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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 judy1 on May 1, 2001, at 10:33:13
I read somewhere that people with bipolar disorder that start and stop meds (not just lithium) and continue to have multiple episodes eventually become treatment resistant to anything. Since I have stopped (again) because i'm pregnant- am i facing the same thing? and perhaps i already have gotten there. any thoughts?- thanks, judy
Posted by SLS on May 1, 2001, at 21:58:08
In reply to Anyone's exp. on discontinued meds, posted by judy1 on May 1, 2001, at 10:33:13
> I read somewhere that people with bipolar disorder that start and stop meds (not just lithium) and continue to have multiple episodes eventually become treatment resistant to anything. Since I have stopped (again) because i'm pregnant- am i facing the same thing? and perhaps i already have gotten there. any thoughts?- thanks, judy
Dear Judy,I think we have both seen this happen plenty of times with antidepressants. However, I don't think this phenomenon can be extrapolated to anticonvulsants or neuroleptic antipsychotics.
You are obviously aware of the notion proposed by several doctors in the early to mid 1990s that starting and stopping lithium might cause a refractoriness to responding to it subsequently. This was based primarily on anecdotal reports. I know someone whose case provides a perfect example of this. She was maintained on lithium for over 8 years. Despite a gradual weaning process, she relapsed into severe depression within three months. Lithium was restarted immediately. She did not respond to it. She has been refractory to countless drug treatments for the 16 years since. Despite these occasional stories, I don't think that the idea of lithium causing its own refractoriness has gained acceptance.
Again, I currently have the impression that one is not likely to become resistant to periodic exposure to anticonvulsants and neuroleptic antipsychotics as has become very evident with antidepressants.
I get the impression that depression is not your primary problem. However, it might be comforting to know that pregnancy itself can ameliorate and prevent depression. I don't know if pregnancy can have the same prophylactic effect against psychosis or mania, but I can't find any indication on Medline that pregnancy can cause them either. It is during the time just before delivery and the postpartum period that both depression and psychosis can emerge. If you decide to discontinue medications for your pregnancy, I think it would be important to restart them immediately upon giving birth, and not breast-feed if you deem it prudent not to.
I hope this has been helpful. Whenever a woman proceeds with a pregnancy, I think the magnitude of any risks drugs pose to the fetus must be weighed against those posed by a protracted severe psychiatric episode of the mother. I wish it were an easy decision for you to make. I can't identify.
- Scott
Posted by judy1 on May 2, 2001, at 11:42:05
In reply to Re: Anyone's exp. on discontinued meds, posted by SLS on May 1, 2001, at 21:58:08
Dear Scott,
Thank you so much for your thorough answer. I agree with the AP evaluation- i've stopped and started risperdal many times and it still worked. I wasn't sure about AEDs, I guess I have never had real success with any. My pdoc said 15% of people with bipolar disorder are treatment resistant to any med regime, that was sobering. There isn't a whole lot out there in terms of women and reproductive health and psychotropics (except maybe ssri's). I guess it's too dangerous to do research on that population. Again, thank you and take care, judy
Posted by SLS on May 3, 2001, at 10:14:54
In reply to Re: Anyone's exp. on discontinued meds » SLS, posted by judy1 on May 2, 2001, at 11:42:05
Hi Judy.
> My pdoc said 15% of people with bipolar disorder are treatment resistant to any med regime, that was sobering.
I think my doctor would disagree with the 15% number. He seems to be much more optimistic. I never bothered to ask about percentages. Perhaps I am afraid of to hear the answer. It really doesn't matter anyway. Right? I don't think I have any better choice than to keep trying, despite the statistics. (growl)
> There isn't a whole lot out there in terms of women and reproductive health and psychotropics (except maybe ssri's).
You are right. It is deplorable and without redemption. As often seems to be the case, woman are neglected by the men conducting medical research, except, of course, when they are horny.
Tricyclics have proven themselves safe for pregnancy. They have been around 20 years longer than Prozac.
> I guess it's too dangerous to do research on that population.
Probably the best way to retrieve information is to do retrospective studies through interview and medical records or set out to follow a cohort longitudinally.
From what I recall, it is generally advised that any suspect drug be discontinued during the first semester and later restarted if necessary. Also, with regard to Prozac, I believe I read (several years ago) that the only statistic to show any significant deviation from the norm was an increase in the rate of premature births. Most of the AEDs (anticonvulstants) and lithium can cause birth defects, particularly if taken during the first trimester.
The tricyclics (with the exception of doxepin) and sertraline (Zoloft) do not accumulate to any significant degree in breast milk. Prozac does appear in breast milk, and can lead to a reduced rate of weight increase for the infant, and perhaps an increase in colic.
***************************************************************One *extremely* important issue that I do not see mentioned very often is that the infant can experience a medication withdrawal syndrome after birth. I believe this is especially true of the SSRIs. As is the case with adults, it seems that Paxil is particularly liable to cause the SSRI withdrawal. My guess is that Effexor would carry a high risk as well. SSRI withdrawal symptoms occuring in newborns is documented.
***************************************************************
I really like your 10-20-30 rule. :-)
- Scott
Posted by Sulpicia on May 3, 2001, at 17:53:38
In reply to Anyone's exp. on discontinued meds, posted by judy1 on May 1, 2001, at 10:33:13
> Hi Judy--
I've had 2 kids, and had to continue on AD med thru 1 pregnancy.
I know the equation is different for bipolar [which my daughter has]
but FWIW, I wanted to pass along some hope: although the first trimester
can be a bear, with nausea and moodiness etc, as the estrogen level climbs
I *believe* you'll feel rather well as far as depression goes.
The last couple of weeks are physically uncomfortable but basically you're
stoned on estrogen.
Might you or your pdoc or ob/gyn find Andrew Stoll's [of Harvard]book/research
on EFA supplementation of use? I don't believe that he mentioned anyone off
meds but perhaps there might be something helpful?And of course, please don't forget to enjoy being pregnant.
Any little tapping feet or fluttering limbs in your tummy??
Be well,
Liz
Posted by SLS on May 3, 2001, at 20:57:11
In reply to Re: Anyone's exp. on discontinued meds » judy1, posted by Sulpicia on May 3, 2001, at 17:53:38
Hi Liz.
What is EFA?
What medication were you taking during your pregnancy? What sorts of things did you and your doctors take into consideration when you came to the decision to continue with drug treatment?
- Scott
> I've had 2 kids, and had to continue on AD med thru 1 pregnancy.
> I know the equation is different for bipolar [which my daughter has]
> but FWIW, I wanted to pass along some hope: although the first trimester
> can be a bear, with nausea and moodiness etc, as the estrogen level climbs
> I *believe* you'll feel rather well as far as depression goes.
> The last couple of weeks are physically uncomfortable but basically you're
> stoned on estrogen.
> Might you or your pdoc or ob/gyn find Andrew Stoll's [of Harvard]book/research
> on EFA supplementation of use? I don't believe that he mentioned anyone off
> meds but perhaps there might be something helpful?
>
> And of course, please don't forget to enjoy being pregnant.
> Any little tapping feet or fluttering limbs in your tummy??
> Be well,
> Liz
Posted by Sulpicia on May 3, 2001, at 22:23:20
In reply to Re: Anyone's exp. on discontinued meds » Sulpicia, posted by SLS on May 3, 2001, at 20:57:11
> Hi Liz.
>
> What is EFA?
>
> What medication were you taking during your pregnancy? What sorts of things did you and your doctors take into consideration when you came to the decision to continue with drug treatment?
>
>
> - Scott
> EFA=essential fatty acids, aka omega 3s, fish oil. According to Stoll's research, and using the RIGHT RATIO between 2 varieties [which of course I don't remember right now] resulted in significantly
fewer relapses for bipolars, ALL OF WHOM REMAINED ON MOOD STABILIZERS ETC. Sorry to shout but I wanted to be clear that this is not a *natural* cure. Stoll's research is as mainstream as it gets
and I thought it might be of use for Judy's docs.Pregnancy: tofranil
Considerations:
1) started up post 12 wks, out of the horror zone. Meds taken within the 1st trimester do the most damage.
2) little to no data that tofranil did anything bad.
3) prior history of depression and depression at the time -- which was incredibly horrible for various and sundry
*situational* reasons.
And frankly, I was waaaaaaaaay young and it was my first child. And not much of an info hound then either.
> Seems like ages ago........
Liz
>
This is the end of the thread.
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