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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by MM on December 25, 2004, at 20:40:44
I've tried Depakote (made me gain a ton of weight) and Trileptal (which I'm on now and I'm thinking of switching to something else). I'm wondering if anyone has taken Lithium and what their experience was, and also any experiences with any other mood stabilizer, including things (like Klonopin?) that might not typically be used as one. Lamictal rash fear overblown? I am BPII (actually BPIII) and I am more of the depressed cycling with some normalcy and lots of anxiety type than getting hypomanic. So if you've found one you liked, or didn't, can you tell me what your experience was? I'd greatly appreciate any feedback. Trying to figure out the puzzle on my own. Thanks.
Meg.
Posted by anxiety_free on December 26, 2004, at 2:39:54
In reply to mood-stablizers?, posted by MM on December 25, 2004, at 20:40:44
Hey! I'm schizoaffective, so I have some experience with these drugs. What's your problem(s) with trileptal? I'm just asking b/c, while lithium prevents suicide, its not the best in terms of antidepressive action or side-effects amongst the mood-stabilizers. Klonopin helped my agitation/anxiety immensely (I now take BuSpar, which also works quite well). Have you tried an atypical antipsychotic? Most all of them are approved for straight up mania, and they're being used off-labael all over the bipolar spectrum, with good results. And of course, there's the prozac+zyprexa combo (symbyax) to think about, but I personally hate prozac and zyprexa. What's your dose of trileptal? If I were your shrink (run now), based on what you've said, I'd up the trileptal, add 1-2mgs Klonopin daily to control the agitation, and start a multi-tasking AD in a few weeks (maybe Remeron, 30mgs). I'd also rx something like trazadone for sleep management and gabatril or neurontin to boost the klonopin, as needed. Since you don't do mania/hyomania much, you might want to stick with the friendlier mood-stabilizers....trileptal and lamictal are strong but have a better side-effect profile than lithium. Klonopin, unfortunately, can worsen depression, so you might want to limit its use as a mood-stabilizer; if it helps, stay on for a few months...if you still needed a benzo, then something like Xanax XR could be introduced in place of Klonopin. Good luck!
Posted by theo on December 26, 2004, at 7:18:41
In reply to re: mood-stabilizers, posted by anxiety_free on December 26, 2004, at 2:39:54
> Hey! I'm schizoaffective, so I have some experience with these drugs. What's your problem(s) with trileptal? I'm just asking b/c, while lithium prevents suicide, its not the best in terms of antidepressive action or side-effects amongst the mood-stabilizers. Klonopin helped my agitation/anxiety immensely (I now take BuSpar, which also works quite well). Have you tried an atypical antipsychotic? Most all of them are approved for straight up mania, and they're being used off-labael all over the bipolar spectrum, with good results. And of course, there's the prozac+zyprexa combo (symbyax) to think about, but I personally hate prozac and zyprexa. What's your dose of trileptal? If I were your shrink (run now), based on what you've said, I'd up the trileptal, add 1-2mgs Klonopin daily to control the agitation, and start a multi-tasking AD in a few weeks (maybe Remeron, 30mgs). I'd also rx something like trazadone for sleep management and gabatril or neurontin to boost the klonopin, as needed. Since you don't do mania/hyomania much, you might want to stick with the friendlier mood-stabilizers....trileptal and lamictal are strong but have a better side-effect profile than lithium. Klonopin, unfortunately, can worsen depression, so you might want to limit its use as a mood-stabilizer; if it helps, stay on for a few months...if you still needed a benzo, then something like Xanax XR could be introduced in place of Klonopin. Good luck!
MM,I'm pretty much the same, depressive with my anxiety breaking thru as my mania (according to my docs diagnosis).
Mood stablizers can worsen depression in general, (including Lamictal), I've found if your not taking an antidepressant. Mood stablizers tend to have antidepressant, mood lifting properties at first that wear off in time and your pretty much "mood stablized."
I been taking a low dose of Keppra for anxiety and my doc added Lamictal for depression. For 6 months I've been trying to find the best dose. The higher I went up (150-200mg), the more sides kicked in, memory problems, burning eyes, acid reflux, nightmares. I've gone back down to 50mg and have now found if I go below 125mg daily, I get this warm feeling in my brain. My doc says she has seen this side effect at lower doses. It's almost like going through a feeling of it wearing off 24/7.
I had some great moments of clarity at 100mg daily but they were short lived.
I'm not trying to steer you away from Lamictal because it might be your magic bullet, but in general it is a high maintanence med you have to contantly tweak.
I am still taking Keppra 250mg twice daily and Lamictal 50mg at bedtime and added 12.5mg Paxil CR in the morning.
I've not been on any SSRI for 8 months and since I've added it, I feel great! Unfortunatly, last night I was already feeling the sexual sides, loss of libido, when my girlfriend was coming on to me. I swear, if someone could somehow harness Paxil CR with no sexual sides, I would be the happiest man alive! It does wonders for my general and social anxiety and even ADD. I actually sat down to read a book, something I've not been able to do for the past 8 months!
Posted by HappyGirl on December 26, 2004, at 11:12:36
In reply to mood-stablizers?, posted by MM on December 25, 2004, at 20:40:44
Hi:
I have an experience on both M.S.s, Depakote in the beginning of my dxed with Bp II and added to the Lithium. However, the effectiveness of Depakote got weaker and weaker as the Lithium started to kick in.In my personal opinion, .... Depakote is a good med., ... I'd say, ... for most of those who was just dxed with Bp II, including for those milder form of Bp II, such as yours. On the otherhand, the Lithium is MORE for the manic side of Bp and thus widely rxes for both Bp I and Bp II. However, if you'd like to choose the Lithium-route/med. regimen, I'd recommend to take a low-dosage of A.D.(preferrably an SSRI, such as Prozac, Zoloft and the like, if you're tolerable on), because as I said the above, the Lithium has more for the hypomania/maia(Bp I) with less A.D. effectiveness. Without an A.D., you may feel 'depressive' moods, particularly during the morning-hours.
H.G.
Posted by ghost on December 26, 2004, at 12:23:00
In reply to Re: mood-stablizers?, posted by HappyGirl on December 26, 2004, at 11:12:36
lamictal rocked for me, although i got the rash. i think it's completely worththe effort, though.
i'm on abilify now. it's mediocre. not as good as lamictal.
...just my two cents.
ghost
Posted by KikiCabell on December 27, 2004, at 17:31:06
In reply to mood-stablizers?, posted by MM on December 25, 2004, at 20:40:44
Hi, there. I am BP I and take Lithium and Geodon among other things. Both have helped me but I'd say mostly with the mania. I haven't noticed any side effects with the Geodon except perhaps a mild agitation. Lithium has loads of side effects for me - shaking, thyroid problems, temperature probs (I get sweaty at times), nausea, just a general feeling of malaise. Obviously it must work well for me to put up with it. :) Depakote made me so fuzzy I couldn't put two thoughts together. Keep in mind that Lithium tends to cause weight gain, too. I got a sinus infection every time I tried Lamictal but it may not have had anything to do with the med.
Good luck.
> I've tried Depakote (made me gain a ton of weight) and Trileptal (which I'm on now and I'm thinking of switching to something else). I'm wondering if anyone has taken Lithium and what their experience was, and also any experiences with any other mood stabilizer, including things (like Klonopin?) that might not typically be used as one. Lamictal rash fear overblown? I am BPII (actually BPIII) and I am more of the depressed cycling with some normalcy and lots of anxiety type than getting hypomanic. So if you've found one you liked, or didn't, can you tell me what your experience was? I'd greatly appreciate any feedback. Trying to figure out the puzzle on my own. Thanks.
> Meg.
Posted by olysi79 on December 27, 2004, at 19:48:25
In reply to mood-stablizers?, posted by MM on December 25, 2004, at 20:40:44
Hi Meg, I am in the same league as you, with nasty mixed episodes which include intense anxiety. I take 900 MGS of Trileptal (personally think I should take more), am moving toward 30 MGS of Paxil, and also take Ativan occasionally. Have you considered a small dose of an antipsychotic for emergencies? I take Zyprexa if I have break through symptoms and boy does it work. Perhaps consider adding something like that to your arsenal of tools.
Best,
Chris
> I've tried Depakote (made me gain a ton of weight) and Trileptal (which I'm on now and I'm thinking of switching to something else). I'm wondering if anyone has taken Lithium and what their experience was, and also any experiences with any other mood stabilizer, including things (like Klonopin?) that might not typically be used as one. Lamictal rash fear overblown? I am BPII (actually BPIII) and I am more of the depressed cycling with some normalcy and lots of anxiety type than getting hypomanic. So if you've found one you liked, or didn't, can you tell me what your experience was? I'd greatly appreciate any feedback. Trying to figure out the puzzle on my own. Thanks.
> Meg.
Posted by MM on December 27, 2004, at 20:02:39
In reply to Re: mood-stablizers? » MM, posted by olysi79 on December 27, 2004, at 19:48:25
Hey Chris,
Yes, I have taken a small dose of anti-psychotic to get me stable at one time. I really didn't like that, but it did calm me, which is what I needed. The Trileptal works ok (900 mgs right now too), but it is messing with my body...meaning, it causes extra enzymes in the liver, which metabolize drugs faster, so I *think* my thyroid medication needs to be doubled, and it also metabolizes estrogen faster, so both of those things are causing weight gain and are worrying to me and that's why I am looking to switch. I am wondering if I really need a mood stabilizer if I don't get hypo or manic unless on an SSRI, or if maybe Klonopin could be used as one.
Thanks for your suggestion. I appreciate it.
Best to you too.
Meg
Posted by MM on December 27, 2004, at 20:05:06
In reply to Re: mood-stablizers? » MM, posted by KikiCabell on December 27, 2004, at 17:31:06
Thank you Kiki. I tried Depakote too before Trileptal and it was really bad for weight gain. Thought I found something better in Trileptal. Well, at least it's less weight. Good luck to you too.
Meg
Posted by MM on December 27, 2004, at 20:14:01
In reply to re: mood-stabilizers, posted by anxiety_free on December 26, 2004, at 2:39:54
Hey Anxiety_free,
I am on 900 mgs Trileptal, upped for the winter months. My problem with it is that it's causing some weight gain for me (I believe) that I can NOT get off despite cutting calories (600 or more a day) and exercising (have not lost ONE pound) and I read that it increases liver enzymes which metabolize medication (I take a thyroid med, which if it isn't working could be causing the weight gain and I wouldn't be able to get it off) and estrogen (which could also cause it). I am happy with Wellbutrin (buprorpion). It has been the only AD to work for me without inducing some "hypomanic" stuff (apparently it's the best AD for bipolars). I am also pretty happy with Klonopin which is why I am considering it as maybe a mood stabilizer (since most of what I have is depression, I'm not sure I need a strong mood stabilizer). I have tried an antipsychotic when I was having extreme anxiety at one time and it helped, but I don't need one now in my opinion. Thank you for all your suggestions :).
Meg
Posted by MM on December 27, 2004, at 20:17:05
In reply to re: mood-stabilizers, posted by theo on December 26, 2004, at 7:18:41
Hey theo,
I'm glad the SSRI's are working for you. I found them to be more trouble than good, but I am on Wellbutrin and it has been working fairly well for me for a few years. I am sort of scared to try Lamictal as my Pdoc had a case of the rash and the person almost died, but if I need to I will. Keppra is a mood stabilizer? I haven't heard much about it, I'll have to look it up. Do you like it?
Thank you.
Meg
Posted by MM on December 27, 2004, at 20:21:58
In reply to Re: mood-stablizers?, posted by HappyGirl on December 26, 2004, at 11:12:36
Hey HappyGirl,
Thanks. I was looking at Lithium because I've read a few places that it has an antidepressant effect as well as a mood-stabilizing effect, but the people who've mentioned lithium say it can have the depressing effect soooo, I'm waiting on that one as it's a pretty high maintenance drug. I have taken Depakote, and it worked ok, except it, in combination with Paxil, made me gain 50 lbs in 2 months (which has significantly worsened my depression, despite losing it). I liked trileptal until I gained some weight with it that I absolutely cannot get off. I am going to my general doc to see if we can do something about this, but if not I want to get off it. I am on Wellbutrin and it has worked very well for me as far as an anti-depressant (and what one can do).
Thank you.
Meg
Posted by MM on December 27, 2004, at 20:23:17
In reply to Re: mood-stablizers?, posted by ghost on December 26, 2004, at 12:23:00
Thanks Ghost. Sorry you got the rash. Did you go up really slow on it and all that? Scary stuff. Hope the abilify ends up working or you find something that does.
Meg
Posted by ghost on December 27, 2004, at 20:42:48
In reply to Re: mood-stablizers? » ghost, posted by MM on December 27, 2004, at 20:23:17
this was my regimen...
25mg for ~2mo
50mg for ~2mo (financially, it was all i could do)
100mg for 2wk
150mg for 2wkwithin a day of the 150mg dose, i was itchy all over, and starting to get a rash. maybe if it'd tapered up evey slower, i would've been fine...
guess i'll never know.
best wishes,
ghost
Posted by banga on December 29, 2004, at 10:42:27
In reply to Re: mood-stablizers? » MM, posted by ghost on December 27, 2004, at 20:42:48
I have been on Lamictal for 6 weeks now. I have not developed a rash. So far I find it great--true to its class, it has stabilized my mood. Though I'd like to feel more motivated, it feels like a great start. It has also helped me with crippling anxiety (thoug I am not diagnosed BPII, I have similar symptoms as you). I don't think the rash thing is necessarily overstated--but keep in mind that the life-threatening type is EXTREMELY rare, for most people that do happen to get a rash it is transient and subsides once they stop/lower medication. And slow titration upwards can help immensely.
So I am at a good start, though people here scare me that this good feeling may fade eventually. I am trying to decide on an AD to boost mood and motivation, but will not take an SSRI again and all others make me gain weight--quickly!!
Zonegran is a new mood stabilizer that has pretty impressive initil results. As it can help with weight loss, I may try to convince my pdoc to add some, to counteract weight gain from a tricyclic.
Good luck!
Posted by MM on December 29, 2004, at 10:58:20
In reply to Re: mood-stablizers?MM, posted by banga on December 29, 2004, at 10:42:27
Thank you banga. Have you tried Wellbutrin? I find it to be the only AD I can tolerate, but I haven't tried any of the older ones. Hope you find what works for you (glad the Lamictal is; hope it continues to). I'll have to do more research on the good ol' mood stabilizers.
Meg
Posted by theo on December 29, 2004, at 15:08:59
In reply to Re: mood-stablizers?MM, posted by banga on December 29, 2004, at 10:42:27
Just curious, when do you take your Lamictal, morning or evening or split dose?
Posted by banga on December 29, 2004, at 17:05:13
In reply to Re: mood-stablizers?MM » banga, posted by theo on December 29, 2004, at 15:08:59
Currently I take the Lamictal at night. But for a while I was splitting the dose, taking it am and pm, because some people here said that they experienced less of a drop in energy in the pm if they split the dose. It may be true--I do get a drop in energy in the afternoon, I think it was better when I split the dose. I will go back to splitting the dose, it's just the holiday scedule has been so disruptive that i kept forgetting to take it in the morning.
Posted by banga on December 29, 2004, at 17:07:14
In reply to Re: mood-stablizers?MM » banga, posted by MM on December 29, 2004, at 10:58:20
I have tried Wellbutrin a few times, seemed not to do anything for me. I had really hoped it would! I could use the energy boost. I keep wondering if I should try it again.....
Posted by Maxime on December 30, 2004, at 1:26:07
In reply to mood-stablizers?, posted by MM on December 25, 2004, at 20:40:44
http://home.comcast.net/~pmbrig/BP_pharm.html
This is a really good site for information on various mood stabilisers and their effects.
Maxime
Posted by Maxime on December 30, 2004, at 1:29:08
In reply to mood-stablizers?, posted by MM on December 25, 2004, at 20:40:44
I was so happy when I found Trileptal. I have no side effects, no weight gain and I don't have to worry about it affecting my other meds.
Why do you want to change?
Maxime0
> I've tried Depakote (made me gain a ton of weight) and Trileptal (which I'm on now and I'm thinking of switching to something else). I'm wondering if anyone has taken Lithium and what their experience was, and also any experiences with any other mood stabilizer, including things (like Klonopin?) that might not typically be used as one. Lamictal rash fear overblown? I am BPII (actually BPIII) and I am more of the depressed cycling with some normalcy and lots of anxiety type than getting hypomanic. So if you've found one you liked, or didn't, can you tell me what your experience was? I'd greatly appreciate any feedback. Trying to figure out the puzzle on my own. Thanks.
> Meg.
Posted by MM on December 30, 2004, at 4:12:40
In reply to Re: mood-stablizers?, posted by Maxime on December 30, 2004, at 1:26:07
Posted by MM on December 30, 2004, at 4:14:38
In reply to Re: mood-stablizers?, posted by Maxime on December 30, 2004, at 1:29:08
How long have you been on Trileptal? I've been on it for a few years...(possibly 4?) and it worked well for the first 3? but now I believe that it is responsible for some weight gain/effects with some other meds/hormones, so I want to switch to see if those things go away I guess. If it turns out it's not Trileptal, then I'll probably go back to it.
Posted by banga on December 31, 2004, at 16:17:15
In reply to Re: mood-stablizers?, posted by Maxime on December 30, 2004, at 1:26:07
Thanks for the BP link. I am in that class of depression, with so many cases of mood disorders including BP that I sometimes wonder if I am a BPII that simply never expericned more than a subclinical hypomania. This link discusses this as well as meds.
Posted by Maxime on January 2, 2005, at 0:00:19
In reply to Re: mood-stablizers? » Maxime, posted by MM on December 30, 2004, at 4:14:38
Hi
I've been on it for one year. That's a long time for me! I am treatment resistent so when Trileptal continued to work after 3 months I was thrilled. I have an eating disorder and I freak out if I have weight gain from a med (but will tolerate some if the med relieves my mental anguish). I haven't had any from Trileptal. But as you know, we all react differently to meds.
I hope you find out what is causing your problems and I hope it's not the trileptal.
Maxime
> How long have you been on Trileptal? I've been on it for a few years...(possibly 4?) and it worked well for the first 3? but now I believe that it is responsible for some weight gain/effects with some other meds/hormones, so I want to switch to see if those things go away I guess. If it turns out it's not Trileptal, then I'll probably go back to it.
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