![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 92 to 116 of 129. Go back in thread:
Posted by SLS on February 20, 2012, at 10:25:30
In reply to Re: Desperate » papillon2, posted by Solstice on February 20, 2012, at 9:16:21
Just in case you didn't see this:
Regarding Topamax treatment, evidence suggests that gradual dosage escalations can help to minimize adverse neurocognitive effects:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656323/http://www.ncbi.nlm.nih.gov/pubmed/11215835
http://www.ncbi.nlm.nih.gov/pubmed/15519117
Also: Dodson WE, Kamin M, Kraut L, et al. Topiramate titration to response: analysis of individualized therapy study (TRAITS) Epilepsia. 2003;37:61520.
- Scott
Posted by Zyprexa on February 20, 2012, at 10:31:33
In reply to Re: Desperate, posted by Solstice on February 18, 2012, at 23:27:20
to get rid of the shakes you could take cogentin. I take that, it works.
Posted by Lou Pilder on February 20, 2012, at 12:51:03
In reply to Scott's response » Lou Pilder, posted by SLS on February 20, 2012, at 10:05:58
> Lou Pilder.
>
> Thank you for replying to my question.
>
> > > > ...the drug that they are promoting.
>
> > > What do you mean by "promoting"? Do you think I have motives to suggest the efficacy of drugs for reasons that are not altruistic? I feel accused and put-down.
>
> > Then, the post here in the link talks about taking Topomax. As I understand the grammatical structure of the statement, it is offering Topomax as something that the mother could have the child take which in my understanding of the word {promotion}, could include as that as being advocated.
>
> I feel accused. You are paraphrasing my words and substituting "advocate" for "promote". You now add "advocate" as if the definitions for these two words were the same. I did not promote Topamax. "Promote" is the word you first used to describe my behavior. You did not use the word "advocate".
>
> SLS: "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."
>
> This is simply education and support.
>
> Just to address your characterization my use of my grammer, I think it would have been appropriate for you to have included a quotation of my words so that they could be scrutinized. I did not suggest that anyone take Topamax. Clearly, I suggested that the poster be aware of the existence of Topamax. I did not promote nor advocate that it be used.
>
> I do advocate the use of Topamax for bipolar disorder. I currently do not promote it. Perhaps I will in the future.
>
> Promote:
>
> http://dictionary.reference.com/browse/promote
>
> "to encourage the sales, acceptance, etc., of (a product), especially through advertising or other publicity."
>
> This is not a question of grammer. It is a question of diction.
>
>
> - ScottFriends,
The post above is one that I think can go a long way to undertsanding the issues here. I will include the link to the post in question here to go back to in order to see the issues involved.
http://www.dr-bob.org/babble/20120212/msgs/1010901.html
Now bw advised that in situations like this, the words in question can become what is what. It is what can be seen, not what the maker of the words says that it means after the fact, but in most of the cases that I have prosecuted, the defendant raises to the judge/magistrate that the word means something different.
Now here is how those type of cases haave been handled in my cases:
The rule is that it is not what the person who is the maker of the word says that it means, or the one contesting the word's meaning says that it means, but what a reasonable person could think that it means. I know of only one case that then went further as to that the phrase {reasonable person} was contested to mean.
Also the magistrate/judge usually states that the plaintif can not invoke what they want the word to mean, except by dictionary definition and such. This is because the defendant does not have to be a mind-reader.
Now in the case at hand here, there are three words that the maker of the document in question here is bringing up. First, he is the maker of the words, I am defending my post from what I read that he made with his words. I can not tell what he wants to mean after the fact, for I could only post my response as seeing the words before the fact. Now let's look at the words....to be contimued
Lou
Posted by Lou Pilder on February 20, 2012, at 13:05:28
In reply to Lou's defense-avderdhaphact » SLS, posted by Lou Pilder on February 20, 2012, at 12:51:03
> > Lou Pilder.
> >
> > Thank you for replying to my question.
> >
> > > > > ...the drug that they are promoting.
> >
> > > > What do you mean by "promoting"? Do you think I have motives to suggest the efficacy of drugs for reasons that are not altruistic? I feel accused and put-down.
> >
> > > Then, the post here in the link talks about taking Topomax. As I understand the grammatical structure of the statement, it is offering Topomax as something that the mother could have the child take which in my understanding of the word {promotion}, could include as that as being advocated.
> >
> > I feel accused. You are paraphrasing my words and substituting "advocate" for "promote". You now add "advocate" as if the definitions for these two words were the same. I did not promote Topamax. "Promote" is the word you first used to describe my behavior. You did not use the word "advocate".
> >
> > SLS: "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."
> >
> > This is simply education and support.
> >
> > Just to address your characterization my use of my grammer, I think it would have been appropriate for you to have included a quotation of my words so that they could be scrutinized. I did not suggest that anyone take Topamax. Clearly, I suggested that the poster be aware of the existence of Topamax. I did not promote nor advocate that it be used.
> >
> > I do advocate the use of Topamax for bipolar disorder. I currently do not promote it. Perhaps I will in the future.
> >
> > Promote:
> >
> > http://dictionary.reference.com/browse/promote
> >
> > "to encourage the sales, acceptance, etc., of (a product), especially through advertising or other publicity."
> >
> > This is not a question of grammer. It is a question of diction.
> >
> >
> > - Scott
>
> Friends,
> The post above is one that I think can go a long way to undertsanding the issues here. I will include the link to the post in question here to go back to in order to see the issues involved.
> http://www.dr-bob.org/babble/20120212/msgs/1010901.html
> Now bw advised that in situations like this, the words in question can become what is what. It is what can be seen, not what the maker of the words says that it means after the fact, but in most of the cases that I have prosecuted, the defendant raises to the judge/magistrate that the word means something different.
> Now here is how those type of cases haave been handled in my cases:
> The rule is that it is not what the person who is the maker of the word says that it means, or the one contesting the word's meaning says that it means, but what a reasonable person could think that it means. I know of only one case that then went further as to that the phrase {reasonable person} was contested to mean.
> Also the magistrate/judge usually states that the plaintif can not invoke what they want the word to mean, except by dictionary definition and such. This is because the defendant does not have to be a mind-reader.
> Now in the case at hand here, there are three words that the maker of the document in question here is bringing up. First, he is the maker of the words, I am defending my post from what I read that he made with his words. I can not tell what he wants to mean after the fact, for I could only post my response as seeing the words before the fact. Now let's look at the words....to be contimued
> LouFriends,
There are three words here that I read {in their context} that as considering myself a reasonable person, responded with the understnding of what the words could mean.The three words are: tool, promote and advocate.
The generally accepted meaning of {tool} is that it is ssomething that facilitates getting a job done correctly.
The generally accepted meaning of to {advocate}, is to write in favor of or be supportive of its inclusion in or for something. This usually happens in what is referred to as a {testamonial} of praise.
The generally accepted meaning of {promote} is to write something that one could think to adopt because there is language that {raises above} what else is in that set of things being talked about.
Now in this case, we have the maker of the words stating:
http://www.dr-bob.org/babble/20120212/msg/1010901.html
Let's see how a resonable person could think as to what the maker of the post could be meaning.
Lou
Posted by Lou Pilder on February 20, 2012, at 13:36:08
In reply to Lou's defense-The words, posted by Lou Pilder on February 20, 2012, at 13:05:28
> > > Lou Pilder.
> > >
> > > Thank you for replying to my question.
> > >
> > > > > > ...the drug that they are promoting.
> > >
> > > > > What do you mean by "promoting"? Do you think I have motives to suggest the efficacy of drugs for reasons that are not altruistic? I feel accused and put-down.
> > >
> > > > Then, the post here in the link talks about taking Topomax. As I understand the grammatical structure of the statement, it is offering Topomax as something that the mother could have the child take which in my understanding of the word {promotion}, could include as that as being advocated.
> > >
> > > I feel accused. You are paraphrasing my words and substituting "advocate" for "promote". You now add "advocate" as if the definitions for these two words were the same. I did not promote Topamax. "Promote" is the word you first used to describe my behavior. You did not use the word "advocate".
> > >
> > > SLS: "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."
> > >
> > > This is simply education and support.
> > >
> > > Just to address your characterization my use of my grammer, I think it would have been appropriate for you to have included a quotation of my words so that they could be scrutinized. I did not suggest that anyone take Topamax. Clearly, I suggested that the poster be aware of the existence of Topamax. I did not promote nor advocate that it be used.
> > >
> > > I do advocate the use of Topamax for bipolar disorder. I currently do not promote it. Perhaps I will in the future.
> > >
> > > Promote:
> > >
> > > http://dictionary.reference.com/browse/promote
> > >
> > > "to encourage the sales, acceptance, etc., of (a product), especially through advertising or other publicity."
> > >
> > > This is not a question of grammer. It is a question of diction.
> > >
> > >
> > > - Scott
> >
> > Friends,
> > The post above is one that I think can go a long way to undertsanding the issues here. I will include the link to the post in question here to go back to in order to see the issues involved.
> > http://www.dr-bob.org/babble/20120212/msgs/1010901.html
> > Now bw advised that in situations like this, the words in question can become what is what. It is what can be seen, not what the maker of the words says that it means after the fact, but in most of the cases that I have prosecuted, the defendant raises to the judge/magistrate that the word means something different.
> > Now here is how those type of cases haave been handled in my cases:
> > The rule is that it is not what the person who is the maker of the word says that it means, or the one contesting the word's meaning says that it means, but what a reasonable person could think that it means. I know of only one case that then went further as to that the phrase {reasonable person} was contested to mean.
> > Also the magistrate/judge usually states that the plaintif can not invoke what they want the word to mean, except by dictionary definition and such. This is because the defendant does not have to be a mind-reader.
> > Now in the case at hand here, there are three words that the maker of the document in question here is bringing up. First, he is the maker of the words, I am defending my post from what I read that he made with his words. I can not tell what he wants to mean after the fact, for I could only post my response as seeing the words before the fact. Now let's look at the words....to be contimued
> > Lou
>
> Friends,
> There are three words here that I read {in their context} that as considering myself a reasonable person, responded with the understnding of what the words could mean.The three words are: tool, promote and advocate.
> The generally accepted meaning of {tool} is that it is ssomething that facilitates getting a job done correctly.
> The generally accepted meaning of to {advocate}, is to write in favor of or be supportive of its inclusion in or for something. This usually happens in what is referred to as a {testamonial} of praise.
> The generally accepted meaning of {promote} is to write something that one could think to adopt because there is language that {raises above} what else is in that set of things being talked about.
> Now in this case, we have the maker of the words stating:
> http://www.dr-bob.org/babble/20120212/msg/1010901.html
> Let's see how a resonable person could think as to what the maker of the post could be meaning.
> Lou
>Friends,
Here is the link to the post in question that the words are in discussion.
http://www.dr-bob.org/babble/20120212/msgs/1010901.html
In the forst statement, the context is defined. The daughter might be experiancing a bipolar mixed-state.
Noew the maker of the words in question responds to that context. The statements are:
A. One more tool to be aware of is Topomax.
B. It works for mixed-states
C. I have seen it work wonders for mixed-states
D. Mixed states are not pleasant for the sufferer
Now I am "the defendant" here as I am defending my response as being what a reasonable person could think when reading the words in question in it's context.
Inj (A), the maker writes that Topomax is a tool, and one more tool. So Topomax could be thought by a reasonable person to a drug that could be included in the tool-box to facilitate helping the mother to get the doctor/psychitrist to prescribe the drug to the daughter.
Then in {B}, the maker of the word state that it {works} for mixed-states. This is a testamoniial of that in the maker of the words thinking, it could be good to get the daughter to take the drug via the psychiatris/doctor to prescribe the drug because it {works}.
Then in {C},the maker of the words states that he has eseen it work wonders for mixed-states. This type of ttestamonial {raises above} the others in consideration which could be thought to be a promotion of the drug by a reasonable person.
Then in {D], the unpleasentness of the sufferer of the mixed state is brought in. This could be thought by a reasonable person to be an advoction to take the drug because the promis that it works from the previous statement gives rise to an advoction to take it to stop the mixed stte because it works ccording to the maker of the wordss. The maker of the words is speaking in favor of the drug, which could be thought to be advocating that the drug be taken, in this case by the daughter. In fact, the mother is confronted with {what if she doesn't go right now to the doctor to get the drug for the daughter?}. This is because the maker of the words states that {it works}, {it is a tool},{he has seen it work wonders} and {mixed-states are not pleasent for tthe sufferer}. What is a mother to do here? She is confronted with that the drug is ssaid by the maker of the words that the daughter is suffering unpleasently and that the drug will work wonders. If that was me as parent, I would rush to get that drug right away , for there is the aspect that it will stop the suffereing of the child. Topomax is a drug used for siezure dissorder. As of my last understanding, the drug is not approved by the FDA for treating mixed-state of bipolar disorder.
Now I hope that you could see something that has been previously unbeknownst to you here. This is just the start. I intend to show you thinks to come, and things that I think could give you a whole new life, and you could sing a new song.
Lou
Posted by ed_uk2010 on February 20, 2012, at 13:57:25
In reply to Re: Desperate » papillon2, posted by Solstice on February 20, 2012, at 9:16:21
Hi Solstice,
Did you see my post above with information about valproate (Depakote)?
I think it may have been missed due to Lou's hijacking. In my opinion, Lou should not be posting on your thread when you specifically asked him not to. If he wants to 'discuss' the safety of psych meds he should start he own thread. Mind you, if it was up to me he would have been blocked a long time ago!
Take care.
Posted by Lou Pilder on February 20, 2012, at 14:50:39
In reply to Re: Lou's defense-ehynupsong, posted by Lou Pilder on February 20, 2012, at 13:36:08
> > > > Lou Pilder.
> > > >
> > > > Thank you for replying to my question.
> > > >
> > > > > > > ...the drug that they are promoting.
> > > >
> > > > > > What do you mean by "promoting"? Do you think I have motives to suggest the efficacy of drugs for reasons that are not altruistic? I feel accused and put-down.
> > > >
> > > > > Then, the post here in the link talks about taking Topomax. As I understand the grammatical structure of the statement, it is offering Topomax as something that the mother could have the child take which in my understanding of the word {promotion}, could include as that as being advocated.
> > > >
> > > > I feel accused. You are paraphrasing my words and substituting "advocate" for "promote". You now add "advocate" as if the definitions for these two words were the same. I did not promote Topamax. "Promote" is the word you first used to describe my behavior. You did not use the word "advocate".
> > > >
> > > > SLS: "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."
> > > >
> > > > This is simply education and support.
> > > >
> > > > Just to address your characterization my use of my grammer, I think it would have been appropriate for you to have included a quotation of my words so that they could be scrutinized. I did not suggest that anyone take Topamax. Clearly, I suggested that the poster be aware of the existence of Topamax. I did not promote nor advocate that it be used.
> > > >
> > > > I do advocate the use of Topamax for bipolar disorder. I currently do not promote it. Perhaps I will in the future.
> > > >
> > > > Promote:
> > > >
> > > > http://dictionary.reference.com/browse/promote
> > > >
> > > > "to encourage the sales, acceptance, etc., of (a product), especially through advertising or other publicity."
> > > >
> > > > This is not a question of grammer. It is a question of diction.
> > > >
> > > >
> > > > - Scott
> > >
> > > Friends,
> > > The post above is one that I think can go a long way to undertsanding the issues here. I will include the link to the post in question here to go back to in order to see the issues involved.
> > > http://www.dr-bob.org/babble/20120212/msgs/1010901.html
> > > Now bw advised that in situations like this, the words in question can become what is what. It is what can be seen, not what the maker of the words says that it means after the fact, but in most of the cases that I have prosecuted, the defendant raises to the judge/magistrate that the word means something different.
> > > Now here is how those type of cases haave been handled in my cases:
> > > The rule is that it is not what the person who is the maker of the word says that it means, or the one contesting the word's meaning says that it means, but what a reasonable person could think that it means. I know of only one case that then went further as to that the phrase {reasonable person} was contested to mean.
> > > Also the magistrate/judge usually states that the plaintif can not invoke what they want the word to mean, except by dictionary definition and such. This is because the defendant does not have to be a mind-reader.
> > > Now in the case at hand here, there are three words that the maker of the document in question here is bringing up. First, he is the maker of the words, I am defending my post from what I read that he made with his words. I can not tell what he wants to mean after the fact, for I could only post my response as seeing the words before the fact. Now let's look at the words....to be contimued
> > > Lou
> >
> > Friends,
> > There are three words here that I read {in their context} that as considering myself a reasonable person, responded with the understnding of what the words could mean.The three words are: tool, promote and advocate.
> > The generally accepted meaning of {tool} is that it is ssomething that facilitates getting a job done correctly.
> > The generally accepted meaning of to {advocate}, is to write in favor of or be supportive of its inclusion in or for something. This usually happens in what is referred to as a {testamonial} of praise.
> > The generally accepted meaning of {promote} is to write something that one could think to adopt because there is language that {raises above} what else is in that set of things being talked about.
> > Now in this case, we have the maker of the words stating:
> > http://www.dr-bob.org/babble/20120212/msg/1010901.html
> > Let's see how a resonable person could think as to what the maker of the post could be meaning.
> > Lou
> >
>
> Friends,
> Here is the link to the post in question that the words are in discussion.
> http://www.dr-bob.org/babble/20120212/msgs/1010901.html
> In the forst statement, the context is defined. The daughter might be experiancing a bipolar mixed-state.
> Noew the maker of the words in question responds to that context. The statements are:
> A. One more tool to be aware of is Topomax.
> B. It works for mixed-states
> C. I have seen it work wonders for mixed-states
> D. Mixed states are not pleasant for the sufferer
> Now I am "the defendant" here as I am defending my response as being what a reasonable person could think when reading the words in question in it's context.
> Inj (A), the maker writes that Topomax is a tool, and one more tool. So Topomax could be thought by a reasonable person to a drug that could be included in the tool-box to facilitate helping the mother to get the doctor/psychitrist to prescribe the drug to the daughter.
> Then in {B}, the maker of the word state that it {works} for mixed-states. This is a testamoniial of that in the maker of the words thinking, it could be good to get the daughter to take the drug via the psychiatris/doctor to prescribe the drug because it {works}.
> Then in {C},the maker of the words states that he has eseen it work wonders for mixed-states. This type of ttestamonial {raises above} the others in consideration which could be thought to be a promotion of the drug by a reasonable person.
> Then in {D], the unpleasentness of the sufferer of the mixed state is brought in. This could be thought by a reasonable person to be an advoction to take the drug because the promis that it works from the previous statement gives rise to an advoction to take it to stop the mixed stte because it works ccording to the maker of the wordss. The maker of the words is speaking in favor of the drug, which could be thought to be advocating that the drug be taken, in this case by the daughter. In fact, the mother is confronted with {what if she doesn't go right now to the doctor to get the drug for the daughter?}. This is because the maker of the words states that {it works}, {it is a tool},{he has seen it work wonders} and {mixed-states are not pleasent for tthe sufferer}. What is a mother to do here? She is confronted with that the drug is ssaid by the maker of the words that the daughter is suffering unpleasently and that the drug will work wonders. If that was me as parent, I would rush to get that drug right away , for there is the aspect that it will stop the suffereing of the child. Topomax is a drug used for siezure dissorder. As of my last understanding, the drug is not approved by the FDA for treating mixed-state of bipolar disorder.
> Now I hope that you could see something that has been previously unbeknownst to you here. This is just the start. I intend to show you thinks to come, and things that I think could give you a whole new life, and you could sing a new song.
> Lou
>Friends, If you are considering being a discussant in this thread or considering taking or getting someone Topomax, I am requesting that you read the following.
To read this article:
A. Bring up Google
B. Type in:
[Topomax. bipolar disorder, not approved by the FDA]
there will be several. I am looking at the one that explains about those using it for weight loss and that there is no proven study to say that Topomax is effective for any psychiatric condition. Could be first
Lou
Posted by Solstice on February 20, 2012, at 15:58:16
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
Okay.. first I want to apologize for perhaps making the issue more about Lou specifically than whats helpful. I dont dislike Lou. I am happy to see him around. He is just as welcome to post on the board as anyone else.I have obviously been in quite a bit of distress over my daughters situation. That likely plays a role in my stumbling a bit in navigating a the hijacking of my thread that is taking place. It has been disruptive and hurtful to me to have to wade through all of that to pick out the posts that are in response to my request for help. That said, no one elses less-than-optimal behavior warrants bad behavior on my part. I don't apologize for not liking my thread being hijacked. But I do want to apologize to Lou and the community for any offense my reactions to this situation have caused. And I apologize to Lou, the community, and Dr. Bob for any incivility on my part.
Solstice
Posted by Solstice on February 20, 2012, at 16:06:19
In reply to Desperate, posted by Solstice on February 18, 2012, at 21:08:07
We see my daughter's psychiatrist tomorrow morning. The many - and varied - responses and links to additional information have been an enormous relief and my angst is markedly lower after taking in the last two days of amazing support from the community. I anticipate the thread continuing as I come back here tomorrow to get feedback from the community regarding any changes (or not) in my daughter's treatment plan.That said, from this point forward, I would greatly appreciate no anti-med posts. I am very receptive to non-med treatment ideas, but posts that are critical of psychiatry or medications in general, including posts alluding to dire warnings of danger, should be posted on a separate thread created and participated in by those who have concerns about the dangers of psychotropic medications.
With much appreciation...
Solstice
Posted by Christ_empowered on February 20, 2012, at 17:34:51
In reply to re: Desperate - Part 2 - Please no anti-med posts, posted by Solstice on February 20, 2012, at 16:06:19
Do you think maybe the lithium+neuroleptic combination might be causing agitation? I don't know if it is or not, just throwing that one out there.
Posted by SLS on February 20, 2012, at 17:38:49
In reply to Re: Apology, posted by Solstice on February 20, 2012, at 15:58:16
> Okay.. first I want to apologize for perhaps making the issue more about Lou specifically than whats helpful.
Your apology is quite generous. However, I don't think you made an issue of someone any more than someone made an issue of themself.
- Scott
Posted by Solstice on February 20, 2012, at 18:21:01
In reply to re: Desperate - Part 2 - Please no anti-med posts, posted by Christ_empowered on February 20, 2012, at 17:34:51
> Do you think maybe the lithium+neuroleptic combination might be causing agitation? I don't know if it is or not, just throwing that one out there.
Good question, CE. But the agitation & irritability is a primary characteristic of her bipolar symptoms. The Geodon knocked it out of the ball park.. and when it shows back up and endures & escalates, her Geodon would be adjusted and we were stable again. So the agitation predates her starting on Latuda/lamictal/lithium. And it has been a real problem for about three months now, reaching crisis proportions before Christmas. The Latuda didn't seem to touch it. The Lamictal hasn't yet had time to build, so dr started lithium. It has gotten somewhat better than it was before, but it is still not stable enough for her to function as well as she needs to be able to function.
I'm really looking forward to our apt tomorrow to discuss some of the gifts of information I've gotten from my friends here :-)
Solstice
Posted by Solstice on February 20, 2012, at 18:24:23
In reply to Re: Apology » Solstice, posted by SLS on February 20, 2012, at 17:38:49
> > Okay.. first I want to apologize for perhaps making the issue more about Lou specifically than whats helpful.
>
> Your apology is quite generous. However, I don't think you made an issue of someone any more than someone made an issue of themself.
>
>
> - Scott
:-) That makes my heart smile.... felt like a big ole warm bear hug :-) I needed that.Solstice
Posted by Phillipa on February 20, 2012, at 18:24:51
In reply to re: Desperate - Part 2 - Please no anti-med posts » Christ_empowered, posted by Solstice on February 20, 2012, at 18:21:01
Best of luck tomorrow. I have an old poster friend also on latuda that just started it and is complaining of insomnia after a switch from zyprexa. Throwing it also out there Phillipa
Posted by SLS on February 20, 2012, at 18:32:48
In reply to re: Desperate - Part 2 - Please no anti-med posts, posted by Solstice on February 20, 2012, at 16:06:19
Well, anyway, Topamax is a drug that I have seen treat successfully bipolar II dysphoric hypomania in a 40 year old woman. She was first treated with 200 mg, but it was subsequently found that 100 mg was just as effective, and reduced the risk of developing kidney stones.
The clinical trials of Topamax to evaluate its efficacy in treating mania have not produced impressive results. I would not make Topamax my first choice as a treatment for pediatric bipolar disorder. However, there are anecdotes that report success with its use. Depakote would be a better choice if one is to explore anticonvulsant mood-stabilizers. My main concerns with Depakote are that the dosage of Lamictal must be reduced and that it might leave your daughter somewhat depressed with continued use.
In any event, I still feel that Topamax is a viable treatment that can yield improvements in mania in bipolar disorder.
- Scott
--------------------
Topiramate as add-on treatment for patients with bipolar mania.Chengappa KN, Rathore D, Levine J, Atzert R, Solai L, Parepally H, Levin H, Moffa N, Delaney J, Brar JS.
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15215-2593, USA. chengappakn@msx.upmc.edu
Abstract
OBJECTIVE:
Anticonvulsant agents such as carbamazepine and valproate are alternatives to lithium in treating subjects with bipolar disorder. Topiramate (Topamax), a new antiepileptic agent, is a candidate drug for bipolar disorder. We evaluated topiramate as adjunctive treatment for bipolar patients.
METHODS:
Eighteen patients with DSM-IV bipolar I disorder [mania (n = 12), hypomania (n = 1), mixed episode (n = 5), and rapid cycling (n = 6)], and two subjects with schizoaffective disorder bipolar type, resistant to current mood-stabilizer treatment were initiated on topiramate, 25 mg/day, increasing by 25-50 mg every 3 7 days to a target dose between 100 and 300 mg/day, as other medications were held constant for 5 weeks. The Young Mania Rating Scale (Y-MRS), Hamilton Depression Rating Scale (Ham-D), and Clinical Global Impression-Bipolar Version Scale (CGI-BP) were used to rate subjects weekly.
RESULTS:
By 5 weeks, 12 (60%) subjects were responders, i.e., 50% reduction in the Y-MRS scores and a CGI of 'much' or 'very much improved'. Three subjects were 'minimally improved', four showed no change, and one was 'minimally worse'. Six subjects had parasthesia, three experienced fatigue, and two had 'word-finding' difficulties; in all cases, side effects were transient. All patients lost weight with a mean of 9.4 lb in 5 weeks, and a significant reduction in body mass index (BMI) occurred too.
CONCLUSIONS:
Topiramate appears to have efficacy for the manic and mixed phases of bipolar illness. Other preliminary data suggest antidepressant efficacy too. Among obese bipolar subjects, the weight loss potential of topiramate may be beneficial. If controlled trials confirm these initial results, topiramate may be a significant addition to the available treatments for bipolar disorder.
------------------------------------------
Posted by Solstice on February 20, 2012, at 18:54:53
In reply to re: Desperate - Part 2 - Please no anti-med posts » Solstice, posted by SLS on February 20, 2012, at 18:32:48
> Well, anyway, Topamax is a drug that I have seen treat successfully bipolar II dysphoric hypomania in a 40 year old woman. She was first treated with 200 mg, but it was subsequently found that 100 mg was just as effective, and reduced the risk of developing kidney stones.
>
> The clinical trials of Topamax to evaluate its efficacy in treating mania have not produced impressive results.I don't know.. but 60% of patients with a wide variety of diagnoses doesn't sound bad to me! Since the study specifically says it appears helpful for mania and hypomania, I'm wondering if the majority of the 60% responders had those two issues.
I would not make Topamax my first choice as a treatment for pediatric bipolar disorder. However, there are anecdotes that report success with its use.
Well.. the first choice was Abilify, which she had all the *bad* side effects. Second choice was Geodon - which was a miracle. The natural third choice was Latuda, which has seemed to fall flat. Lithium and/or Lamictal have reduced the frequency/intensity of the agitation, but not enough improvement to feel like we've found the right thing.
What concerns me is that I don't think we can tell which of these meds provoked the marginal improvement. I think sticking with Lamictal is a strong preference for me because it worked for her sister. However, I should probably note, her sister ironically had the same kind of reaction to Geodon that my younger one had to Abilify. My older one ended up on very low dose Abilify and very high dose Lamictal. It wasn't hard to see that it was the high dose Lamictal that was really hitting the sweet spot for her. She is now off Abilify.
Based on what you know about my daughter so far, what reservations would you have regarding Topamax? Would it be possible for Topamax to stand alone - maybe with Vyvanse - like Geodon did? What about Lamictal.. both Lamictal and Topamax are anti-convulsants. Do they work together, or are they redundant?
> Depakote would be a better choice if one is to explore anticonvulsant mood-stabilizers. My main concerns with Depakote are that the dosage of Lamictal must be reduced and that it might leave your daughter somewhat depressed with continued use.
I would have thought that depakote would be last choice simply because - doesn't it have the weight gain issue?
I wish I understood the varied 'faces' of bipolar depression in adolescents. I know she's got the hypomania - and it might be skating pretty close to mania at times. But that god-awful irritability.. it's so hard to know whether it's a feature of impatient hypomania - or whether it's what bipolar depression looks like in a teenager.
Whatcha think?
>
> In any event, I still feel that Topamax is a viable treatment that can yield improvements in mania in bipolar disorder.
>I've read a lot of the links you provided me.. and Topamax really does seem worth exploring.. especially since it really does look like she does the mixed state thing.
I'm interested in any additional thoughts you have, Scott
Solstice
Posted by Solstice on February 20, 2012, at 19:07:36
In reply to re: Desperate - Part 2 - Please no anti-med posts, posted by Solstice on February 20, 2012, at 18:54:53
Posted by Phillipa on February 20, 2012, at 20:09:31
In reply to re: Desperate - Part 2 - Please no anti-med posts, posted by Solstice on February 20, 2012, at 18:54:53
Are you saying you have another Daughter with same? If so don't they say what works for one could work well for another family member? Phillipa
Posted by Solstice on February 20, 2012, at 20:40:41
In reply to re: Desperate - Part 2 - Please no anti-med posts » Solstice, posted by Phillipa on February 20, 2012, at 20:09:31
> Are you saying you have another Daughter with same? If so don't they say what works for one could work well for another family member? Phillipa
No, it's not the same as with my oldest daughter. She has very complex issues and is legally disabled. Her mood instability is tied to life-long impaired cognition.
Solstice
Posted by SLS on February 21, 2012, at 5:14:42
In reply to re: Desperate - Part 2 - Please no anti-med posts » Phillipa, posted by Solstice on February 20, 2012, at 20:40:41
> > Are you saying you have another Daughter with same? If so don't they say what works for one could work well for another family member? Phillipa
>
> No, it's not the same as with my oldest daughter. She has very complex issues and is legally disabled. Her mood instability is tied to life-long impaired cognition.
>
> Solstice
God bless you for being the mother that you are. Incredible.
- Scott
Posted by SLS on February 21, 2012, at 9:19:25
In reply to re: Desperate - Part 2 - Please no anti-med posts, posted by Solstice on February 20, 2012, at 18:54:53
> I would have thought that depakote would be last choice simply because - doesn't it have the weight gain issue?
Not always. I had no problem with it at all.
> I wish I understood the varied 'faces' of bipolar depression in adolescents.
EXCELLENT!
Pediatric and adolescent depression does look different from depression seen in adults and is characterized by irritability.
Signs and symptoms of depression in teens:Sadness or hopelessness
Irritability, anger, or hostility
Rage
Tearfulness or frequent crying
Withdrawal from friends and family
Loss of interest in activities
Changes in eating and sleeping habits
Restlessness and agitation
Feelings of worthlessness and guilt
Lack of enthusiasm and motivation
Fatigue or lack of energy
Difficulty concentrating
Thoughts of death or suicide
Can you list all of the symptoms that your daughter is currently experiencing here? That might help us get a handle as to how much depression is going on to indicate whether we are looking at dysphoric hypomania (mixed-state) or depression only.
List:
- Scott
Posted by Solstice on February 21, 2012, at 11:27:23
In reply to re: Desperate - Part 2 - Please no anti-med posts » Solstice, posted by SLS on February 21, 2012, at 9:19:25
> > I wish I understood the varied 'faces' of bipolar depression in adolescents.
>
> EXCELLENT!
>
> Pediatric and adolescent depression does look different from depression seen in adults and is characterized by irritability.
>
>
> Signs and symptoms of depression in teens:
>
> Sadness or hopelessness
> Irritability, anger, or hostility ****CHECK****
> Rage ****CHECK****
> Tearfulness or frequent crying ****CHECK****
> Withdrawal from friends and family
> Loss of interest in activities
> Changes in eating and sleeping habits
> Restlessness and agitation ****CHECK****
> Feelings of worthlessness and guilt
> Lack of enthusiasm and motivation
> Fatigue or lack of energy
> Difficulty concentrating ****CHECK****
> Thoughts of death or suicide
>
>
> Can you list all of the symptoms that your daughter is currently experiencing here? That might help us get a handle as to how much depression is going on to indicate whether we are looking at dysphoric hypomania (mixed-state) or depression only.
>
>
List: I put ****CHECK**** by the ones that apply. Please let me know what you think.
Just got home from the PDoc.
THYROID; Dr. said there is no way that it's her thyroid, because the thyroid problems in the family are hypothyroid, and it would need to be hyperthyroid. That said, she said we need to check her thyroid anyway because of the lithium, so we'll do that in 2 weeks.
LATUDA: Dr. said it's falling flat. Daughter goes off of it tonight, and starts a Saphris trial.
LIHIUM Daughter's lithium level was .7 and dr. says it needs to be much higher. She wants to continue the lithium at the same level for now, while we see how things go with Saphris
ANTICONVULSANTS: I was just floored. I brought up Zonegran, Topomax, Trileptal, etc. She said 'absolutely not.' She said that there are no scientific studies proving that they work any better than placebo. She said she did use Topomax when it first came out, but doesn't think it was effective. She said Lamictal and Depakote are the only anticonvulsants she's willing to use. :-(
STIMULANT: She is certain the stimulant is NOT impacting her hypo/manic episodes. She said that in her practice (which is huge, includes lots of pediatric, and has been going 20 yrs), it has been extremely rare and has only happened in males that were diagnosed as young children. Interesting.
So... I'm hopeful that Saphris will work.. and somewhat discouraged by her unwillingness to consider other anticonvulsants.
Solstice
Posted by Beckett on February 21, 2012, at 12:20:45
In reply to Part 2 - Please no anti-med posts - and UPDATE » SLS, posted by Solstice on February 21, 2012, at 11:27:23
I'm hopeful, too. Saphris is reported to be good for agitated bipolar states. Your daughter's doc sounds good to me, Sol. Saphris could take care of any sleep difficulties, too. Best of luck tonight and going forward.
Posted by SLS on February 21, 2012, at 12:45:32
In reply to Part 2 - Please no anti-med posts - and UPDATE » SLS, posted by Solstice on February 21, 2012, at 11:27:23
> So... I'm hopeful that Saphris will work..
I would look forward to trying anything new. Saphris is a reasonable choice. I found it somewhat calming.
> and somewhat discouraged by her unwillingness to consider other anticonvulsants.
I'm surprised that the doctor disqualified Trileptal from consideration. It might not be appropriate for your daughter's case profile, but it helps a great many people where aggression and impulsiveness are present.
Looking at the big picture, I think your doctor is doing some good things, and I don't doubt that she can help your daughter.
- Scott
Posted by Solstice on February 21, 2012, at 17:41:19
In reply to Re: Part 2 - Please no anti-med posts - and UPDATE » Solstice, posted by SLS on February 21, 2012, at 12:45:32
For those who have tried Saphris - how has it done with respect to making you overly sleepy?
My daughter starts it tonight. She had two weeks of terrible sleepiness when she started Geodon, but it did eventually go away. I'm think I'll have her take it at 9pm.
Will that mitigate any sleepiness lasting throughout the school day?
Please describe for me how you experienced any sleepiness that it caused.. i.e. how long did it last, etc.
Thanks everybody!
Solstice
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.