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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by markwell on May 7, 2011, at 16:16:56
From previous posts I explained about being on Tegretol and provigil. The only benefit I get from Tegretol is a few hours of sleep, everything else is awful, constant edginess and depression, intense depression. I want to move in a different direction but my pdoc wants to forge ahead with Tegretol. He says my only option is lithium or ect. The problem I had with lithium is it didn't help my sleep when i tried it for a brief stint. I can't continue like this. Any thoughts? I think the racing thoughts I have are what contribute to my insomnia issues and lithium doesn't help at all with racing thoughts. I'm at such a loss. Bp really sucks. I'd appreciate any ideas!
Mark
Posted by floatingbridge on May 7, 2011, at 17:28:53
In reply to Now what?, posted by markwell on May 7, 2011, at 16:16:56
Markwell, I don't really know. I just wanted to mention that provigil fueled my dysphoric thinking. My mind would go, go, go, for better or worse, even if I was dead tired. Since you mentioned racing thoughts.
I'm not familiar with your other meds. Most likely a regular stimulant is contraindicated for you. I did better with dexedrine. I wanted to pipe up on the off chance that a med you may least expect was hamstringing you.
Best of luck.
Posted by markwell on May 7, 2011, at 17:50:16
In reply to Re: Now what? » markwell, posted by floatingbridge on May 7, 2011, at 17:28:53
I had the racing thoughts before the provigil (4th) day on it. It has gotten worse on it. Did Dexedrine help racing thoughts or was it helpful for energy? I need help with racing thoughts. Thanks for your input.
Posted by floatingbridge on May 7, 2011, at 18:07:43
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 17:50:16
Well, no one thinks I have BP right now. I do have ADD-l (inattentive), and dexedrine settled my mind as it usually does for add-types. I also had and have severe fatigue. So it was dual purpose.
I've never said I've had 'racing' thoughts, but have experienced times when my mind would not stop, even good thoughts. It's a long story, but I'm
contemplating whether ssri's/snri's have contributed to that and mood instability in general. A hallmark, I know, of a BP disorder--I used to be considered BPnos.So, I'm not sure my experience is helpful, but for what it's worth and since you
asked.Are you familiar with the theory or theories that ADHD and BP may share a genetic factor?
It's Saturday, and lots of folks might be out right now. Someone with more experience should be by soon. Are you o.k.?
Maybe a list of your current meds would help folks respond.
fb
Posted by markwell on May 7, 2011, at 18:34:22
In reply to Re: Now what? » markwell, posted by floatingbridge on May 7, 2011, at 18:07:43
Im not suicidal but I'm not really ok. I just feel like I'm losing my mind. This has been so frustrating to me and I don't feel like my condition is treatable, are there cases where Bp is untreatable? I need a mood stabilizer but it's depression that is killing me.
Meds
600mg Tegretol
100 mg provigil....probably going off
Posted by mtdewcmu on May 7, 2011, at 19:09:02
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 18:34:22
> Im not suicidal but I'm not really ok. I just feel like I'm losing my mind. This has been so frustrating to me and I don't feel like my condition is treatable, are there cases where Bp is untreatable? I need a mood stabilizer but it's depression that is killing me.
> Meds
> 600mg Tegretol
> 100 mg provigil....probably going offHow did you come to be diagnosed with bipolar? I've read that some doctors are calling a lot of things bipolar now that would not have been bipolar in the past. I think the "proof" is that mood stabilizers help, but that doesn't really prove anything. Maybe you need to treat this more as an anxiety disorder or unipolar depression.
Posted by mtdewcmu on May 7, 2011, at 19:13:19
In reply to Re: Now what? » markwell, posted by floatingbridge on May 7, 2011, at 18:07:43
> Well, no one thinks I have BP right now. I do have ADD-l (inattentive), and dexedrine settled my mind as it usually does for add-types. I also had and have severe fatigue. So it was dual purpose.
>If you are diagnosed ADD, why was your Dexedrine discontinued? I think for me, it is not particularly healthy and certainly unpleasant to be in a state where I can't focus. There's no distraction from a feeling of general gloom or doom when I can't stay engaged in an activity.
Posted by floatingbridge on May 7, 2011, at 19:21:28
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 18:34:22
Are you bp l or ll?
Have you been treated for anxiety?
I currently used xanax xr, but I'm not pushing benzos. Have you ever tried them?
AP's? (Abilify & seroquel didn't help me, but some people here find them useful.)
What is your experience with neurontin?
Just something to tone it all down...
Does it feel like anxiety? I know racing thoughts can create anxiety. Which is the chicken and which is the egg?
I like that your combo is so spare--but it isn't working. The provigil is for fatigue in your case (guessing) or alerting?
Is the stimulant class contraindicated.
I will find your thread rather than have you repeat yourself.
Glad you are relatively alright. Stay with it, you'll get through this. There are answers. Why does your doctor feel limited? (Did I interpret that correctly.)
Be back later.
fb
Posted by Phillipa on May 7, 2011, at 19:22:07
In reply to Re: Now what? » markwell, posted by mtdewcmu on May 7, 2011, at 19:09:02
So far agree with above. Anxiety sure causes racing thoughts for me. I feel too many are being diagnosed bipolar and new DSM lists even more categories of it. Have you taken or tried Deplin as an adjunct to an ad? I had a conversation with the drug rep from Deplin and was told 15mg has been found to work better and that B12 isn't necessary. Phillipa
Posted by markwell on May 7, 2011, at 19:23:14
In reply to Re: Now what? » markwell, posted by mtdewcmu on May 7, 2011, at 19:09:02
After using paxil for about ten yrs, I've had two full blown manic episodes, hospitalized for both.
Mark
Posted by markwell on May 7, 2011, at 19:34:20
In reply to Re: Now what? » mtdewcmu, posted by Phillipa on May 7, 2011, at 19:22:07
> So far agree with above. Anxiety sure causes racing thoughts for me. I feel too many are being diagnosed bipolar and new DSM lists even more categories of it. Have you taken or tried Deplin as an adjunct to an ad? I had a conversation with the drug rep from Deplin and was told 15mg has been found to work better and that B12 isn't necessary. Phillipa
Thanks Phillipa, benzos that Ive tried have made me more depressed. I don't know if I tried deplin but I'm not taking an ad currently. You can see where my dr might be frustrated.
Posted by floatingbridge on May 7, 2011, at 19:37:53
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 19:23:14
> After using paxil for about ten yrs, I've had two full blown manic episodes, hospitalized for both.
> Mark
>
>Oh. That's cr*ppy. I'm sorry. Still getting to your prior thread. Yeah, sometimes AD's do not have the benign profile they are advertised as having.
:<
So no to neurontin?
Posted by markwell on May 7, 2011, at 19:58:56
In reply to Re: Now what? » markwell, posted by floatingbridge on May 7, 2011, at 19:37:53
I don't know if there's an interaction with tegretol but i'll look into it.
Mark
Posted by mtdewcmu on May 7, 2011, at 20:56:11
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 19:23:14
> After using paxil for about ten yrs, I've had two full blown manic episodes, hospitalized for both.
> Mark
>I'm sorry to hear that. I don't know enough about that disorder to be very helpful.
Posted by floatingbridge on May 7, 2011, at 21:32:59
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 19:58:56
Markwell,
Just read the provigil thread. It does sound like it might not be working. I felt like the odd one out, returning my unused provigil to my doctor after about 9 days. I read on your previous thread a few others not loving it, too.
Are AP's off the table because of the
seroquel trial?Depakote?
(So do you think the racing thoughts might not helped by stabilizers...?)
Also, any discussion about an maoi with your doctor?
That could, maybe, address some of the *anxiety *. But you haven't mentioned
anxiety yourself. Racing thoughts. Are you concerned you are cycling up again?
Or am I getting it straight that the racing thoughts have remained somewhat constant? Did Paxil give some relief (in retrospect)?Are your thoughts insistent, repetitive, or somehow likened in tone, pattern, or content to ocd or gad?
My own knowledge is limited. Others will weigh in soon. I think there's some nice weather going on right now. There have to be other medication classes you can try. You're in the US?
fb
Posted by Phillipa on May 7, 2011, at 21:35:50
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 19:23:14
From the paxil after l0 years? sounds strange???? Phillipa
Posted by markwell on May 7, 2011, at 22:36:20
In reply to Re: Now what? » markwell, posted by Phillipa on May 7, 2011, at 21:35:50
Phillipa, it wasn't a smooth ten yrs. At 20mgs I would get extreme racing tthoughts so I spent the whole time up and down in dosages and trying other ads always ending back on paxil. I've tried Seroquel, zyprexa and Geodon and got td on the Geodon and now my dr is unwilling to script an ap. The ap's helped with racing thoughts but I was quite irritable on them. Depakote made me more depressed and felt really strange on it. Sleep is one of my big issues and I think the racing thoughts are the root to that issue. I've tried sleeping pills and I get a few hrs sleep and feel like crap. You can see my dilemma.
Posted by Phillipa on May 7, 2011, at 23:30:23
In reply to Re: Now what?, posted by markwell on May 7, 2011, at 22:36:20
Yes a Rock and a Hard Place or so they say. Phillipa
Posted by bleauberry on May 8, 2011, at 4:47:59
In reply to Now what?, posted by markwell on May 7, 2011, at 16:16:56
I really hate to say it, but the first thing that jumped out at me was the need for a new doctor. I mean, if he thinks lithium or ect are your only options, geez, that is so wrong. There are so many options we don't have time in a lifetime to try them all.
I'm not sure if the intense depression you talked about was directly attached to the tegretol or if it was already like that before tegretol. If tegretol is aggravating it, I can't imagine continuing to take it. That just boggles my mind. At the most basic level it just defies logic and begs for trouble.
The patient feels aweful. This new med makes the patient feel even more aweful. Cool, let's keep taking it. Huh?? Sorry, I don't get that..
I'm not familiar with your previous meds so I can't really make any suggestions there. For sure there should be some plant medicines in the mix along with the pharmaceuticals. My opinion.
I don't know what the provigil is doing for you or if it causes problems, so no comment there. it wouldn't be surprising is some of the edginess and depression was from that as well. Maybe? Has to be considered.
Cordyceps.
What have you done outside of the psychiatric toolbox? I ask simply because when we get to the point where you are, it is no longer optional or alternative....it becomes mandatory simply by the rules of elimination. Multiple drug failures seem confounding and confusing to most people. It used to do that with me too. But it's not confusing. It's just your body screaming at you....except you aren't listening....that your whole strategy is way off target. It means the meds are impacting stuff that doesn't need to be impacted, impacting stuff that isn't a problem, or too limited in scope to deal with the more widespread comprehensive biologies involved. Meds are so targeted they can miss a lot. We need an approach that covers a lot of potential bases all at the same time. Meds alone aren't very good at that.
Let's say these things happen in the next month:
Diet is seriously overhauled and improved.
Anti-inflammation plants are consumed.
Anti-microbial plants are consumed.
Pro-immune system plants are consumed.
Plants with a ton of scientific evidence in addition to several thousand years of actual usage that help to heal and modulate diverse body chemistries are consumed.When all of the above are done, psychiatric symptoms cannot help but to improve or go away. Lessen the body's burdens, no matter what they are, and symptoms have no other direction to go except better. Meds will almost always work better and be more cooperative as well.
Expel evil and support the righteous. We don't know what the evil's are, but you can be pretty sure at least 2 or 3 of the above list, if not all, are at play. I personally don't see provigil or tegretol doing anything along these lines. Those are purely for attempting to address specific symptoms without any concept or concern of the bigger picture that is causing/aggravating the symptoms.
Posted by markwell on May 8, 2011, at 5:28:10
In reply to Re: Now what?, posted by bleauberry on May 8, 2011, at 4:47:59
My doctor is supposed to be the best in the area I live. I guess his thinking is some of the initial side effects went away, headache, some of the irritability so maybe things will improve. The Tegretol isn't for depression, mood stabilizer. As bad as I am I'm not as suicidal as I was this winter so maybe he perceives that as progress on the Tegretol. The dark long winters in upstate ny kill me. I like your ideas bb but I don't know where to start without the help of a physician or a book or something. It's hard to get out of this hole on my own. The provigil was added for depression and it has clearly exasperated things. I'm taking fishoils but that hasn't helped so far. I feel like I'm headed in a bad direction! I think sleep is the first thing to work on, which relates to the racing thoughts. Thanks for your input.
Posted by floatingbridge on May 8, 2011, at 15:03:27
In reply to Re: Now what?, posted by markwell on May 8, 2011, at 5:28:10
Hi Markwell,
Your doctor can be one of the best, and you could still get a second opinion. That's maybe not easy when one isn't feeling well, I know myself. I still think there are lots of options even given your constraints. My own pdoc was so exasperated when I said I quit to ssri's/snri's. He didn't know what to do. I twisted his arm to try another drug class--just emsam. Anyways, that's my opinion. I tend to favor second opinions and the potential for fresh points of view.
I'm glad you are relatively safe, but if you or your doc has even brought up ect, then that suggests your depression or distress should be taken seriously. However, rTMS is looking more promising than ect, and hopefully soon covered by insurance. There's talk, my pdoc told me, of a rTMS treatment facility being placed in my little insignificant city.
On another thread I read about an agent called topamax. Maybe you've tried it. I haven't. It's tolerated by some who cannot tolerate lyrica, the next generation of neurontin.
Fish oil is great. Everything we can do to maintain and restore brain health and overall health is excellent. I take krill oil. Alot. (Some people do say they feel better w/o it.) I can feel it's helping, and right now I won't ask it to do too much more than that.
There are answers. In the meantime, I am wishing you, at the very least, a good enough Sunday.
This is the end of the thread.
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