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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on August 6, 2005, at 15:20:01
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » med_empowered, posted by SLS on August 6, 2005, at 14:53:26
>Do you recall where you came across the NIMH study? If not, I'll try to find out more about it through their clinical trials postings (If I can find them).
Please post if you find anything :-)
~Ed
Posted by ed_uk on August 6, 2005, at 15:25:18
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by Nickengland on August 6, 2005, at 15:01:10
Hi Nick!
>Totally agree! What I mean by 50mg being the target dose, is just that its all i've been prescribed so far from the psychiatrist...
Oh I see! LOL, sorry!
>Hey now that is what I call being generous :-)
£6.50 for about £100 worth medication isn't bad!
Kind regards
~Ed
Posted by Nickengland on August 6, 2005, at 18:04:30
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by SLS on August 6, 2005, at 15:05:38
Hi Scott,
>I can't believe you went back and checked that out! Yes, I have avoided Topamax because of its cognitive side effects. How silly, right? Considering the severity and refractoriness of my condition, it doesn't make sense to avoid it forever. I guess I should go ahead and put it back near the top of my list of things to try. Thanks. One more ray of hope to cling to.
I have another surprise for you..lol I didn't need to go and check the list as I remembered specifically that Topamax wasn't on it! :-) I have a very good longterm memory for things that interest me - quite literally they stay in mind. that said my everyday short-term memory is a joke, I forget everything, but longterm I have the memory of an elephant lol On a serious note, it maybe of interest (I read somewhere a couple of years ago, memory again, see lol) that one of the benefits, yep benefits of manic-depressives, is that they quite often have very good longterm memories..Good and bad I guess, but mine are often based on factual information.
Anyway, i'm waffling again lol
To be perfectly honest with you, I really havent found the cogitive effects that bad at all. In fact carbamazepine, lithium and sodium valproate I found had worse cognitive side effect compared with Topamax so far. That said, like yourself, before trying Topamax, the 'Dopamax' fear was the thing that held me back.
I always looked at it like this aswell, interms of firstline and order of what should be tired first for a mood stabilser (this is in order of what I tired first to get to Topamax)
Sodium Valproate
Lamotrigine
Lithium
Lamotrigine (shortly again)Carbamazepine
Oxcarbazepine
Gabapentin
Topiramate
Finally ending with Topiramate and Gabapentin so far (plus omega 3 fish oils & Taurine - taurine is one great supplement, proven anticonvulsant properties and great calming effect)
*Experimental - Niacinamide & Tyrosine (vitamin C and vitamin b complex thrown in just for good measure!
I'm possibly wondering about a gabba supplement, but somehow don't see the point, although that Amen psychiatirst thinks its good..Hmmm Blood brain barrier has got me on that one, seeing as it doesn't cross it.>Did the antidepressant effect fade with time?
Like most medication that had a great intial response (for me Trileptal & Gabapentin) the first few days, first week was the best. My body then adapted and of course this did fade alittle. That said, the effects (positive) have still remained and I would say have leveled off to some extent. Nothing perfect, but i'm coping you know, take away the medication and i'd have to deal with the illness and that far, far worse. So all in all I'd say the benefits are still there. The anti-depressant response from this for me, has been alot more pronouced than that of Trileptal, that for sure. It works so differently from Trileptal, I mean side effects wise, not so much drowsyness and no blurred vision. Its different, a whole new ball game. I will say there are side effects and in some repects its not as 'smooth' as Trileptal. I really like the stuff though. Given the choice now if I didnt have the kidney thing with Trileptal, you know id probably stay with Topamax. Oh its great for headaches as well as an added bonus - if you get these, I do and now with this I do not anymore, well very rarely.
> Of interest as well, I've read that Tegretol, Trileptal and Topamax are the main 3 medications that effect the Temperal Lobes.
>Hmm.
I know, lol i'm no expert on the Temeral Lobe area of the brain and i'll adit I got this information from 'crazymeds.org' Thats said, there are pubmed studies that confirm topamax was shown to work on areas of the temeral lobes. (I think) that study may have been on rats lol hmmm No seriously, I've heard its good for temperal lobe epilepsy, there must be a link somewhere. Tegretol is a first line medication for temeral lobe epilepsy, trileptal related. Topamax would be second line for Temperal lobe epilepsy I think. Dr Amen speaks about bipolar being a Temperal lobe condition on his site from what I can gather with responds to anticonvulsants. There could be a link somewhere?
>Damned tachyphylaxis!
Im not sure what tachyphylaxis is?..does not sound good though! :-(
>How long and at what dosage do you feel I should wait before passing judgment?
Thats a very difficult question for me to answer Scott. Its my understanding that huge un-wanted side effects would be the limiting factor in you continuing with Topamax. That and the fact, that because of these side effects you would be getting no real benefit. If that was the case then dosage would only be small, perhaps only in the region of 25-75mg, thats if what I am saying would be true for you and it then could only be a matter for a few weeks, 1 month tops. This could be an unfair judement though based on my experience of medications and more so topamax...I wouldn't want to add anymore as I know there are many more factors with yourself. Bearing in mind your on other medications and you will no doubtly react differently somewhat to me. In general though, I think and feel with this medication, you'll either love it or hate it. I know its hard, but try not to think about quiting it, before you try it :-)
Go low and slow is definately the key if you decide. When I first started it was at 25mg for afew weeks and I had some word finding problems but funnily enough could laugh them off (see what I mean either love it or hate it) anyway, due to some circumstances I re-started the medication and this time at 12.5mg. It certianly made a difference with those word finding skills, when I reached 25mg and now i'm at 37.5mg I dont even have that originally problem that I had back then when I jumped straight in at 25mg, if you get what I mean.
I hope that helps
:-)
Kind regards
Nick
Posted by Nickengland on August 6, 2005, at 18:12:58
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by ed_uk on August 6, 2005, at 15:25:18
Hi Ed!
>Oh I see! LOL, sorry!
No need to be sorry Ed ..Acutally you gave me a good reminder that indeed its not as easy as just keeping the medication at one dosage - it has to meet the needs of your moods! Thanks for the reminder :-)
>£6.50 for about £100 worth medication isn't bad!
Its a great exchange rate!...So when someone buys generic prozac at £2.00, they are being made to pay £6.50!...and then I get that all that, man I feel guilty lol I've often wondered how they balance the accounts in pharmacy's over here, but maths are not my strong point!
Kind regards
Nick
Posted by Slinky on August 6, 2005, at 20:19:57
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by Nickengland on August 6, 2005, at 15:01:10
But, he will provide me with *6 months* medications! - Hey now that is what I call being generous :-)
Blimey Nick...
One suitcase just full of meds..
Slinky
Posted by EERRIICC on August 6, 2005, at 20:56:26
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Hey Scott,
Did you ever get a chance to try this drug?
It's interesting stuff, e-mail me at ericaroundtheclock@hotmail.com.
Posted by Nickengland on August 7, 2005, at 8:34:47
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by Slinky on August 6, 2005, at 20:19:57
>Blimey Nick...
>One suitcase just full of meds..
Hello Slinky lol
Yeah I know that has crossed my mind too!
Its quite strange, he said really is only supposed to give me 3 months worth, if i'm to leave the counrty for a such a long period of time, but then he said (with a weird look on his face :-o) i'll give you 6 months worth.. Hmm, no worries, thanks very much, I replyed!
Honestly though he's quite an intersting GP, sometimes when I see him he can be really nervous, stuttering, and just seem quite unconfident and in a low mood. Other times he really focused, switched on and extreamly confident - I do sometimes wonder if he's Bipolar!...he once admited to me in a round-about way they he get depressed. Must of caught him in quite a funny mood that day, thats for sure!
Good to know he'll trust me with that amount of medication anyway, never been any problems with me in that department before so, I guess that was something he took into consideration, and the fact I havent worked for a year, I could do with some extra help. Top man :-)
Kind regards
Nick
Posted by platinumbride on August 8, 2005, at 14:22:07
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Scott,
I wish I could say more positive things than that keppra was one of the most expensive placebos I ever tried.....
Then again, so was trileptal.Sorry for the bad news, but of course, only my experience.
Diane
> I am thinking about trying Keppra next.
>
> Any comments?
>
> Thanks.
>
>
> - Scott
Posted by SLS on August 13, 2005, at 12:35:00
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by platinumbride on August 8, 2005, at 14:22:07
I began taking Keppra yesterday. I will be at 500mg until I see my doctor on Tuesday.
I decided to discontinue the Trileptal, as the excema-like lesions have continued to spread. I'm disappointed. It was helping a bit.
Right now, I'm taking:
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Keppra 500mgI am expecting to feel worse because the Lamictal and Trileptal have been removed from the regime. I guess I can add back the Lamictal if things get tough.
- Scott
Posted by ed_uk on August 13, 2005, at 18:08:08
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 13, 2005, at 12:35:00
Hi Scott :-)
I really hope the Keppra helps. Perhaps it will have some positive cognitive effects?
Kind regards
~Ed
Posted by SLS on August 14, 2005, at 8:55:13
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by ed_uk on August 13, 2005, at 18:08:08
> Hi Scott :-)
>
> I really hope the Keppra helps. Perhaps it will have some positive cognitive effects?
>
> Kind regards
>
> ~EdAt 500mg / day, I'm not expecting very much. My guess is that 1000-2000mg is the range most people would find helpful to treat bipolar depression. This is still uncharted territory.
Because I have discontinued both Trileptal and Lamictal, I am deteriorating rather quickly. Psychomotor retardation and fatigue are becoming more prominent, and I doubt I will be able to function very well without either of those two drugs. I don't know whether or not to ride it out and hope that some portion of the worsening is due to rebound and will eventually be recovered. I wouldn't have hesitated continuing with the Trileptal had the eczema not continued to spread. I call it eczema for lack of a true indentification. The eruptions and dry patches do not itch and do not exude serous fluids, but they do look eczematous. All of my fingers are affected as well as my scalp and ears. Not pretty.
- Scott
Posted by ed_uk on August 14, 2005, at 9:37:21
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 14, 2005, at 8:55:13
Hi Scott,
>Because I have discontinued both Trileptal and Lamictal, I am deteriorating rather quickly.
I was worried because you weren't posting. Perhaps you could restard Lamictal? I don't think you were having any major side effects from Lamictal, were you?
~Ed
Posted by theo on August 14, 2005, at 10:15:29
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 13, 2005, at 12:35:00
Hello Scott!
I hope the Keppra works for you. I'm very close, after taking Keppra for a year and being off now for about 6 months, to starting it again. The only reason I stopped was the quest for something new and better.
I've tried Topamax, Lamictal and Keppra and it seemed to be the most user friendly for me as far as fast adjustment to dosing. Usually within a couple of days of dose increase you feel the change, and side effects (mainly muscle weakness, slight headache) diminish. I don't know how med sensitive you are but if you are going in 500mg increments, you might try going up in 250mg increments instead. You really have to fine tune this med. If you get angry, agressive for longer than 4 days, chances are you need to back down 250mg.
My pdoc doc started me this way: 250mg bedtime for 4 days, then add another 250mg morning. Then after 4 days add another 250mg bedtime, then 4 days another 250mg morning, etc.
Hopefully for convenience, twice daily dosing will work for you. I actually split my dosing three times daily for a while because my morning dose at 7:00am seemed to wear off about 3:00pm.
Once you increase the dose, are you on a twice daily schedule? Keep me posted on your progress with Keppra and I hope the withdrawal from Triliptal and Lamictal isn't to harsh.
Posted by SLS on August 14, 2005, at 14:26:09
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 14, 2005, at 10:15:29
Hi Theo.
Thanks for the information. You have given me much insight as to the personality of this drug.
I did experience the headaches you referred to. So far, they have been minor and short-lived.
Are you bipolar, Theo?
How would you describe the therapeutic effects of Keppra? Did it act as an antidepressant? Did it work well at first and then fade? Anything else you could offer me regarding Keppra would be much appreciated.
Thanks again.
- Scott
Posted by SLS on August 14, 2005, at 14:37:56
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by ed_uk on August 14, 2005, at 9:37:21
> Hi Scott,
>
> >Because I have discontinued both Trileptal and Lamictal, I am deteriorating rather quickly.
>
> I was worried because you weren't posting. Perhaps you could restard Lamictal? I don't think you were having any major side effects from Lamictal, were you?
>
> ~Ed
It probably makes sense for me to return to Lamictal. I dropped it in favor of Trileptal, hoping that the eczematous eruptions were the result of the two drugs in combination. Lamictal alone does produce a mild form of these skin lesions. Unfortunately, it turned out that Trileptal was the culprit and not the Lamictal. Nothing is ever easy, you know? Damned drugs.I will probably restart the Lamictal this evening. My intention is to begin at 75mg and move up to 150mg if necessary. Generally, it is recommended that one use the same titration schedule to restart Lamictal as to begin taking it for the first time once a period of non-use has exceeded a week. There have been times when I purposely maintained a dosage of 50mg just to avoid a restart titration once I made a decision to continue treatment at 300mg.
- Scott
Posted by ed_uk on August 14, 2005, at 16:30:40
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by SLS on August 14, 2005, at 14:37:56
Hi Scott,
How long have you been off Lamictal?
~ed
Posted by theo on August 14, 2005, at 23:50:43
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 14, 2005, at 14:26:09
>
> Are you bipolar, Theo?
>
> How would you describe the therapeutic effects of Keppra? Did it act as an antidepressant? Did it work well at first and then fade? Anything else you could offer me regarding Keppra would be much appreciated.
>
> Thanks again.
>
>
> - ScottMy regular doc thinks I suffer from a low grade depression, my pdoc thinks I'm BPII. I basically suffer from chronic low self esteem, worry. So, whatever that falls under. I also used to drink quite a bit but am sober now 2 years, so alcoholism is in the mix also. I'm never manic, but my pdoc insists any anxiety that pops up is my mania. Who knows! I've almost given up on diagnosis and just trying different meds hoping to find a fit. My regular doc actually prescribed me Concerta 18mg, which my pdoc never would, and it caused no anxiety and was actually very helpful. The only thing I didn't like is the up and down ride every day.
So, I've been med free just to get a feeling of where I am so when I do start a med, I'll have a better read. I do feel like I need to be on something, but my big dilema is to start with.
Keppra helped me be more assertive in a positive way and even helped with OCD. It also did have some mood lifting properties. And free of side effects except 1 or 2 days headache and muscle weakness.
Since I've been off meds, amazingly I'm not as nervous and feel much more in control. Unfortunatly, I feel domb and gloom depression alot. So I was feeling anxiety from some of my past med trials, especially Lamictal which now looking back amplified my OCD very much.
I'm really at a loss right now what class to go with but I might retry Keppra next and see what happens.
Are you dosing twice daily?
Posted by SLS on August 15, 2005, at 9:53:36
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 14, 2005, at 23:50:43
> My regular doc thinks I suffer from a low grade depression, my pdoc thinks I'm BPII. I basically suffer from chronic low self esteem, worry. So, whatever that falls under. I also used to drink quite a bit but am sober now 2 years, so alcoholism is in the mix also. I'm never manic, but my pdoc insists any anxiety that pops up is my mania.
He might be right. I know someone who remains mixed-state hypomanic without
medication for which an uncomfortable anxiety-like state causes her to pick up alcohol to self medicate. However, she also is very irritable and sometimes has racing thoughts and pressure of speech. She doesn't demonstrate these things except when challenged socially, so, one would never know she was hypomanic
otherwise. She sleeps 7-8 hours. One of the things that complicates her case is that I believe she also suffers from borderline personality disorder (BPD).> Who knows! I've almost given up on diagnosis and just trying different meds hoping to find a fit. My regular doc actually prescribed me Concerta 18mg, which my pdoc never would, and it caused no anxiety and was actually very helpful.
With bipolar disorder, some people display a paradoxical calming and anti-manic effect from stimulants.
> So, I've been med free just to get a feeling of where I am so when I do start a med, I'll have a better read.
Smart.
> I do feel like I need to be on something, but my big dilema is to start with.
Have you ever tried Risperdal or Seroquel? Both drugs demonstrate antidepressant effects. Risperdal in particular can ameliorate OCD, and they of course will help address the hypomanic mixed-state that you might suffer from.
I wish I could get my crystal ball up and running again to help you out. I think the core processor crashed, and repair parts no longer exist. I will be very interested to know what you decide to do.
Right now, I am dosing Keppra twice a day 250mg b.i.d. Dosing twice or three times a day is not an issue with me. I restarted Lamictal at 75mg, but haven't decided what dosage to target. I might stay right here. I think too much sodium channel blockade can produce cognitive blunting and a mild reduction of motivation to initiate activities. This was my experience with Trileptal as well. I really don't know what dosage of Keppra my doctor had in mind to work up to. I'll find out more tomorrow when I see him. I also need to push him along to do the paperwork so that I can get a hold of mifepristone should Keppra not work out.
- Scott>
> Keppra helped me be more assertive in a positive way and even helped with OCD. It also did have some mood lifting properties. And free of side effects except 1 or 2 days headache and muscle weakness.
>
> Since I've been off meds, amazingly I'm not as nervous and feel much more in control. Unfortunatly, I feel domb and gloom depression alot. So I was feeling anxiety from some of my past med trials, especially Lamictal which now looking back amplified my OCD very much.
>
> I'm really at a loss right now what class to go with but I might retry Keppra next and see what happens.
>
> Are you dosing twice daily?
>
>
>
>
Posted by SLS on August 15, 2005, at 9:56:14
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by ed_uk on August 14, 2005, at 16:30:40
> Hi Scott,
>
> How long have you been off Lamictal?
>
> ~edAbout a week. I restarted it yesterday at 37.5mg and will continue it at 75mg if I get enough of a boost from it.
- Scott
Posted by ed_uk on August 15, 2005, at 10:48:57
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by SLS on August 15, 2005, at 9:56:14
>I restarted it yesterday at 37.5mg and will continue it at 75mg if I get enough of a boost from it.
Any benefit so far?
~ed
Posted by theo on August 15, 2005, at 16:33:03
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 15, 2005, at 9:53:36
> He might be right. I know someone who remains mixed-state hypomanic without
> medication for which an uncomfortable anxiety-like state causes her to pick up alcohol to self medicate. However, she also is very irritable and sometimes has racing thoughts and pressure of speech. She doesn't demonstrate these things except when challenged socially, so, one would never know she was hypomanic
> otherwise. She sleeps 7-8 hours. One of the things that complicates her case is that I believe she also suffers from borderline personality disorder (BPD).Wow, this sounds exactly like me! Is she still currently not taking meds? Do you know if she had any successs with meds in the past? With the symptoms described above, was this a BPI or BPII diagnosis?
Posted by SLS on August 15, 2005, at 18:19:55
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 15, 2005, at 16:33:03
> Wow, this sounds exactly like me! Is she still currently not taking meds? Do you know if she had any successs with meds in the past? With the symptoms described above, was this a BPI or BPII diagnosis?BPII with possible BPD.
Currently, she is taking Topamax. In my estimation, it is doing very little for her. She probably would have done well on Risperdal were she not to develop akathisia. For the first week after discontinuing the Risperdal, she was perfectly normal. She then gradually entered the mixed state that she suffers with today. My guess is that another AP like Seroquel would have been helpful. I mentioned to her Trileptal, but her doctor is not terribly receptive to making any changes. She probably seems asymptomatic during her visits with him. Trileptal + Seroquel might be worth exploring.
- Scott
Posted by SLS on August 15, 2005, at 18:22:49
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by ed_uk on August 15, 2005, at 10:48:57
> >I restarted it yesterday at 37.5mg and will continue it at 75mg if I get enough of a boost from it.
>
> Any benefit so far?
A little. I'll probably decide on what to do with dosage over the next few days.
- Scott
Posted by theo on August 15, 2005, at 23:05:05
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 15, 2005, at 18:19:55
> Currently, she is taking Topamax. In my estimation, it is doing very little for her. She probably would have done well on Risperdal were she not to develop akathisia. For the first week after discontinuing the Risperdal, she was perfectly normal. She then gradually entered the mixed state that she suffers with today. My guess is that another AP like Seroquel would have been helpful. I mentioned to her Trileptal, but her doctor is not terribly receptive to making any changes. She probably seems asymptomatic during her visits with him. Trileptal + Seroquel might be worth exploring.
>
>
> - ScottTopamax made me look pale/gray and feel sickly. Also actually gave me avoidance behavior where I would avoid any dealings with people. Also lost about 8 pounds in a couple of weeks. Naturally, I'm 6', 180 pounds and don't need to lose any weight. My sister takes Topamax for migraines and is upset because it hasn't helped her lose a pound, amazing how these meds work so different even compared with a family member.
An AP might be worth a try for me. I've never tried one but would be willing. My doc even said, "it's hard to diagnose you because you seem so normal but from the symptoms you explain, I know you are suffering."
I'm to the point of almost feeling insecure about trying another med because of being let down again, but then take a deep breath and know I must be strong and continue my journey.
By the way, when I was taking Keppra it was when I went from 500mg daily to 750mg daily that I started to feel the positive effects so hopefully you will experience this soon. As I think I mentioned in a past post, my pdoc wanted me to be at 1000mg daily, but when I went from 750mg to 1000mg, I was overly aggressive and even had a little road rage. 250mg can make a big difference, at least with me.
You mentioned you are taking Keppra twice daily. Can you feel the first dose wearing off before it's time for your second dose? I'll be curious to see if you can take it twice daily versus three times daily. The PI says take twice daily (every 12 hours) but it also states the half life to be 6-8 hours which doesn't make much sense to me.
Posted by theo on August 15, 2005, at 23:31:12
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 15, 2005, at 9:53:36
> With bipolar disorder, some people display a paradoxical calming and anti-manic effect from stimulants.
Have you ever tried a stim? The only reason I stopped Concerta was fear of long term use and just did a 15 day trial. Do you know much about Concerta? I'm only talking about 18mg but wonder about long term stim use. Is Concerta suppose to be safer than amphetamines(Adderall)?
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