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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by katia on July 24, 2003, at 15:19:46
Just wondering what other's thoughts and experiences have been with taking only a mood stabilizer for BP (mixed/II/NOS)? My depression are bad and an underlying one is always there. At times I have a very agitated mixed state and sometimes the bipolar II high. And it all can happen within days of each other. I've tried various ADs over the year - Celexa, Effexor, Zoloft, Serzone; none of them working or working briefly and then pooping out and when they did work it was more of a hypomanic working.
I recently found a good well known and respected pdoc who wants to put me on only Depakote for the moment. and see what happens. I'm resistent as I don't want to be fat, bald, and depressed. I'm worried that the side effects will kick in and the depk. will not help my depression, but only take away the energized part and leave me fat, bald, and sad!
Anyone with input as to 1. how does a mood stabilizer help with depression - without an AD to augment it. and 2. Any good experiences (or bad) out there on Depakote? I start it today.
Thanks so much.
Katia
Posted by katia on July 25, 2003, at 16:38:23
In reply to Mood stabilizers enough for bp depression?, posted by katia on July 24, 2003, at 15:19:46
Posted by Jonathan on July 25, 2003, at 23:54:54
In reply to Mood stabilizers enough for bp depression?, posted by katia on July 24, 2003, at 15:19:46
> Any good experiences (or bad) out there on Depakote? I start it today.
Hi, Katia.
I've only been taking Depakote for a fortnight - barely long enough to say much more than a supportive "Hey! I'm taking 500 mg twice a day; how much are you on? Aren't the vivid technicolor dreams great!" before we get redirected to PBS for not being sufficiently pharmacological.
To deal first with your principal concerns, I shouldn't expect to notice either weight gain or hair loss so soon even if it were occurring, but I can say that I haven't experienced any increase in my appetite, and my hair growth and the few strands of hair collected on my brush and comb every day seem normal; by the way, my absence of hair loss isn't caused by a lack of hair to lose - if male baldness is virile then I'm not!
I'll let you know of any changes over the next few months that might be due to Depakote (if I can squeeze through the doorway of the spare bedroom in which I keep my computer and if I can find the keyboard under all my moulted hair).
I'm not that worried about either weight gain or hair loss because they are slow in onset and easily reversed after stopping the drug, and there are plenty of alternative mood stabilizers to try if I have to stop Depakote. If, after I've tried all of them, there is really no alternative to my present slim, hairy but depressed state except for fat, bald and happy, then fat, bald and happy will be my choice: unlike depression, neither weight gain nor hair loss, although unwelcome, will cause me to make serious plans to kill myself.
The thing that concerned me most when I started taking Depakote was that it made me feel so drowsy all day and sleep longer every night; I missed a couple of evening doses in the first week because I fell asleep immediately after dinner. This is a worsening of my normal, lethargic depressive symptoms: there is an external reason, however, independent of drug changes, why I might have become even more depressed recently so perhaps it's unfair to pin all the blame on Depakote.
The second week has been much better: the daytime sleepiness has almost gone, though I still need to sleep about an hour more every night. Perhaps the extra sleep is REM sleep, because my dreams have become very much richer, more interesting and professionally scripted. I remember that the benzodiazepine Mogadon (nitrazepam) had a similar effect on my dreaming life when I was a student unable to sleep unaided in the run-up to exams. This is interesting because both Depakote and benzos, by different mechanisms, enhance GABAergic neurotransmission.
This dream enhancement is the only welcome effect so far, but it's too early yet to expect any therapeutic action: I'll let you know in a few weeks whether or not it seems to be beginning to work. On the plus side, the only adverse effect is a little more lethargy and a need for more sleep. Until it starts to work, if it does, Depakote could almost be a huge, shocking-pink, vanilla-flavoured sugar pill. My pdoc warned me that nausea and even vomiting are common side-effects, which can be prevented by always taking the tablets after food, never on an empty stomach: I've always been very careful to do this and it works.
There are a couple of things you perhaps wanted to know about Depakote but were afraid to ask your well-known pdoc: I was afraid to ask mine, who's almost certainly less famous. Because of the obvious similarity between a seizure and an orgasm, I feared that anticonvulsants like Depakote might cause anorgasmia. I now know that this fear was groundless: it has no adverse sexual effects of any kind, at least for a man. A couple of nights ago I was unwise enough to share two bottles of wine, drinking about half of each. This is obviously a very bad idea for anyone suffering from depression; the good news is that I don't think the Depakote made the consequences any worse than before I started it - I just felt even more miserable than usual the next day.
As well as 1000 mg of Depakote in two 500 mg doses, I'm continuing (at the same dose as before) the two meds that I was already taking:
(1) lithium carbonate 1000 mg every night, which I've been taking for six months, and
(2) lofepramine 70 mg three times a day, which I've been taking for a year.
Lofepramine is a tricyclic antidepressant with similar properties to desipramine (which it has superseded here in the UK) - inhibits reuptake of norepinephrine but not serotonin; antagonist at alpha-1 noradrenoceptors and 5-HT2 - it's rapidly metabolized into desipramine itself.I hope that your introduction to Depakote will be as painless as mine was, Katia, and that your simultaneous withdrawal from antidepressants will remain bearable.
Pleasant dreams :)
Jonathan.
Posted by River1924 on July 26, 2003, at 11:52:44
In reply to How was your first day on Depakote? » katia, posted by Jonathan on July 25, 2003, at 23:54:54
Don't have experience but I've never read much that said any of the bipolar drugs (except lithium and lamictal) did much for the down swing. Until recently, bipolar depression wasn't given much attention. But I think most recent studies suggest a combo, say depakote or lamictal with effexor or zoloft, works best. Your doctor should know that.
Posted by katia on July 26, 2003, at 13:34:21
In reply to How was your first day on Depakote? » katia, posted by Jonathan on July 25, 2003, at 23:54:54
Thanks for your long response!
I've got a couple of questions for you -
What is your diagnosis? And why are you adding Depakote onto lithium. Does lithium not do the trick for you?Also, have you had any experiences where a mood stabiliser is enough for depression? My pdoc seems to want me off ADs (I am now) and onto only a mood stabiliser. I'm just worried that my depressions will get worse without some offset of the "mania".
Also, why do you (your pdoc) choose a tricyclic? Do the newer ones not work for you?
thanks again.
KatiaAs well as 1000 mg of Depakote in two 500 mg doses, I'm continuing (at the same dose as before) the two meds that I was already taking:
(1) lithium carbonate 1000 mg every night, which I've been taking for six months, and
(2) lofepramine 70 mg three times a day, which I've been taking for a year.
Lofepramine is a tricyclic antidepressant with similar properties to desipramine (which it has superseded here in the UK) - inhibits reuptake of norepinephrine but not serotonin; antagonist at alpha-1 noradrenoceptors and 5-HT2 - it's rapidly metabolized into desipramine itself.
Posted by katia on July 26, 2003, at 13:39:11
In reply to Depakote? for Bipolar II depression?, posted by River1924 on July 26, 2003, at 11:52:44
> Don't have experience but I've never read much that said any of the bipolar drugs (except lithium and lamictal) did much for the down swing. Until recently, bipolar depression wasn't given much attention. But I think most recent studies suggest a combo, say depakote or lamictal with effexor or zoloft, works best. Your doctor should know that.
yes, that's exactly why I"m worried. He should know that. Don't really understand his reasoning, other than introduce one thing at a time. We'll see. He wants to stay away from Lamictal (at first) b/c of the chance of the deadly rash. The percentages are low but they are there. and he wants to try something else at first. we'll see. I've already tried effexor - made me mixed and am very sensitive that I went through those w/drawals as my side effect and Zoloft did absolutely nothing for me except made me a zombie. I haven't started yet due to the fact that I'm waiting for it in the mail from a Canadian pharmacy. luckily my pdoc is Canadian even tho' i"m in usa.
thanks for your response.
katia
Posted by nmk on July 27, 2003, at 20:27:16
In reply to Mood stabilizers enough for bp depression?, posted by katia on July 24, 2003, at 15:19:46
Hi Katia,
I posed a similar question to the group on May 27th and received some great insight into the controversy over BPII's using AD's. Click on "May 25" as your period to search and scroll down.
The consensus was that many felt they needed an AD in combonation with an AED but the AD should be used cautiously and in small amounts.
Nicole
Posted by katia on July 28, 2003, at 1:13:11
In reply to Re: Mood stabilizers enough for bp depression? » katia, posted by nmk on July 27, 2003, at 20:27:16
Posted by katia on July 28, 2003, at 2:38:49
In reply to Re: Mood stabilizers enough for bp depression? » katia, posted by nmk on July 27, 2003, at 20:27:16
Thanks.
I found it and actually replied to the guy who started that thread. Just wondering where he is in all this.
katia
Posted by katia on August 11, 2003, at 18:12:29
In reply to How was your first day on Depakote? » katia, posted by Jonathan on July 25, 2003, at 23:54:54
> > Any good experiences (or bad) out there on Depakote? I start it today.
>
> Hi, Katia.
>
> I've only been taking Depakote for a fortnight - barely long enough to say much more than a supportive "Hey! I'm taking 500 mg twice a day; how much are you on? Aren't the vivid technicolor dreams great!" before we get redirected to PBS for not being sufficiently pharmacological.
>
> To deal first with your principal concerns, I shouldn't expect to notice either weight gain or hair loss so soon even if it were occurring, but I can say that I haven't experienced any increase in my appetite, and my hair growth and the few strands of hair collected on my brush and comb every day seem normal; by the way, my absence of hair loss isn't caused by a lack of hair to lose - if male baldness is virile then I'm not!
>
> I'll let you know of any changes over the next few months that might be due to Depakote (if I can squeeze through the doorway of the spare bedroom in which I keep my computer and if I can find the keyboard under all my moulted hair).
>
> I'm not that worried about either weight gain or hair loss because they are slow in onset and easily reversed after stopping the drug, and there are plenty of alternative mood stabilizers to try if I have to stop Depakote. If, after I've tried all of them, there is really no alternative to my present slim, hairy but depressed state except for fat, bald and happy, then fat, bald and happy will be my choice: unlike depression, neither weight gain nor hair loss, although unwelcome, will cause me to make serious plans to kill myself.
>
> The thing that concerned me most when I started taking Depakote was that it made me feel so drowsy all day and sleep longer every night; I missed a couple of evening doses in the first week because I fell asleep immediately after dinner. This is a worsening of my normal, lethargic depressive symptoms: there is an external reason, however, independent of drug changes, why I might have become even more depressed recently so perhaps it's unfair to pin all the blame on Depakote.
>
> The second week has been much better: the daytime sleepiness has almost gone, though I still need to sleep about an hour more every night. Perhaps the extra sleep is REM sleep, because my dreams have become very much richer, more interesting and professionally scripted. I remember that the benzodiazepine Mogadon (nitrazepam) had a similar effect on my dreaming life when I was a student unable to sleep unaided in the run-up to exams. This is interesting because both Depakote and benzos, by different mechanisms, enhance GABAergic neurotransmission.
>
> This dream enhancement is the only welcome effect so far, but it's too early yet to expect any therapeutic action: I'll let you know in a few weeks whether or not it seems to be beginning to work. On the plus side, the only adverse effect is a little more lethargy and a need for more sleep. Until it starts to work, if it does, Depakote could almost be a huge, shocking-pink, vanilla-flavoured sugar pill. My pdoc warned me that nausea and even vomiting are common side-effects, which can be prevented by always taking the tablets after food, never on an empty stomach: I've always been very careful to do this and it works.
>
> There are a couple of things you perhaps wanted to know about Depakote but were afraid to ask your well-known pdoc: I was afraid to ask mine, who's almost certainly less famous. Because of the obvious similarity between a seizure and an orgasm, I feared that anticonvulsants like Depakote might cause anorgasmia. I now know that this fear was groundless: it has no adverse sexual effects of any kind, at least for a man. A couple of nights ago I was unwise enough to share two bottles of wine, drinking about half of each. This is obviously a very bad idea for anyone suffering from depression; the good news is that I don't think the Depakote made the consequences any worse than before I started it - I just felt even more miserable than usual the next day.
>
> As well as 1000 mg of Depakote in two 500 mg doses, I'm continuing (at the same dose as before) the two meds that I was already taking:
> (1) lithium carbonate 1000 mg every night, which I've been taking for six months, and
> (2) lofepramine 70 mg three times a day, which I've been taking for a year.
> Lofepramine is a tricyclic antidepressant with similar properties to desipramine (which it has superseded here in the UK) - inhibits reuptake of norepinephrine but not serotonin; antagonist at alpha-1 noradrenoceptors and 5-HT2 - it's rapidly metabolized into desipramine itself.
>
> I hope that your introduction to Depakote will be as painless as mine was, Katia, and that your simultaneous withdrawal from antidepressants will remain bearable.
>
> Pleasant dreams :)
>
> Jonathan.Hi Jonathan,
How's it going? I just started the Depakote (finally!) two nights ago. Not sure if it's a side effect from the Depakote, but I can get exxxxtreeemely irritable and feel out of control - like I could committ homocide or suicide! (not really, but it's the feeling). It's only been two days, so we'll see. Not much nauseousness for me either. How's it going for you now?
One thing I noticed is you have been on Lithium for awhile AND a tricylic. What made you go on Depakote? It's the only thing I'm on now. I went for about one month with NOTHING at all. It was interesting to see my mood even out and return to the "normal" and familiar craziness rather than the AD induced one.
In your experience and from your knowledge, do you think Depakote will be enough? I'm dxed as BP NOS (not otherwise specified) therefore, falling somewhere in between II and mixed. The depressions are the killer for me and I've rarely gone anytime at all w/o at least bottom/base line of low grade depression since I had my first manic/hypo manic episode at 17/18. I'm 33 now.
Let me know how you are!
thanks.
Katia
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