![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by nmk on May 27, 2003, at 18:43:09
All you BP's out there, please help me with a question. Have been doing alot of reading lately and many doc's have stated that AD's should be used cautiously with BP I and II. Some say that if used, they should be administered in small doses while some say a mood stabilizer should be used solo.
Has the combo of an ssri/snri with a mood stabilizer worked for you guys or is better to try the mood stabilizer solo?
My current combo of 18mg strattera, 50 mg zoloft, and 1200mg of Trileptal isn't working and I am cycling frequently. I don't know if I should ask my pdoc to eliminate the AD's or simply increase the trileptal.
Any thoughts, advice would be appreciated.
Thanks,
Nicole
Posted by ST on May 27, 2003, at 19:40:53
In reply to Should BP II's nix the AD's?, posted by nmk on May 27, 2003, at 18:43:09
Hi,
In my situation, I was rarely manic or hypomanic when unmedicated. But my doctors were so scared to give me very much of an AD that I spent years "medicated", yet severely deprssed because of lack of an AD, or lack of the correct one(s). I finally figured out for myself what the best combo for me is: less of my Depakote and more of an AD, actually two of them instead of one.I'm on 500 mg of Depakote, 350 Wellbutrin and 250 Serzone.
Now, your situation, I'm sure, is different.
Do you become hypomanic frequently when you cycle? If so, your doctors may be correct in being cautious about an AD. When were you first diagnosed and put on medication? Do you notice the Zoloft making you ancy or agitated at all? (I don't recognize the other meds)
I've seen BPIIs going without an AD and, in my opinion, I think it's tragic. Doctors work SO hard to keep us from getting manic that they forget we'd also like not to feel depressed.
Good luck!
ST
Posted by Ritch on May 27, 2003, at 23:08:14
In reply to Should BP II's nix the AD's?, posted by nmk on May 27, 2003, at 18:43:09
> All you BP's out there, please help me with a question. Have been doing alot of reading lately and many doc's have stated that AD's should be used cautiously with BP I and II. Some say that if used, they should be administered in small doses while some say a mood stabilizer should be used solo.
>
> Has the combo of an ssri/snri with a mood stabilizer worked for you guys or is better to try the mood stabilizer solo?
>
> My current combo of 18mg strattera, 50 mg zoloft, and 1200mg of Trileptal isn't working and I am cycling frequently. I don't know if I should ask my pdoc to eliminate the AD's or simply increase the trileptal.
>
> Any thoughts, advice would be appreciated.
>
> Thanks,
>
> NicoleNicole, FIRST, find out *which* antimanic agent actually works the best for you (lithium, Teg, Trileptal, Depakote, etc.) The reason I say that is it could be possible that the Trileptal isn't doing diddly-squat for you. Just because it is *supposed* to work-doesn't mean that it will. Some of the newer AED's can actually trigger mania. After you figure that one out, then work on what antidepressants and what dosages are tolerable and workable.
Posted by nmk on May 28, 2003, at 14:38:14
In reply to Re: Should BP II's nix the AD's?, posted by ST on May 27, 2003, at 19:40:53
> Hi,
> In my situation, I was rarely manic or hypomanic when unmedicated. But my doctors were so scared to give me very much of an AD that I spent years "medicated", yet severely deprssed because of lack of an AD, or lack of the correct one(s). I finally figured out for myself what the best combo for me is: less of my Depakote and more of an AD, actually two of them instead of one.I'm on 500 mg of Depakote, 350 Wellbutrin and 250 Serzone.
> Now, your situation, I'm sure, is different.
> Do you become hypomanic frequently when you cycle? If so, your doctors may be correct in being cautious about an AD. When were you first diagnosed and put on medication? Do you notice the Zoloft making you ancy or agitated at all? (I don't recognize the other meds)
> I've seen BPIIs going without an AD and, in my opinion, I think it's tragic. Doctors work SO hard to keep us from getting manic that they forget we'd also like not to feel depressed.
> Good luck!
> ST
Thanks ST for your response. My pattern is typically 2 weeks of feeling "normal" followed by 2 weeks of depression, agitation, and anxiety. These cycles typically correspond with my monthly cycle (aren't you glad you asked?). I don't know if I experience true hypomania and am confused between this state and one of feeling energized, focused, less depressed, etc. I only recently started the mood cycling after my 2nd bout with postpartum depression, approx. 1 1/2 years ago.
I hope I can eventually get to where you are... a fine balance between all of the meds.Nicole
Posted by nmk on May 28, 2003, at 15:29:44
In reply to Re: Should BP II's nix the AD's? » nmk, posted by Ritch on May 27, 2003, at 23:08:14
> >
> > >
> Nicole, FIRST, find out *which* antimanic agent actually works the best for you (lithium, Teg, Trileptal, Depakote, etc.) The reason I say that is it could be possible that the Trileptal isn't doing diddly-squat for you. Just because it is *supposed* to work-doesn't mean that it will. Some of the newer AED's can actually trigger mania. After you figure that one out, then work on what antidepressants and what dosages are tolerable and workable.Thanks Mitch for your advice...as always it is greatly appreciated. I like your approach and will work with my doc in finding the right AED first. Just a few more questions, please, please...(you should charge a fee you know):)
*I have been on Trileptal 1200 mg for about six weeks now. Would you consider this a fair trial and is it time to move on?
*What about increasing the Trileptal? (my doc says some of his pts. are at a much higher dose). Since I am at such a high dose now I don't know if it is futile to play the waiting game with a higher dose. Plus, I don't know if my tummy could take it.
*Is there an AED that is better suited for rapid cycling?
*Is there an AED that has been known to have more antidepressant qualities that others? What about anxiety?
*Just to play devil's advocate...you suggested to find the right AED before messing with the AD's, right? How will I know if the Trileptal would have worked without my current AD's or with different ones?
Sorry again for the barrage of questions. My pdoc hasn't returned my call and I don't see him for another week.
Take care,
Nicole
Posted by Ritch on May 28, 2003, at 22:31:25
In reply to Re: A few more questions Mitch » Ritch, posted by nmk on May 28, 2003, at 15:29:44
> > >
> > > >
> > Nicole, FIRST, find out *which* antimanic agent actually works the best for you (lithium, Teg, Trileptal, Depakote, etc.) The reason I say that is it could be possible that the Trileptal isn't doing diddly-squat for you. Just because it is *supposed* to work-doesn't mean that it will. Some of the newer AED's can actually trigger mania. After you figure that one out, then work on what antidepressants and what dosages are tolerable and workable.
>
> Thanks Mitch for your advice...as always it is greatly appreciated. I like your approach and will work with my doc in finding the right AED first. Just a few more questions, please, please...(you should charge a fee you know):)
>
> *I have been on Trileptal 1200 mg for about six weeks now. Would you consider this a fair trial and is it time to move on?
>
> *What about increasing the Trileptal? (my doc says some of his pts. are at a much higher dose). Since I am at such a high dose now I don't know if it is futile to play the waiting game with a higher dose. Plus, I don't know if my tummy could take it.
>
> *Is there an AED that is better suited for rapid cycling?
>
> *Is there an AED that has been known to have more antidepressant qualities that others? What about anxiety?
>
> *Just to play devil's advocate...you suggested to find the right AED before messing with the AD's, right? How will I know if the Trileptal would have worked without my current AD's or with different ones?
>
> Sorry again for the barrage of questions. My pdoc hasn't returned my call and I don't see him for another week.
>
> Take care,
>
> Nicole
Nicole, your "devil's advocate" question is the best one. I thought about reposting after I submitted my response because of that. The antidepressants could definitely be wigging you out. It just seemed like 1200mg was a LOT of Trileptal (for *me* it would be-but that's different), so..therefore, etc., made me think that the Trileptal wasn't exerting much of an antimanic or anticycling effect. The Straterra doesn't sound like much at 18mg, but Zoloft inhibits liver enzymes which would tend to increase the Straterra. Also, the most Zoloft I could ever stand (despite finding it a very effective and useful med however) was 25mg/day and that was only for about a week. I was on just 12.5mg/day for many months. Maintenance-wise I could bet by on 12.5mg every third day... SOOOOO, the first most logical thing would be to back off the last med add-on you tried before everything started to get haywire-was it the Straterra? If so, maybe drop it to those 10mg tabs and see if things get better. Zoloft-wise you might cut the dose in half. IOW, leave the Trileptal the same and just cut either the Straterra or Zoloft in half (preferably the last one you added or increased) and see what happens. If you feel stable enough to be a guinea pig! Then you could see if it helps-if not-then look at the Trileptal and assess what merit it has. good luck-Mitch
Posted by McPac on May 29, 2003, at 19:57:35
In reply to Re: Should BP II's nix the AD's?, posted by ST on May 27, 2003, at 19:40:53
"I've seen BPIIs going without an AD and, in my opinion, I think it's tragic. Doctors work SO hard to keep us from getting manic that they forget we'd also like not to feel depressed".
EXACTLY!!
Posted by Ron Hill on May 30, 2003, at 2:13:32
In reply to Should BP II's nix the AD's?, posted by nmk on May 27, 2003, at 18:43:09
Hi Nicole,
> All you BP's out there, please help me with a question. Have been doing alot of reading lately and many doc's have stated that AD's should be used cautiously with BP I and II. Some say that if used, they should be administered in small doses while some say a mood stabilizer should be used solo.
Perhaps you have already seen this, Nicole, but I'll post it just in case you haven't run across it in your superhighway travels. It is on Dr. Phelps' web site and it discusses the AD controversy for BP patients:
http://www.psycheducation.org/bipolar/controversy.htm
> Has the combo of an ssri/snri with a mood stabilizer worked for you guys or is better to try the mood stabilizer solo?
Over the years I tried almost all of the SSRI/SNRI's as an add-on to a moodstabilizer for treat of the atypical depressive side of my BP II. Unfortunately, each and every time the AD eventually left me in worse shape than I was in without it.
Within hours of taking the first dose, each of the AD's would immediately induce some amount of mild euphoric hypomania (even with the mood stabilizer fully ramped up). This typically lasted a week or so. This hypomanic phase was followed by a week or so of relatively normal mood states. However, shortly thereafter, the AD would begin to adversely affect my dopaminergic pathways and, thereby, cause severe emotional blunting, apathy, anhedonia, anergy, hypersomnia, etc. The resulting AD induced atypical depression was worse than the depression associated with being on just a moodstabilizer.
This put me in a difficult place for several years. I struggled with depression when using just a moodstabilizer, but the situation would become even worse shortly after adding on an AD. Therefore, I turned my attention to supplements for treatment of my depressive side. About 18 months ago, I had good success using 200 mg/day of SAM-e. However, out of the blue after five months of very good results, SAM-e started to induce severe irritability and I pulled the plug on it.
The good news is that, with the help of others on this board, I have found a medication/supplements combo that is currently working incredibly well. I take 600 mg/day of Lithobid for my hypomania, 2.5 mg twice a week of Enada NADH in conjunction with 250 mg/day of TMG to treat the atypical depressive phase of my BP II disorder, and 250 mg/day of niacin to control my dysphoric mood states (irritability). I think the niacin is also helping my depression, but its main function is to control my irritability which it does exceedingly well.
I'll not bore you by listing all of the vitamins, minerals and supplements that I take since they are numerous. However, the ones I mentioned above are the heavy hitters and they are the main contributors to my current good mental health. Magnesium, fish oil, and phosphatidyl serine, are definitely worth honorable mention.
Will it last or will it be like SAM-e and turn against me? My hunch is that this combo will go the distance, but time will tell. If it turns against me, I’ll be back to the drawing board looking for other supplements. But in the meantime, I’m healthy and its time to get after the work that has piled up during my sickness.
My best wishes to you Nicole as you search for a solution to your depressive phase.
-- Ron
Posted by nmk on May 30, 2003, at 9:38:35
In reply to Re: A few more questions Mitch » nmk, posted by Ritch on May 28, 2003, at 22:31:25
Thanks Mitch....I think this is the route I should take since my AD doses are so low and can be tinkered with more easily than messing with the AED's first.
I should have gone to pharmacy school. You are the BEST!!!!
Until the next round of questions,
Nicole:)
Posted by nmk on May 30, 2003, at 9:59:43
In reply to Re: The AD Controversy for BP Patients » nmk, posted by Ron Hill on May 30, 2003, at 2:13:32
> Hi Nicole,
>
> > >
> Perhaps you have already seen this, Nicole, but I'll post it just in case you haven't run across it in your superhighway travels. It is on Dr. Phelps' web site and it discusses the AD controversy for BP patients:
>
> http://www.psycheducation.org/bipolar/controversy.htm
>
> > Has the combo of an ssri/snri with a mood stabilizer worked for you guys or is better to try the mood stabilizer solo?
>
> Over the years I tried almost all of the SSRI/SNRI's as an add-on to a moodstabilizer for treat of the atypical depressive side of my BP II. Unfortunately, each and every time the AD eventually left me in worse shape than I was in without it.
>
> Within hours of taking the first dose, each of the AD's would immediately induce some amount of mild euphoric hypomania (even with the mood stabilizer fully ramped up). This typically lasted a week or so. This hypomanic phase was followed by a week or so of relatively normal mood states. However, shortly thereafter, the AD would begin to adversely affect my dopaminergic pathways and, thereby, cause severe emotional blunting, apathy, anhedonia, anergy, hypersomnia, etc. The resulting AD induced atypical depression was worse than the depression associated with being on just a moodstabilizer.
>
> This put me in a difficult place for several years. I struggled with depression when using just a moodstabilizer, but the situation would become even worse shortly after adding on an AD. Therefore, I turned my attention to supplements for treatment of my depressive side. About 18 months ago, I had good success using 200 mg/day of SAM-e. However, out of the blue after five months of very good results, SAM-e started to induce severe irritability and I pulled the plug on it.
>
> The good news is that, with the help of others on this board, I have found a medication/supplements combo that is currently working incredibly well. I take 600 mg/day of Lithobid for my hypomania, 2.5 mg twice a week of Enada NADH in conjunction with 250 mg/day of TMG to treat the atypical depressive phase of my BP II disorder, and 250 mg/day of niacin to control my dysphoric mood states (irritability). I think the niacin is also helping my depression, but its main function is to control my irritability which it does exceedingly well.
>
> I'll not bore you by listing all of the vitamins, minerals and supplements that I take since they are numerous. However, the ones I mentioned above are the heavy hitters and they are the main contributors to my current good mental health. Magnesium, fish oil, and phosphatidyl serine, are definitely worth honorable mention.
>
> Will it last or will it be like SAM-e and turn against me? My hunch is that this combo will go the distance, but time will tell. If it turns against me, I’ll be back to the drawing board looking for other supplements. But in the meantime, I’m healthy and its time to get after the work that has piled up during my sickness.
>
> My best wishes to you Nicole as you search for a solution to your depressive phase.
>
> -- Ron
>
>Hi Ron,
Thanks so much for your post. Yes, it was Dr. Phelps site and a book by Michael Barto's, M.D. (see link below) that made me question my unresponsiveness to treatment. I have never heard of Enada NADH or TMG in the treatment of depression so I will continue to surf to gather more info. How long has this combo been successful for you? Are you also hypothyroid or is the Lithobid simply a supplement?
Thanks again Ron, I appreciate the information.
Nicole
http://www.amazon.com/exec/obidos/ASIN/0595122094/drbobsvirte00-20
Posted by Ron Hill on May 30, 2003, at 11:10:33
In reply to Re: The AD Controversy for BP Patients » Ron Hill, posted by nmk on May 30, 2003, at 9:59:43
Nicole,
> Are you also hypothyroid or is the Lithobid simply a supplement?
No, Lithobid is my moodstabilizer. It is a slow release lithium product (i.e.; prescription medication).
-- Ron
Posted by nmk on May 30, 2003, at 14:26:56
In reply to Re: The AD Controversy for BP Patients » nmk, posted by Ron Hill on May 30, 2003, at 11:10:33
>
> No, Lithobid is my moodstabilizer. It is a slow release lithium product (i.e.; prescription medication).
>
> -- RonSorry Ron, I had Levothroid on my mind when reading your post. Lithobid, Levothroid....they all start sounding the same after awhile.
Nicole
Posted by Ron Hill on May 30, 2003, at 14:30:53
In reply to Re: The AD Controversy for BP Patients » Ron Hill, posted by nmk on May 30, 2003, at 14:26:56
> Lithobid, Levothroid....they all start sounding the same after awhile.
Yeah, I hear ya Nicole.
-- Ron
Posted by Mama Bear on May 31, 2003, at 18:40:18
In reply to Should BP II's nix the AD's?, posted by nmk on May 27, 2003, at 18:43:09
Nicole I don't really know the answer to your question but I have read conflicting reports about the use of AD's especially ssri AD's. I have heard that too much of an AD can cause you to rapid cycle. I would also like to heare responses in regards to this matter. I have a 5 yr old daughter who was just diagnosed with type 2 bipolar and she is going to be put on lithuim the MS. Good luck and keep us posted
Posted by nmk on June 2, 2003, at 10:25:00
In reply to Re: Should BP II's nix the AD's?, posted by Mama Bear on May 31, 2003, at 18:40:18
I usually don't take med changes into my own hands but since my pdoc is out of town, I decided to try going without the strattera to see what would transpire. It is now day 4 and the depression, agitation, and anxiety have lessened considerably. It is the 50 mg of zoloft and 1200 mg of Trileptal that is keeping me afloat.
I can't help to feel anger about spending the past year going from AD to AD, increasing dosages, combining, etc. , etc.. I clearly expressed to my pdoc my rapid mood cycling and my adverse reactions to AD's but instead of backing down on the AD's, he took the opposite approach.
If I have learned one thing from all of this it is that I must continually remain proactive in my treatment. I am so grateful for this board and for those of you that offer such knowledge and compassion.
Nicole
Posted by Barbara Cat on June 2, 2003, at 11:33:32
In reply to Re: Should BP II's nix the AD's?, posted by Mama Bear on May 31, 2003, at 18:40:18
It depends on the AD. My experience spans the gamut with all the SSRIs and SNRIs which went the typical route of off with a blast, poop out, increase, mania, etc. Figured it might be BPII and started adding lithium - a miracle- but was still having depression (but thank God, not the awful mixed states kind anymore). Added lamictal and still depressed. Having tried all the rest I gave in to my pdocs suggestion and started nortriptyline, a good old TCA from way back. It's been amazingly helpful. Side effects were dry mouth and tremors, but these went away after 2 months.
BTW, I was on Remeron for a while while taking lithium, but it still made me feel awful. Must be something about the mechanics of the SSRI family of meds that are nasty for BPII's. I personally endorse tricyclics if you're BPII and still depressed. Works for me, and I've dubbed by my pdoc as a 'remarkably resistant case'.
Posted by Mama Bear on June 2, 2003, at 12:11:34
In reply to Re: No Strattera...doing better, posted by nmk on June 2, 2003, at 10:25:00
Yes Nicole you definately have to take your own medical circumstances and educate yourself on what it is that is going on with you. Everyone is different. I have a 5 yr old daughter and we have almost had to educate her pediatrician about what is going on with her. It is very difficult to get the proper diagnosis since she is a young child. I have to be her advocate. I am glad to here you are doing better in regards to your BP problems. Some doctors don't like the fact that you are educated in what is going on with you. Some feel that because you are not a medical doctor you don't know what you are talking about. What these doctors fail to realize is that you have the information highway called the internet where you can obtain a wealth of information about your problem and many others that affect us. My daughter's pediatrician did not even realize that use of respirdal can and does cause Tardive Dyskinesia. Can you imagine. We were the ones who had to tell him what was going on with her. Who is the educator now. Me I guess. Don't take any thing lying down and accept what your doctor tells you as the gospel. Medical science is all about opinions when there are no conclusive tests that can prove what is happening with your mental illness. We have to rely on how we feel and what we know. Good luck and you are in my thoughts. Mama Bear
Posted by nmk on June 2, 2003, at 14:16:51
In reply to Re: Should BP II's nix the AD's? - Depends, posted by Barbara Cat on June 2, 2003, at 11:33:32
> It depends on the AD. My experience spans the gamut with all the SSRIs and SNRIs which went the typical route of off with a blast, poop out, increase, mania, etc. Figured it might be BPII and started adding lithium - a miracle- but was still having depression (but thank God, not the awful mixed states kind anymore). Added lamictal and still depressed. Having tried all the rest I gave in to my pdocs suggestion and started nortriptyline, a good old TCA from way back. It's been amazingly helpful. Side effects were dry mouth and tremors, but these went away after 2 months.
>
> BTW, I was on Remeron for a while while taking lithium, but it still made me feel awful. Must be something about the mechanics of the SSRI family of meds that are nasty for BPII's. I personally endorse tricyclics if you're BPII and still depressed. Works for me, and I've dubbed by my pdoc as a 'remarkably resistant case'.
>
>Barbara Cat,
It's funny you mentioned that because I have been dubbed the same by my pdoc. I even saw him pulling at his hair on a few occassions. Oh well, at least I am putting his kids through college with what he makes.
My pattern with AD's is very similar to yours...at first i feel great, then I start to feel agitation/anxiety, followed by a few weeks of a deep depression. Then it all starts over again.
Now you have me curious about the remeron. Currently, I take 15 mg for sleep and am wondering if that is contributing to the rapid cycling. It is such a low dose but I will wait to tinker around with that one until I talk to my doctor.
I am glad you finally found a med combo that works. I am going to see if the Trileptal and zoloft continue to work but if the symptoms persist, I think it is wise to move on to the TCA's.
Thanks Barbara!
Posted by nmk on June 2, 2003, at 14:21:12
In reply to Re: Should BP II's nix the AD's? - Depends, posted by nmk on June 2, 2003, at 14:16:51
> > It depends on the AD. My experience spans the gamut with all the SSRIs and SNRIs which went the typical route of off with a blast, poop out, increase, mania, etc. Figured it might be BPII and started adding lithium - a miracle- but was still having depression (but thank God, not the awful mixed states kind anymore). Added lamictal and still depressed. Having tried all the rest I gave in to my pdocs suggestion and started nortriptyline, a good old TCA from way back. It's been amazingly helpful. Side effects were dry mouth and tremors, but these went away after 2 months.
> >
> > BTW, I was on Remeron for a while while taking lithium, but it still made me feel awful. Must be something about the mechanics of the SSRI family of meds that are nasty for BPII's. I personally endorse tricyclics if you're BPII and still depressed. Works for me, and I've dubbed by my pdoc as a 'remarkably resistant case'.
> >
> >
>
> Barbara Cat,
>
> It's funny you mentioned that because I have been dubbed the same by my pdoc. I even saw him pulling at his hair on a few occassions. Oh well, at least I am putting his kids through college with what he makes.
>
> My pattern with AD's is very similar to yours...at first i feel great, then I start to feel agitation/anxiety, followed by a few weeks of a deep depression. Then it all starts over again.
>
> Now you have me curious about the remeron. Currently, I take 15 mg for sleep and am wondering if that is contributing to the rapid cycling. It is such a low dose but I will wait to tinker around with that one until I talk to my doctor.
>
> I am glad you finally found a med combo that works. I am going to see if the Trileptal and zoloft continue to work but if the symptoms persist, I think it is wise to move on to the TCA's.
>
> Thanks Barbara!
>Oops, forgot to post your name.
Posted by nmk on June 2, 2003, at 14:53:43
In reply to Re: No Strattera...doing better, posted by Mama Bear on June 2, 2003, at 12:11:34
> Yes Nicole you definately have to take your own medical circumstances and educate yourself on what it is that is going on with you. Everyone is different. I have a 5 yr old daughter and we have almost had to educate her pediatrician about what is going on with her. It is very difficult to get the proper diagnosis since she is a young child. I have to be her advocate. I am glad to here you are doing better in regards to your BP problems. Some doctors don't like the fact that you are educated in what is going on with you. Some feel that because you are not a medical doctor you don't know what you are talking about. What these doctors fail to realize is that you have the information highway called the internet where you can obtain a wealth of information about your problem and many others that affect us. My daughter's pediatrician did not even realize that use of respirdal can and does cause Tardive Dyskinesia. Can you imagine. We were the ones who had to tell him what was going on with her. Who is the educator now. Me I guess. Don't take any thing lying down and accept what your doctor tells you as the gospel. Medical science is all about opinions when there are no conclusive tests that can prove what is happening with your mental illness. We have to rely on how we feel and what we know. Good luck and you are in my thoughts. Mama Bear
Thanks Mama Bear. Your daughter is fortunate to have such love and support on her side. I hope you will continue to seek out a pediatric psychiatrist who can give you some answers and provide symptom relief to your daughter. Please keep me posted on her progress and you will be in my thoughts too.Sincerely,
Nicole
Posted by Barbara Cat on June 2, 2003, at 15:04:13
In reply to Re: Should BP II's nix the AD's? - Depends, posted by nmk on June 2, 2003, at 14:16:51
I had a great response to Remeron at first and then it quickly pooped out. Raised it, same thing. Eventually I was up to 75mg and feeling awful. This was before lithium. Slowly decreased, started lithium, and didn't start feeling better until I was off it completely. Some people like it alot. It was the easiest to get off of, I will say that for it but I gained 30 pounds. Are you taking lithium at all? If you have similar symptoms as I described you may benefit greatly from it.
Posted by nmk on June 3, 2003, at 13:12:03
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 2, 2003, at 15:04:13
> I had a great response to Remeron at first and then it quickly pooped out. Raised it, same thing. Eventually I was up to 75mg and feeling awful. This was before lithium. Slowly decreased, started lithium, and didn't start feeling better until I was off it completely. Some people like it alot. It was the easiest to get off of, I will say that for it but I gained 30 pounds. Are you taking lithium at all? If you have similar symptoms as I described you may benefit greatly from it.
No, but I am taking 1200 mg of Trileptal. I will see if the cycling is caused by all of the AD's and if not, will pursue a new AED. I am afraid of Lithium because of the weight gain. Have you gained any weight on it? If it is anything like remeron, my appetite would soar 1/2 hour after taking it. Boy, it wasn't a pretty sight watching me eat.
Posted by Barbara Cat on June 3, 2003, at 20:06:48
In reply to Re: Should BP II's nix the AD's? - Depends » Barbara Cat, posted by nmk on June 3, 2003, at 13:12:03
I've been working out alot and trying to lose the Remeron weight but it's not easy. Lithium does not create frenzied eating the way Remeron did. I was literally snarling and slobbering over a Dove ice cream bar on a cold February night while on Rem. Talk about not pretty. I haven't noticed any crazed cravings or overeating since stopping it. I think it may be more a metabolism thing with lithium since it does interfere with thyroid function. I've been on thyroid med for a long-term case of hypothyroid, but lithium has aggravated it. Other than that, I am very grateful and happy for what it's done for me. Beating the weight thing will just take extra effort, which I can do now that I'm not crippled by my mood disorder.
So what has your experience been of Trileptal? You're the first person I've talked to who is taking it. - BCat
>> No, but I am taking 1200 mg of Trileptal. I will see if the cycling is caused by all of the AD's and if not, will pursue a new AED. I am afraid of Lithium because of the weight gain. Have you gained any weight on it? If it is anything like remeron, my appetite would soar 1/2 hour after taking it. Boy, it wasn't a pretty sight watching me eat.
>
Posted by nmk on June 4, 2003, at 12:33:15
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 3, 2003, at 20:06:48
> I've been working out alot and trying to lose the Remeron weight but it's not easy. Lithium does not create frenzied eating the way Remeron did. I was literally snarling and slobbering over a Dove ice cream bar on a cold February night while on Rem. Talk about not pretty. I haven't noticed any crazed cravings or overeating since stopping it. I think it may be more a metabolism thing with lithium since it does interfere with thyroid function. I've been on thyroid med for a long-term case of hypothyroid, but lithium has aggravated it. Other than that, I am very grateful and happy for what it's done for me. Beating the weight thing will just take extra effort, which I can do now that I'm not crippled by my mood disorder.
>
> So what has your experience been of Trileptal? You're the first person I've talked to who is taking it. - BCat
>
> >>Barbara,
I really don't know what to say about the Trileptal since it is difficult to determine if it has made a significant difference. I didn't notice any improvement at first, but after titrating up slowly to 1200 mg, I have noticed that the depression is not as severe. I am still cycling like crazy....going from a hypomanic state, to anxiety/agitation, to mild depression, all in a matter of weeks. So, either the Trileptal is not doing much of anything or the AD's I am on are the culprit. I see my pdoc tomorrow to discuss. On a positive note, I have not experienced any negative side-effects from the trileptal. It should be taken with food since it has a tendency to upset the tummy. It has a tendency to decrease my appetite, which I make up for at night when I take the Remeron.
Nicole
Posted by Barbara Cat on June 5, 2003, at 1:03:24
In reply to Re: Should BP II's nix the AD's? - Depends » Barbara Cat, posted by nmk on June 4, 2003, at 12:33:15
Nicole,
You probably won't get this before seeing your pdoc but you might want to see what he/she thinks about lithium for you. You sound alot like what I used to go through. The depression/anxiety combo is the worst. Mixed states is absolute hell. I can't begin to tell you how lithium has helped me. I was so reluctant to take it even though my pdoc had suggested it periodically, mainly as an augmentor for my ADs that weren't working. Also the stigma - 'lithium, eeeyu, that means really crazy!' It's given me my life back. I know you're concerned about the weight thing but when ya feel good, ya exercise more, so it's a wash. If this next adjustment of current meds isn't doing it, you might try lithium for a trial period just to see. I'm hearing more and more about how if you have a bipolar disorder, you can add on all you want, but lithium is the bedrock.>
> I really don't know what to say about the Trileptal since it is difficult to determine if it has made a significant difference. I didn't notice any improvement at first, but after titrating up slowly to 1200 mg, I have noticed that the depression is not as severe. I am still cycling like crazy....going from a hypomanic state, to anxiety/agitation, to mild depression, all in a matter of weeks. So, either the Trileptal is not doing much of anything or the AD's I am on are the culprit. I see my pdoc tomorrow to discuss. On a positive note, I have not experienced any negative side-effects from the trileptal. It should be taken with food since it has a tendency to upset the tummy. It has a tendency to decrease my appetite, which I make up for at night when I take the Remeron.
>
> Nicole
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