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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Zo on September 22, 2001, at 14:52:45
Nine very sweet and even days in a row, then 2 weeks of feeling stoned & inreasingly agitated. Pdoc says this is all revealing how much I cycle, is talking Lamictal on top of bupe, but I feel so revolting -- at least right now, I need a bupe vacation.
Another major med change. . oh my god. I'm running out of courage and enegry and hope... . . after 14 years of trials. CFS, TLE, ADD, and now he is 100% sure, BPII and cycling. . .Neurontin didn't help. I don't understand Cycling -- does it mean if I were treated, I wouldn't feel sick on Bupe? I'd regain that first glow? This happened on Vicodin too.
I live in fear I am untreatable.
Zo
Posted by SalArmy4me on September 22, 2001, at 15:05:53
In reply to TANKING ON BUPE - help, posted by Zo on September 22, 2001, at 14:52:45
Have you tried moclobemide, reboxetine, and tianeptine?
Posted by Mitch on September 22, 2001, at 15:34:22
In reply to TANKING ON BUPE - help, posted by Zo on September 22, 2001, at 14:52:45
> Nine very sweet and even days in a row, then 2 weeks of feeling stoned & inreasingly agitated. Pdoc says this is all revealing how much I cycle, is talking Lamictal on top of bupe, but I feel so revolting -- at least right now, I need a bupe vacation.
>
> Another major med change. . oh my god. I'm running out of courage and enegry and hope... . . after 14 years of trials. CFS, TLE, ADD, and now he is 100% sure, BPII and cycling. . .Neurontin didn't help. I don't understand Cycling -- does it mean if I were treated, I wouldn't feel sick on Bupe? I'd regain that first glow? This happened on Vicodin too.
>
> I live in fear I am untreatable.
>
> ZoHi Zo,
It could be your body is just adjusting to the presence of the bupe and then you have to switch it to something else to regain that same feeling. Or it possibly is just a jag (a few days) in your cycle that you will have to wait out. Maybe it would be a good idea to start mood charting. You sound like a rapid cycler like myself-you mentioned *nine* even days in a row. I plan trips around my cycling, it is so predictable. If there is something fun I want to plan I avoid the depressive days like the plague. I think the Lamictal might be a good idea-would you be taking it with your Neurontin?
Posted by shelliR on September 22, 2001, at 15:55:18
In reply to TANKING ON BUPE - help, posted by Zo on September 22, 2001, at 14:52:45
> Nine very sweet and even days in a row, then 2 weeks of feeling stoned & inreasingly agitated. Pdoc says this is all revealing how much I cycle, is talking Lamictal on top of bupe, but I feel so revolting -- at least right now, I need a bupe vacation.
>
> Another major med change. . oh my god. I'm running out of courage and enegry and hope... . . after 14 years of trials. CFS, TLE, ADD, and now he is 100% sure, BPII and cycling. . .Neurontin didn't help. I don't understand Cycling -- does it mean if I were treated, I wouldn't feel sick on Bupe? I'd regain that first glow? This happened on Vicodin too.
>
> I live in fear I am untreatable.
>
> Zo
Zo,
I'm sorry you have had such a big disappointment. I don't understand cycling very well, but obviously something happened after nine days on bupe, and I don't think it sounds like tolerance (it seems too sudden). Presumably it doesn't have to do with the bupe, more with a change in your system. That's probably where the bipolar II comes in. It may be that Lamictal will stop the sudden changes and allow you to continue getting the benefit from your other meds, including bupe.FWIW, I took lamictal as an adjunct for my antidepressant, and I had almost no side effects ; for me it wasn't like I was taking a drug and it helped me a lot. Lamictal can cause a dangerous rash, so you need to titrate very very slowly (that will usually prevent the rash), as I'm sure your doctor will tell you. Can your doctor explain the stoned feeling?
I wonder if someone else who is bipolar II can help with the specifics since I stuggle only with severe depression. I've always thought bipolar was from too high to too low, obviously there is lots that I don't understand (like feeling stoned) that hopefully someone with the diagnosis can explain to you.
It seems as if your doc has the diagnosis down now, and can be more specific in using meds for it. Hang in there. Just as you cycled in this bad place, you will cycle back into those sweet days again. I'm sure.
Shelli
Posted by shelliR on September 22, 2001, at 15:59:02
In reply to TANKING ON BUPE - help, posted by Zo on September 22, 2001, at 14:52:45
Posted by Zo on September 22, 2001, at 17:54:28
In reply to Re: TANKING ON BUPE - help » Zo, posted by Mitch on September 22, 2001, at 15:34:22
>would you be taking it with your Neurontin?
no, just Lamictal (and Effexor)Thanks, Mitch. I am tanking even worse. . .this is turning into the weekend from Hell. Suicide looking good right about now. . . . Bupe withdrawal? Too sick to eat or think. Pdoc & therap. both gone.
Good to get your thoughts, I feel real alone in this . .I've got to, somehow, whilst being untreatable, also be more cautious about what I try.
Will start a chart today.
Thanks so much,
Zo
Posted by Zo on September 22, 2001, at 17:57:05
In reply to Re: TANKING ON BUPE - help » Zo, posted by shelliR on September 22, 2001, at 15:55:18
> obviously something happened after nine days on bupe, and I don't think it sounds like tolerance (it seems too sudden).
Dear Shelli, I think you're right. . .and oh jesus I am *really* tanking this long, suicidal day having gone off Bupe. You've said it very well, and if I survive the weekend, will take your advice to heart. Thanks for your kindness,
Zo
Posted by Mitch on September 23, 2001, at 11:03:18
In reply to Re: TANKING ON BUPE - help » Mitch, posted by Zo on September 22, 2001, at 17:54:28
> >would you be taking it with your Neurontin?
> no, just Lamictal (and Effexor)
>
> Thanks, Mitch. I am tanking even worse. . .this is turning into the weekend from Hell. Suicide looking good right about now. . . . Bupe withdrawal? Too sick to eat or think. Pdoc & therap. both gone.
>
> Good to get your thoughts, I feel real alone in this . .I've got to, somehow, whilst being untreatable, also be more cautious about what I try.
>
> Will start a chart today.
>
> Thanks so much,
> ZoZo,
If you get to feeling worse-go visit the ER, ok? There maybe some complex interaction with your meds causing some of your problems, too. I have never taken Buprenorphine (spelling?), so I really can't give you any good advice about it. You may need treatment for the withdrawal. I have had meds boomerang on me in the past and it does suck, but they have always been relatively brief nasty spells. You were on Neurontin for quite some time weren't you? Did you discontinue the Neurontin recently and switch to Lamictal? I got REAL uptight and agitated when I stopped Neurontin. Some folks here have complained about Lamictal causing agitation and anxiety-you might check into that with your doc this week. Sounds like you made a lot of med changes real quickly.
Take care of yourself,
Mitch
Posted by Zo on September 23, 2001, at 17:11:18
In reply to Re: TANKING ON BUPE - help » shelliR, posted by Zo on September 22, 2001, at 17:57:05
Shelli - You're thinking of trying bupe, aren't you?The funny thing is, Vicodin pooped out the same way, so it's something with me and opiates. . .I guess. Will post more as I find out more; meanwhile, if you learn anything. . .Took another Vicodin last night, neatly stopped abrupt mood downswing.
Zo
Posted by Zo on September 23, 2001, at 17:15:36
In reply to Re: TANKING ON BUPE - help » Zo, posted by Mitch on September 23, 2001, at 11:03:18
Mitch, thanks again, yr little notes really help. Tanking abruptly stopped at 4pm. . .then started again at 1:30 am last night, but nipped that sucker in the bud with Vicodin (bupe still too sick-making to contemplate.)
I'm beginning to wonder if bupe didn't *set* off a manic upswing. . that eventually went near to psychotic, started out painting well but then it got scary and I got lost in it. If it was mania, it was the Not Fun kind.
I went off Neurontin over about 2 or 3 months time, but probably too fast at end. How comforting to know you had a wretched time too!
Shrink tomorrow, pdoc Friday. . .too many riddles, too few answers. If there are any. *If* this is cycling or Mixed States, it surely sucks.
Thanks so much,
Zo
Posted by SLS on September 23, 2001, at 19:27:21
In reply to Re: TANKING ON BUPE - help » Mitch, posted by Zo on September 23, 2001, at 17:15:36
> Mitch, thanks again, yr little notes really help. Tanking abruptly stopped at 4pm. . .then started again at 1:30 am last night, but nipped that sucker in the bud with Vicodin (bupe still too sick-making to contemplate.)
>
> I'm beginning to wonder if bupe didn't *set* off a manic upswing. . that eventually went near to psychotic, started out painting well but then it got scary and I got lost in it. If it was mania, it was the Not Fun kind.
>
> I went off Neurontin over about 2 or 3 months time, but probably too fast at end. How comforting to know you had a wretched time too!
>
> Shrink tomorrow, pdoc Friday. . .too many riddles, too few answers. If there are any. *If* this is cycling or Mixed States, it surely sucks.
>
> Thanks so much,
> Zo
Hi Zo.You've got quite a bag full of questions to go in to your doctor with. I wouldn't be surprised if you turn out to be right about buprenorphine and mania. I am very interested to know what your doctor comes up with.
I don't know the particulars of your situation, but if you are experiencing true rapid-cyclicity, you will almost certainly need at least two mood stabilizers. It seems that Tegretol is often chosen at some point, although I would probably lean towards its sister drug, Trileptal. It is supposed to have milder side effects. Lamictal is reported to be very effective in some cases. I have seen Lamictal used in combination with Neurontin. I get the feeling that Neurontin is most effective when used to augment another mood stabilizer as opposed to being used by itself.
You sound strong. I'll be routing for you.
:-)
- Scott
Posted by Zo on September 23, 2001, at 21:23:01
In reply to Re: TANKING ON BUPE - help » Zo, posted by SLS on September 23, 2001, at 19:27:21
> You've got quite a bag full of questions to go in to your doctor with. I wouldn't be surprised if you turn out to be right about buprenorphine and mania. I am very interested to know what your doctor comes up with.
>
> I don't know the particulars of your situation, but if you are experiencing true rapid-cyclicity, you will almost certainly need at least two mood stabilizers. It seems that Tegretol is often chosen at some point, although I would probably lean towards its sister drug, Trileptal. It is supposed to have milder side effects. Lamictal is reported to be very effective in some cases. I have seen Lamictal used in combination with Neurontin. I get the feeling that Neurontin is most effective when used to augment another mood stabilizer as opposed to being used by itself.
>
> You sound strong. I'll be routing for you.
>
> :-)
>
>
> - ScottAm still in dogged pursuit of a Feel Good that doesn't turn out to be mania. Dream on. . .Had a nice time after an appendectomy 2 mos ago & heaps of Vicodin, hence bupe trial (pdoc's idea, it was that or Ultram, which was zip/nada.) He doesn't want to write ongoing Oxycontin. . . but here I am chipping Vicodin to get over the bupe. .. he may just have to try.
Thanks so much for writing, Scott. I've never been in such trouble and reached out to the board before, and am so grateful and cheered. . .. (or could it be that third Vicodin. Hmm.)
Zo
Posted by Elizabeth on September 24, 2001, at 12:40:52
In reply to TANKING ON BUPE - help, posted by Zo on September 22, 2001, at 14:52:45
Zo --
Sorry I wasn't here to respond to your post. (I started a separate thread explaining where I was!) I think you might have been experiencing mania or mixed mania due to the buprenorphine. I believe that any effective AD can cause this, and the rebound depression that you got after you stopped the bupe abruptly was not too surprising. Adding Lamictal doesn't sound like a bad idea.
> I live in fear I am untreatable.
I know the feeling. Keep the faith, eh?
-elizabeth
Posted by Zo on September 24, 2001, at 18:21:15
In reply to Re: TANKING ON BUPE - help » Zo, posted by Elizabeth on September 24, 2001, at 12:40:52
Thanks, Elizabeth. . .I couldn't find you. I couldn't find the front door. Am over the worst of the swings - and back on vicodin for time being or forever. I wonder if Oxy is nice. . . .
Does it make any sense that it would be opiates that would send me cycling. .. worse than any AD?
Thanks,
Zo
Posted by Elizabeth on September 24, 2001, at 19:07:08
In reply to Re: TANKING ON BUPE - help » Elizabeth, posted by Zo on September 24, 2001, at 18:21:15
> Thanks, Elizabeth. . .I couldn't find you. I couldn't find the front door.
? I'm confused now. But glad to hear you're doing better.
> Am over the worst of the swings - and back on vicodin for time being or forever. I wonder if Oxy is nice. . . .
From what I've heard. (I've never taken it.) Unlike hydrocodone, it comes in a formulation that's free of APAP, ibuprofen, aspirin, etc.
Seriously: if you convince a doctor to give you oxy (good luck), *don't* abuse it. You can get yourself into big trouble that way, in addition to ruining your relationship with your doctor.
> Does it make any sense that it would be opiates that would send me cycling. .. worse than any AD?
I think it's possible. Like I said, any effective antidepressant can do that.
-elizabeth
Posted by Zo on September 24, 2001, at 19:33:24
In reply to Re: TANKING ON BUPE - help » Zo, posted by Elizabeth on September 24, 2001, at 19:07:08
I meant I couldn't find you on the board this weekend. Thanks for yr. help. Glad bupe is still working for you. Us ancient ones. . .harder to get the wheels going? Rusty old equipment?
Am closer to getting website up. In all this mess.
Zo
Posted by Zo on September 25, 2001, at 0:37:29
In reply to Re: TANKING ON BUPE - help » Zo, posted by SLS on September 23, 2001, at 19:27:21
Thanks from the heart to all who kept good, faithful company over Death Weekend. I pass on the gories, you never know what might come in handy. . .
Well, In case anyone wants a really stinking test for Bipolar II, see if you feel really, really good, not "manic," not supergrl, just niiiice, on Vicodin after a surgery. Whoa, you must have an opiate depression! So your pdoc Rxs Bupenorphine as an improvement, and that feels *really* nice. The way you've always wanted. The way life was meant to be. Good days that roll into another. You start painting again. The light is beautiful. . . .
And three weeks later to the day, you find yourself planning how the car fits in the garage, and who gets what note. . .
and you somehow conceive to email your pdoc hourly updates all weekend long.
And on Monday, when it abates, when it is all over and you are very tired and he calls you in the evening, he describes the most incredible array of emails. Depression, he says, is flat, and dull. On Saturday you were were furious, you were driven, you were despair itself.
I remembered, he says, when we tried Lamictal in '97 and you went bonkers every week, a year later I came across a reference of that poor interaction.
So I think the thing to do,he says, now that we know *your* mania is just plain nice, and grounded, and slow, is to focus on the mood stabilizers. And there's no reason not to expect Lamictal to work."
So this is the way the world ends. With neither bang nor whimper, not this time, but only surcease. Genuine reason to hope, from suffering comes clarity, not an ending at all but just. . .what everyone wants. More life.
With a little help from my friends,
Zo
Posted by shelliR on September 25, 2001, at 22:38:11
In reply to Re: TANKING ON BUPE - help » Zo, posted by Zo on September 23, 2001, at 17:11:18
>
> Shelli - You're thinking of trying bupe, aren't you?
>
> The funny thing is, Vicodin pooped out the same way, so it's something with me and opiates. . .I guess. Will post more as I find out more; meanwhile, if you learn anything. . .Took another Vicodin last night, neatly stopped abrupt mood downswing.
>
> Zo
Hi Zo.
Sorry, missed this post (I wasn't on the envelope :-) ) I'm glad you're feeling better.You say vicodin pooped out the same way as bupe, but your description of what happened on the bupe didn't sound like poop-out. Sounded more like a crash . Did that happen on the vicodin in the same way?
I do think about trying bupe because I have developed a tolerance to oxycontin and have had to go up twice. Also, it does give me a sort of high, especially right after it kicks in and a few hours later, again when it reaches its peak (I guess when another layer of the long-release kicks in), I don't mind a little high in the evening (sort of like a glass of wine), but I don't like it during the day.
It seems like when you started bupe, you did feel a high. I don't know if you remember. The rap on bupe is that it does not cause any drug high. Would you agree? It might be hard to remember after the awful chaos of your crash. I'm trying to determine whether it is worth pressing my pdoc into letting me try bupe so I can compare it to oxycontin. To see if it would help my depression without the high and without developing a tolerance. My pdoc thinks that the likelihood is just as great that tolerance would develop with bupe, and it would have greater side effects.
As far as trying oxycontin over vicodin, they feel about the same but it's nice that oxy lasts for so long (up to 12 hours, for me about 8 and I start dipping). When I take my second dose there is some overlap, it is late afternoon, and it is a nice time for a high. Also, it has no tylenol in it which is better (for the liver?), but I'm not sure that at the doses we're talking about, that really is a big deal. The bad deal about oxy is the lowest dose is 10mg. So I was taking less than 5mg of vicodin and had to start on 10mg of oxycontin. And each increase has to be 10mg, because you can't split the tablets (they're layered for the time release). So I got up so much faster than I would have liked. Like you can't chew off a sliver here and there; it can absolutely be dangerous because you might get the action of the long release all at once. That's why it's such a good drug to abuse; if you crush it, then shoot or inhale it, you're getting the whole dose at the same time, and more.
Anyway, I not still not convinced that opiates are the way to go for me, but I am interested in buprenorphine. So if you can remember if you felt just good, or good with a bit of high, I'd appreciate the info.
Shelli
Posted by Zo on September 28, 2001, at 0:53:50
In reply to Re: TANKING ON BUPE - help » Zo, posted by shelliR on September 25, 2001, at 22:38:11
> You say vicodin pooped out the same way as bupe, >but your description of what happened on the bupe >didn't sound like poop-out. Sounded more like a crash .
Shelli, You're right, but that may be because I took relatively small amts of Vicodin, whereas the Bupe was a full therapeutic program
> It seems like when you started bupe, you did feel a >high. I don't know if you remember. The rap on bupe is >that it does not cause any drug high.
Oh sure. I was high as a kite, my head filled with warmth, and I told myself Isn't this a nice therapeutic reaction. But what this episode has revealed is that my manic highs are 1. somewhat atypical, because I don't get high enough to be concerned. I just feel good and centered and go about my business. . .instead of being a lump of Chronic Fatigue. I noticed my posture was greatly improved too, drat. Because
2. I lie a little about my manias. A little of denial, or hell, I'd be happy to be high the rest of my life, what's left, I've felt like shit for so long.So there was a true and horrendous crash, because Bupe put me on a true manic-depressive course, ending in Mixed States. And on one of the mixed days, I watched my mood turn to up in 10 minutes, and had done nothing. So this has been a major turning point in my dx life, we've been after this for 8 years. . And I don't know how much would relate to you.
> I'm trying to determine whether it is worth pressing my >pdoc into letting me try bupe so I can compare it to >oxycontin. To see if it would help my depression >without the high and without developing a tolerance.
You know, I just don't see the harm in that. What's the downside? So you get a break from Oxy . .I get very suspecious when pdocs *don't* want you to experiment, because I'd never have made it this far without.
>My pdoc thinks that the likelihood is just as great that >tolerance would develop with bupe, and it would have >greater side effects.
And my pdoc, who is one of the pre-eminent Behavioral Medicine guys on the West Coast, says in his experience, bupe's got a pretty good tolerance level. The side effects for me were dryness and a little nausea. Plus being stoned out of my gourd, of course, but I'm assuming that wouldn't happen to a non-BP.
> When I take my second dose there is some overlap, it is >late afternoon, and it is a nice time for a high.
I never got the second-dose high. I warn you tho, if you're underweight, I had NO interest in food. .
> Anyway, I not still not convinced that opiates are the >way to go for me, but I am interested in buprenorphine.
Sorry, I don't remember your dx. . .but there is no doubt some have an opiate depression, and the only way I know to be certain is to try the avail. opiates. I've done that with lots of meds, backward dxed ADD.
Hope this helps, glad to talk more,
Zo
Posted by SLS on September 28, 2001, at 11:27:37
In reply to Re: TANKING ON BUPE - help » shelliR, posted by Zo on September 28, 2001, at 0:53:50
Hi Zo.
> So there was a true and horrendous crash, because Bupe put me on a true manic-depressive course, ending in Mixed States. And on one of the mixed days, I watched my mood turn to up in 10 minutes, and had done nothing. So this has been a major turning point in my dx life, we've been after this for 8 years. . And I don't know how much would relate to you.
I think it is *critical* that you don't facilitate the induction of mania with drugs.1. Depression almost always follows mania for those who experience depression as part of their illness.
2. The depressions following mania are often the most severe, especially immediately following the state-change.
3. With each successive cycle, the episodes tend to become more severe and treatment-resistant.
I think it is a reasonable option to establish a mood-stabilization regime and continue to take an opioid like buprenorphine, especially if opioids are the only thing you respond to.
Have you ever focused on mood stabilizers in the past?
- Scott
Posted by Zo on September 29, 2001, at 2:24:30
In reply to Re: TANKING ON BUPE - help » Zo, posted by SLS on September 28, 2001, at 11:27:37
No, I never have, and that's clearly what's been so sorely missing. . and why I have indeed gotten worse in some ways over time. I am quite clear, now, on the seriousness of this illness, and the danger of suicide in mixed states in particular, and my pdoc is as clear as he's ever been, after last weekend's emails, that mixed states and rapid cycling (in a day) have been part of the picture for a long time. I think first my CFS and TLE had to improve, for this aspect to emerge.
Plus my hypomania is atypical. Centered, calm. Grounded energy. And only a degree higher, as Brent says, normal well-being. I've felt it, and I've liked it, and not understood nor been willing to face the dangers of courting it, or letting it go on. Until this past weekend.
We didn't even discuss more Bupe. It was *so* nauseating at the end, and so far so good on Lamictal. . .it must have some AD properties. . .Or, could it be, if I am not cycling, I'm actually not that depressed???
Thanks *so* much, Scott
Zo
Posted by Elizabeth on October 1, 2001, at 13:28:59
In reply to Re: TANKING ON BUPE - help, posted by Zo on September 29, 2001, at 2:24:30
> No, I never have, and that's clearly what's been so sorely missing. . and why I have indeed gotten worse in some ways over time.
Maybe. I think recurrent unipolar depression also tends to get worse with each successive episode.
> I am quite clear, now, on the seriousness of this illness, and the danger of suicide in mixed states in particular, and my pdoc is as clear as he's ever been, after last weekend's emails, that mixed states and rapid cycling (in a day) have been part of the picture for a long time.
I've only had a mixed mania once (connected to the serotonin syndrome, not spontaneous) but it was among the worst feelings I've ever had. (This was full-blown psychotic mania, not dysphoric hypomania or anything of that sort.)
> We didn't even discuss more Bupe. It was *so* nauseating at the end, and so far so good on Lamictal. . .it must have some AD properties. . .Or, could it be, if I am not cycling, I'm actually not that depressed???
Lamictal seems to be something of an antidepressant as well as a mood stabiliser, for some people. But I would think that you would have been taking anticonvulsants for some time, for your epilepsy. No?
A bunch of doctors seem to be convinced I had a complex partial seizure, so I'm on a low-ish dose of Trileptal (prescribed by my pdoc) for the time being. I'm supposed to find a neurologist.
-elizabeth
Posted by Zo on October 3, 2001, at 16:43:11
In reply to Re: tanking » Zo, posted by Elizabeth on October 1, 2001, at 13:28:59
> Lamictal seems to be something of an antidepressant as well as a mood stabiliser, for some people. But I would think that you would have been taking anticonvulsants for some time, for your epilepsy. No?
>
Yes, Neurontin. Not the same *at* all.> A bunch of doctors seem to be convinced I had a complex partial seizure, so I'm on a low-ish dose of Trileptal (prescribed by my pdoc) for the time being. I'm supposed to find a neurologist.
>
> -elizabethDo *you* have any idea/intuition why the seizure?
Zo
Posted by Elizabeth on October 5, 2001, at 13:01:34
In reply to Re: tanking » Elizabeth, posted by Zo on October 3, 2001, at 16:43:11
> Do *you* have any idea/intuition why the seizure?
No, except maybe the desipramine could have something to do with it (as a contributing factor, not as the entire cause).
-e
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