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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by brynb on March 22, 2013, at 8:01:40
I'm at my wit's end with constant irritability and moodiness. It seems completely separate from my depression, and no med has come close to touching it.
I'm currently doing Ketamine treatments, taking Lexapro 20 mg and Valium. For a variety of reasons and SEs, I can't take AAPs, mood stabilizers or Lithium.
I'd love any feedback on how I can address this. My pdoc has tried to, but his response is usually an AAP which is a big no-no for me.
Maybe I need an AD change? Mostly, though, anything that hits norepinephrine makes me worse.
Thanks in advance.
-b
Posted by Phillipa on March 22, 2013, at 9:48:48
In reply to Irritability, posted by brynb on March 22, 2013, at 8:01:40
Lexapro not working? Isn't the valium helping? In all seriousness think weather involved. Phillipa
Posted by Sheilac on March 22, 2013, at 13:43:49
In reply to Re: Irritability » brynb, posted by Phillipa on March 22, 2013, at 9:48:48
I know you said no mood stabilizers, but have you tried just a small dose of something mild like Trileptal? I'm just on 600mg.
In the past ADs have made me really irritable. I can tolerate them better with a combo Klonopin and Trileptal.
Maybe your body has gotten used to the Valium dosage? Or maybe a different med like Ativan, Xanax XR or something would help.
With me, my depression or hypomania often results in irritability. It's terrible.
Hope you feel better soon.
Posted by rjlockhart37 on March 22, 2013, at 16:17:50
In reply to Irritability, posted by brynb on March 22, 2013, at 8:01:40
an easy thing is Vistiril....or switching to Ativan. Depakote would help due to the reduced electrical firing in the brain.
Posted by tensor on March 22, 2013, at 17:07:02
In reply to Irritability, posted by brynb on March 22, 2013, at 8:01:40
> I'm at my wit's end with constant irritability and moodiness. It seems completely separate from my depression, and no med has come close to touching it.
>
> I'm currently doing Ketamine treatments, taking Lexapro 20 mg and Valium. For a variety of reasons and SEs, I can't take AAPs, mood stabilizers or Lithium.
>
> I'd love any feedback on how I can address this. My pdoc has tried to, but his response is usually an AAP which is a big no-no for me.
>
> Maybe I need an AD change? Mostly, though, anything that hits norepinephrine makes me worse.
>
> Thanks in advance.
>
> -b
>
>Hyperthyroidism checked?
You can't take Lamictal?
Raise dose of Lexapro or switch to another SSRI.
Tried alpha/beta blockers?
/tensor
Posted by brynb on March 22, 2013, at 17:20:22
In reply to Re: Irritability » brynb, posted by tensor on March 22, 2013, at 17:07:02
Thanks all for the feedback thus far. I might look in to adding Visteral (I've taken it before), though I've been told that over time it can worsen irritability.
Thanks again.
Posted by brynb on March 22, 2013, at 17:23:41
In reply to Re: Irritability » brynb, posted by tensor on March 22, 2013, at 17:07:02
> Hyperthyroidism checked?
>
> You can't take Lamictal?
>
> Raise dose of Lexapro or switch to another SSRI.
>
> Tried alpha/beta blockers?
>
> /tensorhi tensor-
my thyroid was checked and is fine.
i can't take lamictal--it makes me very flat and very depressed (most stabilizers do).
i've taken beta blockers before, but not regularly. perhaps on a regular basis they would help.
thanks again.
b
Posted by b2chica on March 25, 2013, at 13:47:18
In reply to Irritability, posted by brynb on March 22, 2013, at 8:01:40
Posted by Hugh on March 26, 2013, at 13:52:32
In reply to Irritability, posted by brynb on March 22, 2013, at 8:01:40
The muscle relaxant baclofen eliminated my irritability, depression, anxiety. It acts on the GABA-B receptor, so I don't know if it would be safe to take with Valium, since benzos act on the GABA-A receptor. Baclofen increases striatal levels of dopamine. Maybe this is why it made me so happy, and why it started to cause terrible insomnia after a week. I'm hypersensitive to many drugs, especially stimulants.
Posted by brynb on April 5, 2013, at 8:30:42
In reply to Re: Irritability, posted by Hugh on March 26, 2013, at 13:52:32
> The muscle relaxant baclofen eliminated my irritability, depression, anxiety. It acts on the GABA-B receptor, so I don't know if it would be safe to take with Valium, since benzos act on the GABA-A receptor. Baclofen increases striatal levels of dopamine. Maybe this is why it made me so happy, and why it started to cause terrible insomnia after a week. I'm hypersensitive to many drugs, especially stimulants.
Thanks, Hugh. You always offer valuable information. I've heard this before too and will ask my pdoc about it.
Thanks again.
-b
Posted by Phillipa on April 5, 2013, at 20:09:56
In reply to Re: Irritability » Hugh, posted by brynb on April 5, 2013, at 8:30:42
Brynb how are things going? Phillipa
Posted by Hugh on April 6, 2013, at 10:48:38
In reply to Re: Irritability » Hugh, posted by brynb on April 5, 2013, at 8:30:42
Hi Bryn,
You're welcome. And thanks for the kind words.
Since baclofen increases dopamine levels, and since you think you may be bipolar, it's possible that baclofen could cause mania. But you've said that you do poorly on antipsychotics, which block dopamine.
Posted by brynb on April 6, 2013, at 17:50:41
In reply to Re: Irritability » brynb, posted by Hugh on April 6, 2013, at 10:48:38
Hugh,
Does Baclofen work similarly to Neurontin? I didn't think so, as I thought Neurontin didn't actually work on GABA. I only ask because Neurontin makes me textbook manic, and I'd hate to risk that reaction with Baclofen.
Thanks,
b
Posted by Hugh on April 6, 2013, at 18:43:48
In reply to Re: Irritability » Hugh, posted by brynb on April 6, 2013, at 17:50:41
> Hugh,
>
> Does Baclofen work similarly to Neurontin? I didn't think so, as I thought Neurontin didn't actually work on GABA. I only ask because Neurontin makes me textbook manic, and I'd hate to risk that reaction with Baclofen.
>
> Thanks,
> bI took Neurontin for about a month at a very low dose and it didn't make me manic, but nothing ever has. It made me feel calm and, after a while, depressed. Baclofen didn't make me feel wired, but very positive and alert, even at 3:00 am after taking 10 mg of Ambien. Ambien normally knocks me out, but it didn't make a dent in baclofen, and I had been up for over fifty hours straight when I decided I had to stop taking it. Until this point, baclofen had given me one of the best weeks of my life.
I know that Neurontin has something to do with GABA, but I don't think they're sure how it works. According to Olivier Ameisen, baclofen and GHB are the only two GABA-B agonists.
Posted by brynb on April 6, 2013, at 19:10:40
In reply to Re: Irritability, posted by Hugh on April 6, 2013, at 18:43:48
Thanks. I didn't think they were structurally similar.
While I don't love the idea of something that will make my insomnia worse, the idea that it could help with anxiety and irritability is very enticing.
I'm also entertaining the idea of going back on a low-dose of Tramadol; it helped me greatly at one point. Getting your pdoc to be onboard with out of the box meds or "non-psychotropics" is another story, though.
Thanks, Hugh.
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