Posted by Kingfish on August 8, 2001, at 19:12:22
In reply to Re: Should first line mood stabilizers be tried first?, posted by susan C on August 8, 2001, at 18:25:31
> O.K. - first of all, this is very helpful - thank you!
Second of all, I'm a little manic tonight, so I hope my replies make sense.
> >I recall my pdocs reasoning was to try the newest, least apparent side effect mood stablizer/anticonvulsant first. He deduces a possible seizure related issue along with my previous reactions to other meds in addition to my symptoms. I think Some pdocs are more willing to go along with offlable first, if your history indicates non-responsiveness. I think some pdocs are more comfortable with pharmacology and tinkering around with the chemistry of everything.
> >I am thinking that since my pdoc is young and certainly enjoys "tinkering" that he was more gung-ho to start with something new than something old. This is not a criticism - just an observation.
> > Here are some questions your question brought up for me, that I am still trying to sort out:I have a question re: mood stabilizers for those diagnosed as manic depressive.
Which type of manic depressive? I have been seeing pdocs approach the med issue differently if you are a I or a II or a rapid cycler. If you are psychotic or hallucinating.
> >Yes, precisely, which type? I had a difficult time at first getting any diagnosis from my pdoc. I am officially "BPII" but I have hallucinations and some psychotic delusions as do other members in my family. It seems to be getting worse as I get older. And more frequent (not as frequent as yours). I need to keep close tabs on it. One member here, Mitch, has charted his moods for 25 years! I don't think my pdoc has a handle on the severity of this illness, especially as it relates to my family.
> > For example. I am now identified as a rapid cycler (some times up and down several times a day) When pdoc and I talked about my fifth (?) next choice, after depakote kind of helped, and what to add, I said, litium could be added, he said yes, that is the regular course but it only helps 20% of rapid cyclers, and you had uncomfortable side effects when you took it before.(10 years ago) and I asked, it hasn't changed-so, the odds are it won't help? I decided to go with something completely new. Notice the operative word: I ....(I feel like I am trying on a pair of shoes or something....) and after two weeks, I am not sure....
> >Again, exactly!! Last time I was in I told my pdoc what I wanted to do - I wanted to add another stabilizer - Lamictal. Topamax helps but is too sedating to increase. Now I'm second-guessing myself. Why am I telling my pdoc what to do? What am I playing with here?
> >Keppra, makes me a disconnected kind of tired. Every once in a while, there is a break through of clarity, then, it fogs over.
> >I haven't heard of this one. I'm sorry you've had such a hard time finding something. Do meds work for awhile and then "poop" out as people say? I've only been on a stabilizer since last November.
> > How hard it is for us who have a disorder/illness that affects our thinking and we have to make decisions...it is like asking some one with two broken legs to walk a mile for help.
> >Yes, yes, yes!! When the Topamax "kicked in", it was the first time I could think clearly, linearly for maybe twelve years. Why does it affect our thinking, as well as our moods, our actions? The lack of control is maddening..
> > I had already tried lithium. I know my new pdoc posponed depakote because of its side effect profile (weight gain, hair loss) that pdoc had observed. and didn't want to put me through that if it could be avoided (I am already 30 lbs overweight).
> >Those are pretty bad side effects...
> >When the others Topamax (dope-a-max couldn't find words, was struck dumb) and lamictal (swollen gland) and others put me totally to sleep for days, itched all over, etc.) didn't work, we were left with Depakote.
> >Interestingly enough, the dope-a-max effects went away with the Topamax for me, but were Very pronounced at first. I currently have a sore throat on Lamictal, so we'll see.
> >I said I would live at the club, exercise, walk, and I have actuallly lost weight, at times. I have not gained. My hair sort of fell out, but I took zinc and Selium as recommended (dr bob tips, too)and it is lessening, but my mood still, tho not as much, goes up and down. My question is now, after this obvious choices, where do you go from there? My pdoc is a tinkerer, an experimenter, an examiner. So far, I know it is a matter of wait and see, trial and error.
> >> > Should they be taken at all? I know from my experience, and multiple pdoc recommendation, I can not take Anti depressants. Prozac, rx under dx of depression by old pdoc, after 5 years, stopped working and probably caused the crash and worsening of my symptoms. Serzone helped for a while, but I crashed in the end.
> >I don't know. The addition of Lamictal was with the thought of lowering the Prozac (my thought) since it has AD properties. Depression has been much more pronounced for me in the past.
Thank you again!! You have been so helpful - I feel as if I have found a comrade. :)
- K.
poster:Kingfish
thread:74220
URL: http://www.dr-bob.org/babble/20010804/msgs/74236.html