Posted by Lorelai on September 16, 2002, at 9:00:14
In reply to Re: Need advice: meds for bipolar rapid cycling » lorelai, posted by Ritch on September 15, 2002, at 11:38:12
Hi, Lorelai,
>
> Topamax tends to cause some weight loss, and you can get away with once nightly dosing (which is what I like the best about it), BUT, the cognitive side-effects are kind of nasty for some folks, but many have reported them to slowly fade over weeks (once you reach a target dose). I got up to just 50mg/day and couldn't wait out the cog sfx because of my job (I was taking TOP for probably a couple of months total-and titrating the dose upwards, too). It seemed to be a pretty powerful antimanic agent, though. I slept like a log on it after a nightime dose, too. Maybe you could start 25mg at nightime and see how it goes? Neurontin didn't seem to cause weight gain or loss. It worked the best for anxiety associated with dysphoric hypomania/agitated bipolar depression. I don't like needing to take something 3-4x daily, though. If you take it less often than 3x daily, you may notice some agitative rebound/OCD-like effects when the med is leaving your system. If you don't crank the dose up too high at first-the cognitive sfx from it were fairly mild in my experience. It didn't adversely effect my work performance unless I was above 1200mg/day. You might find that going back on Depakote and adding thyroid hormone might prevent weight gain (but that's just a theory). I have a super-conservative thyroid-doc who doesn't like the idea (because of paranoia over bone-density loss), and my pdoc doesn't want that conflict with my internist, so no T4 for me. So, I have got to swap Tdocs. I rapid cycle every 3 weeks chronically, no full blown manias. I think it would be helpful.
>
> hope this has been of some help,
>
> Mitch
**Mitch,
Thanks for the reply--I appreciate it! My pdoc's having a tough time with me, I think, because I seem to have such adverse reactions to everything we try. I don't get this, really, because as a teen I did a wide range of drugs on a near-daily basis (trying to self-medicate, I suppose the shrinks would say, though at the time I thought I was just having fun) and was always one of those people who could maintain control, drive a car, function in school, etc., no matter what drug I was on. So it doesn't make sense to me that as an adult my system is so delicate. Neurontin is my pdoc's latest suggestion, but I hadn't realized I'd have to take it 3 or 4 times a day??? Guess I'd better do some indepth digging, reading around. The idea of bone density loss might be a big problem for me since I'm of Asian descent (more prone to osteoporosis, or so I've heard), so the Depakote/thyroid hormone route doesn't sound like an option. I'm just starting a new job tomorrow and don't like the idea of anything messing with my ability to think (I have bad memories of starting out a new job and having my boss think I was some sort of moron because a couple of weeks into the job I was starting a new med--and I guess I SEEMED like a moron. I stopped the med and she probably thought I'd suddenly grown some brains, lol), so that seems to rule out Topamax, though maybe if I take tiny increments and let my system build up to it slowly...Well, I'll discuss all this with my pdoc on the 24th and see if she has any other ideas. It'd be ideal, of course, to simply not take anything. But, as I'm finding, pretty unrealistic. *sigh*
Best,
Lorelai
poster:Lorelai
thread:119887
URL: http://www.dr-bob.org/babble/20020914/msgs/119997.html