Posted by barbaracat on June 18, 2005, at 21:14:00
In reply to Re: Lithium: How many times do you dose per day? » barbaracat, posted by Sabino on June 18, 2005, at 19:04:51
Wow, we could enter the semi-twins contest as far as symptoms and med trials. Interestingly, I enjoyed the heck out of amphetamines in my younger days too. It calmed me and un-depressed me. I tried a trial with Ritalin a few years back when nothing else was working and I was so disorganized that I'd find my car keys in the fridge and so on. It didn't help at the time, however, lately I've been taking some from my old prescription to help with focus as I plow through my years of bipolar clutter. I find that it does help alot more, maybe due to adding lithium. There's so much overlap with ADD and bipolar anyway. When I'm manic, my cognitive skills go from super sharp to utter chaos. But I can be normally focused and as I understand it, ADD is pretty much a constant thing.
I took Remeron for a short time and gained 40 pounds. I would literally find myself snarling as I wolfed down old frozen stale deserts. It worked for a while then pooped, as all my ADs eventually did until lithium. Prozac wound me up so badly I thought I was in orbit. Zoloft was the only one that was effective (pre lithium) but pooped and then was tanked up to so high a dose that I ended up hospitalized.
I do very poorly on Seroquel, Zyprexa or any of the APs. They leave me feeling drunk and more depressed and sometimes wired. I frequently get paradoxical reactions from drugs.
Your micro-dosing ADs situation is not that uncommon, as I'm finding out as I research this stuff. Recently I was put on Cymbalta the 'new Effexor' because lithium, while great, is not enough to combat periodic depressions. I was put on the typical 30mg starting dose and almost took off into space. It was a wild, wild ride. But I felt something positive immediately and so experimented with micro doses. A 30mg capsule has 300 tiny pellets. I was on 3 of these pellets for over a week, slowly titrating until now, after almost 5 months I'm stable at 80 pellets, or 8mg. It is truly the best AD I've been on and a shame that more people who would benefit are scared off by the intense effects of simply too much.
I've communicated with a number of people who have had a similar experience, most notably with
Cymbalta (the norepinephrine kicks in almost immediately), but have found micro-dosing to work with other ADs as well. All of these people are bipolar. Those with unipolar depression without significant agitation seem to tolerate much higher doses.By fast metabolizer, I suspect you have a genetic susceptibility for a subisozyme, 2D6, of your liver cytochrome CP450 enzymes to lack inhibitors. This would break down the med superfast, and ADs depend on this 2D6 isozyme for detoxification. I have a theory that someday soon we're going hear about bipolars having a genetic malfunction with this enzyme system and why we're so dang sensitive to certain drugs.
What you've described so far rings true as far as bipolar symptoms. Yep, what's in a name and all that as long as the medicine works, but it's good to know because bipolars are a different animal biochemically and it's beneficial to know what helps and what to avoid. One thing that has helped me, on the same line as lithium, is L-taurine, an amino acid that acts as a mood stabilizer and muscle and cell electrical stabilizer.
There's a wonderful website that's devoted to information about bipolar and agitated depression you might want to check out. You could spend weeks following the links.
www.psycheducation.org
> Thanks for the info Barb. I don't know if I'm bipolar or not. I've suffered from depression, anxiety, and, to my mind, ADD. These last couple of years have really taken a toll on me cognitively. Very poor memory, and at times, very poor concentration. Diagnoses are such a hodgepodge anyway, with so many overlapping areas.
>
> Complicating things for me is a super fast metabolism. The very first AD I ever took was Zoloft. That was back in 94. The first day I took it, I was so energized, I remember I actually ran to a nearby tennis court. Most AD's I've quit after the first day. Looking back, I can say that Prozac caused a mixed state. At the time, I just knew I felt horrible and anxiety ridden. Other AD's leave me wiped out on the couch, barely able to drag my behind to the refrigerator. In any case, I never found the relief I sought. Best they ever offered me was a couple hours of hypomania followed by a crash for the rest of the day.
>
> And I've gone on all sorts of different trails in search of relief. Tried Ritalin; too much anxiety, didn't like it at all. Adderall, only sightly better. Never got prescribed Dexadrine, but I'm pretty sure I would have liked it. The thing is, I liked amphetamines when I was a kid some 30 years ago. I know about the tolerance developed with those, and didn't really want to pursue that.
>
> From reading here on PB, I used to go to my Dr. with all sorts of ideas, and as long as the idea wasn't outrageous, he was amenable to letting me try stuff out. Hated almost everything I tried. I tried Provigil for a few days. I would come on to the stuff within an hour of dosing and crash a mere hour and a half later. Tried Adrafinil after a girl on this site touted its efficacy. No luck.
>
> Even went so far as to try Nardil after reading so many of the Nardil Champ's glowing reviews. Made me feel really badly, and dumb as a rock.
>
> Tried Strattera (Lord, what a nightmare that was). Tried Zyprexa for one night. Hated it.
>
> Clonazepam has been a friend for years. I barely take any at all. I used to take 1/3 of an Ambien, and 1/4 of a clonazepam just to help with sleep.
>
> Oh yeah, Paxil was sort of beneficial, but only at a really microdose, I mean like 3mgs (most would say why bother), but I got some benefit, and any more left me wiped out.
>
> The AD with the least side effects for me was Remeron. And that's really not that it doesn't have side effects, but that it's main one (causing sleep) was not undesirable. Even with my fast metabolism, I'd want to eat anything not nailed down, and gained close to 10 pounds.
>
> Last, as I said in my last post, I've been giving Effexor a trial. And this time, at full dose. I got all the way up to 225mgs, along with 15mgs Remeron for sleep. I felt some good things from Effexor on the startup kit. Still with the come up, wear off and crash stuff though.
>
> And, like I said, I was in such a bad way that I had to take a leave of absence for the first time. Always before, I hung on by my fingernails and always worked, but this time, I thought, I either need to get better, or end this charade, because I had become so reclusive, and I was feeling overwhelmed at work too.
>
> A basic meltdown, you might say. So then, a few days ago, I went back to pdoc to get the 'Fit to return to work' note from him. And, I asked if I could try Lithium, which he agreed to. Well, I didn't really feel up to returning, but I went in the next day anyway, and immediately had a panic attack.
>
> There were other meds tried too (I've got what I call 'the shoebox of shame'), but I've wasted too much band width already. Anyway, thanks for the response and encouragement. Early returns are positive on the Li. It really does feel like the best med I've ever tried.
>
> The only side effect that I've had from it thus far is that there's a little hangover effect in the a.m. Does that go away?
poster:barbaracat
thread:509665
URL: http://www.dr-bob.org/babble/20050617/msgs/515200.html