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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Krazy Kat on January 17, 2002, at 18:59:03
I'm Bipolar - just stopped Depakote and am now on Prozac 50 mg, and occassionally Neurontin. The strange thing is that instead of getting manic, I'm falling deeper and deeper into a depression.
Does anyone have any thoughts re: this? I'm trying to avoid another stabilizer or antipsychotic since I want to get pregnant, but I may not be able to avoid it at this rate.
- KK
Posted by ST on January 17, 2002, at 19:30:49
In reply to How can I be depressed on an antidepressant?, posted by Krazy Kat on January 17, 2002, at 18:59:03
Hi,
It sounds like you need a more effective AD, never mind the mood stabilizers. I'm bi polar as well, and Prozac did nothing for my depression. I just sank deeper and deeper. And I don't really get too manic, just depressed. So my pdoc added Wellbutrin to my Depakote and I got good results for awhile, but then became depressed again. It wasn't until I also added an SSRI to this combo that I finally felt balanced. I've been bouncing around on different SSRIs due to certain side effects from each and am now on Effexor. But I just don't think Prozac is a good AD for bi polars. What other ADs have you been on?
Sarah
> I'm Bipolar - just stopped Depakote and am now on Prozac 50 mg, and occassionally Neurontin. The strange thing is that instead of getting manic, I'm falling deeper and deeper into a depression.
>
> Does anyone have any thoughts re: this? I'm trying to avoid another stabilizer or antipsychotic since I want to get pregnant, but I may not be able to avoid it at this rate.
>
> - KK
Posted by TSA West on January 17, 2002, at 20:48:11
In reply to I don't think Prozac is that great for BPs, posted by ST on January 17, 2002, at 19:30:49
Venlafaxine (Effexor) and Wellbutrin (buproprion) are the best antidepressants for bipolar disease, and to my knowledge have no teratogenic effect:
http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html
says
L.James Grold M.D.)
Subject: Possible indications of bipolarity"I have come to the same conclusion on several patients with recurrent depressions starting in adolescence. I also have found in such patients that venlafaxine and buproprion with a mood stablizer like divalproex to be very helpful in smoothing out the moods and in preventing more cycles."
Posted by Krazy Kat on January 17, 2002, at 21:14:42
In reply to Venlafaxine and Wellbutrin » ST, posted by TSA West on January 17, 2002, at 20:48:11
for the advice. I'm having a breakdown of sorts this evening - I've had trouble since stopping Depakote. Trying not to make any decisions now.
===
Posted by ST on January 18, 2002, at 2:21:47
In reply to Venlafaxine and Wellbutrin » ST, posted by TSA West on January 17, 2002, at 20:48:11
Thanks for the link! This is encouraging, since I'm on both Wellbutrin and Effexor.
> Venlafaxine (Effexor) and Wellbutrin (buproprion) are the best antidepressants for bipolar disease, and to my knowledge have no teratogenic effect:
>
> http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html
>
> says
>
> L.James Grold M.D.)
> Subject: Possible indications of bipolarity
>
> "I have come to the same conclusion on several patients with recurrent depressions starting in adolescence. I also have found in such patients that venlafaxine and buproprion with a mood stablizer like divalproex to be very helpful in smoothing out the moods and in preventing more cycles."
Posted by MB on January 18, 2002, at 7:30:51
In reply to Venlafaxine and Wellbutrin » ST, posted by TSA West on January 17, 2002, at 20:48:11
> http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html
Wow! In reading this link I've almost come to the conclusion that I'm bipolar. SSRIs work *wonderfully* the first few days (as long as I have a sedative like a benzo or alcohol to mitigate agitation) but then they poop out after about a week to two weeks. No dose increase helps...even if I stay on the SSRI for years. Hmmm...
Posted by cindylou on January 19, 2002, at 20:31:32
In reply to Thanks, posted by Krazy Kat on January 17, 2002, at 21:14:42
Hi Kat,
Sorry to hear you're feeling so rotten. I know that whenever I have started an SSRI, it will initally cause me to get much more depressed. That initial depression would last about 2 weeks or so, and then my mood would markedly improve. Perhaps that's what's happening to you?Another note -- for me, once the depression got better, the fatigue still persisted with Zoloft and Effexor. Not with Prozac, but it pooped out on me after 2 months.
I truly hope you feel better soon. I am really feeling for you, since I'm struggling with the decision of what to do when we start "trying" again for a baby. It is a very tough decision.
Hang in there ...
cindy
> for the advice. I'm having a breakdown of sorts this evening - I've had trouble since stopping Depakote. Trying not to make any decisions now.
>
> ===
Posted by cindylou on January 19, 2002, at 20:33:51
In reply to Re: Venlafaxine and Wellbutrin » TSA West, posted by MB on January 18, 2002, at 7:30:51
Hi MB --
I had the same strange reactions to meds for years. Finally, about 2 months ago, my pdoc diagnosed me as Bipolar II. I think your hunch may be right ... I'm actually very relieved to have that diagnosis now, because I believe I'm receiving treatment that is much better suited to me (Lamictal + Serzone). Things are looking up, little by little.Take care,
cindy
> Wow! In reading this link I've almost come to the conclusion that I'm bipolar. SSRIs work *wonderfully* the first few days (as long as I have a sedative like a benzo or alcohol to mitigate agitation) but then they poop out after about a week to two weeks. No dose increase helps...even if I stay on the SSRI for years. Hmmm...
Posted by MB on January 19, 2002, at 21:28:08
In reply to Re: Venlafaxine and Wellbutrin » MB, posted by cindylou on January 19, 2002, at 20:33:51
> Hi MB --
> I had the same strange reactions to meds for years. Finally, about 2 months ago, my pdoc diagnosed me as Bipolar II. I think your hunch may be right ... I'm actually very relieved to have that diagnosis now, because I believe I'm receiving treatment that is much better suited to me (Lamictal + Serzone). Things are looking up, little by little.
>
> Take care,
> cindy
Let me know how the Lamictal treats you. Right now, I'm on Neurontin. I've tried Gabitril and trileptal but suffered bad side effects. The Neurontin is good, but it is hard for me to keep my blood levels steady with it for some reason. Lamactil might be one for me to try some time.MB
Posted by JohnX2 on January 19, 2002, at 23:01:42
In reply to How can I be depressed on an antidepressant?, posted by Krazy Kat on January 17, 2002, at 18:59:03
Krazy,The bipolar mind is an elecrical storm.
It needs a stabilizer. Either an anti-psychotic
like zyprexa or a membrane stablizer like
Lamictal or Depakote. That's our game.Stand alone AD's introduced into the electrical
storm may just add to the chaos. The storm
needs to be neuralized before an AD can be
"sneaked" into the back door as my pdoc puts
it. I firmly believe in this philosophy after
having failed experiences with both positive anti-depressant
responses that pooped out and also anti-depressants
making depression worse. Its just going to be
a wild card unless your bipolar is realllllly
mild or you are misdiagnosed as bipolar.The mood stabilizers have always been my
successfull game and it took a long painful
journey to figure this out. I'm bp type II.good luck.
john
> I'm Bipolar - just stopped Depakote and am now on Prozac 50 mg, and occassionally Neurontin. The strange thing is that instead of getting manic, I'm falling deeper and deeper into a depression.
>
> Does anyone have any thoughts re: this? I'm trying to avoid another stabilizer or antipsychotic since I want to get pregnant, but I may not be able to avoid it at this rate.
>
> - KK
Posted by TSA West on January 20, 2002, at 1:04:08
In reply to Re: How can I be depressed on an antidepressant? » Krazy Kat, posted by JohnX2 on January 19, 2002, at 23:01:42
I agree with JohnX2.
Wishing you Kat a long life of happiness,
----------------TSA West--------------------
Posted by Krazy Kat on January 20, 2002, at 9:44:11
In reply to Re: How can I be depressed on an antidepressant? » Krazy Kat, posted by JohnX2 on January 19, 2002, at 23:01:42
John:
I wasn't able to make it more than a few days w/o my stabilizer... you are certainly correct!! I feel "fine" now I started it again. I have to admit this is a serious illness that must be treated.
- KK
Posted by Mr. Scott on January 20, 2002, at 16:27:29
In reply to Re: How can I be depressed on an antidepressant? » Krazy Kat, posted by JohnX2 on January 19, 2002, at 23:01:42
John,
I wanted to ask you if you think klonopin qualifies as a mood stabilizer that one could combine with an AD to settle the storm and hence get a sustained AD response? Or do you think it has to be Lithium, Depakote, Zyprexa, tegretol, etc..Scott
Posted by JohnX2 on January 21, 2002, at 0:19:00
In reply to Re: How can I be depressed on an antidepressant? » JohnX2, posted by Mr. Scott on January 20, 2002, at 16:27:29
Hi Scott,I found out by accident that Klonopin is a
form of mood stabilizer. This was when I was
misdiagnosed as Major Depression and added
Klonopin to Effexor to help with sleep.
Taking it as an add on to the Effexor trial was
the 1st time my mood *really* stabilized after
a bunch of AD tests (i.e it was the Klonopin,
not the effexor).Klonopin is an anti-convulsant acting at the
GabaA receptor. It is a poor mood stabilizer
over time as the body develops tolerance to
its effects, but short term it should have
some stabilizing effect for any bipolar patient.
It would never be used as a primary stabilizer
however. It was looked into for use in epilepsy,
but disgarded due to the tolerance build up issue.regards,
John> John,
>
>
> I wanted to ask you if you think klonopin qualifies as a mood stabilizer that one could combine with an AD to settle the storm and hence get a sustained AD response? Or do you think it has to be Lithium, Depakote, Zyprexa, tegretol, etc..
>
> Scott
Posted by mr.scott on January 21, 2002, at 11:49:22
In reply to Re: How can I be depressed on an antidepressant? » Mr. Scott, posted by JohnX2 on January 21, 2002, at 0:19:00
Thanks for your reply John!
Which of the more conventional stabilers have worked for you? Some of them can be challenging to tolerate.
Scott
Posted by JohnX2 on January 21, 2002, at 16:17:31
In reply to Re: How can I be depressed on an antidepressant? » JohnX2, posted by mr.scott on January 21, 2002, at 11:49:22
My trials (in order):- Klonopin 4mg
1st med to stabilize my mood (after
barking up the anti-depressant route).
Made me really drowsy (until
tolerance built up).- Depakote , upto 1000+ mg
Placebo (Strange)- Lamictal 1st trial
Quit at 100 mg due to rash.
Doctor dosed it too quickly.Many moons later...
- Lamictal 2nd trial (150-225 mg Current)
Has had 0 side effects and works the
best for me at 150 mg, but it was the
most challenging to dose onto (it
took 2 months of careful dosing, but was
well worth the wait).While dosing experienced transient slurred
speech, stupor, itchy skin.- Neurontin (upto 400 mg TID Temporary)
Took only while tapering Klonopin. Helped relieve
anxiety and tingling in extremities. VERY
ANNOYING DOSING SCHEDULE. A little brain fog
that never went away. Kept me in control while
lowering the Klonopin dose (this was about 1 yr
ago). I didn't want to stay on this one long
term because I had to take it exactly 8 hrs
apart or I would have crappy side effects.- Topamax (200 MG BID Current)
This is working awesome for me as an ADD-ON
to LAMICTAL (see above). I am one of the few
people to use this strategy. The Topamax has
a property that makes it similar to the benzos
like Klonopin and for some reason I am having
good luck in that it is not having coginitive
side effects AT ALL. I believe that when added
on TOP of LAMICTAL it behaves uniquely as opposed to
when used alone. This is just my guess as my
experience has been unique (and you could
argue the case base on the neurological
underpinnings between how the two meds would work
together).So, right now I take 4 meds:
Lamictal 150 mg
Topamax 400 mg
Klonopin 2.5 mg
Zyprexa 5 mgI am quitting the Klonopin because the Topamax
replaces it. And the Zyprexa makes me a little
fat. So I hope I can quit that. If I can narrow
my meds down to Lamictal and Topamax I can safely
say that I have no side effects from medication.Everyone's results may very.
I still scratch my head to my placebo
Depakote response.regards,
john
> Thanks for your reply John!
>
> Which of the more conventional stabilers have worked for you? Some of them can be challenging to tolerate.
>
> Scott
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