Posted by Peter on March 9, 2003, at 13:50:47
In reply to Re: Another horrible 'episode'-so sick and tired of it » Peter, posted by Ritch on March 9, 2003, at 10:20:22
Hey Mitch.
> .....The SSRI's helped me the most, but seemed to cause alcohol cravings and emotional blunting after a few months of being on them. This reaction to SSRI's seems to be the sole criteria by which my doctor has diagnosed me as falling somewhere within the 'bipolar spectrum.' He believes that a type of SSRI-induced hypomania causes my alcohol cravings & impulsivity....
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> Peter, I get "SSRI-induced hypomania" as well, but it is an *immediate* phenomena, not a delayed one. Also, I can take very small doses and not get hypomanic, and the anxiety is clearly helped. Have you considered micro-doses? BTW, I couldn't tolerate 5mg of Prozac most of the year (excessive activation/insomnia). My *maintenance* dose of Prozac was in the 2.5mg range (every day).
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>The interesting thing is that I've always had profoundly beneficial responses to SSRI's for at least a month or 2. More specifically, they 've helped me a lot with sepression, social anxiety, agoraphobia, public performancec (musician), etc. But the 'hypomania' wouldn't occur for a few months-and when it does, I don't know if it's hypomania.
> Wow, 2.5mg seems tiny. The only 2 SSRI's on which I've been up to a fairly hefty amount are Paxil and Zoloft. But my doc said he wants to stay on a 'small' Prozac dose (5mg). I was prescribed Paxil for the first time by my internist doctor back in '94 because I had like a week long panic episode in response to someone in my dorm getting meningitis. I didn't know anything about meds, so I kept taking it for about 2 years-even through all my hard drug use. Who knows if it made my drug-seeking worse than it already was? that's the qiestion.
> .....My doc considered TCA's but said since he still believes I have some form of 'mild' bipolar disorder, TCA's aren't good because they'd push me into 'hypomanias' moreso than SSRI's.........
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> The important point here is that you haven't TRIED a TCA yet. Stims are *supposed* to be *bad* for bipolar disorder (like TCA's). What is his rationale behind giving you stims, then? Evidently he didn't have any qualms with you trying stimulants. TCA's can work rather well for agoraphobic symptoms and GAD.
> That's what I thought, too. But he said that stimulants have much less of a tendency to push someone into hypomania than antidepressants, especially TCA's. He said he treats a lot of bipolar patients with a mood stabilizer and a stimulant instead of an antidepreesant. If their depression doesn't respond adequately, that's when he considers an AD add-on.
> ......I told my doc and he said while the adderall mught be exacervating my mood swings, he wants to first see if reducing the lamictal might help. If it doesn't, I'd then go on to reduce the adderall-all while the prozac is beginning to 'work' (hopefully). He told me to drop the lamictal dose from 100mg to 50mg in a day, saying I won't experience withdrawal because it has such a long half-life. Well, I did that starting today, but all I can say is this is the worst I've felt in a long time.......
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> Do you think the Lamictal has helped you in any way?
> Honestly, it's been such a long bout with the lamictal that I can't really tell. I'd go through a few days of felling more balanced and hopeful about the med, but then I'd go through all the bad stuff again. Either way, it certainly hasn't helped to any noticeable degree, anywhere near how my doc said it 'could' help-as an 'all-in-one' solution. There has been no real improvement in my anxiety and my depressive episodes, when they hit me, are just as bad, if not worse. I did for a bit think the med was working and was superior to the other MS's Itried, but I think my periods of feeling hopeful were largely influenced by my doctor's positive feelings about the med for atypical depression and mixed/rapid cycling BP, and even anxiety. But 6 months is enough of a trial. If it hasn't worked as he said by now, it doesn't seem like the right choice.
>BTW, It amazes me how attentive you are to people's problems and how helpful you are. I really admire that. Thanks again Mitch,
Peter
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poster:Peter
thread:207296
URL: http://www.dr-bob.org/babble/20030306/msgs/207438.html