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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by 4wd on October 12, 2005, at 23:12:24
Please help me figure out what would be a good one to try. It's starting to look like I may have some bipolar tendencies (agitation with depression, that feeling that I'm so full of (negative) energy that I might explode, anxiety in the morning, fine at night).
I want something that works fast - I want to try to either verify or rule out bipolar as a diagnosis and figure if I try one that works quick, I'll then know right away if it's bipolar or just depression + anxiety.
I can't risk something that's going to make me hungry or fat. I'm almost a year into recovery from bulimia and I don't want to go back there.
I'm anxious and want something calming.
I'm depressed (on Celexa which keeps me out of depression but seems to make me more agitated and anxious and makes my muscles spasm) so something with good effects on mood.
Can't take Lamictal. It caused really bad headaches before I ever got up to 50mg.
I have lifelong issues with insomnia which are at present resolved. A miracle happened and I am now sleeping normally for the first time in over 30 years so I don't want to mess that up.
This is very confusing for me since it never ocurred to me until my last pdoc appt. that bipolar might be an issue. I'm still kind of in shock and don't have a clue. I guess I can just take my pdocs' advice but I think you guys might know more from personal experience, you know?
What might be best?Marsha
Posted by lunesta on October 12, 2005, at 23:33:32
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
neurontin
Posted by Maxime on October 13, 2005, at 0:36:45
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
Hi marsha
It's a hard question to answer because everyone reacts differently. Trileptal is weigh neutral with few side effect. I wouldn't say it has a calming effect though.
I know Seroquel is used as a mood stabiliser. You don't gain the kind of weight you do on Zyprexa. It's used for anxiety too.
Hope this helps. You might want to check out the Alternative Board too.
Maxime
> Please help me figure out what would be a good one to try. It's starting to look like I may have some bipolar tendencies (agitation with depression, that feeling that I'm so full of (negative) energy that I might explode, anxiety in the morning, fine at night).
>
> I want something that works fast - I want to try to either verify or rule out bipolar as a diagnosis and figure if I try one that works quick, I'll then know right away if it's bipolar or just depression + anxiety.
>
> I can't risk something that's going to make me hungry or fat. I'm almost a year into recovery from bulimia and I don't want to go back there.
>
> I'm anxious and want something calming.
>
> I'm depressed (on Celexa which keeps me out of depression but seems to make me more agitated and anxious and makes my muscles spasm) so something with good effects on mood.
>
> Can't take Lamictal. It caused really bad headaches before I ever got up to 50mg.
>
> I have lifelong issues with insomnia which are at present resolved. A miracle happened and I am now sleeping normally for the first time in over 30 years so I don't want to mess that up.
>
> This is very confusing for me since it never ocurred to me until my last pdoc appt. that bipolar might be an issue. I'm still kind of in shock and don't have a clue. I guess I can just take my pdocs' advice but I think you guys might know more from personal experience, you know?
>
>
> What might be best?
>
> Marsha
Posted by RobertDavid on October 13, 2005, at 0:59:05
In reply to Re: If I have to start a mood stabilizer...? » 4wd, posted by Maxime on October 13, 2005, at 0:36:45
Lyrica is the "new" neurotin. It's more potent with less side affects. I'm currently taking it for anxiety, but my doctor says it's a good mood stabilizer. I hope that's helpful, best of luck!
Posted by blueberry on October 13, 2005, at 6:54:41
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
My only experience is with low dose lithium (75mg - 300mg) and low dose depakote (500mg).
I found lithium to be stimulating, and actually almost caused panic attacks. So not sure if that would be good for calming. Of course, we all respond differently.
Depakote is calming, relieves depression, anxiety, and mania stuff all at the same time. It is fast. Began working on day 1. In clinical trials it usually works within 6 days. But it comes with weight gain. Trileptal is often used to counteract weight gain. Don't know much about neurontin except that it isn't as popular as it once was because it didn't pan out as being as effective as initially thought. Again though, we all respond differently, so it may be great for some people.
Zypexa is an option, though it also comes with initial weight gain which tends to go away after about 3 months or so. The antipsychotics work very fast, like within hours or days. I don't think they stop the anxiety and mania stuff, they just block it so you can't feel it.
Back in the old days klonopin was the calming mood stabilizer. A lot of docs shy away from the benzos though.
Posted by fairywings on October 13, 2005, at 11:17:35
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
> I want something that works fast - I want to try to either verify or rule out bipolar as a diagnosis and figure if I try one that works quick, I'll then know right away if it's bipolar or just depression + anxiety.
>
> I can't risk something that's going to make me hungry or fat. I'm almost a year into recovery from bulimia and I don't want to go back there.
Topamax and Zonegran won't make you fat, usually make you lose weight. I just got off of Topamax, it made me calm, but it's not w/o it's side effects which is why I went off. You can check them out on crazy meds or Rx list.Good luck!
fw
Posted by fuchsia on October 14, 2005, at 3:23:21
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
I don't know how long you waited on the lamictal but I also got bad headaches at dosages below 50mg and they did eventually go away when I waited on the same dose. I am at 100mgs now and at my last dose increase (from 75mg) I got a lot fewer headaches than I did with the very tiny dose increments I did at the beginning.
I wish I'd tried a mood stabiliser years ago; it makes such a huge difference.
Posted by Sonya on October 14, 2005, at 7:34:50
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
What has worked for me (& is currently still working) is 500mg Depakote. As far as weight gain, I did gain on 1,000mg in the beginning but since I've reduced it to 500mg I've been able to lose weight (16 lbs). But I also take Wellbutrin and eat a restricted calorie diet. I just want you to know you don't have to gain weight on Depakote. You might try the low dose at 500mg. I experience no other bad side effects from it.
Posted by 4wd on October 14, 2005, at 20:58:02
In reply to Re: If I have to start a mood stabilizer...? » 4wd, posted by Sonya on October 14, 2005, at 7:34:50
Thank you all. I believe I am experiencing ultra ultra rapid cycling. I wake up full of agitation (that's what wakes me up, three hours too early). I'm scared and full of terrible nervous energy. This sometimes stays all day and then I feel okay at night. Other days, I have spells of the deepest depression one minute and terror the next. Sometimes both at the same time. I feel hopeless and like I can't control my brain and sometimes suicidal because it's all driving me crazy.
I know how I react to all the ADs but I have no experience with BP meds at all. I am terrified. I've read that bipolar with ultra rapid cycling or mixed states is hard to treat.
Marsha
Posted by Maxime on October 15, 2005, at 0:14:53
In reply to Re: If I have to start a mood stabilizer...?, posted by 4wd on October 14, 2005, at 20:58:02
I THINK that Tegretol is the "ms" of choice for rapid cyclers if I remember correctly. I am sorry you are going through such a rough time.
Hugs,
Maxime> Thank you all. I believe I am experiencing ultra ultra rapid cycling. I wake up full of agitation (that's what wakes me up, three hours too early). I'm scared and full of terrible nervous energy. This sometimes stays all day and then I feel okay at night. Other days, I have spells of the deepest depression one minute and terror the next. Sometimes both at the same time. I feel hopeless and like I can't control my brain and sometimes suicidal because it's all driving me crazy.
>
> I know how I react to all the ADs but I have no experience with BP meds at all. I am terrified. I've read that bipolar with ultra rapid cycling or mixed states is hard to treat.
>
> Marsha
Posted by SLS on October 15, 2005, at 9:54:04
In reply to Re: If I have to start a mood stabilizer...? » 4wd, posted by Maxime on October 15, 2005, at 0:14:53
> I THINK that Tegretol is the "ms" of choice for rapid cyclers if I remember correctly. I am sorry you are going through such a rough time.
Lamictal is also a drug touted as being particularly effective for rapid-cycling, even though it isn't very powerful to treat mania once it is triggered. Very often, two mood stabilizers are necessary for rapid cycling.
- Scott
Posted by 4wd on October 15, 2005, at 22:16:31
In reply to Re: If I have to start a mood stabilizer...? » 4wd, posted by Maxime on October 15, 2005, at 0:14:53
> I THINK that Tegretol is the "ms" of choice for rapid cyclers if I remember correctly. I am sorry you are going through such a rough time.
>
> Hugs,
> Maxime
>
Hi Maxime,Thanks. I'm sorry you've been in such a bad place lately too. It does sound like you feel al little better now - maybe hope that the sulpiride will work? Sometimes just having a little tiny ray of hope is enough to keep you going. I hope it works for you. When will you start the Prozac?
marsha
>
Posted by Maxime on October 16, 2005, at 23:00:28
In reply to Re: If I have to start a mood stabilizer...? » Maxime, posted by 4wd on October 15, 2005, at 22:16:31
Hi
I don't know about the prozac. I wanted to take it instead of the Parnate. But my pdoc wants me to take a small amount with the Parnate which Ed and SLS are warning me not to do. I don't have the prozac yet so who knows.
I had a rough few days where I stayed in bed. Now I feel bit better now because of an important decision I have made ... so we shall see.
What med do you think you will go with?
xoxo
Maxime> > I THINK that Tegretol is the "ms" of choice for rapid cyclers if I remember correctly. I am sorry you are going through such a rough time.
> >
> > Hugs,
> > Maxime
> >
> Hi Maxime,
>
> Thanks. I'm sorry you've been in such a bad place lately too. It does sound like you feel al little better now - maybe hope that the sulpiride will work? Sometimes just having a little tiny ray of hope is enough to keep you going. I hope it works for you. When will you start the Prozac?
>
> marsha
>
> >
>
>
Posted by Maxime on October 16, 2005, at 23:04:45
In reply to If I have to start a mood stabilizer...?, posted by 4wd on October 12, 2005, at 23:12:24
A bit long but worth the read. :-)
MaximeRapid cycling and mixed-state/dysphoric mania from http://home.comcast.net/7Epmbrig/BP_pharm.html#rapid
Rapid cycling is defined in DSM-4 as four or more episodes of abnormal mood (depression or mania) within 12 months, demarcated either by partial or full remission for at least two months or a switch to an episode of opposite polarity. Mixed-state or "dysphoric" mania describes those patients with simultaneous symptoms of depression and mania; according to DSM-4, the full criteria for both must be met. A great many more patients will have subsyndromal mixed states, failing to meet criteria for either mania or depression, or both. Many now feel (e.g., McElroy) that the DSM criteria are too restrictive, and that these subsyndromal patients should be treated as having mixed bipolar disorder. Mood in these patients is typically irritable and/or depressed, with other signs of activation (agitation, a feeling of internal pressure, racing thoughts, restless energy).
Mood charting is extremely revealing with regard to cycling patterns, and many dysphoric/mixed-state patients show cycling patterns when moods are charted. If a mixed-state patient is closely questioned, s/he may reveal ultradian (within one 24 hour period) patterns of mood cycling. Many patients who cycle never get into the hypomanic range; if the cycles of waxing and waning depression are more frequent than four times a year, such patients should be considered rapid cycling bipolar patients when they have a history of (hypo)mania.
The single most effective treatment for rapid cycling is to discontinue antidepressants!!!
The best predictor for cycle acceleration is a history of antidepressant-induced mania. All antidepressants can accelerate cycling; bupropion is said to be least likely to do so (actual studies are meager), with MAOIs a close second, but even these agents can be counterproductive. By and large, antidepressants should be used sparingly if at all. Stopping an antidepressant will sometimes have quite rapid effects on settling down mood cycling. Care must be taken, however, to taper (over ten days to two weeks) rather than suddenly stop ADs, since rapid discontinuation also promotes mania. As mentioned above, the trend of the cycling pattern should usually be the basis of decision-making, since decreased cycling will typically precede euthymia. The best early sign of response is not improvement of mood per se but decrease in cycle amplitude and frequency. It may take several months on what will prove ultimately to be the correct regimen for cycling to disappear entirely. Patience in this regard is essential.
Thyroid status should be assessed carefully in rapid cycling patients, as the evidence for the utility of thyroid augmentation is stronger in this subcategory. Hyperthyroid augmentation has been tried in a handful of studies, and could be considered for very treatment-resistant patients. Thyroid doses (T4, with or without T3) can be pushed to the point of tachycardia, obviously with informed consent, and careful assessment of the risk/benefit ratio.
Valproate is the treatment of choice for rapid cycling and mixed or dysphoric manic states. One study suggested that combining valproate with lithium may be useful. Carbamazapine is generally accepted as the second choice agent. (It remains to be seen if oxcarbazepine will prove to be equivalent to CBZ here.) Both gabapentin and lamotrigine have been used increasingly for this as well, with some success (see Calabrese et al 2000), though lamotrigine has been reported to backfire and promote mania. Nonetheless, the Expert Consensus Guidelines now recommend lamotrigine as a first-line option for current depression in the context of rapid cycling. Stoll et al have a study suggesting that lithium plus choline may be effective for rapid cyclers. A calcium channel blocker could be considered. Combination treatment with several mood stabilizers with or without an atypical neuroleptic is recommended for treatment-resistant cases. ECT is sometimes effective.
> Please help me figure out what would be a good one to try. It's starting to look like I may have some bipolar tendencies (agitation with depression, that feeling that I'm so full of (negative) energy that I might explode, anxiety in the morning, fine at night).
>
> I want something that works fast - I want to try to either verify or rule out bipolar as a diagnosis and figure if I try one that works quick, I'll then know right away if it's bipolar or just depression + anxiety.
>
> I can't risk something that's going to make me hungry or fat. I'm almost a year into recovery from bulimia and I don't want to go back there.
>
> I'm anxious and want something calming.
>
> I'm depressed (on Celexa which keeps me out of depression but seems to make me more agitated and anxious and makes my muscles spasm) so something with good effects on mood.
>
> Can't take Lamictal. It caused really bad headaches before I ever got up to 50mg.
>
> I have lifelong issues with insomnia which are at present resolved. A miracle happened and I am now sleeping normally for the first time in over 30 years so I don't want to mess that up.
>
> This is very confusing for me since it never ocurred to me until my last pdoc appt. that bipolar might be an issue. I'm still kind of in shock and don't have a clue. I guess I can just take my pdocs' advice but I think you guys might know more from personal experience, you know?
>
>
> What might be best?
>
> Marsha
Posted by fuchsia on October 18, 2005, at 7:00:04
In reply to Re: If I have to start a mood stabilizer...? » 4wd, posted by Maxime on October 16, 2005, at 23:04:45
That's an interesting post Maxime.
When they say-
"It may take several months on what will prove ultimately to be the correct regimen for cycling to disappear entirely. Patience in this regard is essential."
-I wonder how many people are really that patient. I'm trying to settle on the lowest possible dose for my lamictal but I can't wait more than two weeks on any dose before I want to try the next one up.
That question of how long will it take on the ultimately correct regimen to get the effect has been on my mind.
Posted by 4wd on October 18, 2005, at 13:01:02
In reply to Re: If I have to start a mood stabilizer...?, posted by fuchsia on October 18, 2005, at 7:00:04
> That's an interesting post Maxime.
>
> When they say-
>
> "It may take several months on what will prove ultimately to be the correct regimen for cycling to disappear entirely. Patience in this regard is essential."
>
> -I wonder how many people are really that patient. I'm trying to settle on the lowest possible dose for my lamictal but I can't wait more than two weeks on any dose before I want to try the next one up.
>
> That question of how long will it take on the ultimately correct regimen to get the effect has been on my mind.
Exactly . It's very hard to be patient when you've BEEN being patient for years and now they want yo to wait more months.marsha
Posted by 4wd on October 18, 2005, at 13:07:06
In reply to Re: If I have to start a mood stabilizer...? » 4wd, posted by Maxime on October 16, 2005, at 23:04:45
Thanks Maxime, for that article. I've been thinking valproate. I guess I'll leave it up to my pdoc - I need to quit trying to self prescribe, I think. Not because I don't have good info but because it is ultimately to my detriment to spend hours obsessing over what the proper med or combo might be.
I've decreased my Celexa from 10mg to 5mg and am feeling a bit less agitated. I'm also a bit more apathetic and sluggish but I'd rather have that than the fear and agitation. I've been keeping a mood chart for about 10 days now, too, so maybe that will help him figure this out.
Maxime, I don't like the sound of the important decision. I have a date marked on my calendar - it was November 11 but I've now moved it back to March 11 of next year. I don't know if it's the same kind of decision but I'm thinking my date on the calendar might not be a good idea.
Anyway, the idea of the Prozac plus Parnate is kind of scary. Did your pdoc address the serotonin syndrome issue when bringing this up?
Hoping all the best things for you,
Marsha
Posted by 4wd on October 18, 2005, at 22:10:48
In reply to Re: If I have to start a mood stabilizer...? » Maxime, posted by 4wd on October 18, 2005, at 13:07:06
Maxime,
Sorry if I sounded preachy. I am worried about you - you are such a valuable person - I don't want anything to happen to you.
Marsha
Posted by Maxime on October 19, 2005, at 14:05:45
In reply to Re: If I have to start a mood stabilizer...? » Maxime, posted by 4wd on October 18, 2005, at 13:07:06
My Pdoc is now gone for a couple of weeks. He is old and works from his home so he doesn't have a backup to fill in for him. I didn't get the prozac and I don't have plans to take it with the Parnate. What I wanted was to switch over to Prozac completely because Prozac and Parnate are the only to AD that have ever worked for me.
I hope the your new med helps you.
Maxime> Thanks Maxime, for that article. I've been thinking valproate. I guess I'll leave it up to my pdoc - I need to quit trying to self prescribe, I think. Not because I don't have good info but because it is ultimately to my detriment to spend hours obsessing over what the proper med or combo might be.
>
> I've decreased my Celexa from 10mg to 5mg and am feeling a bit less agitated. I'm also a bit more apathetic and sluggish but I'd rather have that than the fear and agitation. I've been keeping a mood chart for about 10 days now, too, so maybe that will help him figure this out.
>
> Maxime, I don't like the sound of the important decision. I have a date marked on my calendar - it was November 11 but I've now moved it back to March 11 of next year. I don't know if it's the same kind of decision but I'm thinking my date on the calendar might not be a good idea.
>
> Anyway, the idea of the Prozac plus Parnate is kind of scary. Did your pdoc address the serotonin syndrome issue when bringing this up?
>
> Hoping all the best things for you,
> Marsha
>
This is the end of the thread.
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