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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 29 to 53 of 54. Go back in thread:
Posted by johnj on May 18, 2003, at 13:12:28
In reply to How long will this last? Re: Remeron for Atypical , posted by McPac on May 18, 2003, at 12:42:55
I am curious as to why you started at 15 mg? That amount did not help my depression, but made me zoned out. I slept well but if felt as if someone was standing on my brain. I wonder if rasing the dose to 30 mg is better? I have some heart jitters but nothing like what you describe. Talk to your doc. take care
johnj
Posted by LyndaK on May 18, 2003, at 14:42:12
In reply to Re: Remeron for Atypical Dep » JrBecker, posted by johnj on May 18, 2003, at 10:40:50
I know you targeted your post to jrbecker, but I experienced something similar when I first started Remeron (the eyes-going-out-of-focus thing). I attributed it to the fact that Remeron acts like a muscle relaxant on me and I think it was relaxing my eye muscles a bit. I don't have that problem now.
I too have a unipolar depression with anxiety. Remeron has helped me more than anything else I've tried, in fact I am pretty much in a state of remission at this point. It has helped me so much with sleep that I RARELY take my Ativan anymore. Remeron is the only med. I'm on now.
Hope you find what works for you.
Lynda
Posted by johnj on May 18, 2003, at 18:32:26
In reply to Re: Remeron for Atypical Dep » johnj, posted by LyndaK on May 18, 2003, at 14:42:12
Hi Lynda,
Thank you very much for the reply. Today my wife and I went to the library and drove to a lake to read. Since I just ramped up I expect some unpleasant SE. It may very well act like you said since I do find my body a little limp now that you mention it. If I continue to walk I do pretty well, the motion thing I guess, and looking at things up close is not as bad either. Distance is the majority of the problem. But, reading can be tricky as I sometimes get lost where I am at. I don't feel in tune and sharp as usual, but right now this is better than where I was headed on Friday! I do wonder what I would feel like off my TCA, lowered lithium, and benzo though. But, that is a ways off.
Any other SE effects that you had that went away?
I don't feel the weight gain is a huge problem since I am on lithium and a TCA. take care and thank you
johnj
Posted by kashusha on May 19, 2003, at 17:58:34
In reply to Re: Remeron and increased appetite?? HELP!, posted by Earthmamma on May 14, 2003, at 23:14:42
> > Kashusha
> Did he eat more or the same? I've heard some people have this appetite problem, but that it goes away after a while (I know everyone is different so it's hard to compare). When did the weight gain occur? Was it initial, or something that was stretched out over the entire year he was on it? I'm hoping that I'll at least be able to mantain my weight. I run about 4-5 miles every other day, and lift weights 3-4. Hopefully everything will be ok. I've been on it now about a month and I haven't noticed and gain, just my hunger increased.
> Thanks,
> Cheers,
> Kyah :)
> Mamma to 2 ^Angelic^ girls
> ~Annika June~ June 30th, 1999
> *Lorien Moss* April 15th, 2002
>
> "It is never too late to be what you might have been"
> ~George Eliot~
>He gained the weight gradually. He went to the gym and exercised, but nothing helped until he went off Remeron. I think it increased his appetite, but I think his metabolism was more of a problem. He had never (really, never!) gained weight before in his life.
Posted by LyndaK on May 19, 2003, at 22:51:49
In reply to Re: Remeron for Atypical Dep, posted by johnj on May 18, 2003, at 18:32:26
Hi Johnj,
Glad you're feeling a little better. Sedation, dizziness (lowered blood pressure?), and feeling hungry all the time were the main side-effects I noticed starting up. All resolved with time and/or increased dose. I did gain 20 lbs. which hasn't budged, but I think that too is related to the muscle relaxant effect (i.e. if your muscles are less active in general - even at rest - your metabolism is lower), but others on this board differ on that opinion. From my experience, this drug seems to have a strong effect all by itself, so I don't know how it would interact with other drugs in combination.
Hang in there and good luck.
Lynda
Posted by johnj on May 20, 2003, at 9:09:13
In reply to Re: Remeron for Atypical Dep » johnj, posted by LyndaK on May 19, 2003, at 22:51:49
Hi Lynda,
Thanks for the response. I feel pretty good today and the heavy head feeling has subsided considerably. I actually lowered my benzo dose since I felt ok, probably not wise but I just didnt' feel any anxiety. Today I am much clearer, but do have the staring/focusing problem too. I am getting more accomplished at work. I have noticed a little shortness of breath when speaking. Last night I was able to look at my illness out and away from usual depressed me. It is odd how just a tweak of biochemistry and things seem better. I hope it lasts and I can get off some of my other meds, especially the TCA. I think that will help with sedation and fuzziness too. Thanks again and take care.
johnj
Posted by LyndaK on May 21, 2003, at 0:27:32
In reply to Re: Remeron for Atypical Dep, posted by johnj on May 20, 2003, at 9:09:13
< I actually lowered my benzo dose since I felt ok, probably not wise but I just didnt' feel any anxiety.
I think that's a perfectly reasonable thing to do (just my opinion). That's what I did. The Remeron started working for my anxiety/sleep so I didn't need the benzo any more. On rare occasions I take 1/2 mg. of Ativan just to help me get to sleep, so my doc still prescribes it so I have it when I need it, but I really don't need it very often.
Glad you're continuing to do better! ;-)
Take Care!
Lynda
Posted by earthmamma on May 22, 2003, at 19:12:52
In reply to Re: Remeron and increased appetite?? HELP! » Earthmamma, posted by kashusha on May 14, 2003, at 9:06:39
Will it be like this the whole time I'm on it? Do these side effects go away with a higher dose, or in time? I would be willing to go up to 45 or 60 MG if it might help! It's the worst at night, especially since that's when I work out, and I'm ravenous afterwards. I do 60 minutes of cardio (running, elliptical, stationary bike) and lift weights before my cardio usually. I've started really limiting my carbs and I eat really well. Lots of soy products, veggies and lean protiens. But, I am 10 lbs heavier than BEFORE I started working out (could it be muscle gain? I don't know.) My clothes still fit, so I'm not sure if it's just coincidental, but it's also around the same time that I started taking the Remeron. I started lifting weights seriously about this time also (aproximately a month ago). My hunger is crazy, I feel like I could eat forever, and never really feel full. Will this last the whole time I'm taking remeron or can I look forward to feeling normal again? It's really helped with my anxiety, but I don't know if this is a fare trade-off. All I can think about is food, and what I will eat next, even as I'm eating! I've never had this problem.
I've worked really hard to get back into shape after having two babies, and I know that weight gain will only depress me more. I had severe PPD starting when Lorien was just 6 weeks old and was on Paxil for a year but hated the side effects (loss of libido, ringing in ears, tightness in my head....)
Any positive experiences here, or am I doomed to get fat no matter what I do?
HELP!
Cheers,
Kyah :)
Mamma to 2 ^Angelic^ girls
~Annika June~ June 30th, 1999
*Lorien Moss* April 15th, 2002"It is never too late to be what you might have been"
~George Eliot~
Posted by johnj on May 23, 2003, at 9:17:08
In reply to Does the increased hunger go away?, posted by earthmamma on May 22, 2003, at 19:12:52
Earthmama,Hi. I think your hunger is a combo of the med and the workout. When I started remeron for the first time I also started lifting weights. I gained over ten pounds, but it was mostly muscle. Even when I was not on remeron and I was working out a few years back I was always hungary. More muscle = increased burning of calories and muscle weighs more than fat too. Trying getting some high fiber to make you feel full. I am having some stomach upset on remeron this time, but I have a problem not being able to eat when my anxiety depression worsens.
I love the anxiety relief remeron gives too.I have two side effects that bother me more than weight gain. Some spacey, unable to focus my eyes, and pressure on my forehead. But, without this drug I wouldn't be able to work. One more note, I once went off remeron and it was so easy. I weaned down over a few days and had ZERO side effects. My depression just came back later. I don't know if I helped at all, but remeron is pretty damn good if you can take the side effects. I have come to the realization that I would rather be fat(IF I don't excercise) than unemployed. Take care
johnj
Posted by earthmamma on May 23, 2003, at 10:40:31
In reply to Re: Does the increased hunger go away?, posted by johnj on May 23, 2003, at 9:17:08
Thanks John. That really helps. I'm hoping that this hunger will be something I can control, b/c yes, it has helped my anxiety. Today is day 3 of no Paxil (I weaned slowly down to 2.5 MG) and I'm a bit anxious, but nothing I can't handle. My pharmacist said it shouldn't last too long and to take my Xanax if I need it. Thanks again,
Cheers,
Kyah :)
Mamma to 2 ^Angelic^ girls
~Annika June~ June 30th, 1999
*Lorien Moss* April 15th, 2002"It is never too late to be what you might have been"
~George Eliot~
Posted by Ron Hill on May 23, 2003, at 11:11:59
In reply to Re: Does the increased hunger go away?, posted by johnj on May 23, 2003, at 9:17:08
Hi John,
You sound better in your writings since you started Remeron? Are you sleeping better?
-- Ron
-----------------------------
> Earthmama,
>
> Hi. I think your hunger is a combo of the med and the workout. When I started remeron for the first time I also started lifting weights. I gained over ten pounds, but it was mostly muscle. Even when I was not on remeron and I was working out a few years back I was always hungary. More muscle = increased burning of calories and muscle weighs more than fat too. Trying getting some high fiber to make you feel full. I am having some stomach upset on remeron this time, but I have a problem not being able to eat when my anxiety depression worsens.
> I love the anxiety relief remeron gives too.
>
> I have two side effects that bother me more than weight gain. Some spacey, unable to focus my eyes, and pressure on my forehead. But, without this drug I wouldn't be able to work. One more note, I once went off remeron and it was so easy. I weaned down over a few days and had ZERO side effects. My depression just came back later. I don't know if I helped at all, but remeron is pretty damn good if you can take the side effects. I have come to the realization that I would rather be fat(IF I don't excercise) than unemployed. Take care
> johnj
Posted by johnj on May 23, 2003, at 12:00:17
In reply to Re: You sound better since you started Remeron? » johnj, posted by Ron Hill on May 23, 2003, at 11:11:59
Hi Ron,
Yes, after a week of sleeping 7 hours or more my clarity has returned. It is kind of scary thinking one drug can make me feel better so fast. It does leave me somewhat tentative since I have had so many ups and downs this past year or so. Mostly down is probably more accurate. I feel my language skills, ability to crack jokes like I used to, and work concentration has all improved.
Like I mentioned above there are a few SE that are troublesome. Another one is a little anger and inappropriate urge(more like a fleeting thought) to do something I wouldn't normally due. For example, the thought to kick my boss when I was talking to him. However, that may be totally appropriate! ;) Just some weird stuff like that. I would never do that but the thought bothers me. Like my brain is playing "what if" games with me. We will see how I feel after lunch. Meals have made my head even heavier so I need to figure out WHY, and how to help that. It may be a transient side effect I don't know for sure. Hope you are feeling well.
cheers
johnj
Posted by johnj on May 23, 2003, at 12:16:25
In reply to Re: You sound better since you started Remeron? » johnj, posted by Ron Hill on May 23, 2003, at 11:11:59
Ron,
One more thing I forgot to mention. I can see that remeron has reduced my anxiety to almost nothing. Therefore, I sleep better. All of my past depressive episodes have been at a time when anxiety is high. Sleeping used to help me overcome anxiety. But, once the anxiety gets to be too great, my sleeps gets screwed up. I have often brought this up to my pdoc, but they don't seem very interested. I think if I tackle the anxiety things get better. When I first started meds in 1993 it was after a panic attack which plunged me into depression. This may come in handy in the future when new meds are developed.
Thanks for listening.
johnj
Posted by McPac on May 23, 2003, at 18:45:35
In reply to Re: How long will this last? Re: Remeron for Atypical » McPac, posted by johnj on May 18, 2003, at 13:12:28
I started Remeron a while back at 7.5 mg's.....did NOT get the increased norepinephrine until I raised it to 15 mg's......I really dislike this increased NE crap---jittery, nervous, heartbeat increased....major bummer because I wanted to make Remeron my main anti-dep......take care!
Posted by johnj on May 24, 2003, at 10:00:32
In reply to johnj,Re: How long will this last? Re: Remeron for, posted by McPac on May 23, 2003, at 18:45:35
Hello McPac,
I didn't think the NE effects kicked in until one was above 30 mg or so. But, you make a very good point since I had a heart that was pounding like crazy on day 4. It greatly subsided a few days later. How about raising you dose slowly? I jumped in at 30 mg because at low doses 7.5 mg or so I felt like a truck hit me. I once tried 45 mg and it was not good, a lot of spaciness. Where did you get the info on NE and remeron? I am very curious because I am still on a TCA and wonder if I am getting a double dose on NE. I REALLY hope to kick the TCA. Let me know how things are going, again, I broke 15 mg tablets into 4 chunks at one point. Maybe that is what you need? take care
johnj
Posted by earthmamma on May 24, 2003, at 12:12:59
In reply to Re: johnj,Re: How long will this last? Re: Remeron for » McPac, posted by johnj on May 24, 2003, at 10:00:32
What is NE? Am I just dense? LOL! Oh, and I'm wondering if anyone else noticed their hunger/weight gain was controlled if they upped their dose. I'm oon 30 MG now, and I KNOW I've gained weight b/c my clothes are a *bit* snug, despite my extremely active lifestyle and good food choices. Has anyone been able to control their weight gain with diet like Atkin's? I'm going to try it, even tho I already eat very little carbs or processed foods. I'm not going to be at the mercy of some medication, after I've worked so hard to lose weight and get in shape after having children.
Thanks for any advice,
Cheers,
Kyah :)
Mamma to 2 ^Angelic^ girls
~Annika June~ June 30th, 1999
*Lorien Moss* April 15th, 2002"It is never too late to be what you might have been"
~George Eliot~
Posted by johnj on May 26, 2003, at 11:24:33
In reply to Re: johnj,Re: How long will this last? Re: Remeron, posted by earthmamma on May 24, 2003, at 12:12:59
Eartmamma,
NE is norepinephirine(adreneline). Please see the link below to it's connection with depression.
http://www.biopsychiatry.com/anxnorad.htm
I have tried different doses and really didn't notice a change in hunger. But, then I am on a tricyclic AD and lithium and they increase hunger too. I would recommend healthy eating and excercise. If it is working for your depression I would thing twice about quitting. Look at adding some supplemnts too. good luck and keep us posted.
johnj
Posted by lillabelle on June 2, 2003, at 5:25:42
In reply to johnj,Re: How long will this last? Re: Remeron for, posted by McPac on May 23, 2003, at 18:45:35
Hi McPac, have been following your threads and it seems that you may/might/who knows have similiar reactions to norepiephrine as i may/might/who knows. As I have posted in another thread I get horrible jitters/anxiety/panic from meds like prozac and stimulants and come to think of it tofranil and cocaine (the one time I tried it) too, which apparently all affect norepiephrine. Does remeron affect norep significantly? I know how frustrating it is to have a paradoxical reation to meds. Doctors look at you as if you're making it up and it's difficult to relate to all the 'good reactions'out there. It's the 'why me'thing. I know because I have had adverse reactions to practically everything!! But the 'jumping out of your skin jitters'has to be one of the worst. The odd thing is that when I tried remeron, several years ago, I DID NOT, have this reaction. Instead i was angry and irritible and not pleasant to be around. I had lots of ruminating thoughts and i WAS HUNGRY ALL THE TIME. It's not just the weight gain (alto who needs that) it's the unnatural feeling of constantly needing to eat. Like needing to pee or needing to sleep all the time is not nice either. One of the great side effects for me was that I had a sex life again. After years of ant-d's and other psychotrophic meds this was a miracle. I'm not sure if I added something to the remeron if the anger would abate. I may try it again in the future if all else fails. Look forward to replies..........
Posted by earthmamma on June 3, 2003, at 20:52:16
In reply to Re: johnj,Re: How long will this last? Re: Remeron for, posted by lillabelle on June 2, 2003, at 5:25:42
Ok, this is rediculous. My once loose size 6's (I was about a 4/5) are now tight. I don't eat ANY processed foods or sugar and I exercise regularly. I'm sick of this. I've only been on Remeron about 2 months and I'm up at least 10 lbs. It's helped a lot with my anxiety, but now I'm just depressed every day b/c of this weight gain, and I'm at the mercy of this drug. What other drugs are out there that will be as effective (I finally got OFF Paxil, that was HELL) for anxiety and panic attacks but doesn't effect weight??!! I'm not lazy, nor do I eat "bad" food. I don't drink, smoke or do drugs (other than Remeron of course LOL!) and I'm just sinking deeper and deeper. I want to stop this before I gain more weight! Also, I am angry all the time and annoyed very easily. I feel like all I do it yell at dh and the kids.
I have a docs appointment tomorrow (the 4th) and I'll ask him what he thinks, but I'm willing to bet he'll just tell me to eat smartly and don't overindulge...stay active blah blah blah. There are a lot of people (including the pharmacist I trust so much) who think that it's just as easy as not eating too much. But I honestly think that this drug has messed with my metabolism. I've worked way too hard to get back into shape after two kids to let some med screw with me.
Also, this is really weird, but when I take a deep breath my hands and feet tingle, like pins and needles! What's up with that??HELP!!!
Cheers,
Kyah :)
Mamma to 2 ^Angelic^ girls
~Annika June~ June 30th, 1999
*Lorien Moss* April 15th, 2002"It is never too late to be what you might have been"
~George Eliot~
Posted by johnj on June 4, 2003, at 8:24:49
In reply to Another med for anxiety/panic instead of Remeron?, posted by earthmamma on June 3, 2003, at 20:52:16
Earthmamma:
First, most docs don't understand the SE issues since they haven't been there. Maybe you could ask you doc about changing your dose? I went from 30 to 15 due to "sponge head" feelings and I also have the breath issues. It is listed as a rare SE but at times I can't feel if my lungs are getting full or not(very strange indeed). I have heard paxil fas weight gain so I am little suprised that didn't happen to you. Maybe the med isn't for you. I will look to get off it when I see my doc next. Hope your appt goes well and hang in there. Sorry I can't be of more help.
johnj
Posted by McPac on June 5, 2003, at 17:02:47
In reply to Re: johnj,Re: How long will this last? Re: Remeron for, posted by lillabelle on June 2, 2003, at 5:25:42
Yes, Remeron certainly does effect NE levels, particularly at the higher doses.
Also, some people DO get increased irritability when starting the med (usually goes away as body adjusts).
Posted by joebob on July 17, 2003, at 17:04:28
In reply to Re: Period for Remeron's benefits to kick-in? » charlie12, posted by jrbecker on May 1, 2003, at 15:30:03
i have mixed state d/a...
went to neurologist....
she gave me depakote as a 2 week pretreatment before lexapro....
now i am first seeing all this remeron stuff....
i mostly have loss of motivation with depression and anxiety....and i have lost a lot of weight due to no appetite
Posted by jrbecker on July 18, 2003, at 10:12:59
In reply to depakote prior to lexapro........for jrbecker » jrbecker, posted by joebob on July 17, 2003, at 17:04:28
joebob, thanks for the praise, much of it is undeserved.
so you've recently started lexapro? how many weeks have you been on the depakote?
So your dx is BP II, considering your mixed-state, or is this just med-induced? Please explain your episodes of hypomania, are they dysphoric (anxious, agitated in nature) or are they more or less euphoric experiences, but slightly out of control?
How is your mood [specifically] being treated thus far? Are you happy with the Lex and it's just the side effects you're having a problem with, or is your depression still lingering (not anxiety)?
Oppositely, is your anxiety [not your mood] worse on Lexapro than off of it?
What's your motivation been like before the meds. Is this just apathy from the meds, or just part of your symptoms, or if both, then to what extent can you attribute them to either.
Once again, how has your appetite been prior to your meds? Lex for many kills appetite.
What's our sleep like -- too much, too little, presently and, also what's it like when you're off meds?
What's your general consensus on the depakote and how much are you taking?
Posted by joebob on July 18, 2003, at 12:39:45
In reply to Re: depakote prior to lexapro........for jrbecker » joebob, posted by jrbecker on July 18, 2003, at 10:12:59
i doubt the paise is much undeserved....you have a knack for this sort of thing and may be a 'healer' in disguise.....we live in the republic of santa monica so i have a somewhat 'california' perspective
i started the depakote 10 days ago, after hearing the advice to pre-treat hot type brains prior to ssri implementation, re: notable brain activity expert
i will start the lex on tuesday after the 2 weeks pre dosing on the dep
i do not have a formal diagnosis of bipolar II as far as i know, my neurologist is not too communicative, very busy etc.
she gave me trazadone for sleep...i take 100 mg an hour before bed and it is great...she also gave me valium for anxiety, which i use occasionally as needed
i started the dep at 250mg and over the last 2 days went to 500mg.........i do think the dep has done something to mellow me out a little, but am concerned about long term use and may try to taper off after the lex kicks in fully....as an interesting side note, a dear friend of mine, who is a neuropsychologist and naturopath told me that depakote may get some sort of approval as a brain protective med, this info from a pharm rep who is a natural type like both of us, and who specializes in depakote representaion.....he trusts her to tell it straight, btw he is also the one who gave me the pre-dosing tip after a professional seminar, a very knowledgable guy and knows me very well.....btw, you can also use neurontin as a pretreatment for ssris, and one more (i don't have the notes at hand)...
it does seem the depakote is causing some weird/intense dreams & recall, which i normally don't have....i do have some constipation, and i can tell when i'm typing that i make more mistakes and am slower
i tried a very small dose of lexapro some months ago and on the 3rd day or so i had some hypomania (?), i.e. racing thoughts, agitation, anxiety...so i stopped
have been under external stressors for 3 years, and at the time it all started i started smoking which i think is what mostly kills my appetite, and raises my dopamine levels or so i hear..i have lost weight due to simply not eating, just smoking and drinking beer....i am hoping that if the lex does its job i will regain some appetite but still need to address the smoking, zyban didn't work for me for smoking
i have been using kirunal fairly regularly on the advice of david horrobin, but as the stressors keep increasing on me i need stronger help, but i do like the kirunal and am giving it on occasion to my 5 year old son, as i suspect he has a 50% chance of having the wrong 5htt gene
see: http://weeksmd.com/articles/psychiatry/Depression_and_Schizophrenia__Essential_Fatty_Acids.pdf
and:
http://www.fincastle.com/sp_products.htmli have also gone back to chewing some lithium orotate a couple of times a day....i have used it over the years and think of it as a useful supplement for lots of people, not just bipolars....i still have some bottles hans neiper gave me
see:
http://www.mwt.net/~drbrewer/cancer.htmmy motivation has been mostly tied up by emotional paralysis ie, anxiety, confusion, fear of making an expensive mistake, etc
i would say in closing that the biggest help to me over the last couple of years has been classical homeopathy, as is definitely true for my wife and child, but right now i need more help and made the difficult decision to try the meds to get up and running again.........in the future i may try the joan larson approach but for now am not up to it, need a simpler fix......i am sure she is on to something and know i am a high histamine type
see:
http://www.healthrecovery.com/Biochemical_Restoration.htmli hope there is something useful for you and others in this long post......
thank you for your kind attention
> joebob, thanks for the praise, much of it is undeserved.
>
> so you've recently started lexapro? how many weeks have you been on the depakote?
>
> So your dx is BP II, considering your mixed-state, or is this just med-induced? Please explain your episodes of hypomania, are they dysphoric (anxious, agitated in nature) or are they more or less euphoric experiences, but slightly out of control?
>
> How is your mood [specifically] being treated thus far? Are you happy with the Lex and it's just the side effects you're having a problem with, or is your depression still lingering (not anxiety)?
>
> Oppositely, is your anxiety [not your mood] worse on Lexapro than off of it?
>
> What's your motivation been like before the meds. Is this just apathy from the meds, or just part of your symptoms, or if both, then to what extent can you attribute them to either.
>
> Once again, how has your appetite been prior to your meds? Lex for many kills appetite.
>
> What's our sleep like -- too much, too little, presently and, also what's it like when you're off meds?
>
> What's your general consensus on the depakote and how much are you taking?
>
>
Posted by jrbecker on July 18, 2003, at 13:55:18
In reply to Re: depakote prior to lexapro........for jrbecker » jrbecker, posted by joebob on July 18, 2003, at 12:39:45
First advice: whatever you do, add or subtract one med at a time. It's really hard to find out what you're responding to if you change up too many things at once.
It sounds like you're in a more comfortable spot now that you're on the depakote. I would think that if you can tolerate it, then you should consider bumping it up (750mg - 1500mg). This will not only help your mood stabilize, but it will also definitely help your anxiety. Thirdly, at a certain higher dosage an appetitive effect will kick in. Give this a little bit of time to figure out before you jump into an antidepressant regimen again. As for depakote (as well as lithium) being a neuroprotectant, that's definitely the case. All the more reason why you should try to stay on one, even if it's just a low dose. For more info, see
http://www.psycheducation.org/bipolar/frameset.html
One more strategy might be to add in a low dose of lithium to the depakote. It all rests on what drug and what dosage you can tolerate.
Next up. Now that you're ready, I would consider another trial of an antidepressant. Lexapro is as good as anywhere to start within the SSRI class. Why Lex? It has a very minor side effect profile. At the same time, it can be very potent. Even the starting dose for some people can be very over-powering. And based on what you've said, it might exacerbate three of your symptoms: apathy, anxiety, and lack of appetite. But you don't know that for certain. Everybody reacts differently. Some gain weight on it, have their anxiety reduced, and it has no effect on their motivation.
*Note: on any of the ADs, perhaps it is prudent to start below the normal therapeutic dose, taking into account your hypomania last time. For instance, ask your doc about trying just 5mg for a few weeks on Lex.
If after a month (remember, give it at least 4-6 weeks to see not only the mood response, but also the lowering of the side effects), you don't feel like you're having a great response with the Lex, I think you come to a fork in the road. Do you A) want to consider another SSRI, or B) go for another AD class.
If you and your doc choose A), I think you should take a look at Zoloft. It has a slight appetitatve effect, and it won't make you too apathetic. It also might help you quit the smokes (we'll get to that).One more option in the class, I would try celexa -- very different from Lexapro. Most people find it a lot "softer."
If you choose B) I think you should talk to your doc about Serzone or Remeron. Either one will help you sleep (you can then ax the trazadone) and it will be a lot better for your anxiety than most of the SSRIs are. Both have been shown to be more effective in treatment-resistant depression than the SSRIs. Plus, they will help your appetite. Lastly, I would try Wellbutrin/Zyban again, but only if you feel very stabilized -- it can induce irritability.
OK, as for the valium, it's fine if you're using it only occassionally. But if you're using it all too frequently, I would consider a regular benzo (ativan, klonopin) instead. BUT, my guess is that once you up the depakote and are on an AD you like, you won't need it. So try to cut the downers out all together as soon as you can. That won't help the motivation.
As for the smokes. Well, hey, I've been there. I smoked on and off for years. It's a great antidepressant in itself. Here's the catch though, it can actually induce depression in most people -- there are studies to back this up. This happens because the HPA axis is being overstimulated and the nicotine is actually exaccerbating the stress-response. This just shows you the delicate interplay between anxiety and depression. So not to be a PSA, but the smokes ain't helping. When (and only when)you're at a very comfortable point down the line, consider quitting. You'll miss the euphoric hits you get a few times a day, but I promise you that your anxiety and depression will recede noticeably.
As for the alternative therapies you've been trying. I'm all for it, and I'm big fan of non-traditional therapies myself. I will say this though: the meds have the highest percentage of working in most people. Don't overload yourself in relying too much on them or taking too much of them right now (some supplements will counteract your meds). Stick to this as the cornerstone of your treatment plan first. Then you can go back to adding back in the homeopathic supplements later. By the way, if you were to start anywhere on this, I would recommend a multi-vitamin, some folate and B12, and possibly some fish oil (some like it, some don't).
As for psychotherapy, have you considered it? It helps, even if you chalk it up to placebo. There are lots of reasons why it works for me, but probably the biggest is that it makes me vocalize what I plan to do about my own problems. For instance, in dealing with my own lack of motivation, by talking out what I want to do (or should be doing) I take ownership for action in making it happen. Or perhaps just talking through your problems might be beneficial.
Lastly, if you don't feel like your neuro doc is the best fit for you -- go shopping for a new one. Don't settle on someone who can just write your scripts. Take the time to find someone who is patient (and has enough people-skills) to explain your options in psychopharm therapy. This is no doubt part of your current problem.
Tell me your thoughts on this.
> i doubt the paise is much undeserved....you have a knack for this sort of thing and may be a 'healer' in disguise.....we live in the republic of santa monica so i have a somewhat 'california' perspective
>
> i started the depakote 10 days ago, after hearing the advice to pre-treat hot type brains prior to ssri implementation, re: notable brain activity expert
>
> i will start the lex on tuesday after the 2 weeks pre dosing on the dep
>
> i do not have a formal diagnosis of bipolar II as far as i know, my neurologist is not too communicative, very busy etc.
>
> she gave me trazadone for sleep...i take 100 mg an hour before bed and it is great...she also gave me valium for anxiety, which i use occasionally as needed
>
> i started the dep at 250mg and over the last 2 days went to 500mg.........i do think the dep has done something to mellow me out a little, but am concerned about long term use and may try to taper off after the lex kicks in fully....as an interesting side note, a dear friend of mine, who is a neuropsychologist and naturopath told me that depakote may get some sort of approval as a brain protective med, this info from a pharm rep who is a natural type like both of us, and who specializes in depakote representaion.....he trusts her to tell it straight, btw he is also the one who gave me the pre-dosing tip after a professional seminar, a very knowledgable guy and knows me very well.....btw, you can also use neurontin as a pretreatment for ssris, and one more (i don't have the notes at hand)...
>
> it does seem the depakote is causing some weird/intense dreams & recall, which i normally don't have....i do have some constipation, and i can tell when i'm typing that i make more mistakes and am slower
>
> i tried a very small dose of lexapro some months ago and on the 3rd day or so i had some hypomania (?), i.e. racing thoughts, agitation, anxiety...so i stopped
>
> have been under external stressors for 3 years, and at the time it all started i started smoking which i think is what mostly kills my appetite, and raises my dopamine levels or so i hear..i have lost weight due to simply not eating, just smoking and drinking beer....i am hoping that if the lex does its job i will regain some appetite but still need to address the smoking, zyban didn't work for me for smoking
>
> i have been using kirunal fairly regularly on the advice of david horrobin, but as the stressors keep increasing on me i need stronger help, but i do like the kirunal and am giving it on occasion to my 5 year old son, as i suspect he has a 50% chance of having the wrong 5htt gene
>
> see: http://weeksmd.com/articles/psychiatry/Depression_and_Schizophrenia__Essential_Fatty_Acids.pdf
>
> and:
> http://www.fincastle.com/sp_products.html
>
> i have also gone back to chewing some lithium orotate a couple of times a day....i have used it over the years and think of it as a useful supplement for lots of people, not just bipolars....i still have some bottles hans neiper gave me
>
> see:
> http://www.mwt.net/~drbrewer/cancer.htm
>
> my motivation has been mostly tied up by emotional paralysis ie, anxiety, confusion, fear of making an expensive mistake, etc
>
> i would say in closing that the biggest help to me over the last couple of years has been classical homeopathy, as is definitely true for my wife and child, but right now i need more help and made the difficult decision to try the meds to get up and running again.........in the future i may try the joan larson approach but for now am not up to it, need a simpler fix......i am sure she is on to something and know i am a high histamine type
>
> see:
> http://www.healthrecovery.com/Biochemical_Restoration.html
>
> i hope there is something useful for you and others in this long post......
>
> thank you for your kind attention
>
> > joebob, thanks for the praise, much of it is undeserved.
> >
> > so you've recently started lexapro? how many weeks have you been on the depakote?
> >
> > So your dx is BP II, considering your mixed-state, or is this just med-induced? Please explain your episodes of hypomania, are they dysphoric (anxious, agitated in nature) or are they more or less euphoric experiences, but slightly out of control?
> >
> > How is your mood [specifically] being treated thus far? Are you happy with the Lex and it's just the side effects you're having a problem with, or is your depression still lingering (not anxiety)?
> >
> > Oppositely, is your anxiety [not your mood] worse on Lexapro than off of it?
> >
> > What's your motivation been like before the meds. Is this just apathy from the meds, or just part of your symptoms, or if both, then to what extent can you attribute them to either.
> >
> > Once again, how has your appetite been prior to your meds? Lex for many kills appetite.
> >
> > What's our sleep like -- too much, too little, presently and, also what's it like when you're off meds?
> >
> > What's your general consensus on the depakote and how much are you taking?
> >
> >
>
>
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Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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