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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Lyrical13 on July 23, 2004, at 14:58:07
anyone found a good med for bp2 that's not so incredibly sedating? I'm on Depakote right now and just want to sleep. I have periods of severe depression with some hypomania. not rapid cycling.
Posted by holymama on July 23, 2004, at 16:42:42
In reply to good med for bp2, posted by Lyrical13 on July 23, 2004, at 14:58:07
Hi Lyrical,
I've been trying out different meds for my bipolar II for about a year now, and understand about the lethargy and sleepiness caused by some drugs. A small amount of wellbutrin added to my cocktail (150 mg) helped my energy levels A LOT. I feel much more myself and get much more done on it. Also, I don't know if this helps, but I am on 4 meds for my bipolar, but small amounts of each. That may cause less drowsiness than a large dose of one, perhaps. Just some ideas for you. Best of luck. ~~Autumn~~
Posted by karen m. on July 23, 2004, at 16:43:48
In reply to good med for bp2, posted by Lyrical13 on July 23, 2004, at 14:58:07
i'm using lamictal for depression but it is mainly a BP drug. No sleepiness for me.
it's a fairly clean drug with few side effects. might be worth reading up on.
Posted by SLS on July 23, 2004, at 17:14:52
In reply to good med for bp2, posted by Lyrical13 on July 23, 2004, at 14:58:07
> anyone found a good med for bp2 that's not so incredibly sedating? I'm on Depakote right now and just want to sleep. I have periods of severe depression with some hypomania. not rapid cycling.
Does Depakote effectively prevent your depression?Are you taking an antidepressant?
Do you need an antidepressant?
Does the hypomania occur only during antidepressant treatment?
Did you want to move towards using another anticonvulsant or an antipsychotic?
- Scott
Posted by Lyrical13 on July 23, 2004, at 18:28:54
In reply to Re: good med for bp2 » Lyrical13, posted by SLS on July 23, 2004, at 17:14:52
HI Scott
It's still me...the same lyrical as the non-sedating bp2 med. Depakote causes the depression I think. And i had periods of hypomania without any meds and the worst one was while on Effexor. So hypomania occurs with and without ADs. I would be open to exploring atypical APs or AS meds. Just want something that doesn't completely knock me out or make me feel like a zombie.
Posted by SLS on July 23, 2004, at 18:48:58
In reply to Re: good med for bp2, posted by Lyrical13 on July 23, 2004, at 18:28:54
Hi.
> I would be open to exploring atypical APs or AS meds
What's an "AS" med?
- Scott
Posted by TJO on July 24, 2004, at 6:58:18
In reply to Re: good med for bp2 » Lyrical13, posted by SLS on July 23, 2004, at 18:48:58
Hi,
Seroquel works wonders for me at 700mg. At any lower dose it is incredibly sedating but for some reason at that high of a dosage it isn't. I'm not sure if I am bipolar I or II but it doesn't matter-the drug works and doesn't give me intolerable side effects. The only weight gain I have experienced was from me pigging out at the "all-you-can-eat" chinese buffet too many times. The med itself doesn't change my metabolism or slow it down. I have a little bit of dry mouth occasionally and sometimes have a slight delay in urinating. That's it-no foggy headedness, no sexual side effects, no risk of TD. Yay.
Also I should add that I am on another atypical AP at the same time. I take Abilify 30 mg in the am.
Tammy
Posted by Lyrical13 on July 24, 2004, at 7:49:25
In reply to Re: good med for bp2 » Lyrical13, posted by SLS on July 23, 2004, at 18:48:58
AS=Anti-Seizure like Neurontin, Depakote, etc.
Posted by SLS on July 24, 2004, at 8:35:02
In reply to Re: good med for bp2, posted by Lyrical13 on July 24, 2004, at 7:49:25
> AS=Anti-Seizure like Neurontin, Depakote, etc.
>Thanks. :-)
Usually AED (anti epilepsy drug)
- Scott
Posted by SLS on July 24, 2004, at 8:52:56
In reply to Re: good med for bp2, posted by Lyrical13 on July 24, 2004, at 7:49:25
It is so hard to give advice to someone. I'm afraid that I might pick wrong. I don't know. Maybe we can work through this together.
Step #1
Since depression is so much of a problem, and Depakote by itself doesn't adequately treat it, that indicates that you probably need an antidepressant. Which would you choose and why?
- Scott
Posted by Lyrical13 on July 25, 2004, at 10:20:49
In reply to Re: good med for bp2 » Lyrical13, posted by SLS on July 24, 2004, at 8:35:02
Thanks on AED...didn't know that one.
re: choosing AD. Probably Celexa because it worked for me before with few side effects if any. It has been a couple years since I have taken it so it might work for me again. Or I might try Wellbutrin..I took that briefly to counteract the effects of Paxil (sexual SE's). I have taken a few different SSRI's so maybe one that works on a different chemical would be helpful. My pdoc is concerned about them pushing me into manic phase but if I have a MS along with it maybe they would balance each other? I see my doc on WEd. so am planning on discussing this with him.
Posted by SLS on July 25, 2004, at 10:53:19
In reply to Re: good med for bp2, posted by Lyrical13 on July 25, 2004, at 10:20:49
I don't mind having a dialogue if you don't. It might be a pretty cool way to arrive at a decision.
How do you feel right now?
> re: choosing AD. Probably Celexa because it worked for me before with few side effects if any. It has been a couple years since I have taken it so it might work for me again.
Did it poop-out and stop working? Why did you stop taking it?
> Or I might try Wellbutrin..I took that briefly to counteract the effects of Paxil (sexual SE's).
Did Paxil work? Why did you stop taking it?
> I have taken a few different SSRI's so maybe one that works on a different chemical would be helpful.
I guess the questions above cover this, but why were all of the SSRIs you tried inadequate?
> My pdoc is concerned about them pushing me into manic phase but if I have a MS along with it maybe they would balance each other?
How manic do you get?
Does Depakote work to control your manias?
The goal is to find a replacement for Depakote. However, it is important to know that you have a drug to use in an emergency as a fire-extinguisher against mania. Zyprexa might also be a good drug for this purpose. You might want to start out with AD + Trileptal, and use Depakote or Zyprexa in case a manic reaction occurs that warrants treatment. Other mood stabilizers that you can discuss with your doctor would be:
AED:
Trileptal
Lamictal
Topamax
Neurontin(?)
Zonegran(?)
Keppra(?)AP:
Zyprexa
Seroquel
Risperdal
Abilify(?)lithium (of course)
How did you feel on Effexor before you became hypomanic on it? What else were you taking at the time?
- Scott
Posted by ST on July 25, 2004, at 23:25:19
In reply to good med for bp2, posted by Lyrical13 on July 23, 2004, at 14:58:07
Hi,
I'm a BP II and I have used this cocktail to much success: Wellbutrin, Depakote and Celexa. The only problem was Celexa made me gain A LOT of weight - but everyone is different. For me, being on just one AD didn't do the trick; I needed two that work differently to do the job (my depressions are severe). You may want to try Lexapro, since it is chemically similar to Celexa, but "supposedly" without the weight gain side effects.
Good luck!
Posted by Lyrical13 on July 26, 2004, at 10:16:58
In reply to Re: good med for bp2 » Lyrical13, posted by SLS on July 25, 2004, at 10:53:19
> I don't mind having a dialogue if you don't. It might be a pretty cool way to arrive at a decision.
>
> How do you feel right now?Right now I am just tired all the time and want to sleep or just lay around...no motivation. Low level depression I think. I am occasionally a little sad. I'm not manic though.
>
> > re: choosing AD. Probably Celexa because it worked for me before with few side effects if any. It has been a couple years since I have taken it so it might work for me again.
>
> Did it poop-out and stop working? Why did you stop taking it?Re: Celexa...I was on it for 3 years and eventually maxed it out (60 mg). After a while that didn't work any more either so I had to switch meds.
>
> > Or I might try Wellbutrin..I took that briefly to counteract the effects of Paxil (sexual SE's).
>
> Did Paxil work? Why did you stop taking it?Paxil worked but it killed my sex drive. I felt like I was just wooden. That was distressing on its own.
>
> > I have taken a few different SSRI's so maybe one that works on a different chemical would be helpful.
>
> I guess the questions above cover this, but why were all of the SSRIs you tried inadequate?The only other AD I tried (besides the WEllbutrin in combo with Paxil...which worked pretty well. I just stopped taking it in the summer one year because I felt pretty good and didn't think I needed it then) Anyway....after Celexa pooped out, I tried Serzone. I felt "zoned". It helped but eventually we maxed that out and a year later we switched to Effexor. Effexor XR was wonderful. It took care of my depression through the fall and winter. When spring came is when I got manic. My worst hypomanias are basically some irritability, spending sprees (maybe $200 at a time...total of $500 in one month) and LOTS of projects all at once (I counted 15 one time). Also only 2-4 hours of sleep per night and not feeling tired. That's my all time worst.
>
> > My pdoc is concerned about them pushing me into manic phase but if I have a MS along with it maybe they would balance each other?
>
> How manic do you get? see above
>
> Does Depakote work to control your manias?Yes...mania got much better once I got on Depakote.
>
> The goal is to find a replacement for Depakote. However, it is important to know that you have a drug to use in an emergency as a fire-extinguisher against mania. Zyprexa might also be a good drug for this purpose. You might want to start out with AD + Trileptal, and use Depakote or Zyprexa in case a manic reaction occurs that warrants treatment. Other mood stabilizers that you can discuss with your doctor would be:
>
> AED:
> Trileptal
> Lamictal
> Topamax
> Neurontin(?)
> Zonegran(?)
> Keppra(?)
>
> AP:
> Zyprexa
> Seroquel
> Risperdal
> Abilify(?)
>
> lithium (of course)
>
>
> How did you feel on Effexor before you became hypomanic on it? What else were you taking at the time? see aboveThanks for your suggestions. Lyrical
>
>
> - Scott
Posted by SLS on July 26, 2004, at 16:24:02
In reply to med dialogue, posted by Lyrical13 on July 26, 2004, at 10:16:58
I might have missed something along the way, but I am assuming that you are not taking any antidepressants currently. Is the answer as simple as adding Effexor to Depakote, or is the Depakote really messing you up?
I think if I were in your shoes, from the way you describe things, I would want to discontinue the Depakote and see how I reacted to Trileptal and make decisions from there.
If you don't react adversely to Trileptal, but the depression persists, I would then add Effexor and watch for mania. If Trileptal doesn't prevent mania despite dosage increases, I would then treat the mania acutely with Zyprexa or Depakote. Once under control, you can proceed to experiment with other mood stabilizers if necessary.
Regarding Lamictal: Lamictal isn't a very good drug to treat mania, although I am not yet convinced that it won't prevent it. I am doubtful, though. For severe depression, Lamictal by itself usually doesn't make for a very good antidepressant. If someone has experienced differently, please chime in. Taking one drug would be so much easier. If your depression is mild to moderate, it might be worth a try.
- Scott
Posted by Lyrical13 on July 27, 2004, at 7:36:09
In reply to Re: med dialogue » Lyrical13, posted by SLS on July 26, 2004, at 16:24:02
No antidepressants right now. I don't know if my pdoc will want to add an AD to the Depakote. I already suggested it once and he wasn't too keen on it. So I will probably be trying a new drug all together. I imagine he'll want to stay away from Effexor regardless since that seemed to cause mania for me. I"ve heard that is a common SE even for folks who are not BP. I"ll let you know how things turn out. I am thinking seriously about Trileptal since my sister took it and it seemed to help her. Maybe we have similar chemistry?
Posted by SLS on July 27, 2004, at 8:03:29
In reply to Re: med dialogue, posted by Lyrical13 on July 27, 2004, at 7:36:09
> I am thinking seriously about Trileptal since my sister took it and it seemed to help her. Maybe we have similar chemistry?
Yup. There's a real good chance of it.
I would go ahead and try the Trileptal. It sounds like a good bet.
- Scott
Posted by SLS on July 28, 2004, at 20:04:43
In reply to Re: med dialogue, posted by Lyrical13 on July 27, 2004, at 7:36:09
Hi.
I spoke to someone today who is bipolar II and is doing very well on a combination of Lamictal and Seroquel. She tends to spend more time in hypomania, but has been depressed more recently because antidepressants were discontinued. Lamictal and Seroquel were started together several months ago. The depression gradually lifted and she is feeling very well - balanced. I thought you might be interested.
- Scott
Posted by starlight on July 29, 2004, at 11:42:46
In reply to Re: med dialogue ? Lyrical13, posted by SLS on July 28, 2004, at 20:04:43
I take Lamictal, Trileptal and Effexor and like the combo. I'm having a bit of breakthrough depression right now, but have been through a lot and am waiting about a week to see if it will pass. You can always try Topomax and Wellbutrin too, but Wellbutrin has the tendency to make some folks agitated. On the combo that I take I have no sexual dysfunction.
starlight
Posted by lyrical_13 on July 31, 2004, at 15:46:16
In reply to Re: med dialogue » Lyrical13, posted by SLS on July 28, 2004, at 20:04:43
I saw my pdoc and after he lectured me about not being on a high enough dose to be effective on Depakote (he just can't accept that I am sensitive to meds), he agreed to try Trileptal. what dosages are people taking? He ultimately wants me on 600mg 2x day. I'll be starting with 150 once a day and working up from there. for right now we're just trying the one med. We'll see what happens from there. I'm been having a little free floating anxiety off and on. No particular reason, no precipitating factors just suddenly very anxious for no reason. Very odd. I usually have this in combo with my depression. Just constant generalized anxiety.
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