![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by nmk on May 30, 2003, at 9:38:35
In reply to Re: A few more questions Mitch » nmk, posted by Ritch on May 28, 2003, at 22:31:25
Thanks Mitch....I think this is the route I should take since my AD doses are so low and can be tinkered with more easily than messing with the AED's first.
I should have gone to pharmacy school. You are the BEST!!!!
Until the next round of questions,
Nicole:)
Posted by nmk on May 30, 2003, at 9:59:43
In reply to Re: The AD Controversy for BP Patients » nmk, posted by Ron Hill on May 30, 2003, at 2:13:32
> Hi Nicole,
>
> > >
> Perhaps you have already seen this, Nicole, but I'll post it just in case you haven't run across it in your superhighway travels. It is on Dr. Phelps' web site and it discusses the AD controversy for BP patients:
>
> http://www.psycheducation.org/bipolar/controversy.htm
>
> > Has the combo of an ssri/snri with a mood stabilizer worked for you guys or is better to try the mood stabilizer solo?
>
> Over the years I tried almost all of the SSRI/SNRI's as an add-on to a moodstabilizer for treat of the atypical depressive side of my BP II. Unfortunately, each and every time the AD eventually left me in worse shape than I was in without it.
>
> Within hours of taking the first dose, each of the AD's would immediately induce some amount of mild euphoric hypomania (even with the mood stabilizer fully ramped up). This typically lasted a week or so. This hypomanic phase was followed by a week or so of relatively normal mood states. However, shortly thereafter, the AD would begin to adversely affect my dopaminergic pathways and, thereby, cause severe emotional blunting, apathy, anhedonia, anergy, hypersomnia, etc. The resulting AD induced atypical depression was worse than the depression associated with being on just a moodstabilizer.
>
> This put me in a difficult place for several years. I struggled with depression when using just a moodstabilizer, but the situation would become even worse shortly after adding on an AD. Therefore, I turned my attention to supplements for treatment of my depressive side. About 18 months ago, I had good success using 200 mg/day of SAM-e. However, out of the blue after five months of very good results, SAM-e started to induce severe irritability and I pulled the plug on it.
>
> The good news is that, with the help of others on this board, I have found a medication/supplements combo that is currently working incredibly well. I take 600 mg/day of Lithobid for my hypomania, 2.5 mg twice a week of Enada NADH in conjunction with 250 mg/day of TMG to treat the atypical depressive phase of my BP II disorder, and 250 mg/day of niacin to control my dysphoric mood states (irritability). I think the niacin is also helping my depression, but its main function is to control my irritability which it does exceedingly well.
>
> I'll not bore you by listing all of the vitamins, minerals and supplements that I take since they are numerous. However, the ones I mentioned above are the heavy hitters and they are the main contributors to my current good mental health. Magnesium, fish oil, and phosphatidyl serine, are definitely worth honorable mention.
>
> Will it last or will it be like SAM-e and turn against me? My hunch is that this combo will go the distance, but time will tell. If it turns against me, I’ll be back to the drawing board looking for other supplements. But in the meantime, I’m healthy and its time to get after the work that has piled up during my sickness.
>
> My best wishes to you Nicole as you search for a solution to your depressive phase.
>
> -- Ron
>
>Hi Ron,
Thanks so much for your post. Yes, it was Dr. Phelps site and a book by Michael Barto's, M.D. (see link below) that made me question my unresponsiveness to treatment. I have never heard of Enada NADH or TMG in the treatment of depression so I will continue to surf to gather more info. How long has this combo been successful for you? Are you also hypothyroid or is the Lithobid simply a supplement?
Thanks again Ron, I appreciate the information.
Nicole
http://www.amazon.com/exec/obidos/ASIN/0595122094/drbobsvirte00-20
Posted by Ron Hill on May 30, 2003, at 11:10:33
In reply to Re: The AD Controversy for BP Patients » Ron Hill, posted by nmk on May 30, 2003, at 9:59:43
Nicole,
> Are you also hypothyroid or is the Lithobid simply a supplement?
No, Lithobid is my moodstabilizer. It is a slow release lithium product (i.e.; prescription medication).
-- Ron
Posted by nmk on May 30, 2003, at 14:26:56
In reply to Re: The AD Controversy for BP Patients » nmk, posted by Ron Hill on May 30, 2003, at 11:10:33
>
> No, Lithobid is my moodstabilizer. It is a slow release lithium product (i.e.; prescription medication).
>
> -- RonSorry Ron, I had Levothroid on my mind when reading your post. Lithobid, Levothroid....they all start sounding the same after awhile.
Nicole
Posted by Ron Hill on May 30, 2003, at 14:30:53
In reply to Re: The AD Controversy for BP Patients » Ron Hill, posted by nmk on May 30, 2003, at 14:26:56
> Lithobid, Levothroid....they all start sounding the same after awhile.
Yeah, I hear ya Nicole.
-- Ron
Posted by Mama Bear on May 31, 2003, at 18:40:18
In reply to Should BP II's nix the AD's?, posted by nmk on May 27, 2003, at 18:43:09
Nicole I don't really know the answer to your question but I have read conflicting reports about the use of AD's especially ssri AD's. I have heard that too much of an AD can cause you to rapid cycle. I would also like to heare responses in regards to this matter. I have a 5 yr old daughter who was just diagnosed with type 2 bipolar and she is going to be put on lithuim the MS. Good luck and keep us posted
Posted by nmk on June 2, 2003, at 10:25:00
In reply to Re: Should BP II's nix the AD's?, posted by Mama Bear on May 31, 2003, at 18:40:18
I usually don't take med changes into my own hands but since my pdoc is out of town, I decided to try going without the strattera to see what would transpire. It is now day 4 and the depression, agitation, and anxiety have lessened considerably. It is the 50 mg of zoloft and 1200 mg of Trileptal that is keeping me afloat.
I can't help to feel anger about spending the past year going from AD to AD, increasing dosages, combining, etc. , etc.. I clearly expressed to my pdoc my rapid mood cycling and my adverse reactions to AD's but instead of backing down on the AD's, he took the opposite approach.
If I have learned one thing from all of this it is that I must continually remain proactive in my treatment. I am so grateful for this board and for those of you that offer such knowledge and compassion.
Nicole
Posted by Barbara Cat on June 2, 2003, at 11:33:32
In reply to Re: Should BP II's nix the AD's?, posted by Mama Bear on May 31, 2003, at 18:40:18
It depends on the AD. My experience spans the gamut with all the SSRIs and SNRIs which went the typical route of off with a blast, poop out, increase, mania, etc. Figured it might be BPII and started adding lithium - a miracle- but was still having depression (but thank God, not the awful mixed states kind anymore). Added lamictal and still depressed. Having tried all the rest I gave in to my pdocs suggestion and started nortriptyline, a good old TCA from way back. It's been amazingly helpful. Side effects were dry mouth and tremors, but these went away after 2 months.
BTW, I was on Remeron for a while while taking lithium, but it still made me feel awful. Must be something about the mechanics of the SSRI family of meds that are nasty for BPII's. I personally endorse tricyclics if you're BPII and still depressed. Works for me, and I've dubbed by my pdoc as a 'remarkably resistant case'.
Posted by Mama Bear on June 2, 2003, at 12:11:34
In reply to Re: No Strattera...doing better, posted by nmk on June 2, 2003, at 10:25:00
Yes Nicole you definately have to take your own medical circumstances and educate yourself on what it is that is going on with you. Everyone is different. I have a 5 yr old daughter and we have almost had to educate her pediatrician about what is going on with her. It is very difficult to get the proper diagnosis since she is a young child. I have to be her advocate. I am glad to here you are doing better in regards to your BP problems. Some doctors don't like the fact that you are educated in what is going on with you. Some feel that because you are not a medical doctor you don't know what you are talking about. What these doctors fail to realize is that you have the information highway called the internet where you can obtain a wealth of information about your problem and many others that affect us. My daughter's pediatrician did not even realize that use of respirdal can and does cause Tardive Dyskinesia. Can you imagine. We were the ones who had to tell him what was going on with her. Who is the educator now. Me I guess. Don't take any thing lying down and accept what your doctor tells you as the gospel. Medical science is all about opinions when there are no conclusive tests that can prove what is happening with your mental illness. We have to rely on how we feel and what we know. Good luck and you are in my thoughts. Mama Bear
Posted by nmk on June 2, 2003, at 14:16:51
In reply to Re: Should BP II's nix the AD's? - Depends, posted by Barbara Cat on June 2, 2003, at 11:33:32
> It depends on the AD. My experience spans the gamut with all the SSRIs and SNRIs which went the typical route of off with a blast, poop out, increase, mania, etc. Figured it might be BPII and started adding lithium - a miracle- but was still having depression (but thank God, not the awful mixed states kind anymore). Added lamictal and still depressed. Having tried all the rest I gave in to my pdocs suggestion and started nortriptyline, a good old TCA from way back. It's been amazingly helpful. Side effects were dry mouth and tremors, but these went away after 2 months.
>
> BTW, I was on Remeron for a while while taking lithium, but it still made me feel awful. Must be something about the mechanics of the SSRI family of meds that are nasty for BPII's. I personally endorse tricyclics if you're BPII and still depressed. Works for me, and I've dubbed by my pdoc as a 'remarkably resistant case'.
>
>Barbara Cat,
It's funny you mentioned that because I have been dubbed the same by my pdoc. I even saw him pulling at his hair on a few occassions. Oh well, at least I am putting his kids through college with what he makes.
My pattern with AD's is very similar to yours...at first i feel great, then I start to feel agitation/anxiety, followed by a few weeks of a deep depression. Then it all starts over again.
Now you have me curious about the remeron. Currently, I take 15 mg for sleep and am wondering if that is contributing to the rapid cycling. It is such a low dose but I will wait to tinker around with that one until I talk to my doctor.
I am glad you finally found a med combo that works. I am going to see if the Trileptal and zoloft continue to work but if the symptoms persist, I think it is wise to move on to the TCA's.
Thanks Barbara!
Posted by nmk on June 2, 2003, at 14:21:12
In reply to Re: Should BP II's nix the AD's? - Depends, posted by nmk on June 2, 2003, at 14:16:51
> > It depends on the AD. My experience spans the gamut with all the SSRIs and SNRIs which went the typical route of off with a blast, poop out, increase, mania, etc. Figured it might be BPII and started adding lithium - a miracle- but was still having depression (but thank God, not the awful mixed states kind anymore). Added lamictal and still depressed. Having tried all the rest I gave in to my pdocs suggestion and started nortriptyline, a good old TCA from way back. It's been amazingly helpful. Side effects were dry mouth and tremors, but these went away after 2 months.
> >
> > BTW, I was on Remeron for a while while taking lithium, but it still made me feel awful. Must be something about the mechanics of the SSRI family of meds that are nasty for BPII's. I personally endorse tricyclics if you're BPII and still depressed. Works for me, and I've dubbed by my pdoc as a 'remarkably resistant case'.
> >
> >
>
> Barbara Cat,
>
> It's funny you mentioned that because I have been dubbed the same by my pdoc. I even saw him pulling at his hair on a few occassions. Oh well, at least I am putting his kids through college with what he makes.
>
> My pattern with AD's is very similar to yours...at first i feel great, then I start to feel agitation/anxiety, followed by a few weeks of a deep depression. Then it all starts over again.
>
> Now you have me curious about the remeron. Currently, I take 15 mg for sleep and am wondering if that is contributing to the rapid cycling. It is such a low dose but I will wait to tinker around with that one until I talk to my doctor.
>
> I am glad you finally found a med combo that works. I am going to see if the Trileptal and zoloft continue to work but if the symptoms persist, I think it is wise to move on to the TCA's.
>
> Thanks Barbara!
>Oops, forgot to post your name.
Posted by nmk on June 2, 2003, at 14:53:43
In reply to Re: No Strattera...doing better, posted by Mama Bear on June 2, 2003, at 12:11:34
> Yes Nicole you definately have to take your own medical circumstances and educate yourself on what it is that is going on with you. Everyone is different. I have a 5 yr old daughter and we have almost had to educate her pediatrician about what is going on with her. It is very difficult to get the proper diagnosis since she is a young child. I have to be her advocate. I am glad to here you are doing better in regards to your BP problems. Some doctors don't like the fact that you are educated in what is going on with you. Some feel that because you are not a medical doctor you don't know what you are talking about. What these doctors fail to realize is that you have the information highway called the internet where you can obtain a wealth of information about your problem and many others that affect us. My daughter's pediatrician did not even realize that use of respirdal can and does cause Tardive Dyskinesia. Can you imagine. We were the ones who had to tell him what was going on with her. Who is the educator now. Me I guess. Don't take any thing lying down and accept what your doctor tells you as the gospel. Medical science is all about opinions when there are no conclusive tests that can prove what is happening with your mental illness. We have to rely on how we feel and what we know. Good luck and you are in my thoughts. Mama Bear
Thanks Mama Bear. Your daughter is fortunate to have such love and support on her side. I hope you will continue to seek out a pediatric psychiatrist who can give you some answers and provide symptom relief to your daughter. Please keep me posted on her progress and you will be in my thoughts too.Sincerely,
Nicole
Posted by Barbara Cat on June 2, 2003, at 15:04:13
In reply to Re: Should BP II's nix the AD's? - Depends, posted by nmk on June 2, 2003, at 14:16:51
I had a great response to Remeron at first and then it quickly pooped out. Raised it, same thing. Eventually I was up to 75mg and feeling awful. This was before lithium. Slowly decreased, started lithium, and didn't start feeling better until I was off it completely. Some people like it alot. It was the easiest to get off of, I will say that for it but I gained 30 pounds. Are you taking lithium at all? If you have similar symptoms as I described you may benefit greatly from it.
Posted by nmk on June 3, 2003, at 13:12:03
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 2, 2003, at 15:04:13
> I had a great response to Remeron at first and then it quickly pooped out. Raised it, same thing. Eventually I was up to 75mg and feeling awful. This was before lithium. Slowly decreased, started lithium, and didn't start feeling better until I was off it completely. Some people like it alot. It was the easiest to get off of, I will say that for it but I gained 30 pounds. Are you taking lithium at all? If you have similar symptoms as I described you may benefit greatly from it.
No, but I am taking 1200 mg of Trileptal. I will see if the cycling is caused by all of the AD's and if not, will pursue a new AED. I am afraid of Lithium because of the weight gain. Have you gained any weight on it? If it is anything like remeron, my appetite would soar 1/2 hour after taking it. Boy, it wasn't a pretty sight watching me eat.
Posted by Barbara Cat on June 3, 2003, at 20:06:48
In reply to Re: Should BP II's nix the AD's? - Depends » Barbara Cat, posted by nmk on June 3, 2003, at 13:12:03
I've been working out alot and trying to lose the Remeron weight but it's not easy. Lithium does not create frenzied eating the way Remeron did. I was literally snarling and slobbering over a Dove ice cream bar on a cold February night while on Rem. Talk about not pretty. I haven't noticed any crazed cravings or overeating since stopping it. I think it may be more a metabolism thing with lithium since it does interfere with thyroid function. I've been on thyroid med for a long-term case of hypothyroid, but lithium has aggravated it. Other than that, I am very grateful and happy for what it's done for me. Beating the weight thing will just take extra effort, which I can do now that I'm not crippled by my mood disorder.
So what has your experience been of Trileptal? You're the first person I've talked to who is taking it. - BCat
>> No, but I am taking 1200 mg of Trileptal. I will see if the cycling is caused by all of the AD's and if not, will pursue a new AED. I am afraid of Lithium because of the weight gain. Have you gained any weight on it? If it is anything like remeron, my appetite would soar 1/2 hour after taking it. Boy, it wasn't a pretty sight watching me eat.
>
Posted by nmk on June 4, 2003, at 12:33:15
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 3, 2003, at 20:06:48
> I've been working out alot and trying to lose the Remeron weight but it's not easy. Lithium does not create frenzied eating the way Remeron did. I was literally snarling and slobbering over a Dove ice cream bar on a cold February night while on Rem. Talk about not pretty. I haven't noticed any crazed cravings or overeating since stopping it. I think it may be more a metabolism thing with lithium since it does interfere with thyroid function. I've been on thyroid med for a long-term case of hypothyroid, but lithium has aggravated it. Other than that, I am very grateful and happy for what it's done for me. Beating the weight thing will just take extra effort, which I can do now that I'm not crippled by my mood disorder.
>
> So what has your experience been of Trileptal? You're the first person I've talked to who is taking it. - BCat
>
> >>Barbara,
I really don't know what to say about the Trileptal since it is difficult to determine if it has made a significant difference. I didn't notice any improvement at first, but after titrating up slowly to 1200 mg, I have noticed that the depression is not as severe. I am still cycling like crazy....going from a hypomanic state, to anxiety/agitation, to mild depression, all in a matter of weeks. So, either the Trileptal is not doing much of anything or the AD's I am on are the culprit. I see my pdoc tomorrow to discuss. On a positive note, I have not experienced any negative side-effects from the trileptal. It should be taken with food since it has a tendency to upset the tummy. It has a tendency to decrease my appetite, which I make up for at night when I take the Remeron.
Nicole
Posted by Barbara Cat on June 5, 2003, at 1:03:24
In reply to Re: Should BP II's nix the AD's? - Depends » Barbara Cat, posted by nmk on June 4, 2003, at 12:33:15
Nicole,
You probably won't get this before seeing your pdoc but you might want to see what he/she thinks about lithium for you. You sound alot like what I used to go through. The depression/anxiety combo is the worst. Mixed states is absolute hell. I can't begin to tell you how lithium has helped me. I was so reluctant to take it even though my pdoc had suggested it periodically, mainly as an augmentor for my ADs that weren't working. Also the stigma - 'lithium, eeeyu, that means really crazy!' It's given me my life back. I know you're concerned about the weight thing but when ya feel good, ya exercise more, so it's a wash. If this next adjustment of current meds isn't doing it, you might try lithium for a trial period just to see. I'm hearing more and more about how if you have a bipolar disorder, you can add on all you want, but lithium is the bedrock.>
> I really don't know what to say about the Trileptal since it is difficult to determine if it has made a significant difference. I didn't notice any improvement at first, but after titrating up slowly to 1200 mg, I have noticed that the depression is not as severe. I am still cycling like crazy....going from a hypomanic state, to anxiety/agitation, to mild depression, all in a matter of weeks. So, either the Trileptal is not doing much of anything or the AD's I am on are the culprit. I see my pdoc tomorrow to discuss. On a positive note, I have not experienced any negative side-effects from the trileptal. It should be taken with food since it has a tendency to upset the tummy. It has a tendency to decrease my appetite, which I make up for at night when I take the Remeron.
>
> Nicole
Posted by McPac on June 5, 2003, at 15:06:53
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 5, 2003, at 1:03:24
"Mixed states is absolute hell".
>>>>>>>Barb, I may have asked you this before but what is a 'mixed state'? Is it feeling 2 different emotions at once? Thanks!
Posted by Barbara Cat on June 6, 2003, at 1:10:54
In reply to Barb, Re: Should BP II's nix the AD's? - Depends, posted by McPac on June 5, 2003, at 15:06:53
I wrote a pretty detailed post about mixed states a few months ago if you want to search for it, but glad to answer. It's when mania and depression collide. The depression is very agitated, despairing, black and almost psychotic. It's wailing terror and despair frequently mixed with panic, day in day out. Like being sucked into a black hopeless abyss. Nightmarish, at least for me. Few bipolars get mixed states, thank God. It's extreme and I think it crosses into schizoprenic territory. It's not agitated depression either. I don't know what it is but I know that Edgar Allen Poe and Edvard Munch who painted "The Scream" surely had it. It's rather cosmic and apocolyptic and probably interesting if it didn't feel so awful. Anyhow, lithium has healed me of that horror.
> "Mixed states is absolute hell".
>
> >>>>>>>Barb, I may have asked you this before but what is a 'mixed state'? Is it feeling 2 different emotions at once? Thanks!
Posted by nmk on June 6, 2003, at 10:56:52
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 5, 2003, at 1:03:24
> Nicole,
> You probably won't get this before seeing your pdoc but you might want to see what he/she thinks about lithium for you. You sound alot like what I used to go through. The depression/anxiety combo is the worst. Mixed states is absolute hell. I can't begin to tell you how lithium has helped me. I was so reluctant to take it even though my pdoc had suggested it periodically, mainly as an augmentor for my ADs that weren't working. Also the stigma - 'lithium, eeeyu, that means really crazy!' It's given me my life back. I know you're concerned about the weight thing but when ya feel good, ya exercise more, so it's a wash. If this next adjustment of current meds isn't doing it, you might try lithium for a trial period just to see. I'm hearing more and more about how if you have a bipolar disorder, you can add on all you want, but lithium is the bedrock.
>
> >
> > >
>Barbara,
Talked to my pdoc yesterday (before I read your post) and we decided to tinker with the AD's first and if I continue to cylce, we will raise the dose of Trileptal. I am currently at 1200mg but he stated that I could go up as high as 2800 mg. The thought of that freaks me out. The third line of defense will be to switch to a new mood stabilizer, in which I will discuss Lithium and Lamictal since I have also read so many positive experiences with both meds. I have no problem with Lithium.....at this point, I will do whatever works.
Can I ask you a few questions??? What is your dose of Lithium? Do you take an AD to augment? Since you started Lithium, have you cycled at all or have things been pretty stable? Other than the weight gain, any negative s/e's for you?
Thanks for all of your help and support Barbara, I really do appreciate it.
Nicole
Posted by Barbara Cat on June 6, 2003, at 11:42:06
In reply to Re: Should BP II's nix the AD's? - Depends » Barbara Cat, posted by nmk on June 6, 2003, at 10:56:52
Hi Nicole,
Happy to answer. You can scroll to the bottom for my dose info and skip the following if you want. I'm including my med history cause it puts my thoughts in order. I've had infrequent but very bizarre depressions all my life. Was on Elavil for a short time mid-70s but hated the side effects. Went on Zoloft and other SSRI's in 1984. They worked pretty good, but would always poop out after a few months and I had to keep going to higher doses. As time went on the depressions were cycling more rapidly with truly awful terror and angst mixed in. Nothing helped, and I had a 'breakdown' in 1999 and was hospitalized and off work for 5 months. The rest helped, no doubt, and I eventually felt better but still very shaky. Then 'it' started up again and I was put on Remeron 2 years ago. Worked great then same pattern. I also developed severe fibromyalgia during this time so had to deal with bad somatic pain as well. I was working in a very stressful high-tech job and falling apart. Things got so bad I truly in despair and stopped working. It was really, really baaaaad. I applied for disability and am currently on the last round in the process. I am very blessed to have a wonderful loving husband who was my rock of support during this time.My pdoc suggested lithium as an augmentor since Remeron was fizzling out and I resisted for months. I then began to recall times of intense hyperactivity all my life that I never associated with bipolar symptoms because it was such fun and so very productive. Plus the hyperactivity and depressions were separate. The hyperactivity unfortunately started getting jangled and intense, meshing with my garden variety major depression as I got older. It turned into what I think is bipolar mixed states, agitated and horrible symptoms that were fast becoming my predominant state. So I thought, OK, I believe I have classic bipolar signs and agreed to try lithium, 600mg a day.
Within 1 week it felt like a black veil had lifted. I was tapering off Remeron and still feeling a little weird even at 7.5mg, so went off it completely and only then felt great. Hated the weight I put on from inactivity and Remeron and tried Topomax for 1 month. Hated it, felt pissed off all the time.
Sure enough, major depression returned only thank God without the mixed states component so my pdoc added lamictal which seemed to help at first at 75mg (couldn't go any higher without anxiety). It was very nice, energetic and sparkly happy. Then it of course started pooping. I was holding my own until my Mother died in very tragic circumstances last fall and I fell apart and was really at the edge. My pdoc said "OK, let's go to good old tricyclics". I said ANYTHING! So I've been on nortryptiline at 75mg since January and am feeling very good. This is the longest I've ever gone feeling stable. So my doses are:
lithium 600mg (very low dose but working)
lamictal 75mg
nortriptyline 75mg
ambien 10mg to sleep
10-12 grams liquid fish oilNot many side effects from this low lithium dose, but when I added the nortriptyline I had annoying tremors and cotton mouth that lasted about 2 months and then decreased enough to not be so annoying.
I think the fish oil helps alot, as well as numerous 'state of the art' supplements. My thyroid medication had to be raised because lithium does clobber the thyroid. This is the major objection I have to it cause I already was hypothyroid. But being at the right level of thyroxine has made a HUGE difference. Whew, what a diatribe. - BarbCat
> Talked to my pdoc yesterday (before I read your post) and we decided to tinker with the AD's first and if I continue to cylce, we will raise the dose of Trileptal. I am currently at 1200mg but he stated that I could go up as high as 2800 mg. The thought of that freaks me out. The third line of defense will be to switch to a new mood stabilizer, in which I will discuss Lithium and Lamictal since I have also read so many positive experiences with both meds. I have no problem with Lithium.....at this point, I will do whatever works.
>
> Can I ask you a few questions??? What is your dose of Lithium? Do you take an AD to augment? Since you started Lithium, have you cycled at all or have things been pretty stable? Other than the weight gain, any negative s/e's for you?
>
> Thanks for all of your help and support Barbara, I really do appreciate it.
>
> Nicole
>
Posted by nmk on June 6, 2003, at 14:22:46
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 6, 2003, at 11:42:06
> Hi Nicole,
> Happy to answer. You can scroll to the bottom for my dose info and skip the following if you want. I'm including my med history cause it puts my thoughts in order. I've had infrequent but very bizarre depressions all my life. Was on Elavil for a short time mid-70s but hated the side effects. Went on Zoloft and other SSRI's in 1984. They worked pretty good, but would always poop out after a few months and I had to keep going to higher doses. As time went on the depressions were cycling more rapidly with truly awful terror and angst mixed in. Nothing helped, and I had a 'breakdown' in 1999 and was hospitalized and off work for 5 months. The rest helped, no doubt, and I eventually felt better but still very shaky. Then 'it' started up again and I was put on Remeron 2 years ago. Worked great then same pattern. I also developed severe fibromyalgia during this time so had to deal with bad somatic pain as well. I was working in a very stressful high-tech job and falling apart. Things got so bad I truly in despair and stopped working. It was really, really baaaaad. I applied for disability and am currently on the last round in the process. I am very blessed to have a wonderful loving husband who was my rock of support during this time.
>
> My pdoc suggested lithium as an augmentor since Remeron was fizzling out and I resisted for months. I then began to recall times of intense hyperactivity all my life that I never associated with bipolar symptoms because it was such fun and so very productive. Plus the hyperactivity and depressions were separate. The hyperactivity unfortunately started getting jangled and intense, meshing with my garden variety major depression as I got older. It turned into what I think is bipolar mixed states, agitated and horrible symptoms that were fast becoming my predominant state. So I thought, OK, I believe I have classic bipolar signs and agreed to try lithium, 600mg a day.
>
> Within 1 week it felt like a black veil had lifted. I was tapering off Remeron and still feeling a little weird even at 7.5mg, so went off it completely and only then felt great. Hated the weight I put on from inactivity and Remeron and tried Topomax for 1 month. Hated it, felt pissed off all the time.
>
> Sure enough, major depression returned only thank God without the mixed states component so my pdoc added lamictal which seemed to help at first at 75mg (couldn't go any higher without anxiety). It was very nice, energetic and sparkly happy. Then it of course started pooping. I was holding my own until my Mother died in very tragic circumstances last fall and I fell apart and was really at the edge. My pdoc said "OK, let's go to good old tricyclics". I said ANYTHING! So I've been on nortryptiline at 75mg since January and am feeling very good. This is the longest I've ever gone feeling stable. So my doses are:
>
> lithium 600mg (very low dose but working)
> lamictal 75mg
> nortriptyline 75mg
> ambien 10mg to sleep
> 10-12 grams liquid fish oil
>
> Not many side effects from this low lithium dose, but when I added the nortriptyline I had annoying tremors and cotton mouth that lasted about 2 months and then decreased enough to not be so annoying.
>
> I think the fish oil helps alot, as well as numerous 'state of the art' supplements. My thyroid medication had to be raised because lithium does clobber the thyroid. This is the major objection I have to it cause I already was hypothyroid. But being at the right level of thyroxine has made a HUGE difference. Whew, what a diatribe. - BarbCat
>
>
>
> >
Barbara,
I appreciate the diatribe.....it is somehow comforting to hear your story and how you have made it to this point.Like you, I never considered myself bipolar since I didn't experience the classic manic highs (or the real lows for that matter). But looking back, i also had periods of intense energy, productivity, and that feeling that I was on top of the world. But after my first bout with PPD seven years ago, and my more serious bout 1 1/2 year ago, my life has never been the same. I feel as though my brain chemistry has been permanently altered and I am working like hell to get it straightened out. I have three kids and a full-time career (can you tell it is a slow Friday?), and a husband, and am determined to get well to keep everything intact. It kills me to think how this is all affecting my children. I have told them in the simpliest of terms what is going on yet they are too young to understand the complexities of it all. The main point i try to convey is that none of this is their fault.
As I read, surf the web, and listen to the great people on this board, I am slowly gaining insight into the diagnosis and treatment of my bp II (oh, I forgot to mention my pdoc). I am slowly getting there but feel that I have a way to go.
Thank you for everything....I love reading your posts!
Nicole:)
Posted by McPac on June 6, 2003, at 14:50:49
In reply to Re: Should BP II's nix the AD's? - Depends » nmk, posted by Barbara Cat on June 6, 2003, at 11:42:06
Hi Barb,
As I've told you before, your symptoms have always so closely seemed to resemble mine. Your posts so eloquently and vividly explain in CLEAR detail so many of the same symptoms that I've felt. I often wish that I could type faster (instead of the one-finger, 'pecking' method that I employ.....I don't respond as often or as lengthy as I would if I could just sit down and type out a long post in no time....also, a crazy work schedule often keeps me from posting too). Anyway, I'm going to respond to different points you made in your last response to Nicole (below)....see what you think.Happy to answer. You can scroll to the bottom for my dose info and skip the following if you want. I'm including my med history cause it puts my thoughts in order. I've had infrequent but very bizarre depressions all my life. Was on Elavil for a short time mid-70s but hated the side effects. Went on Zoloft and other SSRI's in 1984. They worked pretty good, but would always poop out after a few months and I had to keep going to higher doses. As time went on the depressions were cycling more rapidly with truly awful terror and angst mixed in. Nothing helped, and I had a 'breakdown' in 1999 and was hospitalized and off work for 5 months. The rest helped, no doubt, and I eventually felt better but still very shaky. Then 'it' started up again and I was put on Remeron 2 years ago. Worked great then same pattern. I also developed severe fibromyalgia during this time so had to deal with bad somatic pain as well. I was working in a very stressful high-tech job and falling apart. Things got so bad I truly in despair and stopped working. It was really, really baaaaad. I applied for disability and am currently on the last round in the process. I am very blessed to have a wonderful loving husband who was my rock of support during this time.
>>>>>>>>>>Barb, for 20 YEARS I have not been able to quite figure something out....here is what happened.....20+ yrs. ago I was diagnosed with terrible ocd/anxiety/depression. I was eventually put on Nardil which worked very well (not AS good for ocd as the depression/anxiety, but it was a HUGE improvement). I was young (in my teens). Didn't want to be a 'mental case' on psych drugs (all these yrs. later and the 'stigma' is still there just the same). Anyway, I wasn't on the Nardil long....took it and chucked it down the toilet one day...wouldn't go back to the shrink either....got away with it for a few months. Stress and anxiety started getting worse... started feeling very nervous, anxious....then, TERRIBLY nervous.....I knew something was terribly wrong. I had been getting more and more steadily nervous for some time. Then, one night while w/ my girlfriend at her house (playing cards)I was EXTREMELY nervous---that was the biggest thing of all---my nerves were falling completely apart, not a little nervous like on a first date but it was as if my actual nerves were chaotically 'dancing' in my body....it was a physical sensation which felt like my nerves were actually 'breaking down' (LITERALLY a nervous breakdown!) It wasn't like a spur-of-the-moment panic attack...it had been building for quite some time, slowly getting worse and worse as days and weeks went by. I felt unbearable dread and agitation...that night was pure hell....more than ANYTHING it was my NERVES! The next day, back to shrink. He tried to put me on tofranil and something for nerves. It wasn't strong enough. I took it briefly, day or two, but the incredible, unbearable F'ing NERVE problem worsened again...I BEGGED him to put me in hospital, even though I HATED that idea, I NEEDED FAST relief! In the hospital, I was 'knocked out' on meds (THANK GOD!!!)....I was heavily sedated the whole time (probably didn't even know what I was taking). Within one week, I was FINE! He had put me on lithium, xanax and something else. The xanax was cool---it 'chilled' me out and helped my nerves settle down. And the lithium mellowed me out, smoothed me out...things that bothered me before didn't bother me at all (or at least NOT like before). AND, perhaps most importantly, I believed that the lithium had a tremendous effect on that agitation and that NERVE-JANGLING feeling! (YEARS later UNFORTUNATELY I had an anti-dep. added to the mix...I always KNEW I needed THAT!)
Anyway, I ALWAYS wondered what the H@ll that unbearable agitated/nervous/dreadfully panicky feeling was---was that a mixed-state thing? When I tried to go off my lithium recently, I noticed after a while that that 'feeling inside' was creeping back...I tell you the worst part for me is this nerve-jangling feeling. I started the lithium again and that feeling went away (it's different somehow that regular nervousness). Anyway, JUST a few short months ago I was reading Dr. Amen's book....in it he mentioned that aside from lithium being used for mood control that it was also very good for some people as a NERVE STABILIZER....THAT is what it seems to do for me SOOO WELL...it keeps that nerve-jangling feeling away! It also works great for me in the mood-control department too. But I've never really read many posts here describing this 'nerve-jangling breakdown' feeling....(maybe I have and just didn't know others were describing the same feeling)...I know many here have terrible anxiety but this seems like a 'variation' of regular bad nervousness...this is nervousness to an incredibly bad degree.My pdoc suggested lithium as an augmentor since Remeron was fizzling out and I resisted for months.
I then began to recall times of intense hyperactivity all my life that I never associated with bipolar symptoms because it was such fun and so very productive. Plus the hyperactivity and depressions were separate. The hyperactivity unfortunately started getting jangled and intense, meshing with my garden variety major depression as I got older.>>>>>>Sounds SOOOOOO familiar!
It turned into what I think is bipolar mixed states, agitated and horrible symptoms that were fast becoming my predominant state.
>>>>>>>>Again, sounds soooo familiar! Only, how is it a 'happy-sad collision' at the same time? For me, it's all shitty feelings---agitation/irritability/nerves/anxiety/stress/depressed/flustered, etc.
So I thought, OK, I believe I have classic bipolar signs and agreed to try lithium, 600mg a day.
>>>>>>>Barb, I'm a big guy and I'm only on 300 mg/day! My level is probably around .03 right now---downright puny and sub-therapeutic....I'm sure I'd feel better by taking 600 mg/day...that would be all I would need though....just enough to mellow me and keep me feeling fine...I've never needed the higher dosage and higher blood levels....
Within 1 week it felt like a black veil had lifted.
>>>>>>>lithium rules, lol,....I think MANY here would feel 100% better on it.....
I was tapering off Remeron and still feeling a little weird even at 7.5mg, so went off it completely and only then felt great. Hated the weight I put on from inactivity and Remeron and tried Topomax for 1 month. Hated it, felt pissed off all the time.
Sure enough, major depression returned only thank God without the mixed states component>>>>>>>>lithium will keep those mixed-states away, keep taking your lithium BarbCat!
so my pdoc added lamictal which seemed to help at first at 75mg (couldn't go any higher without anxiety). It was very nice, energetic and sparkly happy. Then it of course started pooping. I was holding my own until my Mother died in very tragic circumstances last fall and I fell apart and was really at the edge. My pdoc said "OK, let's go to good old tricyclics". I said ANYTHING! So I've been on nortryptiline at 75mg since January and am feeling very good.
>>>>>>>>>I'd LOVE to be able to take the good ol' TCA's!! (They don't work on my ocd as well as the ssri's though....that's my DOWNFALL! I have to take these ssri's! Great for my ocd but the side effects---MUCH WORSE than the old TCA's for me! (Don't believe the marketing/hype about ssri's having less side effects....ssri's have the worst s/e's by far!!!!!!!!!They BLOW....but I have no choice)
This is the longest I've ever gone feeling stable.
>>>>>>Keep doing just what you're doing Barb! The lithium will be very GOOD to you!!
So my doses are:
lithium 600mg (very low dose but working)
lamictal 75mg
nortriptyline 75mg
ambien 10mg to sleep
10-12 grams liquid fish oil>>>>>>I'm also on a mood stabilizer(lithium)/AD(Zoloft)/sleep-aid (Remeron)combo, & fish oil....Barb, 10-12 grams of liquid fish oil daily? GOOD for you! I take liquid fish oil too, have been for some time now, it seems to help...at 10-12 grams a day, that can be expensive right? Are you growing gills yet, lol?
I also take lots of supplements.Not many side effects from this low lithium dose, but when I added the nortriptyline I had annoying tremors and cotton mouth that lasted about 2 months and then decreased enough to not be so annoying.
I think the fish oil helps alot, as well as numerous 'state of the art' supplements.Yep!
My thyroid medication had to be raised because lithium does clobber the thyroid. This is the major objection I have to it cause I already was hypothyroid. But being at the right level of thyroxine has made a HUGE difference.
>>>>>I wonder about my thyroid level....was tested at TSH: 3.126...Thyroxine (T4): 6.1 about 6 months ago....
Whew, what a diatribe.
>>>>>>I've never written so much in a post! Probably won't ever do it again, lol....I've got to go and rest my "finger" now, lol....TAKE CARE!
- BarbCat
Posted by McPac on June 6, 2003, at 15:02:45
In reply to Barb, Re: Should BP II's nix the AD's? - Depends, posted by McPac on June 6, 2003, at 14:50:49
To clarify one point in my prior post.......
"(YEARS later UNFORTUNATELY I had an anti-dep. added to the mix...I always KNEW I needed THAT!)"
>>>>>>>>>I should have had an AD added MUCH, MUCH earlier than my doc did....I switched docs and got the AD added...I would have been much happier for years with an AD added.
Posted by Barbara Cat on June 10, 2003, at 0:41:04
In reply to Barb, Re: Should BP II's nix the AD's? - Depends, posted by McPac on June 6, 2003, at 14:50:49
Hi,
Thanks for your great post. We do have much in common. I know what you mean about different kinds of anxiety. There's the incessant worry, tongue tied obsessive kind of anxiety and there's the OTHER kind that really has no description. You mentioned how strange it is in mixed states that 'happy and sad happen at the same time'. One thing is becoming very clear to me as I live with this thing is that manic does not necessarily mean 'happy', like most of us think it does. I guess it depends on which neural systems are being affected at the time, but all mania seems to have one thing in common, and that is a frantic frenzied urgency. You know, spend, spend, spend, clean, clean, clean, party, party, party, projects, projects, projects, terror, terror, terror. Ron Hill had a hit that there is an 'off switch', probably electrical, that doesn't respond and things spiral out of control.Why it spirals up or down is anyone's guess. I imagine different mixtures of electrical misfires can happen simultaneously. And who knows what this weird mixed states thing is anyway? It's nice to have a label for things, I guess, but I sure haven't run across my brand of it very often.
Maybe for me is has nothing to do with Bipolar, maybe it's periodic schizophrenia (but I don't think such an animal exists. You either are or you aren't). I was going to describe more of my experiences in this state, but reading it over I realized it is not to be lightly divulged, so out it went. It is truly terrifying, bizarre and not psychosis. In fact, I've been on anti-psychotic meds that did didly squat during an episode.
I don't know what to call my episodes anymore, so Bipolar mixed-states it is since my pdoc needs to give it a dx. Wish I knew, but haven't even been able to discuss the details with my pdoc. Tried to but he began asking pointed questions clearly leading in the direction of outright psychosis and it just ain't that way with me. I think it is a gift that I will one day understand. I think this is true of many of us. I know that in my 20 minutes every 8 weeks, there's just no way I'm going to get depth psychology. There are no insurance mandated doctors that I feel I could confide in so I read many books and make hay while the sun shines.
Soooo, the good news is that I haven't had one of these doozys since lithium. Also, reading and listening to Eckhard Tolle's "The Power of Now" books and CDs has healed me more deeply than anything else. - BarbCat
This is the end of the thread.
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