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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by bipolarspectrum on June 20, 2005, at 0:32:17
Hi,
I see my pdoc on tuesday and I'm looking for any ideas for bipolar depression besides lamictal and lithium?????
bps
Posted by SLS on June 20, 2005, at 6:02:25
In reply to What are good ideas for bipolar depression????, posted by bipolarspectrum on June 20, 2005, at 0:32:17
How about Parnate along with a mood stabilizer(s)? When MAOIs were still reasonably popular in the 1980s, Parnate was chosen preferentially over the others for bipolar depression. Adding lithium seemed to work synergistically with Parnate as an antidepressant. If you already have lithium and Lamictal in place, I would leave both on-board and simply add the Parnate.
- Scott
Posted by Ron Hill on June 20, 2005, at 12:06:11
In reply to What are good ideas for bipolar depression????, posted by bipolarspectrum on June 20, 2005, at 0:32:17
> Hi,
> I see my pdoc on tuesday and I'm looking for any ideas for bipolar depression besides lamictal and lithium?????
> bps
------------BPS,
I'm BP II and I totally agree with what Scott said above. In addition to Parnate, perhaps you could also consider the MAOI's Nardil or Deprenyl (Selegiline).
The depressive phase of my BP II disorder is the atypical variety (low motivation, low energy, hypersomia, mood reactivity, anhedonia, etc). I'm currently in week four of a low-dose Selegiline trial. It's too early in the trial to make predictions regarding its long-term effectiveness, but so far it's working extremely well. It is giving me back my life (so far).
One advantage of Selegiline is that at dosages below about 15 - 20 mg/day the MAOI diet restrictions are not required (i.e.; no cheese effect). I'd encourage you to read up on MAOIs (if you haven't already) before your appointment. Some p-docs are reluctant to prescribe MAOIs because of the potentially fatal cheese effect. Therefore, the more you know going into to the appointment the better chance you have of convincing your p-doc that a trial would be safe and might be worth a try.
MAOIs are not without their side effects, so do some reading.
-- Ron
BP II and OCPD
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal
5 mg/day Deprenyl (as tx for atypical depression)
Posted by yesac on June 20, 2005, at 14:49:16
In reply to What are good ideas for bipolar depression????, posted by bipolarspectrum on June 20, 2005, at 0:32:17
> I see my pdoc on tuesday and I'm looking for any ideas for bipolar depression besides lamictal and lithium?????
I don't know but if you get any good ideas let me know! I need to find something too.I have read that Strattera can be useful in BP depression because it's less likely to activate agitation or mania. But it's got a lot of nasty side effects and often doesn't work at all. Still, it might be what I end up trying next.
(The lith and Seroquel are definitely better than nothing and give me a slight lift, but I'm left with a kind of gloomy I-don't-really-like-life kind of depression-- just not suicidal and agitated and flipped out)
Posted by bipolarspectrum on June 22, 2005, at 3:36:34
In reply to Re: What are good ideas for bipolar depression????, posted by yesac on June 20, 2005, at 14:49:16
Thanx for the posts,
Well I see the pdoc and theres gonna be no changes.. this will mean I'm stuck on lithium, topamax, olanzapine and a little lexapro... wahooo, lots of fun.. and get this, hes leaving for a month! i know pdocs have to have lives, but why does my pdoc have to have one!
bps
Posted by yesac on June 22, 2005, at 12:48:24
In reply to Re: What are good ideas for bipolar depression????, posted by bipolarspectrum on June 22, 2005, at 3:36:34
> Well I see the pdoc and theres gonna be no changes.. this will mean I'm stuck on lithium, topamax, olanzapine and a little lexapro... wahooo, lots of fun.. and get this, hes leaving for a month!
Why no change? I thought you wanted to try Seroquel? Did your doctor have something against making changes to your regimen?That sucks that he's leaving. I hate it when they leave. But hey, at least he's coming back right?
Posted by bipolarspectrum on June 22, 2005, at 22:06:41
In reply to Why no change? » bipolarspectrum, posted by yesac on June 22, 2005, at 12:48:24
Hey Yessac,
He claims I have to give these drugs a longer trial.. its already been 2-3 weeks with no response.. oh well, whats another 4 weeks i guess!
bpsh
Posted by yesac on June 23, 2005, at 14:31:48
In reply to Re: Why no change?, posted by bipolarspectrum on June 22, 2005, at 22:06:41
I guess it can't hurt to give them a longer trial. Have you been on all 4 of them for 3 weeks, or some for longer?
Topamax, lithium, Zyprexa, and Lexapro?
Well I don't know about all of them but it definitely took a while for lithium to kick in for me. Probably 5 or 6 weeks. And only with Seroquel.
I can certainly understand your impatience though. It's so frustrating to wait and wait. I'm making myself wait another two weeks before I try something new (for attention), because I think I need to just stay put for a little while... but I'm also tempted to tweak my doses of lith and Seroquel to see if it might be better.
It never ends, does it?
Posted by Sabino on June 23, 2005, at 19:50:14
In reply to Re: Why no change? » bipolarspectrum, posted by yesac on June 23, 2005, at 14:31:48
>> Well I don't know about all of them but it definitely took a while for lithium to kick in for me. Probably 5 or 6 weeks. And only with Seroquel....
It never ends, does it?<<Hi again. Can you tell me what it feels like when Li kicked in?
Yup. It never ends. Still, I'm not in the horrible place I was about two months ago.
BPS -- I'm presently taking Effexor XR 150, and Remeron 15, along with maybe 450 Lithobid.
I don't feel great yet, but I'm no longer thinking about making my exit daily.
Good luck.
Posted by yesac on June 24, 2005, at 11:13:25
In reply to Re: Why no change?, posted by Sabino on June 23, 2005, at 19:50:14
> Hi again. Can you tell me what it feels like when Li kicked in?Yeah, it's hard to believe that it's actually only been about 3 weeks since it *kicked in*. Basically, I just noticed that I felt much less agitated and aggressive, somewhat less irritable, more calm and stable. It seems like my mood is more constant and there's less lability (ups and downs a hundred times a day). In terms of depression, I'd say that my mood is a few notches up, not great, not *happy*, but somewhat improved. And like you said, I'm not suicidal every single day. I still think about it, but it doesn't feel quite so much like I need to do it, like life is completely unbearable.
> Yup. It never ends. Still, I'm not in the horrible place I was about two months ago.
Yeah, that's how I'm looking at it too. I know things aren't perfect, probably never will be, but at least I have a starting point now. At least it seems now like there is some hope. And when I think back, it definitely is better now than even a month ago.Good luck to you too.
Posted by Sabino on June 24, 2005, at 23:31:55
In reply to Re: Why no change?, posted by yesac on June 24, 2005, at 11:13:25
Thanks. That's really encouraging to hear. I'm guessing that's what I'll experience too, since when you talk about your symptoms, they sound a lot like mine.
Good luck to both of us!
Posted by bipolarspectrum on June 26, 2005, at 17:25:21
In reply to Re: Why no change? » bipolarspectrum, posted by yesac on June 23, 2005, at 14:31:48
Thanx for the replies,
Yeah, it feels like it never ends.. I'm on 600 mg lithium, 20 mg lexapro and 15 mg olanzapine.. I stopped the topamax, it was making me so thirsty... I can only hope that lexapro and lithium combine together to work on my depression... sometimes it feels like it'll end..
bps
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