Posted by Ron Hill on November 14, 2007, at 12:42:40
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Man! » Ron Hill, posted by kaleidoscope on November 9, 2007, at 12:09:45
> Hi Ron
> What benefit do you get from Keppra? I guess I'm suspicious because there's virtually no evidence to support its use in psychiatry, although it's clearly useful in epilepsy.
Keppra works great to tx my bipolar II ultra rapid cycling. I always go through one complete cycle every 15 days. Let me tell my background before discussing Keppra.My ultra rapid cycling was induced in 1996 by a p-doc who, without any testing, misdiagnosed me as ADHD, and started feeding me Ritalin. Initially, the Ritalin caused me to hyper-focus, with good energy, and motivation.
This was the first time that I ever visited a pdoc. Unfortunately, I knew nothing about p-dx's and nothing about p-meds. I went to see the p-doc because I was having trouble staying motivated to work hard at my job as an engineer.
Like you, Ed, I believe that a full day's pay deserves a full day's effort. Therefore, I was trying to find out why I lacked the motivation and energy that I had always had for my job prior to then.
Well, long story short, within a couple of weeks of taking 20 mg/day of IR Ritalin, I became VERY IRRITABLE with severe mood swings. I went in and told the pdoc that I needed to stop taking Ritalin because of the severe mood swings. His response was; "Stick with me, we can add Paxil to the Ritalin and it will take away the moodiness".
As a bipolar patient, the SSRI without any moodstabilizer on-board pushed me into a full blown mania. Further, I began to rapid cycle. I was not yet married, so I did not have anyone to tell the pdoc that I was all screwed up. The pdoc was apparently oblivious to my condition.
For example, while in mania one time I bought the pdoc a $350 fly fishing rod. He accepted it with a smile and a thank you, but no mention of mania. Hell-oh, pdoc; his lights were on, but apparently nobody was home.
My workplace put up with my completely inappropriate manic behavior for as long as they could, but eventually they had to show me the door. A couple of months later I fell into a debilitating atypical depression that I could not pull out of.
No job, no income, and so debilitated with depression that I could not even go out to apply for jobs. Further, Paxil caused me to gain so much weight that none of my business clothes fit.
As a result, Ed, I lost everything except my house, and I darn near lost it as well. I even cashed in my retirement account. All because a pdoc did not take time to give me a simply screening test.
A screening test plainly shows that I have bipolar disorder and NOT ADHD. Can you say malpractice? However, I was so bad off that I was not able to contact a malpractice attorney before the two-year Statute of Limitations ran out. In fact, I've only recently gotten well enough that I would be able to contact the proper attorneys and follow through with the malpractice process.
Geeze, my long-story-short turned out to be more long than short. Sorry. But, I gave all this history to say this: Before starting Keppra, my cycle consisted of ten days of deep debilitating depression, one day of dysphoric mixed state, and four days of normal mood. The process repeated over and over and over and ... over ..., never ending. I can set my watch by my cycling frequency. The timing is that predictable.
The most useful thing I've ever began, was to start tracking my mood states daily using a scale of 0 to 5 in an Excel spreadsheet format. Excel then presents these data graphically. The depression verses time graph is absolutely eye opening, because it so clearly shows the ultra rapid cycling frequency, severity, and pattern.
Each day I enter numerical values (0 = no symptoms, to 5 = dead from ..., well you know). I track the severity of the following mood states; 1) Depression, 2) Hypomania, 3) Irritability, and 4) Obsessive Compulsive Personality Disorder symptoms. Each of these four major categories is displayed on four respective graphs.
My OCPD symptoms are usually very mild. In fact, with the addition of Deplin, I no longer have OCPD symptoms, nor do I become irritable.
I suspect that my OCPD symptoms may be what you deal with, although you have it much worse than I do. Keep it in the back of your mind that Deplin took away all of my OCPD symptoms via what feels to me like a serotoninergic action, but without the SSRI-induced apathy thingy. But, of course, Nardil is playing into all this as well in a very beneficial manner.
My irritability and OCPD symptoms are always zero since I added 15 mg/day of Deplin. My wife says the Deplin has changed me from "growly-boy", to "lovey-dovey boy". And my mood tracking data support her observation.Getting back to your question, Keppra greatly reduces the severity of my rapid cycling. I still complete one full cycle every 15 days, but since the addition of Keppra, my cycle consists of two or three days of depression, and twelve or thirteen days of a normal mood state.
Paradoxically, if I take any more than 1000 mg/day, Keppra makes me depressed. The PB archives show that this happens to a lot of pts taking Keppra.
My med cocktail is currently working very well. The addition of Deplin has brought back my belly laughter, enjoyment of a sunset, the smell of a fresh rain, etc. As I previously mentioned, Deplin has completely taken away my irritability and my OCPD symptoms. However, I have only been taking it for a little more than three weeks. Time will tell with regard to long-term efficacy.
However, despite the fact that the severity and duration of my depressive phases have been lessened tremendously, I still cycle into an atypical mini-depressive phase (i.e.; low energy, lack of motivation, sleepy-tired, etc), for two or three days out of every 15 day cycle. But, with one very recent exception.
During my most recent depressive phase a few days ago, I got to thinking that perhaps my 15 day cycling is somewhat akin to other types of cycling that are hormonal in their cause. So, as I was entering depression this time, for one day on a PRN basis, I applied four pumps of Androgel, exogenous testosterone applied dermal. And, by golly, I instantly snapped out of the depressive and I did not return to depression after the one day of testosterone tx. Way too early to tell if it will continue to work, but it worked this time. As always, time will tell.
Ed, read my post regarding Deplin that I posted earlier today:
http://www.dr-bob.org/babble/20071104/msgs/795014.html
Also, here are some links to abstracts of a few small open studies and case histories. And, your are right, I've not seen a good double blind study on Keppra tx of bipolar disorder or bipolar rapid cycling. None the less, many researchers and pdocs are very intrigued by a tx that might reduce the hard to treat rapid cycling:
http://jop.sagepub.com/cgi/content/abstract/17/2/239
The follow are for the tx of p-disorder other than bipolar disorder:
-- Rondx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
4 pumps of Androgel on a prn basis.
poster:Ron Hill
thread:793089
URL: http://www.dr-bob.org/babble/20071104/msgs/795051.html