Posted by tom2228 on July 3, 2010, at 12:55:38
In reply to Re: Oxcarbazepine (Trileptal) + MAOIs (sort of urgent) » tom2228, posted by Ron Hill on July 3, 2010, at 5:21:39
> > So here's the story, I've got ADHD, social anxiety, and some sort of bipolar, I suspect cyclothymia. I started cycling some time in childhood but I can't pinpoint when.. I'm 18 now and the cycling has gotten more and more rapid .. from months to weeks and days at one point. Heavy weed smoking and all the antidepressants and stimulants (I've been on 18 meds and many more combos) have probably contributed to this, though it could be the natural progression of the disorder too.
> -------------------
>
> Tom, I do not know you, so I run the risk of coming off as a know-it-all jacka*s. It is currently in the middle of the night, so forgive me for being blunt.
>
> You are Bipolar II. And, your p-docs have induced your rapid cycling by giving you antidepressants and pstims without a full complement of moodstablizers fully ramped up first.
>
> The same thing happened to me, 14 years ago. I was misdiagnosed as ADHD and given Ritalin and SSRI's. The two worst things that can be done to a Bipolar patient is to give the patient a pstim and/or an SSRI without moodstabilizers on board FIRST.
>
> As a result, I go through one complete cycle every 15 days consisting of six days of debilitating depression, and nine days of normal mood. My 15-day ultra rapid cycle repeats over, and over, and over, without end. My depressive episodes used to be a lot worse in severity and duration. The treatment of bipolar ultra rapid cycling is VERY difficult.
>
> Even with moodstabilizers, a bipolar patient should not be given an SSRI, and maybe not a pstim. Over time, the pstim will more than likely destabilize the Bipolar II patient's mood. In the end, the pstim often causes irritability.
>
> Tom, if it is okay with you, I want to follow up and give you some free screening tests tomorrow or in the next few days. Also, I will try with all my heart to convince you to pay about $80 to take a very in depth test.
>
> > OXC has a short half-life and "wears off" within a couple hours, the active metabolite is what allows for the usual twice-daily dosing.
>
> Not true, Tom. The half life of the parent is 2 hours, but the half life of the pharmacologically active 10-monohydroxy metabolite is nine hours. See the Pharmacokinetics section on page 2.
>
> http://www.pharma.us.novartis.com/product/pi/pdf/trileptal.pdf
>
> -- Ron
>
> dx: Bipolar II with ultra rapid cycling, and mild OCPD
>
> 600 mg/day Trileptal
> 200 mg/day Lamictal
> 500 mg/day Keppra
> 90 mg/day Nardil
>
> 3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
> 35 ml of Calsons Bottled Fish Oil
> 100 mg/day phosphatidylserene
> Centrum Chewable Multi-vitamins; Only 100% of all the usual vitamins
> 2000 IU Vitamin E
> 850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate).
> Dark therapy via LowBlueLight glasses (When I remember)
>
>
> Whats next to add:
>
> 25 mg/day agomelatine (if my p-doc wakes up and smells the roses due to my submitted research) {Valdoxan}
> 300 mg/day of lithum carbonate
> CoQ10
> NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
> GTF Chromium
> Cromium Picolinate
> Cinnamon
>
>
>
>
>First of all thanks Ron, it's good to know you've combined that much Nardil with trileptal w/ no problems... Glad that it works for you! I'm only on 20mg Parnate (today is day 10), so I don't think it should be much of an issue. And the trileptal is very low, too low I think, probably adding another 75mg in for a total of 225.. but can't decide whether to do 150 + 75 or 75 TID.
So I'm not really worried anymore, just worried about getting the doses right.. It's tricky when you're using low doses (trileptal) because it doesn't last long enough for BID, but TID is annoying with the ups and downs. Which is related to the parent drug/ metabolite thing happening.
What was not true about what I said? When I said OXC I was referring to the parent compound itself having the short half life, not the whole med metabolites included. OXC itself as the parent has a different feel (feels stronger on the serotonin and dopamine) and "wears off" after a couple hours, and the 10-MHD is what allows Trileptal to be BID.
I've been experimenting seeing whether it's better to stagger the trileptal and parnate , taken together all that serotonin at once makes me sluggish.. What's your take on this Ron?
What makes you think BP II and not cyclothymia? And does mixed episodes on antidepressants (I'm not really sure if I've had them unmedicated) make me BP I then?
I have always cycled rapidly even before meds.. hypomanias (a lot less frequent) never lasted longer than a few weeks. I would cycle between relative normality and depression a couple times a season.. but there's always been some chronic mild depression even in times of stability.. had a messed up childhood. I definitely have had major depressive episodes, but they are rare these days. When I cycle down it is usually to a dysthymic state. Haven't seen much of the hypomania for a while now, that's probably the trileptal doing its job. But I do get in these agitated states where which seem to be related to my cycle -- would you call that hypomania, or mixed, or something else?
But yes since meds things have sped up a lot, and was the worst while being a heavy weed smoker + stimulants.. cycles just like you describe but WEEKLY, that was pure hell. The depression is no longer severe or long-standing, and the environmental component which was a BIG contribution as a kid (bad childhood) seems to have gone. It simply comes out of nowhere OR at the slightest irrational trigger.. the psychomotor retardation that defines it makes it near impossible to realize what's going on, to cope, or understand that it is a cycle and will get better. I am just goneBut I am truly ADHD. I've been off my Vyvanse for 2 weeks and I am hurtin' big time.. I really do need a stimulant. The lack of functioning makes my depression and anxiety worse. Add to it that I'm physically restless to the point that it's downright uncomfortable. Ive been using caffeine to deal but it has so many more side-effects than dextroamphetamine, which just works so much better.
Doc appt on Tues I'm gonna talk about adding the Vyvanse back in lower doses.
Other things I've been thinking about is switching to depakote (gaba transaminase inhibitor) or adding some klonopin. Any time i have something GABAergic I feel brought back down to a level of peace that seems to have gone away over the years. I've heard the klonopin + parnate combo is awesome for social anxiety , which I have. Was on vacation this week and with some smirnoff on top of my meds I felt really great.. heh.
sorry this is lengthy again! can't seem to summarize off stims...
poster:tom2228
thread:951790
URL: http://www.dr-bob.org/babble/20100628/msgs/953127.html