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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 129. Go back in thread:
Posted by Lou Pilder on February 19, 2012, at 16:13:52
In reply to Re: Desperate » Solstice, posted by herpills on February 18, 2012, at 22:15:43
> I'm sorry to hear your daughter is not doing well. My opinion is it seems like the meds need to get straightened out first. From what I understand you are saying she dropped the Geodon and then is put on Lamictal, Lithium, and Latuda? I just feel like she is on too many meds, but I know it's hard if she has ADHD and bipolar. Keep working with her doctor and also take advantage of any non- med options that could help. Is she involved in any activities that help her focus/calm?
herpills,
You wrote,[...take advantage of any non-med options...]
Thanks, I think that's good
Lou
Posted by ed_uk2010 on February 19, 2012, at 16:15:12
In reply to Re: Desperate » SLS, posted by Solstice on February 19, 2012, at 0:45:12
>I'll bet Depakote has been studied in children, since it is an anti-epileptic.
Valproate (Depakote, Epilim etc) is one of the most widely used long-term medications in children. In fact, it is used much more in children and young people than any of the other meds than your daughter is taking! Valproate is a first-line drug for most forms of epilepsy in children, being effective against a wide range of different epilepsy subtypes.
Valproate sometimes causes weight gain, but probably less than most antipsychotics. Contraception should be prescribed where appropriate because valproate is not safe during pregnancy.
Few drugs have received much study specifically for childhood bipolar disorder, and so there is a tendency to use drugs in a similar manner to in adulthood (especially for older teenagers).
A few considerations.....
1. Valproate is generally more effective for manic symptoms than Lamictal. Lamictal is more useful for depressive symptoms.
2. If Latuda is not beneficial, it may be wise to taper off it - if the doctor advises.
3. If lithium is not effective after a few weeks, or if it is not tolerated, valproate might prove to be a suitable replacement.
4. Since valproate interacts with Lamictal, the dose will require adjustment. If Lamictal is not clearly beneficial, it may be tapered prior to starting valproate.
Posted by Lou Pilder on February 19, 2012, at 16:17:14
In reply to Re: Desperate, posted by papillon2 on February 18, 2012, at 23:13:52
> Her Lithium dose (90mg) is tiny, much less than the amounts even prescribed to augment anti-depressants in unipolar depression. You'll know when the blood level comes back, but I'm guessing it is minute and could be increased substantially. Lithium is the gold standard for bipolar and is very good for mania.
>
> Are the shaky hands definitely coming from Lithium and not something else? I'm not doubting that it COULD be Lithium as I myself an extremely sensitive to Lithium and have toxicity symptoms at low doses (125-250mg). It just sounds like a lot of meds were added at the same time, which would be confusing for anyone in deducing which side effects come from each med. And as I said, that Lithium dose is TINY.
>
> I think the side effects of Lithium are greatly overplayed. It is prescribed in much lower doses than it used to be and kidney and thyroid functioning are carefully monitored. I'd take it over an atypical anti-psychotic any day; the side effects of AAPs are far worse in my opinion.
>
> Lamictal and Topamax are the only bipolar meds I can think of that don't cause weight gain in most people. However, while Topamax generally makes people lose weight it can produce significant cognitive impairment ("Californian Barbie Syndrome"). I agree that a blood relative performing well on Lamictal is reason enough to stick with it.
>
> You may find this article helpful if you are concerned about cardiometabolic side effects. Refer to table 1 in particular: https://www.cmellc.com/CMEActivities/tabid/54/ctl/ActivityController/mid/545/activityid/2205/Default.aspxpapillion2,
You wrote,[...can produce significant cognitive impairment...]
Thank's. I think that's good
Posted by Lou Pilder on February 19, 2012, at 16:18:43
In reply to Re: Desperate, posted by sigismund on February 18, 2012, at 23:20:10
> I would be taking things away rather than adding more.
Sig,
You wrote the above. Thanks, I think that's good
Lou
Posted by Lou Pilder on February 19, 2012, at 16:32:23
In reply to Re: Desperate, posted by bleauberry on February 19, 2012, at 8:58:09
> This is certainly a heartbreaking story and all of us have experienced, or do experience, to a minor moderate or severe degree. Your comment "worn to a frazzle" only begins to describe the devastation. So sorry!
>
> Like others have said, Vynase I think is suspect. It doesn't matter that it used to be fine, because of these reasons....
> Our bodies, brains, and diseases are always in motion...not static...and things change/morph with time. While we view meds such as Vynase as therapeutic, keep in mind that when used illegally the end result is almost always bad....any of the amphetamines lead to an eventual downfall...just because it has an authorized prescription attached to it does not change that. That said, Vynase may not be a problem at all, but to me is at least suspect.
>
> Not sure why Zyprexa was not considered, but I would personally put more hope and trust in that one than any of its peers.
>
> I think other things need to be looked at. I'm trying to think, what are some of the issues that struggling mothers find in their troubled kids? You know, the guerrilla medicine stuff that patients are forced in to when doctors alone fall short? Well, probably the most common issue is toxicity...usually lead and/or mercury. Might want to study up on DMSA and chelation, if for no other reason to know that the whole issue actually exists and is behind bizarre symptoms of many kids. It is a gray area, and some medical elites will poo-poo the whole thing, and of course their patients are the ones probably staying sick. Mothers know what works. Chelation is one of their more successful tools. Where did the toxins come from at such a young age? Maybe passed on from the mother? Something unknown in the living environment? How about immunization shots, many of which have mercury as a preservative? If a person is defective in certain genes, they will tend to accumulate and store toxins rather than normally excrete them. Thus easy toxicity from even miniscule exposure. And the obvious brain bizarreness that would follow.
>
> Has she tried a gluten free diet? How about dairy free? Many of the gray area pros and mothers find dairy to be a factor in the bizarre psychiatric symptoms of kids. Study up on gluten, how it destroys the cilia lining in the intestines, and how that wreaks havoc on the nervous system by allowing large undigested molecules to enter straight into the bloodstream and of course obvious impact on the workings in the brain.
>
> Lots of people with lyme disease or similar occult hidden infections display bizarre patterns and histories very much like what you have seen. People freak out because they think that I think everyone has lyme disease, because I mention this all the time, but the true scenario is that if the profile fits it has to be considered and not thrown out in haste. The profile fits. A two week blind trial of an antibiotic such as Doxycycline would provide most of the clues to make a fairly solid clinical diagnosis one way or the other, rule it in or rule it out. It has to be ruled out before tossing the idea away. Only a trial can provide the "pattern" response to know.
>
> In terms of meds, wow, that is a tough one. I mentioned zyprexa already. I'm also thinking that in some situations such as this one, the patient may actually do better on a combo of antidepressants and benzos, avoiding the mood stabilizers. Those who operate in a black-and-white world of bipolar versus unipolar would disagree, claiming antidepressants are trouble and mood stabilizers are mandatory. Sometimes yes, sometimes no. Can't make a blanket treatment based on a word such as bipolar or whatever....we have to try stuff to see what helps or what hurts, and sometimes the things we find helpful we can't explain why.
>
> The whole thing is too gray to approach with a cookie cutter protocol (as in stimulant for ADHD and mood stabilizer for bipolar)....it just aint that straight forward.
>
> Reduction of stored toxins, reduction of toxin exposure, careful choices of foods and experiments finding which aggravate, which help, and which are neutral. Most likely troubles from gluten and dairy. Self test for hidden infections.
>
> I know you need ideas right now that will help fast. I don't know what that would be, except maybe zyprexa. But since she is so young, there is a real long battle ahead....and that's why I am stressing....screaming from the hilltops actually....to gain firm command of the issues I've mentioned here. Because those are the very issues other mothers in your shoes are finding helpful. The meds by themselves are rarely the answer. We get lucky sometimes, as you already experienced, and that can land us in a false sense of security that we can get lucky like that again and again. I wish. Just don't see that happen hardly ever.
>
> Battle evil with all you've got and every weapon you can get your hands on. Meds are only a part of that war. Next comment maybe could appear off topic, IMO directly on topic, Jesus wants to be involved in this war so if you haven't personally asked Him to join you, something to consider. He promised wisdom to any who would ask for it.
>
> I like all the approaches mentioned here (wish they were my own ideas). What I like about them is they demonstrate true healing potential, risks are low, expense low, and suitable for a lifetime.bleau,
You wrote,[...just because it has an authorized prescription attached to it...]
Thanks, I think that's good.
Lou
Posted by Lou Pilder on February 19, 2012, at 16:36:17
In reply to Re: Desperate » Solstice, posted by sigismund on February 19, 2012, at 15:32:08
> With our kids I was very concerned not to medicalise the normal intractable problems of life. We could easily have done that. There is an alternative view about disease progression. I really do feel it would have been a disaster for us to have medicalised a very difficult situation. Rightly or wrongly. And I am sceptical about ADHD and bipolar diagnoses.
>
> I don't know anything about those drugs. I would be so worried. Her body is still developing and is being affected by the drugs, they aren't working well and our knowledge is so limited.
>
> I wish I could say something more helpful.Sig,
Thanks for what you posted here. It could go a long way in helping people make a more informed decision as to have their child take mind-altering drugs.
Lou
Posted by Solstice on February 19, 2012, at 17:20:51
In reply to Re: Desperate » Solstice, posted by sigismund on February 19, 2012, at 15:32:08
> With our kids I was very concerned not to medicalise the normal intractable problems of life. We could easily have done that. There is an alternative view about disease progression. I really do feel it would have been a disaster for us to have medicalised a very difficult situation. Rightly or wrongly. And I am sceptical about ADHD and bipolar diagnoses.
I understand, and do think there really are people who have unrealistic expectations about child/adolescent behavior and may be too quick to think normal child behavior is 'abnormal' and in need of treatment with medications. That said, in my daughter's case, believe me - there was no question. Even after she was settled on Geodon and I considered the turnaround miraculous, believe me, she was still fully adolescent with all of its accompanying difficulties. :-)
> I don't know anything about those drugs. I would be so worried. Her body is still developing and is being affected by the drugs, they aren't working well and our knowledge is so limited.I understand those concerns as well. I tend to have a high tolerance for 'pain' so her bipolar could have easily been overlooked. That said, her symptoms (at diagnosis 3 yrs ago) were catastrophic enough that after things settled down, she thanked me repeatedly for not letting it go.. for addressing it aggressively. She does not think she would have had the relatively good live she's had so far if the bipolar had not been caught and treated.
There is risk in everything. Treating, of course, has risks. But failing to find effective treatment for mental illness also has catastrophic risks such as: suicide - and destroyed relationships, finances, careers, etc.
> I wish I could say something more helpful.I appreciate your input.
Solstice
Posted by Lou Pilder on February 19, 2012, at 17:25:00
In reply to Re: Desperate » Solstice, posted by Phillipa on February 19, 2012, at 10:52:45
> Just got on the board wow Soltice things are not good right now and I'm seriously so sorry for your whole family. I quickly read the whole thread. I see her thyroid hasn't been tested. This rather angers me as that should be the first thing checked. Especially due to her age evolving hormonal changes and being on lithium. I'd seriously get all other illnesses ruled out and then tackle meds more throughly. Seriously the thyroid I found so often was involved in mental illness when working. What if it was this? And at her age raging hormones sure complicate the picture. You mentioned Sister is she suffering from mental illness? I'm so sorry but I have witnessed lithium causing the shaking of the hands that tremor and on very low doses also. Phillipa
Phillipa,
You wrote the above about checking thyroid. Thanks, I think that's good.
Lou
Posted by Lou Pilder on February 19, 2012, at 17:30:45
In reply to Re: Desperate » Solstice, posted by sigismund on February 19, 2012, at 15:32:08
> With our kids I was very concerned not to medicalise the normal intractable problems of life. We could easily have done that. There is an alternative view about disease progression. I really do feel it would have been a disaster for us to have medicalised a very difficult situation. Rightly or wrongly. And I am sceptical about ADHD and bipolar diagnoses.
>
> I don't know anything about those drugs. I would be so worried. Her body is still developing and is being affected by the drugs, they aren't working well and our knowledge is so limited.
>
> I wish I could say something more helpful.Sig and friends,
I appreciate what sig has posted here because it has support from psychologists and doctors. If you are interested in seeing a video that supports Sig's posting here, I invite you to view the following.
Lou
To see this video:
A. Pull up Google
B. Type in:
[youtube, Drugging our children w/Psychiatry's antipsychotic drugs]
you will see a pic of Dr John Breeding
Posted by Lou Pilder on February 19, 2012, at 18:23:52
In reply to Re: Desperate, posted by bleauberry on February 19, 2012, at 8:58:09
> This is certainly a heartbreaking story and all of us have experienced, or do experience, to a minor moderate or severe degree. Your comment "worn to a frazzle" only begins to describe the devastation. So sorry!
>
> Like others have said, Vynase I think is suspect. It doesn't matter that it used to be fine, because of these reasons....
> Our bodies, brains, and diseases are always in motion...not static...and things change/morph with time. While we view meds such as Vynase as therapeutic, keep in mind that when used illegally the end result is almost always bad....any of the amphetamines lead to an eventual downfall...just because it has an authorized prescription attached to it does not change that. That said, Vynase may not be a problem at all, but to me is at least suspect.
>
> Not sure why Zyprexa was not considered, but I would personally put more hope and trust in that one than any of its peers.
>
> I think other things need to be looked at. I'm trying to think, what are some of the issues that struggling mothers find in their troubled kids? You know, the guerrilla medicine stuff that patients are forced in to when doctors alone fall short? Well, probably the most common issue is toxicity...usually lead and/or mercury. Might want to study up on DMSA and chelation, if for no other reason to know that the whole issue actually exists and is behind bizarre symptoms of many kids. It is a gray area, and some medical elites will poo-poo the whole thing, and of course their patients are the ones probably staying sick. Mothers know what works. Chelation is one of their more successful tools. Where did the toxins come from at such a young age? Maybe passed on from the mother? Something unknown in the living environment? How about immunization shots, many of which have mercury as a preservative? If a person is defective in certain genes, they will tend to accumulate and store toxins rather than normally excrete them. Thus easy toxicity from even miniscule exposure. And the obvious brain bizarreness that would follow.
>
> Has she tried a gluten free diet? How about dairy free? Many of the gray area pros and mothers find dairy to be a factor in the bizarre psychiatric symptoms of kids. Study up on gluten, how it destroys the cilia lining in the intestines, and how that wreaks havoc on the nervous system by allowing large undigested molecules to enter straight into the bloodstream and of course obvious impact on the workings in the brain.
>
> Lots of people with lyme disease or similar occult hidden infections display bizarre patterns and histories very much like what you have seen. People freak out because they think that I think everyone has lyme disease, because I mention this all the time, but the true scenario is that if the profile fits it has to be considered and not thrown out in haste. The profile fits. A two week blind trial of an antibiotic such as Doxycycline would provide most of the clues to make a fairly solid clinical diagnosis one way or the other, rule it in or rule it out. It has to be ruled out before tossing the idea away. Only a trial can provide the "pattern" response to know.
>
> In terms of meds, wow, that is a tough one. I mentioned zyprexa already. I'm also thinking that in some situations such as this one, the patient may actually do better on a combo of antidepressants and benzos, avoiding the mood stabilizers. Those who operate in a black-and-white world of bipolar versus unipolar would disagree, claiming antidepressants are trouble and mood stabilizers are mandatory. Sometimes yes, sometimes no. Can't make a blanket treatment based on a word such as bipolar or whatever....we have to try stuff to see what helps or what hurts, and sometimes the things we find helpful we can't explain why.
>
> The whole thing is too gray to approach with a cookie cutter protocol (as in stimulant for ADHD and mood stabilizer for bipolar)....it just aint that straight forward.
>
> Reduction of stored toxins, reduction of toxin exposure, careful choices of foods and experiments finding which aggravate, which help, and which are neutral. Most likely troubles from gluten and dairy. Self test for hidden infections.
>
> I know you need ideas right now that will help fast. I don't know what that would be, except maybe zyprexa. But since she is so young, there is a real long battle ahead....and that's why I am stressing....screaming from the hilltops actually....to gain firm command of the issues I've mentioned here. Because those are the very issues other mothers in your shoes are finding helpful. The meds by themselves are rarely the answer. We get lucky sometimes, as you already experienced, and that can land us in a false sense of security that we can get lucky like that again and again. I wish. Just don't see that happen hardly ever.
>
> Battle evil with all you've got and every weapon you can get your hands on. Meds are only a part of that war. Next comment maybe could appear off topic, IMO directly on topic, Jesus wants to be involved in this war so if you haven't personally asked Him to join you, something to consider. He promised wisdom to any who would ask for it.
>
> I like all the approaches mentioned here (wish they were my own ideas). What I like about them is they demonstrate true healing potential, risks are low, expense low, and suitable for a lifetime.bleau,
You wrote, [...maybe because they are young...]
Here is a video that I would like for you and others interested that I think could be soomething important in this discussion.
Lou
To see this video:
A. Pullup Google
B. Type in:
[youtube, Labeling Kids with Mental Disorders]
usually first. You will see a pic of a child with letters on his shirt...posted on Dec 20 2010 time is 2 min
Posted by Phillipa on February 19, 2012, at 20:11:55
In reply to Lou's thanks-thyroid » Phillipa, posted by Lou Pilder on February 19, 2012, at 17:25:00
Lou I must congratulate you that you are now posting Thank you's and positive stuff. So appreciative of your comments keep it up. But remember Solstice did ask you not to post on this thread. But since then very nice. Phillipa
Posted by Phillipa on February 19, 2012, at 20:14:33
In reply to Lou's response-Dr John Breeding » sigismund, posted by Lou Pilder on February 19, 2012, at 17:30:45
Lou you were doing good don't go backwards okay? Phillipa
Posted by Phillipa on February 19, 2012, at 20:16:27
In reply to Lou's response-bohguzlehybulz » bleauberry, posted by Lou Pilder on February 19, 2012, at 18:23:52
Lou I was so hopeful Really I was can you openly apologize? Please. Phillipa
Posted by SLS on February 19, 2012, at 21:13:33
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
- Scott
Posted by SLS on February 19, 2012, at 21:25:54
In reply to Re: Desperate » Solstice, posted by SLS on February 19, 2012, at 21:13:33
> Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
Mixed states are not pleasant for the sufferer.
- Scott
Posted by Solstice on February 19, 2012, at 22:14:21
In reply to Re: Desperate » Solstice, posted by SLS on February 19, 2012, at 21:13:33
> Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
>
>
> - Scott
I want to understand it better.She has never had what we normally think of as 'depression' - in that she has never been shut down, or in bed, or sad, or feeling hopeless.
On the contrary, her self-image is either what I would consider fairly balanced, or it's inflated. She could never be accused of thinking poorly of herself. She's not at all self-conscious. She's generally sensitive to and compassionate toward the suffering of others. She has a reputation of being the champion of the underdog.
The elevation that gets my attention is where her self-expectations get markedly unreasonable, talking incessantly and randomly, being intense and excessively 'hyper,' and is unable to sleep for extended periods.
What makes it especially difficult is that her perceptions of things (during her current state) are really off, and somewhat paranoid. Her rapid and random thinking and talking means she doesn't *really* hear what the other is saying - so she jumps to crazy conclusions to fill in the gaps, I guess. Anyway, that's what I've been observed as contributing to her reactivity. She will have these intense and out-of-proportion reactions to things. It's very unpredictable. I can be having a fairly normal conversation with her (despite her intensity, etc.), and she'll suddenly completely misinterpret something and fly off the handle - and get really crazy. Any attempts to diffuse it seems to further agitate her. She can't be reasoned with, and her ideas about what's going on just get more and more illogical. All that can happen in a flash - and once she escalates like that, she gets really intense about how impossible her life is and it takes on a desperate quality.
I want to understand what goes with what. I don't know which symptoms fall into which category. I've felt blessed that her bipolar has been more hypomania alternating with a normal state - except that I think she spent the first 14 years of her life in a perpetual hypomania that got difficult enough to get our attention when she hit puberty. It was an unbelievable experience to 'meet' the real *her* when the Geodon diminished the hypomania. I remember her telling me how weird it was for her to realize that she was feeling 'feelings.' Before Geodon, her head was spinning so fast all the time that she never genuinely 'felt' a range of emotions. She liked a lot of stuff and was real excitable, but it wasn't until the Geodon settled the hypomania that she started to get to know herself, and feel moved by things, or concerned about things - the more moderate range of emotions that are felt deeply.
Sorry - I'm getting sidetracked - but I've read a lot of things that made it sound like the irritability/anger explosions are related to the hypomania.. but that didn't make sense to me. Is the irritability a feature of hypomania, or is it really a version of depression? I just don't understand how it works, which makes it kind of hard to discuss with her doctor, and even with my daughter.
Appreciate the help, Scott.
Solstice
Posted by Solstice on February 19, 2012, at 22:22:24
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
> One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
>Is Topamax typically used in conjunction with anything else?
What kind of cognitive side effects does it have? I know I can look it up online, but it'll be very generalized and be the same as all the other same-class medications. My daughter would be distressed if something made her feel cognitively dull.. so if there's a way to avoid that it would be important to avoid it.
> Mixed states are not pleasant for the sufferer.I know... it is so hard for me to watch. It's very disruptive for her. She told me the other day that she felt 'trapped' in the cycle - and feels desperate about feeling like she'll never break out of it. She has not been herself at all, and it's painful.
Solstice
Posted by papillon2 on February 19, 2012, at 22:50:27
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
> Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects.
I always thought the cognitive side effects of Topamax were a foregone conclusion. It's good to know they can be avoided by slow titration, kind of like Lamictal and SJS.
Thanks Scott.
Posted by Solstice on February 19, 2012, at 23:22:53
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
>
> One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
Scott -I read some patient dialogue about Topamax, and they discussed whether slow titration serves to minimize cognitive side effects. Some thought that slow titration did not minimize cognitive impairment, but rather masked it because it was less noticeable when the decline built more slowly.
I cannot judge the validity of their statements, but I am very interested in what you think about the merits.
Also - one of them said they switched to Zonegran, which supposedly did not have the cognitive impairment side effect. We just need to be careful about trying anything that is known to make irritability/agitation worse.
Solstice
Posted by SLS on February 19, 2012, at 23:39:42
In reply to Re: Desperate - tell me more, Scott » SLS, posted by Solstice on February 19, 2012, at 22:14:21
Hi Solstice.
A mixed-state is difficult to characterize and even more difficult to diagnose properly.
Hypomania can involve mixed-states.
Mixed states are described as being a combination of mania and depression, but this really doesn't say very much about what these states actually look like in real life.
In your daughter's case, I would characterize her current state as being a dysphoric hypomania, which is a type of mixed-state.
http://www.bipolarmixedstates.com/bipolarmixedstates.html
"A dysphoric mania consists of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms (MMDT). Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation. Alcohol, drug abuse, and some antidepressant drugs may trigger dysphoric mania in susceptible individuals."
I have suffered several dysphoric manic episodes that were associated with antidepressant drug treatment. Depakote and Zyprexa have each worked extremely well to dissolve the mania. It took less than 48 hours for each drug to put out the fire.
These are some of the things I experienced:
- Racing thoughts.
- Reduced need for sleep - 3 hours.
- Irritability.
- Rage attacks.
- Impatience for people who were too slow.
- Flight of ideas.
- Grandiose or expansive ideas and plans.
- No euphoria.
- Inflated self-esteem.
- Distractability
- Inability to complete tasks.
- Manufacturing associations between unrelated things.
- Pressured, rapid, and loud speech.
- Scott
Posted by SLS on February 19, 2012, at 23:46:05
In reply to Re: Desperate » SLS, posted by papillon2 on February 19, 2012, at 22:50:27
> > Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects.
>
> I always thought the cognitive side effects of Topamax were a foregone conclusion. It's good to know they can be avoided by slow titration, kind of like Lamictal and SJS.Yes. I was able to get to 200 mg and actually had an improvement in my clarity of thought with no problems finding words or slowed rate of speech. It actually improved my depression somewhat. I found it somewhat energizing.
It seems that once triggered, cognitive impairments persist. The key is not to trigger them in the first place. I started at 25 mg. It took me a month or so to reach 200 mg.
- Scott
Posted by SLS on February 19, 2012, at 23:55:41
In reply to Re: Desperate - another question, Scott » SLS, posted by Solstice on February 19, 2012, at 23:22:53
> I read some patient dialogue about Topamax, and they discussed whether slow titration serves to minimize cognitive side effects.
This has been the observation of my doctor. This was my experience as well.
> Some thought that slow titration did not minimize cognitive impairment, but rather masked it because it was less noticeable when the decline built more slowly.
In the end, how do you mask stupefaction?
> I cannot judge the validity of their statements, but I am very interested in what you think about the merits.
I can't guarantee anything. If I were a doctor, and observed this in many of my patients and in those of my colleagues, I could be more confident in saying such things.
> Also - one of them said they switched to Zonegran, which supposedly did not have the cognitive impairment side effect.
I found Zonegran to be pretty "clean" cognitively. Weight gain was not a problem. It just didn't work at all to improve my depression. I have no idea what track record it has for mania or mixed-states.
I did see Topamax 100 mg totally wipe out a raging mixed-hypomania within a week.
- Scott
Posted by Twinleaf on February 20, 2012, at 1:17:10
In reply to Re: Desperate » sigismund, posted by Solstice on February 19, 2012, at 17:20:51
I think it's wonderful that you are able to understand your daughter so well, and describe her symptoms so clearly, despite the enormous distress her condition must be.causing you. I think you are getting some very good suggestions from people who know a lot about bipolar illness; I hope at least one of them really helps her.
One thing caught my attention: how, under stress, she begins to distort her feelings about others' motives. Do you think this is something that psychotherapy might help her with? In addition, if you found a really good therapist, it would be an additional source of support, which might make things a bit easier for you. I realize that she has two neurologically based illnesses, but the interpersonal stresses resulting from them might be helped considerably by a caring therapist.
Posted by sigismund on February 20, 2012, at 1:23:45
In reply to Lou's response-Dr John Breeding » sigismund, posted by Lou Pilder on February 19, 2012, at 17:30:45
Actually I misspoke.
It is not the diagnoses so much I have problems with so much as the treatment.
So long as the treatment is not worse than the disease.
ADHD is so obviously culturally mediated.
I must look up the stats from different countries for ADHD. Including non western countries.
I read today that a change in the DSM led to a 200% increase in treatment in a very short time here.
These are my concerns as a parent. (Speaking personally, I would like some amphetamine treatment for myself.) Also as a parent I can imagine how appallingly difficult this is for Solstice.
Posted by Lou Pilder on February 20, 2012, at 5:09:33
In reply to Re: Desperate » SLS, posted by SLS on February 19, 2012, at 21:25:54
> > Oh. I forgot to mention that your daughter might currently be experiencing a bipolar mixed-state. That would explain the morphing of the hypomania from one that feels pleasant to one that feels dysphoric.
>
> One more tool to be aware of is Topamax. It works for mixed states, as does Depakote. Topamax treatment must be initiated at a very low dosage and titrated gradually in order to avoid cognitive side effects. 100 mg may be all that is needed. I have seen it work wonders for mixed states. Topamax is known to produce weight loss, just in case that is an issue.
>
> Mixed states are not pleasant for the sufferer.
>
>
> - ScottFriends,
Just because someone posts concerning their promotion of a drug for children to take, their promotion could be short of the full understnding of the drug that they are promoting. If all of the facts about a drug were known before it was taken or given to a child, then I think that the person making the decision to institute the drug for a child to take could have a better understnding of the drug and then make a more informed decision as to give the drug to a child or not.
Now Topomax is the drug being promoted for a child to take here. But is that all there is to making a decision as to give it to a child, that someone on an internet site promotes it? If a parent went to the doctor and said that they wanted their child to take Topomax because someone on an internet site was promoting it, do you think that the doctor then would change his/her treatment because of that?
Let's look at a little about this drug, Topomax. The drug has the ability to act on the brain to lower the threshold in relation to seizures, which is used to treat epilepsy. The chemical structure of the drug and its history, I am prohibited here from showing in an exposition due to the prohibitions to me from Mr. Hsiung. His prohibition to me is based on that it {might not} be conducive to civic harmony, whatever that could mean. But if it {might} not, then it could also {might be}? So if usiing Mr. Hsiung's thinking in relation that topics that {might not be}, then could not it then be considerd that {NO} topic could be posted here because is it not a fact that any topic {MIGHT NOT BE} conducive to civic harmony, whatever that could be?
Now it is important for me to tell you this because what I could say without the prohibitions could IMHHO save lives and prevent someone from getting a life-ruining condition from these drugs. Because of the prohibitions, someone could die because they were not allowed to know educational material from me here. This is in tune with Mr. Hsiung's TOS here? Is it not that his TOS states that teh forum is for support and education? when I came here, I saw his TOS and I took him a his word. Yet today, the education that I could gie you is prohibited here by the nature of Mr. Hsiung posting to me prohibitions of what I can post or not based upon that someone {might} be {civically unharmonized}?, whatever that could mean, and I do not know.
Here is a video that I think could help in this discussion about the drug, Topomax. There is much more to this drug besides what is in the video.
Lou
to see this video:
A. Pull up Google
B. Type in:
[youtube,Topamax Lawyer-A Historical Timeline of Topomax Side Effects]
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