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Dr. Bob is Robert Hsiung, MD,
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Posted by b2chica on October 3, 2012, at 11:16:49
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 3, 2012, at 9:56:02
i tried to make appt with pdoc but she madeit for the 26th of october...gee could you get any further away?
i can call again today and see if i can get in sooner.i would not loose my job if i were to go in for even a few weeks.
i never thought of going higher in the generic. course last time with the teva brand i went up to 10 and got psychosis. so i need to be careful. i was fine first couple days (like today) no psychosis symptoms. but CRAZY anxiety, earlier apathy with energy, but now energy with energy. getting agitated. took gabapentin about 1/2 hour ago.
boss left for a few hours. give me time to myself.
-seroquel gave me severe cognitive blunting but i have never tried latuda or safris. Geodon, gave me psychosis. abilify gave severe anger and agitation to well, lets just say my T was a witness to it.
and risperdal did nothing. didnt help depression or agitation, i was on that for about only a month but pdoc said that was enough. i should have seen something.anyway.
i feel like a hopeless cause lately. my sypmtoms seem so all over the place, but i think its my mind more.
can you see more specific things in me? thats why i like to post true emotions. sometimes i can track myself that way.
anyway.
i'm just debating the money issue right now.
i want to give myself one more week. trying this different generic zyprexa and see what happens. and see if i can get into pdoc sooner.thanks Scott
Posted by phidippus on October 3, 2012, at 11:56:47
In reply to Re: PS. what should i do? » Zyprexa, posted by b2chica on October 3, 2012, at 8:48:09
I think you should do 20 mg on the Olanzapine.
Eric
Posted by phidippus on October 3, 2012, at 12:27:09
In reply to Re: PS. what should i do? » SLS, posted by b2chica on October 3, 2012, at 11:16:49
>with the teva brand i went up to 10 and got psychosis
Can you describe your psychosis?
>CRAZY anxiety, earlier apathy with energy
I know you can't tolerate mood stabilizers, but one would go a long way to relieving your symptoms.
>Geodon, gave me psychosis
Can you describe this psychosis?
>but i think its my mind more.
How do you mean?
>can you see more specific things in me?
I see you're struggling to keep everything under control. You are not a hopeless cause.
Up the olanzapine to 20 mg, you'll get get better control of your mixed state.
Eric
Posted by b2chica on October 3, 2012, at 12:46:47
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 12:27:09
>describe psychosis?
with TEVA zyprexa at 10 after 2 or three days i became raging paranoia, had to leave work cuz "everyone was staring at me, whispering things, they were going to tell the director of dept about my illness and i was sure she is going to do what she can to fire me." i was getting visual illusions about every 15min or so (very freq.) i was getting messages from whom i can only guess was the dead to give to others.
>Geodon psychosis?
i became enraged and started going to the 'seady' side of town looking for a gun. was having constant visuals of myself putting the metal gun in my mouth (was tasting the metal), and othertimes to my head feeling the pressure of the explosion. i was sure that others wanted me dead as well. very angry but lots of energy. other visuals like bugs and such. but the self-injury/death visuals were the worst.i'm feeling more stable right now for the time being. i took gabapentin about 10:30 so its about fully kicked in now. (i notice in 10 min lethargy but 2 hours before it seems to help mood).
but yesterday i did a full cycle in one day, anxiety in morning, agitation afternoon. by the time i got home it was all i could do to lay down and dream of death. i fell asleep about 6, woke up 8:30 help put kids to bed. had cereal and about 9 or 9:30 went to sleep again.if i go a full cycle again today i will call pdoc and speak with him.
and if upping zyprexa doesnt help i'll do hospital next week.im thinking logically right now so anyway, thats the plan as i see things now.
thanks Eric.
Posted by b2chica on October 3, 2012, at 12:48:11
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 10:06:36
> Have you tried Keppra or Zonegran?
>
> What kind of side effects did you get from the mood stabilizers?
>
> Eric
i have tried neither. i've heard those names here but no where else...are they an herbal supplement? or Rx'd?
Posted by phidippus on October 3, 2012, at 13:04:01
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 12:48:11
Keppra is an anticonvulsant that has been studied as a mood stabilizer. It has few side effects. A 3000 mg dose is usually good at stopping mania fast.
Zonegran is another anticonvulsant and it has a bunch of case studies studies showing it is effective at treating bipolar disorder.
I've used both-I really like Keppra.
Both drugs require a prescription.
Eric
Posted by phidippus on October 3, 2012, at 13:33:34
In reply to Re: PS. what should i do?, posted by b2chica on October 3, 2012, at 12:46:47
I'm inclined to think that the dose of your medication was not high enough and you started having psychotic features because of it. This explanation is simpler than trying to figure out how the medication made you psychotic when its designed to treat psychosis. I'm wondering what would have been if you raised the TEVA Zyprexa up to 20 mg.
Same goes for the Geodon.
>the self-injury/death visuals were the worst.
I get those all the time.
>I could do to lay down and dream of death
You're not suicidal are you?
Maybe you need a stronger antipsychotic. Has your doctor ever discussed Clozapine with you?
Could you tell me everything you're on?
Eric
Posted by SLS on October 3, 2012, at 13:51:26
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 3, 2012, at 10:17:10
Is this what you present as proof that Zyprexa is not a mood stabilizer, or is it proof that Zyprexa produces metabolic side effects and that Lilly is a ruthless capitalist corporation?
I can't read all of that. What I do see, though, is a piece of writing that appears to me to be more political than scientific. It is more concerned with Lilly than it is with the clinical value of Zyprexa to real people.
Does Zyprexa act as a mood stabilizer?
Do you agree with the following?
"A true mood stabilizer will work in acute manic episodes without inducing depression, acute bipolar depression without inducing mania, and protect the patient from future episodes of mania or depression."
If not, how would you define "mood stabilize"?
- Scott
Posted by b2chica on October 3, 2012, at 14:07:28
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 13:33:34
i dont really know what happens chemically. i've always thought (somehow) zyprexa increases my dopmanine (i know its labeled antagonist) but maybe it allows for more inthe syntaptic cleft? thus getting me out of stupor. Zyprexa for almost 10 years has been my 'go to' drug when things got too tough for me and ALWAYS worked within 24/48 hours. ReALLY fast.
anyway i wasn't suicidal last night but my thoughts were of death in general. and i was so immobilized that i couldnt have acted if i wanted to.
no pdoc never mentioned CLozapine with me.
am currently on
Pristiq 100mg (am)
Adderall (20mg am, 10mg noon and 4pm-ish)
gabapentin (rx'd for 5xday, but then i was supposed to stop, and then he said no, dont stop...im a little confused so i'm using minimal. about 3x day.)
perphenazine added 2mg 2:00 (oops gotta take now) and 6mg pm. yesterday i took one extra. got urge to eat my pills (again not really suicidal just thoughts of death)
i'm fine now.
then xanax up to 2mg PRN, normally take 1mg in evening.
oh and zyprexa last night i started 10mg.
Posted by Beckett on October 3, 2012, at 14:38:02
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 14:07:28
B2C, have you factored in the increase in Pristiq this time as a possible reason why the zyprexa is not doing the trick in the same way? Could this be a factor?
Posted by b2chica on October 3, 2012, at 14:53:13
In reply to Re: PS. what should i do?, posted by Beckett on October 3, 2012, at 14:38:02
yes. i even suggested that the up in pristiq is the cause of the up mood.
but the fact was i was getting bad before the 'uppage'. So he left it alone.hasn't mentioned anything about it since.
but about the zyprexa, the name brand worked, i just only had a few samples when i stopped taking name brand the symptoms came back.thanks.
Posted by SLS on October 3, 2012, at 15:14:27
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 14:07:28
Have you discontinued Lamictal?
Why are you still taking Pristiq if it is not preventing depression?
Did Pristiq work when you first started taking it? Does it continue to give you a partial response?
Did it make a difference to raise the dosage of Pristiq from 50 mg to 100 mg?
When you tried Wellbutrin, were you also taking Pristiq?
When you tried Wellbutrin, were you also taking Zyprexa?
Have you ever taken Effexor 300 mg/day?
I bet there are lots of things you haven't tried yet. You actually seem quite treatable. Just keep taking your Trileptal 600 mg/day. If you can induce mania, it should be easily controlled by using a mood stabilizer or an antimanic antipsychotic.
I think you are going to need an anticovulsant mood stabilizer (Trileptal 600 - 900 mg/day), an antimanic antipsychotic (Zyprexa 15 - 20 mg/day) and, if necessary, one or two antidepressants (Effexor 300 mg/day or Pristiq 200 mg/day; Wellbutrin 300 mg/day).
One can make the argument that treating you with only a combination of Trileptal and lithium makes sense. I guess it depends on where along the bipolar spectrum you are, and how much depression persists despite continued treament.
Try to keep things simple and have patience. This is not an easy thing to do. To tell you the truth, to avoid suicidaity and remain employable, it might make sense to continue with Zyprexa or switch to Abilify while continuing with Trileptal. As you can see, there are plenty of alternative treatments available. You have reason to be optimistic, despite the difficult time you are enduring right now.
- Scott
Posted by phidippus on October 3, 2012, at 15:17:20
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 14:07:28
>i've always thought (somehow) zyprexa increases my dopmanine (i know its labeled antagonist) but maybe it allows for more in the syntaptic cleft?
Zyprexa downregulates dopamine and antagonizes 5ht receptors. It is not a dopamine reuptake inhibitor. If there were something left in the synaptic cleft it would just stay there. It would not set off an action potential and the neuron would remain at rest. Usually anything residing in the synaptic cleft gets cleaned up by one enzyme or another.
>ALWAYS worked within 24/48 hours.
It still should, I just think you need a higher dose because you're not on a mood stabilizer.
>i was so immobilized that i couldnt have acted if i wanted to.
Good. If you ever are in crisis, just babblemail me.There is another problem. You're taking 100 mg of Pristiq , which may be destabilizing your mood. That's a maximum dose. Oi, mi ija! I became manic on 50 mg of Pristiq. I'm not going to tell you to change the dose or anything, just know it could be f*ck*ng you up.
Eric
usu
Posted by b2chica on October 3, 2012, at 15:35:10
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 3, 2012, at 15:14:27
i dont think this was meant for me... is it?
b2c
Posted by b2chica on October 3, 2012, at 15:38:21
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 15:17:20
> >i've always thought (somehow) zyprexa increases my dopmanine (i know its labeled antagonist) but maybe it allows for more in the syntaptic cleft?
>
> Zyprexa downregulates dopamine and antagonizes 5ht receptors. It is not a dopamine reuptake inhibitor. If there were something left in the synaptic cleft it would just stay there. It would not set off an action potential and the neuron would remain at rest. Usually anything residing in the synaptic cleft gets cleaned up by one enzyme or another.Hey thanks. that helps to know.
> >ALWAYS worked within 24/48 hours.
>
> It still should, I just think you need a higher dose because you're not on a mood stabilizer.
>
> >i was so immobilized that i couldnt have acted if i wanted to.
>
> Good. If you ever are in crisis, just babblemail me.i just might. thanks.
> There is another problem. You're taking 100 mg of Pristiq , which may be destabilizing your mood. That's a maximum dose. Oi, mi ija! I became manic on 50 mg of Pristiq. I'm not going to tell you to change the dose or anything, just know it could be f*ck*ng you up.
>
> Erici'm sure it is messing things. but quite frankly i'd rather deal with this end then the crazy bad depression i get.
Gracias mi hermano> usu
Posted by SLS on October 3, 2012, at 15:46:14
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 15:17:20
> There is another problem. You're taking 100 mg of Pristiq , which may be destabilizing your mood.
That's very possible.
> That's a maximum dose.
I wish it weren't.
I think 100 mg/day is too low to set as a maximum dose.
http://www.ncbi.nlm.nih.gov/pubmed/22883315
Also, the original clinical trials went up to 400 mg/day. It is in the best interests of the drug company to recommend the lowest dosage they think they can get away with so as to minimize side effects and make their product more marketable. It's a juggling act.
http://www.ncbi.nlm.nih.gov/pubmed/17917552
Pristiq 50 mg/day made you manic. Would 200 mg/day make you more manic? Perhaps this was an all-or-nothing phenomenon once you reached a threshold dose. If I were depressed and had not responded to Pristiq 100 mg/day, I would sure lobby a doctor to try 200 mg/day. I am all but sure that we will see higher dosages of Pristiq used once clinicians begin to push the envelope. Perhaps 300 mg/day of Pristiq will be used as commonly as is 300 mg/day of Effexor. Wyeth suggested a maximum dose of Effexor as 225 mg/day when it first came out. Now, Wyeth recommends 375 mg/day. Interesting, right?
- Scott
Posted by b2chica on October 3, 2012, at 15:46:15
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 3, 2012, at 15:14:27
> Have you discontinued Lamictal?
i haven't been on lamictal
> Why are you still taking Pristiq if it is not preventing depression?
> Did Pristiq work when you first started taking it? Does it continue to give you a partial response?
the pristiq is working on depression...or it was/is..??unsure
pristiq has worked for an amazing 3 years (except normally once or so a year things go wacky and we have to augment)
> Did it make a difference to raise the dosage of Pristiq from 50 mg to 100 mg?yes made difference going up to 100, worked great. then too great.
> When you tried Wellbutrin, were you also taking Pristiq?
i tried wellbutrin back inthe day. it was the first AD to really work well for me. pooped out after about a year. then three years later tried again, both generics and name brand, didnt work.
no wasnt taking pristiq at same time> When you tried Wellbutrin, were you also taking Zyprexa?
yes off and on wellbutrin and zyprexa, mostly no though.
> Have you ever taken Effexor 300 mg/day?
effexor was HORRIBLE to me.
> I bet there are lots of things you haven't tried yet. You actually seem quite treatable. Just keep taking your Trileptal 600 mg/day. If you can induce mania, it should be easily controlled by using a mood stabilizer or an antimanic antipsychotic.
i'm confused with questions...are you sure your talking to me?
i'm not on Trileptal either. it almost gave me a stroke. got ataxia, nystagmus, and was 'locked in' for about 12 hours.
> I think you are going to need an anticovulsant mood stabilizer (Trileptal 600 - 900 mg/day), an antimanic antipsychotic (Zyprexa 15 - 20 mg/day) and, if necessary, one or two antidepressants (Effexor 300 mg/day or Pristiq 200 mg/day; Wellbutrin 300 mg/day).
>
> One can make the argument that treating you with only a combination of Trileptal and lithium makes sense. I guess it depends on where along the bipolar spectrum you are, and how much depression persists despite continued treament.
>
> Try to keep things simple and have patience. This is not an easy thing to do. To tell you the truth, to avoid suicidaity and remain employable, it might make sense to continue with Zyprexa or switch to Abilify while continuing with Trileptal. As you can see, there are plenty of alternative treatments available. You have reason to be optimistic, despite the difficult time you are enduring right now.
> - Scottif the pristiq hadn't worked i wanted to try your suggestion of desipramine from a few months ago. but the pristiq worked...then too well. now, wacky.
i listed my meds earlier but here:
pristiq 100
adderall 20, 10, 10
perphenazine 2mg, 6mg
gabapenting rx'd 5xday, only taking about 3 now
xanax rx'd 2mg, only take about 1mg pm for sleep
zyprexa starting yesterday 10mg pmi'm going to try to stablize out and change the gabapentin back to at least 3-4 times day (mid morning when anxiety hits, 1pm, 6pm and bedtime.
i'm going to lower xanax as that can cause me depression at times. (unless its really needed for anger etc.)
and keep zyprexa at 10 for 4 more days.IF that doesn't work i'll do outpatient hospital so they can sort things out.
right now i feel a little fuzzy (like i do when depression hits) but i have a lot of electric energy inside, some physical but mostly mentally. i'm trying to read some physics books to calm my mind. and also crocheting when i can, helps as its physical AND very repetative.
thanks ALways Scott!
b2c.
Posted by b2chica on October 3, 2012, at 15:47:29
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 15:46:14
Very...
Posted by SLS on October 3, 2012, at 15:50:00
In reply to Re: PS. what should i do? » SLS, posted by b2chica on October 3, 2012, at 15:46:15
Oh, my.
I am indeed confusing you with someone else. It's like I made up a hybrid patient out of two different people.
I guess you can take 1/2 of the advice I gave.
But which 1/2?
LOL.
Sorry.
- Scott
Posted by phidippus on October 3, 2012, at 16:15:57
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 13:51:26
>I can't read all of that
You should read it all. It's just damn interesting.
>Is this what you present as proof that Zyprexa is not a mood stabilizer
Hardly. Its just a revealing read.
>Lilly is a ruthless capitalist corporation?
You have to admit they can be *ssh*l*s.
>appears to me to be more political than scientific
Does it have to be scientific? If it is political, how does that denigrate the piece?
>the clinical value of Zyprexa to real people.
I incurred diabetes as a result of taking Zyprexa. Lilly ended up paying me a lot of money for their clinically valued drug.
Bottom line is Lilly bought its FDA approval for Zyprexa and its status as a mood stabilizer so they could make a few more people fat. The fatter we are, the more meat their is for the zombie horde Lilly is preparing for the end of days.
Ahem, I would call a mood stabilizer "any medication that controls severe mood swings". I wouldn't specify mania or depression.
Eric
Posted by phidippus on October 3, 2012, at 16:25:51
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 15:38:21
>i'm sure it is messing things. but quite frankly i'd rather deal with this end then the crazy bad depression i get.
I've been there.
Eric
ps. Up your Olanzapine! I promise you won't go crazy.
Posted by SLS on October 3, 2012, at 16:47:02
In reply to Re: PS. what should i do?, posted by phidippus on October 3, 2012, at 16:15:57
Just because a drug has therapeutic properties doesn't mean that it must not be judged by evaluating its benefits versus costs and risks. It does.
Lithium is an effective mood stabilizer. Yet, people have died of kidney failure for having taken it. How would you evaluate the value of lithium?
I don't understand your point.
If Zyprexa has no value, why do you recommend it to others that they take it and take more of it?
I think your definition of "mood stabilizer" is far too broad. For some people, Xanax prevents "mood swings". Is Xanax a mood stabilizer?
Zyprexa is what is. According to your definition, it is a mood stabilizer. In addition, according to the definition suggested by the literature you cited, Zyprexa is a mood stabilizer while Xanax is not.
What other drugs do you consider to be "true" mood stabilizers?
"A true mood stabilizer will work in acute manic episodes without inducing depression, acute bipolar depression without inducing mania, and protect the patient from future episodes of mania or depression."
It's really not a bad definition.
- Scott
Posted by Zyprexa on October 3, 2012, at 20:01:59
In reply to Re: PS. what should i do? » Zyprexa, posted by b2chica on October 3, 2012, at 8:48:09
Are you taking brand name zyprexa or a brand of generic olanzapine?? And which one?
Posted by brynb on October 3, 2012, at 20:57:44
In reply to Hospital when feeling ok??, posted by b2chica on October 2, 2012, at 12:11:18
Hi b2c,
Hope you're doing ok. I may have missed it somewhere, but have you ever taken lithium (even a low dose)? I like how it addresses the depression, mania and suicidal thoughts.
Also, do you take Adderall for fatigue/depression or ADD? I find it to be a pretty rough drug emotionally, but maybe because I don't have ADD.
Be well...
Posted by phidippus on October 3, 2012, at 23:32:10
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 16:47:02
>How would you evaluate the value of lithium?
I had kidney failure on lithium. I still take it. For me, Lithium is invaluable and represents a true mood stabilizer. Zyprexa is simply an anti-manic and does nothing else.
>I don't understand your point.
Do you have to? This is simply a difference of opinion. My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers.
>why do you recommend it to others that they take it and take more of it?
Others? I recommended an increase in dosage because 1. the person wasn't going to switch to something else and 2. the person was happy with Zyprexa.
>Xanax prevents "mood swings"
Wow.
>According to your definition, it is a mood stabilizer
Sh*t, I totally forgot what I wrote as a definition. Your definition is fine, I just think its too bipolar specific. My definition is broad on purpose-it takes into account other disorders, such as borderline personality.
Eric
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