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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by HMK on April 17, 2002, at 13:20:07
I'm bipolar taking Effexor XR 75 mg., Geodon 60 mg. twice a day, and Neurontin 400 mg. three times a day. Lately I've been having the worst problems with rapid cycling- 2 days high, 1/2 day normal, then 2 days low.
What have people found in their experience to be the best medication for rapid cycling? I'm thinking Depakote- hate the weight gain but I'm absolutely desperate this time. I'm so tired of the suicidal depressed sleeping all the time then no sleep hyper crazed feelings. Almost had to go to the ER last Friday because I was so suicidal.
Am waiting to hear back from my psychiatrist who lives out of town. Would love some imput from people who have experienced this themselves.
Best wishes,
Heather
Posted by crepuscular on April 17, 2002, at 13:47:38
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
sorry to hear about your situation heather. my shortest cycles were about 2 weeks. seroquel has helped dramatically.
tried it?
Posted by rainbowlight on April 17, 2002, at 17:10:58
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
I am a rapid cycler too, mine can be hourly. Lamictal has evened me out pretty well. I still have a bit of ups and downs, but they don't bother me too much. I hope you find something that works and that you are feeling better soon!
Posted by Katrina on April 17, 2002, at 17:11:07
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
I don't know what helps...I have mixed states and depression. You're not alone.
I am trying lamictal, trileptal and a bit of klonopin. It may be starting to help after one week on a low amount of the trileptal and 4 weeks on lamictal.
Posted by JohnX2 on April 18, 2002, at 1:12:08
In reply to Re: Rapid cycling help needed!!, posted by Katrina on April 17, 2002, at 17:11:07
> I don't know what helps...I have mixed states and depression. You're not alone.
> I am trying lamictal, trileptal and a bit of klonopin. It may be starting to help after one week on a low amount of the trileptal and 4 weeks on lamictal.Ditto. Sounds like a good game plan if you want to avoid Depakote.
John
Posted by HMK on April 18, 2002, at 7:58:29
In reply to Re: Rapid cycling help needed!!, posted by JohnX2 on April 18, 2002, at 1:12:08
I'm desperate enough that I decided to start taking Depakote again. My doctor didn't seem to understand how awful the idea of weight gain is to someone who is already 120 lbs overweight. But I don't seem to have a choice since I've tried everything else. Along with my hypothyroidism, I can't think of any more efficient way to GAIN WEIGHT.
This is just a nightmare. Why won't anyone help me? Now I'm taking so many pills I can't keep track- Effexor, Geodon, Valium, Depakote, Neurontin and I still feel like crap.
Well great now I'm crying here at work again. I wouldn't wish this on anyone. I just want to find a way out.
Heather
Posted by Ritch on April 18, 2002, at 13:34:21
In reply to Re: Rapid cycling help needed!! » JohnX2, posted by HMK on April 18, 2002, at 7:58:29
> I'm desperate enough that I decided to start taking Depakote again. My doctor didn't seem to understand how awful the idea of weight gain is to someone who is already 120 lbs overweight. But I don't seem to have a choice since I've tried everything else. Along with my hypothyroidism, I can't think of any more efficient way to GAIN WEIGHT.
>
> This is just a nightmare. Why won't anyone help me? Now I'm taking so many pills I can't keep track- Effexor, Geodon, Valium, Depakote, Neurontin and I still feel like crap.
>
> Well great now I'm crying here at work again. I wouldn't wish this on anyone. I just want to find a way out.
> Heather
Heather,I hear you. I have had to start taking Depakote again because it is the only thing (except maybe lithium) that will settle my dysphoria down effectively. I ran out a few days ago and WHEW! man what a grouch I could turn into. I am only taking 125mg at bedtime-but it makes a BIG difference. Maybe if you get can your thyroid supplementation cranked up enough (without driving you out of your skin) you may actually *lose* some weight even with the Depakote. I am on multiple meds too. It $costs$ more, too, but I want the best stuff, doesn't everybody? I was thinking to myself the other day what the perfect weight gain combination would be and I come up with high-dose Depakote+Remeron+Zyprexa! Seriously though, Effexor could be agitating you somewhat-you might mention that to your doc.
good luck,
Mitch
Posted by crepuscular on April 18, 2002, at 13:57:23
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
this may seem extreme, but a good series of ECT treatments might really help. it seems like you are on so many drugs that sorting everything out is impossible.
i am so sorry you are feeling so bad - it really sucks. hang in there.
Posted by wendy b. on April 18, 2002, at 14:32:48
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
Dear Heather,
I'm so sorry you have been having such a hard time! Keep posting to this Board, it's a big help to just be able to unload. Have you posted on PsychSocial Babble-land yet? Trying to remember if I've seen your name...
I have BPII, and have had rapid cycling too, but not to the distraction you are having. I am on Neurontin 3000 to 3600 daily, plus Wellbutrin, 350 mg daily. Xanax to help with anxiety when I need it.
Regarding meds, I agree with Ritch (Mitch), I suspect the Effexor is making you go up and down... Many, many people cannot tolerate the drug well, just look at the number of people who've discussed it on this board, and who've found it difficult to take. Getting off is hell (I did it about a year ago), but it is possible to titrate down veeerrrrry slowly. Luckily tapering down isn't hard with Effexor, you can just mix the little beady-things in the capsule into morning orange juice and swallow it that way. So you can really control how slowly you taper down. But anyway, I'd suggest it to your pdoc and see what s/he says. There are a lot of other antidepressants out there that you could try...
Also, what do you think about taking some time off from work? Do you have any sick leave due to you? Until you figure out the meds, anyway? I think it would help, if it's a possibility... although I know many places of employment do not offer it in their benefits packages, & some don't even have such packages at all. (\sigh/)
But being away from the stresses and hassles of your job, for a while, is very helpful, I know because I did that, too.hope you get well soon, & a big hug,
Wendy> I'm bipolar taking Effexor XR 75 mg., Geodon 60 mg. twice a day, and Neurontin 400 mg. three times a day. Lately I've been having the worst problems with rapid cycling- 2 days high, 1/2 day normal, then 2 days low.
>
> What have people found in their experience to be the best medication for rapid cycling? I'm thinking Depakote- hate the weight gain but I'm absolutely desperate this time. I'm so tired of the suicidal depressed sleeping all the time then no sleep hyper crazed feelings. Almost had to go to the ER last Friday because I was so suicidal.
>
> Am waiting to hear back from my psychiatrist who lives out of town. Would love some imput from people who have experienced this themselves.
>
> Best wishes,
> Heather
Posted by judy1 on April 18, 2002, at 18:48:44
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
Hi!
I agree with everyone here, dump the effexor. I've seen a couple of the top bp pdocs and they both said ADs were really bad for rapid cyclers and both were in love with lamictal- well maybe love is a little strong :-) Take care and welcome to the world of rapid cycling (as long as you get good highs)- Judy
Posted by Morgana on April 18, 2002, at 21:35:55
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
Hi Heather,
I'm BPII and a *very* rapid cycler. They actually have a word for the extreme rapid cycling. Ultridian. Isn't it nice to have a special name?
I take Lamictal for the rapid cycling and it works wonderfully! Better than Depakote did.
I have found that too much AD causes cycling. I still have to take an AD because I am definitely a depressive BP, but I don't take high dosages. From what I have observed here and in my support group, Effexor is a very stimulating AD. Perhaps a lower dose, or less stimulating AD?
I also took Neurontin at one point and it didn't seem to do anything for the cycling, at all! Lamictal has really been a lifesaver.
I hope you find the right combination,
Morgana, BPII – Nardil, Lamictal & Verapamil
Posted by fiona on April 20, 2002, at 11:13:08
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
Hi Heather,
I know what it's like, sucks huh? I have cyclothymia and my cycles are a complete nightmare they are usually around 2-3 days of high 3-4 days low and then I'm lucky if I get 1 normal day in between.
I am currently on tegretol 400mg per day and also an A/D called Dothiepin 75mg per day. This seems to have evened me out slightly, but there is a drawback in that I sometimes get an attack of the fuzzies and people think I've suddenly turned stupid! I have also gained a few pounds since I went on the tegretol which isn't so good.
My sister who is bipolar 1 and a very rapid cycler (is that a word? nevermind) has also been put on tegretol. She was on depakote, which worked very well for her, and it didn't affect her weight, but she had to change because of her liver function tests. I don't think that it is automatic that depakote makes you gain weight, I think it all depends on the dosage etc.
For me the tegretol is doing ok (I haven't felt suicidal since I have been on it!) and although I said I gained some weight it was only 5 or 6 pounds.
I hope you find the right combination for you soon, take care,Fiona
Posted by omega man on May 4, 2002, at 13:06:17
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
i had rapid cycle last year every day...crying in morning running round at night....I had to be hospitalized..stabilized...
Really its the best thing...they give bland diet...quiet ward...no life stimulus...
what else is there ?
Posted by Zo on May 5, 2002, at 15:49:37
In reply to Re: Rapid cycling help needed!! » HMK, posted by Morgana on April 18, 2002, at 21:35:55
Lamictal has saved my life too. Rapid--pretty much daily--cycling into an agitated/hypomanic state at end of day, BPII, a misunderstood illness. .. went for a long time without diagnosis. You don't have to get euphoric--angry mental energy will do!Zo
Posted by JohnX2 on May 5, 2002, at 18:15:53
In reply to Re: Rapid cycling help needed!! » Morgana, posted by Zo on May 5, 2002, at 15:49:37
>
> Lamictal has saved my life too. Rapid--pretty much daily--cycling into an agitated/hypomanic state at end of day, BPII, a misunderstood illness. .. went for a long time without diagnosis. You don't have to get euphoric--angry mental energy will do!
>
> ZoZo,
I have the same intra-day cycle. I find if I bump my Lamictal
dose it goes away at the cost of a blistering headache and apathy.
Strange.John
Posted by HMK on May 6, 2002, at 11:21:41
In reply to Re: Rapid cycling help needed!! » HMK, posted by Ritch on April 18, 2002, at 13:34:21
Hello, all! I ended up going to the Mayo Clinic and seeing a psychiatrist there who recommended that I return to my old standby Risperdal. Within 2 days of returning to the Risperdal (versus the Geodon which I had started to take instead), my rapid cycling ended. I now take 500 mg. Depakote, 75 Effexor, and 3 mg. Risperdal and feel pretty good.
It was so funny- yesterday riding in the car with my friend I turned to her with a shocked look on my face and said, "Oh my gosh- I think I'm happy."
What a shocker.Best wishes,
Heather
Posted by Morgana on May 7, 2002, at 8:31:58
In reply to Re: Rapid cycling help needed!! » Morgana, posted by Zo on May 5, 2002, at 15:49:37
Zo,
It took a long time for me to be diagnosed as well. It's pretty sad actually, because I have known what manic-depression is my whole life. My father is a psychotherapist, and while he believed in therapy only, I was there when he went through college and talked about all the forms of 'mental illness'.
But based on the description of mania, I knew I didn't go 'typically' manic. I didn't find out what hypomania was until 2 years ago. Then it all made perfect sense. It was such a relief. I knew that my depression was more complicated and I didn't find any success with antidepressants. They would kick me into hypomania (what I thought was normal - finally!) and I would work and clean furiously and talk everyone's ear off. Then of course I would crash. Back to the doctor "The AD isn't working". Over and over again.
Being properly diagnosed and treated has truly saved my life. Fortunately for me I am a responder to meds - I just needed the right kind.
I'm glad Lamictal worked for you. I am always cheered when I hear that meds are working for someone. I have this deep fear that one day the meds will just stop working and life will be... So, it helps ease that fear to hear the meds work, especially when they work for long periods of time.
Take care of yourself,
Morgana, BPII - Nardil, Lamictal & Verapamil
Posted by Morgana on May 7, 2002, at 8:38:55
In reply to Re: Rapid cycling help needed!! » Zo, posted by JohnX2 on May 5, 2002, at 18:15:53
John,
Part of the reason I take Lamictal is as a migraine preventative. I hadn't heard that Lamictal can cause headaches...that doesn't sound very helpful. :( I still have way, way too many headaches, even though my migraines are better (thanks to Nardil!).
Do you know what kind of interaction causes the headache? Someone mentioned an interaction with Tyrosine...? I am very, very sensitive to tyramine. My diet is more restrictive than the MAOI diet. It gets really really old. If the Lamictal is contributing in some way...sigh.
Any info you have would be great,
Morgana, BPII - Nardil, Lamictal & Verapamil
Posted by Zo on May 8, 2002, at 1:15:27
In reply to Rapid cycling help needed!!, posted by HMK on April 17, 2002, at 13:20:07
Actually, I'm not sure I understand your doses. 75mg of Effexor is hardly worth bothering with. But did it aggravate the RC? That should be apparent. Neither Geodon or Neurontin should cause any cycling at all.
Just a FYI, I'm still on a therapeutic dose of Effexor, 225mg., and also my old standby, 10mg Dexedrine. Is it possible your lows are so low because of so little of any AD? Lamictal doesn't seem to cut depression on it's own, but I'm not the only one whose depression it *ended* when added to basic meds.
I should mention, I added Provigil a few months ago, and my sleep quality is even more improved, my up and down even less. I wish you the very best package of meds! Hope this helps.
Zo
Posted by JohnX2 on May 8, 2002, at 2:20:02
In reply to Re: Rapid cycling help needed!! » JohnX2, posted by Morgana on May 7, 2002, at 8:38:55
> John,
>
> Part of the reason I take Lamictal is as a migraine preventative. I hadn't heard that Lamictal can cause headaches...that doesn't sound very helpful. :( I still have way, way too many headaches, even though my migraines are better (thanks to Nardil!).
>
> Do you know what kind of interaction causes the headache? Someone mentioned an interaction with Tyrosine...? I am very, very sensitive to tyramine. My diet is more restrictive than the MAOI diet. It gets really really old. If the Lamictal is contributing in some way...sigh.
>
> Any info you have would be great,
>
> Morgana, BPII - Nardil, Lamictal & VerapamilLamictal at high doses triggers a tension headache and
jaw tension. I get this on other meds too (mainly serotonin
meds).I don't think that my problem is in any way similar to
a migraine headache. Not at all.A good number of the antiepileptic/mood stabilizers help
migraine (and I suppose as you mentioned this includes Lamictal).I also got headaches from Trileptal (Tegetrol cousin) and
very high doses of Neurontin. But for most people these medicines
are analgesics for headaches/myofacial pain. So what I am experiencing
is unique.I have heard of other people getting Lamictal induced tension
headaches/jaw tension. But usually it dissipates, and I think this
is uncommon in general.Take Care,
John
Posted by Morgana on May 8, 2002, at 20:11:50
In reply to Re: Rapid cycling help needed!! » Morgana, posted by JohnX2 on May 8, 2002, at 2:20:02
Hi John,
Well...unfortunately I suffer from tension headaches as well.
I have slight curvature in my neck, both ways (viewed from the back and from the side).
I grind my teeth and I am a very 'active' sleeper (translation: not very well - certainly not very restful).
I take a prescription anti-inflammatory, meclomin, every morning and a muscle relaxant, soma, every night. My neck and shoulder don't get a break from the tension unless I take the muscle relaxant. It makes all the difference in the world.
But, I still get the tension headaches. My neurologist says to take more anti-inflammatory, but I don't know how effective it is and I hate to take it all the time.
Anytime I take something with seratonin properties it is very stimulating...so I tend to be very active, which can lead to lots of tension. I just sorta figured it was the activity/stress causing the headaches. But if there is some chemical reaction, I'd like to get to it somehow. To be headache free would be a miracle.
I'm sorry you're 'unusual'. I hate it when the doctors tell me that. "You're such an unusual case". Oy.
Take care of yourself,
Morgana, BPII - Nardil, Lamictal & Verapamil
Posted by JohnX2 on May 8, 2002, at 20:54:09
In reply to Re: Rapid cycling help needed!! » JohnX2, posted by Morgana on May 8, 2002, at 20:11:50
> Hi John,
>
> Well...unfortunately I suffer from tension headaches as well.
>
> I have slight curvature in my neck, both ways (viewed from the back and from the side).
>
> I grind my teeth and I am a very 'active' sleeper (translation: not very well - certainly not very restful).
>
> I take a prescription anti-inflammatory, meclomin, every morning and a muscle relaxant, soma, every night. My neck and shoulder don't get a break from the tension unless I take the muscle relaxant. It makes all the difference in the world.
>
> But, I still get the tension headaches. My neurologist says to take more anti-inflammatory, but I don't know how effective it is and I hate to take it all the time.
>
> Anytime I take something with seratonin properties it is very stimulating...so I tend to be very active, which can lead to lots of tension. I just sorta figured it was the activity/stress causing the headaches. But if there is some chemical reaction, I'd like to get to it somehow. To be headache free would be a miracle.
>
> I'm sorry you're 'unusual'. I hate it when the doctors tell me that. "You're such an unusual case". Oy.
>
> Take care of yourself,
>
> Morgana, BPII - Nardil, Lamictal & VerapamilMorgana,
I notice you are taking Nardil.
Do you find that medicine is a good AD to help combat
cycling?John BPII - Serzone, Lamictal, Klonopin
Posted by Morgana on May 8, 2002, at 23:40:05
In reply to Re: Rapid cycling help needed!! » Morgana, posted by JohnX2 on May 8, 2002, at 20:54:09
John,
Nardil is great as an AD and I haven't noticed any cycling. Lots of energy in the day, tired by the end of it. Wake up on my own (so amazing!) and start another good day.
I started out at 15 mg, ramped up to 60, then cut back to 30. I stopped sleeping at 60. 30 seems to be perfect.
There was more of an improvement of social phobia symptoms at 60 though. My hands and feet actually stopped sweating. Something I have lived with since I was born. Now that I've cut back to 30, the sweaty hands and feet are back, but not as bad as it was before. I was very impressed with the way Nardil works on anxiety. Every symptom I had/have was gone. Just gone.
Oh, and I don't have any side effects it seems. I did at the higher dosages, but they went away when I cut back. Even the ones I had were tolerable, except for the not sleeping one.
I saw one of your posts about Lithium (I can't keep up with all the posts...not enough time in the day!) - wondering if it would help the cycling... My fiancé’s experience, being a long time lithium user, is that lithium brings down the mania - hypo or full blown mania. It doesn't do anything to lift the depression though. He was having some swings into depression a few years back so they added Lamictal since it has a lifting effect. It seems to work for him. Of course, he's not a rapid cycler and he's BPI. Still, if lithium brings down mania - that would cut out the up swings, which would help prevent the crashes. Theoretically anyway.
Hope you find the perfect cocktail,
Morgana BPII - Nardil, Lamictal & Verapamil
P.S. What symptoms do you take the Klonopin for? I discovered that having a longer acting muscle relaxant at night really helps my neck/head. It's something we might try...
Posted by vagen on November 20, 2002, at 8:02:09
In reply to Re: Rapid cycling help needed!! » Morgana, posted by JohnX2 on May 8, 2002, at 20:54:09
> > Hi John,
> >
> > Well...unfortunately I suffer from tension headaches as well.
> >
> > I have slight curvature in my neck, both ways (viewed from the back and from the side).
> >
> > I grind my teeth and I am a very 'active' sleeper (translation: not very well - certainly not very restful).
> >
> > I take a prescription anti-inflammatory, meclomin, every morning and a muscle relaxant, soma, every night. My neck and shoulder don't get a break from the tension unless I take the muscle relaxant. It makes all the difference in the world.
> >
> > But, I still get the tension headaches. My neurologist says to take more anti-inflammatory, but I don't know how effective it is and I hate to take it all the time.
> >
> > Anytime I take something with seratonin properties it is very stimulating...so I tend to be very active, which can lead to lots of tension. I just sorta figured it was the activity/stress causing the headaches. But if there is some chemical reaction, I'd like to get to it somehow. To be headache free would be a miracle.
> >
> > I'm sorry you're 'unusual'. I hate it when the doctors tell me that. "You're such an unusual case". Oy.
> >
> > Take care of yourself,
> >
> > Morgana, BPII - Nardil, Lamictal & Verapamil
>
> Morgana,
>
> I notice you are taking Nardil.
> Do you find that medicine is a good AD to help combat
> cycling?
>
> John BPII - Serzone, Lamictal, KlonopinMorgana,
Noticed you are on lamictal, have any odd side effects? How does it mix with your other meds?Thanks
This is the end of the thread.
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