2007, at 7:46:09
In reply to Re: need help with bipolar diagnosis, posted by med_empowered on February 8, 2007, at 1:02:39
Thanks for answering med_empowered.. I thought everyone had left the building...or was counting their pills...
I guess I know after several decades there is no short answer. I certainly know there is no magic pill.
I'm sure everyone knows you just always get to these points with the meds where you say do i push on with more serious drugs,and scarier side effects, or do I trash them all and just work to improve my physical health? (forgetting of course that without meds you are a lump mud) Is surviving good enough with depression?
I will say I am terrified of sedation, because with two kids, that is already my biggest struggle and concern.Thanks again, med_emp. the more I see the docs, the more I realize they have no idea what we are going thru there is such a wealth of experience here.
Posted by med_empowered on February 8, 2007, at 11:04:28
In reply to Re: need help with bipolar diagnosis, posted by bch on February 8, 2007, at 7:46:09
hi again! yeah, the thing that sucks about shrinks is that even though you're paying $$$ for their time and you're right there in front of them, talking about your issues, they have a tendency to not see the person in front of them. They may see symptoms or disorders, but they seem to blind themselves to the actual *person* they're talking to.
Have you looked into alternative medicine? It doesn't have to replace the med(s) of your choice; it may help you get more mileage out of them. For instance, patients who are low in certain B-vitamins may not respond well to Prozac; add in b-vitamins plus the Prozac, and response and remission rates increase.
Do you live in a medical marijuana state? If you do, I'd say jump on it--for a lot of people, pot (possibly plus some psychotropics) really works wonders for mood disorders, and its a lot more tolerable than, say, depakote.
Since you have weight issues, I'd recommend getting your blood sugar and what not looked at by a proactive doc, maybe one versed in alternative medicine. Blood sugar can impact mood which impacts behavior and eating...some people find that adding in blood sugar controlling meds (like metformin) reduces mood swings and reduces need for other meds...its like re-establishing a sort of homeostasis, instead of covering up the result of imbalance with meds.
I wish you the best of luck...try to keep us all updated on how you're doing. www.remedyfind.com is a pretty good place, too, to see reviews of medications and herbs and therapies for all kinds of physical and emotional issues.
Posted by ronaldo on February 8, 2007, at 11:09:09
In reply to need help with bipolar diagnosis, posted by bch on February 7, 2007, at 20:59:02
Hello bch
It sounds to me like you are suffering from dysphoric elation which is the opposite of euphoric elation. You may not be primarily depressed at all. You may be suffering from dysphoric mania.
Dysphoric mania
The concurrent presence of symptoms of depression and mania together. Also called Mixed bipolar state.http://www.medicalglossary.net/Dysphoric_mood.htm
I am a manic depressive myself and I suffer from dysphoric elation. It is in fact the opposite of depression but it leaves me feeling intensely irritable and I am ready to bite my wife's head off. It is a feeling of impatience and why is the world conspiring against me.
Euphoric Elation: feel great, can't stop talking, full of wonderful ideas, propensity towards financial and sexual indiscretions, you feel so alive and excited.
Dysphoric Elation: the opposite of Euphoric Elation. I rarely experience Euphoric Elation. With me its usually Dysphoric. I nurture grievances against various people. I am intensely irritable, impatient, easily frustrated, quick to anger, liable to lose my temper, everyone else is an idiot but they just can't see it.
Definition of Dysphoric mania
Dysphoric mania: The concurrent presence of symptoms of depression and mania together. Also called Mixed bipolar state
http://www.medterms.com/script/main/art.asp?articlekey=24356There are many treatments for Bipolar Disorder. The Gold Standard is Lithium-Bicarbonate. I have been taking Lithium for some 25 years or more. I tolerate it well. I have blood tests every 3 months to check my lithium levels and these are always around 0.8 mMol/liter. This is right in the therapeutic window which is from 0.7 to 1.1 approx. The checks on my thryroid, my kidneys, and my liver have always been OK. I feel fine on Lithium. I was on Zyprexa, initially rx'd for sleep. After 18 months it didn't make me sleep anymore but I was persuaded to stay on it because allegedly 'it helped the Lithium to work'. I have now almost weaned myself off it over a period of 2 months. If you take it take it at 2.5 mg and don't stay on it for years and years. You will have trouble coming off it.
Well I hope this info has been useful to you.
Being Bipolar is only a name tag. Bipolars themselves cover all shades of the bipolar-spectrum
Posted by ronaldo on February 8, 2007, at 11:16:51
In reply to Re: need help with bipolar diagnosis, posted by bch on February 8, 2007, at 7:46:09
Hi bch,
more about mixed states from
http://en.wikipedia.org/wiki/Bipolar_disorder
Mixed state
Main article: Mixed state (psychiatry)
In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage).[2]Mixed episodes can be the most volatile of the bipolar states, as moods can easily and quickly be triggered or shifted.
Posted by bch on February 8, 2007, at 12:15:22
In reply to Re: need help with bipolar diagnosis fao bch, posted by ronaldo on February 8, 2007, at 11:16:51
Thanks so much you two. i am going to check these links.
Interesting you should mention pot, med_emp, cuz on my first pdoc visit she asked me about reactions to various substances i'd experimented with in H.S. and I HATED POT!! I tried so hard, cuz it was what all my friends did. At first of course I just laughed hysterically and then gorged on sweets, but very quickly, every time I would get high, the paranoia was unbearable and I would hear things (demonic) in the songs (EVEN DISCO AND ABBA!! okay, maybe that isn't so suprising LOL)
I eventually just made alcohol my drug of choice. I still am extremely cautious with my alcohol consumption. I am way too much fun when tipsy.Thanks again and I would really appreciate more insight, especially on the chemicals the different ssri's target and why I need seratonin so much. It is amazing when you read something here and go AHA and then find a creative way to present to the docs in order to make them think it was their idea, a little like husbands and four year olds. Please don't report me, I don't want to insult any husbands, doctors, or 4 year olds. Humor is the way I survive, but sometimes I find my self laughing till it hurts only to notice no one else is laughing!!
Thanks again for your encouragement and insight.
Posted by bch on February 8, 2007, at 12:27:56
In reply to Re: need help with bipolar diagnosis fao bch, posted by bch on February 8, 2007, at 12:15:22
Well, I guess I will try the Topamax, it's either that or cut my losses (AGAIN) and wash out and go back to prozac alone. You know I never pushed on to heavier doses of prozac cuz I was scared of the side effects, so i think maybe I should just do that.
(the scared thing I keep writing is really reinforcing the pdoc's cloninger(SP?)personality profile showing High Harm Avoidance and LOW persistance!!)
Posted by delna on February 12, 2007, at 13:44:11
In reply to So scared to try topamax!!!, posted by bch on February 8, 2007, at 12:27:56
Hi
Your condition sounds alot like what I experienced before I accepted I had bipolar II and finally took meds..I too had these 'highs' which were turbulent and miserable. Plus the mixed states that the others mentioned, which as you know are unbearable.
What really ,really helped me was lamactil. Not only does it curb anxiety and agitation (the awful 'high') it actually lifts bipolar depression (which is usually resistant to most things)
Personally I had a rough time with topiramate but I was a rare case. Why are you so scared of it BTW?
Anyway lamactil is a great fallback suggestion if you don't like the topiramate...plus I didnt gain an ounce ( and I put on weight with meds just by looking at them ;) )
Well, best of luck- there are always options if one drug is not helpful.
Posted by bch on February 12, 2007, at 14:21:57
In reply to Re: So scared to try topamax!!! » bch, posted by delna on February 12, 2007, at 13:44:11
Thanks delna,
I have had a horrible weekend, am going to get the topamax today. I am scared because I am so tired of not knowing what is the meds and what is just me.. I guess. Also, if it doesn't work, I don't know how much longer I can do this. And that sounds soooooo selfish when I look at the years people on this board have been searching for the right med and haven't wimped out like me. My husband is a wonderful man, but he is skeptical. I really was functioning pretty well over the last few years, at least on the face of things. And the weight is big issue. I weigh over 100 lbs more than I did when we married, and he loves me, but I am pushing it. So I cannot even see using a typical mood stabilizer.
I am printing your post and will try lamactil before giving up.Thank you so much for responding.
I feel very alone, and even though a diagnosis with treatment that worked would be welcomed, not everyone wants to hear your new diagnosis....and if i do have any "manic" symptoms, sharing too much with people would be up there.
Thanks again for the shot of courage....
This is the end of the thread.
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