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Dr. Bob is Robert Hsiung, MD,
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Posted by zeugma on August 18, 2005, at 7:16:39
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 18:46:16
>
>
> 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.>>Interestingly I was prescribed a light box many years ago after my first sleep study. Let's say 'compliance' was an issue. It was impossible for me to wake up before 2 pm on a consistent basis, much less at 6 am as the sleep doc advised. I used it intermittently over the years and unsurprisingly got no major benefit from it.
I wake up now fairly regularly by 6 am. I could retry it, as the thing takes up half my apartment (!).
<From what I understand, depression can affect adversely the periodicity of hypocretin secretion.
>Do you have any thoughts then on why modafinil is not considered an effective AD? I seem to get an AD effect from it, but that could be because it reduces core symptoms of melacholia (agitation and lack of interest in food).
> 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.>
yes, that's on the right track. i have serious executive function issues. Notably, these are helped more by provigil than by ritalin, though I do derive some benefit from ritalin.
>
> For me, Abilify has increased motivation and mental energy. It has also protected me from suicidality by dissipating anxious catastrophic thinking.
>It's well worth it then.
-z
>
> - Scott
>
Posted by theo on August 18, 2005, at 16:41:57
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 16, 2005, at 8:05:38
Hey Scott,
What dose are you currently at with the Keppra? Are you feeling anything positive or negative?
Ted
Posted by SLS on August 19, 2005, at 8:39:33
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 18, 2005, at 16:41:57
> Hey Scott,
>
> What dose are you currently at with the Keppra? Are you feeling anything positive or negative?
>
> TedI began taking 500mg of Keppra on Sunday. I will be moving up to 1000mg today. So far, I haven't experienced any negative effects on mood or cognition. This alone is a positive outcome at this juncture. Keppra has been known to make depression worse in some people. One of the things I hate about starting a new drug is that I place so much hope in it so soon. I experienced a small improvement in energy over the past two days. So, my silly mind interprets this as evidence that the drug will ultimately bring me into complete remission. Why is that? After so many "false starts" and treatment-failures, you would think I should at least remain neutral in my outlook, if not demonstrate overt pessimism based on my treatment statistics.
I guess I really don't expect very much from Keppra. The NIMH hasn't seen it successfully treat severe depression. However, this was probably in the absence of antidepressants. My doctor doesn't think much of the drug. Ivan Goldberg wasn't terribly impressed either. No one here has reported a robust antidepressant response in the treatment of chronic depression. I had it on my list simply because it was so different from the other anticonvulsants I've tried. However, I haven't tried Topamax yet. I was hoping to stay away from that drug because of how easily these drugs affect negatively my cognition.
So, here I am.
Life is funny. The one Medline article that captured my interest was this one:
When I decided to go for a second opinion consultation, I was recommended to see Dr. Kaufman. I had no idea he was the author of this article. I really didn't know anything about him. When I asked him what he thought of the idea of using Keppra, he smiled at me and asked me why I was interested in it. When he showed me a copy of the article abstract, I said, "Yeah, I read this." LOL. It was his suggestion that I give it a try. If it works, he would like to write me up. Hopefully, he'll have good reason to.
- Scott
-------------------------------------------1: Epilepsy Behav. 2004 Dec;5(6):1017-20. Related Articles, Links
Monotherapy treatment of bipolar disorder with levetiracetam.Kaufman KR.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu
Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Publication Types:
Case ReportsPMID: 15582854 [PubMed - indexed for MEDLINE]
Posted by ed_uk on August 19, 2005, at 9:43:22
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
>No one here has reported a robust antidepressant response in the treatment of chronic depression.
.......but not many babblers have tried it.
~ed
Posted by willyee on August 19, 2005, at 13:16:38
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Please guy keep us updated,im still trying to get this med prescribed with no success.
Posted by theo on August 19, 2005, at 17:11:58
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Keppra does have unique mood lifting properties that you should experience soon after you bump your dose up passed 500mg. I actually felt a little slowed on 500mg, but once I went to 750-1000 it seemed to make me more alert/assertive. It's one of those meds that seems to pick up speed with higher doses.
One thing about Keppra, you will know in a few days if you need to adjust up or down.
Posted by Nickengland on August 19, 2005, at 17:29:36
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Hello Scott,
I wish you the best of luck with Keppra ~ seems like you're stepping into new territory so to speak, and with that, like with all medication we try we're always taking some kind of risk on whether or not the effects of the drug will hold out or work to the extent we need them too.
I really do hope levetiracetam gives you success, i'm sure your keep us up-dated and i'll look out for your posts when they come up...it will be great to hear that its working well and i hope it is so far...
Kind regards
Nick
Posted by theo on August 19, 2005, at 23:38:22
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Forgot to ask, is he saying methylphenidate did not precipitate manic features while taking Keppra?
I was at work earlier and just re-read your post. Interesting you actually spoke with Dr. Kaufman?
I am at a weird phase in my battle. I've been off meds for a while and know I can make it through the day, but realize I'm not happy and life seems overwhelming. Sometimes I wish my symptoms were extreme so I could at least be more easily diagnosed. I've been off meds long enough where I almost feel weak, like I'm giving in to "drugs." To medicate or not to medicate, this battle is stressful in itself.
Keppra actually worked better in many ways than other meds I tried, but I got anxious and thought I needed to add this and that etc, etc. I always want "something better" and it can really make getting well difficult.
Keep me posted on your progress with Keppra. I really hope it works for you. I don't know if you ever check out the crazymed site, but the individual totally revamped the Keppra section and it's loaded with information.
Posted by theo on August 22, 2005, at 22:56:11
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 19, 2005, at 8:39:33
Scott,
How is the increase in Keppra. Are you feeling anything positive (or negative) at all?
Ted
Posted by SLS on August 23, 2005, at 5:58:56
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 22, 2005, at 22:56:11
Hi Ted.
> How is the increase in Keppra. Are you feeling anything positive (or negative) at all?
I am not feeling anything negative.
:-)
This is a good thing.
I'll keep you posted.
- Scott
Posted by SLS on August 24, 2005, at 6:37:47
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 22, 2005, at 22:56:11
Yesterday was a good day. I had more energy than usual and accomplished more than I have in quite a while. No side effects.
- Scott
Posted by willyee on August 24, 2005, at 14:49:48
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 6:37:47
DO you feel the keppra might be poteintating the parnate so that its working more effectivly.
Or do you feel any benifits from keppra seem to pretain to keppras use soly?
I know it might be too early too tell,im confused i have to see my doc soon and i dont know whether to ask for topamx or keppra,theres no other AD im willing to go on also i get parnate free from a proram by its manufacturer so i just have to hope something can kick start this med again,its really seemms like a lost cause at this point,good luck!!
Posted by willyee on August 24, 2005, at 15:11:13
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by willyee on August 24, 2005, at 14:49:48
I keep reading a lot about users of keppra personaly saying they actualy had to drop,or go ON a anti-depressant due to the depression inducing effects of keppra.
Aside from personal entries,i also see general documants reporting this also,in fact i have actualy seen one postive thing about it....
Combination of keppra,klonopin,and i believe amandatine.So possable the addition of at least a very small dose if klonopin might actualy help the keppra,i dunno.
Posted by SLS on August 24, 2005, at 17:57:26
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by willyee on August 24, 2005, at 15:11:13
Hi.
Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
My doctor did warn me that Keppra might make depression worse, so your information regarding its being depressogenic are probably valid. Although I don't feel any worse, I don't feel any better either. Perhaps I will feel worse from this point on. I'll keep posting.
- Scott
Posted by willyee on August 24, 2005, at 18:33:15
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 17:57:26
Wish u luck
Posted by theo on August 24, 2005, at 22:52:11
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 17:57:26
> Hi.
>
> Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
>
> My doctor did warn me that Keppra might make depression worse, so your information regarding its being depressogenic are probably valid. Although I don't feel any worse, I don't feel any better either. Perhaps I will feel worse from this point on. I'll keep posting.
>
>
> - ScottI'm sorry to hear this. Are you now at 500mg twice daily?
Posted by SLS on August 25, 2005, at 7:00:05
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 24, 2005, at 22:52:11
Hi Ted.
> > Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
> I'm sorry to hear this. Are you now at 500mg twice daily?
Yes. I started off at 500mg/day and titrated up to 1000mg/day within a week. Maybe moving up to 2000mg will recapture the antidepressant effect, but I am not optimistic. My response pattern to Keppra matches those of my transient responses to other drugs. After such a response dissipates for me, dosage increases don't seem to help.
Damn it.
I am pissed.
I would not be afraid of Keppra, Ted. Although it has been associated with the precipitation of mental side effects at a rate of 6%, any exacerbation of your condition would be completely reversible upon the discontinuation of this drug. Keppra does things that the other anticonvulsants do not do. It binds to a receptor on synaptic vesicles. Although the significance of this has not been elucidated, you can be guaranteed that you are trying something novel and not just repeating things that you have tried before.
- Scott
Posted by theo on August 25, 2005, at 8:02:09
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 25, 2005, at 7:00:05
Although it has been associated with the precipitation of mental side effects at a rate of 6%, any exacerbation of your condition would be completely reversible upon the discontinuation of this drug.
What sort of mental side effects at 6%?
Also Scott, I would experiment taking 250mg midday in between your two 500mg doses, just to try. When I went to 3 times daily, normally 7:00am, 2:00pm and last dose at 9:00pm, that midday dose really seemed to kick it in versus twice daily dosing. Maybe because of it's short half life. Hell, it wouldn't hurt to try. Maybe you could even handle 500mg midday.
Ted
Posted by SLS on August 26, 2005, at 9:44:13
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 25, 2005, at 8:02:09
> > Although it has been associated with the precipitation of mental side effects at a rate of 6%, any exacerbation of your condition would be completely reversible upon the discontinuation of this drug.
> What sort of mental side effects at 6%?
Depression, irritability, aggression, psychosis.
Yesterday afternoon was horrible. Between the hours of 12:00pm - 4:00pm, my depression worsened to a point that I had not experienced in well over a year. It approached my unmedicated baseline. I did recover, but I still have not experienced the improvement I did several days ago. I am still taking 1000mg.
Do dosages over 1000mg provide you with a better antidepressant effect?
How high did you go, and what caused you to discontinue it?
One study that tracked rapid-cyclers noted a few intervening exacerbations between periods of remission. I hope that is what is going on with me.
In a recent NIMH study of levetiracetam, they looked at a couple of dozen bipolar patients. Of course, this isn't many at all. However, none of those who were severely depressed responded to it. Patients were given 2000-3000mg.
Several studies noted that levetiracetam had positive effects on rapid cyclers, including the NIMH study. I was an ultra-rapid cycler for over two years. I can only hope that there is something about my biology that is cyclic that this drug will finally address.
One can hope...
- Scott
Posted by SLS on August 27, 2005, at 9:08:28
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 24, 2005, at 17:57:26
> Keppra had been producing a broad improvement for few days but seems to have stopped working. I am not happy.
I am still not happy.
I'm waiting for this stuff to start working again. I am not optimistic.
I am tempted to add back the Trileptal to rule-out any contribution it may have had to producing my initial antidepressant response to Keppra. Although I had discontinued Trileptal days before beginning Keppra, who knows?
At 1000mg of Keppra, I have experienced almost no side effects. Just a little bit of dizziness in the beginning.
The few studies using Keppra for bipolar disorder targeted 2000mg as a minimum dosage. This is the same dosage most often used for epilepsy, although I have seen dosages of 3000-4000mg used. These higher dosages might actually be associated with a reduced efficacy and carry a higher liability for mental side effects such as irritability, aggression, and psychosis.
- Scott
Posted by SLS on August 27, 2005, at 9:27:20
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 27, 2005, at 9:08:28
In the following case study of bipolar disorder, the dosage of Keppra found to be optimal for the patient was 2500mg. She initially demonstrated a rapid moderate antimanic response to 1000mg. 2500mg prevented the recurrence of all bipolar features, including manic, rapid-cycling mixed-states, and depression, all of which she had presented with in the past. It is difficult to assess whether or not Keppra monotherapy possesses antidepressant effects, but it apparantly does have antimanic effects. As I have already described, I sustained a brief antidepressant effect from Keppra, but I am also taking several other drugs, including Parnate and nortriptyline. Keppra might at least provide a true mood-stabilizing effect as it seems to have acted as a prophylactic against depression as well as manic mixed states in this one patient.
- Scott
--------------------------------------------
Epilepsy Behav. 2004 Dec;5(6):1017-20. Related Articles, Links
Monotherapy treatment of bipolar disorder with levetiracetam.Kaufman KR.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu
Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Publication Types:
Case ReportsPMID: 15582854 [PubMed - indexed for MEDLINE]
Posted by theo on August 27, 2005, at 11:06:17
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 26, 2005, at 9:44:13
> Do dosages over 1000mg provide you with a better antidepressant effect?
As I mentioned, I would try a midday dose, maybe 250mg for starters or 500mg if you feel comfortable. I would try taking it 3 times daily versus two. As a matter of fact, I would try to keep each dose equal mg's to keep it at a steady state. It wasn't until I took it this way that I felt positive effects. Seriously, 3 daily doses can make a world of difference with Keppra, at least it did for me.
The PI states that "peak plasma in one hour, steady state in just two days." It also says "plasma half-life is 7 +- 1 hour and is unaffected by either dose(mg) or repeated administration." This stuff is in and out, no accumulation even when you take more of it per dose. That's why I think frequency of dose, taking it 3 times daily versus two only seems logical.
> How high did you go, and what caused you to discontinue it?I'm med sensitive. I got to 500mg morning, 250mg midday and 500mg bedtime (1250mg). It was to much as far as causing me to be over assertive, a little road rage. The fact that I needed to stick with 3 times daily dosing, I dropped to 250mg 3 times daily (750mg). This seemed to work pretty well, but my pdoc suggested I add Lamictal because I thought I still felt like I needed a little more boost. Once I got to 150mg Lamictal, I was having all sorts of cognitive side effects and worsened OCD, so I stopped both to start from square one again. It sucks, but when you are taking 3 or 4 meds, it gets tuff trying to figure out what med is causing the problems. This is the only reason I discontinued Keppra. Now I know the Lamictal was the cause.
> In a recent NIMH study of levetiracetam, they looked at a couple of dozen bipolar patients. Of course, this isn't many at all. However, none of those who were severely depressed responded to it. Patients were given 2000-3000mg.
Again, I'm curious about the frequency of dosing, when I tried 500mg twice daily, I would start to feel like I was coming of it before it was time for my 2nd dose, I felt like I was crashing, dizzy, faint confused. When I went to 3 times daily, it kicked in and was smooth because it reached a steady state.
Ted
Posted by SLS on August 27, 2005, at 11:37:20
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 27, 2005, at 11:06:17
Hi Ted.
Thank you so much for your input. I'm going ahead and raising my dosage to 1500mg (500mg t.i.d.) as per your suggestion. The studies that I have seen used b.i.d. dosing. It was even suggested to me by one doctor to take 2000mg h.s.
I'm glad you were able to isolate Lamictal as the culprit. It must have been torturous for you to be on nothing for awhile. What are your current plans?
- Scott
Posted by theo on August 27, 2005, at 14:30:49
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 27, 2005, at 11:37:20
> Hi Ted.
>
> Thank you so much for your input. I'm going ahead and raising my dosage to 1500mg (500mg t.i.d.) as per your suggestion. The studies that I have seen used b.i.d. dosing. It was even suggested to me by one doctor to take 2000mg h.s.
>I would definitely try 1500mg t.i.d., at least you should know in a few days if t.i.d. dosing helps.
> I'm glad you were able to isolate Lamictal as the culprit. It must have been torturous for you to be on nothing for awhile. What are your current plans?
Believe it or not, since I was currently on nothing, I wanted to try Wellbutrin XL to see how I respond. I've been taking it for 8 days with a little stimulation and not much anxiety, which surprised me. Looking back, I think a lot of my anxiety was caused by SSRI's.
The only negative factor, flatulance!! No loss of libido, but shrinkage. Back in my party days, I remember some stimulants (cocaine) causing this, very sexual but no blood flow in that area, very bizarre. I found in the Wellbutrin XL PI where it states low sexual side effects, but then goes say "AT LEAST 1% of males experienced flatulance." Needless to say, this is not going to work for my girlfriend and honestly, I don't know if it's really doing much anyway. It is strange because on SSRI's my reaction would be delayed ejaculation, but this is flat out zero erection. Some stims like Concerta don't cause this, but if I were to take let's say a diet pill or even Provigil, it would. Have you ever heard of this with Wellbutrin?
I'll probably retry Keppra. Keep me posted on the t.i.d. dosing. Are you starting t.i.d. dosing today?
Ted
Posted by SLS on August 27, 2005, at 15:23:07
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 27, 2005, at 14:30:49
Hi Ted.
> I'll probably retry Keppra. Keep me posted on the t.i.d. dosing. Are you starting t.i.d. dosing today?Yes. I've already taken my afternoon 500mg dose. I doubt my doctor will have a problem with my doing this. I did try to call him yesterday to get his OK, but the office was closed. I plan on asking him to let me go to 2000mg when I see him next week. I have so little patience.
I hope your undesireable side effects from Wellbutrin are only transient. I would recommend that you continue with it and try to be patient. 8 days is not enough to evaluate either therapeutic effect or the persistence of side effects.
Good luck!
"The wisdom of patience comes in knowing that one must give Time time to work."
So much easier said than done when pain and frustration are involved.
- Scott
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