![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 50. This is the beginning of the thread.
Posted by LISABECK on October 22, 2000, at 21:10:47
I DIDN'T SEE MY POST LISTED ABOUT TOPAMAX! DID IT GO THRU?? I WAS ASKING IF ANYONE IS TAKING IT FOR PANIC DISORDER...I'M REALLY WORRIED BECAUSE I CAN'T FIND ANYONE TAKING IT FOR PD, AND I FEEL LIKE IT SHOULDN'T HAVE BEEN GIVEN TO ME!!! SOMEONE PLEASE RESPOND
Posted by Sharon J. on October 22, 2000, at 23:11:35
In reply to TOPAMAX, posted by LISABECK on October 22, 2000, at 21:10:47
Hi, Lisabeck:
Yes, your post came through. I saw your first post with the same title, and read it because I take Topomax. However, I did not have anything to offer you, as I do not take it for a panic disorder, so I did not send you a response.
I have a suggestion for you: You might want to title your post differently and send it through again, this time being more specific in your title about what you need so that other folks won't "skip" over it so easily. Just saying "Topomax" is too general, and I found that other ways of titling posts are better in getting the response you need. Look at some other posts and see how they are titled, and you can see what I mean.
Might I suggest something like: TOPOMAX FOR PANIC DISORDERS? I NEED INPUT!...or...Anyone else taking Topomax for THIS?
There are wonderful resources out here, and sometimes it is easy to overlook a post if it is too nonspecific. Don't take it personally that you got no responses yet. I highly suggest you "dress up" your title to get more people interested and to help your post get noticed.
Sharon
Posted by LISABECK on October 24, 2000, at 22:07:14
In reply to Re: TOPAMAX, posted by Sharon J. on October 22, 2000, at 23:11:35
THANK YOU SHARON...I'M GOING TO TRY YOUR SUGGESTION NOW!!!
Posted by LISABECK on October 24, 2000, at 22:11:30
In reply to Re: TOPAMAX, posted by Sharon J. on October 22, 2000, at 23:11:35
HI, I REALLY NEED TO KNOW OR FIND SOMEONE WHO HAS BEEN GIVEN TOPAMAX FOR PANIC DISORDER. THE REASON BEING IS THAT I CAN'T FIND ANYONE, AND I'M KIND OF WORRIED. I'VE ONLY SEEN THAT IT'S BEING USED FOR BIPOLAR AND SEIZURES, AND DEPRESSION. I'M NOT TAKING THE SSRI'S ANYLONGER BECASUE OF THE EXCESSIVE WEIGHT GAIN.......PLEASE...SOMEONE....I'M NOW ON 36MGS OF TOPAMAX, BUT I DON'T FEEL ANY DIFFERENT YET. I'M ALSO STILL TRYING TO WEAN OFF PAXIL WHICH HAS BEEN HELL. I'M FINALLY DOWN FROM 30MGS TO 10MGS WHICH TOOK ME 2.5 MONTHS. THANKS...
Posted by shellie on October 25, 2000, at 0:00:13
In reply to TOPAMAX FOR PANIC DISORDER-DESPERATELY NEED INPUT, posted by LISABECK on October 24, 2000, at 22:11:30
Lisa, It's possible that no one is responding to your post because they haven't taken topomax for panic disorder. I haven't seen any studies concerning topomax and panic disorder or anxiety. What does your doctor say? Have you asked him/her why they selected topomax. Since you've been on paxil, maybe your doctor thinks there's an underlying depression under your panic. When a doctor prescribes medication, it is perfectly appropriate for you to ask why that particular medication would be useful to you. You obviously are quite worried about the topomax. Why don't you call your doctor and ask?
p.s., fyi, it is best not to write your messages in upper case, that it violates board protogal. (upper case messages are interpreted as screaming). I just wanted to point that out because I'm assuming you are not aware of that.
Shellie
Posted by B Day on October 25, 2000, at 12:24:47
In reply to TOPAMAX, posted by LISABECK on October 22, 2000, at 21:10:47
Hey Lisa,
I found a few page links for you regarding Topamax that might help you learn a little more about and its properties, dosages, side effects, usage, etc. It seems that Topamax is another one of those anticonvulsant meds that has shown itself sometimes helpful in treating emotional disorders although I haven't read anywhere of it being used as the first choice for treating panic disorders. There does seem to be some such implementation though. Perhaps your doc has a good reason or maybe not. Myself, I know nothing about the drug or its administration.
The following page on Dr. Bob's site contains info on the pharmacological treatment of panic disorder it is aptly named "Pharmacological Treatment of Panic Disorder". The first half of the page is in Spanish. The English version is in the lower half of the page. I read nothing there regarding Topamax or Topiramate, but I may have missed something. It is still informative. Here is the url: http://www.dr-bob.org/tips/panic.html
Also on Dr. Bob's site there is a page under the RxQx section which discusses antidepressants that help generalized anxiety disorder. As with the aforementioned page, the title of this one is equally well matched to its content being named "Antidepressants that help generalized anxiety disorder"! The url is as follows: http://www.dr-bob.org/rxqx/antideps-gen-anxiety.html
Now here is a page on this site which discusses Topamax and does mention its use with Panic and various other anxiety disorders. This page is drably named "Topiramate", but its still pretty good. You can find it here: http://www.dr-bob.org/tips/split/Topiramate.html
There is also a good set of pages on Anxiety related treatments under the tips section of Dr. Bob's site.
1) Go to the tips page on this site: http://www.dr-bob.org/tips/
2) Check the Anxiety box under Problems in the form at the bottom of the page in the right frame.
3) Click on submit to submit the form. A list of links will appear in the left frame.Here are a few external links which are pretty good links for both panic disorders and Topamax:
This page is pretty comprehensive and straight from the Surgeon General's office regarding anxiety disorders: http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2_1.html
This site, Mental Health Net contains pages for various anxiety disorders (including a separate page for panic disorder) as well as some good links to other sites about PD, but no page on Topamax that I could find: http://www.mentalhealth.com
Mental Health Net also has a good set of links to sites where you can find much information about all sorts of medications used in psychopharmacological treatment. You can find it here: http://www.mentalhealth.com/fr13.html#Drug
There are many online resources you can find via Yahoo or one of the various search engines. Some may prove more useful even than the ones I've provided. I hope you find enough of the answers you need to help you sort your thoughts and feelings out about your treatment. Good luck!
B
Posted by B Day on October 25, 2000, at 12:48:04
In reply to TOPAMAX, posted by LISABECK on October 22, 2000, at 21:10:47
Lisa,
PS: If your not experiencing any serious adverse reaction to the Topamax at this time and if you've not already done so, you might give yourself some time, at least a few days, to learn more about the drug and your condition in particular.
The insite you gain might help you better understand what's happening to you and also if another form of med treatment might be better suited to your symptoms.
It might also help you decide how you want to discuss your thoughts and concerns with your physician as well.
I had one brief episode of panic many years ago. I've been fortunate and thankful that it never reoccurred. To this day I would have to say it was probably the single most nightmarish experience I've ever had.
Best wishes from he who knows little,
B
Posted by LISABECK on October 25, 2000, at 22:38:40
In reply to Re: TOPAMAX, posted by B Day on October 25, 2000, at 12:24:47
B. Thank you so much for the information. She gave me the medication because she has a few people on it for panic disorder. I have tried many SSRI's. They have caused me to gain so much weight. And the Paxil made me feel worse. THanks Again. Lisa
Posted by Karla on October 27, 2000, at 6:37:21
In reply to TOPAMAX FOR PANIC DISORDER-DESPERATELY NEED INPUT, posted by LISABECK on October 24, 2000, at 22:11:30
> HI, I REALLY NEED TO KNOW OR FIND SOMEONE WHO HAS BEEN GIVEN TOPAMAX FOR PANIC DISORDER. THE REASON BEING IS THAT I CAN'T FIND ANYONE, AND I'M KIND OF WORRIED. I'VE ONLY SEEN THAT IT'S BEING USED FOR BIPOLAR AND SEIZURES, AND DEPRESSION. I'M NOT TAKING THE SSRI'S ANYLONGER BECASUE OF THE EXCESSIVE WEIGHT GAIN.......PLEASE...SOMEONE....I'M NOW ON 36MGS OF TOPAMAX, BUT I DON'T FEEL ANY DIFFERENT YET. I'M ALSO STILL TRYING TO WEAN OFF PAXIL WHICH HAS BEEN HELL. I'M FINALLY DOWN FROM 30MGS TO 10MGS WHICH TOOK ME 2.5 MONTHS. THANKS...
I am currently taking Topamax to prevent Migranes, prevent seizures, and to help prevent social anxiety. It has reduced the headaches and seizures but not stoped them and has uneffected the anxiety at all. I am now at 125 mg. I am waiting to go up in dosage. Yes this medicine is suppose to cause weight loss. Yeh!!!! Good luck to You!!
Posted by KarenK on October 31, 2000, at 10:31:45
In reply to Re: TOPAMAX FOR PANIC DISORDER-DESPERATELY NEED INPUT, posted by Karla on October 27, 2000, at 6:37:21
Lisa,
I just started on topamax for anxiety. I gained a lot of weight from many years of depression and I asked my shrink about giving it a try for the weight loss. I'm on week 3 and up to 25 mg twice a day. So far so good.
Karen
Posted by Michelle123 on January 8, 2005, at 12:30:41
In reply to Re: TOPAMAX, posted by LISABECK on October 24, 2000, at 22:07:14
Hi, this site has been very informative, so first I need to say thanks.
Now for the problem...I have tried almost everything with only limited temporary help (or such severe side effects, I had to stop). This list includes: Prozac (regular and weekly), Paxil (regular and CR), Zoloft, Serzone, Trazadone, Wellbutrin (regular And XR), Effexor (Regular and XR), Trycyclics (can't remember which ones, sorry), Depakote, Trileptal, Lithium, Lamictal, Topamax, Zyprexa, Abilify,Valium, Klonopin, Xanax, Ritalin, Dexedrine, Adderall, atenolol, Risperdal, Provigil, Ambien, Buspar, and probably some I can't remember right now.
My symptoms include IRRITABILITY, lethargy, lack of motivation, moodiness, insomnia and the need to sleep all the time (sounds weird but I am sure someone can relate)and did I mention irritability?
So my question is: Any advice on where to go next? The SSRI's gave temporary with little relief (note: I did not ever get full relief) and the rest had such severe side effects, I can't tolerate them. But I need some help.
Any advice is greatly appreciated. Thanks, Michelle
Posted by Ritch on January 8, 2005, at 16:49:13
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
> Hi, this site has been very informative, so first I need to say thanks.
>
> Now for the problem...I have tried almost everything with only limited temporary help (or such severe side effects, I had to stop). This list includes: Prozac (regular and weekly), Paxil (regular and CR), Zoloft, Serzone, Trazadone, Wellbutrin (regular And XR), Effexor (Regular and XR), Trycyclics (can't remember which ones, sorry), Depakote, Trileptal, Lithium, Lamictal, Topamax, Zyprexa, Abilify,Valium, Klonopin, Xanax, Ritalin, Dexedrine, Adderall, atenolol, Risperdal, Provigil, Ambien, Buspar, and probably some I can't remember right now.
>
> My symptoms include IRRITABILITY, lethargy, lack of motivation, moodiness, insomnia and the need to sleep all the time (sounds weird but I am sure someone can relate)and did I mention irritability?
>
> So my question is: Any advice on where to go next? The SSRI's gave temporary with little relief (note: I did not ever get full relief) and the rest had such severe side effects, I can't tolerate them. But I need some help.
>
> Any advice is greatly appreciated. Thanks, MichelleHi there, your drug list looks like the list of meds I've tried over the eons (with some exceptions)! Could you tell us what meds you are currently on now, and what your latest change with meds was? I also have trouble with sleep maintenance at times and next day foggy head, and irritability spells. Have you tried any Neurontin for the sleep maintenance and irritability issues? Have you been checked out for a possible sleep disorder or thyroid trouble, etc.? One thing that I've found out is that good dense sleep = fewer temper problems. There has been *one* med that I've found in the last several years that seems to really work well on sound sleep and that was Keppra. Tried that one? I got a little grouchy from it though.. so I don't know if that would be a good fit for you or not. But everybody's different. What were the downsides of the mood stabilizers you mentioned.. particularly Depakote and Trileptal? Just curious. Hope this helps some.
Posted by Lyrical13 on January 9, 2005, at 10:59:48
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need HELP » Michelle123, posted by Ritch on January 8, 2005, at 16:49:13
Did you try these meds one at a time or in combination with each other? For BP2 one med by itself won't do it. You will most likely need a combination of meds. Some of the mood stabilizers are supposed to work on their own (Lamictal, Lithium, Trileptal, Depakote) but that is not necessarily the case. I found that I couldn't take Lamictal (got a rash), Depakote caused depression and made me a complete slug...wanted to sleep ALL the time and such a zombie even when awake, not to mention teh weight gain. Now am on Trileptal and so far it is OK but am also taking Celexa during my more depressed time of year (now) for the depression aspect. But according to my pdoc, the jury is out on using AD's for bipolar depression...some say it causes mania. Others say it's OK to use.
Good luck. I'm in kind of the same boat. My list isn't quite as long as yours but I'm worried I'll be in the same situation!
Lyrical
Posted by johnnystats on January 9, 2005, at 13:57:51
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
> Hi, this site has been very informative, so first I need to say thanks.
>
> Now for the problem...I have tried almost everything with only limited temporary help (or such severe side effects, I had to stop). This list includes: Prozac (regular and weekly), Paxil (regular and CR), Zoloft, Serzone, Trazadone, Wellbutrin (regular And XR), Effexor (Regular and XR), Trycyclics (can't remember which ones, sorry), Depakote, Trileptal, Lithium, Lamictal, Topamax, Zyprexa, Abilify,Valium, Klonopin, Xanax, Ritalin, Dexedrine, Adderall, atenolol, Risperdal, Provigil, Ambien, Buspar, and probably some I can't remember right now.
>
> My symptoms include IRRITABILITY, lethargy, lack of motivation, moodiness, insomnia and the need to sleep all the time (sounds weird but I am sure someone can relate)and did I mention irritability?
>
> So my question is: Any advice on where to go next? The SSRI's gave temporary with little relief (note: I did not ever get full relief) and the rest had such severe side effects, I can't tolerate them. But I need some help.
>
> Any advice is greatly appreciated. Thanks, Michelle>I'd try looking at the site www.crazymeds.org Apparantly, the person who runs it has bipolar and and has a lot of personal and medical experience with drugs for people who are bipolar. You didn't say in your post if you tried these drugs one at a time or in combinational therapy, but the latter seems to work well for bipolar. I myself finally realized that the side effects of medication were better than no meds at all.
Posted by Michelle123 on January 9, 2005, at 18:04:11
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need HELP » Michelle123, posted by Ritch on January 8, 2005, at 16:49:13
> Could you tell us what meds you are currently on now, and what your latest change with meds was?
I am currently about to try naltrexone for the first time with the omega 3 fish oil.
Have you tried any Neurontin for the sleep maintenance and irritability issues? Have you been checked out for a possible sleep disorder or thyroid trouble, etc.?
Yes I have tried that and it did help a little with restless leg syndrome but not too much with the rest. Also, the sleep study indicated that I never get past stage 3, however, no recommendations were made and nothing ever came of it. Due to not getting to REM (however, i am always in a semi-conscious dream state- I control my dreams)i do not qualify for narcolepsy.
There has been *one* med that I've found in the last several years that seems to really work well on sound sleep and that was Keppra.
Never tried that one (Wow a new one)What were the downsides of the mood stabilizers you mentioned.. particularly Depakote and Trileptal?
Both made me extremely groggy and the depakote increased joint pain.Also, a few people have asked about combinations of meds and YES I have tried several, unfortunately the combination makes for even more side effects which really decreases the likelihood that I will tolerate them and therefore, haven't had success with that either.
Posted by Maxime on January 9, 2005, at 19:29:16
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 9, 2005, at 18:04:11
Hi
Have you tried an MAOI as your antidepressant? Parnate would be a good one for you since it is stimulating. It is least like to bring on hypomania.As for a mood stabiliser. Try taking niacin which is really good for irritability. There are some anti-arhythmia heart meds as well that work well as stabilisers and some for Parkisons as well.
Here is a link to different meds for bipolar meds many of which you might not have thought of trying.
http://home.comcast.net/~pmbrig/BP_pharm.html
I hope you find relief soon.
Maxime
Posted by Maxime on January 9, 2005, at 19:32:46
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
Actually your symptoms when I read them SOUND like depression alone. I am assuming there is a reason why you were dx'd bp2? What was it?
Maxime
> Hi, this site has been very informative, so first I need to say thanks.
>
> Now for the problem...I have tried almost everything with only limited temporary help (or such severe side effects, I had to stop). This list includes: Prozac (regular and weekly), Paxil (regular and CR), Zoloft, Serzone, Trazadone, Wellbutrin (regular And XR), Effexor (Regular and XR), Trycyclics (can't remember which ones, sorry), Depakote, Trileptal, Lithium, Lamictal, Topamax, Zyprexa, Abilify,Valium, Klonopin, Xanax, Ritalin, Dexedrine, Adderall, atenolol, Risperdal, Provigil, Ambien, Buspar, and probably some I can't remember right now.
>
> My symptoms include IRRITABILITY, lethargy, lack of motivation, moodiness, insomnia and the need to sleep all the time (sounds weird but I am sure someone can relate)and did I mention irritability?
>
> So my question is: Any advice on where to go next? The SSRI's gave temporary with little relief (note: I did not ever get full relief) and the rest had such severe side effects, I can't tolerate them. But I need some help.
>
> Any advice is greatly appreciated. Thanks, Michelle
Posted by Michelle123 on January 10, 2005, at 17:37:22
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle, posted by Maxime on January 9, 2005, at 19:29:16
> Hi
> Have you tried an MAOI as your antidepressant?
No but My doctor has recommended Parnate, just been scared cause I live on coffee, chocolate and pizza....
>
> As for a mood stabiliser. Try taking niacin which is really good for irritability. There are some anti-arhythmia heart meds as well that work well as stabilisers and some for Parkisons as well.
>
I will definitely look into that- thank you and will go to the web site as well
>
>
> Again thanks to all!
Michelle
>
Posted by CareBear04 on January 10, 2005, at 22:09:53
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
hi michelle,
i just read your post and haven't read any of the followups. i just wanted to say that i'm with you right now and understand how frustrating it is. i've been diagnosed as BPII, too, and i've been through all the meds. right now, my primary mood stabilizer is lamictal, 200mg, and i don't think it's a high enough dose, or else lamictal is just worthless. lithium has always worked really well for me, but in the past few months, i got really toxic over and over and my body keeps rejecting even small doses. i feel like i need to be back on it, though, because my mood is slipping fast right now, and i don't know of anything else that will help. i was in the hospital for my insurance-alloted 10 days in november. it was my third psych hospialization in two years, and all it did for me was affirm that no psych unit in the world can help me b/c i'm too strong-willed to be submissive and docile like they want you to be in the hospital, and i ask too many questions and have read too many books and stuff. i'm on a horrible mess of meds right now; i can't even remember them all-- lamictal, zoloft, prozac, haldol, percocet, ambien, klonopin, xanax, zofran, phenergan, adderall, and i'm sure i'm forgetting others. i'm restricted from taking courses until i get off the heavy-duty narcotics, and i have all these other restrictions on my life to the point that i feel tied up and stuck for both psych and physical reasons. like you, i need something that works. i'll try to catch up on the replies, and i hope people have been able to help you, but i just wanted to let you know that i'm frustrated, too, and you're not the only one. take care.
Posted by Lyrical13 on January 11, 2005, at 14:33:20
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle, posted by Michelle123 on January 10, 2005, at 17:37:22
> > Hi
> > Have you tried an MAOI as your antidepressant?
> No but My doctor has recommended Parnate, just been scared cause I live on coffee, chocolate and pizza....
>The caffeine in the coffee and chocolate are probably not helping your sleep issues. Chocolate has an even higher level of caffeine than coffee does. Personally I avoid caffeine because it exacerbates several of my health problems. Mainly in terms of blood sugar and anxiety. Caffeine is a stimulant...so if you have anxiety or sleep issues, it's going to cause problems with body chemistry even hours after you consume it. On the occasions that I do have something with caffeine I definitely notice it...much more jittery and anxious. also in terms of hypoglycemia, the adrenal gland is involved in regulating blood sugar...for hypoglycemics, our bodies produce too MUCH insulin or when the body is triggered to release insulin to metabolize sugar in the blood, we keep dumping more insulin which then results in low blood sugar. I'm probably getting too complicated here, but that prompted another thought..... you might also be hypoglycemic....it mimics the symptoms of several different conditions including sleep issues (not sleeping or sleeping too much) depression, anxiety and many other things. and I have talked to a couple of people who are both bipolar and hypoglycemic. I'm not a doctor though. This is something you'll have to check out for yourself. I do notice though that when my blood sugar has been messed up, I don't sleep as well. Something to think about.....
Good luck
Lyrical
Posted by Michelle123 on January 11, 2005, at 18:58:41
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need H » Michelle123, posted by CareBear04 on January 10, 2005, at 22:09:53
> hi michelle,
> i just wanted to say that i'm with you right now and understand how frustrating it is. and you're not the only one.Sorry to hear that you are feeling this way too. I will say that going off of everything has been somewhat helpful lately. I am now taking only the fish oil. I am a little anxious (I guess ~ jittery and irritable) but am able to work. So either the cycle is winding down, or I am better off without some of the side effects. However, I do think that going off the SSRI's was tougher than anything I ever did. But it may be worth it not to feel so tired, hungry and flat.
Now to try and find something to calm my nerves without sedating me. (Hey that may be my next topic.)
Take care
Michelle
Posted by CareBear04 on January 12, 2005, at 1:55:31
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle, posted by Maxime on January 9, 2005, at 19:29:16
maxime, can parnate be used in combination with other psych meds, or are there too many interactions? i've heard it can be really effective, so i asked a dr about it recently, and he said that it was meant to be used sort of as monotherapy and it was a measure of last resort. i'm on a lot of benzos, pain meds, adderall, SSRIs, and others. i know the SSRIs would have to go, but do you know what else? thanks!
Posted by Maxime on January 12, 2005, at 21:36:42
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle » Maxime, posted by CareBear04 on January 12, 2005, at 1:55:31
Hi
Yes, the SSRI would have to go. But I take Adderal, klonopin and trileptal with Parnate.I also take thorazine when I need it. You can even take a small amount of a trycyclic although it is SUPPOSE to be contraindicated.
So you can it with other psych meds.
Maxime
> maxime, can parnate be used in combination with other psych meds, or are there too many interactions? i've heard it can be really effective, so i asked a dr about it recently, and he said that it was meant to be used sort of as monotherapy and it was a measure of last resort. i'm on a lot of benzos, pain meds, adderall, SSRIs, and others. i know the SSRIs would have to go, but do you know what else? thanks!
Posted by zero on January 13, 2005, at 0:08:52
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
Since you seem to be stressing the IRRITABILITY part, it brings to mind the place where bipolar meets borderline (are lots of theories on this).
For this, there's a combination of Prozac (start 1st, take daily for 1 week), then add Tegretol (mood stabilizer).
I can't tolerate Prozac, but Tegretol helps me big time with IRRITABILITY, plus your list indicates you haven't tried Tegretol yet (don't mistake it for Trileptal, it's chemical cousin - very different effects). Tegretol is great for anxiety also.
Hope this helps.
z.
(Bipolar II w. Irritability, Anxiety)
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