![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 407 to 431 of 948. Go back in thread:
Posted by fluffy on August 23, 2003, at 13:17:23
In reply to Re: Naturopath visit results, please read » katia, posted by BarbaraCat on August 23, 2003, at 12:22:16
Hey Katia and Patricia--
Aside from all of this Psycho-babble stuff, I've found that one book in particular was extremely helpful to me when I was first diagnosed. And I have finally bought a copy instead of getting it from the library. When I feel like I am questioning what's going on with my moods/diagnosis, it straightens me out and gives good treatment options. It's called "The Bipolar Disorder Survival Guide". I highly recommend it, even though it doesn't dwell on the particularities of bipolar II. All of the information can be applied.Just a thought--take it or leave it.
I hope you guys are well. I've cycled out once again, and feeling normal. However, the Li is coming soon--I have an appt. on monday with my pdoc.Katy
Posted by Ima on August 23, 2003, at 14:46:36
In reply to Re: Naturopath visit results, please read » katia, posted by BarbaraCat on August 23, 2003, at 12:22:16
Its okay for me to respond to responses, right?(Im still new at this :)
> >>I actually asked my pdoc about testing my hormones, but he said that my "problem" was mood related, probably not hormonal. I wonder if they do affect one another and/or if they are just two individual pieces (to make the whole!)that need sorting out? Maybe you need both?
Hormone balance no problem after a hysterectemy? Pleeease!
Of course they affect each other, but your right , the depression problem may exist in some people from childhood, even before puberty.
>
> **Your pdoc is not the one to ask about hormonal testing.Definately.
** said most doctors don't use hormonal testing because they don't know what to do with the numbers!!As my GP told me the numbers are not the best indicator of a womans hormonal needs. You & I may test in the normal range for estrogen levels but not feel the same. I may need more than you to feel normal.
The question is do you want to open the hormonal can of worms? It will take alot energy to get it balanced and then youll have to deal with cycles again. If you feel in your gut that this may be a piece of the puzzle, it wont hurt to start. There are little side effects to Natural hormone therapy.
** But if you're hormonally unbalanced, you're swimming against the tide to try to get your moods balanced.
I agree. But the change of menopause (in this case, pre mature) is inevitable. At some point we (woman)all will have to live with diminshed hormone capacity. That was one of the factors that figured into the national study. Women were taking Premarin long after the change because they "felt better". But the 1 - 2% increase in cancer is a serious consideration.
**It's pretty intense and I'm wondering if it's too much right now while I'm trying to sort out the meds?Youll get lots of helpful suggestions and ideas to look into on this site. You know what you need. Follow your gut and keep investigating.
A great book on Hormones is "Natural Hormone Balace for Woman" by Uzzi Reiss
Peace
Ima
Posted by katia on August 23, 2003, at 15:23:04
In reply to Re: Naturopath visit results, please read » katia, posted by BarbaraCat on August 23, 2003, at 12:22:16
>There's a psychiatric condition known as 'kundalini psychosis', believe it or not.
Yes, I've known about this.
>>Yoga is wonderful for depression and anxiety but again, there are so many different kinds. I'd opt for the more calming and centering kinds, like Kripalu, Anusara, even Iyengar, and be cautious about the really activating ones like Kriya, Kundalini, Ashtanga (Bikram).
Actually Ashtanga and Bikram are two different types. I do Bikram sometimes/often and it helps. But I don't consider it yoga so much.
>However, if you get a good gut reaction to this class and teacher and it would be a good community, good exercise and good philosphy then it could be a real gift during this time. Whatever, you can keep a cool head and body as well as taking with a grain of salt anything any teacher tells you.
yes, I agree. This is not a movement yoga. It's sitted meditation working actively with the charkas. I'm going to go to a few different kinds of meditations and see what feels best.As you probably know from the previous posts, I contacted my pdoc and told him about my reaction (initial) to Depakote. He told me to ramp it up and see what happens. I did and am at 500mg now for three days. I didn't need the Seroquel for sleep last night and slept well. I'm starting to feel a bit more stable, which is great. But I'm still not quite there.
thanks for your input.
Katia
Posted by katia on August 23, 2003, at 15:26:37
In reply to Katia and Patricia--a good book, posted by fluffy on August 23, 2003, at 13:17:23
> Hey Katia and Patricia--
>
> Aside from all of this Psycho-babble stuff, I've found that one book in particular was extremely helpful to me when I was first diagnosed. And I have finally bought a copy instead of getting it from the library. When I feel like I am questioning what's going on with my moods/diagnosis, it straightens me out and gives good treatment options. It's called "The Bipolar Disorder Survival Guide". I highly recommend it, even though it doesn't dwell on the particularities of bipolar II. All of the information can be applied.
>
> Just a thought--take it or leave it.
> I hope you guys are well. I've cycled out once again, and feeling normal. However, the Li is coming soon--I have an appt. on monday with my pdoc.
>
> KatyThanks Katy,
I'll check it out. I've read one called "Bipolar Disorder" A guide for patients and families.it helped some.
k.
Posted by BarbaraCat on August 23, 2003, at 21:15:13
In reply to Re: Naturopath visit results, please read, posted by jota on August 23, 2003, at 11:29:50
> A lot of evidence has been accumulating that men with treatment-resistant depression have very low levels of testosterone. When we finally checked it, mine turned out to be off the charts low. I would definitely urge men reading this forum to get theirs checked.
**And women as well! My testosterone was barely squeaking down there and testosterone has so much to do with mood and energy of all kinds. What kind of supplementing are you using? My husband was on the Androderm patch for a while but it gave him headaches. His levels were excrutiatingly low and now that he's not on anything he's slowly turning into a lass before my horrified eyes. I'm using a topical cream containing testosterone along with other hormones.
Posted by Ponder on August 24, 2003, at 11:42:21
In reply to Re: Katia and Patricia--a good book » fluffy, posted by katia on August 23, 2003, at 15:26:37
>
> Thanks Katy,
> I'll check it out. I've read one called "Bipolar Disorder" A guide for patients and families.
>
> it helped some.
> k.I, too, found Bipolar Disorder: A Guide for Patients and Familes to be an excellent book, but was frustrated with the authors failing to list weight gain as a side effect of medications that are notorious for it. Weight gain poses a grave threat to anyone's health, and yet the propensity for it that psych drugs endow is rarely discussed openly by professionals. There is stuff in the medical journals on it, but in a book like this one--both credible, fairly comprehensive, and well-written--you'd expect to see the issue addressed.
With Depakote, he mentioned that he had heard of some weight gain with the drug, but had not seen it in his practice. Is there anyone on this board who did NOT gain weight with Depakote?
Posted by Ponder on August 24, 2003, at 11:56:13
In reply to Naturopath visit results, please read, posted by BarbaraCat on August 22, 2003, at 22:11:59
B-Cat, you are so right about the difficulty in getting coordinated care on the hormonal piece of the puzzle. My psych-doc doesn't know what to do with estrogen/progestin, my family practice doc doesn't know beans about psychiatric issues, my gyn doesn't want to deal with anything but the HRT. I've never seen an endocrinologist, but understand they have a beef with anything but the most conservative thyroid supplementation (partly because of the osteoporosis risk).
The HRT thing is confusing. I've heard that these hormones play a huge role in mood disorders, but the effects are unpredictable. So, I guess it's another one of those try-it-and-see kinds of things. I've been reluctant to discontinue for fear of destabilizing.
Truth is, I'm pretty much afraid of everything these days. I've lost hope for feeling any better than marginal. I have a few days of euthymia a month and they are wonderful, but the rest of the time I'm just grateful that I'm able to get out of bed in the morning. So I keep taking my usual meds and call it good. It's so hard to evaluate treatment efficacy with rapid-cycling BP that the try-it-and-see method is stressful. I can't always tell what is helping vs. just cycling out of the depression for a while. I fear I may be spending my money and subjecting my body to drugs/supplements that are not really helping at all.
Well, there, I've talked about several issues, I guess, and in not too organized a way. But there it is.
Thanks, B. for your lucid and helpful posts.
Posted by fluffy on August 24, 2003, at 15:04:42
In reply to Re: Katia and Patricia--a good book » katia, posted by Ponder on August 24, 2003, at 11:42:21
Hi Ponder-
I think there are two books with similar names. I'm not sure, but the Bipolar Survival Guide addressed weight gain. But all in all, I know what you mean. It's kind of a problem with the psychitrists. I was just telling my boyfriend last night that I wish psychiatrists were more blunt about the course of bipolar disorder and the side effects of drugs. For most doctors, it's a trade off--health problems in the long run, or the patient running the risk of having consecutive and more severe episodes. Weight gain or suicide? ALSO--Not EVERYONE gains weight on Depakote--it's a POSSIBLE side effect.
The psychiatrists who do have expertise with mood disorders have an obligation to inform patients of the risks and possible side effects of medications, as well as the probable future of maybe more episodes. I think they just don't want to bog patients down with too much bad news at once. Could you imagine if your psychiatrist said "you have a disorder that will be with you for the rest of your life. the only way to control it is with medication. And we're not sure which ones with work for you--you might be miserable for years trying new ones. And most of the kinks are not worked out, so you may feel like a zombie and gain 40 lbs." Esp. since most BP patients get treatment only when they feel depressed, it's probably good that they dwell on the positives of treatment. I was too close to suicide to hear all of the negatives at once. I'm kind of glad that things were sugar coated and that I've come to understand the positves and negatives for myself.
Posted by BarbaraCat on August 24, 2003, at 16:10:53
In reply to Re: Naturopath visit results, please read » BarbaraCat, posted by Ponder on August 24, 2003, at 11:56:13
Hey there, it's been a while! Great to hear from you again! Are you taking HRT? What kind? You know that there's the standard formulary crap - Prempro and the like which is derived from mare's urine. That is the most problematic and it's tragic that it's the bulk of what gets prescribed. If this is what you're taking, or Premarin and Norprin or any of the standard generic synthetics, you are not doing yourself any favors. You have to ask for the bio-identical and even then you get the one size fits all dosage. They never test. Why? Because testing isn't cheap! I had been taking Prometrium which is micronized bioidentical progesterone and estrace which is bioidentical estrogen, (but estriol only instead of estradiol also), thinkin I was at least getting the 'natural' kind. No one ever tested me and it turned out that I was getting way too much estrogen and ended up with a buildup in the lining of my uterus, lumpy breasts and a precancerous condition that eventually caused hemorraging. Fun. My thyroid zoomed through the roof because I was on lithium but no one seemed very concerned even though I'm well aware of what normal levels should be and the many problems even miniscule abnormal levels cause. I had to INSIST I be given more thyroid than they were willing to prescribe (the party line being, oh, even though you're a little hypothyroid, it shouldn't cause any problems). BULL SHIT!!!!!
In short, my hormones were all screwed up and even the most basic dumb HMO tests showed this. Do you think my pdoc ever looked at those records, even though all my 'care' providers were in the same building? Did he ever bother to put the obvious pieces together that just maybe my loopy hormones were affecting my mood? Did my primary care doc ever consider that the very obvious unbalanced state of my physical systems had anything to do with the intense psychic suffering I was experiencing? Does anyone remember PMS?? Any woman (or man living with such woman) who's gone through rabid PMS can tell you about the hormone/mood connection.
So yes, you're point regarding concern about all the meds doing much good and maybe doing harm is very relevant. What's interacting negatively? Is there anything beyond hit or miss psych treatment that should be considered and explored? If you have an unusually good MD who knows what the heck they're doing, then thank the Great Spirit every night. Most of them are not the physicians/healers of the past. They don't have time and are dictated by HMO guidelines and drug company funding. We absolutely MUST take charge and learn about our bodies, and ESPECIALLY our hormones. I am on a soap box about this one and if I reach just one person, I can eventually die feeling like I've made a difference. We're putting our psyches in the hands of well-meaning sound-bite technicians who have no idea beyond the basics of what to do with us. We have to go farther than looking at our brain chemistry. WHY is our brain responding the way it is? What is causing the imbalance? What imbalances are our brain chemistry causing? The wholeness of our being isn't divided at our necks. Two books can help:
"Screaming to be Heard", Elizabeth Vliet
"The Wisdom of Menopause", Christiane NorthrupUltimately, it means hoofing around and finding a talented and dedicated health practitioner who knows what the heck they're doing and takes the time to get to know precious you. It probably means paying out of pocket because, I assure you, the only concern managed care and health insurance companies give a rip about concerning your continued good health is if you don't cost them anything. They are out to cut costs and are NOT on your side. I'll keep my woefully inadequate HMO in case I get run over by a truck, but for my health, my naturopath is now my mentor because she is one smart cookie and I trust her wisdom and experience. Sorry to rant, but boy oh boy, am I pissed! The answer was right in front of their bamboozled faces and it was I who had to stamp my feet and do something! - Barbara
Posted by katia on August 24, 2003, at 17:11:37
In reply to Re: Katia and Patricia--a good book » katia, posted by Ponder on August 24, 2003, at 11:42:21
> >
> > Thanks Katy,
> > I'll check it out. I've read one called "Bipolar Disorder" A guide for patients and families.
> >
> > it helped some.
> > k.
>
> I, too, found Bipolar Disorder: A Guide for Patients and Familes to be an excellent book, but was frustrated with the authors failing to list weight gain as a side effect of medications that are notorious for it. Weight gain poses a grave threat to anyone's health, and yet the propensity for it that psych drugs endow is rarely discussed openly by professionals. There is stuff in the medical journals on it, but in a book like this one--both credible, fairly comprehensive, and well-written--you'd expect to see the issue addressed.
>
> With Depakote, he mentioned that he had heard of some weight gain with the drug, but had not seen it in his practice. Is there anyone on this board who did NOT gain weight with Depakote?
>Hi,
I actually am on my second week of Depakote at 500mg a day. I definitely have not lost weight and I don't have a scale, but I think I may be gaining weight. I've been really good about not overeating and getting exercise, but my clothes are tight! And so, it's not due to overeating. My period also just started so it could've been that. But I'm defin. not losing weight and I've already maxed out my average range of weight. I feel a bit heavy. I just hope that the weight gain doesn't happen!
How about you? Did you take Dep.? and gain weight? I've heard of a couple of people who took dep. and did not gain weight.katia
Posted by Jota on August 24, 2003, at 21:35:00
In reply to Re: Naturopath visit results, please read » jota, posted by BarbaraCat on August 23, 2003, at 21:15:13
> What kind of supplementing are you using? My husband was on the Androderm patch for a while but it gave him headaches.I'm using AndroGel. At 7.5 g, my testosterone level was still extremely low. Now at 10g and will do another blood test in a week. I haven't noticed any side effects so far. Instead, diminished headaches. And increased sexual desire.
Jordan
Posted by Dr. Bob on August 24, 2003, at 22:22:32
In reply to Re: Naturopath visit results, please read, posted by Ima on August 23, 2003, at 14:46:36
> A great book on Hormones is "Natural Hormone Balace for Woman" by Uzzi Reiss
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by McPac on August 24, 2003, at 22:50:07
In reply to Naturopath visit results, please read, posted by BarbaraCat on August 22, 2003, at 22:11:59
"I did saliva tests of these hormones: estrogen, progesterone, DHEA, testosterone and cortisol. I also did a test for human growth hormone which makes all the others work".
>>>>>>>>>>>>> Barb, would these tests be the standard hormone tests to have done, male or female? Are there add'l tests you'll have done? Is it really expensive?
GOOD FOR YOU BCat......Hope this really helps you a lot! I agree w/ ALL you say about the medical establishment. It's a joke. Keep us posted!!!
Posted by BarbaraCat on August 24, 2003, at 23:55:52
In reply to Barb, Re: Naturopath visit results, please read, posted by McPac on August 24, 2003, at 22:50:07
> >>>>>>>>>>>>> Barb, would these tests be the standard hormone tests to have done, male or female? Are there add'l tests you'll have done? Is it really expensive?
***Hi Mr. Mac,
They were saliva tests done by a company called ZRT Labs in Portland, OR. Check out their website:Saliva tests get bad raps because they're considered inaccurate, but I had blood serum and urine tests done as well and the levels matched. I did this to ease my mind that I was going to be getting accurate test data once I fired my HMO 'health care team' - hah! Saliva tests are used primarily by naturopaths and holistically oriented physicians. When I asked at my HMO if I could get them done, they either didn't know anything about them or blabbed the party line 'we don't have enough scientific data on them' crap. I had to insist I get specific and individual blood and urine tests done to measure the hormones I knew I needed to be looking at. The tests were relatively expensive and not 'formulary' but my HMO did pick up the tab because I literally stamped my foot. So once I had those 'medically acceptable' test values in hand, I went to my naturopath who ordered saliva tests, which are easy to use, less expense, and much more sensitive. We'll be using the saliva tests to monitor my treatment, but if there's a test better served by blood serum testing, we'll go that route. In other words, whatever works the best. I am currently paying for all this out of pocket, but some health insurance companies cover alternative care. But you have to be careful to find the right practitioner. Just because they're 'alternative' doesn't mean they're good!
Saliva tests ran around $150 for measuring reproductive hormones, DHEA, cortisol.
There's a very thorough thyroid test that measures way beyond the standard TSH test. It measures ratios of T3 to T4, reverse T3, free and bound T3 - basically, a more accurate picture of how the cells are really uptaking thyroxine. That one is around $140, but I didn't have it done because my TSH values were so obviously high that my hypothyroidism is a given.
I also did a blood spot test to measure IG-1, or human growth hormone. That one was $75.
My naturopath visits cost about $150 each and I spend 60 minutes with her each time. She would not sell any vitamin supplements to me saying that my body would not use them very well at this time. This is not the usual case with many naturopaths who have walls of exotic pills they're all too happy to sell you. The woman I'm seeing is a rare jewell and I had to kiss alot of frogs before finding her.
My medicines to correct my hormonal imbalances were compounded into a topical cream by a compounding pharmacy. It contains progesterone, estradiol and estriol (the two estrogens women need), DHEA, and testosterone. The amounts of each hormone are individually tailored to me based on values from my saliva tests. I rub a small amount on my skin every morning. A month's supply of this cream is $30. Already I'm feeling a difference in energy and motivation (probably the testosterone of which I tested at near zero). In fact, it's probably fueling my 'I'm pissed as hell and not gonna take it any more!' attitude.
I'm also taking a more exotic treatment, Human Growth Hormone, because my very low levels were a red flag indicating that this imbalance could be throwing off everything down line. HGH is a pituitary derived hormone and if the pituitary is off, which is the case in many chronically stressed folks, then this may be the upline source of all the the cascading imbalances downline - the infamous HPA-axis disregulation. I take a very small amount as a shot in the butt 6 days a week. This will cost about $140 a month, which is a major bargoon considering most sources you'll find on the internet quote around $400 a month. The place I'm getting it (prescription from my naturopath) is Women's International Pharmacy, a very reputable mail order compounding pharmacy. If you're interested in pursuing this path, you might contact them and ask for recommendations health professionals in your area who use their services. They serve both men and women. There's some interesting reading material on their site. Check it out at:
http://www.womensinternational.com/about.htmlLater, BarbCat
Posted by McPac on August 25, 2003, at 1:13:04
In reply to Re: Barb, Re: Naturopath visit results, please read » McPac, posted by BarbaraCat on August 24, 2003, at 23:55:52
Thank you for all that info Barb! Much appreciated!
ALSO, I've got a dilemna that I'd LOVE to run by you because I really do value your thoughts and opinions.
Okay, for years I've taken AD's and lithium together....I've always taken a much smaller amount of lithium than most bipolars (I am likely bipolar, though very rarely get even the mini-highs (hypomania), I'm VERY much just the depression part)....anyway, I would, for YEARS, take only 600 mgs/day of Lithium along w/ my anti-dep (and this worked very, very well).......over the last couple of years, I have tried to even DEcrease that small lithium dose, taking only 300 mg/day of lithium w/ my AD...my lithium level is PUNY, something like .016 or .02 last time I checked it...in other words downright microscopic for a bipolar......anyways, over the last couple of years (since lowering my lithium dose to these PUNY levels) I have felt like total crap much of this time--- I have had a lot of AGITATED feelings with ANGER problems....and when I try to switch AD's, as soon as I get to just a moderately high dose, the agitation/anger/irritability gets MUCH worse....for a while I kept thinking that it's just the AD's that are causing the anger....but NOW I'm seriously thinking that it's the PUNY, DEcreased lithium dose, THAT WHEN COMBINED WITH the AD's, that is the problem....in other words, that the AD's are 'destabilizing' me or making me feel agit/angry but it's BECAUSE I'm on TOO LITTLE of a mood stabilizer....Isn't that a signal or tip-off to bipolar in many cases---that if someone is trying different AD's and having really bad effects and no success (and often feel even worse!) that they may be bipolar and need a mood stab. WITH their AD? I think my agitation/anger/irrit on the AD's is telling me that I need to increase my mood stab....(I KNOW that one AD (Prozac) was DEFINITELY a TERRIBLE drug for me, TERRIBLE anger/rage......but now, as more and more seem to cause problems, I think my PUNY lith. dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol, what do you think Barb?
Posted by BarbaraCat on August 25, 2003, at 11:58:40
In reply to BARB!, Naturopath visit results, please read, posted by McPac on August 25, 2003, at 1:13:04
**I think your take on the situation is right on. Yes, I do think that taking an AD without an adequate amount of mood stabilizer is a sure recipe for what your describing, if you're bipolar - and some research suggests even if you're not bipolar. However, you state that you 'rarely get the hypomanic highs' which tells me that you equate BP 'manias' as the classic ones, the kind everyone's impressions of mania is (myself included until I found out better). Mania/hypomania is NOT always the bubbly, get things done, madcap high time that we all have associated it with. It's more likely IRRITABILITY and AGITATION. For me, when I have the classic madcap manias, they last only a short time and then disintegrate quickly into frazzled annoyance and rage. Mainly, I don't get the enjoyable stuff at all, but only the trigger fire anger and disorganization on the manic side and the lethargy and life sucks kind on the depressive side. Before lithium I was getting both together in godawful mixed states. I'm not on very much lithium at 600mg because I want to keep my edge so I still have some hypomania of different sorts occasionally, and I still get variations of 'life sucks' (but, really, it does!) depressions. But thank God, no more mixed states. I could live with ANYTHING but not mixed states! Once again, you MUST understand beyond any doubt that your symptoms of anger, irritability, rage are most likely undertreated manic symptoms. Mainly depression with irritability and agitation (also known as hypomania) IS the description for BPII. It's also the description for agigatated depression or depressive GAD, but this is splitting hairs. It sounds like you are BPII to me and if this is true, you absolutely need an effective level of mood stabilizer. If you are getting horrible mixed states, you're more likely BPI (as I now know myself to be), although I don't think this is the case with you, but in any case, you'd STILL need a mood stabilizer. I have my own experiences about too little lithium:
A year and a half ago I ran out of lithium and my mail order pharmacy took about 10 days to get the prescription to me, so I was without for over 2 weeks. I was taking Remeron at the time so I thought I was covered at least until I got my lith in the mail. I started having a very enjoyable hypomania so I didn't start taking the lith once I got it back thinking 'oh boy, I sure feel good so I probably don't need it'. The pleasant hypomania didn't last all that long and quickly turned into disorganization, irritability, snappy quick-trigger anger, sarcasm (my poor husband!), spending money I didn't have, sleeplessness, poor judgement. Once I went back to my 600mg things mellowed out within 1 week. Note that I'm only taking 600mg which is way below my therapeutic window, but it's obviously making a big difference.
I went off Remeron because it really made me feel awful and started lamictal along with lithium. About 6 months ago I started having alarming increases in my thyroid TSH levels which is a problem with taking lithium when one is hypothyroid as I am. So I decided to reduce lithium because I was concerned about permanently damaging my thyroid. I got down to 300mg every other day within a 3 week period and experienced the rage, hot temper stuff pretty dramatically. So again, within 1 week of restarting things smoothed out.
I have a few thoughts on this and your experience will shed light. There's always a withdrawal period where things are shaky. I've wondered whether if I just stayed the course I'd eventually smooth out without the lithium. It sounds like you've been on a substandard dose for a while still have symptoms and so your anger/irritability are not due to withdrawal. The other thing is taking an AD at all when you're BP. What kind are you taking? I had nothing but problems with all the ADs I ever took, even with lithium as an augmentor. The only one that helped was nortriptyline, briefly, when I was suicidally depressed after my Mom's death. But once I emerged from that, I stopped nortrip and eventually felt much better without it. Lamictal 125mg and lithium seem to be doing the trick as far as keeping me from destabilizing. One other thing to consider is, are you really BP? Could it be that you're actually unipolar depressed and not getting high enough a dose of your AD? Even if this is true, my personal opinion is that anyone taking an AD should also take it with a mood stabilizer. Sigh, so many variables. My personal hit is that you're not on enough lithium or whatever mood stabilizer you choose, and you're destabilizing with the AD. One more thought. A high level of testosterone is also associated with anger and aggression. Can you possibly have the mixed blessing of having too much of a good thing? A hormone panel test would tell.
Have you read "Why your depression isn't getting better" by Michael Bartos, MD? He describes what you're going through very well and states without any doubt that BPs most definitely and absolutely require a mood stabilizer, should reconsider using ADs at all, and NEVER use ADs without a mood stabilizer. Here's the website:
Also, here's the recommended book page of a website I like very much. The entire website is great. You might find something that helps:
http://www.mcmanweb.com/book-16.htm
And finally, you've been suffering with this for a long time now, Mac. I can only imagine how hard it must be. Why not just up your lithium and see? If you start feeling better, I'll bet you can start lowering your dose of ADs and you'll get an even better response. But only after the withdrawal subsides. What does your pdoc say in all this? He/she should be very aware and up on this whole AD/mood stabilizer issue. If he/she is not, why not?
BarbaraCat
> Okay, for years I've taken AD's and lithium together....I've always taken a much smaller amount of lithium than most bipolars (I am likely bipolar, though very rarely get even the mini-highs (hypomania), I'm VERY much just the depression part)....anyway, I would, for YEARS, take only 600 mgs/day of Lithium along w/ my anti-dep (and this worked very, very well).......over the last couple of years, I have tried to even DEcrease that small lithium dose, taking only 300 mg/day of lithium w/ my AD...my lithium level is PUNY, something like .016 or .02 last time I checked it...in other words downright microscopic for a bipolar......anyways, over the last couple of years (since lowering my lithium dose to these PUNY levels) I have felt like total crap much of this time--- I have had a lot of AGITATED feelings with ANGER problems....and when I try to switch AD's, as soon as I get to just a moderately high dose, the agitation/anger/irritability gets MUCH worse....for a while I kept thinking that it's just the AD's that are causing the anger....but NOW I'm seriously thinking that it's the PUNY, DEcreased lithium dose, THAT WHEN COMBINED WITH the AD's, that is the problem....in other words, that the AD's are 'destabilizing' me or making me feel agit/angry but it's BECAUSE I'm on TOO LITTLE of a mood stabilizer....Isn't that a signal or tip-off to bipolar in many cases---that if someone is trying different AD's and having really bad effects and no success (and often feel even worse!) that they may be bipolar and need a mood stab. WITH their AD? I think my agitation/anger/irrit on the AD's is telling me that I need to increase my mood stab....(I KNOW that one AD (Prozac) was DEFINITELY a TERRIBLE drug for me, TERRIBLE anger/rage......but now, as more and more seem to cause problems, I think my PUNY lith. dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol, what do you think Barb?
Posted by katia on August 25, 2003, at 14:38:09
In reply to BARB!, Naturopath visit results, please read, posted by McPac on August 25, 2003, at 1:13:04
Hi McPac,
ditto on all Barb says.>>dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol,
for me, I was on ADs for a year (four different kinds) and they messed me up worse. (didn't help). I've recently been dxed as BP and have begun a new regime of only mood stabilizers - no ADs. we'll see how it goes. But from what I've heard and my pdoc says, ADs are not the best things for BP people.
all the best,
Susan
Posted by katia on August 25, 2003, at 14:39:20
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
Hi Barb,
Thanks for those links! I'm actually starting my thesis and wondering what to write about???? I think it's on BP. Those books will come in handy.
katia
Posted by katia on August 26, 2003, at 1:40:52
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
Hi Katy!
I actually was just reading "Seabiscuit" and there it was! Your word bobbles! used in relation to the horses.
I had to let you know!
Katia
Posted by BarbaraCat on August 26, 2003, at 12:30:48
In reply to Re: BARB!, Naturopath visit results, please read » BarbaraCat, posted by katia on August 25, 2003, at 14:39:20
Katia,
What's your major? I recall you were getting an MS, but don't think you mentioned in what. Good luck in it! I'm going back to school as well, eventually ending up a Holistic Nurse with an emphasis in Psychiatry - but first, the plain ol' RN license (just hope I don't have to clean bedpans for too long).> Hi Barb,
> Thanks for those links! I'm actually starting my thesis and wondering what to write about???? I think it's on BP. Those books will come in handy.
> katia
Posted by katia on August 26, 2003, at 12:55:57
In reply to Re: BARB!, Naturopath visit results, please read » katia, posted by BarbaraCat on August 26, 2003, at 12:30:48
Hi Barb,
If we get re-directed to social babble; just follow the link and we'll take it from there. It's easy!I'm entering my fourth year and almost finished with a degree (M.A.) in Transpersonal Psychology and a certificate in life coaching.
I can see you being a holistic nurse. Have you started yet with the program?
I was just thinking this morning that I"m sick of not having nor ever had a proper career. I'm sick of not being able to channel my creative energy into a career type of "life purpose".I guess I'm starting to feel better. More able. perhaps it's the depakote? But the scary part is now, doing something positively with my somewhat evening out of mood. Like the storms have settled a bit and I'm left looking at the wreck
around me after years of torment. And it's time to be happy and explode and direct all the pent up energy and DO something satisfying with my life! I'm just scared and unsure of how to make my next step. I've created space - took a quarter off, took out extra student loans to supplement my devastating financial state. Now. it's time! I need to take a leap of faith.
so maybe I'll direct this into my thesis?by the way, it's GREAT that you're thinking of going back for a new career. I love and applaud that. You're in your 50s right? There is one woman in my program who is 87 I think! It's wonderful to see. Did you ever have children? It sounds like you were a project manager for awhile?
katia
Posted by McPac on August 26, 2003, at 14:04:34
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
Awesome post Barb, simply awesome...SOOO helpful!
I will reply to that post soon (got to get my car to the garage for some repairs)...thank you SOO much!
Posted by McPac on August 26, 2003, at 14:05:49
In reply to Re: BARB!, Naturopath visit results, please read, posted by katia on August 25, 2003, at 14:38:09
Posted by McPac on August 26, 2003, at 17:21:16
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
**I think your take on the situation is right on. Yes, I do think that taking an AD without an adequate amount of mood stabilizer is a sure recipe for what your describing, if you're bipolar - and some research suggests even if you're not bipolar.
>>>>>>>>>>>>>>> Barb, can you elaborate on this, "and some research suggests even if you're not bipolar"?
However, you state that you 'rarely get the hypomanic highs' which tells me that you equate BP 'manias' as the classic ones, the kind everyone's impressions of mania is (myself included until I found out better). Mania/hypomania is NOT always the bubbly, get things done, madcap high time that we all have associated it with. It's more likely IRRITABILITY and AGITATION.
>>>>>>>>>>> So hard to distinguish when the irrit and agitation and anger is from bipolar and when it is from certain meds...that is the hardest thing to tell! Take Remeron, at 30 mg's I seem to be relatively free from the anger/irrit/agitation....but at 45 mg, DIFFERENT story! Is it the bipolar being affected at the 45 mg dose or is it med side effects (and these ARE side effects that the med can cause and that others do get)? Some will say "it's the bipolar breaking through"....but this is the whole crux of the matter, IS IT the bp breaking through OR is it the med's side effects breaking through? Check this out---I've been on 30 mg of Remeron for about a week now and do NOT feel anger at this dose....I took 5 mg's of Lexapro today and I can feel some agitation/irrit from that! The ssri's really seem to cause that problem for me, some ssri's worse than other ones ..... but that seems like a med side effect, not a bipolar response....another reason that makes it SO hard to tell what is the problem, bipolar or med s/e, is that SO many of these meds do have anger/irrit/agitation as known side effects! I mean, if I took an aspirin or a Tums and then got terribly angry/irrit/agitated I would just think that my bipolar was acting up...but when I take Zoloft, Lexapro, etc., and it happens then I don't know if it's my bp or the med s/e? Even with the Remeron, many folks (others here have said this too during my discussions w/ them) have gotten increased agit/irrit/anger on Remeron due to a s/e. It's in the Remeron literature also. For a while I kept thinking, "well it can't always be the med...it must be me"....but all of the meds that I felt this way on DID have it listed as a possible side effect. It is worse on higher doses also...as I raise the dose, the problems increase. One big problem is that I NEED to take a higher dose---a lower dose isn't enough med to help the dep/ocd.
For me, when I have the classic madcap manias, they last only a short time and then disintegrate quickly into frazzled annoyance and rage. Mainly, I don't get the enjoyable stuff at all
>>>>>>>>>>> Barb, I USED to get a LOT of the fun mini-highs (very enjoyable, very happy, productive,creative).....not much of that anymore!
, but only the trigger fire anger and disorganization on the manic side and the lethargy and life sucks kind on the depressive side. Before lithium I was getting both together in godawful mixed states. I'm not on very much lithium at 600mg because I want to keep my edge so I still have some hypomania of different sorts occasionally, and I still get variations of 'life sucks' (but, really, it does!) depressions. But thank God, no more mixed states. I could live with ANYTHING but not mixed states!
Once again, you MUST understand beyond any doubt that your symptoms of anger, irritability, rage are most likely undertreated manic symptoms.
>>>>>>>>>>>>>> Yes, Barb...I think I'm actually having a type of 'double-whammy' effect--- anger/irrit/agit from bipolar PLUS also getting those same s/e's with some of the meds I've taken! I can definitely understand that those symptoms are bp symptoms...AND I have no doubt that some of the meds that I have taken have also given me those symptoms via med side effects...confusing and very hard to deal with! An AD that worked for dep/ocd/and anxiety WITHOUT also causing the anger/irrit/agit is what I need.
Mainly depression with irritability and agitation (also known as hypomania) IS the description for BPII.
>>>>>>>>>> I USED to get the "happy" mini-highs...now it looks like more of the "angry/agit/irrit" kind....would that still be a bp11? (can't recall the distinction between bp1 and 2).
It's also the description for agigatated depression or depressive GAD, but this is splitting hairs.
It sounds like you are BPII to me and if this is true, you absolutely need an effective level of mood stabilizer. If you are getting horrible mixed states, you're more likely BPI (as I now know myself to be), although I don't think this is the case with you, but in any case, you'd STILL need a mood stabilizer. I have my own experiences about too little lithium:A year and a half ago I ran out of lithium and my mail order pharmacy took about 10 days to get the prescription to me, so I was without for over 2 weeks. I was taking Remeron at the time so I thought I was covered at least until I got my lith in the mail. I started having a very enjoyable hypomania so I didn't start taking the lith once I got it back thinking 'oh boy, I sure feel good so I probably don't need it'. The pleasant hypomania didn't last all that long and quickly turned into disorganization, irritability, snappy quick-trigger anger, sarcasm (my poor husband!), spending money I didn't have, sleeplessness, poor judgement. Once I went back to my 600mg things mellowed out within 1 week. Note that I'm only taking 600mg which is way below my therapeutic window, but it's obviously making a big difference.
>>>>>>>>>>>>> I wrote a long post within the last week or so about what lithium does for me---how it keeps this particular dreaded anxiety/depressive condition from returning...only it sounds like I also use lithium the way some use a benzo! I may well have had a terrible mixed state before and just not knew what it was called! Is it a state of TERRIBLE anxiety AND terrible depression COMBINED into one feeling? Barb, bp1 OR 2 and the treatment is the same regardless right?
I went off Remeron because it really made me feel awful and started lamictal along with lithium. About 6 months ago I started having alarming increases in my thyroid TSH levels which is a problem with taking lithium when one is hypothyroid as I am. So I decided to reduce lithium because I was concerned about permanently damaging my thyroid. I got down to 300mg every other day within a 3 week period and experienced the rage, hot temper stuff pretty dramatically. So again, within 1 week of restarting things smoothed out.
I have a few thoughts on this and your experience will shed light. There's always a withdrawal period where things are shaky. I've wondered whether if I just stayed the course I'd eventually smooth out without the lithium.>>>>>>>>>>> I have wondered a LOT! that IF I could find an AD that helped my dep/ocd/anxiety WITHOUT ALSO causing the anger side effects, could I do without the lithium? Apparently I'll never get to find out because the meds that DO help me simultaneously cause the anger/irrit/agit s/e's! I'd LOVE to find out though.....I've wondered if I was taking a benzo like Klonopin if then I could go off the lithium, since it seems I use my low lithium dosage more like a benzo for anxiety than as a mood stab. anyway.
It sounds like you've been on a substandard dose for a while still have symptoms and so your anger/irritability are not due to withdrawal. The other thing is taking an AD at all when you're BP.
>>>>>>>>> I'm forced to Barb---due to @#$%$#! OCD! I DID used to (YEARSSSSSS ago) only take lithium WITHOUT an AD......not good---I was depressed (needed the mood-lift badly) and I NEEDED an AD as an anti-ocd med.......if it weren't for the stupid ocd I would try that! I'd try to boost my mood using natural supps perhaps but the ocd forces me take an AD for it.
What kind are you taking?
I had nothing but problems with all the ADs I ever took, even with lithium as an augmentor.>>>>>>>>>>>> the ad's WORK well for me Barb...it's just that anger/irrit side effect thing...ruins everything. Dr. Heller says that buspar counters that but nobody here seems to know about that.
The only one that helped was nortriptyline, briefly, when I was suicidally depressed after my Mom's death. But once I emerged from that, I stopped nortrip and eventually felt much better without it. Lamictal 125mg and lithium seem to be doing the trick as far as keeping me from destabilizing. One other thing to consider is, are you really BP? Could it be that you're actually unipolar depressed and not getting high enough a dose of your AD? Even if this is true, my personal opinion is that anyone taking an AD should also take it with a mood stabilizer. Sigh, so many variables.>>>>>>>>>> TOO many variables...wayyyyy too many!
My personal hit is that you're not on enough lithium or whatever mood stabilizer you choose, and you're destabilizing with the AD. One more thought. A high level of testosterone is also associated with anger and aggression.
>>>>>>>>>>> The anger only comes from the meds....without the offending meds, there is no anger problem.
Can you possibly have the mixed blessing of having too much of a good thing? A hormone panel test would tell.
Have you read "Why your depression isn't getting better" by Michael Bartos, MD? He describes what you're going through very well and states without any doubt that BPs most definitely and absolutely require a mood stabilizer, should reconsider using ADs at all, and NEVER use ADs without a mood stabilizer.
Here's the website:Also, here's the recommended book page of a website I like very much. The entire website is great. You might find something that helps:
http://www.mcmanweb.com/book-16.htm
thanks!
And finally, you've been suffering with this for a long time now, Mac. I can only imagine how hard it must be. Why not just up your lithium and see?
>>>>>>>>> Barb, I am upping the lithium dose (600 mgs/day will do the trick).....oh, I'll feel better---it WILL help the anger/irrit thing...but it STILL doesn't tell me if it's just countering the AD's side effects OR if it is helping bipolar symptoms---since the bipolar symptoms AND the ad s/e's are the SAME!
If you start feeling better, I'll bet you can start lowering your dose of ADs and you'll get an even better response.>>>>>>>>>>>> Yep, if not for my stupid ocd...THAT would get WORSE!
But only after the withdrawal subsides. What does your pdoc say in all this?
>>>>>>>>>>>> Don't go to one now Barb......never liked my previous ones, they just weren't worth much at all.....can't get anything accomplished in 5 minutes w/ them anyway (the "alotted" time, lol).......actually, I was going to go to this one but he moved out of state recently.
He/she should be very aware and up on this whole AD/mood stabilizer issue. If he/she is not, why not?>>>>>>>>>>>>I went for years, total JOKE...the 5-minute, worthless visits..."NEXT"..."NEXT"....lol......I ALWAYS felt WORSE when I was going! Hated it for many reasons. I'd rather drop dead than go,lol
BarbaraCat
> Okay, for years I've taken AD's and lithium together....I've always taken a much smaller amount of lithium than most bipolars (I am likely bipolar, though very rarely get even the mini-highs (hypomania), I'm VERY much just the depression part)....anyway, I would, for YEARS, take only 600 mgs/day of Lithium along w/ my anti-dep (and this worked very, very well).......over the last couple of years, I have tried to even DEcrease that small lithium dose, taking only 300 mg/day of lithium w/ my AD...my lithium level is PUNY, something like .016 or .02 last time I checked it...in other words downright microscopic for a bipolar......anyways, over the last couple of years (since lowering my lithium dose to these PUNY levels) I have felt like total crap much of this time--- I have had a lot of AGITATED feelings with ANGER problems....and when I try to switch AD's, as soon as I get to just a moderately high dose, the agitation/anger/irritability gets MUCH worse....for a while I kept thinking that it's just the AD's that are causing the anger....but NOW I'm seriously thinking that it's the PUNY, DEcreased lithium dose, THAT WHEN COMBINED WITH the AD's, that is the problem....in other words, that the AD's are 'destabilizing' me or making me feel agit/angry but it's BECAUSE I'm on TOO LITTLE of a mood stabilizer....Isn't that a signal or tip-off to bipolar in many cases---that if someone is trying different AD's and having really bad effects and no success (and often feel even worse!) that they may be bipolar and need a mood stab. WITH their AD? I think my agitation/anger/irrit on the AD's is telling me that I need to increase my mood stab....(I KNOW that one AD (Prozac) was DEFINITELY a TERRIBLE drug for me, TERRIBLE anger/rage......but now, as more and more seem to cause problems, I think my PUNY lith. dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol, what do you think Barb?
Posted by BarbaraCat on August 26, 2003, at 20:18:08
In reply to Re: BARB!, Naturopath visit results, please read, posted by McPac on August 26, 2003, at 17:21:16
Whew, baby! Alot here! I need to think about all this, but the fact you have OCD really does make it a hornet's nest. I don't know all that much about OCD but have heard that SSRI's are the meds of choice for it. One thing I can say before responding in more depth may interest you.
Remeron is a tricky med. I was on it for 6-8 months or so. At low doses (15-20mg) it acts mainly on serotonin and at a specific receptor site. It acts like a sleeping aid and makes people pretty groggy for hours in the morning (and let's not forget the pork-out syndrome). As you start raising it norepinephrine kicks in rather strongly. The magic number seems to be 45mg at which point it becomes much more activating. It sure did for me. I liked the extra motivation I got on it but was becoming anxious without really knowing why. Because anxiety causes depression everytime for me and I was getting more depressed, I raised it until I was hovering at 80mg. I felt great for a few weeks, then awful. I kept thinking that raising it would make me all effervescent, and activate me to raise my energy/exercise level for its AD and anti-porky effects. But I was having terrible anxiety, not so much irritability (that's more a BP thing for me and that's part of answers part II). I went on clonazapam to deal with the anxiety and it helped so very much. This was before lithium.
The most sedating and calming AD I've ever been on was Trazadone. It knocked me out at night which was a blessing, I could have easily stayed in bed til noon and had to force myself to get moving, but after a brisk shower was OK. It greatly helped my depression as well for many years. It is a lethargic med, which was mostly fine for me because my depressions are always characterized by too much anxiety. But sometimes the blobs were too strong and it was hard to motivate. I think that could have been helped if I motivated to exercise alot more, but back then I could get away with blobbing and still keep my girlish figure. ;-) I would consider it again if I ever needed an AD and if I started having bad insomnia, but would do so with caution because it causes weight gain and I've been working so hard at getting it off and also, lithium and lamictal are doing it for me so far. Another thing is that Trazodone is related to Remeron in it's 5H-3 (I think that's the one) receptor site target, but doesn't have any of the activating NE effects.
I quit Traz because Prozac broke onto the scene and everyone wanted some, including me. Tried Buspar briefly because of the anxiety I was getting with Zoloft and Wellbutrin combo (Gad, Zoloft made me apathetic and Wellbutrin made me speedy - can't win!) and it didn't do much except make me feel dizzy. Most pdocs don't think much of it. Didn't like Serzone one bit, even though it's very similar to Trazadone.
As I mentioned, Clonazapam helped me very very much in the anxiety department. Didn't dope me up, calmed me down and has some mood stabilizer qualities as well (says my pdoc). That's a good idea you have about benzos and/or lithium. Only way is to try, I guess, but don't stop the lithium until you know the benzo is working. Also, if Rem is working for you really really well, then bully! But it could be part of your problem, Mac. I recall reading something about Rem being indicated for OCD? Is that true? But they're all similar and all indicated for separate conditions. My suspicion is that it's a marketing ploy. If you follow the money, you'll find out that just about every mental health research project is funded by a pharmaceutical company somewhere along the money chain. Vested interest? Of course not! Pure altruism!
The other BP issues I'll get back to you on. But one thing to part with. I think the current revolving door 5 minute psych thing is an utter travesty and waste of time also and probably does more harm than not. All they can do is try yet another pill to put another temporary bandaid on our pain. They don't like the system either, but the current psych training is target the symptom pharmacology and most don't know there's anything else. Drug companies fund ALL aspects of physician education and research. I really hate managed care. ESPECIALLY since my insurance premiums have gone UP and not down, which was the whole point of the managed care mess we're in now.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.