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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by alexa on May 2, 2001, at 3:16:53
I have now been hospitalized 4 times within a one year's period and am afraid that it will happen again and again. They were all suicide attempts, but this last time was the most serious and it was all impulse. Can anyone out there shed some light on their experience?
I really hate being bipolar. I inherited it from my Mom - who was only just diagnosed 2 years ago. So, growing up was absolute hell. I wish that I didn't have to feel so incapacitated and so scrutinized by my family. I want to feel like the independant person I want to be.
I'm on 50mg Topomax at 9am and 50mg at 5pm, plus 450mg Effexor at 9am and 100mg Seroquel at 9pm. I also take Klonopin 3x day at .5mg and PRN. Having to take the pills also gets to me because I get to resent having to take them. I just want to feel...normal - if there is such a thing. I have lost 10lbs on the Topomax, but it is also, I believe, because I got off of the Depakote and Zyprexa (they were awful because they made me so incredibly groggy that I got into 2 car accidents on my commutes.)
I'm just wishing that I can lead a normal life here. But, my family wants me to move back home (3000mi away) so that they can watch over me. But, I love it here in California, I really do. I think that the sunlight and the mountains bring me joy.
Thank you all for listening.
Alexa
Posted by judy1 on May 2, 2001, at 9:59:51
In reply to Topomax, Just out of the Hospital, and Bipolar, posted by alexa on May 2, 2001, at 3:16:53
Dear Alexa,
I'm sorry you are having such a difficult time. Having grown up with a manic- depressive father and dxed bipolar myself I can really identify here. First of all, it's pretty obvious your med regime isn't working if this is your 4th hospitalization in a year. Effexor is about as destabilizing as they come (and don't let your pdoc tell you otherwise)- you should not be on any antidepressants. As far as the other 3, I'm surprised you don't spend 24 hours/day in bed, but maybe the effexor gave you the energy for the suicide attempt (been there too). I truly hope you are getting therapy, the luggage of having a parent with this disorder is tremendous. And I may be biased about agreeing with you about California- but I believe it helps too (at least until the electric bill comes) and unless your Mom is stable, that really can't help you much now. I'm pregnant and just taking klonopin, and until recently relied a great deal on therapy- I know I need to go back. But read the threads on topomax, most people don't like it. Lamictal has a fairly low side-effect profile and will work well for your depression. Are you psychotic now? If not, why are you on seroquel? Are you anxious or having panic attacks- klonopin? If you are close to a University, ask the Dept. of Psychiatry if they can recommend a bipolar expert- and make sure they understand how difficult it is for you to take 4 different drugs. I wish you all the best- judy
Posted by alexa on May 2, 2001, at 19:21:13
In reply to Re: Topomax, Just out of the Hospital, and Bipolar » alexa, posted by judy1 on May 2, 2001, at 9:59:51
I don't know what you mean about Effexor being destabilizing? Please tell me more. I'm at 450mg/day.
They told me the Seroquel 100mg/day was to help give me clear thoughts (no, not psychotic that I know of, but my mom is :(
Thanks
alexa
Posted by SalArmy4me on May 3, 2001, at 1:11:17
In reply to Re: Topomax, Just out of the Hospital, and Bipolar, posted by alexa on May 2, 2001, at 19:21:13
On the contrary--Dr. Bob's colleagues agreed that bipolars do better on venlafaxine and buproprion than on other antidepressants: http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html
> I don't know what you mean about Effexor being destabilizing? Please tell me more. I'm at 450mg/day.
>
> They told me the Seroquel 100mg/day was to help give me clear thoughts (no, not psychotic that I know of, but my mom is :(
>
>
> Thanks
>
>
> alexa
Posted by KarenK on May 5, 2001, at 14:11:36
In reply to Topomax, Just out of the Hospital, and Bipolar, posted by alexa on May 2, 2001, at 3:16:53
Dear Alexa,
My teenage son has bipolar and hates it every bit as much as you do. Every bit as much as I do. It is absolute hell. And normal looks better than normal should look.
After looking at your meds, it doesn't look like your pdoc has a plan. You said you were on depakote and zyprexa so I'm guessing you gained weight and then came the topamax so you could lose the weight. Now you were also complaining of being too groggy from the depakote, maybe even depressed, so you get the effexor. Trade in the depakote/zyprexa combo for seroquel but it's not always enough to counteract the edginess you feel from the effexor so now you have to take klonopin PRN. With bp in a crisis mode unfortunately this happens. You don't have time to plan. But if things are quiet now, it might be time to review what each drug is there for and if your meds can be simplified. You should really have a mood stabilizer in there. The basic three are depakote, lithium, or tegretol.
You didn't say where you are in California but there are experts in bipolar at Stanford University. One name I've heard is Dr. Chang.
I wish you the very best of luck and send you cyber hugs
KarenK
Posted by alexa on May 7, 2001, at 13:07:58
In reply to Re: Topomax, Just out of the Hospital, and Bipolar, posted by KarenK on May 5, 2001, at 14:11:36
Dear Karen,
I wonder how your son is handling this as a teenager. I am 29 and handling a career in Mechanical Engineering and he has more on his plate as a teenager growing up and I feel for him and his emotions as well as for you and your concerns. My roommate - who is 10yrs older than I - serves as my best friend and also as my "older sister" - watching over me and my mental health. I love her to death, but sometime, more often than not, the resentment of this chemical imbalance causes me to feel a great deal of resentment toward her that is not her fault - it isn't warranted. But, it is because she loves me that she makes me stick to the rules of the meds, the sleep times, the alchol, etc.
I thought that the Topomax served as the Mood Stabilizer. I just recently suggested to the pdoc to up my dosage to 200mg/day because I was feeling the edginess and moodiness at work and was feeling like I was unable to focus. I also have and have had eating disorder issues currently and in the past and the topomax is working to make me lose weight. I've lost 16lbs so far in 1 month. A year ago I was anorexic and for the past 3yrs have been battling bulimia. So, the Depakote/Zyprexa combo of gaining 40lbs was REALLY depressing for me. It was really awful.Now, I find that the Effexor (450mg), Topomax (200mg), Seroquel (100mg), and Klonopin (.5 4X/day) is working out pretty smoothly so far.
I wish the best for you and especially for your son. I have been hospitalized now 4 times in a one year period and hope that he does not have to experience that at all! I've been learning more with each hospital visit and do not claim to be "perfect" yet. I know that inside of me that there is the side that wants to be healthy and follow the rules. And yet, there is the other side that wants to throw in the towel and say, foget it, it's not worth it, I'm stuck with this awful illness that no one will love me for.
At that point, it is so important for me to remember that I have such a loving family that each and every one in it accepts me no matter what and is not afraid of me and will not treat me any different no matter what I've done - suicide attempts (4 times) (hospitalizations) (impulsive desisions)- that my family will stand by me and hug me and hug me even more and will try to understand my illness. That is all that I ask of them. And slowly, my family is understanding me. It is a slow process, but it makes me happy to know that they are trying their best to understand the highs and the lows and the dark periods and the darker periods.
I wish you and your son the best and I send the both of you a great big cyber hug and kiss.
Love,Alexa
Posted by judy1 on May 8, 2001, at 11:20:57
In reply to Re: Topomax, Just out of the Hospital, and Bipolar, posted by alexa on May 7, 2001, at 13:07:58
> I thought that the Topomax served as the Mood Stabilizer. I just recently suggested to the pdoc to up my dosage to 200mg/day because I was feeling the edginess and moodiness at work and was feeling like I was unable to focus. I also have and have had eating disorder issues currently and in the past and the topomax is working to make me lose weight. I've lost 16lbs so far in 1 month. A year ago I was anorexic and for the past 3yrs have been battling bulimia. So, the Depakote/Zyprexa combo of gaining 40lbs was REALLY depressing for me. It was really awful.
Alexa- I've had consults with some of the top bipolar people in the country (including Akiskal) and each of them said that ALL AD's were destabilizing including Wellbutrin and Effexor. I want to add that I have bipolar 1, rapid cycling and perhaps may be more susceptible than you. But I have to wonder why you needed more topamax- is it possible that your fairly high dose of effexor is causing the moodiness you're experiencing? I also had an eatind disorder and gained a great deal of weight on Zyprexa and went on Topamax with the intent of losing it, but it dulled my cognitive abilities a great deal. When you originally posted you indicated you were distressed by the polypharmacy your pdoc was using; my suggestions were a way of perhaps reducing the # of meds you take. I wish you all the best.
P.S. When I had breakthough agitation, etc. my docs would simply add or up dosages- so that I was taking 6 meds at a time. It wasn't intil my present pdoc tapered me down to 2 that I realized they were treating side-effects of my meds instead of my illness. Disclaimer: This is my experience. Take care.
Posted by alexa on May 8, 2001, at 11:33:10
In reply to Alexa, posted by judy1 on May 8, 2001, at 11:20:57
Please explain more about the AD's being destabilizing. How is this know and is this known by everyone? Why would the pdocs prescribe an AD and a mood stabilizer and anti-anxiety med for bipolar if that were the case? Isn't an AD necessary to combat the depression?
Thanks for your insight,
Alexa
Posted by judy1 on May 9, 2001, at 18:04:43
In reply to Re: All AD's Destabilizing? » judy1, posted by alexa on May 8, 2001, at 11:33:10
Dear Alexa,
You might like to read Dr. Jim Phelp's site: http://psycheducation.com/ The rationale in treating bipolar disorder is optimizing the mood stabilizer in order to prevent depression and mania. The problem is while most mood stabilizers are efficient at preventing mania, depressive symptoms often remain. In my experience lamictal is the only one that does not induce depression (in fact I have become manic on it). I just read an article that while topamax was effective in weight loss, only 13% improved on it. Since you have had 4 episodes in a year (or more?) you qualify as a rapid cycler and should NOT take an AD. I worry about seroquel, while the pharmaceutical co.s claim atypicals cause less EPS than older AP's, I feel they are too new to have solid evidence to the contrary. I only use APs when psychotic- I have been in to many psych wards seeing the 'haldol shuffle' to fear their effects. I believe I already indicated I take klonopin for comorbid panic disorder, I have had over a dozen episodes in the last year and am considered 'treatment resistant'. I hope you read Dr. Phelp's site and realize that agitation may be your AD and not your illness. And please question your use of seroquel. I hope this helps- judy
Posted by SLS on May 10, 2001, at 6:44:57
In reply to Re: All AD's Destabilizing? » alexa, posted by judy1 on May 9, 2001, at 18:04:43
Hi Judy.
Sorry to bother you, but how do you go about finding, contacting, and consulting with the various experts who have helped with your case?
I don't see how my case (chronic bipolar depression) can be treated without antidepressants.
Thanks.
- Scott
Posted by Mitch on May 10, 2001, at 10:00:23
In reply to Re: All AD's Destabilizing? » judy1, posted by SLS on May 10, 2001, at 6:44:57
I have got bipolarII rapid cycling with a pattern that according to latest algorithms says that I shouldn't take AD's either. But, what if you also have comorbid anxiety disorders (like I do-social anxiety)? I went off all AD's for a couple of months-yes the "cycling" did fade, but I noticed that other symptoms of depression and hypomania-such as inability to concentrate/sleepiness and mental acuity/hyperactivity *continued*, it was just the *mood* "label" that lifted-I stopped feeling a few days of elation and a few days of melancholy out of every three week cycle. I wonder if they would study this closer they would find that eliminating AD's only helps with the most obvious *mood* labels-and the other constellations of symptoms are not being investigated.
> Hi Judy.
>
> Sorry to bother you, but how do you go about finding, contacting, and consulting with the various experts who have helped with your case?
>
> I don't see how my case (chronic bipolar depression) can be treated without antidepressants.
>
> Thanks.
>
>
> - Scott
Posted by judy1 on May 10, 2001, at 11:16:49
In reply to Re: All AD's Destabilizing? » judy1, posted by SLS on May 10, 2001, at 6:44:57
Dear Scott,
My shrink contacted Dr. Akiskal at UCSD and asked for a consult, also UCLA, etc. (I contacted Dr. Ivan Goldberg on my own) If I remember correctly you have predominant depressive symptoms and are not a rapid cycler. My comments to Alexis was in the context of her referring to 4 hospitalizations in a year which like me qualifies as rapid cycling.
P.S. You are one of my favorite people on this board, so please don't apologize. I know the struggle you have been going through with depression, and I agree with you that AD's are probably your only option. Take care, judy
Posted by judy1 on May 10, 2001, at 11:19:43
In reply to Re: All AD's Destabilizing? » SLS, posted by Mitch on May 10, 2001, at 10:00:23
Hi Mitch,
Are you currently on a benzo- I happen to think klonopin is the best choice in someone who has comorbid anxiety disorder. Good luck, judy
Posted by Mitch on May 10, 2001, at 23:20:54
In reply to Re: All AD's Destabilizing? » Mitch, posted by judy1 on May 10, 2001, at 11:19:43
Yes, I am currently taking Klonopin .5mg 2-3x times daily as well. But, I had trouble with "menacing" anxiety even with the Benzo-in other words I was on just Neurontin 100mg tid and
the Klonopin (that's it), and was still feeling what I call "black anxiety" (BUT without mood lability). It seems that only SSRI's help, but I can't tolerate more than just a tiny dose and they sure enough make the cycling more pronounced. My doc thinks I *also* have OCD like symptoms-which I discount-I think it is mostly GAD and Social Anxiety.> Hi Mitch,
> Are you currently on a benzo- I happen to think klonopin is the best choice in someone who has comorbid anxiety disorder. Good luck, judy
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