![[dr. bob]](/dr-bob-sm.gif)
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 JonW on March 8, 2002, at 15:10:01
My diagnosis would be something like Bipolar II + Atypical Depression (same as BP2?) + Bad Social Phobia + ADD. All of these are subject to change of course... I'm currently taking Depakote + Neurontin + Zoloft + Zyprexa. I've gotten the impression that you have similar symptoms as mine. If so, what is your current treatment? Sometimes anectodal research is like oxygen, you know?
Several doctors whom I respect have suggested that I go on Nardil. Zoloft has taken the life out of me and doesn't seem to be helping with SP. Does Nardil have this same side-effect? I'd love to hear of different people's experiences on Nardil and other MAOIs? Anyone's advice is much appreciated.
Thanks in advance,
Jon
Posted by JohnX2 on March 8, 2002, at 17:08:36
In reply to Johnx2, others -- Nardil Question, etc., posted by JonW on March 8, 2002, at 15:10:01
Hi JonW,Nardil is a very well respected medicine for social phobia/atypical depression.
Many people believe the MAO inhibitors are an effective 1st line treatment
for these symptoms (although many people do well on other classes of
medicines too). There are other MAO inhibitors used, mainly
Parnate and Selegiline, but Nardil is sometimes more pupular for social
phobia becuase it is may be a bit better for anxiety.For atypical depression occasionally the SSRIs dont works out
and people do feel a bit of emotional blunting, so maybe the Nardil isn't a bad option.
The main downside is the dietary restriction. I haven't taken
Nardil, but others on the board have and I have seen positive
comments.As far as the ADD goes, I don't know about the ability to
combine stimulants like Ritalin or Adderall with an MAO
inhibitor, check with your doctor for medicine interactions.
Do you take stimulants for ADD? (Sometimes ADD/anxiety symptoms in Bipolar II
are confused with hypomania in my pdoctors opinion)Depakote is a good 1st line mood stabizer for bipolar II and
Neurontin is popular add on for anxiety. I have taken
Neurontin to help stabilize my mood and deal with anxiety
issues. Some other people use Lamictal (me), or Lithium, or
Tegetrol as mood stabilizers, but they are all fine choices
for individual cases.I have taken Zyprexa to help me with anxiety and sleep and
it really helped a lot.I think getting a good diagnosis and having a good rapport
with a trusted doctor is most important. Sounds
like you are on a good track. Hopefully you can get
some more feedback on Nardil, I have heard it can be very good
for social phobia/atypical depression. Your results
may vary, as always.Best Wishes,
John> My diagnosis would be something like Bipolar II + Atypical Depression (same as BP2?) + Bad Social Phobia + ADD. All of these are subject to change of course... I'm currently taking Depakote + Neurontin + Zoloft + Zyprexa. I've gotten the impression that you have similar symptoms as mine. If so, what is your current treatment? Sometimes anectodal research is like oxygen, you know?
>
> Several doctors whom I respect have suggested that I go on Nardil. Zoloft has taken the life out of me and doesn't seem to be helping with SP. Does Nardil have this same side-effect? I'd love to hear of different people's experiences on Nardil and other MAOIs? Anyone's advice is much appreciated.
>
> Thanks in advance,
> Jon
Posted by JohnX2 on March 8, 2002, at 17:38:44
In reply to Re: Johnx2, others -- Nardil Question, etc. » JonW, posted by JohnX2 on March 8, 2002, at 17:08:36
Jonw,Oh, I don't have any problems with
social phobia (at least I don't have a diagnosis).I've pondered for years what the source of
my "agitation" is. I'm convinced its just
some form of hypomania. Also struggled with
an ADD diagnosis, but seemed to rule that out.
But it is common for bipolar. If Im a little euphoric,
then its obvious. But its possible to be hypomanic
but not euphoric, this is "dysphoric hypomania".These are some symptoms:
- I have A LOT of difficulty sitting still.
- Also I have a really bad memory.
I have difficulty reading books (like to read
short magazine articles). Get bored easily.
- Am really good at math and science (electrical engineer),
but use a calculator to multiply high single
digit numbers.
-Have to leave my cubicle at work
every 20 minutes to "walk around" and chat with
people.
-Driving my car and listenig to loud music calms
me down immensely.
-caffeine junky
-can be extremely confrontational
-very self critical (while also confrontational
and dont put up with other peoples crud).
- get bored easily
- stimulants do NOT calm me down, they drive me
hypomanic.
- when I'm agitated, feeling "anxious", I'm not
psychologically worrying about anything, its purely
physical energy. (more an indicator of dysphoric
hypomania).
- The anti-anxiety medicine Klonopin calms be
down (1st medicine to stabilize my mood). I've
seen a few bipolars run into this by accident.
Taking AD's, given Klonopin for anxiety/agitation, and then
magically the mood stabilizes. Why? Because
Klonopin is also an anti-convulsant/mood stabilizer
like Depakote/Neurontin, etc. So sometimes I see
bipolars treated as unipolar depression unknowingly
using a medicine like Klonopin as a mood stabilizer.
I did this for many months before getting a good
bipolar diagnosis.Anyways, I take these medicines below, but it's really not
completely relavent to your situation. Everyone here dx'd as
bipolarII has a different recipe. You just need to find what
you are comfortable with (hopefully a good doctor
calls the shots with you).Topamax 400 mg
Serzone 300 mg
Lamictal 150 mg
Klonopin 1 mgI'd prefer to just be on mood stabilizers.
Mainly only Lamictal, but the Serzone and Topamax
help with some headaches. The Klonopin I am trying
to quit. I've taken Zoloft and it made me manic.
It made my mood a little flat after that. Wellbutrin
was better but it also made me manic. Wellbutrin
was the best for motivation, energy, drive.Of the medicines I take, Lamictal and Klonopin
are popular. Serzone and Topamax are more fringe.
Your results may vary, yada.good luck with your medicines.
John
>
> Hi JonW,
>
> Nardil is a very well respected medicine for social phobia/atypical depression.
> Many people believe the MAO inhibitors are an effective 1st line treatment
> for these symptoms (although many people do well on other classes of
> medicines too). There are other MAO inhibitors used, mainly
> Parnate and Selegiline, but Nardil is sometimes more pupular for social
> phobia becuase it is may be a bit better for anxiety.
>
> For atypical depression occasionally the SSRIs dont works out
> and people do feel a bit of emotional blunting, so maybe the Nardil isn't a bad option.
> The main downside is the dietary restriction. I haven't taken
> Nardil, but others on the board have and I have seen positive
> comments.
>
> As far as the ADD goes, I don't know about the ability to
> combine stimulants like Ritalin or Adderall with an MAO
> inhibitor, check with your doctor for medicine interactions.
> Do you take stimulants for ADD? (Sometimes ADD/anxiety symptoms in Bipolar II
> are confused with hypomania in my pdoctors opinion)
>
> Depakote is a good 1st line mood stabizer for bipolar II and
> Neurontin is popular add on for anxiety. I have taken
> Neurontin to help stabilize my mood and deal with anxiety
> issues. Some other people use Lamictal (me), or Lithium, or
> Tegetrol as mood stabilizers, but they are all fine choices
> for individual cases.
>
> I have taken Zyprexa to help me with anxiety and sleep and
> it really helped a lot.
>
> I think getting a good diagnosis and having a good rapport
> with a trusted doctor is most important. Sounds
> like you are on a good track. Hopefully you can get
> some more feedback on Nardil, I have heard it can be very good
> for social phobia/atypical depression. Your results
> may vary, as always.
>
> Best Wishes,
> John
>
> > My diagnosis would be something like Bipolar II + Atypical Depression (same as BP2?) + Bad Social Phobia + ADD. All of these are subject to change of course... I'm currently taking Depakote + Neurontin + Zoloft + Zyprexa. I've gotten the impression that you have similar symptoms as mine. If so, what is your current treatment? Sometimes anectodal research is like oxygen, you know?
> >
> > Several doctors whom I respect have suggested that I go on Nardil. Zoloft has taken the life out of me and doesn't seem to be helping with SP. Does Nardil have this same side-effect? I'd love to hear of different people's experiences on Nardil and other MAOIs? Anyone's advice is much appreciated.
> >
> > Thanks in advance,
> > Jon
Posted by JonW on March 8, 2002, at 21:00:44
In reply to Re: Johnx2, others -- Nardil Question, etc. » JonW, posted by JohnX2 on March 8, 2002, at 17:08:36
Thanks Johnx2!
Zoloft seems to be treating me a little bit better lately, but maybe I'm just cycling. Anyway, has anyone successfully treated the blahs you get on zoloft?
Thanks,
Jon>
> Hi JonW,
>
> Nardil is a very well respected medicine for social phobia/atypical depression.
> Many people believe the MAO inhibitors are an effective 1st line treatment
> for these symptoms (although many people do well on other classes of
> medicines too). There are other MAO inhibitors used, mainly
> Parnate and Selegiline, but Nardil is sometimes more pupular for social
> phobia becuase it is may be a bit better for anxiety.
>
> For atypical depression occasionally the SSRIs dont works out
> and people do feel a bit of emotional blunting, so maybe the Nardil isn't a bad option.
> The main downside is the dietary restriction. I haven't taken
> Nardil, but others on the board have and I have seen positive
> comments.
>
> As far as the ADD goes, I don't know about the ability to
> combine stimulants like Ritalin or Adderall with an MAO
> inhibitor, check with your doctor for medicine interactions.
> Do you take stimulants for ADD? (Sometimes ADD/anxiety symptoms in Bipolar II
> are confused with hypomania in my pdoctors opinion)
>
> Depakote is a good 1st line mood stabizer for bipolar II and
> Neurontin is popular add on for anxiety. I have taken
> Neurontin to help stabilize my mood and deal with anxiety
> issues. Some other people use Lamictal (me), or Lithium, or
> Tegetrol as mood stabilizers, but they are all fine choices
> for individual cases.
>
> I have taken Zyprexa to help me with anxiety and sleep and
> it really helped a lot.
>
> I think getting a good diagnosis and having a good rapport
> with a trusted doctor is most important. Sounds
> like you are on a good track. Hopefully you can get
> some more feedback on Nardil, I have heard it can be very good
> for social phobia/atypical depression. Your results
> may vary, as always.
>
> Best Wishes,
> John
>
> > My diagnosis would be something like Bipolar II + Atypical Depression (same as BP2?) + Bad Social Phobia + ADD. All of these are subject to change of course... I'm currently taking Depakote + Neurontin + Zoloft + Zyprexa. I've gotten the impression that you have similar symptoms as mine. If so, what is your current treatment? Sometimes anectodal research is like oxygen, you know?
> >
> > Several doctors whom I respect have suggested that I go on Nardil. Zoloft has taken the life out of me and doesn't seem to be helping with SP. Does Nardil have this same side-effect? I'd love to hear of different people's experiences on Nardil and other MAOIs? Anyone's advice is much appreciated.
> >
> > Thanks in advance,
> > Jon
Posted by JohnX2 on March 8, 2002, at 21:05:58
In reply to Zoloft and The Blahs! Ugh!!, posted by JonW on March 8, 2002, at 21:00:44
What do you mean by "blahs" ? :(Its pretty tricky not to have a few at least a few ups and
downs. There are some strategies to smooth things
out. (mood stabilizer augmentations, etc).-John
> Thanks Johnx2!
>
> Zoloft seems to be treating me a little bit better lately, but maybe I'm just cycling. Anyway, has anyone successfully treated the blahs you get on zoloft?
>
> Thanks,
> Jon
>
> >
> > Hi JonW,
> >
> > Nardil is a very well respected medicine for social phobia/atypical depression.
> > Many people believe the MAO inhibitors are an effective 1st line treatment
> > for these symptoms (although many people do well on other classes of
> > medicines too). There are other MAO inhibitors used, mainly
> > Parnate and Selegiline, but Nardil is sometimes more pupular for social
> > phobia becuase it is may be a bit better for anxiety.
> >
> > For atypical depression occasionally the SSRIs dont works out
> > and people do feel a bit of emotional blunting, so maybe the Nardil isn't a bad option.
> > The main downside is the dietary restriction. I haven't taken
> > Nardil, but others on the board have and I have seen positive
> > comments.
> >
> > As far as the ADD goes, I don't know about the ability to
> > combine stimulants like Ritalin or Adderall with an MAO
> > inhibitor, check with your doctor for medicine interactions.
> > Do you take stimulants for ADD? (Sometimes ADD/anxiety symptoms in Bipolar II
> > are confused with hypomania in my pdoctors opinion)
> >
> > Depakote is a good 1st line mood stabizer for bipolar II and
> > Neurontin is popular add on for anxiety. I have taken
> > Neurontin to help stabilize my mood and deal with anxiety
> > issues. Some other people use Lamictal (me), or Lithium, or
> > Tegetrol as mood stabilizers, but they are all fine choices
> > for individual cases.
> >
> > I have taken Zyprexa to help me with anxiety and sleep and
> > it really helped a lot.
> >
> > I think getting a good diagnosis and having a good rapport
> > with a trusted doctor is most important. Sounds
> > like you are on a good track. Hopefully you can get
> > some more feedback on Nardil, I have heard it can be very good
> > for social phobia/atypical depression. Your results
> > may vary, as always.
> >
> > Best Wishes,
> > John
> >
> > > My diagnosis would be something like Bipolar II + Atypical Depression (same as BP2?) + Bad Social Phobia + ADD. All of these are subject to change of course... I'm currently taking Depakote + Neurontin + Zoloft + Zyprexa. I've gotten the impression that you have similar symptoms as mine. If so, what is your current treatment? Sometimes anectodal research is like oxygen, you know?
> > >
> > > Several doctors whom I respect have suggested that I go on Nardil. Zoloft has taken the life out of me and doesn't seem to be helping with SP. Does Nardil have this same side-effect? I'd love to hear of different people's experiences on Nardil and other MAOIs? Anyone's advice is much appreciated.
> > >
> > > Thanks in advance,
> > > Jon
Posted by JonW on March 9, 2002, at 12:46:37
In reply to Re: Zoloft and The Blahs! Ugh!!, posted by JohnX2 on March 8, 2002, at 21:05:58
Sorry, I mean apathy, no energy or motivation to do even the smallest things at times... :(
Does anyone know if these types of side-effects are common with Nardil?Jon
>
> What do you mean by "blahs" ? :(
>
> Its pretty tricky not to have a few at least a few ups and
> downs. There are some strategies to smooth things
> out. (mood stabilizer augmentations, etc).
>
> -John
>
>
>
> > Thanks Johnx2!
> >
> > Zoloft seems to be treating me a little bit better lately, but maybe I'm just cycling. Anyway, has anyone successfully treated the blahs you get on zoloft?
> >
> > Thanks,
> > Jon
Posted by Ritch on March 9, 2002, at 13:22:48
In reply to Zoloft and The Blahs! Ugh!!, posted by JonW on March 8, 2002, at 21:00:44
> Zoloft seems to be treating me a little bit better lately, but maybe I'm just cycling. Anyway, has anyone successfully treated the blahs you get on zoloft?
>
> Thanks,
> JonJon,
The one thing I found that worked remarkably well with Zoloft (to *defog* your head) was a little bit of nortriptyline added-on. I tried 10-30mg/day with 12.5mg of Zoloft and it worked quite well. Your resting heartrate will get elevated some and you might get some clammy cool extremities from it though. You have got to give it a full two weeks or more for it to kick in.
Just a suggestion,
Mitch
Posted by Elizabeth on March 9, 2002, at 15:40:18
In reply to Johnx2, others -- Nardil Question, etc., posted by JonW on March 8, 2002, at 15:10:01
Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
Just some opinions, for whatever they're worth.
-elizabeth
Posted by JonW on March 9, 2002, at 16:38:16
In reply to Re: Nardil » JonW, posted by Elizabeth on March 9, 2002, at 15:40:18
Hi Elizabeth,
Thanks for the informative post! I've read other post of yours and have found them useful as well.
As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
Thanks,
Jon> Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
>
> Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
>
> I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
>
> MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
>
> MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
>
> Just some opinions, for whatever they're worth.
>
> -elizabeth
Posted by JohnX2 on March 9, 2002, at 20:57:20
In reply to Re: Nardil » Elizabeth, posted by JonW on March 9, 2002, at 16:38:16
Hi JonW,
What mood stabilizers have you tried besides Depakote?Have you been able to get onto an anti-depressant without
getting such a wild manic response?Has your pdoc talked about taking more
mood stabilizers like lithium, lamictal, more depakote?My pdoc's opinion is that most bipolars should be treated
with more mood stabilizers and as few ads as possible.Has your physician ever started you solely on a mood stabilizer,
before adding on ADs?I'm just wondering what the strategy is to avoid the pattern of
cycling. I had the same snag, and Lamictal was the only medicine
that helped me without causing a big cycle (Lamictal of the
mood stabilizers has a good anti-depressant action). Lithium
is good at snaggig the bad mania.Even now that I have good Lamictal and Topamax
some Serzone dosing makes me hypomanic. I might add
some Lithium soon.sorry for all the questions.
best wishes,
-John
> Hi Elizabeth,
>
> Thanks for the informative post! I've read other post of yours and have found them useful as well.
>
> As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
>
> What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
>
> Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
>
> Thanks,
> Jon
>
>
>
> > Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
> >
> > Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
> >
> > I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
> >
> > MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
> >
> > MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
> >
> > Just some opinions, for whatever they're worth.
> >
> > -elizabeth
Posted by JonW on March 9, 2002, at 22:11:00
In reply to Re: Nardil » JonW, posted by JohnX2 on March 9, 2002, at 20:57:20
I've been on several combinations of mood stabilizers and have just added ADs because I couldn't take it anymore. Be that decision a good one or a bad one.
I think it would be easiest for me to first list all of my recent cocktails:
lamictal
lamictal + depakote
depakote + geodon
depakote + geodon + gabatril
depakote + trileptal + geodon
depakote + trileptal
trileptal + geodon
trileptal + seroquel
depakote + trileptal + zyprexa
depakote + trileptal + zyprexa + neurontin
depakote + trileptal + zyprexa + neurontin + (ritalin, dexedrine, aricept)
depakote + trileptal + zyprexa + lithium
depakote + trileptal + zyprexa + neurontin + zoloftI've also been on nearly all of these with Klonopin. Lamictal gave me horrible memory problems, and made me more emotional -- neurontin has this same effect on my emotions. Lithium makes me depressed and fast! I suppose wellbutrin has been the least rocky AD, but it makes me extremely irritable and probably the worst headache I've ever had. I wouldn't mind the highs of the ADs except I'm irritable along with the "high" and it never lasts.
Jon
>
> Hi JonW,
>
>
> What mood stabilizers have you tried besides Depakote?
>
> Have you been able to get onto an anti-depressant without
> getting such a wild manic response?
>
> Has your pdoc talked about taking more
> mood stabilizers like lithium, lamictal, more depakote?
>
> My pdoc's opinion is that most bipolars should be treated
> with more mood stabilizers and as few ads as possible.
>
> Has your physician ever started you solely on a mood stabilizer,
> before adding on ADs?
>
> I'm just wondering what the strategy is to avoid the pattern of
> cycling. I had the same snag, and Lamictal was the only medicine
> that helped me without causing a big cycle (Lamictal of the
> mood stabilizers has a good anti-depressant action). Lithium
> is good at snaggig the bad mania.
>
> Even now that I have good Lamictal and Topamax
> some Serzone dosing makes me hypomanic. I might add
> some Lithium soon.
>
> sorry for all the questions.
>
> best wishes,
>
> -John
>
> > Hi Elizabeth,
> >
> > Thanks for the informative post! I've read other post of yours and have found them useful as well.
> >
> > As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
> >
> > What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
> >
> > Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
> >
> > Thanks,
> > Jon
> >
> >
> >
> > > Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
> > >
> > > Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
> > >
> > > I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
> > >
> > > MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
> > >
> > > MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
> > >
> > > Just some opinions, for whatever they're worth.
> > >
> > > -elizabeth
Posted by JohnX2 on March 9, 2002, at 23:09:01
In reply to Re: Nardil » JohnX2, posted by JonW on March 9, 2002, at 22:11:00
Hi Jon,
Well, can't say you haven't "been there done
that" with the mood stabilizers! Sorry.Depakote was a placebo for me.
Neurontin had an anti-anxiety but no
mood stabilizer effect.
Lamictal works at 150 mg, but does nothing
at any other dose (gives me a headache
at higher dose).Unfortunately I took Effexor,Paxil,Wellbutrin,
and Zoloft, and Serzone before getting a good bipolar diagnosis.
Of those, Sezone gave me an AD response without
a mood stabilizer and didn't make me severly
manic, whereas Zoloft and Wellbutrin made me
manic.Lately I was taking this for a few months:
Lamictal 150 mg
Zyprexa 5-15 mg
Klonopin 6 mg
Topamax 400 mgI was tolerant to Klonopin and I don't know if
you saw my posts, when I started to dump it I became
really manic and my pdoc pushed my Zyprexa to 15 mg.
But the mania was really bad...I spent 300 dollars on
plumbing tubing trying to build a golf driving range
in my dining room and I thought there was a conspiracy
at work to get me fired, etc..ugh.Anyways I got the Klon. down to 1 mg and the bad
mania went away and I subsequently stopped Zyprexa (which
I generally liked) due to some twitching.
I added Serzone to help with some headaches,
and frankly it has really helped my mood. But now I
am a bit cylothymic again. I go through intraday swings.
Its better than without the Serzone. I don't know if I
can really tweak it any more. So for me Serzone is
about the only AD i can tolerate. It helps without
causing too much hypomania and it isn't making
me swing back into depression. So I just found
this by trial and error (I've only been on it
a few weeks, but I did ok on it before. Cross my fingers).
Btw, if you dose Serzone up very slowly it is
excellent for anxiety and sleep.Some people think you ultimately gotta deal
with the little swings. Do you feel the atypical anti-psychotics
have helped you out more?If you went back to an old anti-depressant that you liked, do
you think your current regimine of stabilizers would do a better
job of smoothing things over?Sorry you have been through the wringer. I know you must be
like me and want to just kinda get it over with and
"stick" with something, and move on, right?Usually if I am down, my symptoms are atypical too, I
have no drive, etc. I really loved wellbutrin if it didn't
make me so manic and give me headaches. I'm into these
fringe ideas for mood stabilizers that are in clinical trials
that I think might help me, but I can't talk my pdoc into
them.What do you think about Mitch's augmentation idea?
Maybe good for a quick test before switching AD's
altogether.Also, I'd contemplate an MAOI myself, but I live in Texas
and all I eat is tex-mex cheese and i would cheat on the
beer, is the diet all that bad? Eh, probably make
me manic. I loved Adderall, but it drove me kookoo according
to my friends (whom I kept calling all day and night).
What did the stims do to you (keep you calm)?PS, I'd love to swap my hypomanic stories if I didn't
have so many silly and embarrassing episodes.best wishes,
John
> I've been on several combinations of mood stabilizers and have just added ADs because I couldn't take it anymore. Be that decision a good one or a bad one.
>
> I think it would be easiest for me to first list all of my recent cocktails:
>
> lamictal
> lamictal + depakote
> depakote + geodon
> depakote + geodon + gabatril
> depakote + trileptal + geodon
> depakote + trileptal
> trileptal + geodon
> trileptal + seroquel
> depakote + trileptal + zyprexa
> depakote + trileptal + zyprexa + neurontin
> depakote + trileptal + zyprexa + neurontin + (ritalin, dexedrine, aricept)
> depakote + trileptal + zyprexa + lithium
> depakote + trileptal + zyprexa + neurontin + zoloft
>
> I've also been on nearly all of these with Klonopin. Lamictal gave me horrible memory problems, and made me more emotional -- neurontin has this same effect on my emotions. Lithium makes me depressed and fast! I suppose wellbutrin has been the least rocky AD, but it makes me extremely irritable and probably the worst headache I've ever had. I wouldn't mind the highs of the ADs except I'm irritable along with the "high" and it never lasts.
>
> Jon
>
> >
> > Hi JonW,
> >
> >
> > What mood stabilizers have you tried besides Depakote?
> >
> > Have you been able to get onto an anti-depressant without
> > getting such a wild manic response?
> >
> > Has your pdoc talked about taking more
> > mood stabilizers like lithium, lamictal, more depakote?
> >
> > My pdoc's opinion is that most bipolars should be treated
> > with more mood stabilizers and as few ads as possible.
> >
> > Has your physician ever started you solely on a mood stabilizer,
> > before adding on ADs?
> >
> > I'm just wondering what the strategy is to avoid the pattern of
> > cycling. I had the same snag, and Lamictal was the only medicine
> > that helped me without causing a big cycle (Lamictal of the
> > mood stabilizers has a good anti-depressant action). Lithium
> > is good at snaggig the bad mania.
> >
> > Even now that I have good Lamictal and Topamax
> > some Serzone dosing makes me hypomanic. I might add
> > some Lithium soon.
> >
> > sorry for all the questions.
> >
> > best wishes,
> >
> > -John
> >
> > > Hi Elizabeth,
> > >
> > > Thanks for the informative post! I've read other post of yours and have found them useful as well.
> > >
> > > As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
> > >
> > > What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
> > >
> > > Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
> > >
> > > Thanks,
> > > Jon
> > >
> > >
> > >
> > > > Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
> > > >
> > > > Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
> > > >
> > > > I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
> > > >
> > > > MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
> > > >
> > > > MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
> > > >
> > > > Just some opinions, for whatever they're worth.
> > > >
> > > > -elizabeth
Posted by JohnX2 on March 9, 2002, at 23:19:17
In reply to Re: Nardil » JohnX2, posted by JonW on March 9, 2002, at 22:11:00
Hi Jon,I haven't taken lithium, but I've been
contemplating it, and it seems as though a number
of people here take a "pinch" of lithium to
augment an antidepressant.What dosing of lithium did you take?
I see there was no AD on that one.-John
> I've been on several combinations of mood stabilizers and have just added ADs because I couldn't take it anymore. Be that decision a good one or a bad one.
>
> I think it would be easiest for me to first list all of my recent cocktails:
>
> lamictal
> lamictal + depakote
> depakote + geodon
> depakote + geodon + gabatril
> depakote + trileptal + geodon
> depakote + trileptal
> trileptal + geodon
> trileptal + seroquel
> depakote + trileptal + zyprexa
> depakote + trileptal + zyprexa + neurontin
> depakote + trileptal + zyprexa + neurontin + (ritalin, dexedrine, aricept)
> depakote + trileptal + zyprexa + lithium
> depakote + trileptal + zyprexa + neurontin + zoloft
>
> I've also been on nearly all of these with Klonopin. Lamictal gave me horrible memory problems, and made me more emotional -- neurontin has this same effect on my emotions. Lithium makes me depressed and fast! I suppose wellbutrin has been the least rocky AD, but it makes me extremely irritable and probably the worst headache I've ever had. I wouldn't mind the highs of the ADs except I'm irritable along with the "high" and it never lasts.
>
> Jon
>
> >
> > Hi JonW,
> >
> >
> > What mood stabilizers have you tried besides Depakote?
> >
> > Have you been able to get onto an anti-depressant without
> > getting such a wild manic response?
> >
> > Has your pdoc talked about taking more
> > mood stabilizers like lithium, lamictal, more depakote?
> >
> > My pdoc's opinion is that most bipolars should be treated
> > with more mood stabilizers and as few ads as possible.
> >
> > Has your physician ever started you solely on a mood stabilizer,
> > before adding on ADs?
> >
> > I'm just wondering what the strategy is to avoid the pattern of
> > cycling. I had the same snag, and Lamictal was the only medicine
> > that helped me without causing a big cycle (Lamictal of the
> > mood stabilizers has a good anti-depressant action). Lithium
> > is good at snaggig the bad mania.
> >
> > Even now that I have good Lamictal and Topamax
> > some Serzone dosing makes me hypomanic. I might add
> > some Lithium soon.
> >
> > sorry for all the questions.
> >
> > best wishes,
> >
> > -John
> >
> > > Hi Elizabeth,
> > >
> > > Thanks for the informative post! I've read other post of yours and have found them useful as well.
> > >
> > > As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
> > >
> > > What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
> > >
> > > Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
> > >
> > > Thanks,
> > > Jon
> > >
> > >
> > >
> > > > Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
> > > >
> > > > Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
> > > >
> > > > I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
> > > >
> > > > MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
> > > >
> > > > MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
> > > >
> > > > Just some opinions, for whatever they're worth.
> > > >
> > > > -elizabeth
Posted by JohnX2 on March 10, 2002, at 1:30:48
In reply to Re: Nardil » JohnX2, posted by JonW on March 9, 2002, at 22:11:00
Hi Jon,(sorry I keep posting, that's what us hypomanics do).
When I first met my latest pdoc, he introduced me to this new
concept for bipolar of not using any ADs. I always used to believe
that most people used a mood stabilizer + an AD. But I've
learned since then that there is a pretty big division of school
of thought.So when I was mildly depressed and seeing my pdoc I was really
pissed that he wouldn't add an AD and I thought he
was such an anti-hypomanite. His feeling was that he needed to
wipe out every sympom of hypomania, see where I was then (hopefully
the depression would be gone), and if things were still in a low,
then we would "sneak an anti-depressant into the back door".
My doctors main concern is giving an AD would cause one to
cycle back into severe depression. He felt for me that if
my mixed symptoms would go away the chances of an AD destabilizing
me would be low.It seems like your pdoc is in the same school and maybe was
really scared that an AD would make you really depressed.
Anyways I'm actually shocked to see so many different med
combos of mood stabilizers. Were you exhibiting symptoms
of hypomania that your doctor was concerned about as you went
through all these trials?I certainly see your frustration. As you dose in an anti-depressant
you want to be stabilized enough so that the AD doesn't cycle
you back into dispair (well, you already know this). But you are
just testing the AD add-ons after a long run of mood
stabilizers......I was major depression symptom free for about 1 year on Lamictal but
still a bit low at times and wanted to test anti-depressants, but
my psychiatrist pushed back as I still had mixed hypomanic symptoms
like agitation. When I quit the klonopin I went severly manic and
this had bad conequences at my job (I almost got fired) and I
crashed into 2 major depressions (what an aweful feeling to go
back into that state). So I understand what my doctor was concerned
about.What are you thinking?
take care,
John
> I've been on several combinations of mood stabilizers and have just added ADs because I couldn't take it anymore. Be that decision a good one or a bad one.
>
> I think it would be easiest for me to first list all of my recent cocktails:
>
> lamictal
> lamictal + depakote
> depakote + geodon
> depakote + geodon + gabatril
> depakote + trileptal + geodon
> depakote + trileptal
> trileptal + geodon
> trileptal + seroquel
> depakote + trileptal + zyprexa
> depakote + trileptal + zyprexa + neurontin
> depakote + trileptal + zyprexa + neurontin + (ritalin, dexedrine, aricept)
> depakote + trileptal + zyprexa + lithium
> depakote + trileptal + zyprexa + neurontin + zoloft
>
> I've also been on nearly all of these with Klonopin. Lamictal gave me horrible memory problems, and made me more emotional -- neurontin has this same effect on my emotions. Lithium makes me depressed and fast! I suppose wellbutrin has been the least rocky AD, but it makes me extremely irritable and probably the worst headache I've ever had. I wouldn't mind the highs of the ADs except I'm irritable along with the "high" and it never lasts.
>
> Jon
>
> >
> > Hi JonW,
> >
> >
> > What mood stabilizers have you tried besides Depakote?
> >
> > Have you been able to get onto an anti-depressant without
> > getting such a wild manic response?
> >
> > Has your pdoc talked about taking more
> > mood stabilizers like lithium, lamictal, more depakote?
> >
> > My pdoc's opinion is that most bipolars should be treated
> > with more mood stabilizers and as few ads as possible.
> >
> > Has your physician ever started you solely on a mood stabilizer,
> > before adding on ADs?
> >
> > I'm just wondering what the strategy is to avoid the pattern of
> > cycling. I had the same snag, and Lamictal was the only medicine
> > that helped me without causing a big cycle (Lamictal of the
> > mood stabilizers has a good anti-depressant action). Lithium
> > is good at snaggig the bad mania.
> >
> > Even now that I have good Lamictal and Topamax
> > some Serzone dosing makes me hypomanic. I might add
> > some Lithium soon.
> >
> > sorry for all the questions.
> >
> > best wishes,
> >
> > -John
> >
> > > Hi Elizabeth,
> > >
> > > Thanks for the informative post! I've read other post of yours and have found them useful as well.
> > >
> > > As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
> > >
> > > What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
> > >
> > > Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
> > >
> > > Thanks,
> > > Jon
> > >
> > >
> > >
> > > > Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
> > > >
> > > > Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
> > > >
> > > > I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
> > > >
> > > > MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
> > > >
> > > > MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
> > > >
> > > > Just some opinions, for whatever they're worth.
> > > >
> > > > -elizabeth
Posted by JohnX2 on March 10, 2002, at 2:34:49
In reply to Re: Nardil » JonW, posted by Elizabeth on March 9, 2002, at 15:40:18
>I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.Hi Elizabeth,
I had the opposite thing happen to me.
My 1st psychiatrist gave me 4 anti depressants.
2 of them didn't work. 2 of them made me manic
and pooped out. One of them made me nearly psychotic(wellbutrin).
I made it clear to the psychiatrist what happened.I also described to the physician symptoms similar to ADD.
Inability to sit still, addiction to caffeine, like to drive
car fast, like loud music, etc.He gives me an ADD test:
-asks me to name months backwards ( which I do).
-lists some fruits, changes subjects, comes back to the fruits.
I tell him what fruits he mentions.He asks me about my schooling. I was an honor roll student
all my life.I walk out of his office with Adderall. I do manic
things on Adderall that ruin my life, I won't list them
here.3 doctors later I am diagnosed with bipolar disorder.
1 other doctor thinks I should be prescribed Adderall also.
Do you think my case is atypical?
Thanks for your insight.
-John
Posted by JohnX2 on March 10, 2002, at 4:02:31
In reply to Re: add vs. bipolar » Elizabeth, posted by JohnX2 on March 10, 2002, at 2:34:49
Hi Elizabeth,
Sorry I'm ranting (feel like Dennis Miller tonight)...
Here's what's funny, I always get the atypical experience.
My 1st pdoc hated meds (atypical) and was huge into therapy.
So when I was in group therapy he complained sarcastically
"everyone is bipolar these days".
(complaining about his philosophy about bipolar
overdiagnosis).I felt bad when I left his practice knowing
that people's lifes were in his hands. He wouldn't
even precribe a benzo to a girl who kept complaining
of panic attacks and was becoming agorophobic.Later found out he was notorious for under dx'ing
bipolar.I did read your post by Blue Cheer and agree with your
thoughts. I had some other good thoughts (ok,rants) about
good pdocs, mostly my thoughts about getting a good
starting dx and how important it is
to take the right class of medicines and *continually* look
at the trends of medicine responses and to be
flexible on changing the dx/classes of medicines.
Maybe you bumped into those posts and gasped. ;)Best wishes. Hope you are feeling better.
-John
>
> >I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
>
> Hi Elizabeth,
>
> I had the opposite thing happen to me.
>
> My 1st psychiatrist gave me 4 anti depressants.
> 2 of them didn't work. 2 of them made me manic
> and pooped out. One of them made me nearly psychotic(wellbutrin).
> I made it clear to the psychiatrist what happened.
>
> I also described to the physician symptoms similar to ADD.
> Inability to sit still, addiction to caffeine, like to drive
> car fast, like loud music, etc.
>
> He gives me an ADD test:
> -asks me to name months backwards ( which I do).
> -lists some fruits, changes subjects, comes back to the fruits.
> I tell him what fruits he mentions.
>
> He asks me about my schooling. I was an honor roll student
> all my life.
>
> I walk out of his office with Adderall. I do manic
> things on Adderall that ruin my life, I won't list them
> here.
>
> 3 doctors later I am diagnosed with bipolar disorder.
>
> 1 other doctor thinks I should be prescribed Adderall also.
>
> Do you think my case is atypical?
>
> Thanks for your insight.
>
> -John
Posted by JonW on March 10, 2002, at 10:44:47
In reply to Re: Nardil » JonW, posted by JohnX2 on March 9, 2002, at 23:09:01
Hi John,
Thanks for your reply. Well, I've had a somewhat positive experience with Klonopin as well. I would get into this agitated skin crawling somewhat mixed states, and one Klono (.5) is all it would take to calm the seas. It really is an amazing drug. For awhile, I was taking it as part of my cocktail. Unfortunately, it was making me even more depressed and Dr. Ivan Goldberg pointed out that it often makes difficult to treat people even more difficult to treat. So I dropped it for Neurontin, which I think was a good decision.
Does Lamictal at 150mg give you any memory problems? I would be in a conversation with someone thinking about what I was going to say in response to what they were saying and then when it was my turn to speak I would have no idea what I wanted to say. I felt like such an idiot! :) And topomax, AKA stupimax, doesn't give you any bad side-effects?
I only take 2.5mg of Zyprexa but it gives me twitches, and if I go to 5mg they are a lot worse. I was thinking of replacing it with Seroquel. Since you said that you still have swings throughout the day, I assume you have ultra rapid or ultradian cycling. I've heard nimodipine mentioned as having a special place for this type of cycling. Have you ever tried nimodipine? I was thinking of asking my psydoc about it.
I'm not sure what AD I've had the best response to because I don't think I've ever really stuck it out long enough with many I've been on. Previously, I felt moclobemide was the best but I'm not sure. Zoloft definitely made me the most hypomanic but this time with time with the mood stabilizers on board I didn't seem to have a hypomanic reaction. However, I get very agitated and irritable at 25mg and have had to drop down to 12.5mg. Lately, it seems to be brightning my mood a bit after I dropped Aricept. Maybe I'm just cycling or I shook things up by dropping Aricept, I don't know. I'm looking for as much chemical help as possible and I'm concerned that Zoloft is going to fool into thinking I'm OK and allow me to get by. That's why I'm interested in Nardil because it might be a more complete solution -- especially, considering my symptoms. Say Nardil is the thing for me, do you think it's possible to accomplish similar results without Nardil? Is there any reason to believe moclobemide would be as good as Nardil? Sorry for the long post, I'm rambling.
Thanks,
Jon> Hi Jon,
>
> Well, can't say you haven't "been there done
> that" with the mood stabilizers! Sorry.
>
> Depakote was a placebo for me.
> Neurontin had an anti-anxiety but no
> mood stabilizer effect.
> Lamictal works at 150 mg, but does nothing
> at any other dose (gives me a headache
> at higher dose).
>
> Unfortunately I took Effexor,Paxil,Wellbutrin,
> and Zoloft, and Serzone before getting a good bipolar diagnosis.
> Of those, Sezone gave me an AD response without
> a mood stabilizer and didn't make me severly
> manic, whereas Zoloft and Wellbutrin made me
> manic.
>
> Lately I was taking this for a few months:
>
> Lamictal 150 mg
> Zyprexa 5-15 mg
> Klonopin 6 mg
> Topamax 400 mg
>
> I was tolerant to Klonopin and I don't know if
> you saw my posts, when I started to dump it I became
> really manic and my pdoc pushed my Zyprexa to 15 mg.
> But the mania was really bad...I spent 300 dollars on
> plumbing tubing trying to build a golf driving range
> in my dining room and I thought there was a conspiracy
> at work to get me fired, etc..ugh.
>
> Anyways I got the Klon. down to 1 mg and the bad
> mania went away and I subsequently stopped Zyprexa (which
> I generally liked) due to some twitching.
> I added Serzone to help with some headaches,
> and frankly it has really helped my mood. But now I
> am a bit cylothymic again. I go through intraday swings.
> Its better than without the Serzone. I don't know if I
> can really tweak it any more. So for me Serzone is
> about the only AD i can tolerate. It helps without
> causing too much hypomania and it isn't making
> me swing back into depression. So I just found
> this by trial and error (I've only been on it
> a few weeks, but I did ok on it before. Cross my fingers).
> Btw, if you dose Serzone up very slowly it is
> excellent for anxiety and sleep.
>
> Some people think you ultimately gotta deal
> with the little swings. Do you feel the atypical anti-psychotics
> have helped you out more?
>
> If you went back to an old anti-depressant that you liked, do
> you think your current regimine of stabilizers would do a better
> job of smoothing things over?
>
> Sorry you have been through the wringer. I know you must be
> like me and want to just kinda get it over with and
> "stick" with something, and move on, right?
>
> Usually if I am down, my symptoms are atypical too, I
> have no drive, etc. I really loved wellbutrin if it didn't
> make me so manic and give me headaches. I'm into these
> fringe ideas for mood stabilizers that are in clinical trials
> that I think might help me, but I can't talk my pdoc into
> them.
>
> What do you think about Mitch's augmentation idea?
> Maybe good for a quick test before switching AD's
> altogether.
>
> Also, I'd contemplate an MAOI myself, but I live in Texas
> and all I eat is tex-mex cheese and i would cheat on the
> beer, is the diet all that bad? Eh, probably make
> me manic. I loved Adderall, but it drove me kookoo according
> to my friends (whom I kept calling all day and night).
> What did the stims do to you (keep you calm)?
>
> PS, I'd love to swap my hypomanic stories if I didn't
> have so many silly and embarrassing episodes.
>
> best wishes,
> John
Posted by JonW on March 10, 2002, at 15:31:11
In reply to Re: anti-hypomanites?, posted by JohnX2 on March 10, 2002, at 1:30:48
Hi John,
When I took lithium I was on depakote + trileptal + neurontin + zyprexa, but no AD. I also took it a year or so back and had the same reaction -- horrible depression within a couple of hours.
I agree with the idea of first trying to avoid all destabilizing agents (which obviously includes anti-depressants). Unfortunately, it seems like that is not going to be an option for me which makes things a lot more complicated. I couldn't be more satisified with my psydoc, but I think I might benefit from getting a second opinion from someone who is bit more specialized.
It's ashame how many people see second rate psydocs for their mental health problems. The difference between a top doctor and a run of the mill doctor is the difference between life and death -- figuratively and literally. OK, rant over. :)
Well, I'm glad things are considerably better for you than they have been, and hopefully we'll both find the right combo of drugs someday.
Jon
Posted by JohnX2 on March 10, 2002, at 17:06:57
In reply to Re: Nardil » JohnX2, posted by JonW on March 10, 2002, at 10:44:47
Hi Jon,Are you typing on a mac or pc? I type in this teeny box in a pc on Netscape, it is really
annoying me! I have to scroll a bar at the bottom to read a post as I type it!
(I design computer chips btw, you'd think i could figure out how to set up my browser, duh).Anyways, it seems you are a bit like Mitch and quite sensitive to the lower dose of the
medicines, especially the anti-depressants. He would be a really good person to talk to
about anti-depressant add on strategies to avoid cycling/irritation. I usually do OK in the
therapeutic dosing range, i.e. I feel no perceptable benefit/change until I bump the dose of
the anti-depressant up to the normal range, and then all hell breaks loose (except Serzone!);).> Thanks for your reply. Well, I've had a somewhat positive experience with Klonopin as well. I would get into this agitated skin crawling somewhat mixed states, and one Klono (.5) is all it would take to calm the seas. It really is an amazing drug. For awhile, I was taking it as part of my cocktail. Unfortunately, it was making me even more depressed and Dr. Ivan Goldberg pointed out that it often makes difficult to treat people even more difficult to treat. So I dropped it for Neurontin, which I think was a good decision.
>Klonopin is a bit of a depressant, even for me. When I took it by itself, it did have a tendency to make
me depressed. I was OK when I used it in conjunction with other medicines. But you are not alone, a lot of
people complain about the medicine being a little bit depressing and do well switching to Neurontin. I really
likes Neurontin, except for the 3x a day dosing. But at this point, if I feel good, I don't give a rat's ass if
I have to do hand-stands every 1/2 hour to achieve it!> Does Lamictal at 150mg give you any memory problems? I would be in a conversation with someone thinking about what I was going to say in response to what they were saying and then when it was my turn to speak I would have no idea what I wanted to say. I felt like such an idiot! :) And topomax, AKA stupimax, doesn't give you any bad side-effects?
Well when I started Lamictal I bumped the dose really slowly. As I bumped the dose the medication made
my speech slurred and my thoughts were really foggy. But this usually wore of after 2 or 3 days if I stayed
at the same dose and I didn't change any other medicines either. Were you having memory problems after staying
at a solid dose for a while? I've seen fewer brain fog posts on Lamictal than the other anti-convulsants, but
as you know every one is different. Neurontin caused less brain fog, but it was more persistent and never let up for me.
Topamax has a bad reputation for brain fog. Me, NONE. Some people do just fine. A lot of time I think medicines
pick up really bad reputations on the internet. I pushed that medicine to the max in 2 weeks with no
cognitive impairment. Its very similar to Klonopin, but less sedating.>
> I only take 2.5mg of Zyprexa but it gives me twitches, and if I go to 5mg they are a lot worse. I was thinking of replacing it with Seroquel. Since you said that you still have swings throughout the day, I assume you have ultra rapid or ultradian cycling. I've heard nimodipine mentioned as having a special place for this type of cycling. Have you ever tried nimodipine? I was thinking of asking my psydoc about it.I took Zyprexa between 5-15 mg. It helped my anxiety from klonopin tolerance and sleep. If you think the Zyprexa is causing twitching
(which wasn't there before), please discuss this with your doctor. I'm really not sure how much nimodipine is being used if any
for psychiatric illness. I looked a bit at some research on that for treatment refractory depression, but the widespread
use has not been adopted (your doctor probably will not have heard about its use, its really a research concept).>
> I'm not sure what AD I've had the best response to because I don't think I've ever really stuck it out long enough with many I've been on. Previously, I felt moclobemide was the best but I'm not sure. Zoloft definitely made me the most hypomanic but this time with time with the mood stabilizers on board I didn't seem to have a hypomanic reaction. However, I get very agitated and irritable at 25mg and have had to drop down to 12.5mg. Lately, it seems to be brightning my mood a bit after I dropped Aricept. Maybe I'm just cycling or I shook things up by dropping Aricept, I don't know. I'm looking for as much chemical help as possible and I'm concerned that Zoloft is going to fool into thinking I'm OK and allow me to get by. That's why I'm interested in Nardil because it might be a more complete solution -- especially, considering my symptoms. Say Nardil is the thing for me, do you think it's possible to accomplish similar results without Nardil? Is there any reason to believe moclobemide would be as good as Nardil? Sorry for the long post, I'm rambling.Don't worry about rambling! This newsgroup is called "Psycho-BABBLE",
not "Pscho-Cliffs-Notes".Let me ramble, if you will:
I guess I would be concerned about really getting you up and running, you
mentioned you have been hospitalized twice. Do you feel that your mood stabilizers
can hold you up enough to swap in and out anti-depressants?Frankly, moclobemide doesn't have the best good track record, but you are really
sensitive to meds, so I wouldn't want to predict a response. Nardil, as Elizabith noted,
is reallt good for social phobia and atypical depression symptoms.
You also indicated success on Parnate. Nardil is like Parnate, just less likely
to be irritating (general trend). You seem to be really sensitive to ADs so
I'm not a good person to comment on predicting how you would do, Mitch is someone
who takes really low doses of ADs. The dose of Zoloft you are taking is very low.
One thing you may try, this is just a thought given how sensitive you are to
anti-depressants, is just a *dash* of deprnyl (Selegiline), say 5-10 mg.
This is low enough not to require the dietary restriction, and may be all
you need. (God help me, If some people read that last sentence there may
be some real back lash). This may do well with the atypical depression
in a manner similar to Parnate (not sure how your mood stabilizers
would react anxiety wise). Ask your pdoc. (Others reading this
can comment. Please don't flame me, thanks)Hey, can you let us know which AD's you've taken with and without
the mood stabilizers and at what doses? What happened exactly?
What kind of hypo(manic) symptoms occured? Have you had good conversations
with your doctor about hypomania, etc?
I can fill you in if you are interested
in my experiences.I noticed you talked about having social phobia,
but also being maybe passive aggressive towards
authority at times.Also you mentioned that Parnate made you really "well" in 2 days and you "Aced"
an interview but verbally assaulted someone.I'm curious, how would you consider doing well on
an interview as being symptomatic as bipolar?Also, in what sense was there a "verbal assault"?
Were you hyper and being out of line. Or was this
just a situation where someone said something
wrong to you, and maybe you were sticking up for
yourself? Did this happen during an interview?Also, are you a caffeine addict? And do you find
that driving your car really fast and blasting
music gets you going? (When I'm really manic I
like to drive my car 100 mph down
the interstate and maybe pop in a Peter Gabriel
CD into my Bose system and play the song
"Big Time". Good song about megalogmania!).What really has been incapacitating you over
the past six months?Have you ever been in a situation where you
were quite, but maybe you felt a bit anxious and
your adrenaline started to run, and all of a sudden
you had a burst of energy, your thoughts really
started to run and you had no problems socializing
with people for a short stint (you were unusually
confident for a bit)?What are your favorite educational disciplines?
(math/science/english/history). I hate anything
that is not absolute. I really hated taking
classes that required me to write essays. I was
petrified to even sit down and write a sentence.
My brain would freeze up because every sentence
had to be perfect. I couldn't stand the fact
that my work would be subjectively questioned
by someone else and maybe rejected. So I shuned
history/english/etc and stuck with math/science,etc
where the answer is usually true or false.Sorry to ask so many questions. I'm trying to
see if i can relate your experience to my own.best wishes,
John>
> Thanks,
> Jon
>
>
>
> > Hi Jon,
> >
> > Well, can't say you haven't "been there done
> > that" with the mood stabilizers! Sorry.
> >
> > Depakote was a placebo for me.
> > Neurontin had an anti-anxiety but no
> > mood stabilizer effect.
> > Lamictal works at 150 mg, but does nothing
> > at any other dose (gives me a headache
> > at higher dose).
> >
> > Unfortunately I took Effexor,Paxil,Wellbutrin,
> > and Zoloft, and Serzone before getting a good bipolar diagnosis.
> > Of those, Sezone gave me an AD response without
> > a mood stabilizer and didn't make me severly
> > manic, whereas Zoloft and Wellbutrin made me
> > manic.
> >
> > Lately I was taking this for a few months:
> >
> > Lamictal 150 mg
> > Zyprexa 5-15 mg
> > Klonopin 6 mg
> > Topamax 400 mg
> >
> > I was tolerant to Klonopin and I don't know if
> > you saw my posts, when I started to dump it I became
> > really manic and my pdoc pushed my Zyprexa to 15 mg.
> > But the mania was really bad...I spent 300 dollars on
> > plumbing tubing trying to build a golf driving range
> > in my dining room and I thought there was a conspiracy
> > at work to get me fired, etc..ugh.
> >
> > Anyways I got the Klon. down to 1 mg and the bad
> > mania went away and I subsequently stopped Zyprexa (which
> > I generally liked) due to some twitching.
> > I added Serzone to help with some headaches,
> > and frankly it has really helped my mood. But now I
> > am a bit cylothymic again. I go through intraday swings.
> > Its better than without the Serzone. I don't know if I
> > can really tweak it any more. So for me Serzone is
> > about the only AD i can tolerate. It helps without
> > causing too much hypomania and it isn't making
> > me swing back into depression. So I just found
> > this by trial and error (I've only been on it
> > a few weeks, but I did ok on it before. Cross my fingers).
> > Btw, if you dose Serzone up very slowly it is
> > excellent for anxiety and sleep.
> >
> > Some people think you ultimately gotta deal
> > with the little swings. Do you feel the atypical anti-psychotics
> > have helped you out more?
> >
> > If you went back to an old anti-depressant that you liked, do
> > you think your current regimine of stabilizers would do a better
> > job of smoothing things over?
> >
> > Sorry you have been through the wringer. I know you must be
> > like me and want to just kinda get it over with and
> > "stick" with something, and move on, right?
> >
> > Usually if I am down, my symptoms are atypical too, I
> > have no drive, etc. I really loved wellbutrin if it didn't
> > make me so manic and give me headaches. I'm into these
> > fringe ideas for mood stabilizers that are in clinical trials
> > that I think might help me, but I can't talk my pdoc into
> > them.
> >
> > What do you think about Mitch's augmentation idea?
> > Maybe good for a quick test before switching AD's
> > altogether.
> >
> > Also, I'd contemplate an MAOI myself, but I live in Texas
> > and all I eat is tex-mex cheese and i would cheat on the
> > beer, is the diet all that bad? Eh, probably make
> > me manic. I loved Adderall, but it drove me kookoo according
> > to my friends (whom I kept calling all day and night).
> > What did the stims do to you (keep you calm)?
> >
> > PS, I'd love to swap my hypomanic stories if I didn't
> > have so many silly and embarrassing episodes.
> >
> > best wishes,
> > John
Posted by Seamus2 on March 10, 2002, at 23:42:13
In reply to Johnx2, others -- Nardil Question, etc., posted by JonW on March 8, 2002, at 15:10:01
From reading your initial post "Johnx2, others -- Nardil Question, etc." I'd say try Parnate instead.
Will follow up after reading replies.
Posted by Seamus2 on March 10, 2002, at 23:51:24
In reply to Re: Nardil » JonW, posted by Elizabeth on March 9, 2002, at 15:40:18
My initial recommendation for Parnate was the activity it seems to exert against the ADD; with which Elizabeth's commentary would concur.
Posted by Seamus2 on March 10, 2002, at 23:54:25
In reply to Re: Nardil » Elizabeth, posted by JonW on March 9, 2002, at 16:38:16
>>Parnate (I only took it for 2 days) in particular made me sooo high and overconfident... <<
Can you recall how many of those little red pills you took each day?
Posted by Seamus2 on March 10, 2002, at 23:57:50
In reply to Re: Nardil » JohnX2, posted by JonW on March 10, 2002, at 10:44:47
>>I'm rambling.<<
Yes, you are.
Have you ever eliminated caffeine completely?
Posted by JonW on March 11, 2002, at 14:12:33
In reply to Re: Nardil, posted by Seamus2 on March 10, 2002, at 23:54:25
> >>Parnate (I only took it for 2 days) in particular made me sooo high and overconfident... <<
>
> Can you recall how many of those little red pills you took each day?I took 2 pills. Maybe the overconfidence was self-confidence, how would I know? :) The real problem was the agitation and irritability. It felt like dexedrine -- incredible at first, but as it's wearing off I become suicidal. It blows my mind how I can experience so much from a single pill in a single day.
Jon
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