![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 422 to 446 of 948. Go back in thread:
Posted by BarbaraCat on August 25, 2003, at 11:58:40
In reply to BARB!, Naturopath visit results, please read, posted by McPac on August 25, 2003, at 1:13:04
**I think your take on the situation is right on. Yes, I do think that taking an AD without an adequate amount of mood stabilizer is a sure recipe for what your describing, if you're bipolar - and some research suggests even if you're not bipolar. However, you state that you 'rarely get the hypomanic highs' which tells me that you equate BP 'manias' as the classic ones, the kind everyone's impressions of mania is (myself included until I found out better). Mania/hypomania is NOT always the bubbly, get things done, madcap high time that we all have associated it with. It's more likely IRRITABILITY and AGITATION. For me, when I have the classic madcap manias, they last only a short time and then disintegrate quickly into frazzled annoyance and rage. Mainly, I don't get the enjoyable stuff at all, but only the trigger fire anger and disorganization on the manic side and the lethargy and life sucks kind on the depressive side. Before lithium I was getting both together in godawful mixed states. I'm not on very much lithium at 600mg because I want to keep my edge so I still have some hypomania of different sorts occasionally, and I still get variations of 'life sucks' (but, really, it does!) depressions. But thank God, no more mixed states. I could live with ANYTHING but not mixed states! Once again, you MUST understand beyond any doubt that your symptoms of anger, irritability, rage are most likely undertreated manic symptoms. Mainly depression with irritability and agitation (also known as hypomania) IS the description for BPII. It's also the description for agigatated depression or depressive GAD, but this is splitting hairs. It sounds like you are BPII to me and if this is true, you absolutely need an effective level of mood stabilizer. If you are getting horrible mixed states, you're more likely BPI (as I now know myself to be), although I don't think this is the case with you, but in any case, you'd STILL need a mood stabilizer. I have my own experiences about too little lithium:
A year and a half ago I ran out of lithium and my mail order pharmacy took about 10 days to get the prescription to me, so I was without for over 2 weeks. I was taking Remeron at the time so I thought I was covered at least until I got my lith in the mail. I started having a very enjoyable hypomania so I didn't start taking the lith once I got it back thinking 'oh boy, I sure feel good so I probably don't need it'. The pleasant hypomania didn't last all that long and quickly turned into disorganization, irritability, snappy quick-trigger anger, sarcasm (my poor husband!), spending money I didn't have, sleeplessness, poor judgement. Once I went back to my 600mg things mellowed out within 1 week. Note that I'm only taking 600mg which is way below my therapeutic window, but it's obviously making a big difference.
I went off Remeron because it really made me feel awful and started lamictal along with lithium. About 6 months ago I started having alarming increases in my thyroid TSH levels which is a problem with taking lithium when one is hypothyroid as I am. So I decided to reduce lithium because I was concerned about permanently damaging my thyroid. I got down to 300mg every other day within a 3 week period and experienced the rage, hot temper stuff pretty dramatically. So again, within 1 week of restarting things smoothed out.
I have a few thoughts on this and your experience will shed light. There's always a withdrawal period where things are shaky. I've wondered whether if I just stayed the course I'd eventually smooth out without the lithium. It sounds like you've been on a substandard dose for a while still have symptoms and so your anger/irritability are not due to withdrawal. The other thing is taking an AD at all when you're BP. What kind are you taking? I had nothing but problems with all the ADs I ever took, even with lithium as an augmentor. The only one that helped was nortriptyline, briefly, when I was suicidally depressed after my Mom's death. But once I emerged from that, I stopped nortrip and eventually felt much better without it. Lamictal 125mg and lithium seem to be doing the trick as far as keeping me from destabilizing. One other thing to consider is, are you really BP? Could it be that you're actually unipolar depressed and not getting high enough a dose of your AD? Even if this is true, my personal opinion is that anyone taking an AD should also take it with a mood stabilizer. Sigh, so many variables. My personal hit is that you're not on enough lithium or whatever mood stabilizer you choose, and you're destabilizing with the AD. One more thought. A high level of testosterone is also associated with anger and aggression. Can you possibly have the mixed blessing of having too much of a good thing? A hormone panel test would tell.
Have you read "Why your depression isn't getting better" by Michael Bartos, MD? He describes what you're going through very well and states without any doubt that BPs most definitely and absolutely require a mood stabilizer, should reconsider using ADs at all, and NEVER use ADs without a mood stabilizer. Here's the website:
Also, here's the recommended book page of a website I like very much. The entire website is great. You might find something that helps:
http://www.mcmanweb.com/book-16.htm
And finally, you've been suffering with this for a long time now, Mac. I can only imagine how hard it must be. Why not just up your lithium and see? If you start feeling better, I'll bet you can start lowering your dose of ADs and you'll get an even better response. But only after the withdrawal subsides. What does your pdoc say in all this? He/she should be very aware and up on this whole AD/mood stabilizer issue. If he/she is not, why not?
BarbaraCat
> Okay, for years I've taken AD's and lithium together....I've always taken a much smaller amount of lithium than most bipolars (I am likely bipolar, though very rarely get even the mini-highs (hypomania), I'm VERY much just the depression part)....anyway, I would, for YEARS, take only 600 mgs/day of Lithium along w/ my anti-dep (and this worked very, very well).......over the last couple of years, I have tried to even DEcrease that small lithium dose, taking only 300 mg/day of lithium w/ my AD...my lithium level is PUNY, something like .016 or .02 last time I checked it...in other words downright microscopic for a bipolar......anyways, over the last couple of years (since lowering my lithium dose to these PUNY levels) I have felt like total crap much of this time--- I have had a lot of AGITATED feelings with ANGER problems....and when I try to switch AD's, as soon as I get to just a moderately high dose, the agitation/anger/irritability gets MUCH worse....for a while I kept thinking that it's just the AD's that are causing the anger....but NOW I'm seriously thinking that it's the PUNY, DEcreased lithium dose, THAT WHEN COMBINED WITH the AD's, that is the problem....in other words, that the AD's are 'destabilizing' me or making me feel agit/angry but it's BECAUSE I'm on TOO LITTLE of a mood stabilizer....Isn't that a signal or tip-off to bipolar in many cases---that if someone is trying different AD's and having really bad effects and no success (and often feel even worse!) that they may be bipolar and need a mood stab. WITH their AD? I think my agitation/anger/irrit on the AD's is telling me that I need to increase my mood stab....(I KNOW that one AD (Prozac) was DEFINITELY a TERRIBLE drug for me, TERRIBLE anger/rage......but now, as more and more seem to cause problems, I think my PUNY lith. dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol, what do you think Barb?
Posted by katia on August 25, 2003, at 14:38:09
In reply to BARB!, Naturopath visit results, please read, posted by McPac on August 25, 2003, at 1:13:04
Hi McPac,
ditto on all Barb says.>>dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol,
for me, I was on ADs for a year (four different kinds) and they messed me up worse. (didn't help). I've recently been dxed as BP and have begun a new regime of only mood stabilizers - no ADs. we'll see how it goes. But from what I've heard and my pdoc says, ADs are not the best things for BP people.
all the best,
Susan
Posted by katia on August 25, 2003, at 14:39:20
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
Hi Barb,
Thanks for those links! I'm actually starting my thesis and wondering what to write about???? I think it's on BP. Those books will come in handy.
katia
Posted by katia on August 26, 2003, at 1:40:52
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
Hi Katy!
I actually was just reading "Seabiscuit" and there it was! Your word bobbles! used in relation to the horses.
I had to let you know!
Katia
Posted by BarbaraCat on August 26, 2003, at 12:30:48
In reply to Re: BARB!, Naturopath visit results, please read » BarbaraCat, posted by katia on August 25, 2003, at 14:39:20
Katia,
What's your major? I recall you were getting an MS, but don't think you mentioned in what. Good luck in it! I'm going back to school as well, eventually ending up a Holistic Nurse with an emphasis in Psychiatry - but first, the plain ol' RN license (just hope I don't have to clean bedpans for too long).> Hi Barb,
> Thanks for those links! I'm actually starting my thesis and wondering what to write about???? I think it's on BP. Those books will come in handy.
> katia
Posted by katia on August 26, 2003, at 12:55:57
In reply to Re: BARB!, Naturopath visit results, please read » katia, posted by BarbaraCat on August 26, 2003, at 12:30:48
Hi Barb,
If we get re-directed to social babble; just follow the link and we'll take it from there. It's easy!I'm entering my fourth year and almost finished with a degree (M.A.) in Transpersonal Psychology and a certificate in life coaching.
I can see you being a holistic nurse. Have you started yet with the program?
I was just thinking this morning that I"m sick of not having nor ever had a proper career. I'm sick of not being able to channel my creative energy into a career type of "life purpose".I guess I'm starting to feel better. More able. perhaps it's the depakote? But the scary part is now, doing something positively with my somewhat evening out of mood. Like the storms have settled a bit and I'm left looking at the wreck
around me after years of torment. And it's time to be happy and explode and direct all the pent up energy and DO something satisfying with my life! I'm just scared and unsure of how to make my next step. I've created space - took a quarter off, took out extra student loans to supplement my devastating financial state. Now. it's time! I need to take a leap of faith.
so maybe I'll direct this into my thesis?by the way, it's GREAT that you're thinking of going back for a new career. I love and applaud that. You're in your 50s right? There is one woman in my program who is 87 I think! It's wonderful to see. Did you ever have children? It sounds like you were a project manager for awhile?
katia
Posted by McPac on August 26, 2003, at 14:04:34
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
Awesome post Barb, simply awesome...SOOO helpful!
I will reply to that post soon (got to get my car to the garage for some repairs)...thank you SOO much!
Posted by McPac on August 26, 2003, at 14:05:49
In reply to Re: BARB!, Naturopath visit results, please read, posted by katia on August 25, 2003, at 14:38:09
Posted by McPac on August 26, 2003, at 17:21:16
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 25, 2003, at 11:58:40
**I think your take on the situation is right on. Yes, I do think that taking an AD without an adequate amount of mood stabilizer is a sure recipe for what your describing, if you're bipolar - and some research suggests even if you're not bipolar.
>>>>>>>>>>>>>>> Barb, can you elaborate on this, "and some research suggests even if you're not bipolar"?
However, you state that you 'rarely get the hypomanic highs' which tells me that you equate BP 'manias' as the classic ones, the kind everyone's impressions of mania is (myself included until I found out better). Mania/hypomania is NOT always the bubbly, get things done, madcap high time that we all have associated it with. It's more likely IRRITABILITY and AGITATION.
>>>>>>>>>>> So hard to distinguish when the irrit and agitation and anger is from bipolar and when it is from certain meds...that is the hardest thing to tell! Take Remeron, at 30 mg's I seem to be relatively free from the anger/irrit/agitation....but at 45 mg, DIFFERENT story! Is it the bipolar being affected at the 45 mg dose or is it med side effects (and these ARE side effects that the med can cause and that others do get)? Some will say "it's the bipolar breaking through"....but this is the whole crux of the matter, IS IT the bp breaking through OR is it the med's side effects breaking through? Check this out---I've been on 30 mg of Remeron for about a week now and do NOT feel anger at this dose....I took 5 mg's of Lexapro today and I can feel some agitation/irrit from that! The ssri's really seem to cause that problem for me, some ssri's worse than other ones ..... but that seems like a med side effect, not a bipolar response....another reason that makes it SO hard to tell what is the problem, bipolar or med s/e, is that SO many of these meds do have anger/irrit/agitation as known side effects! I mean, if I took an aspirin or a Tums and then got terribly angry/irrit/agitated I would just think that my bipolar was acting up...but when I take Zoloft, Lexapro, etc., and it happens then I don't know if it's my bp or the med s/e? Even with the Remeron, many folks (others here have said this too during my discussions w/ them) have gotten increased agit/irrit/anger on Remeron due to a s/e. It's in the Remeron literature also. For a while I kept thinking, "well it can't always be the med...it must be me"....but all of the meds that I felt this way on DID have it listed as a possible side effect. It is worse on higher doses also...as I raise the dose, the problems increase. One big problem is that I NEED to take a higher dose---a lower dose isn't enough med to help the dep/ocd.
For me, when I have the classic madcap manias, they last only a short time and then disintegrate quickly into frazzled annoyance and rage. Mainly, I don't get the enjoyable stuff at all
>>>>>>>>>>> Barb, I USED to get a LOT of the fun mini-highs (very enjoyable, very happy, productive,creative).....not much of that anymore!
, but only the trigger fire anger and disorganization on the manic side and the lethargy and life sucks kind on the depressive side. Before lithium I was getting both together in godawful mixed states. I'm not on very much lithium at 600mg because I want to keep my edge so I still have some hypomania of different sorts occasionally, and I still get variations of 'life sucks' (but, really, it does!) depressions. But thank God, no more mixed states. I could live with ANYTHING but not mixed states!
Once again, you MUST understand beyond any doubt that your symptoms of anger, irritability, rage are most likely undertreated manic symptoms.
>>>>>>>>>>>>>> Yes, Barb...I think I'm actually having a type of 'double-whammy' effect--- anger/irrit/agit from bipolar PLUS also getting those same s/e's with some of the meds I've taken! I can definitely understand that those symptoms are bp symptoms...AND I have no doubt that some of the meds that I have taken have also given me those symptoms via med side effects...confusing and very hard to deal with! An AD that worked for dep/ocd/and anxiety WITHOUT also causing the anger/irrit/agit is what I need.
Mainly depression with irritability and agitation (also known as hypomania) IS the description for BPII.
>>>>>>>>>> I USED to get the "happy" mini-highs...now it looks like more of the "angry/agit/irrit" kind....would that still be a bp11? (can't recall the distinction between bp1 and 2).
It's also the description for agigatated depression or depressive GAD, but this is splitting hairs.
It sounds like you are BPII to me and if this is true, you absolutely need an effective level of mood stabilizer. If you are getting horrible mixed states, you're more likely BPI (as I now know myself to be), although I don't think this is the case with you, but in any case, you'd STILL need a mood stabilizer. I have my own experiences about too little lithium:A year and a half ago I ran out of lithium and my mail order pharmacy took about 10 days to get the prescription to me, so I was without for over 2 weeks. I was taking Remeron at the time so I thought I was covered at least until I got my lith in the mail. I started having a very enjoyable hypomania so I didn't start taking the lith once I got it back thinking 'oh boy, I sure feel good so I probably don't need it'. The pleasant hypomania didn't last all that long and quickly turned into disorganization, irritability, snappy quick-trigger anger, sarcasm (my poor husband!), spending money I didn't have, sleeplessness, poor judgement. Once I went back to my 600mg things mellowed out within 1 week. Note that I'm only taking 600mg which is way below my therapeutic window, but it's obviously making a big difference.
>>>>>>>>>>>>> I wrote a long post within the last week or so about what lithium does for me---how it keeps this particular dreaded anxiety/depressive condition from returning...only it sounds like I also use lithium the way some use a benzo! I may well have had a terrible mixed state before and just not knew what it was called! Is it a state of TERRIBLE anxiety AND terrible depression COMBINED into one feeling? Barb, bp1 OR 2 and the treatment is the same regardless right?
I went off Remeron because it really made me feel awful and started lamictal along with lithium. About 6 months ago I started having alarming increases in my thyroid TSH levels which is a problem with taking lithium when one is hypothyroid as I am. So I decided to reduce lithium because I was concerned about permanently damaging my thyroid. I got down to 300mg every other day within a 3 week period and experienced the rage, hot temper stuff pretty dramatically. So again, within 1 week of restarting things smoothed out.
I have a few thoughts on this and your experience will shed light. There's always a withdrawal period where things are shaky. I've wondered whether if I just stayed the course I'd eventually smooth out without the lithium.>>>>>>>>>>> I have wondered a LOT! that IF I could find an AD that helped my dep/ocd/anxiety WITHOUT ALSO causing the anger side effects, could I do without the lithium? Apparently I'll never get to find out because the meds that DO help me simultaneously cause the anger/irrit/agit s/e's! I'd LOVE to find out though.....I've wondered if I was taking a benzo like Klonopin if then I could go off the lithium, since it seems I use my low lithium dosage more like a benzo for anxiety than as a mood stab. anyway.
It sounds like you've been on a substandard dose for a while still have symptoms and so your anger/irritability are not due to withdrawal. The other thing is taking an AD at all when you're BP.
>>>>>>>>> I'm forced to Barb---due to @#$%$#! OCD! I DID used to (YEARSSSSSS ago) only take lithium WITHOUT an AD......not good---I was depressed (needed the mood-lift badly) and I NEEDED an AD as an anti-ocd med.......if it weren't for the stupid ocd I would try that! I'd try to boost my mood using natural supps perhaps but the ocd forces me take an AD for it.
What kind are you taking?
I had nothing but problems with all the ADs I ever took, even with lithium as an augmentor.>>>>>>>>>>>> the ad's WORK well for me Barb...it's just that anger/irrit side effect thing...ruins everything. Dr. Heller says that buspar counters that but nobody here seems to know about that.
The only one that helped was nortriptyline, briefly, when I was suicidally depressed after my Mom's death. But once I emerged from that, I stopped nortrip and eventually felt much better without it. Lamictal 125mg and lithium seem to be doing the trick as far as keeping me from destabilizing. One other thing to consider is, are you really BP? Could it be that you're actually unipolar depressed and not getting high enough a dose of your AD? Even if this is true, my personal opinion is that anyone taking an AD should also take it with a mood stabilizer. Sigh, so many variables.>>>>>>>>>> TOO many variables...wayyyyy too many!
My personal hit is that you're not on enough lithium or whatever mood stabilizer you choose, and you're destabilizing with the AD. One more thought. A high level of testosterone is also associated with anger and aggression.
>>>>>>>>>>> The anger only comes from the meds....without the offending meds, there is no anger problem.
Can you possibly have the mixed blessing of having too much of a good thing? A hormone panel test would tell.
Have you read "Why your depression isn't getting better" by Michael Bartos, MD? He describes what you're going through very well and states without any doubt that BPs most definitely and absolutely require a mood stabilizer, should reconsider using ADs at all, and NEVER use ADs without a mood stabilizer.
Here's the website:Also, here's the recommended book page of a website I like very much. The entire website is great. You might find something that helps:
http://www.mcmanweb.com/book-16.htm
thanks!
And finally, you've been suffering with this for a long time now, Mac. I can only imagine how hard it must be. Why not just up your lithium and see?
>>>>>>>>> Barb, I am upping the lithium dose (600 mgs/day will do the trick).....oh, I'll feel better---it WILL help the anger/irrit thing...but it STILL doesn't tell me if it's just countering the AD's side effects OR if it is helping bipolar symptoms---since the bipolar symptoms AND the ad s/e's are the SAME!
If you start feeling better, I'll bet you can start lowering your dose of ADs and you'll get an even better response.>>>>>>>>>>>> Yep, if not for my stupid ocd...THAT would get WORSE!
But only after the withdrawal subsides. What does your pdoc say in all this?
>>>>>>>>>>>> Don't go to one now Barb......never liked my previous ones, they just weren't worth much at all.....can't get anything accomplished in 5 minutes w/ them anyway (the "alotted" time, lol).......actually, I was going to go to this one but he moved out of state recently.
He/she should be very aware and up on this whole AD/mood stabilizer issue. If he/she is not, why not?>>>>>>>>>>>>I went for years, total JOKE...the 5-minute, worthless visits..."NEXT"..."NEXT"....lol......I ALWAYS felt WORSE when I was going! Hated it for many reasons. I'd rather drop dead than go,lol
BarbaraCat
> Okay, for years I've taken AD's and lithium together....I've always taken a much smaller amount of lithium than most bipolars (I am likely bipolar, though very rarely get even the mini-highs (hypomania), I'm VERY much just the depression part)....anyway, I would, for YEARS, take only 600 mgs/day of Lithium along w/ my anti-dep (and this worked very, very well).......over the last couple of years, I have tried to even DEcrease that small lithium dose, taking only 300 mg/day of lithium w/ my AD...my lithium level is PUNY, something like .016 or .02 last time I checked it...in other words downright microscopic for a bipolar......anyways, over the last couple of years (since lowering my lithium dose to these PUNY levels) I have felt like total crap much of this time--- I have had a lot of AGITATED feelings with ANGER problems....and when I try to switch AD's, as soon as I get to just a moderately high dose, the agitation/anger/irritability gets MUCH worse....for a while I kept thinking that it's just the AD's that are causing the anger....but NOW I'm seriously thinking that it's the PUNY, DEcreased lithium dose, THAT WHEN COMBINED WITH the AD's, that is the problem....in other words, that the AD's are 'destabilizing' me or making me feel agit/angry but it's BECAUSE I'm on TOO LITTLE of a mood stabilizer....Isn't that a signal or tip-off to bipolar in many cases---that if someone is trying different AD's and having really bad effects and no success (and often feel even worse!) that they may be bipolar and need a mood stab. WITH their AD? I think my agitation/anger/irrit on the AD's is telling me that I need to increase my mood stab....(I KNOW that one AD (Prozac) was DEFINITELY a TERRIBLE drug for me, TERRIBLE anger/rage......but now, as more and more seem to cause problems, I think my PUNY lith. dose is a BIG part of the problem.....would most bipolars get totally messed up (agit/anger/irrit) if they were only taking an AD WITHOUT their mood stabilizer? Sorry for that rambling post, lol, what do you think Barb?
Posted by BarbaraCat on August 26, 2003, at 20:18:08
In reply to Re: BARB!, Naturopath visit results, please read, posted by McPac on August 26, 2003, at 17:21:16
Whew, baby! Alot here! I need to think about all this, but the fact you have OCD really does make it a hornet's nest. I don't know all that much about OCD but have heard that SSRI's are the meds of choice for it. One thing I can say before responding in more depth may interest you.
Remeron is a tricky med. I was on it for 6-8 months or so. At low doses (15-20mg) it acts mainly on serotonin and at a specific receptor site. It acts like a sleeping aid and makes people pretty groggy for hours in the morning (and let's not forget the pork-out syndrome). As you start raising it norepinephrine kicks in rather strongly. The magic number seems to be 45mg at which point it becomes much more activating. It sure did for me. I liked the extra motivation I got on it but was becoming anxious without really knowing why. Because anxiety causes depression everytime for me and I was getting more depressed, I raised it until I was hovering at 80mg. I felt great for a few weeks, then awful. I kept thinking that raising it would make me all effervescent, and activate me to raise my energy/exercise level for its AD and anti-porky effects. But I was having terrible anxiety, not so much irritability (that's more a BP thing for me and that's part of answers part II). I went on clonazapam to deal with the anxiety and it helped so very much. This was before lithium.
The most sedating and calming AD I've ever been on was Trazadone. It knocked me out at night which was a blessing, I could have easily stayed in bed til noon and had to force myself to get moving, but after a brisk shower was OK. It greatly helped my depression as well for many years. It is a lethargic med, which was mostly fine for me because my depressions are always characterized by too much anxiety. But sometimes the blobs were too strong and it was hard to motivate. I think that could have been helped if I motivated to exercise alot more, but back then I could get away with blobbing and still keep my girlish figure. ;-) I would consider it again if I ever needed an AD and if I started having bad insomnia, but would do so with caution because it causes weight gain and I've been working so hard at getting it off and also, lithium and lamictal are doing it for me so far. Another thing is that Trazodone is related to Remeron in it's 5H-3 (I think that's the one) receptor site target, but doesn't have any of the activating NE effects.
I quit Traz because Prozac broke onto the scene and everyone wanted some, including me. Tried Buspar briefly because of the anxiety I was getting with Zoloft and Wellbutrin combo (Gad, Zoloft made me apathetic and Wellbutrin made me speedy - can't win!) and it didn't do much except make me feel dizzy. Most pdocs don't think much of it. Didn't like Serzone one bit, even though it's very similar to Trazadone.
As I mentioned, Clonazapam helped me very very much in the anxiety department. Didn't dope me up, calmed me down and has some mood stabilizer qualities as well (says my pdoc). That's a good idea you have about benzos and/or lithium. Only way is to try, I guess, but don't stop the lithium until you know the benzo is working. Also, if Rem is working for you really really well, then bully! But it could be part of your problem, Mac. I recall reading something about Rem being indicated for OCD? Is that true? But they're all similar and all indicated for separate conditions. My suspicion is that it's a marketing ploy. If you follow the money, you'll find out that just about every mental health research project is funded by a pharmaceutical company somewhere along the money chain. Vested interest? Of course not! Pure altruism!
The other BP issues I'll get back to you on. But one thing to part with. I think the current revolving door 5 minute psych thing is an utter travesty and waste of time also and probably does more harm than not. All they can do is try yet another pill to put another temporary bandaid on our pain. They don't like the system either, but the current psych training is target the symptom pharmacology and most don't know there's anything else. Drug companies fund ALL aspects of physician education and research. I really hate managed care. ESPECIALLY since my insurance premiums have gone UP and not down, which was the whole point of the managed care mess we're in now.
Posted by McPac on August 26, 2003, at 21:17:11
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 26, 2003, at 20:18:08
Whew, baby! Alot here! I need to think about all this, but the fact you have OCD really does make it a hornet's nest.
>>>>>>>>>>> yes, the OCD makes everything much trickier.
I don't know all that much about OCD but have heard that SSRI's are the meds of choice for it.
>>>>>>>>>> Yeah...they work great for it....it's just the anger side effect thingy that fouls things up w/ those
One thing I can say before responding in more depth may interest you.
Remeron is a tricky med. I was on it for 6-8 months or so. At low doses (15-20mg) it acts mainly on serotonin and at a specific receptor site. It acts like a sleeping aid and makes people pretty groggy for hours in the morning (and let's not forget the pork-out syndrome). As you start raising it norepinephrine kicks in rather strongly. The magic number seems to be 45mg at which point it becomes much more activating. It sure did for me. I liked the extra motivation I got on it but was becoming anxious without really knowing why. Because anxiety causes depression everytime for me and I was getting more depressed, I raised it until I was hovering at 80mg. I felt great for a few weeks, then awful. I kept thinking that raising it would make me all effervescent, and activate me to raise my energy/exercise level for its AD and anti-porky effects. But I was having terrible anxiety, not so much irritability (that's more a BP thing for me and that's part of answers part II). I went on clonazapam to deal with the anxiety and it helped so very much. This was before lithium.
>>>>>>>>> Remeron at low-doses is GREAT for sleep problems for me....at 30 mg, it seems rather WEAK as an AD and for ocd and seems to have little anxiolytic effects....unfortunately, at 45 mg's I get the anger effect.....I'll see after I've INcreased my lith dose for awhile IF perhaps I can THEN take 45 mg without the anger problem---THAT would be cool (though I don't know if it would help anxiety at that dose)
The most sedating and calming AD I've ever been on was Trazadone.
>>>>>>>>>> Barb, is Trazadone the same med as Desyryl? I took Desyryl YEARS ago...didn't do much of anything at all for me....in fact, I got REALLY bad while on it (depression/anxiety)...just didn't seem to have ANY effect at all on me.
It knocked me out at night which was a blessing, I could have easily stayed in bed til noon and had to force myself to get moving, but after a brisk shower was OK. It greatly helped my depression as well for many years. It is a lethargic med, which was mostly fine for me because my depressions are always characterized by too much anxiety. But sometimes the blobs were too strong and it was hard to motivate. I think that could have been helped if I motivated to exercise alot more, but back then I could get away with blobbing and still keep my girlish figure. ;-) I would consider it again if I ever needed an AD and if I started having bad insomnia, but would do so with caution because it causes weight gain and I've been working so hard at getting it off and also, lithium and lamictal are doing it for me so far. Another thing is that Trazodone is related to Remeron in it's 5H-3 (I think that's the one) receptor site target, but doesn't have any of the activating NE effects.
I quit Traz because Prozac broke onto the scene and everyone wanted some, including me. Tried Buspar briefly because of the anxiety I was getting with Zoloft and Wellbutrin combo (Gad, Zoloft made me apathetic and Wellbutrin made me speedy - can't win!) and it didn't do much except make me feel dizzy. Most pdocs don't think much of it. Didn't like Serzone one bit, even though it's very similar to Trazadone.
As I mentioned, Clonazapam helped me very very much in the anxiety department. Didn't dope me up, calmed me down and has some mood stabilizer qualities as well (says my pdoc). That's a good idea you have about benzos and/or lithium.
>>>>>>>>>>>> I tell you, I think I MIGHT be able to get off lithium IF Klonopin could work that way for me....maybe, maybe not.....Klonopin is one drug I've wondered about for some time....used to be on xanax years ago (GREAT calming, mellowing med---hard as #$@!% to get off of for me back then...I am DEFINITELY keeping Klonopin in mind...will have to see how GP reacts to that! Don't know if he's a benzophobe or not, lol. I've heard Depakote is very good for the anger thing...don't know much about Dep, if it's a good mood stab. or not for most people? Funny thing is, ANGER is NOT an issue with me without meds that cause it...if I didn't have to take certain meds, there'd be no anger issue. But I still think I'm likely bipolar, anger issues or not....so a mood stab. is very likely always going to be a piece of my puzzle. There's sooo many variables that it's SOOO hard to tell exactly whats what!
Only way is to try, I guess, but don't stop the lithium until you know the benzo is working. Also, if Rem is working for you really really well, then bully! But it could be part of your problem, Mac. I recall reading something about Rem being indicated for OCD? Is that true?
>>>>>>>>>>> Yes, Remeron is effective for some folks for ocd....usually at the higher doses (yet Remeron @ 45 mg's STARTS my anger problem...see what a MESS all this crap is? I feel like curing cancer would be wayyyy easier than sorting out a complex psych patient's crappola!
But they're all similar and all indicated for separate conditions. My suspicion is that it's a marketing ploy. If you follow the money, you'll find out that just about every mental health research project is funded by a pharmaceutical company somewhere along the money chain. Vested interest? Of course not! Pure altruism!
>>>>>>>>>>>> I said the SAME thing here before and was called a "conspiracy theorist"....LOL!...yeah right!
The other BP issues I'll get back to you on. But one thing to part with. I think the current revolving door 5 minute psych thing is an utter travesty and waste of time also and probably does more harm than not.
>>>>>>>>>>> I always felt MUCH worse AFTER each visit! Can you imagine trying to explain/sort out this MESS in 5 minute increments?! Unreal!
All they can do is try yet another pill to put another temporary bandaid on our pain. They don't like the system either, but the current psych training is target the symptom pharmacology and most don't know there's anything else. Drug companies fund ALL aspects of physician education and research. I really hate managed care. ESPECIALLY since my insurance premiums have gone UP and not down, which was the whole point of the managed care mess we're in now.
>>>>>>>>>> It really is a joke! NO DOUBT! Thanks Barb!
p.s. How's the Primal Defense treating you?
Posted by Dr. Bob on August 26, 2003, at 23:12:23
In reply to Re: BARB!, Naturopath visit results, please read » BarbaraCat, posted by katia on August 26, 2003, at 12:55:57
> If we get re-directed to social babble; just follow the link and we'll take it from there. It's easy!
I'm glad you don't think it's a big deal. :-) Here's a link:
http://www.dr-bob.org/babble/social/20030818/msgs/254576.html
Bob
Posted by fluffy on August 27, 2003, at 12:26:35
In reply to Redirect: careers, posted by Dr. Bob on August 26, 2003, at 23:12:23
Hi Barb-cat, Katia, McPac, Patricia (and all!)
I just thought I'd share my progress with my little problem of needing med augmentation. I went to my pdoc yesterday. I felt like I was in the "hot-seat" of "who wants to be a basket-case?" BTW, as an aside--does anyone know where the term "basket case came from? did they carry the head-cases of yore with baskets to the asylum? Just curious...
Since the Lamictal alone doesn't seem to do the trick @200mg, I was given two choices: Lithium or Wellbutrin. I sat there for like 30 minutes with him debating the pro's and con's. (thank god he can spend that time with me...he doesn't work by the hour, as he hired by a university, and is a researcher). After much deliberation, I decided on the Li. I think I'd rather experience some lethargy and maybe a case of the shakes than another mixed state. It doesn't seem like my problem is only a depressed episode anyway. I feel like I'm completely cyclothymic at this point. I guess I have co-morbid cyclothymia with BPII.
Like you, McPac, I've felt this whole ordeal has all been very, very confusing. I've had to wrestle with the AD crap, too since I only had major depressions when I was younger. I've had the same questions as you--was my agitation side effects or an underlying problem?? Since being treated with AD's, the underlying problem of BPII has emerged, I guess. And since I can't seem to tolerate SSRI's anymore, I'm taking the safe, mood stabilizer route, now.
So I'm holding my breath and jumping into the Li pool. I'll keep you posted.
Katy
Posted by Ponder on August 27, 2003, at 14:41:45
In reply to basket-case in a wave-pool, posted by fluffy on August 27, 2003, at 12:26:35
Katy,
I found your post interesting as you assessed your history and made an effort to identify your current state (cyclothymic). My history is similar, having been treated for depression quite unsuccessfully despite every class of AD meds since my early 20's.
I read a lot of medical literature and regularly review the symtoms of these various states, not just the symtoms listed in the DSMV, but also articles that describe in greater detail how a patient might experience these states. In retrospect I believe I may have been Bipolar all along. Doctors weren't too good at diagnosing BPAD in those days.Then, a few years ago I had what was clearly a horrendous and protracted mixed states episode that was more suggestive of Bipolar I. It crashed, of course, into incapacitating depression that ultimately resulted in the loss of my career.
I am currently on Lamictal 200 and WB 300-400/day, but also Ativan as needed. Anxiety has always been a strong component of my illness, although I did not realize it when I was working, thinking instead that I was "stressed" about the many tasks that needed doing and that I would be "unstressed" as soon as I got them all done, which was never. Any med to control the anxiety made me too sleepy to work efficiently, so I lived with the anxiety instead.
I did not realize at that time what a strong contributing factor anxiety was to the whole mix of other symptoms.
My bipolar fluctuations continue, but I have not had a bad-as-it's-ever-been depression since that time a 3 years ago. I wonder if the multitude of treatments that I am receiving is actually working, with "bleed-through" mood variations, or if Bipolar II ignited into Bipolar I and later settled down to cyclothymia (well, something a little more intense than cyclothymia, perhaps).
For the life of me, I don't know how a patient is supposed to determine this, and doctors rely on patient reports, so they don't seem to help much in this process if the patient is not pretty good at self-diagnosis and assessment of their own symptoms.
The literature seems to suggest that these different states are distinct pathological entities. In one article, it said that having a mixed-states episode ruled out Bipolar II and indicated Bipolar I. So, I don't know if a person can move from one Dx to another. When I was younger, I had clearer delineation between depression, euthymia, and hypomanic. Now it seems I constantly deal with an amorphous mix of difficulties interspersed with a blessed few days of relative wellness from time to time.
Lamictal/WB may be an overly activating combo. I don't know. I recently had my first full-blown anxiety attack (partly situational, but, you know, I've had plenty of stress in the past and didn't have a panic attack). I backed off the WB a little and added in the Ativan. But I continue to wonder if Lithium would be better, especially since Barbara has had such success with low-dose Li as a part of her combo.Having been through a million med trials and even neurosurgery (VNS) you'd think I would be over the fear of the med-trial process, but instead I seem to be even more reluctant to change anything. This state of clyclothymic-like symptoms is better than full-blown manic-depressive cycles, so I find myself grateful for the improvement and fearful of spending more time feeling sick from side-effects, lack of efficacy, etc. with new drugs.
I will be very interested in your experience with Lamictal and Lithium. You may even decide to add in WB after that if you find yourself needing more energy/motivation. From what I have read on the board, that may be a good combo. Many people seem to have had good success with Lamictal/Lithium. WB seems to be a pretty versatile add-on with little propensity for destabilization.
I hope you'll keep us all posted on your progress. The sharing of these experiences is so valuable to us all.
Posted by katia on August 27, 2003, at 14:58:06
In reply to Re: basket-case in a wave-pool » fluffy, posted by Ponder on August 27, 2003, at 14:41:45
Hi Ponder,
I wonder if DXs can change over time. I imagine if you are medicated from BPI and the result from the med is cyclo. then you are still BPI b/c you're on meds? And would it be BPI in remission/dormat, but not exinct?Good question.
Anyone else have answers?
Katia
Posted by Ron Hill on August 27, 2003, at 15:42:44
In reply to Re: The Cortisol/Sugar Connection » Ron Hill, posted by Barbara Cat on August 17, 2003, at 17:22:30
Barbara,
Thank you very much for taking the time to dig up this cortisol/sugar information for me. Sorry to take ten days to post my thanks.
In the early 80's I became convinced that a low-fat high-complex carbohydrate diet was best for my health and my training. I was wrong! About four or five years ago I came to the conclusion that I am slightly-to-moderately hypoglycemic. So I read "Enter the Zone" by Dr. Barry Sears and the book changed my thinking with regard to diet.
As a result, I try to never eat sugar during the day in order to avoid the blood sugar rollercoaster (eat sugar, insulin released, blood sugar goes too low). I experience the rollercoaster even with complex carbohydrates. Therefore, I always try to eat adequate protein and a small amount of good fat with my fruits and vegetables (and occasional whole grains). However, since I am a junk-food addict at heart, I would periodically binge on treats just before bedtime. My rationale was that the blood sugar rollercoaster associated with my late night snack would be inconsequential because I'd be asleep when my blood sugar dropped. But after reading the information you kindly provided, I have changed my thinking on the subject and I’m attempting to forgo my late night indulging.
Tell me this; what good is it for me to have an addictive personality if I'm not allowed to partake in any of my addictions?
Thanks again, BCat!
-- Ron
---------------------------> Hi Ron,
> Here's a quick and dirty on the subject:
>
> http://vitamintrader.com/articles/1997_04_HypoG.html
>
> There's basically a condition called 'reactive hypoglycemia' which isn't in the mainstream medical lexicon, which only measures fasting glucose and more severe/standard hypoglycemia. "Reactive hypoglycemia" describes a condition that roller coasters up and down the sugar scale all day, causing our already stressed out adrenal systems additional dysfunction. As this article briefly goes into, cortisol which controls blood sugar, should remain low at night. Adrenal glands make cortisol. Adrenal glands become malfunctioning through an overload of stress. There results an inability to smoothly orchestrate cellular insulin/glucose transport causing depression and anxiety among other health issues. Too high a simple sugar condition in the blood causes spikes of cortisol trying to control the sugar/insulin symphony and it just can't because this hormonal system/balance is dysfunctional. Cortisol spikes are like little jolts of adrenaline and high octane caffeine - not good for nighttime sleepies.
>
> Anyhow, the whole subject is fascinating and only one piece of the puzzle that is emerging for me - the Hypothalamus/Pituitary/Adrenal axis implication in many of our woes (I know in my own). There's also a very good little known book called "Lights Out: Sleep, Sugar, and Survival" by T.S. Wiley. Stuff in there that seems no-brainer revolutionary material but we never hear about it or make the connection. I think you'd enjoy it. Happy reading. - Barbara
Posted by fluffy on August 27, 2003, at 16:35:57
In reply to Re: basket-case in a wave-pool » fluffy, posted by Ponder on August 27, 2003, at 14:41:45
Hi Ponder--
Thank you for your almost poetic and thoughtful post (I suppose as your name implies!--ponderous indeed!). I'm so sorry that you lost your career due to your illness. I hope that you are well enough to resume in some capacity. I really don't know how I managed to keep my job. Aside from hallucinations, I had every symptom of a mixed state for days at my job--crying, thinking about suicide, pacing, --you know--excrutiating and devistating. (then a 3 month long depression where I stared into space for hours).
So maybe I am bipolar I. Who knows. I didn't really report everything when I got my diagnosis. But even then, the intern who diagnosed me said I was BPI. It devistated me, as I refused to believe that I was mentally ill, and he revised his diagnosis to BPII since I hadn't been hospitalized. I know I should have been, though. How I survived that episode, I do not know.
I think that a diagnosis can surely change as time goes on. I was diagnosed as first having panic disorder (1st episode), then major depression (2nd episode), then BPII (3rd and most recent full episode). Hopefully, with the aid of medications, a person will not escalate into a new diagnosis. I suppose I should just be happy with being cyclothymic at this point. But I want to test it out a little more and try to get as close to normal as possible. A book that I've been reading ("Bipolar Disorder Survival Guide")states that most BP patients can expect soft cycling, even on medication. I'm going to try to soften my cycling even more, since I'm still having marked impairment with sleep loss, agitation, lethargy, guilt, etc. So I'll definitely let you know how it goes. And thanks for the advice about the Wellbutrin. I had some similar thoughts about maybe adding it if I felt too tired or depressed with the Lithium on board. I just hope I tolerate the Li, and that it works.
Stay well Ponder (and others reading)
I enjoy your thoughts,Katy
Posted by katia on August 27, 2003, at 16:46:54
In reply to Re: Cortisol/Sugar Connection - Thanks BCat! » Barbara Cat, posted by Ron Hill on August 27, 2003, at 15:42:44
Hi Ron and Barb,
I'm actually going in for a metabolic testing. The website is [www.bloodph.com]. Apparently, unless you find out your metabolic type, none of the other kinds of diets/nutrition regimes really work. It's best to just read what he has to say as I'll butcher it.I was going to do this two years ago, but finally decided not to go. I'm ready for this now. I have an appt. next week. Just thought I'd throw in my 2c as you both are on nutritionalish topics.
katia
Posted by Kacy on August 27, 2003, at 16:50:14
In reply to basket-case in a wave-pool, posted by fluffy on August 27, 2003, at 12:26:35
As to your aside:
per American Heritage:
"In the grim slang of the British army during World War I, it referred to a quadruple amputee."per The Phrase Finder http://phrases.shu.ac.uk/meanings/85850.html
"Originally a soldier who had lost his arms "and legs and had to be conveyed in a wicker wheelchair."Just go to The Phrase Finder and type one in and you'll often get the answer.
Posted by BarbaraCat on August 27, 2003, at 18:08:06
In reply to Re: basket-case in a wave-pool » fluffy, posted by Ponder on August 27, 2003, at 14:41:45
Hi Ponder,
Your post could have been written by me, it was so familiar. Your comments on anxiety causing a spiral were so right-on.I never considered myself BP at all thinking, as many do, that 'manic depression' looked like Patty Duke's wild and crazy form of it - very separate depression and loony mania. Only recently I realized that my 'depressions' were very different from what others seemed to experience and were instead very descriptive of bipolar mixed states. I've had the classic polar opposite swings but I never really equated the manic with anything except high spirits or disorganization, and the depressions were, well, vanilla depression. But then the mixed states, always with me tho infrequently through my life, were no longer an every few years event, but were fast becoming a constant way of life.
I think it was Starlight on another thread that suggested that the very intense almost psychotic symptoms in a mixed state are really more indicative of BP-I than BP-II. Mine certainly were psychedelic and nightmarish. I wonder, like you, if my 'basket-caseness' started off as unipolar depression but then devolved into BP. But looking back, the BP signs were there all along, it's just that the depression and mania were more separate and distinct.
My pdoc suggested Wellbutrin a while back when none of the SSRIs were working. I tried it along with Zoloft at one point because of the apathy I got with zoloft, but WB made me feel too wired. Today, I'm feeling kinda dopey and have given into the temptation of bed slug-dom. I feel perfectly OK about it but you've got me thinking about WB. Nah, I think I'll stick to Lam and low dose lithium. We seem to have many similarities and I sure want to frequently compare notes with you. - Barbara
Posted by BarbaraCat on August 27, 2003, at 18:25:53
In reply to basket-case in a wave-pool, posted by fluffy on August 27, 2003, at 12:26:35
Good luck with lithium, Katy!!! I hope and pray it works for you as well as for me. It may take 2-3 weeks, but for me, I noticed a diff in 3 days. A note on the tremors. I got them very mildly at first on lithium and then they subsided. When I started nortriptyline, they REALLY came on like gangbusters. I couldn't even put in my contact lenses and my handwriting went to hell in a 'hand basket' (there's that basket thing again). The tremors subsided somewhat but it was only after stopping the nortriptyline that they went away completely. I was concerned at first that it was the lithium and that I'd have to reconsider taking it, because my fine motor skills were shot to hell (in a hand-basket), but I'm relieved that it wasn't the fault of lithium. I got some frequent peeing spells at first and some other annoying side effects that I can't remember. I think I felt nauseous at first, so I take it with or after a meal. Oh yeah, my hair felt weird at first, wouldn't hold haircoloring, and got very curly which it never was before! I'm now back to thick and wavy and normal. How strange! I kinda liked the curly! I also use extra sea salt as recommended because it gets excreted with increased urine and salt also benefits lithium's nerve conduction.
I'd encourage you to play around with subtherapeutic doses if you can. My pdoc subscribed 900mg for me, but I found it to be too much and too zombie-like, even though I was in the low end of the therapeutic window. I think lithium acts as a synergistic potentiator with other meds so the party line on dosing may not be accurate when you're taking something like lamictal. Again, good luck, Fluffsters! - Barbara
Posted by BarbaraCat on August 27, 2003, at 19:03:57
In reply to Re: Cortisol/Sugar Connection - Thanks BCat! » Barbara Cat, posted by Ron Hill on August 27, 2003, at 15:42:44
Hi Ron,
Yeah, I think most of us were in that low fat, high complex carbs camp and tried diligently to follow it. I never really could. I suscribe more to the 'food as a vehicle for butter and whipped cream' philosophy. And eggs without the yolk? Never! So I was always a rebel when it came to that, even though I feared I was fatally clogging up my arteries. Even though I always ate well and hardly ever any junk food, I always slathered on the butter and oil. I eventually said 'hell with it, it doesn't seem to be hurting Julia Childs' and am glad I followed my intuition and taste buds.My sister-in-law, however, who I'm convinced has body dysmorphic condition, has been anal about fat for around 10 years now. She even uses no-fat 1/2 and 1/2 in her coffee. What a weird concept! Yes, she's thin, but she's starting to look like beef jerky, her face is dry and lined, her hair is dry and she's got some very definite harpy qualities that could use some good Omega 3s. Her son, who has also been the low, no fat recepient of her diet, has got ADD and other learning disabilities. When I last saw her, she peered at me and said 'Barbara, you're almost 6 years older than me. You're supposed to have worse skin than me. How come your skin looks so good?' and I said "Two words: lotsa fat". I've sinced balanced my protein after reading Barry Sears' books and follow a close version of The Zone diet. But I WILL have real whipped cream on my strawberries and that is that!
I really recommend you get "Lights Out" by Wiley as I mentioned previously. I'm re-reading it and wow! does it make sense. They explain the reasoning behind carb/cortisol metabolism from an evolutionary and neurological standpoint that is helping me to understand WHY rather than to just follow a lifestyle and diet because it seems to makes sense.
About addictions: I love Mark Twain's analogy of bad habits and addictions as ballast. He says if we have no bad habits to get rid of it's like being on a sinking ship with no ballast to throw overboard - you're screwed. But I think that eating high carbs late at night will cause the ship to sink anyway due to our fat selves being on board. - Barbara
Posted by BarbaraCat on August 27, 2003, at 21:22:39
In reply to BARB!, Naturopath visit results, please read, posted by McPac on August 26, 2003, at 21:17:11
Deseryl and Trazadone are one and the same. I had to take 150mg to get an AD effect. Most docs stop at 50mg. I don't think it would be the best first line defense, but might be better than something like Buspar to control anxiety. But clonazapam would be my first choice. I can't even remember how many mornings I stumbled into work late because of traz hangover.
Remeron at 45mg is when I started feeling anxiety and unbalance. The NE effect that kicks in that level is pretty harsh. I'd put money on the possibility that this is what's contributing to your irritability. Why Remeron? I was a devoted fan for a while, but eventually dropped it like a hot potato. I clung on to it at 15mg for a few months after starting lithium and still felt icky. Someone on this board said 'just stop taking it, cold turkey'. I did. It was the easiest med to quit and I felt better almost immediately. I'm one of those classic cases who can't take SSRI's or their analogs because of the BP. Maybe there's another med that would work better for you. I just have a bad feeling about Remeron. It sure made me feel jittery once I got to 45mg. Here's a site I found on OCD and meds:
http://www.ocfoundation.org/ocf1050a.htm
You originally asked about BPI vs. BPII. Of course, BPI is more severe, that goes without question. I'm not sure if it's just a matter of degrees of symptoms or not. BPII is characterized by occasional hypomania but primarily depression that doesn't get better with SSRI's. BPI's have psychosis and frequent manias. If there are mixed states involved, BPI's are much more severe and hallucinogenic than BPIIs. There's a definite psychosis present. You might already be familiar with this website, but I think he's got the best BP info around:
http://www.psycheducation.com/depression/frameset.html
If I were you, here's what I'd do. I'd go back to your former dose of lithium, 600mg wasn't it? I'd take clonazepam, low dose, 3x a day for 2-3 weeks to break the anxiety cycle. I personally didn't get addicted to it at all and was able to take it when needed after that 3 week loading. I'd try to find some other med than Remeron. Perhaps you've tried others and this is the best one so far? Maybe it will be OK once you calm the anxiety with clonazapam. Maybe the lithium will calm things down. But I'm tellin' ya, Remeron is a strange one and there's got to be something else out there for you.
About Primal Defense. I'm about at 6 of those teeny little measures a day. I think it's helping cause I'm not feeling so toxic, but I sure wish I could poop a whole lot more. I thought PD was going to help with that. Oh well, irritable bowel syndrome is just one of those things that comes with fibromyalgia. As I get better, my plumbing will improve. PD is helping out in the meantime. My naturopath recommends it and if it's good enough for her, then by golly, it must be good. How about you? - Barbara
Posted by katia on August 27, 2003, at 22:14:14
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 27, 2003, at 21:22:39
Hi Barb,
I'll let you know how it goes for me next week with the metabolic testing. It might be something that could be helpful to you. People have claimed "miracles" from this and it's mainly about diet/nutrition. I left the website earlier. Have a look at it. Also, if you want to follow up on that career topic, just click on the link from Dr. Bob and I'll chat with you there too. It's pretty interchangeable, not so divided as you probably think.
Katia
Posted by McPac on August 27, 2003, at 23:23:25
In reply to Re: BARB!, Naturopath visit results, please read » McPac, posted by BarbaraCat on August 27, 2003, at 21:22:39
Remeron at 45mg is when I started feeling anxiety and unbalance. The NE effect that kicks in that level is pretty harsh. I'd put money on the possibility that this is what's contributing to your irritability.
>>>>>>>>>>> Oh yeah! Up to 30 mg of Rem I can handle---though at 30mg I don't quite get enough mood-lift and it does squat it seems for anxiety (just seems WEAK at that dose).....but at 45 mg, that stupid NE kicks in, I get angry and irritable and somewhat agitated.....45 mg is too activating for me.....maybe that energetic, activating stuff is great for some folks, NOT me it seems!
Why Remeron?>>>>>>>>>>>> Only because it is one of a VERY few non-ssri AD's that has worked for OCD for some folks. At low-doses I love it...that higher dose-NE effect ruins it for me!). I don't get as many side effects at all from Rem (except at 45mg!!)....but it just seems too weak at 30mg...for me anyway.
I was a devoted fan for a while, but eventually dropped it like a hot potato. I clung on to it at 15mg for a few months after starting lithium and still felt icky.
>>>>>>>>>> Rem at 7.5 mg makes a GREAT sleep aid.
Someone on this board said 'just stop taking it, cold turkey'. I did. It was the easiest med to quit and I felt better almost immediately.
>>>>>>>> Yes, it is easier and quicker to quit.
I'm one of those classic cases who can't take SSRI's or their analogs because of the BP.
>>>>>>>>>>>>> Barb, it seems that some meds I CAN handle well at lower-moderate doses (but they're usually not totally effective there) YET those same meds, when I hit certain slightly higher dose levels, cause the anger/irrit/agitation.........it seems to me that the anger/irrit/agit comes out when those meds hit a certain activation level....like Zoloft, at 50 mg I'm okay, but 75 mg starts the anger....Remeron, 30 mg ok, 45 mg, ANGER....same w/ other meds....it's like a certain activation level is reached and then whammo! along w/ that increased activation comes the nasty effects....does that make sense? Seems like there's got to be some psychiatric term for that? (they've got a term for everything else, lol)
Maybe there's another med that would work better for you. I just have a bad feeling about Remeron. It sure made me feel jittery once I got to 45mg. Here's a site I found on OCD and meds:
http://www.ocfoundation.org/ocf1050a.htm
>>>>>>>>>>> The OCFoundation! I used to belong to that....glad to see that site again!
You originally asked about BPI vs. BPII. Of course, BPI is more severe, that goes without question. I'm not sure if it's just a matter of degrees of symptoms or not. BPII is characterized by occasional hypomania but primarily depression that doesn't get better with SSRI's.
>>>>>>>>>>>>>>> Barb, I'm definitely primarily depressed w/ the occassional mini-highs ....... yet the ssri's work GREAT (but I took the ssri's with low-dose lith....don't think I'd do well w/ssri without lith.......so does that sound more like bp2?......never had the psychotic symptoms......the lows get unbelievably low though (w/out meds)....... have had TERRIBLE anxiety mixed together w/ lows before........still sound more bp2?
BPI's have psychosis and frequent manias. If there are mixed states involved, BPI's are much more severe and hallucinogenic than BPIIs. There's a definite psychosis present.
>>>>>>>>>>>>> Can someone be bp1 even if they've NEVER had the psychotic part?
You might already be familiar with this website, but I think he's got the best BP info around:
http://www.psycheducation.com/depression/frameset.html
Thanks!
If I were you, here's what I'd do. I'd go back to your former dose of lithium, 600mg wasn't it?
>>>>>>>>>> Yep, 600 mg lith does the trick! Could probably get by w/ 450 too but I've restarted the 600 already (Barb---does such a low lith dosage...plus my PUNY blood level....does that indicate that I don't have a terribly severe case of bp? maybe a milder case? (although the lows, as I said, ARE severe w/ out meds)
I'd take clonazepam, low dose, 3x a day for 2-3 weeks to break the anxiety cycle. I personally didn't get addicted to it at all and was able to take it when needed after that 3 week loading.
>>>>>>>>>>>>> I think that many folks REALLY need something to keep their anxiety away...keeping that anxiety away often leads to keeping depression and the other crap away...seems like anxiety often leads to depression then on to other terrible symptoms )anxiety>depression>"everything" at once!......kick anxiety's butt and oftentimes avoid the rest! Klonopin is definitely a drug I've got my eye on (took xanax years ago, great! but incredibly hard to get off of...that's why I've tried to stay away from Klonopin so far)
I'd try to find some other med than Remeron. Perhaps you've tried others and this is the best one so far?
>>>>>>>>>>>>> again, non-ssri ocd meds are VERY few.
Maybe it will be OK once you calm the anxiety with clonazapam. Maybe the lithium will calm things down. But I'm tellin' ya, Remeron is a strange one and there's got to be something else out there for you.
>>>>>>>>>>>> I really think I know what I'm going to try next---Celexa.....it's an ssri I know....I'm very confident it will work for the dep/ocd/anxiety for me....again, my ssri problem is that anger/irrit thingy ..... but I think I can handle Celexa....esp. on lith 600 mg/day....I HATE calling any doc and asking for a new med trial...but tomorrow I am.
About Primal Defense. I'm about at 6 of those teeny little measures a day. I think it's helping cause I'm not feeling so toxic, but I sure wish I could poop a whole lot more. I thought PD was going to help with that. Oh well, irritable bowel syndrome is just one of those things that comes with fibromyalgia. As I get better, my plumbing will improve. PD is helping out in the meantime. My naturopath recommends it and if it's good enough for her, then by golly, it must be good. How about you?
>>>>>>>>>>>>> I've never tried it yet Barb....I'd love to believe (and find out) that some NATURAL substance could really, dramatically improve major psych symptoms....don't know if Primal Defense can do much on its own....maybe a piece of the puzzle....seems like cleaning out the inside and taking great care of the inside should help though....I'll no doubt try it in time...take care BC! THANK YOU so much also!!!!
- Barbara
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