Posted by SLS on July 1, 2005, at 9:00:53
In reply to Re: Trileptal is pooping-out on me., posted by linkadge on June 30, 2005, at 23:28:50
Hi Link.
> Proper prefronal cortex activity is *key* to maintaining an anhedonia free life.
I think you are absolutely right about the involvement of the PFC in my case of bipolar disorder. I experience something similar to the deficit syndrome seen in schizophrenia.
> Most of Dr. Manji's work shows that certain family history of unremitting bipolar depression is associated with some pretty hefty shrinkage in the subgenual prefrontal cortex.
Wonderful.
> Manji's work seemd to show that lithium/depakote (even when used it what seemd to be almost homeopathic doses) protected, and revered many prefrtal cortex shrinkage.
I'll keep that in mind. For me, dosages would have to be very small as both drugs, when taken chronically, makes me feel worse.
> Unfortunately carbamazapine had no effect. It is good on the temporal lobes, but not as neurotrophic/neurorestorative as lithium/depakote.
It will be interesting to see where Trileptal takes me. If I respond robustly to it, I think it might give you another clue as to how the pieces of the puzzle fit together. The subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression. Perhaps the white matter in this adjoining region becomes hyperactive for lack of information processing in the hypofunctional subgenual gyrus gray matter. Sodium channel antagonists like Tegretol and Trileptal might reduce the activity in the cingulate white matter in depression. That sounds pretty stupid, actually. Never mind. I was just trying to bring into the equation the successes seen in the use of DBS for severe depression, but that might be something that is applicable only to unipolar depressives who experience sadness. Maybe DBS doesn't work for bipolar depression.
Crap. I wish I could read more than just a few sentences before having to stop. My cognitive slowing is another reason to believe that I have a deficit in executive function in the PFC.
> Mifesteprone *may* help, but are cortisol issues a biggie for you right now?
I don't know. In the past, I have tested positive to dexamethasone suppression test and salivary cortisol. I go out of my way to keep my level of stress to a minimum. I've been doing that for years. I avoid anxiety-provoking thoughts and situations.
> Nortryptaline seems like a good choice. Bipolars with prefronal issues seem to repsond well to Nortryptaline. I read a study that shows that it does have a nice frontal cortex catecholamine effect. (probably aided by its 2a blockade)I also glean mild benefit from atypical neuroleptics. More 5-HT2a blockade. As for catecholamines, I experience about 3 days of improvement from taking amphetamine and bromocriptine.
> For my last doctors visit, I was really trying to find a "focus on the frontal cortex" approach to helping myself.
> People with anhedonia and apathy show lots of prefronal hypofunction. It just keeps turning off, for various reasons. For any AD treatment to produce a result, there needs to be an activation of the frontal cortex.
I agree. There also seems to be a need for a reduction of activity in the cingulate. This might be secondary to subgenual PFC hypoactivity. Perhaps my idea wasn't so stupid. I don't know. What an exciting time it must be in neuroscience and psychiatry. I wish I could experience it from the other side of the fence.
> First I wanted to have the right circutry, so I was going to take a low dose of depakote, and augment that with loads of fish oil, which has great activity in the frontal cortexs' dopamine/serotonin networks. Infact, a high intake of omega 3 in lab rats doubled their frontal cortex serotonin/dopamine content in a month.
> After I worked on the circutry, I wanted to maximize activity there through all available means. Which would include 5-hta/c antagonism which increase frontal neurotransmitter output, plus 5-ht1a agonism (frontal cortex loaded with 5-ht1a receptors), some direct/indirect noradrenergic activity.
> I was thinking (for my case)
> Remeron, Buspar, Fish Oil, depakote, and maybe
> a little celexa.
> Doctor wouldn't hear of it.Linkadge, I think for future visits, and prior to seeing a doctor for the first time, you send them a letter laying out your history, symptom profile, previous treatments, and your most immediate treatment ideas. Keep your comments organized and focused rather than rambling and thinking out loud. Give the practicioner a little time to digest your case and develop a respect for your knowledge and intellect before they ever meet you. He will also need time to engage his humility circuits.
> Other combinations I have thought of are...
> Try more trileptal if you think it will help. Don't loose hope if it doesn't. Focus on the frontal cortex, thats how to beat bipolar depression IMHO.
My doctor came up with the same conclusion independent of any input on my part. I got lucky.
I will. Sometimes if you throw enough sh*t against the wall, some of it is bound to stick.
THANK YOU SO MUCH, LINKADGE!!!
- Scott
poster:SLS
thread:520955
URL: http://www.dr-bob.org/babble/20050627/msgs/521890.html