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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by stresser on January 24, 2005, at 10:58:57
I would like some input from some of you who have experiences with medication and bipolar. My daughter has been diagnosed with bipolar II or somewhere around there, and the doc put her on topamax for that and binge eating disorder. She was also taking welbutrin for depression. The welbutrin started making her very sweating and he told her to stop taking it until her next appt. The topamax was working fine until she hit 400mg per day, then her hair started to fall out, and she became very upset. He then told her to stop taking it, and we started to titrate her down from that. She will go in for her appt. with her psychiatrist tomorrow, and I don't know what medications to avoid. She has gained over 30 pounds in the past two years with depression, and has trouble concentrating. She has gone from being a driven student to an "I just want to get by" type of student. Should I suggest an ADD medication? Some doctors don't like it when you suggest meds, but I really don't care....I will do what it takes. She says she is depresssed again because she's not taking an anti-depressenat right now. Advice please!-L
Posted by banga on January 24, 2005, at 11:59:02
In reply to Need information concerning meds before next appt, posted by stresser on January 24, 2005, at 10:58:57
Hi,
I am no expert, but this is what comes to mind:
1) Topamax is notorious for causing cognitive difficulties, this may at least in part be interfering with her concentration and mental sharpness. You're right, docs dont usually like to consider stimulants unless there is a clear diagnosis of ADHD.
2) there are two other mood stabilizers --alternatives to topomax--that don't lead to weight gain--they are Lamictal and Zonegran. With Lamictal, you have to be careful, a bad side effect can be a rash. Zonegran is not well-studied, but there seem to be a lot of people who find it helpful.
3) I am not bipolar, but have depression with anxiety and irritability (some may even make a case for Bioplar II for me). I was immensely helped by a couple of the newer antipsychotics, Geodon and Risprdal. It is becoming more and more common to use these with mood disorders, especially bioplar. There is also Abilify, one which I in fact may switch to today. The effect was pretty fast--four days and I felt SO different, no anxiety, no depression. The effect wore off with time, but I am working on ways to get them to not poop out on me. Geodon and Abilify do not cause weight gain typically.These are my thoughts, but as you know our bodies are different and what works for one person may not work for the next.
Good luck,B.
Posted by Ritch on January 24, 2005, at 13:34:26
In reply to Need information concerning meds before next appt, posted by stresser on January 24, 2005, at 10:58:57
> I would like some input from some of you who have experiences with medication and bipolar. My daughter has been diagnosed with bipolar II or somewhere around there, and the doc put her on topamax for that and binge eating disorder. She was also taking welbutrin for depression. The welbutrin started making her very sweating and he told her to stop taking it until her next appt. The topamax was working fine until she hit 400mg per day, then her hair started to fall out, and she became very upset. He then told her to stop taking it, and we started to titrate her down from that. She will go in for her appt. with her psychiatrist tomorrow, and I don't know what medications to avoid. She has gained over 30 pounds in the past two years with depression, and has trouble concentrating. She has gone from being a driven student to an "I just want to get by" type of student. Should I suggest an ADD medication? Some doctors don't like it when you suggest meds, but I really don't care....I will do what it takes. She says she is depresssed again because she's not taking an anti-depressenat right now. Advice please!-L
I agree with Banga that the Topamax probably has dulled her cognition, so an ADD med probably would just cause more trouble than it is worth. It would be better to avoid med-induced ADD in the first place by switching the Topamax or perhaps lowering it. Has that been considered? Maybe the doctor is starting her dosages too high and raising them too rapidly.
Posted by stresser on January 24, 2005, at 19:43:43
In reply to Re: Need information concerning meds before next appt » stresser, posted by Ritch on January 24, 2005, at 13:34:26
Her dosage was started at 25mg in Sept. and just now at 400mg. She went up very slowely, and was having problems with her grades long before that. Her trouble with grades falling began around her freshman year of high school, she is now a junior. I think I may aske the doctor about the Zonegran tomorrow....I have done some research on that and read some posts about it. Thanks so much for your imput everyone! You are very helpful and much appreciated. -L
Posted by shoebox on January 25, 2005, at 7:54:19
In reply to Re: Need information concerning meds before next appt, posted by stresser on January 24, 2005, at 19:43:43
Hi there. I am BPII also, and after years on the let's-try-it-and-see-what-happens carousel, my pdoc and I hit a successful combination: Lamictal and Prozac. Obviously, there is no way to predict whether or not this combination will work for your daughter, but I have two friends who are BPII and are on the same combination, and feeling just about "normal" now. I've been on this combination for around a year, and so far so good.
Lamictal does not cause weight gain, generally, and you do have to start low and titrate up, but the incidence of rash when titration is gradual, is tiny.
Lamictal *can* interfere with certain cognitive functions, at least at first, and it made me "fuzzy" for a while--I had trouble thinking of words I wanted to say in conversation, for example--but it stabilized after a few months, and now with the Prozac added in, I'm in very good shape for the first time in many years.
I also have been on a few ADD drugs (pdoc still isn't sure whether the ADD is symptomatic of the depression, or if it exists on its own, but he treated me for it anyway). Provigil would be my first choice if you want to bring it up with your doctor. It is not an amphetamine, and it is compatible with the other drugs I mentioned. I have only been off it because my husband and I are trying for a baby right now. Even without the Provigil, I am feeling pretty good, thanks to the Prozac.
***It is *vital* that any SSRI your daughter is put on be combined with a mood stabilizer, to minimize the risk of a hypomanic reaction.***
Though it was great for treating mania and anxiety, Geodon made me fat and lazy, so after I was out of the woods with a hypomanic episode I 'd suffered, I ditched the Geodon and moved on to something else. That was the beginning of a string of Lamictal + [antidepressant] "experiments", all of which failed. Having run out of options, we went back to good old Prozac, which I'd taken years ago. With lamictal added, Prozac has not caused hypomania, or anything close. I'm even sleeping like a baby for the first time in years.
Sorry to go on so long! I have a LOT of experience with drug combinations as a BPII patient, and would love to be able to help, and save others the trouble and legwork that I went through. Please feel free to ask any questions you may have. :-)
> Her dosage was started at 25mg in Sept. and just now at 400mg. She went up very slowely, and was having problems with her grades long before that. Her trouble with grades falling began around her freshman year of high school, she is now a junior. I think I may aske the doctor about the Zonegran tomorrow....I have done some research on that and read some posts about it. Thanks so much for your imput everyone! You are very helpful and much appreciated. -L
Posted by stresser on January 25, 2005, at 17:52:45
In reply to Re: Need information concerning meds before next appt, posted by shoebox on January 25, 2005, at 7:54:19
Thank you for the information. She went to the doctor and he put her on zoloft and trileptal. Do you know anything about trileptal? I take zoloft and I have not had any weight gain or unpleasant side effects other than heart palpatations. (I tend to have those on other SSRI's also) She has a binge eating disorder, and the doctor was trying to stay away from anything that would irritate that. I am really leary of her starting these new meds, and thinking of not giving her the trileptal. She did just fine on an anti-depressant before we diagnosed her as being bipolar II or III, just couldn't find the right one because of side effects. -L
Posted by shoebox on January 25, 2005, at 18:52:36
In reply to Re: Need information concerning meds before next appt » shoebox, posted by stresser on January 25, 2005, at 17:52:45
I'm not that familiar with Trileptal; a good friend of mine started on it a few months back and gave a glowing report. I was considering it at one point because it seemed I had run out of options among the ADs to go with the Lamictal; my pdoc wondered if a different mood stabilizer would work with one of the ADs. Fortunately the Prozac and Lamictal combination worked out, so I didn't have to switch.
Hmm--I wonder why the doc prescribed Trileptal instead of Lamictal? Will have to research that, if only to satisfy my own curiosity.
I would be cautious about giving her only the Zoloft if she is indeed BPII or III. I wasn't dxed with BPII until four years ago. I had been on numerous ADs over a period of about 12 years, and nothing ever seemed to keep working ("Prozac poopout"). I can't help wondering if that "poopout" that so many people experience with SSRIs and newer ADs is the result of undiagnosed bipolar disorder. The reason I think this is that, while I had a few minor instances of mild hypomania over the years (unrecognized by me or my pdoc), I didn't really start to feel "solid" (not irritable, serene, no anxiety) until I was put on the mood stabilizer, and I suspect that if one had been added to one of the SSRIs I was on, there might have been a better outcome. Just my hunch, though.
> Thank you for the information. She went to the doctor and he put her on zoloft and trileptal. Do you know anything about trileptal? I take zoloft and I have not had any weight gain or unpleasant side effects other than heart palpatations. (I tend to have those on other SSRI's also) She has a binge eating disorder, and the doctor was trying to stay away from anything that would irritate that. I am really leary of her starting these new meds, and thinking of not giving her the trileptal. She did just fine on an anti-depressant before we diagnosed her as being bipolar II or III, just couldn't find the right one because of side effects. -L
Posted by shoebox on January 25, 2005, at 19:08:57
In reply to Re: Need information concerning meds before next appt » shoebox, posted by stresser on January 25, 2005, at 17:52:45
Me again. Here is a great site's take on Trileptal:
http://www.psycheducation.org/depression/meds/trileptal.htm
This page contains links to additional Trileptal info that you might be interested in. Long story short, Trileptal's side effects profile compares favorably to Lamictal's and has the advantage of not causing the rash that Lamictal (rarely) can bring on if it isn't titrated carefully. I'm assuming that's why the pdoc prescribed it. Note that on this link, it is pointed out that most of the typical side effects associated with Trileptal can be avoided if the starting dose is low and is increased slowly.
> Thank you for the information. She went to the doctor and he put her on zoloft and trileptal. Do you know anything about trileptal? I take zoloft and I have not had any weight gain or unpleasant side effects other than heart palpatations. (I tend to have those on other SSRI's also) She has a binge eating disorder, and the doctor was trying to stay away from anything that would irritate that. I am really leary of her starting these new meds, and thinking of not giving her the trileptal. She did just fine on an anti-depressant before we diagnosed her as being bipolar II or III, just couldn't find the right one because of side effects. -L
Posted by stresser on January 26, 2005, at 6:49:04
In reply to Re: Need information concerning meds before next appt, posted by shoebox on January 25, 2005, at 19:08:57
Thank you very much for the site, I will look it over. I did give her both the meds. I hope the zoloft doesn't make her gain weight, that's my worry. She's deffinatly needing the trelptal, last night she was nasty, and unable to live with. Bring it on! -L
Posted by shoebox on January 26, 2005, at 7:33:47
In reply to Re: Need information concerning meds before next appt » shoebox, posted by stresser on January 26, 2005, at 6:49:04
> Thank you very much for the site, I will look it over. I did give her both the meds. I hope the zoloft doesn't make her gain weight, that's my worry. She's deffinatly needing the trelptal, last night she was nasty, and unable to live with. Bring it on! -L
I've never heard of Zoloft causing weight gain. The newer classes of ADs are generally known to suppress appetite just a bit. My two sisters-in-law have been on Zoloft for several years (they both have OCD) and they are both slim.
One more thing: I am surprised that your daughter's doc put her on Wellbutrin at all, since it is known to cause "rebound" binge eating if it is discontinued. If she gained weight since stopping the Wellbutrin, that might explain why.
Just keep her away from Depakote! It makes you absolutely RAVENOUS. Great drug, but I sure didn't like the extra twenty pounds it put on me!
Posted by stresser on January 26, 2005, at 14:11:51
In reply to Re: Need information concerning meds before next appt, posted by shoebox on January 26, 2005, at 7:33:47
Wellbutrin didn't do anything for her eating at all, just depression. When she went off it last year the first time she didn't have any problem with it, so I don't anticipate a problem this time either. I hope not anyway. -L
This is the end of the thread.
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