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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Kingfish on June 26, 2001, at 18:41:50
Can anyone else share with me why they think their pdoc prescribes an AD and a mood stabilizer for Bipolar Disorder or BP II?
It seems to me that the right mood stabilizer alone should do the trick, but my pdoc just switched me from Celexa to Prozac to counteract my sedation problem with Topamax (which many of you are sick of hearing about) and it dawned on me too late that I should have asked this question (one AMenz had mentioned in a previous post).
I suppose I should point out that my "main" problem is depression, but I just recently came off a hypomanic episode and he felt I was depressed, which is probably true, but I'm afraid I'm just going to cycle back up.
So, why ever prescribe an AD for a Bipolar person?
Thanks!
- K.
Posted by sl on June 26, 2001, at 18:48:26
In reply to Why ever prescribe an AD for Bipolar Dis.?, posted by Kingfish on June 26, 2001, at 18:41:50
From my limited understanding, the [correct] AD keeps you from going down, the mood stabilizer keeps you from going up...and Voilá, you have a comfortable middle ground. :)
sl
> Can anyone else share with me why they think their pdoc prescribes an AD and a mood stabilizer for Bipolar Disorder or BP II?
>
Posted by SalArmy4me on June 26, 2001, at 20:48:16
In reply to Why ever prescribe an AD for Bipolar Dis.?, posted by Kingfish on June 26, 2001, at 18:41:50
Effexor and Wellbutrin are better ADs for the depression side of bipolar disorder:
From: LJGROLD@aol.com (L.James Grold M.D.)
Date: Fri, 16 Feb 1996 20:40:31 -0500
Subject: Possible indications of bipolarity"I have come to the same conclusion on several patients with recurrent depressions starting in adolescence. I also have found in such patients that venlafaxine and buproprion with a mood stablizer like divalproex to be very helpful in smoothing out the moods and in preventing more cycles..." http://www.dr-bob.org/tips/split/Possible-indications-of-bi.html
Posted by judy1 on June 26, 2001, at 23:34:36
In reply to Why ever prescribe an AD for Bipolar Dis.?, posted by Kingfish on June 26, 2001, at 18:41:50
A lot of bipolar experts feel AD's do worsen cycling in bipolar disorder, so I agree with you. Lamictal is probably the only mood stabilizer proven to have AD properties- is that something you have tried yet?- judy
Posted by Kingfish on June 27, 2001, at 7:32:57
In reply to Re: Why ever prescribe an AD for Bipolar Dis.? » Kingfish, posted by judy1 on June 26, 2001, at 23:34:36
I haven't tried Lamictal because my pdoc's wary of switching the Topamax since it has worked. I was going to suggest tapering off the Celexa and adding Lamictal when he came up with adding Prozac.
I really like him so don't want to get into a situation where I need to seek a second opinion.
Thanks for yours, though. :)
Posted by Kingfish on June 27, 2001, at 7:36:56
In reply to Re: Why ever prescribe an AD for Bipolar Dis.?, posted by sl on June 26, 2001, at 18:48:26
I hadn't thought of it that way - I guess I'll see if this helps and if I feel better but then don't go back up again, the theory will be proven for me.
I still wonder why a "stabilizer" can't do both, though. I guess they just don't know how they work, realy yet, anyhoo. I want everything to do exactly as it says. :)
Thanks for your input!
> >
Posted by judy1 on June 27, 2001, at 10:42:59
In reply to Re: Why ever prescribe an AD for Bipolar Dis.? » judy1, posted by Kingfish on June 27, 2001, at 7:32:57
I used to feel a lot like you, that maybe my pdoc would be insulted if I wanted another opinion. Actually my ex-shrink was (this is the one where there were major boundary transgressions on his part); basically he told me (and this was over lamictal!) that if I wanted to go on it I would have to see someone for at least 6 months for treatment and he wouldn't see me. I realize now this was all part of our relationship- power- ego whatever problems. With my shrink now, if I ever want to try a new med or have questions- he'll actually make the phone call. But we have a healthy therapeutic relationship, maybe you need to examine your own feelings and better yet discuss with him your fears of 'rocking the boat'. I only say this is because lamictal has been a very beneficial med in a lot of people and I don't want to see you suffer. Okay off my soapbox :-) judy
Posted by Elizabeth on June 27, 2001, at 12:48:28
In reply to Why ever prescribe an AD for Bipolar Dis.?, posted by Kingfish on June 26, 2001, at 18:41:50
> Can anyone else share with me why they think their pdoc prescribes an AD and a mood stabilizer for Bipolar Disorder or BP II?
Yeah, sure. Mood stabilisers often don't work so great for depression, even the ones with known AD qualities like lithium and Lamictal. And some BPs have really bad depressions as well as manias or hypomanias.
The important thing is never to prescribe an AD *alone* to a bipolar patient!
-elizabeth
Posted by Elizabeth on June 27, 2001, at 12:52:40
In reply to Re: Why ever prescribe an AD for Bipolar Dis.?, posted by SalArmy4me on June 26, 2001, at 20:48:16
> Effexor and Wellbutrin are better ADs for the depression side of bipolar disorder
Wellbutrin has been shown to be less likely to trigger mania than some of the other ADs -- this is pretty well-established. Tricyclics are the worst; SSRIs, Remeron, and Serzone don't seem to be as bad; but Effexor has a variable reputation, and I've known pdocs who feel that Effexor is worse in this regard than other newer ADs.
-elizabeth (who had a manic episode associated with serotonin syndrome on Effexor)
Posted by Mitch on June 29, 2001, at 1:29:42
In reply to Re: Why ever prescribe an AD for Bipolar Dis.? » SalArmy4me, posted by Elizabeth on June 27, 2001, at 12:52:40
I don't think that drug category *alone* can determine what is most likely to trigger hypomania or worsened cyling. I have had desipramine make me obviously hypomanic, while nortriptyline (at equiv. doses) did not. Remeron made me irritable, but Wellbutrin did not. Serzone didn't help with depression, but settled my agitation. Everyone is different and you can't *slam* any particular drug category.
Mitch
Posted by Kingfish on June 29, 2001, at 7:37:21
In reply to Re: Why ever prescribe an AD for Bipolar Dis.? » SalArmy4me, posted by Elizabeth on June 27, 2001, at 12:52:40
Thanks to everyone for their help!!
This is the end of the thread.
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