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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by KarenRB53 on June 27, 2016, at 17:35:20
After taking antidepressants for over 20 yrs, Celexa the last 8 yrs...my doc had me taper off slowly and now it's been about 3 months with just Ativan prn. No depression so dr said this is an indication of bipolar2 as instead of becoming depressed without meds...I'm actually going the other way. In no way am I manic however do have more motivation, etc. So he wants me to go on a mood stabilizer...Gabapentin. Kind of wary as I think I'm ok but he wants me to try it. Any opinions or info on taking Gabapentin for bipolar2 appreciated.
Posted by linkadge on June 27, 2016, at 19:14:58
In reply to Gabapentin for Bipolar2, posted by KarenRB53 on June 27, 2016, at 17:35:20
SSRI withdrawl is commonly associated with mania (euphoric or dysphoric). Also, as SSRIs typically cause initial tiredness / apathy, coming off them can improve energy levels.
As serotonin levels decrease, dopamine levels can rebound causing some bipolar like symtpoms.
You might wish to come off the SSRI more slowly (depending what your symptoms are) before going on a mood stabilizer.
Gabapentin is not really a mood stabilizer.
Lithium, depakote, tegretol and lamotringe are really the only primary mood stabilizers with evidence of efficacy.
Linkadge
Posted by KarenRB53 on June 27, 2016, at 19:44:33
In reply to Re: Gabapentin for Bipolar2, posted by linkadge on June 27, 2016, at 19:14:58
In your opinion how long approximately does it take for the side effects of stopping antidepressants to pass? I realize everyone is different. Also, is it common to have vision problems for so long after tapering off antidepressants? I still have blurry vision and eyes just seem funny.
I have read that Gabapentin is not a mood stabilizer and I think that's why miso hesitant in taking it. Thanks for sharing information.
Karen
Posted by Christ_empowered on June 28, 2016, at 7:54:29
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 27, 2016, at 19:44:33
hi. welcome to babble!
gabapentin was all the rage for bipolar II in years past. Turns out...while it was on patent, the company illegally promoted "off label" uses heavily, especially in psychiatric indications. If I recall correctly, the company paid a huge $ettlement to the gov't for illegal behavior. And yet...
...the prescribing continues, lol. I take low dose (100mgs) as needed gabapentin on top of more standard meds for Bipolar I. I rarely need it. When I do...it helps, but just as a mild sedative.
Gabapentin might help your anxiety. Some docs are using gabapentin and the new super-neurontin, Lyrica, instead of benzodiazepines. I think Lyrica has better and more data on its use in anxiety.
You might want to consider a 2nd opinion ((I think)), if your insurance will cover it. Psychiatry is so subjective, and so many variables aside from your actual problems often go into diagnosis+treatment.
Hope this helps.
Posted by Tabitha on June 28, 2016, at 12:34:45
In reply to Gabapentin for Bipolar2, posted by KarenRB53 on June 27, 2016, at 17:35:20
> After taking antidepressants for over 20 yrs, Celexa the last 8 yrs...my doc had me taper off slowly and now it's been about 3 months with just Ativan prn. No depression so dr said this is an indication of bipolar2 as instead of becoming depressed without meds...I'm actually going the other way. In no way am I manic however do have more motivation, etc. So he wants me to go on a mood stabilizer...Gabapentin. Kind of wary as I think I'm ok but he wants me to try it. Any opinions or info on taking Gabapentin for bipolar2 appreciated.
Speaking as a bipolar II, I'm not sold on gapapentin as a mood stabilizer. Like others I have the impression it was a fad that passed after it was found to be not as effective as claimed. As I recall the excitement was that it might work as well as depakote and tegretol but without the side effects. Nowadays they say the same about lamotrigine. I was on gabapentin for a year or so, in combo with other meds. It was a pretty low dose and I honestly don't remember whether it helped or not.
I'm a little confused about your pdoc's reasoning. So if you're OK without your SSRI drug, how does that translate into saying you have bipolar II? Bipolar II symptoms are mood swings from depression to hypomania, without true mania. Another indicator is that SSRI drugs tend to induce mania. What you're describing sounds more like you had an episode of depression that hasn't recurred after stopping SSRI, and you're having ongoing anxiety. I am just not understanding why your pdoc wants to add a mood stabilizer at all right now.
Posted by KarenRB53 on June 28, 2016, at 15:56:26
In reply to Re: Gabapentin for Bipolar2 » KarenRB53, posted by Tabitha on June 28, 2016, at 12:34:45
I have had depression most of my life and I've been on antidepressants for over 25 yrs. Prozac was first one and because it "lifted " me...it was like a miracle really. Looking back, i was probably hypo manic. My friends said I was like a different person! Anyway, I thought it was great at the time and it worked for me for aboutb5 yrs or so. I did use Buspar at times because I was a little too excitable and impulsive. So on it went, trying to find an antidepressant that would work as well as the Prozac but never did. Anyway, about 3 or 4 months ago, after being on Celexa..I asked my dr if I could try Prozac again as Celexa just kind of kept me going...well he put me on Prozac and I tapered off Celexa and the Prozac didn't make any difference so we agreed that I'd get off both, just use Ativan prn and get it out of my system. So, here we are..it's been over 3 months without antidepressants and even though I'm very emotional I'm not depressed so he said he thinks I'm bipolar2..(my sister was bipolar, committed suicide and my father was bipolar or manic depressive as it was called then. So..Gabapentin! Or a mood stabilizer is what he thinks is what I should be on now. No more antidepressants. Sorry to go on like this but wanted to explain.
Posted by Christ_empowered on June 28, 2016, at 16:30:51
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 15:56:26
hi. gabapentin is probably more tolerable than most mood stabilizers, but...my personal experience has been that it helps agitation and anxiety, not so much with keeping mood swings under control.
Posted by linkadge on June 28, 2016, at 18:32:16
In reply to Re: Gabapentin for Bipolar2, posted by Christ_empowered on June 28, 2016, at 16:30:51
Hey,
It really depends on how your moods were on antidepressants and before antidepressants. Antidepressant withdrawal can produce many symptoms resembling bipolar, including:
- mood instability
- anger, irritability, rage attacks
- increase in energy
- paranoia
- insomniaComing off celexa, I was very abrupt, snapping at people, breaking things and started to have some paranoid thoughts (which I have not had before or since).
I ended up getting diagnosed as bipolar and put on lithium, which helped to some extent. Lithium alone (at a therapeutic dose) ended up producing depression as did tegretol and Depakote. We ended up going back on an antidepressant with some lithium which worked fairly well.
I would say that (depending on how quickly you came off the SSRI) withdrawal could last a few weeks to a few months. If you've been on SSRIs for years, however, it can take years to adjust to not being on them.
If you want to go the bipolar route, then choose a proven treatment for bipolar lithium --> Depakote --> tegretol --> lamotrigine --> olanzapine etc.
The problem with taking one of these other unproven anticonvulsants for bipolar, is that you may not get a clear idea of whether you are bipolar. For people with bipolar, approved mood stabilizers usually work well enough for people to recognize they really do have bipolar.
Linkadge
Posted by KarenRB53 on June 28, 2016, at 18:36:50
In reply to Re: Gabapentin for Bipolar2, posted by Christ_empowered on June 28, 2016, at 16:30:51
Since being off antidepressants I've had no depression, however, am very emotional, agitated and anxious. Ativan helps for sure but I use that prn and don't ever take more than 1 1/2 mg daily. I'm scared of side effects as I'm very sensitive to meds. Could the agitation, anxiety and being emotional actually be indications that I need mood stabilizers? I appreciate the responses and information and opinions I've received so much!
Karen
Posted by Christ_empowered on June 28, 2016, at 18:51:39
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 18:36:50
mood stabilizers could make you less agitated and emotional. I don't know if gabapentin would do the job, but it is more tolerable than a lot of the other options.
If gabapentin doesn't work well, my personal advice ((if you want to take this class of meds)) would be lamictal.
Posted by linkadge on June 28, 2016, at 19:09:18
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 18:36:50
For many people, SSRIs act more as emotional anesthetics than antidepressants. It depends on how long you've been off. Its not uncommon for people to feel "better" (mood wise) when they come off antidepressants only to have it slowly dissolve into a host of other symptoms.
Now it could be that you are bipolar, but I just wanted to make the point that coming off AD's can throw the brain chemistry for a ride which can resemble many other illnesses. Not everyone coming off the drugs immediately lapses back into depression.
>Could the agitation, anxiety and being emotional >actually be indications that I need mood >stabilizers?
Possibly, but not necessarily. Again, if you stopped SSRI's recently (within say 2-4 months), then you may need more time to really tell. SSRI withdrawal can often involve the symptoms you describe: anxiety, agitation, heightened emotional responses. SSRIs often dampen emotional range, and so coming off them can do the opposite.
You could retest by going back on a small amount of SSRI. If it improves things, it might be a sign that your brain is still adjusting to not being on an SSRI.
You can certainly try mood stabilizers (with your doctors supervision, of course), but I recommend going slow and recognizing that there could be different forces at work.
Bipolar II can be difficult to diagnose and doesn't always work the way regular bipolar works.
For instance...here is a study suggesting that long term prozac was actually effective in controlling both depression and mania in BP II.
http://www.goodtherapy.org/blog/prozac-bipolar-II-relapse-prevention-071012
Being sensitive to meds myself, I have found that I need to go much slower (going on and coming off) that I need to move in very small doses and that I need to listen to how meds are affecting me.
Linkadge
Posted by KarenRB53 on June 28, 2016, at 20:09:21
In reply to Re: Gabapentin for Bipolar2, posted by linkadge on June 28, 2016, at 19:09:18
Thank you all for the great information and suggestions. I am going to give it more time to see how I feel before doing anything else or starting on any new meds. I will post my progress or whatever to share with others who may go through same thing. This has been so helpful!
Karen
Posted by Tabitha on June 28, 2016, at 20:37:45
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 15:56:26
> I have had depression most of my life and I've been on antidepressants for over 25 yrs. Prozac was first one and because it "lifted " me...it was like a miracle really. Looking back, i was probably hypo manic. My friends said I was like a different person! Anyway, I thought it was great at the time and it worked for me for aboutb5 yrs or so. I did use Buspar at times because I was a little too excitable and impulsive. So on it went, trying to find an antidepressant that would work as well as the Prozac but never did. Anyway, about 3 or 4 months ago, after being on Celexa..I asked my dr if I could try Prozac again as Celexa just kind of kept me going...well he put me on Prozac and I tapered off Celexa and the Prozac didn't make any difference so we agreed that I'd get off both, just use Ativan prn and get it out of my system. So, here we are..it's been over 3 months without antidepressants and even though I'm very emotional I'm not depressed so he said he thinks I'm bipolar2..(my sister was bipolar, committed suicide and my father was bipolar or manic depressive as it was called then. So..Gabapentin! Or a mood stabilizer is what he thinks is what I should be on now. No more antidepressants. Sorry to go on like this but wanted to explain.
Thanks for the details, now your dx makes more sense. I'm very sorry about your sister. I had the same situation with my mom. :-(
We've had a lot of similar med experiences, too. I understand why your pdoc wants you on a mood stabilizer, so you don't get another recurrence. Maybe s/he is planning to try the ones with least side effects first, then keep going until they find one that works. My most recent pdoc started me on lamotrigine, then when that seemed to poop out, added lithium. I'm really noticing an improvement with the lithium, although I got tremors from it.
I was also on an SNRI, but am tapering off it. So far so good. If anything I feel calmer without it. All the SSRIs & SNRIs seem to work to lift me out of an episode of depression, but don't work so well for maintenance.
Posted by Horse on June 29, 2016, at 3:56:44
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 15:56:26
My understanding of BPll is that it's not dx'd unless there is an episode of major depresion. At least that's what a few doctors have told me. When you say long standing depression, I wonder if you'd consider your depression as dysthymia. I ask because I am dx'd as BPll as well, and was so during an episode of major depression after a lifetime of dysthymia. Originally I was dx'd with cyclothymia, and I could say I was excitable expressed though way depression, mild hypomania, and most of all, anxiety. In some ways, I consider the rugged, quick mood changes the most impairing. The greatest relief for this symptom has been Lamictal (lamotrigine). Gabapentin could be useful as stress relief, but personally I doubt it'd help beyond that for BPll. This is all my biased opinion based on experience and a little reading, but I thought to share for what it's worth.
> I have had depression most of my life and I've been on antidepressants for over 25 yrs. Prozac was first one and because it "lifted " me...it was like a miracle really. Looking back, i was probably hypo manic. My friends said I was like a different person! Anyway, I thought it was great at the time and it worked for me for aboutb5 yrs or so. I did use Buspar at times because I was a little too excitable and impulsive. So on it went, trying to find an antidepressant that would work as well as the Prozac but never did. Anyway, about 3 or 4 months ago, after being on Celexa..I asked my dr if I could try Prozac again as Celexa just kind of kept me going...well he put me on Prozac and I tapered off Celexa and the Prozac didn't make any difference so we agreed that I'd get off both, just use Ativan prn and get it out of my system. So, here we are..it's been over 3 months without antidepressants and even though I'm very emotional I'm not depressed so he said he thinks I'm bipolar2..(my sister was bipolar, committed suicide and my father was bipolar or manic depressive as it was called then. So..Gabapentin! Or a mood stabilizer is what he thinks is what I should be on now. No more antidepressants. Sorry to go on like this but wanted to explain.
Posted by Horse on June 29, 2016, at 3:59:43
In reply to Re: Gabapentin for Bipolar2, posted by linkadge on June 28, 2016, at 19:09:18
Interesting link and information as well as points of view. Thank you :)
> For many people, SSRIs act more as emotional anesthetics than antidepressants. It depends on how long you've been off. Its not uncommon for people to feel "better" (mood wise) when they come off antidepressants only to have it slowly dissolve into a host of other symptoms.
>
> Now it could be that you are bipolar, but I just wanted to make the point that coming off AD's can throw the brain chemistry for a ride which can resemble many other illnesses. Not everyone coming off the drugs immediately lapses back into depression.
>
> >Could the agitation, anxiety and being emotional >actually be indications that I need mood >stabilizers?
>
> Possibly, but not necessarily. Again, if you stopped SSRI's recently (within say 2-4 months), then you may need more time to really tell. SSRI withdrawal can often involve the symptoms you describe: anxiety, agitation, heightened emotional responses. SSRIs often dampen emotional range, and so coming off them can do the opposite.
>
> You could retest by going back on a small amount of SSRI. If it improves things, it might be a sign that your brain is still adjusting to not being on an SSRI.
>
> You can certainly try mood stabilizers (with your doctors supervision, of course), but I recommend going slow and recognizing that there could be different forces at work.
>
> Bipolar II can be difficult to diagnose and doesn't always work the way regular bipolar works.
>
> For instance...here is a study suggesting that long term prozac was actually effective in controlling both depression and mania in BP II.
>
> http://www.goodtherapy.org/blog/prozac-bipolar-II-relapse-prevention-071012
>
> Being sensitive to meds myself, I have found that I need to go much slower (going on and coming off) that I need to move in very small doses and that I need to listen to how meds are affecting me.
>
> Linkadge
>
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Posted by herpills on June 29, 2016, at 10:53:30
In reply to Re: Gabapentin for Bipolar2, posted by linkadge on June 28, 2016, at 19:09:18
Posted by herpills on June 29, 2016, at 10:57:03
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 20:09:21
> Thank you all for the great information and suggestions. I am going to give it more time to see how I feel before doing anything else or starting on any new meds. I will post my progress or whatever to share with others who may go through same thing. This has been so helpful!
>
> KarenI think that sounds reasonable, a wait a see approach if you feel you have things under control...I agree with others gabapentin doesn't make the most sense, I'd go with Lyrica if you're looking for something to help anxiety, I think it helps depression as well. Lamotrigine is good but not that strong, if you're having a severe depression it usually needs antidepressant therapy, whether it's unipolar or bipolar depression...
Posted by SLS on June 29, 2016, at 13:57:48
In reply to good post Re: Gabapentin for Bipolar2 (nm) » linkadge, posted by herpills on June 29, 2016, at 10:53:30
Posted by Phillipa on June 29, 2016, at 22:09:16
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 28, 2016, at 15:56:26
Maybe just the benzos for anxiety. Depression doesn't have to last forever. Maybe that aspect is now gone? I'm all the way anxiety. Benzos for me. Phillipa
Posted by KarenRB53 on June 30, 2016, at 11:13:24
In reply to Re: Gabapentin for Bipolar2 » KarenRB53, posted by Phillipa on June 29, 2016, at 22:09:16
> Maybe just the benzos for anxiety. Depression doesn't have to last forever. Maybe that aspect is now gone? I'm all the way anxiety. Benzos for me. Phillipa
I do have a lot of anxiety...always have. Ativan works well for me but have to say with being off all antidepressants ....I feel the need to take Ativan more often. Usually I was taking 1mg at night and 1/2 mg during the day if needed. Definitely need to take the 1/2 during the day now. Does anyone take benzodiazepines regularly...say ...every 6 hrs or so. On a schedule kind of? I've tried longer lasting clonazepam...doesn't work for me.
Posted by Christ_empowered on June 30, 2016, at 15:03:10
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 30, 2016, at 11:13:24
hi. have you tried valium or xanax xr? Nothing wrong with ativan, just...valium has a longer half life, and the xanax xr is an all day medication. Just some ideas.
I hope gabapentin works for you. Lyrica might be another good option ((just guessing, clearly)).
Posted by Phillipa on June 30, 2016, at 18:45:42
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 30, 2016, at 11:13:24
I used to take them during the day. Now only at night time. As for some reason stopped working and just relaxing me many years ago. I did not increase the dose though. But still take 2.5mg lexapro & 25mg of luvox. Bet if I stopped them with that low doseage wouldn't notice it. Phillipa
Posted by KarenRB53 on June 30, 2016, at 20:14:21
In reply to Re: Gabapentin for Bipolar2, posted by Christ_empowered on June 30, 2016, at 15:03:10
Ok....little concerned because I'm so angry at everything and everyone. Everyday. Re- reading info above...I do realize it could be part of the antidepressants still coming out . Not acting on anger really...well maybe have said a few things I wouldn't normally say to people however even Ativan isn't helping today. Even the TV is making me angry....so sitting quietly trying to be calm. This could just be a bad day, right?
Posted by Christ_empowered on June 30, 2016, at 20:17:40
In reply to Re: Gabapentin for Bipolar2, posted by KarenRB53 on June 30, 2016, at 20:14:21
you're allowed to feel angry and have bad days. I'm glad you have Ativan to smooth out the transition off the antidepressants, especially since you were treated for so long.
As for new meds...that's your call. Personally, I think ((from what very little I know about your situation)) that you might want to completely transition off daily psych meds (except the ativan) and see how you feel. The last thing you'd want to do is over-medicated what might just be normal life issues and emotions.
Posted by KayBee01 on July 24, 2016, at 9:31:29
In reply to Re: Gabapentin for Bipolar2, posted by linkadge on June 28, 2016, at 19:09:18
Hi again...its been just over 4 months now that I've stopped SSRI's completely. Doing okay as far as depression goes. Did not start on Gabapentin and only take ativan prn. I'm having vision problems..very blurry eyesight and eyes feel very strained, also balance off when walking. Are these side effects of coming off SSRI's completely? My dr is very vague when I asked him. Again, thanks for any information.
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