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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Cath78 on January 16, 2001, at 18:08:15
I've been diagnosed as having Aytypical Bi-Polar disorder. My doc thinks that I need a combination of an antidepressant and mood-stabilizer.
I've never experienced a manic episode.
I don't want to take a mood-stabilizer because I don't think my mood needs stabilizing, I mean isn't normal to experience various moods over the course of a day?
As long as my mood doesn't dip too low too frequently, then I'm happy with my changing moods. I don't want to feel blah all the time which is my reason for not wanting to take lithium or depakote or tegretol or any of those other drugs.
Am I wrong about what these drugs are supposed to do for me? Can they really boost the anti-depressant effect of the lithium without making me feel blah or flat all the time?
Posted by JohnL on January 17, 2001, at 2:29:22
In reply to Mood Stabilizers to combat Depression, no mania, posted by Cath78 on January 16, 2001, at 18:08:15
> I've been diagnosed as having Aytypical Bi-Polar disorder. My doc thinks that I need a combination of an antidepressant and mood-stabilizer.
> I've never experienced a manic episode.
> I don't want to take a mood-stabilizer because I don't think my mood needs stabilizing, I mean isn't normal to experience various moods over the course of a day?
> As long as my mood doesn't dip too low too frequently, then I'm happy with my changing moods. I don't want to feel blah all the time which is my reason for not wanting to take lithium or depakote or tegretol or any of those other drugs.
> Am I wrong about what these drugs are supposed to do for me? Can they really boost the anti-depressant effect of the lithium without making me feel blah or flat all the time?Hi Cath,
Ya know, I tend to feel that if 'blahness' is the main complaint, then mood stabilizers are not appropriate. I mean, anything is possible, and I could be all wrong, but generally I focus on other meds first before trying mood stabilizers.If you do go the mood stabilizer route, I think Lithium or Lamictal might be your best shots. I've tried them all. I found Tegretol or Depakote to be a bit on the dulling lethargic side, while Lithium or Lamictal were a bit on the stimulating side. But none of them did anything for my blahness except maybe make it worse. Lamictal helped in terms of social interaction, but I really had no interest in anything. But I was at least functional.
Generally I don't like antidepressants or mood stabilizers for the 'blahness' type of depression. If one is feeling blah all the time, yet not really severely depressed and not crying all the time, then usually an uplifting med seems more appropriate to me. In the SSRI category, that would be Prozac. In the tricyclic category it would be Desipramine. Ritalin or Adderall can be very helpful. Wellbutrin sometimes is helpful, though my doc has only seen spotty results with it. More often than not though I've seen the best improvements with a combination of low dose antipsychotic plus low dose stimulant. I for example did OK with Zyprexa and Ritalin, after not doing well with anything else, but I found I did the best with Amisulpride+Adrafinil (antipsychotic+stimulant). This has completely blown away any antidepressant or mood stabilizer I've ever taken. Blown them in the weeds. I do like a little Prozac in the background.
If your doc ends up putting you on Celexa or Paxil or Effexor or something like that, it would not surprise me at all if you improved in some ways, yet were not helped all that much in ways that are important. These meds don't often do much for the 'blahs'. Sometimes, but usually not. In other words, nowhere near getting completely well. And if your doc is sold on the atypical bipolar thing, then point out to him that Zyprexa (antipsychotic) is now approved for bipolar. Risperdal is very similar, though not as sedating, so it might be even a better choice, though it hasn't been officially approved for bipolar. You might want to do all you can to steer your doc in the antipsychotic+stimulant line of thinking and avoid years of frustration with the other likely meds that might be prescribed. And all you would need is small doses, versus possibly large doses of other meds.
Of course I could be all wrong. There are people who have experienced miracles with Lithium, SSRIs, Depakote, etc. I'm just trying to line up your best odds for success right from the get-go. You can always fall back to other meds if the higher-probability ones don't work out. No sense in starting with the lower-probability ones, which SSRIs and mood stabilizers are, as I see I it.
John
Posted by Cath78 on January 17, 2001, at 14:33:42
In reply to Re: Mood Stabilizers to combat Depression, no mania, posted by JohnL on January 17, 2001, at 2:29:22
John,
Thanks for your opinion and for sharing your experience and ideas regarding these medications. I've been on effexor, wellbutrin, prozac, depakote, lithium, trileptal, and ritalin (not all together at the same time). Prozac did nothing for me. Wellbutrin made me weak and dizzy. Effexor brought me out of being suicidal but it also disrupted my sleep patterns, took away my appetite, made me tired, and generally wasn't what I needed. Depakote didn't lift my blah mood and made me a little more drowsy. I'm not sure what lithium accomplished. Ritalin was nice in that it energized me but it also made me feel on edge all the time. Trileptal made me nauseous and tired. I'm currently on Nuerontin and Zoloft. I have no significant complaints about the zoloft but I'm still kind of blah and I'm not feeling like doing much of anything, but I am doing a lot of things anyway because the zoloft makes that possible. I haven't figured out whether or not I like neurontin yet.
Cath
Posted by JohnL on January 17, 2001, at 17:28:36
In reply to Re: Mood Stabilizers to combat Depression, no mania, posted by Cath78 on January 17, 2001, at 14:33:42
> John,
>
> Thanks for your opinion and for sharing your experience and ideas regarding these medications. I've been on effexor, wellbutrin, prozac, depakote, lithium, trileptal, and ritalin (not all together at the same time). Prozac did nothing for me. Wellbutrin made me weak and dizzy. Effexor brought me out of being suicidal but it also disrupted my sleep patterns, took away my appetite, made me tired, and generally wasn't what I needed. Depakote didn't lift my blah mood and made me a little more drowsy. I'm not sure what lithium accomplished. Ritalin was nice in that it energized me but it also made me feel on edge all the time. Trileptal made me nauseous and tired. I'm currently on Nuerontin and Zoloft. I have no significant complaints about the zoloft but I'm still kind of blah and I'm not feeling like doing much of anything, but I am doing a lot of things anyway because the zoloft makes that possible. I haven't figured out whether or not I like neurontin yet.
>
> Cath
Cath,
Based on what you've told me, you sound to me like a perfect candidate for Amisulpride+Adrafinil, with low dose Zoloft in the background if you like. Zoloft can itself be kind of numbing to emotions, so maybe just a tad in the background would be fine, while the other meds do the real work.The blahness is likely dopamine and norepinephrine related. Not likely serotonin related. To narrow it down further, it probably doesn't have much to do with low levels of NE or dopamine. Wellbutrin or Effexor would have worked better than they did otherwise. Hypo-dopamine function sounds likely to me. Hypo NE function too. Amisulpride will stimulate dopamine, yet in a different way than stimulants. Much kinder and gentler without the edginess and roller coaster rides. Adrafinil will help the NE along, stimulating existing levels of NE without increasing the levels. Kind of like greasing an engine to run better. Either one alone I feel confident would help you more than any of the other meds you've taken. But both together is so much better. Both are effective--I would guess 85% of the time--at restoring interest, motivation, and energy, while at the same time providing a sense of calm, social comfort, and confidence. In short, they are not friendly at all to dysthymia, depression, or especially the blahs. These drugs hate the blahs and blow the blahs right off the map.
It is a different arena though. One must mailorder one's own meds from a European source, pick it up out of the mailbox about a week or two later, and begin a dosing schedule without ever speaking to a doctor about. It does take some getting used to. It took me years of trials and failures before I finally resorted to some of the wonderful European meds, and I'm now kicking myself in the ass that it took so long. In Europe Adrafanil is considered to be far superior to the Prozacs of the world.
The FDA is so slow. The USA has the slowest most burdensome drug approval program in the entire world. One of the benefits is that safety is the top priority (though even here the FDA makes plenty of mistakes despite its best efforts). The downfall is that millions of people who could benefit from a foreign med must continue to suffer or die instead. But the internet has changed all that. With the internet, there are no borders. International mailorder pharmacies can legally mail you just about anything except stimulants and narcotics. Just something to think about.
I think you are a prime candidate for Amisulpride+Adrafinil. I'll spare you my lengthy reasoning. But just so you know, I believe the wonder drugs you seek already exist and are helping other right here at this board. But they don't come from the USA. They come in the mail. Just something to think about.
John
Posted by Bob on January 17, 2001, at 22:20:26
In reply to Re: Mood Stabilizers to combat Depression, no mania, posted by JohnL on January 17, 2001, at 17:28:36
> > John,
> >
> > Thanks for your opinion and for sharing your experience and ideas regarding these medications. I've been on effexor, wellbutrin, prozac, depakote, lithium, trileptal, and ritalin (not all together at the same time). Prozac did nothing for me. Wellbutrin made me weak and dizzy. Effexor brought me out of being suicidal but it also disrupted my sleep patterns, took away my appetite, made me tired, and generally wasn't what I needed. Depakote didn't lift my blah mood and made me a little more drowsy. I'm not sure what lithium accomplished. Ritalin was nice in that it energized me but it also made me feel on edge all the time. Trileptal made me nauseous and tired. I'm currently on Nuerontin and Zoloft. I have no significant complaints about the zoloft but I'm still kind of blah and I'm not feeling like doing much of anything, but I am doing a lot of things anyway because the zoloft makes that possible. I haven't figured out whether or not I like neurontin yet.
> >
> > Cath
>
>
> Cath,
> Based on what you've told me, you sound to me like a perfect candidate for Amisulpride+Adrafinil, with low dose Zoloft in the background if you like. Zoloft can itself be kind of numbing to emotions, so maybe just a tad in the background would be fine, while the other meds do the real work.
>
> The blahness is likely dopamine and norepinephrine related. Not likely serotonin related. To narrow it down further, it probably doesn't have much to do with low levels of NE or dopamine. Wellbutrin or Effexor would have worked better than they did otherwise. Hypo-dopamine function sounds likely to me. Hypo NE function too. Amisulpride will stimulate dopamine, yet in a different way than stimulants. Much kinder and gentler without the edginess and roller coaster rides. Adrafinil will help the NE along, stimulating existing levels of NE without increasing the levels. Kind of like greasing an engine to run better. Either one alone I feel confident would help you more than any of the other meds you've taken. But both together is so much better. Both are effective--I would guess 85% of the time--at restoring interest, motivation, and energy, while at the same time providing a sense of calm, social comfort, and confidence. In short, they are not friendly at all to dysthymia, depression, or especially the blahs. These drugs hate the blahs and blow the blahs right off the map.
>
> It is a different arena though. One must mailorder one's own meds from a European source, pick it up out of the mailbox about a week or two later, and begin a dosing schedule without ever speaking to a doctor about. It does take some getting used to. It took me years of trials and failures before I finally resorted to some of the wonderful European meds, and I'm now kicking myself in the ass that it took so long. In Europe Adrafanil is considered to be far superior to the Prozacs of the world.
>
> The FDA is so slow. The USA has the slowest most burdensome drug approval program in the entire world. One of the benefits is that safety is the top priority (though even here the FDA makes plenty of mistakes despite its best efforts). The downfall is that millions of people who could benefit from a foreign med must continue to suffer or die instead. But the internet has changed all that. With the internet, there are no borders. International mailorder pharmacies can legally mail you just about anything except stimulants and narcotics. Just something to think about.
>
> I think you are a prime candidate for Amisulpride+Adrafinil. I'll spare you my lengthy reasoning. But just so you know, I believe the wonder drugs you seek already exist and are helping other right here at this board. But they don't come from the USA. They come in the mail. Just something to think about.
> JohnJohn:
I have seen you post quite a bit on this board lately in strong support of the your patented "A&A" combo. It must really be working very well for you. How long have you been on it?
Bob
Posted by JohnL on January 18, 2001, at 2:46:04
In reply to Re: Mood Stabilizers to combat Depression, no mania, posted by Bob on January 17, 2001, at 22:20:26
> John:
>
> I have seen you post quite a bit on this board lately in strong support of the your patented "A&A" combo. It must really be working very well for you. How long have you been on it?
>
> BobHi bob,
The patented A&A combo! :-) That's funny. I guess I do push this combo, but only in certain cases. Primarily cases where several meds from several different categories have already been tried, the type of depression is characterized by prominent blahness, or someone is just fed up with the whole routine. When frustration mounts, I think it's important to know that other avenues exist. Hope is crucial. Sometimes just by someone's description of their depression I can get the sense in advance that SSRIs will be disappointing, and that A&A would be better. A&A is especially well suited for certain types of depression, but probably not for any type of depression. A&A I don't think would be a good choice for someone suffering from depression with significant anxiety. Not that A&A would worsen anxiety, though I guess it's possible, but anxiety generally needs more of a serotonin or GABA approach instead of a dopamine/NE approach. The blah kind of depression though is a different beast. Our common meds seem rather impotent at treating this kind.Unlike SSRIs or mood stabilizers, which would likely do zip for a non-depressed person, A&A can provide benefits to anyone, not just someone with a chemical imbalance. And as has been noticed here by a small handful of people who have tried A&A after being disappointed with just about everything else, improvement is very likely. While the odds for success with any random drug are about 70%, I would roughly guess the odds for success with A&A is probably closer to 85% or 90%. Just a guess though. Nothing at all scientific.
I've been on this combo now for a few months. Though I experienced improvement rather quickly, I must admit I still am experiencing gradual steady improvement as time goes on. Each passing week seems a tad better than the previous week.
John
Posted by phillybob on January 21, 2001, at 21:59:19
In reply to Mood Stabilizers to combat Depression, no mania, posted by Cath78 on January 16, 2001, at 18:08:15
Cath, you might find the following two recent discussion threads helpful reading: Depakote for Dysthymia ( http://www.dr-bob.org/babble/20010111/msgs/51535.html ) and Topamax Experiences ( http://www.dr-bob.org/babble/20001231/msgs/50878.html ).
John, also, in one, I asked a question of you in regards to your own symptoms. I now see you've been on the A&A combo for 2 months. That's a lifetime for me, medication-wise, (and much of us)! What are the side effects of such and are there any know long term side effects?
This is the end of the thread.
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