Posted by Ritch on December 17, 2002, at 12:37:13
In reply to Re: Can Klonopin decrease AD efficacy? » Ritch, posted by MB on December 17, 2002, at 11:41:31
> > Wow!, you are having *ultradian* mood cycles. What sounds especially spooky is the early morning rage thing and then getting very depressed later on. That is not uncommon with folks with intermittent explosive tempers (like me-which at worst follows a rage/panic/depression sequence), but that is also not uncommon with temporal lobe epilepsy either. I think you went and did a bunch of SPECT scan stuff, right? What was the result of all that? You never replied about ever trying any Depakote---have you tried any? Just a hunch, but it sounds like you might benefit a lot from Depakote+T4 or something like it.
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> Yeah, I did do the SPECT thing, and the evaluation was that I needed an anticonvulsant (there was way too much activity in my left temporal lobe). Also, hyperactivity in the limbic region (I thought that would indicate euphoria, but I was wrong, the doc said it was indicative of depression). He wanted to add an SSRI to the AE, stating that the AE would counter the rage and agitation I get from the SSRIs. Then he wanted me on Adderall since activity in my frontal lobes dropped drastically when I took a concentration test. It sounded nice in theory, but things didn't go as planned. There were all sorts of intolorance issues, and I wasn't able to get on the meds in the order the doc wanted me to. I was so sensitive to side effects that he was actually starting to get a little mad and flustered. I know a girl on Depakote for Bipolar One who swears by it, but she's pretty med tolorant. She takes Depakote, Wellbutrin, and an SSRI...and she's pretty much taking the maximum sugested doses of each one. I don't know how she can even complete a sentence, but she's pretty sharp, finished school, and has maintained a pretty sexy bod (she runs daily). Where she gets the energy on those meds, I don't know!! I'm scared of the depakote/weight thing. I'm once bitten, twice shy from 40 lb gain on Paxil. I'm already on thyroxine. Is that T-3 or T-4, I get confused. Anyway, the guy evaluating the spect scan did a battery of thyroid tests (went way beyond the normal TSH test) and said to keep my thyroid meds the way they are. What has your experience with Depakote been? I was hospitalized with a woman who said that her Depakote doses felt like being hit in the head with a sledgehammer when they "kicked in." For some reason that always stuck with me. Also, the son of a therapist I knew almost died from Depakote induced liver failure. I've had such bad luck with drugs (sensitivity, intolorance, etc), that when I hear bad stories like those it scares me to death.
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> MBHey, thanks for responding. OH, thyroxine is T4. There are all sorts of meds that "work" for me, but I can't seem to tolerate many meds and can't tolerate standard doses of practically ANYTHING. I suppose I am one of those "brittle" bipolar types. I know what you mean by everything looking great on paper. I can't believe the dosages people take, either. When I saw that neurologist, he was talking about boosting Depakote up to 1500-2000mg ("where it will really work well"), and I just about freaked. We DID try Neurontin up to 1800mg/day for a while, but I just blanked totally out at work (at 1200mg/day or higher). I tried Gabatril up to 24mg/day and had near total amnesia, it sucked. I was on Depakote at 500mg/day for a year or so, but I had some serious sleepiness/concentration/aggravated depressive issues with it even at that dosage. I was trying to train someone at work and she just turned right around (because I was hem-hawing, restarting, forgetting where I was, etc.), and just said "Do you have Attention Deficit Disorder or something-what the hell!". I have been on 250mg at bedtime for quite a while, but in the last few weeks I started having trouble getting up in the morning, and I would just sleepandsleepandsleep. So, I dropped it back to 125mg which helped, and added a little bit of Trileptal. The Trileptal is activating, so that helps too, but I think it is making me paranoid so I have cut it back to just 75mg midday. Before that we tried some Ritalin (which worked sort of ok), and Wellbutrin (caused agitation). A combo of Depakote 250mg, Adderall 5mg, Effexor 12.5mg (and less) with Klonopin .5mg, was pretty close to "just right", but the freaking Adderall made me too uptight. Dexedrine was calming OTOH, but didn't help me concentrate like Adderall did. I am hoping I can go back up to 250mg of Depakote (from 125mg), and MAYBE a little Straterra with a little Effexor will do the trick (on the sleepiness/concentration issues). The 250mg of Depakote is the "right spot" for me. Lower and I am less stable, higher and I can't think. But I have to take something else even at 250mg to prevent me from sleeping more than 8hrs a day (and napping). I'm not worried about the liver stuff. Maybe if I was 20 I would be more concerned, but the "liver thing" is less of a risk the older you get (with Depakote anyhow).
poster:Ritch
thread:131530
URL: http://www.dr-bob.org/babble/20021217/msgs/132164.html