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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by KarenRB53 on December 8, 2004, at 20:44:13
I've just been diagnosed with soft bipolar. After taking Prozac for 6yrs I now have hypomania episodes quite often. I feel such rage and agitation and anger at small insignificant things. I want to hurt someone or myself. My pdoc wants me to add lithium to the Prozac. Just wondered what others thought. Is this a good way to start or would another mood stabilizer be better to try first. Thanks for any suggestions. I'm really quite frightened. I'm also very sensitive to meds. Karen
Posted by anxiety_free on December 8, 2004, at 21:21:19
In reply to Lithium for soft bipolar, posted by KarenRB53 on December 8, 2004, at 20:44:13
Drugs such as Depakote, Tegratol, Trileptal, and Lamictal have pretty much replaced Lithium as "first line" therapy; usually lithium is used if newer meds fail. That said, some docs swear by the stuff, ESPECIALLY when harm to self or others is involved in a manic/hypomanic state. But, there are options; atypical anti-psychotics are being used successfully for bipolar, and don't require all the lab work. The previously mentioned drugs are also effective. Has your doc thought about also pulling the Prozac? Talk to him/her about your options...if you're sensitive to meds, I'd try to get either an atypical antipsychotic or something like Trileptal. Good luck!
Posted by lostforwards on December 8, 2004, at 21:23:39
In reply to Lithium for soft bipolar, posted by KarenRB53 on December 8, 2004, at 20:44:13
Do you have the problem off the prozac? I recall someone saying that these cases of hypomania that occur on antidepressants may not count as real bipolar. I don't know. If I'd been taking prozac for 6 years with no problems I'd be suspicious if my doctor gave me a new diagnosis. Do you have any other symptoms besides feeling angry and aggressive? It might be that the drug has been affecting you in one way or another. You could try another weaker antidepressant if the aggression and difficulty with restraining yourself didn't exist prior to prozac before starting the lithium. That's just my opinion.
As far as treatment of symptoms is concerned, I don't see anything wrong with taking Lithium and Prozac. The lithium could just be used to curb aggression ( which it is used for sometimes ) and work as an antidepressant rather than actually stabilize mood if it's not taken in the therapeutic range. I think it has to be at the right dose, giving the right blood level, for a person with bipolar. If you do take it for bipolar, you'll have to get blood tests done to make sure your blood level is in the right range.
Posted by lorilu on December 9, 2004, at 17:15:22
In reply to Lithium, posted by anxiety_free on December 8, 2004, at 21:21:19
Trileptal was given to my son as a first line therapy also and also because he is a child. It was given as a mood stabilizer and works great.
I take 400 mg of Topamax and it has been my only mood stabilizer and it has "cured" many of the same symptoms you wrote of; however I work through the "stupids" (the side effects) The side effects of Topamax aren't soo... bad I got my Masters on it and I am able to teach. I just cut down on it when I have real important stuff due (Then I'm grumpy and can't wait to get back up..wait my family can't wait for me to get back up to the right dose) ;)
> Drugs such as Depakote, Tegratol, Trileptal, and Lamictal have pretty much replaced Lithium as "first line" therapy; usually lithium is used if newer meds fail. That said, some docs swear by the stuff, ESPECIALLY when harm to self or others is involved in a manic/hypomanic state. But, there are options; atypical anti-psychotics are being used successfully for bipolar, and don't require all the lab work. The previously mentioned drugs are also effective. Has your doc thought about also pulling the Prozac? Talk to him/her about your options...if you're sensitive to meds, I'd try to get either an atypical antipsychotic or something like Trileptal. Good luck!
Posted by linkadge on December 9, 2004, at 19:41:40
In reply to Re: Lithium » anxiety_free, posted by lorilu on December 9, 2004, at 17:15:22
Lithium can be a very good medication however. It has molecular targets that the other mood stabalziers don't have. Lithium is also neuotrophic, (stimulates the production of new brain cells). The other mood stabalziers are not neurotrophic.
Linkadge
Posted by KarenRB53 on December 9, 2004, at 19:55:01
In reply to Re: Lithium, posted by linkadge on December 9, 2004, at 19:41:40
What I'm concerned about is that this hypomania I'm experiencing may be just from the Prozac and I would hate to add Lithium if thats the case. Wouldn't I have to wean off the Prozac to find out if thats the problem? Or would I take the low dosage of lithium to help alleviate the agitation and rage I feel on the Prozac? Karen
Posted by anxiety_free on December 9, 2004, at 20:14:20
In reply to Re: Lithium, posted by KarenRB53 on December 9, 2004, at 19:55:01
I think you may want a second opinion. If you're on an SSRI and experiencing hypomania, there is ALWAYS the possibility that the hypomania is SSRI-induced, especially with Prozac which has a bad reputation in this department. Psychotic episodes can, rarely, also be caused by anti-depressants or worsened by them. Anyway, the only way I can see the doc justifying NOT trying a withdrawal of the Prozac is if you would become suicidal or something equally bad. So, if I were you, I'd push for trying to taper the Prozac FIRST, provided your hypomania isn't so bad you pose a threat to yourself and/or others. If s/he resists, get a second opinion, and soon. You MAY be bipolar II (note the capitalized may); usually that doesn't require treatment with something as hardcore as lithium unless you're treatment resistant. Then again, you may just be having Prozac troubles. In any case, good luck to you!
Posted by KarenRB53 on December 10, 2004, at 7:15:43
In reply to Weaning off Prozac...., posted by anxiety_free on December 9, 2004, at 20:14:20
Thanks so much. I'm definitely going to talk to me pdoc about weaning off Prozac first. Karen
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