![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by phillybob on March 2, 2000, at 13:38:17
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Brenda on March 2, 2000, at 11:18:53
In my travels (I am a layperson, not a doctor so check with one): there seems to be good anecdotal evidence that Neurontin and Lamictal (anti-siezure meds) help curtail cycling (and perhaps have some anti-depressant effect, though I think augmentation is more their gig); Depakote (another anti-siezure med?) is often used for cycling (though not much AD effect if at all); Lithium (at least in smaller doses than you have been taking) seems also to be okay in conjunction with an AD (even an MAOI such as Parnate or Nardil in the U.S.).
I have not read anything about any of these anti-cyling meds not continuing to work nor having deleterious long term effects.
Posted by Janice on March 3, 2000, at 11:44:30
In reply to Re: Rapid Cycling Bipolar Disorder, posted by phillybob on March 2, 2000, at 13:38:17
I will look into all your suggestions. I guess I'm really looking for an anti-depressant that doesn't increase my highs and lows. Or, like most folks at psycho-babble, SOMETHING/ANYTHING to get rid of the depression. The search continues, Janice
Posted by Scott L. Schofield on March 6, 2000, at 10:24:11
In reply to Thank you for your help, posted by Janice on March 3, 2000, at 11:44:30
> I am a rapid cycler with 2 regular cycles a week - 1 in the middle of the week (the high), and the low during the week-end. This weekly rhythm cycles on an annual cycle. So my complete picture of my depression is related to light and sleep, which I do my best to manage with regular sleep and light therapy, which help. Still though, I generally have a mild to moderate depression during the fall and winter. So far anti-depressants have only contributed to increasing my highs and lows.
>
> I currently take 600 mg of lithium (which I will be increasing shortly). Not only does it stop my highs, it also has been the best anti-depressant I've used. I also take 25 mg of Dexedrine for ADHD (this actually helps decrease my cycle).
> So my questions:
>
> Does lithium lose efficacy over time?
>
> Are there other mood stabilizers that act as anti-depressants?
>
> Are there other medications that act as anti-depressants for rapid cyclers other than ADs?
>
> Which ADs are least likely to increase rapid cycling?
>
> Do many rapid cyclers find complete relief of their symptoms?
The suggestions you received as to which mood-stabilizer to use for treating rapid-cycling bipolar disorder are good ones. You would be very fortunate if any one by itself does the job. Rapid-cyclicity is difficult to treat. Most of the more recent strategies involve using combinations of mood-stabilizers, with or without antidepressants. If you are not experiencing much in the way of side-effects with lithium, you should probably stay on it. If I were in your position, I would first try adding Depakote to the lithium, and then Neurontin into the mix. It would be a good approach to add them one at a time to establish the efficacy of each - even if you only experience a partial improvement. This is important information that may aid you in choosing teatment options in the future. If no go, I would switch from Neurontin to Lamictal, or simply add Lamictal to the other three, if your doctor has no objections, I think it would be smarter to add it. It would save a lot of time by reducing the number of permutations necessary to test all the combinations by using only two at a time. "If you throw enough shit against the wall, some of it is bound to stick". Remember that when using Lamictal in combination with Depakote, you must cut the dose of Lamictal by half. You must also start with a smaller dose and increase it more slowly. This is because Depakote interferes with the body's attempt to get rid of it. You want to avoid provoking the body into producing a potentially dangerous reaction. This reaction usually appears first as a rash. Follow the schedule of titration suggested by the PDR. The average effective dosage of Lamictal for bipolar disorder is 200mg. if one is not taking Depakote (the range for epilepsy is 300- 600). You may want to use half of this dosage - 100mg, If you start feeling great, maintain the treatment regimen for a while. Later, you can discontinue one drug at a time to weed out those that are not contributing to your remission.One thing that sounds suspicious to me is that you describe that your "down" period always occurs on weekends. It is unlikely that your cycle is exactly 168 hours (7 days) long. At some point, I would think that there would be a phase-shift that would cause your cycle to move forward or backward through the week. You may want to take notice of how your sleeping habits may change between Friday and Monday. Perhaps such a change upsets your internal clocks. It might be a sort of jet-lag type trigger. I don't know. If you are going to bed late and waking up late (retarding the cycle), this may possibly be the cause of the depression. That there is some seasonality associated with your condition may indicate that your circadian clocks are vulnerable
Good Luck.
- Scott
Posted by Janice on March 6, 2000, at 21:07:09
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Scott L. Schofield on March 6, 2000, at 10:24:11
You sound like you really know what you're talking about Scott. Are you saying that before I start any AD, I should be extremely stable? I have SAD too, and this weekly cycle cycles on the SAD cycle.
So right now since it's February, and I do live in Canada and it's Monday, I am fairly stable and moderately depressed. But I need to be more stable before an AD, otherwise I will be up and down again. Thanks for all that information.
>
My cycle's lowest day is usually always Saturday (except maybe twice a year), and highest day is either Tuesday or Wednesday.Yes my circadian rhythm has been off, as far as I know, my whole life. I try to keep my sleep as regular as possible, but this, so far, has been almost impossible. AFter decades of the Monday to Friday thing, my body's clock seems to have developed its own rhythm. Just recently, I've been noticing I sleep very little on Sunday nights (regardless of whether I am exhausted or well rested)...Monday to Friday, I sleep more and more until Saturday - the sleeping day. There is no phase-shift that causes my cycle to move forward or backward through the week. My circadian rhytm is such that I cannot get to sleep at night and have troubles getting out of bed.
Sleep causes depression.
Little sleep shifts me into mania.
and I seem to have very little control over the whole thing.It sounds like a ridiculously easy problem to solve - but for me, it's very difficult. I do my best but am uncertain if I will ever be able to get my sleep and moods regular.
Anyway Scott thanks for your insights. If you have any ideas about readjusting my circadian rhythm, I would love to hear them. I also have ADHD, which could be where these rhytm problems originate from. Janice
Posted by judy on March 6, 2000, at 22:38:18
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Janice on March 6, 2000, at 21:07:09
Hi Janice,
I think Scott suggested the best mood stabilizer combo I was ever on- depakote and lamictal. Lamictal had an excellent anti-depressant effect at 200mgs and as Scott said you need to carefully monitor your depakote levels. The regularity of your cycles are really unique, mine vary greatly in length, mania 1-2 weeks, depressions about a month. When I lived in northern U.S., my depressions lasted the entire winter and light therapy also helped significantly. I've been told by a prominent bipolar expert that I have "a difficult variation of what is already a difficult disease to treat." I wish you the best of luck.
Posted by Scott L. Schofield on March 7, 2000, at 10:09:02
In reply to Re: Rapid Cycling Bipolar Disorder, posted by judy on March 6, 2000, at 22:38:18
Judy:
I think Scott suggested the best mood stabilizer combo I was ever on- depakote and lamictal. Lamictal had an excellent anti-depressant effect at 200mgs and as Scott said you need to carefully monitor your depakote levels. The regularity of your cycles are really unique, mine vary greatly in length, mania 1-2 weeks, depressions about a month. When I lived in northern U.S., my depressions lasted the entire winter and light therapy also helped significantly. I've been told by a prominent bipolar expert that I have "a difficult variation of what is already a difficult disease to treat." I wish you the best of luck.
Janice:
So right now since it's February, and I do live in Canada and it's Monday, I am fairly stable and moderately depressed. But I need to be more stable before an AD, otherwise I will be up and down again.
Me:
Before beginning any of these things, I think you should first establish a dosage of lithium that produces therapeutic blood-levels. This is the minimum "mood-stabilizing" action you must take so as to try preventing a manic reaction to any antidepressant drug trials. You may be pleasantly surprised. At this point, you may want to test the waters of using an antidepressant. Given your history of SAD-type stuff, an SSRI might be a good starting point. Lithium and SSRIs may act synergistically (1+1=3). I might be inclined to add Depakote first, though. Using lithium plus Depakote in combination sort of covers the two major categories of bipolar disorder.I think that Judy is on the mark regarding the Depakote and Lamictal combo. I suggested to my doctor that this could be a hell of a combination globally. I was close to making that my first recommendation, but I thought the dosing interaction (the need to use only half the usual Lamictal dosage) might be unpalatable to your doctor. Lamictal definitely possesses significant antidepressant properties, although this might be limited to bipolar disorder (which it seems you do have). My gut feeling is that Neurontin may be a somewhat better choice to address rapid cyclicity (only an uneducated guess). Again, you and your doctor must determine how desirable using a combination of Lithium+Depakote+Lamictal+Neurontin would be. It would certainly save a lot of time. Of course, severe negative reactions upon the addition of each drug must be anticipated as a possibility. The only thing that I see as a concern, though, is the appearance of a rash when introducing Lamictal. I think it is wise to use the titration schedule listed in the PDR. I should note that when Lamictal is started to rapidly and produces this reaction, many times it can be discontinued and restarted successfully.
The dosing of each drug can be accomplished clinically, using side-effects as a determinant (as tolerated). One very important factor that must be considered is how each drug affects the other's blood levels (pharmacokinetics). Many anticonvulsants (used here as mood-stabilizers) have the tendency to cause the body to increase the rate at which it eliminates them. The Depakote - Lamictal interaction is the exception. The PDR offers some good guidelines to follow, and details the extent to which the clearance of each drug affects the others. Many of these drugs even affect their own clearance after a while (autoinduction of metabolism).
Janice:
My cycle's lowest day is usually always Saturday (except maybe twice a year), and highest day is either Tuesday or Wednesday.
Yes my circadian rhythm has been off, as far as I know, my whole life. I try to keep my sleep as regular as possible, but this, so far, has been almost impossible. AFter decades of the Monday to Friday thing, my body's clock seems to have developed its own rhythm. Just recently, I've been noticing I sleep very little on Sunday nights (regardless of whether I am exhausted or well rested)...Monday to Friday, I sleep more and more until Saturday - the sleeping day. There is no phase-shift that causes my cycle to move forward or backward through the week. My circadian rhytm is such that I cannot get to sleep at night and have troubles getting out of bed.Sleep causes depression.
Little sleep shifts me into mania. and I seem to have very little control over the whole thing.
It sounds like a ridiculously easy problem to solve - but for me, it's very difficult. I do my best but am uncertain if I will ever be able to get my sleep and moods regular.
Me again:
Circadian rhythms - fascinating, but often a pain-in-the-ass. One interesting and important feature of many cases of depression is that sleep-deprivation can exert an antidepressant effect. This is sometimes used as a prognosticator of which drugs may have a better chance of working. Sleep-deprivation is sometimes used to potentiate the antidepressant response to a drug. However, sleep-deprivation can also precipitate mania. One must be careful to try to minimize this possibility if there is a history of mania.One suggestion comes to mind. Once you optimize your dosage of lithium (and possibly add Depakote), you may want to try total sleep-deprivation for one night. This will serve as a test to see if it produces an antidepressant effect. I would suggest doing it Friday night going into Saturday. Hopefully, you will feel modestly better towards morning and up until early afternoon. At this point, you may begin to lose the improvement, and will certainly feel sleep-deprived. It is important that you stay awake until you go to bed at your normal time. If you can't help yourself, you can take naps that last no longer that 20 minutes. Use an alarm clock to prevent going over 20 minutes. Do not oversleep Sunday morning!
If this stuff works, you may be able to develop a strategy that uses sleep-deprivation to manipulate your circadian rhythm. However, this should not require *total* sleep-deprivation. On Friday night, go to bed at your normal time, or at least at a reasonable hour. Wake up at 2:00 AM, and remain awake thereafter. You can try to stretch it to 3:00 AM, but use 2:00 AM initially to establish whether it works or not. The same rules apply regarding naps, and you must wait until your usual bedtime to go to sleep.
Even if this regime doesn't work, I feel that it is *extremely* important to maintain good sleep hygiene. It is probably most important to wake up at the same time every day and not oversleep. Saturday mornings are probably the culprit here. If you work a "regular" 9 - 5 job, my suggestion is to use a sleeping schedule of 11:00pm - 7:00am or 10:00pm - 6:00am, except for any therapeutic sleep-deprivation.
I hope something here helps.
- Scott-------------------------------------------------
Depress Anxiety 1997;5(4):175-89
Alternative approaches to refractory depression in bipolar illness.
Post RM, Leverich GS, Denicoff KD, Frye MA, Kimbrell TA, Dunn R
Biological Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD 20892-1272, USA.
Thus, there appears to be a large variety of approaches to refractory bipolar depression. In contrast to several decades ago, wherein augmentation of lithium with antidepressants and neuroleptics was essentially the only treatment mode available, a panoply of treatment options now exist. However, their relative efficacy in different illness subtypes and stages remains to be better delineated, as do their optimal sequencing and use in combination in individual patients. It is the opinion of these authors and many of our colleagues in the field that initial use of several mood stabilizer drugs in combination may have a preferable long-term outcome in some rapid cycling patients, compared with the immediate use of a unimodal antidepressant with an inadequate single mood stabilizer, although this remains to be systematically studied. The use of thyroid augmentation strategies would appear to have merit in relationship to not only the potential treatment of lithium-related hypothyroidism, but also in augmenting antimanic and antidepressant effects. As one moves toward some of the complex combination treatment strategies discussed in this chapter, one has to be particularly careful about drug interactions and their potential for toxicity as well as therapeutic effects. Perhaps a prevailing guideline would be to use these agents more carefully in combination therapy than in monotherapy, with slow upward titration of dose to individual patients' side effects thresholds, even in preference to targeting of conventional blood level windows. In this way, side effects can be avoided during the assessment of complex combination regimens. In addition, one should be aware of potential pharmacokinetic interactions. For example, with the addition of valproate to carbamazenine, one should reduce the dose of carbamazepine, as valproate will not only increase the free fraction of carbamazepine based on displacement of protein binding, but will lead to increased accumulation of carbamazepine-10,11-epoxide. This epoxide is not measured in conventional assays but could contribute to the side effects profile (Ketter and Post, 1994). Similarly, valproate will markedly increase blood levels of lamotrigine; the starting dose of this agent should be substantially lower than conventional dosage when these two drugs are used in combination. We suggest the utility of detailed mapping with a formal system-such as the Life Chart Methodology (LCM) (Leverich and Post, 1996)-of mood fluctuation vs. medications in order to optimize and rationalize complex combination therapy. In this way, not only can the nuances of partial response be better defined, but also basic decisions about the therapeutic index and relative likelihood of response can be more readily assessed. We have discussed the other merits of the life chart method as an important clinical treatment tool as well as a research tool in other venues, but reemphasize its potential great importance in the treatment of refractory cyclic bipolar patients, in whom an initial period of remission of depression may, in many instances, be as likely attributable to the natural course of illness as the current intervention being offered. As such, it behooves the clinician to have a systematic database for the more subtle issues of dose titration and sequential addition of medications in complex combination regimens. In the face of inefficiency to one combination strategy, how one moves to the next strategy remains a highly individualized, clinically-based algorithm. We suggest the potential utility of moving towards a new set of mood stabilizers and then repeating some of the unimodal antidepressant additions and augmentation trials in an attempt to overcome refractory depression. Refractory depression in bipolar patients should be viewed as a medical emergency in light of the high potential for suicide in the illness in general (Chen and Dilsaver, 1996) and in patients who have either sustained or episodic refractory depression.
Posted by Janice on March 7, 2000, at 11:52:14
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Scott L. Schofield on March 7, 2000, at 10:09:02
Scott,
Thank you for all that wonderful information - I wish my pdoc could explain it to me that way.Bells went off inside my head when I read the sleep regime you suggested. I think it would work...getting up at 3am on Friday. My only concern is that I have always been half insane (I'm sure this is the illness) about my sleep. But over the years I have made some significant gains with the help of medications. I used to nap, but now I don't - thanks to Dexedrine, which gives me the power to be able to make the choice.
I have just read your information once, and will come back to it again Scott. Thanks again.
Lithium works very well for me. I tried the other stabilizer (the one where your blood has to be tested), which worked very well, but I was unable to tolerate it at low doses.
Judy - it's seems funny that so many rapid cycler's moods cycle on man made and natural units of time (24 hour, 1 week, 2 weeks, 1 month, annually, seasonally). Did you ever do shift work that last for 2 weeks or a month? Maybe we are physically very sensitive people.
I am hoping to leave Canada every winter for 2 or 3 months eventually for a sunny and warm climate. Good to hear it has helped you. Janice
Posted by Sarah on March 7, 2000, at 12:35:17
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Janice on March 7, 2000, at 11:52:14
Hey, Janice, if you are considering winter relocation you should check out Arizona. Lotsa good deals on rent for the winter visitors. We have a buncha "snowbirds" that come here every year! (lotsa Canadians) Almost like "Little Canada" here! Also, the University here in town (University of Arizona, Tucson) is always doing studies on new AD's and other alternatives to meds. There are many groups for all types of depression, sleep problems, etc... We also have some wonderful Pdocs! I have found the best doc I have ever had here! Very open minded and accepting town! Wonderful place really! The weather is great (right now we have cold and rain, which is very unusual) I was complaining to my husband the other day because it was in the high 60's and I thought it was cold!! He told me to think back about 2 years the the weather we had back home this time of year... (so quickly we forget!) I know I sound like an ambassador, but it has made a big difference in my husbands SAD and sleep habits. Hard to be depressed and napping on such a beautiful day!! We just spent the weekend laying around the pool working on our tan! Anyway, just my two cents...
Posted by dove on March 7, 2000, at 12:40:26
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Janice on March 7, 2000, at 11:52:14
For some strange reason, I have almost an identical cycle to your's Janice. Weekends are the worst, with weekdays, especially Wednesday, being the best, and most stable. I have experimented with the sleep-deprivation, getting up at 1am and staying up untill the next night. It pushed me over the edge. Started the day with great energy and spirits, by afternoon I was very aggravated and starting a manic-cycle, which is almost more dangerous to me than depression because it's always mixed.
I still haven't been put on any mood-stabilizer, the p-docs want to wait, making sure I'm truly mixed manic rather than just anxious, ADHD, OCD, atypical major depressed... Isn't that nice, so I'll have to wait until they trust my own description of what is churning inside me.
Another note, I did horrible on Tegretol, truly horrifying, but Verapamil had a mind blowing effect, and that's in the positive. It has been the *only* med ever, that calmed the cycles. I have gone to four p-docs, and two internal medicine docs, asking for it. Well, it ain't no scheduled med now is it, and no one's trying to buy it on the streets, so what's the problem. Their reasoning always returns to the primary p-doc's opinion that I need to get stabilized on the AD first, then add the mood-stabilizer. I live in a rinky-dink little midwest town, limited insurance, limited choices, keep hoping for the proverbial lightbulb to pop on over the doc's heads.
Keep us updated, I am very interested in how you manage the plethora of symptoms.
dove
Posted by Scott L. Schofield on March 7, 2000, at 17:33:50
In reply to Re: Rapid Cycling Bipolar Disorder, posted by dove on March 7, 2000, at 12:40:26
> Another note, I did horrible on Tegretol, truly horrifying, but Verapamil had a mind blowing effect, and that's in the positive. It has been the *only* med ever, that calmed the cycles. I have gone to four p-docs, and two internal medicine docs, asking for it. Well, it ain't no scheduled med now is it, and no one's trying to buy it on the streets, so what's the problem. Their reasoning always returns to the primary p-doc's opinion that I need to get stabilized on the AD first, then add the mood-stabilizer. I live in a rinky-dink little midwest town, limited insurance, limited choices, keep hoping for the proverbial lightbulb to pop on over the doc's heads.
>
> Keep us updated, I am very interested in how you manage the plethora of symptoms.
>
> doveHi.
There are *many* citations in the literature regarding the use of verapamil in bipolar disorder. Unfortunately, most of them describe studies that have been designed to evaluate its efficacy in treating acute and severe mania. Most of these indicate that it has only modest positive effects for this presentation. However, verapamil is more likely to be effective in hypomania and mixed-states, and may be particularly useful as an adjunct to mood-stabilizers. Anecdotal reports describe verapamil as being effective to treat the depressive phase of bipolar illness as well, and may serve as a prophylactic against relapse into both phases. Verapamil seems to be of little value for treating unipolar depression, however.
There is sufficient rationale to try verapamil when other alternatives fail.
I included just three Medline citations below so that you may have something in black-and-white to show your doctor.
- Scott----------------------------------------------------------------
Am J Psychiatry 1992 Jan;149(1):121-2
Verapamil versus lithium in acute mania.
Garza-Trevino ES, Overall JE, Hollister LE
University of Texas Health Science Center, San Antonio.Twenty acutely manic patients were studied in a double-blind randomized trial comparing verapamil with lithium. The Petterson Mania Scale, the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression (CGI) were administered before treatment and weekly during 4 weeks of treatment to evaluate response to verapamil and lithium. Both treatment groups improved significantly, and there were no significant overall differences between treatments.
-----------------------------------------------------------------
Neuropsychobiology 1993;27(3):184-92
Calcium antagonists in manic-depressive illness.
Dubovsky SL
University of Colorado School of Medicine, Denver, CO 80262.Increased free intracellular calcium ion concentration ([Ca2+]i) has been found in lymphocytes and blood platelets of patients with bipolar affective disorders when they are acutely ill, but not after recovery. Because lithium alters intracellular calcium ion dynamics and lowers platelet [Ca2+]i in affectively ill patients but not controls, drugs whose primary action is to modulate [Ca2+]i in hyperactive cells have been used as antimanic agents. The best studied of these is verapamil, a calcium channel blocking agent (CCB) that appears most effective for lithium-responsive patients. Because they interact with different central CCB receptors, second-generation CCBs may have a different spectrum of action. CCBs are usually well tolerated and may be useful for a number of other psychiatric, neurological and medical conditions.
--------------------------------------------------------------------
Compr Ther 1990 Dec;16(12):18-23
Perspectives on bipolar illness.
Cook BL, Winokur G
Department of Psychiatry, College of Medicine, University of Iowa, Iowa City.Based on evidence available at present, it appears that heterogeneity does exist within bipolar disorder. Persons with mania differ in family history of affective illness, their age at the onset of illness, sex, and organic cause and course of the illness. The question of how these variables influence an individual's response to treatment has never been systematically studied. Multicenter trials of the various antimanic agents need to be conducted to determine whether the various subgroups of manic patients have different pharmacological response profiles. At present, the clinical management of mania is best approached using lithium carbonate in a dosage adequate to achieve a 12-hour serum lithium level to 1.0 to 1.2 mEq/L. The time to response is usually 2 to 3 weeks, and during this period an antipsychotic or benzodiazepine agent may be added to help control symptoms such as agitation or sleeplessness. Prophylactic maintenance with 12-hour serum lithium levels between 0.8 and 1.0 mEq/L should be used for at least 6 to 12 months after resolution of the manic episode. In patients with more than one episode, lithium maintenance therapy may need to be continued indefinitely. In patients who are not responsive to lithium, the most prominent alternative therapies include anticonvulsants and calcium-channel blocking agents. Anticonvulsants (e.g., carbamazepine, valproic acid, clonazepam) are generally first used as alternative therapy (either alone, or in combination with lithium), followed by a calcium-channel blocker (e.g., verapamil). Clinical practice would generally suggest first using the alternative agent alone, then adding lithium if response is inadequate.
------------------------------------------------------------------
Schizophr Res 1999 Sep 29;39(2):153-8; discussion 163
Comparative pharmacology of bipolar disorder and schizophrenia.
Post RM
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892-1272, USA. robert.post@nih.govThe treatment of acute mania and schizophrenia overlap considerably in terms of the typical and atypical neuroleptics, but begin to diverge with the recognized mood stabilizers for bipolar affective illness--lithium, carbamazepine, and valproate--which are substantially less effective in schizophrenia than in affective illness. Moreover, the L-type calcium channel blocker verapamil is reported to be effective in mania, but it may exacerbate schizophrenia. A series of new putative mood stabilizing anticonvulsants (such as lamotrigine, gabapentin, and topiramate) and possible second-messenger targeted treatments (tamoxifen and omega-3 fatty acids) deserve further study in both affective and schizophrenic syndromes. Repeated transcranial magnetic stimulation (rTMS) of the brain offers considerable promise in the treatment of a variety of neuropsychiatric syndromes, especially with preliminary evidence of frequency-dependent effects on regional cerebral blood flow. New insights about the potential neurotrophic effects of lithium and the gene transcriptional effects of other psychotropics offer exciting new targets for therapeutics and strategies for future clinical trials and therapeutic applications in both syndromes.
----------------------------------------------------------------
Posted by judy on March 7, 2000, at 18:39:20
In reply to Re: Rapid Cycling Bipolar Disorder, posted by dove on March 7, 2000, at 12:40:26
Whoa! Your doc is trying to stabilize you on an AD first? Is he nuts? I landed up with a psychotic manic episode on prozac alone. I'm really sorry you have to put up with that. On the CCB front, my sister does extremely well on verapamil; I just started a CCB called Norvasc for atypical angina and it seems very calming. So there definitely may be something there. Take care.
Posted by Janice on March 8, 2000, at 10:24:57
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Sarah on March 7, 2000, at 12:35:17
Hi Sarah, I like the States very much. In fact, the woman I inherited all this from (my mother) is in Arizona right now (Yuma). I keep telling her, she has the exact life I want.
Good for you and your husband for making that change in your lives, and I'm glad to hear that something as simple as a sunny climate can change the course of someone's depression.
I have about another 3 to 4 decades in the work force before I can do any serious migrating. I'm planning on working for myself and am hoping I will be able to spend 2 to 3 months a year Jan-March outside of Canada. I work in design, so this should be possible (well I may need to fly back every 3 or 4 weeks).
I definately agree with your 2 cents worth. Thanks for the thought. Janice
Posted by Janice on March 8, 2000, at 11:53:56
In reply to Re: Rapid Cycling Bipolar Disorder, posted by dove on March 7, 2000, at 12:40:26
Hi Dove,
When you wrote about your relatives one time, I thought to myself, 'hey, we've even got similar wacky relations'.
Here's my theory about my rapid cycling, for whatever it's worth. Many people with ADHD don't do well when their time isn't structured (the weekends), plus they are generally hypersensitive both emotionally and, maybe more importantly, physically.
So on the week-ends, I had basically been a slave to my impulses, which affected my sleeping, waking and eating. And being physically sensitive and already intensely emotionally from the ADHD, this cycle developed that continues to kindle itself and which continues to worsenover time.
My OCD started at 5 - trichotillomania. It is also a result of the ADHD, as it gives me something to concentrate when my mind is out of control and I do it WHENEVER MY BODY IS STILL(even if it's for 5 seconds).
Eating problems already existed at 7 (weighed 30 lbs), and got significantly worse at 12. Again, asa result of the ADHD, my inability to organize meals (food bores me), and then not having the impulse control to stop myself from binging.
Both of the above are helped with Dexedrine.
Dove, I think Scott is right. My last psychiatrist was trying to stabilize me on ADs with 600 mg lithium. 5 years, didn't work. For the last year, I haven't even been taking and ADs (just lithium) and I am much better for it, just half stable, moderately depressed and a bit of cycling...but nothing like it was like on the ADs.
I read this article you may find interesting for your daughter. About the differences between ADHD and bipolar in children and how to treat them. It's at bipolarchild.com/articles.html
If I remember correctly you also have PTSD. I have this one too, and I attribute it also to the ADHD. Because if you take a child of my temperment and expose them to any kind of trauma...most likely, they will get PSTD.
I'd like to say I'm sick of all this, but it's all I've ever known. I'm not sure if this has been your experience, but I find that as I age, the depression gets worse. I don't mind the insanity, but the depression...well that can drive anyone to get help!
I'd love to ask you some questions about your disorders. Janice
Isn't that nice, so I'll have to wait until they trust my own description of what is churning inside me.
that sounds frustrating Dove! I've just recently gone through a plethora of tests because of a doctor like this...so he could discover from someone else's mouth exactly everything I told him. I think he is an ass, but I am too lazy to get another doctor.
Posted by Janice on March 8, 2000, at 17:06:14
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Janice on March 8, 2000, at 11:53:56
Posted by dove on March 9, 2000, at 14:59:34
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Janice on March 8, 2000, at 11:53:56
First, let me thank Scott, Janice and Judy for the extended info and thoughts. The citations that Scott dug up are very interesting, a little much for my brain, but should prove interesting when I bring them in. Janice, I went to the website for bipolar children and have printed off a bunch of stuff to bring to my daughters p-doc. Great stuff, I truly appreciate the time and effort. Thank you all!
Second, actually saw my p-doc this afternoon, and he informed me of his departure for sunny skies UCLA way. I have one last appointment with him in six weeks and then he's gone. He said I should be able to transfer my care over to one of his associates, so that should prove interesting to say the very least. I had already tried to transfer but had been told that none of them were taking on any more, run in me circles while we're at it I guess :-)
On another note, I used to find my depressions so much worse than my up-up-up-and-away mania's, but for the last five or so years, my mania's have been so mixed with aggressive depression and energetic hopelessness, that I find them much more dangerous for my safety. Possibly I am actually depressed and it's not manic, but it sure feels like some kind of evil malignant mania possessing me.
Anyway, thanks everybody, you're all wonderful!
dove
Posted by Scott L. Schofield on March 10, 2000, at 11:34:30
In reply to Re: Rapid Cycling Bipolar Disorder, posted by dove on March 9, 2000, at 14:59:34
> On another note, I used to find my depressions so much worse than my up-up-up-and-away mania's, but for the last five or so years, my mania's have been so mixed with aggressive depression and energetic hopelessness, that I find them much more dangerous for my safety. Possibly I am actually depressed and it's not manic, but it sure feels like some kind of evil malignant mania possessing me.
Dear Dove,I sometimes feel stupid when suggesting the most obvious. I haven't been around long enough to know which things people have tried in the past. It probably wouldn't make much difference anyway, having a sieve for a memory (and probably a shrunken hippocampus).
I can't imagine that you haven't tried one of the recognized mood-stabilizers yet, but I believe that Depakote would be the more established of these for treating mixed-states. If it were to work, it might obviate the need for adding or changing antidepressants.
It might also be worth getting some feedback regarding the use of Klonopin (clonazepam). It may take the edge off and moderate the manic component without sending you into a full-blown depression. Being a benzodiazepine, one would naturally have trepidations regarding the reputation of the benzos for being physically addictive. However, Klonopin is unique among them, having anticonvulsant properties and an ability to alter serotonergic activity (5HT2C receptor agonist, among others). It has even been demonstrated to be capable of augmenting the SSRIs, and promote a more rapid antidepressant response. I don't think these properties are likely to display tolerance, so long-term use can be justified. Klonopin is recognized as being effective in the treatment of dysphoric mania.
It sounds like you may be closer to an answer than you think. I hope so.
- Scott
Posted by Janice on March 14, 2000, at 0:56:24
In reply to Re: Rapid Cycling Bipolar Disorder, posted by Scott L. Schofield on March 10, 2000, at 11:34:30
Hi Scott and Dove,
I just wanted to share with you both my week-end. Although separating all the variables is almost impossible, I think it was success.
Both Saturday and Sunday, I woke up 1 1/2 hours earlier than usual. I thought a 2am wake-up would have been too ambitious, plus dove's experience worried me a bit.
For the most part of the week-end, I felt quite cheerful.
dove, I don't know if you have this problem, But my diet changes drastically between my 2 cycles. On Saturdays, I find myself stuffing down numerous chocolate bars. no meals, just junk. Sunday morning, cookies for breakfast. Sunday evening, back to normal mode with a healthy, nutritious meal.
Mood-wise, I have to say, the week-end was a great success.
On Sunday, I went jogging hoping it would help me sleep Sunday night (the night I don't usually sleep). Well, I'm optimistically guessing that the shortened sleep Friday and Saturday, plus the jog Sunday most definately helped. It took me only about an hour to get to sleep and my sleep was good.
I am on the right track!
dove, yes I have to agree, mixed states are the most dangerous. I hope you get your stabilizer soon.
hi Scott, (follow up from your other posting)
thanks for the compliment. it was kind of like having the rug pulled out under me that I wasn't even aware existed. I adapt quickly to new ideas.I have the same kind of problem in real life. I worry about whether I said the right thing at the right time...if I said something too intensely ...if I'm acting too high strung, etc. Basically, I worry about missing social cues and passing for normal. I don't mind being wrong though.
Do you have cycling depression Scott?
Do you have ADHD?
Janice
Posted by dove on March 14, 2000, at 8:47:29
In reply to Rapid Cycling Bipolar Disorder...Scott Dove, posted by Janice on March 14, 2000, at 0:56:24
Good morning Janice, Scott and all of babble-land,
Chocolate and cookies for meals on the weekends, hmmm... Yes, I think I may partake of the same exact nutritional woes as Janice. So, eating healthy helps too, I shouldn't be surprised, yet I am. Doh! Alright, so with the junk food identified as one of the culprits, we'll move on to the next item, sleep.
I have the same struggle with falling asleep, all my life, even as a baby. My Amitriptyline plus Serzone an hour before bed does the trick these days. Your experience is of very great value though, for those of us who may need the info if we're ever removed from our sedating meds. I'm glad, really glad actually, that there's a way to deal with this without relying on meds. I hope others struggling with weekend sleep problems read this, and I hope it works again next weekend.
Keep your thoughts rolling in, I appreciate the effort :-)
dove
Posted by Scott L. Schofield on March 14, 2000, at 8:49:27
In reply to Rapid Cycling Bipolar Disorder...Scott Dove, posted by Janice on March 14, 2000, at 0:56:24
> Hi Scott and Dove,
>
> I just wanted to share with you both my week-end. Although separating all the variables is almost impossible, I think it was success.
>
> Both Saturday and Sunday, I woke up 1 1/2 hours earlier than usual. I thought a 2am wake-up would have been too ambitious, plus dove's experience worried me a bit.
>
> For the most part of the week-end, I felt quite cheerful.
>
> dove, I don't know if you have this problem, But my diet changes drastically between my 2 cycles. On Saturdays, I find myself stuffing down numerous chocolate bars. no meals, just junk. Sunday morning, cookies for breakfast. Sunday evening, back to normal mode with a healthy, nutritious meal.
>
> Mood-wise, I have to say, the week-end was a great success.
>
> On Sunday, I went jogging hoping it would help me sleep Sunday night (the night I don't usually sleep). Well, I'm optimistically guessing that the shortened sleep Friday and Saturday, plus the jog Sunday most definately helped. It took me only about an hour to get to sleep and my sleep was good.
>
> I am on the right track!
Reading this brings me great joy.There is no better reason to participate on this board – with the exception of getting well myself (unpardonably selfish).
- Scott
Posted by Scott L. Schofield on March 14, 2000, at 11:46:02
In reply to Rapid Cycling Bipolar Disorder...Scott Dove, posted by Janice on March 14, 2000, at 0:56:24
> hi Scott, (follow up from your other posting)
> thanks for the compliment. it was kind of like having the rug pulled out under me that I wasn't even aware existed. I adapt quickly to new ideas.> I have the same kind of problem in real life. I worry about whether I said the right thing at the right time...if I said something too intensely ...if I'm acting too high strung, etc. Basically, I worry about missing social cues and passing for normal. I don't mind being wrong though.
My problem is, that because I have never been wrong, I feel that people expect too much of me. Once, I thought I was wrong. But I was mistaken.
I can personally identify with everything you describe. This was particularly true for me in high school and through most of my 20’s. Much of it was due to my depression, as social anxiety is one of its features. It was pretty intense there for a while. I think the term “phobia” would apply here. Some of it was also due to the fact that I was a psychological mess. How much of this was the result of possibly being depressed from an early age is hard to say. Even now, I feel socially inhibited, especially in crowds. During the few brief periods when a drug has helped me in the past, all of that stuff vanishes as if by magic.
> Do you have cycling depression Scott?Not now, but I did for a two-year period between ages 20 and 22. It was like clockwork. I would be severely depressed continuously for 8 days. Then, over the course of a single hour, my state would change to euthymia (or something close to it). After 3 days in this state, I would abruptly switch to depression again. This, too, would occur within an hour. After recognizing the cycle as being the manifestation of bipolar disorder, I began to keep a social calendar around it. It was that regular. When I was put on lithium, the cycling stopped, and has never reappeared.
Shit. As I’m writing this and remembering my history, I’m scared that I will never get well. Actually, I have felt this way for many years – and for good reason - but I can’t afford to recognize it. To do so might lead me down a path of inevitable destination.
> Do you have ADHD?
No. I’m pretty sure I don’t. None of my doctors have ever mentioned it.
- Scott
Posted by Janice on March 15, 2000, at 12:47:05
In reply to Re: Rapid Cycling Bipolar Disorder...Scott Dove, posted by Scott L. Schofield on March 14, 2000, at 11:46:02
thank you for your support.
I am on lithium dove (sorry I didn't mean to give you the impression I'm not on drugs).
I going to try more mood stabilizers before trying ADs again. I've recently begun to accept the fact I may never do well on ADs. so I'll try manipulating my environment with sleep and lights.
Scott, sorry to hear about your social anxiety. It sometimes seems to be part of the package. Did you ever have any luck on ADs? tried lights? You know you were wrong...at least about being wrong! hey, isn't that called perfectionism?
Dove, I'll be curious to see how you do on mood stabilizers. Keep me in touch. and I'll be curious about your daughter, whenever you have written about her...I think of myself as a child and it breaks my heart.
Janice
Posted by Gisele on February 3, 2004, at 19:36:36
In reply to Re: Rapid Cycling Bipolar Disorder...Scott Dove, posted by Scott L. Schofield on March 14, 2000, at 11:46:02
Hello,
I feel a little freaked out right now. I was just diagnosed with bipolar 2. I am presently on 30mg of prozac with little side effects. I think it helps because when I try to get off it, I do poorly. (I get totally depressed, big time)
Right now I am scared and feeling a bit overwhelmed with the whole idea.Finding this post has helped. I wonder if I'm even at the right place for making a new post? Anyway.
My main concern is deciding what meds to take and if I can get off prozac?
I also wonder about alternative therapy. I've heard of this pig mixture they began giving to pigs which improved their moods and apparently they are using this mix or herbs or whatever with people with some success????/
"E power" ???
any comments?
Sincerely,
Gisele
Posted by nucase on March 10, 2004, at 18:01:05
In reply to Re: Rapid Cycling Bipolar Disorder...Scott Dove, posted by Gisele on February 3, 2004, at 19:36:36
> Hello,
>
> I feel a little freaked out right now. I was just diagnosed with >bipolar
Hi,I am exactly in the same situation you are (just diagnosed BP2). Sucks, doesn't it? At the same time it just makes me look at my life quite differently. Am I not sure who I am anymore.
I have been on paxil for about two years and it did help to improve (but certainly not cure) my depression. It made me feel flat though. Recently, I switch to a cocktail of Effexor and Amitripthyline that had horrendous effects on my mood (e.g. drove me over the edge) but it is too early to really tell. Anyway, I can't help much but wanted to let you know that you are now alone. If you find out about it though, I'll try the pig mixture any day ;)
Posted by KimberlyDi on March 12, 2004, at 16:29:49
In reply to Re: Rapid Cycling Bipolar Disorder...Scott Dove, posted by Gisele on February 3, 2004, at 19:36:36
I'm sorry. Some things stick in my mind. I'm always one to ask why?
I'm a possible rapid-cycler, undiagnosed, and having good success on my first mood stabilizer. I don't think being diagnosed "BP" is terrible. Living through it undiagnosed is what would be terrible. I can look back and see how my mood swings affected my perception of things. And how that perception affected reality because it changed my actions and reactions. It's difficult to know what's normal when you live life on an emotional rollercoaster.
Good Luck!
KDi in TX
Posted by kotsunega on March 13, 2004, at 21:45:17
In reply to How can one tell if a pig is in a good mood?, posted by KimberlyDi on March 12, 2004, at 16:29:49
> I'm a possible rapid-cycler, undiagnosed, and having good success on my first mood stabilizer. I don't think being diagnosed "BP" is terrible. Living through it undiagnosed is what would be terrible. I can look back and see how my mood swings affected my perception of things. And how that perception affected reality because it changed my actions and reactions. It's difficult to know what's normal when you live life on an emotional rollercoaster.
>
> Good Luck!
> KDi in TXYou're so right. I am a rapid cycler leaning to the manic side. My mood drug of choice is Zyprexa, and I'm telling you, until I started taking it 3 years ago, my life was in ruins. What a difference in perception and actions finding the right drug can make!!
kotsunega
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