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Dr. Bob is Robert Hsiung, MD,
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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)?
Posted by SLS on August 16, 2005, at 8:05:38
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 15, 2005, at 23:31:12
Hi Theo.
I hope today finds you well.
I can't say that I feel anything positive from Keppra at 500mg that I should notice a fluctuation throughout the day. If my doctor has me increase the dosaged today, I might take it three times a day. I have to take an afternoon dose of Parnate anyway, so it is not really an added inconvenience.
I think the appearance of agressiveness would be a good thing for me. Depression leaves me feeling passive, inhibitited, and submissive.
Dexedrine (amphetamine) helps me for a few days only. Ritalin (methylphenidate) has no effect. As far as long term use is concerned, I haven't seen a trend in the reporting of irreversible side effects for Dexedrine, Adderall, or methylphenidate. Linkadge would be a good person to ask about this. To my knowledge, it is only Desoxyn (methamphetamine) that represents a hazard to the integrety of nerve terminals.
- Scott
Posted by zeugma on August 16, 2005, at 15:17:27
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 16, 2005, at 8:05:38
> Hi Theo.
>
> I hope today finds you well.
>
> I can't say that I feel anything positive from Keppra at 500mg that I should notice a fluctuation throughout the day. If my doctor has me increase the dosaged today, I might take it three times a day. I have to take an afternoon dose of Parnate anyway, so it is not really an added inconvenience.
>
> I think the appearance of agressiveness would be a good thing for me. Depression leaves me feeling passive, inhibitited, and submissive.
Hi Scott.Ritalin definitely makes me more aggressive. If lack of aggression were my target symptom, then 30 mg Ritalin would be ideal, at least for half the day. Unfortunately it is not my only target symptom, so I have to find treatments more broadly effective and excessive inhibition is hardly my biggest problem, although a 'normal' person might well find it intolerable.
I don't think amphetamines or methylphenidate have more long-term effects than other classes of medication. Linkadge did mention a 'chromosome study' but did not elaborate on this. I myself would gladly take methylphenidate if it helped more of my ADHD symptoms, but it leaves too many untreated, although it does a good job at treating sleepiness. I am a walking set of DSM-IV disorders, and I have to go for optimal treatments, not ideal ones.
Lack of aggression is a real problem for males.
-z
>
> Dexedrine (amphetamine) helps me for a few days only. Ritalin (methylphenidate) has no effect. As far as long term use is concerned, I haven't seen a trend in the reporting of irreversible side effects for Dexedrine, Adderall, or methylphenidate. Linkadge would be a good person to ask about this. To my knowledge, it is only Desoxyn (methamphetamine) that represents a hazard to the integrety of nerve terminals.
>
>
> - Scott
Posted by SLS on August 16, 2005, at 16:15:18
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 16, 2005, at 15:17:27
Pemoline?
DA agonists?
Abilify?
- Scott
Posted by zeugma on August 16, 2005, at 16:34:41
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 16, 2005, at 16:15:18
> Pemoline?
Tried it, worked great, was taken off it because of drastic weight loss.
>
> DA agonists?
>
I brought up bromocriptine to my pdoc. Do you consider modafinil an indirect DA agonist?> Abilify?
Am I irrationally afraid of AP's? I've heard that Abilify in particular is bad for akathisia, which I have endogeneously. Modafinil actually works for this problem, not methylphenidate or anything else, except to a small degree nortriptyline, probably because of NOR's anticholinergic activity. >
>
-z
> - Scott
Posted by SLS on August 17, 2005, at 7:52:45
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 16, 2005, at 16:34:41
Hi Zeugma.
> > Pemoline?
>
> Tried it, worked great, was taken off it because of drastic weight loss.
> >
> > DA agonists?
> >
> I brought up bromocriptine to my pdoc. Do you consider modafinil an indirect DA agonist?I am still undecided. So far, this drug has demonstrated increases in glutamatergic neurotransmission in at least two structures: the thalamus and the hypothalamus. Excitation of the neurons in the thalamus might stimulate DA neurons elsewhere in the limbic system such as the nucleus accumbans to produce reward. In the hypothalamus, certain nuclei are encouraged to secrete a substance called hypocretin, which when it reaches the cortex produces wakefulness. These are not necesarily dopaminergic. Modafinil has not been shown to be effective in treating ADHD.
> > Abilify?
> Am I irrationally afraid of AP's?
It is not irrational to be concerned with the long-term risks of neuroleptics. I still have a few "irrational" cortical neural circuits that are uncomfortable with the idea, despite my decision to start taking them several years ago. I think there are subpopulations that are more vulnerable to the development of EPS with the atypicals. For instance, older persons, particularly those with dementia, are several times more liable.
> I've heard that Abilify in particular is bad for akathisia, which I have endogeneously.
The akathisia produced by Abilify is usually moderate and time-limited as a startup side effect. It could conceivably stabilize DA synapses by acting as a patial agonist rather than a full antagonist as does the other neuroleptics.
> Modafinil actually works for this problem,
That's interesting. Do you have any theories as to why?
Have you tried anticholinergic drugs like Akineton (biperidin)? They might suppress REM sleep.
Maybe you can take pemoline and Zyprexa together. That might help with the weight loss issue and confer anxiogenic effects and enhance "clarity of thought".
- Scott
Posted by zeugma on August 17, 2005, at 16:29:03
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45
Hi Scott.
>
> > > Pemoline?
> >
> > Tried it, worked great, was taken off it because of drastic weight loss.
> > >
> > >
> > >
> > Do you consider modafinil an indirect DA agonist?
>
> I am still undecided. So far, this drug has demonstrated increases in glutamatergic neurotransmission in at least two structures: the thalamus and the hypothalamus. Excitation of the neurons in the thalamus might stimulate DA neurons elsewhere in the limbic system such as the nucleus accumbans to produce reward. In the hypothalamus, certain nuclei are encouraged to secrete a substance called hypocretin, which when it reaches the cortex produces wakefulness. These are not necesarily dopaminergic. Modafinil has not been shown to be effective in treating ADHD.>It is effective for my disorder, whatever its etiology, although it treats different symptoms than Ritalin. For example:
Color perception:
Improves on Ritalin dose-dependently, no effect from modafinil.
Physical coordination: Improves on modafinil, no effect or worsened on Ritalin.
Reaction time: improved on Ritalin, slowed on modafinil.
Pattern perception: improved on both, but more so on modafinil.
Organization: improved on modafinil, no effect or only slightly improved on Ritalin, and any improvement on Rit HIGHLY dose-dependent.
Color perception is known to be dopaminergically mediated, and this argues against a strong role for modafinil as dopaminergic.
Hypothalamically mediated parameter:
Appetite: Modafinil is the only drug on which I have an appetite. Modafinil is the only drug on which I have demonstrated weight gain. Appetite is known to be orexinergically (aka hypocretin) mediated- the word 'orexin' means 'appetite' in Greek. I have narcoleptic as well as appetitive problems, and both are orexinergically mediated and localized in the hypothalamus.
> >
>
>
>
> > I've heard that Abilify in particular is bad for akathisia, which I have endogeneously.
>
> It could conceivably stabilize DA synapses by acting as a patial agonist rather than a full antagonist as does the other neuroleptics.Perhaps.
>
> > Modafinil actually works for this problem,
>
> That's interesting. Do you have any theories as to why?I think the hypothalamus is concerned with the processing of interoceptive, particularly autonomic, stimuli. I think the same dysfunction that causes me to have no appetite also causes spasticity, of which akathisia is a manifestation. Modafinil has been reported to reduce spasticity in cerebral palsy. I consider myself to have some kind of movement disorder, related to hypothalamic dysfunction.
>
> Have you tried anticholinergic drugs like Akineton (biperidin)? They might suppress REM sleep.
>
I was on high doses of Cogentin when treated with an AP. I experienced unusually vivid dreaming during this time, secondary to neuroleptic administration.
> Maybe you can take pemoline and Zyprexa together. That might help with the weight loss issue and confer anxiogenic effects and enhance "clarity of thought".
>That's an interesting idea. Do you think Zyprexa has cognotropic properties?
-z
>
> - Scott
>
Posted by zeugma on August 17, 2005, at 16:46:54
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45
What benefits have you had from the addition of Abilify?
Have you ever tried gabapentin?
-z
Posted by zeugma on August 17, 2005, at 17:33:47
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45
by the way, exhaustive info about Keppra is now available at http://crazymeds.org/
I hope Keppra helps you.
-z
Posted by SLS on August 17, 2005, at 18:46:16
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 17, 2005, at 16:29:03
Z.
It looks like you have established a hypocretin connection to your condition given the narcolepsy and appetitive depression you have observed and the way they are influenced by modafinil. You might want to begin looking at the way the X and Y clocks are synchronized and see if there is some way to cue or reset them using environmental stimuli like a light box or well-timed melatonin ingestion. From what I understand, depression can affect adversely the periodicity of hypocretin secretion.
As far as Zyprexa is concerned, many people on PB have described it as producing or enhancing "clarity" of thought or thinking more clearly. I myself experienced this when I added it to help control an antidepressant-induced mania. I think Zyprexa has a positive influence on executive function in areas that might also contain hypocretin neurons such as PFC.
For me, Abilify has increased motivation and mental energy. It has also protected me from suicidality by dissipating anxious catastrophic thinking.
- Scott
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