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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 58 to 82 of 82. Go back in thread:
Posted by willyee on August 24, 2005, at 15:11:13
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by willyee on August 24, 2005, at 14:49:48
I keep reading a lot about users of keppra personaly saying they actualy had to drop,or go ON a anti-depressant due to the depression inducing effects of keppra.
Aside from personal entries,i also see general documants reporting this also,in fact i have actualy seen one postive thing about it....
Combination of keppra,klonopin,and i believe amandatine.So possable the addition of at least a very small dose if klonopin might actualy help the keppra,i dunno.
Posted by SLS on August 24, 2005, at 17:57:26
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by willyee on August 24, 2005, at 15:11:13
Hi.
Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
My doctor did warn me that Keppra might make depression worse, so your information regarding its being depressogenic are probably valid. Although I don't feel any worse, I don't feel any better either. Perhaps I will feel worse from this point on. I'll keep posting.
- Scott
Posted by willyee on August 24, 2005, at 18:33:15
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 17:57:26
Wish u luck
Posted by theo on August 24, 2005, at 22:52:11
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 17:57:26
> Hi.
>
> Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
>
> My doctor did warn me that Keppra might make depression worse, so your information regarding its being depressogenic are probably valid. Although I don't feel any worse, I don't feel any better either. Perhaps I will feel worse from this point on. I'll keep posting.
>
>
> - ScottI'm sorry to hear this. Are you now at 500mg twice daily?
Posted by SLS on August 25, 2005, at 7:00:05
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 24, 2005, at 22:52:11
Hi Ted.
> > Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
> I'm sorry to hear this. Are you now at 500mg twice daily?
Yes. I started off at 500mg/day and titrated up to 1000mg/day within a week. Maybe moving up to 2000mg will recapture the antidepressant effect, but I am not optimistic. My response pattern to Keppra matches those of my transient responses to other drugs. After such a response dissipates for me, dosage increases don't seem to help.
Damn it.
I am pissed.
I would not be afraid of Keppra, Ted. Although it has been associated with the precipitation of mental side effects at a rate of 6%, any exacerbation of your condition would be completely reversible upon the discontinuation of this drug. Keppra does things that the other anticonvulsants do not do. It binds to a receptor on synaptic vesicles. Although the significance of this has not been elucidated, you can be guaranteed that you are trying something novel and not just repeating things that you have tried before.
- Scott
Posted by theo on August 25, 2005, at 8:02:09
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 25, 2005, at 7:00:05
Although it has been associated with the precipitation of mental side effects at a rate of 6%, any exacerbation of your condition would be completely reversible upon the discontinuation of this drug.
What sort of mental side effects at 6%?
Also Scott, I would experiment taking 250mg midday in between your two 500mg doses, just to try. When I went to 3 times daily, normally 7:00am, 2:00pm and last dose at 9:00pm, that midday dose really seemed to kick it in versus twice daily dosing. Maybe because of it's short half life. Hell, it wouldn't hurt to try. Maybe you could even handle 500mg midday.
Ted
Posted by SLS on August 26, 2005, at 9:44:13
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 25, 2005, at 8:02:09
> > Although it has been associated with the precipitation of mental side effects at a rate of 6%, any exacerbation of your condition would be completely reversible upon the discontinuation of this drug.
> What sort of mental side effects at 6%?
Depression, irritability, aggression, psychosis.
Yesterday afternoon was horrible. Between the hours of 12:00pm - 4:00pm, my depression worsened to a point that I had not experienced in well over a year. It approached my unmedicated baseline. I did recover, but I still have not experienced the improvement I did several days ago. I am still taking 1000mg.
Do dosages over 1000mg provide you with a better antidepressant effect?
How high did you go, and what caused you to discontinue it?
One study that tracked rapid-cyclers noted a few intervening exacerbations between periods of remission. I hope that is what is going on with me.
In a recent NIMH study of levetiracetam, they looked at a couple of dozen bipolar patients. Of course, this isn't many at all. However, none of those who were severely depressed responded to it. Patients were given 2000-3000mg.
Several studies noted that levetiracetam had positive effects on rapid cyclers, including the NIMH study. I was an ultra-rapid cycler for over two years. I can only hope that there is something about my biology that is cyclic that this drug will finally address.
One can hope...
- Scott
Posted by SLS on August 27, 2005, at 9:08:28
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 17:57:26
> Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
I am still not happy.
I'm waiting for this stuff to start working again. I am not optimistic.
I am tempted to add back the Trileptal to rule-out any contribution it may have had to producing my initial antidepressant response to Keppra. Although I had discontinued Trileptal days before beginning Keppra, who knows?
At 1000mg of Keppra, I have experienced almost no side effects. Just a little bit of dizziness in the beginning.
The few studies using Keppra for bipolar disorder targeted 2000mg as a minimum dosage. This is the same dosage most often used for epilepsy, although I have seen dosages of 3000-4000mg used. These higher dosages might actually be associated with a reduced efficacy and carry a higher liability for mental side effects such as irritability, aggression, and psychosis.
- Scott
Posted by SLS on August 27, 2005, at 9:27:20
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 27, 2005, at 9:08:28
In the following case study of bipolar disorder, the dosage of Keppra found to be optimal for the patient was 2500mg. She initially demonstrated a rapid moderate antimanic response to 1000mg. 2500mg prevented the recurrence of all bipolar features, including manic, rapid-cycling mixed-states, and depression, all of which she had presented with in the past. It is difficult to assess whether or not Keppra monotherapy possesses antidepressant effects, but it apparantly does have antimanic effects. As I have already described, I sustained a brief antidepressant effect from Keppra, but I am also taking several other drugs, including Parnate and nortriptyline. Keppra might at least provide a true mood-stabilizing effect as it seems to have acted as a prophylactic against depression as well as manic mixed states in this one patient.
- Scott
--------------------------------------------
Epilepsy Behav. 2004 Dec;5(6):1017-20. Related Articles, Links
Monotherapy treatment of bipolar disorder with levetiracetam.Kaufman KR.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu
Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Publication Types:
Case ReportsPMID: 15582854 [PubMed - indexed for MEDLINE]
Posted by theo on August 27, 2005, at 11:06:17
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 26, 2005, at 9:44:13
> Do dosages over 1000mg provide you with a better antidepressant effect?
As I mentioned, I would try a midday dose, maybe 250mg for starters or 500mg if you feel comfortable. I would try taking it 3 times daily versus two. As a matter of fact, I would try to keep each dose equal mg's to keep it at a steady state. It wasn't until I took it this way that I felt positive effects. Seriously, 3 daily doses can make a world of difference with Keppra, at least it did for me.
The PI states that "peak plasma in one hour, steady state in just two days." It also says "plasma half-life is 7 +- 1 hour and is unaffected by either dose(mg) or repeated administration." This stuff is in and out, no accumulation even when you take more of it per dose. That's why I think frequency of dose, taking it 3 times daily versus two only seems logical.
> How high did you go, and what caused you to discontinue it?I'm med sensitive. I got to 500mg morning, 250mg midday and 500mg bedtime (1250mg). It was to much as far as causing me to be over assertive, a little road rage. The fact that I needed to stick with 3 times daily dosing, I dropped to 250mg 3 times daily (750mg). This seemed to work pretty well, but my pdoc suggested I add Lamictal because I thought I still felt like I needed a little more boost. Once I got to 150mg Lamictal, I was having all sorts of cognitive side effects and worsened OCD, so I stopped both to start from square one again. It sucks, but when you are taking 3 or 4 meds, it gets tuff trying to figure out what med is causing the problems. This is the only reason I discontinued Keppra. Now I know the Lamictal was the cause.
> In a recent NIMH study of levetiracetam, they looked at a couple of dozen bipolar patients. Of course, this isn't many at all. However, none of those who were severely depressed responded to it. Patients were given 2000-3000mg.
Again, I'm curious about the frequency of dosing, when I tried 500mg twice daily, I would start to feel like I was coming of it before it was time for my 2nd dose, I felt like I was crashing, dizzy, faint confused. When I went to 3 times daily, it kicked in and was smooth because it reached a steady state.
Ted
Posted by SLS on August 27, 2005, at 11:37:20
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 27, 2005, at 11:06:17
Hi Ted.
Thank you so much for your input. I'm going ahead and raising my dosage to 1500mg (500mg t.i.d.) as per your suggestion. The studies that I have seen used b.i.d. dosing. It was even suggested to me by one doctor to take 2000mg h.s.
I'm glad you were able to isolate Lamictal as the culprit. It must have been torturous for you to be on nothing for awhile. What are your current plans?
- Scott
Posted by theo on August 27, 2005, at 14:30:49
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 27, 2005, at 11:37:20
> Hi Ted.
>
> Thank you so much for your input. I'm going ahead and raising my dosage to 1500mg (500mg t.i.d.) as per your suggestion. The studies that I have seen used b.i.d. dosing. It was even suggested to me by one doctor to take 2000mg h.s.
>I would definitely try 1500mg t.i.d., at least you should know in a few days if t.i.d. dosing helps.
> I'm glad you were able to isolate Lamictal as the culprit. It must have been torturous for you to be on nothing for awhile. What are your current plans?
Believe it or not, since I was currently on nothing, I wanted to try Wellbutrin XL to see how I respond. I've been taking it for 8 days with a little stimulation and not much anxiety, which surprised me. Looking back, I think a lot of my anxiety was caused by SSRI's.
The only negative factor, flatulance!! No loss of libido, but shrinkage. Back in my party days, I remember some stimulants (cocaine) causing this, very sexual but no blood flow in that area, very bizarre. I found in the Wellbutrin XL PI where it states low sexual side effects, but then goes say "AT LEAST 1% of males experienced flatulance." Needless to say, this is not going to work for my girlfriend and honestly, I don't know if it's really doing much anyway. It is strange because on SSRI's my reaction would be delayed ejaculation, but this is flat out zero erection. Some stims like Concerta don't cause this, but if I were to take let's say a diet pill or even Provigil, it would. Have you ever heard of this with Wellbutrin?
I'll probably retry Keppra. Keep me posted on the t.i.d. dosing. Are you starting t.i.d. dosing today?
Ted
Posted by SLS on August 27, 2005, at 15:23:07
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 27, 2005, at 14:30:49
Hi Ted.
> I'll probably retry Keppra. Keep me posted on the t.i.d. dosing. Are you starting t.i.d. dosing today?Yes. I've already taken my afternoon 500mg dose. I doubt my doctor will have a problem with my doing this. I did try to call him yesterday to get his OK, but the office was closed. I plan on asking him to let me go to 2000mg when I see him next week. I have so little patience.
I hope your undesireable side effects from Wellbutrin are only transient. I would recommend that you continue with it and try to be patient. 8 days is not enough to evaluate either therapeutic effect or the persistence of side effects.
Good luck!
"The wisdom of patience comes in knowing that one must give Time time to work."
So much easier said than done when pain and frustration are involved.
- Scott
Posted by theo on August 28, 2005, at 22:58:07
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 27, 2005, at 15:23:07
> "The wisdom of patience comes in knowing that one must give Time time to work."
>
> - ScottSo true.
Keep me posted on your opinion and results, hopefully, with t.i.d. versus b.i.d. dosing with Keppra.
Ted
Posted by Dakota32 on August 30, 2005, at 9:34:12
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
It's funny, the name of the doctor that started me on Keppra last week was Dr. Kauth (eerie coiencidence) anyway, hi I'm new to this board, wrote a big intro yesterday with attached questions, but when I went to submit I still had to give my confirmation #, and my post got lost somewhere after that. It was like a page long with alot of great history, but I'm suffering very bad;ly wcarpol tunnel, so it's very painful, and pisses me off that I have to type it over, so I haven't yet. Maybe someone could help me retrieve it. I would have copied it had I known.... Thanks D"32"
Posted by Dakota32 on August 30, 2005, at 10:00:34
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 14, 2005, at 8:55:13
Have you researched Johnsons syndrome? A seriously bad skin reaction to certain drugs that can litteraly make your skin fall off. It's rae but I know one particular medicatin my psych was going to put me on he said lterally 1 in 6 get the disorder, especially if you have known allergies (cats dogs, mold, hayfever) which I am a definite canidate so he didn't even try the drug. Obviously one of the many things I see him for is ancxiety, not the thing you want to hear when you have anxiety as bad as I do, the thought that he was even contemplating it with me, made me look twicew at his license and really realized he is basically still trying to diagnose or fingd something that works. Been on Keppra for a week and a half now 500mg, supposed to start taking it in the day too this week. So far feel really happy, no aggression or depresion, have made a lot of life changing decisions (to improve life) over the last 2 months, so don't know if it's me making good choices that don't aggraevate the depression, or the med or both? Can anyone else tell me of your mood the first week or 2 on keppra?
Posted by theo on August 30, 2005, at 23:27:09
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 27, 2005, at 15:23:07
Hey Scott,
How's the t.i.d. versus b.i.d. dosing going with Keppra, any improvement with 500mg t.i.d.?
Ted
Posted by SLS on August 31, 2005, at 6:34:48
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 30, 2005, at 23:27:09
> Hey Scott,
>
> How's the t.i.d. versus b.i.d. dosing going with Keppra, any improvement with 500mg t.i.d.?
>
> Ted
NG.Keppra has all but abandoned me. My initial response to it was very encouraging. I had begun to feel myself emerge from depression with a return of the acuity of my senses and intellect. I had fun. Now, nothing.
:-(
- Scott
Posted by theo on September 1, 2005, at 22:58:27
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 31, 2005, at 6:34:48
> Keppra has all but abandoned me. My initial response to it was very encouraging. I had begun to feel myself emerge from depression with a return of the acuity of my senses and intellect. I had fun. Now, nothing.
>
> :-(
>
>
> - ScottI'm sorry to hear the news. Wellbutrin doesn't seem to being do much more than a cup of coffee with a nice headache to go with.
I saw my pdoc today, first time in a few months, and she wants me to try Cymbalta. I told her I would but want some sort of back up plan. She said we would try some "treatment resistant" meds in 6 weeks if I don't like it.
I know you had no luck with Cymbalta, but I have a few questions. Any weird startup feelings? Also, she said to take at bedtime because some patients complain of sleepiness? What was your experience? Did you stop it because of side effects, or simply because it didn't work for you?
Posted by Bowtie Bob on September 2, 2005, at 7:20:55
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by Dakota32 on August 30, 2005, at 10:00:34
> Have you researched Johnsons syndrome? A seriously bad skin reaction to certain drugs that can litteraly make your skin fall off. It's rae but I know one particular medicatin my psych was going to put me on he said lterally 1 in 6 get the disorder, especially if you have known allergies (cats dogs, mold, hayfever) which I am a definite canidate so he didn't even try the drug. Obviously one of the many things I see him for is ancxiety, not the thing you want to hear when you have anxiety as bad as I do, the thought that he was even contemplating it with me, made me look twicew at his license and really realized he is basically still trying to diagnose or fingd something that works. Been on Keppra for a week and a half now 500mg, supposed to start taking it in the day too this week. So far feel really happy, no aggression or depresion, have made a lot of life changing decisions (to improve life) over the last 2 months, so don't know if it's me making good choices that don't aggraevate the depression, or the med or both? Can anyone else tell me of your mood the first week or 2 on keppra?
You are referring to Stevens-Johnson Syndrome. I assume that you were on Lamictal regarding this one. SJ can kill people...they end up in the burn units.
Posted by SLS on September 4, 2005, at 8:01:57
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 31, 2005, at 6:34:48
> > How's the t.i.d. versus b.i.d. dosing going with Keppra, any improvement with 500mg t.i.d.?
> Keppra has all but abandoned me. My initial response to it was very encouraging. I had begun to feel myself emerge from depression with a return of the acuity of my senses and intellect. I had fun. Now, nothing.
>
> :-(I have increased the dosage of Keppra to 2000mg for three days. I have nothing new to report. Same old stuff. Depression: still there. Frustration: still there. Hope: dwindling.
- Scott
Posted by theo on September 7, 2005, at 23:29:44
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on September 4, 2005, at 8:01:57
Hey Scott,
Any luck with the Keppra? Are you hanging in or about to throw in the towel with it?
Also, did you have ANY luck with Cymbalta at 30mg for any period, or is 60mg best minimum dose?
Ted
Posted by SLS on September 8, 2005, at 6:53:45
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on September 7, 2005, at 23:29:44
Hi Ted.
> Any luck with the Keppra? Are you hanging in or about to throw in the towel with it?
I haven't given up on Keppra yet. I almost quit taking it last week after my initial improvement disappeared at 1000mg. However, I feel that it is still helping a little. For me, the more gradual the improvement, the better the prognosis for remission. It is difficult for me to tell if there is a genuine trend towards improvement, but since I don't have many obvious alternatives left to try, I want to give Keppra a fair chance at working. I am currently taking 2000mg. This is the dosage being used investigationally for the treatment of bipolar disorder.
> Also, did you have ANY luck with Cymbalta at 30mg for any period, or is 60mg best minimum dose?I responded briefly to Cymbalta at a dosage of 60mg. In unusual cases, people can glean an improvement at very low dosages of almost any antidepressant. However, I would target 60mg as soon as possible with Cymbalta if you can tolerate it. I started at 30mg for a week to avoid side effects.
- Scott
Posted by theo on September 8, 2005, at 7:57:00
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on September 8, 2005, at 6:53:45
Thanks, and I forgot to ask, have you found t.i.d. dosing any better than b.i.d. for Keppra and its short half life? How are you taking the 2000mg?
Posted by SLS on September 9, 2005, at 8:08:22
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on September 8, 2005, at 7:57:00
> Thanks, and I forgot to ask, have you found t.i.d. dosing any better than b.i.d. for Keppra and its short half life? How are you taking the 2000mg?
I am taking 1000 b.i.d. I wish I could say that I were experiencing a trend towards improvement, but I feel as if things have plateaued. Still, in the grand scheme of things, I haven't been on 2000mg for that long, and a robust response might not occur for weeks. In the meantime, I am continuing to work with my doctor to get mifepristone. The FDA might not allow it.
- Scott
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