Posted by Ame Sans Vie on January 12, 2004, at 8:19:28
In reply to Can you all give me some feedback?, posted by Emme on January 11, 2004, at 20:20:28
> Hello All,
Hiya. :-)
> I'm trying to brainstorm on ideas for improving my meds. My pdoc usually has some thoughts, but I like to have some ideas percolating also.
lol, yup, I know the feeling.
> Dx: Bipolar spectrum. Mostly evil hideous depression. Little hypomania - the excess energy turns up as anxiety, edginess, noise hypersensitivity.
>
> I'm on 350 mg Lamictal, 25 mg atenolol (to control physical symptoms of anxiety), clonazepam and xanax (at the moment, low doses as needed. Occasional crumb of seroquel. Intermittent selegiline (5-10 mg).
>
> I'm more level on the Lamictal - less bouncy, and partial remission from depression. I need to acheive better remission of depression. But medicating me is like trying to walk a tightrope between the sluggish "eeyore" depression and the anxiety. And I am sensitive to side effects. When I'm really depressed, I need perking up and *motivation*. But something too activating makes me jittery, so I need anxiety control that doesn't zombify me (alternatives to clonazepam?).As far as benzodiazepines are concerned, many people find Xanax to be minimally sedating and more uplifting than most others in this class. You mentioned you already take it though... how does it compare with clonazepam for you?
Some other benzos that may be less zombifying are Ativan (lorazepam), Serax (oxazepam), and Paxipam (halazepam). If you're outside the U.S., Lexotan (bromazepam) may be worth a try.
If you're just using anxiolytics on an as-needed basis, then maybe you would be better off with phenobarbital (Luminal/Solfoton -- a long-acting [about 12 hours] barbiturate that works well for anxiety and can also increase energy levels). Amobarbital (Amytal), secobarbital (Seconal), amobarbital/secobarbital (Tuinal), and pentobarbital (Nembutal) are also barbiturates and can have a phenobarbital-like effect, but they may be better if you need something shorter-acting. Equanil (meprobamate) or Soma (carisoprodol) are also good options for as-needed use. Equanil is specifically touted as an anti-anxiety medication, while Soma is a muscle-relaxant which partially metabolizes into meprobamate in your system. I've always found Soma to be wonderful at eradicating anxiety and inducing a sort of easy-going, happy-go-lucky feeling. Again though, these drugs are usually only a good idea if they're used intermittently
> The Lamictal seems to be stimulating - I don't feel anxious per se, but my pulse is running high even with the atenolol. It would be nice to have new ideas for something to "balance" out the Lamictal and calm my system as well as ideas for improving depression.
I also felt quite over-stimulated with Lamictal... it felt very Paxil-like, too. I discontinued it the very day I began feeling SSRI-type side effects. The benzos, barbs, meprobamate, and carisoprodol I mentioned above are all possible candidates, I feel, to counterract the Lamictal stimulation. Depakote is another possibility.
As for your heart rate, that's something you absolutely should discuss with your doctor. Perhaps a higher dose of atenolol, a switch to another beta-blocker (i.e. propranolol), or the addition of an alpha-adrenergic agonist like clonidine or guanfacine is in order.
> The most optimistic-feeling/motivated days I've had have been on 5 or 10 mg selegiline. But I was also kind of revved - the stuff is stimulating. I've had awful days on it too - so I worry it may induce cycling. I may continue to use it on an as-needed basis when I'm immobilized, but I'm notdecided.
Of course you have to exercise extreme caution when administering stimulants to bipolars, but how about trading in the selegiline for a very low dose of methylphenidate (2.5mg prn), magnesium pemoline (56.25mg), or an amphetamine (5mg prn) to see how that fares you?
> Have tried:
> Li
> SSRIs out of the picture
> neurontin (great but dropped WBC count)
> Effexor
> Gabitril
> Remeron
> Trileptal.
>
> Others:
> Standard MAOIs. I know they make pharmacologic sense for me. But I'm unwilling to assume the worry with the diet (I *know* I'd obsess). I'm a vegetarian and I eat too many questionable things, especially ethnic foods.I very much agree with the others who've suggested giving an MAOI a shot, but, even more so than with more typical antidepressants, you have to be careful about the drug inducing mania. MAOIs have been known to lift mood even in non-depressed folks -- something that can't be said for SSRIs, TCAs, or atypicals.
> Risperidol: Just trying a few days. I'm not sure it's doing anything that seroquel didn't do.
I'd probably stick with Seroquel... I may be mistaken, but I believe research shows that Risperdal and Zyprexa are more likely than other antipsychotics to cause diabetes.
> Provigil: low dose has helped sometimes when I'm really sluggish. Sometimes it sends me into orbit. Sometimes I don't even feel it.
>
> Strattera: tried it briefly, neither bad nor good. Probably didn't try it long enough. (keep that as an option?)Perhaps... Strattera and Wellbutrin are two meds I forgot earlier that may be useful for treating the benzo zombification. Again though, there is the risk of induction of mania.
> Keppra: I didn't hate it. But it made me feel simultaneously emotionally edgy and apathetic. And my brain didn't produce any thoughts.
>
> Topomax: seemed to make me more depressed. Of course I wasn't taking Lamictal then... revisit it....? Will it make my hair fall out?I'd put Topamax on the "should all else fail" list if I were you... the fact that it caused depression once before doesn't really work in its favor.
> Zonegran: Well, I was sleepless and very depressed on it after about 5 days. Scary. But then I was also very depressed a few days after stopping it. So maybe I felt awful by coincidence and I was premature on nixing that? Anyone find it helped depression? Anxiety?
Sorry -- no experience here.
> That's probably most of it. I think my doc has stayed away from depakote and tegretol because of their side effect profiles and as I understand it, depakote is better suited for controlling mania.
That's true -- though, as I mentioned above, Depakote may also be a good MS to reduce stimulation caused by lamotrigine. And Tegretol is nothing more than Trileptal with an extra oxygen atom tacked on (Tegretol--carbamazepine; Trileptal--oxcarbazepine). I haven't heard personally of any cases where Tegretol worked when Trileptal did not, or vice versa -- they're basically the same drug, though Trileptal is safer.
poster:Ame Sans Vie
thread:299547
URL: http://www.dr-bob.org/babble/20040109/msgs/299730.html