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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Raisinb on October 31, 2011, at 16:36:06
I was diagnosed with BP 2 about two months ago. Before that I had been experiencing severe depressions; ADs would always work but only for short periods and Wellbutrin did make me manic.
Since the dx I have been on Lithium 900, Lamictal 100, Seroquel 75, and 1 or 2 Xanax to sleep. Since I went on these meds I have random periods of rage--grinding my teeth, shaking, over small things. Also I have a few bad days every week, but in the last 2 weeks the bad days didn't stop and got worse, and now I am seriously depressed. My pdoc said first, "well, you're on a lot of medication, maybe reducing it would help." I was feeling suicidal at that moment and vetoed that idea. She then increased the lithium to 1050 and cut the seroquel to 25 and added Zoloft 25.
Is such a low dose of Zoloft likely to work, and should I think about maybe getting rid of one of the mood stabilizers? I am thinking the lithium. I have never been manic except for the Wellbutrin episode, but have been briefly hypo manic in the past year. And the lithium is evidently not controlling my depression, and it is causing acne and mental fog. And I want to know what is causing the rage.
Thoughts?
Posted by floatingbridge on October 31, 2011, at 17:39:11
In reply to Thoughts/advice?, posted by Raisinb on October 31, 2011, at 16:36:06
Were you meds added in order one by one? I ask because that might make it easier to think back to reactions to each.
So lithium was the last increase.
When was the lamictal added? That can be activating.
When was the Zoloft added (after the symptoms you describe?). The amount is probably low to start because I'm guessing your pdoc is being cautious. Zoloft can be activating, too.
I had a tough start up on lamictal. The anxiety and irritation were intense. Just based on my experience, and without knowing how long or well you tolerated it, I would suggest looking at that.
Others should weigh in soon.
I don't know about lithium creating mixed type states. Maybe someone here does.
Posted by jono_in_adelaide on October 31, 2011, at 17:41:18
In reply to Thoughts/advice?, posted by Raisinb on October 31, 2011, at 16:36:06
That does seem like a lot of meds so quickly into your diagnosis
On a side note, Xanax isnt the best benzo for sleep, consider changing it to temazepam, its a better sedative than xanax, and less addictive.
The seroquel dose is too low to be doing anything other than acting as a mild sedative and antihistamine.
Maybe you could drop the lithium and seroquel, and add some Zyprexia.
Posted by Phillipa on October 31, 2011, at 18:02:25
In reply to Re: Thoughts/advice?, posted by jono_in_adelaide on October 31, 2011, at 17:41:18
Lithium can cause a tremor. Lamictal for me wasn't activating neutal but then only got to 50mg. Years ago zoloft made me tired. I had the same reaction to wellbutrin and was okay when went back to previous meds? Phillipa
Posted by creepy on October 31, 2011, at 19:29:54
In reply to Thoughts/advice?, posted by Raisinb on October 31, 2011, at 16:36:06
Maybe lamictal is too activating and its pushing you into a mixed state. Which is pretty impressive considering youre on lithium too.
Maybe you could tolerate lamictal at ~200mg which is a mood stabilizing dose. It usually works best at keeping depressive episodes down but isnt as good on hypomania.
Odds are that zoloft would be a problem. Although a lot of people like myself dont go mixed on it, but will on just about any other SSRI.
You could also ask for a PRN script for something like zyprexa to help with the agitation and irritability.
Posted by Raisinb on October 31, 2011, at 19:44:27
In reply to Re: Thoughts/advice? » Raisinb, posted by floatingbridge on October 31, 2011, at 17:39:11
Hi floating bridge,
No, the first three were added all at once a couple months ago when I was hospitalized. The Lamictal I started at 25 mg and went up to 100 over a couple of weeks. I didn't get Zoloft until four or five days ago when I went in with severe depression.
I have been on Lamictal before--now this was a few years ago and I didn't have a bipolar dx yet--but it didn't seem to do this to me. I think I was in Lexapro at the time.
Posted by Raisinb on October 31, 2011, at 19:48:11
In reply to Re: Thoughts/advice?, posted by creepy on October 31, 2011, at 19:29:54
Interesting, it didn't occur to me that it could be the Lamictal, since I have been on it before and it didn't seem to do anything. I am on so much lithium that a mixed state would surprise me, but maybe it is. I was also on Zoloft for a year or so and to my memory it did not cause mania or hypomania, it just smoothed things out and made me calm.
Posted by Phillipa on October 31, 2011, at 21:05:53
In reply to Thoughts/advice?, posted by Raisinb on October 31, 2011, at 16:36:06
Took me awhile but remember you. I'm sorry you are not doing great at the moment. Phillipa
Posted by Raisinb on October 31, 2011, at 21:24:33
In reply to Re: Thoughts/advice? » Raisinb, posted by Phillipa on October 31, 2011, at 21:05:53
Thank you Phillippa.
Posted by alchemy on November 2, 2011, at 19:46:31
In reply to Thoughts/advice?, posted by Raisinb on October 31, 2011, at 16:36:06
Did you start taking that med combo all at once (or in a short time)? If so, that really makes it hard to figure out and your dr. is a moron. It doesn't make sense to me if being on meds made you worse to increase one of them (the lithium).
Those are bad rage episodes, I'm sorry. And it's weird that you are having random fits that sound like "cycling" to me with all of the mood stabilizers. From what I am reading, it sounds like you became BP2 after starting the meds. Agitation can be considered a form of mania (don't ask me why, when I've had agitation it isn't a happy place)
Lamictal seems to cause initial agitation in a lot of people (myself included). I would say you may have increased your dose too quickly, but because it's getting worse that doesn't seem the case.For me - Lamictal increases make me agitated for a while, but ironically, I think Lamictal may be what helped my long-term agitation. (I also got acne with both lithium & lamictal when I first tried them)
Antipsychotics (seroquel) give me agitation.
I have taken 2mg long-acting xanax during the day for a few years now. It talks the edge off of some mild anxiety & agitation.To confuse you compared to the other posts (we all have our different experiences), I would try decreasing the lithium first and stay on the Zoloft for now. Lithium can be used as an "add-on" for depression, but usually isn't used as an anti-depressant. Lamictal can be an anti-depressant as well as a mood stabilizer. 100mg is on the low side. I think as a whole, more people react more negatively to lithium than lamictal (don't quote me though).
Have you ever tried taking your xanax during the rage episodes? (until you figure out what is going on). Why aren't you taking ambien for sleep instead of xanax?
What has your experience with SSRIs or is Zoloft your first?
And don't decrease anything too quickly :) That's not fun either.
Posted by Raisinb on November 5, 2011, at 10:45:47
In reply to Re: Thoughts/advice?, posted by alchemy on November 2, 2011, at 19:46:31
Alchemy--I take Xanax bc both ambien and lunesta stopped working for me a few years ago, unfortunately. I'm on all the meds at once bc I was hospitalized 2 months ago for suicide attempts and that is where I first got the BP 2 dx, they are they one's who put me on the meds.
My doctor has ditched the seroquel altogether, raised the Zoloft to 50 mg, and is considering reducing Lamictal. I feel better. I have had four solid, good days. This may be just part of the cycle, though.
Unfortunately I have started to get a tiny bit of the famed lithium acne. I have some accutane I acquired from sources I won't name, but it won't last forever.
Posted by floatingbridge on November 5, 2011, at 11:21:51
In reply to Update, posted by Raisinb on November 5, 2011, at 10:45:47
Maybe your mood is beginning to level out two months into treatment. I'm glad you've had some good days.
Posted by alchemy on November 6, 2011, at 14:26:37
In reply to Update, posted by Raisinb on November 5, 2011, at 10:45:47
I'm so glad you are feeling better.
That makes sense about the xanax and that you were still pretty bad before taking these meds.
This is the end of the thread.
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