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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by cb on August 9, 2001, at 17:58:22
Please help! My 16 yr. old son, diagnosed bipolar 2 yrs ago spent a few months in the hospital this spring. He was discharged on wellbutrin, lithium, neurontin, zyprexa and synthroid. For the last few months he has been suffering from severe anxiety (anxiety was not a problem before these meds.. His dr. has reduced the wellbutrin and zyprexa and discontinued the neurontin. Still severely anxious. Two nights ago, he started on Klonopin - with no improvement in the anxiety - In fact, he seems more anxious and hostile. He will be going back to high school in a couple of weeks but only if he can get this pervasive anxiety under control. I've been reading on this site for the last couple of months and I think you all are the experts. Please help!
--anxious Mom
Posted by Ted on August 9, 2001, at 18:54:07
In reply to bipolar meds and anxiety, posted by cb on August 9, 2001, at 17:58:22
For anxious/angry bipolar symptoms, I swear by SSRI + depakote. I take zoloft, wellbutrin, & depakote. Also, wellbutrin has the tendency to stimulate anxiety, while SSRIs tend to reduce it. Remember: one patient's medicine is another's poison.
Ted
> Please help! My 16 yr. old son, diagnosed bipolar 2 yrs ago spent a few months in the hospital this spring. He was discharged on wellbutrin, lithium, neurontin, zyprexa and synthroid. For the last few months he has been suffering from severe anxiety (anxiety was not a problem before these meds.. His dr. has reduced the wellbutrin and zyprexa and discontinued the neurontin. Still severely anxious. Two nights ago, he started on Klonopin - with no improvement in the anxiety - In fact, he seems more anxious and hostile. He will be going back to high school in a couple of weeks but only if he can get this pervasive anxiety under control. I've been reading on this site for the last couple of months and I think you all are the experts. Please help!
> --anxious Mom
Posted by Maung on August 9, 2001, at 19:01:19
In reply to bipolar meds and anxiety, posted by cb on August 9, 2001, at 17:58:22
> Please help! My 16 yr. old son, diagnosed bipolar 2 yrs ago spent a few months in the hospital this spring. He was discharged on wellbutrin, lithium, neurontin, zyprexa and synthroid. For the last few months he has been suffering from severe anxiety (anxiety was not a problem before these meds.. His dr. has reduced the wellbutrin and zyprexa and discontinued the neurontin. Still severely anxious. Two nights ago, he started on Klonopin - with no improvement in the anxiety - In fact, he seems more anxious and hostile. He will be going back to high school in a couple of weeks but only if he can get this pervasive anxiety under control. I've been reading on this site for the last couple of months and I think you all are the experts. Please help!
> --anxious MomI'm sorry to hear of your son's difficult time right now. How long has your son been on Wellbutrin? Often times, pdocs prescribe wellbutrin to bipolars because it is an antidepressant least associated with cycle acceleration....however, some side affects can be anxiety and hostility...they can be dose related and may go away with time. You might want to call your pdoc and ask these questions...if your son's symptoms don't go away perhaps your pdoc could switch him to another antidepressant. There are many other antidepressants your pdoc can try if Wellbutrin doesn't work.
Posted by cb on August 9, 2001, at 19:17:09
In reply to Re: bipolar meds and anxiety, posted by Maung on August 9, 2001, at 19:01:19
> Thanks for such a quick response! His problem with antidepressants is that they tend to make him manic. Zoloft was great for the depression but always led to manic episodes. He's tried Paxil and Celexa as well. Same results. After each manic episode he tries to get by without an AD but gets very depressed. Before his hospitalization he was on depakote and celexa - he ended up suicidal (mixed state?). Dr said no more SSRIs - the nurses at the hopital swear that the SSRIs lead to mania regularly.
His wellbutrin was lowered from 400 mg a day to 300 mg but it doesn't seem to have reduced the anxiety. Dr. thinks synthroid may be contributing to it? SHouldn't the klonopin have helped.
Thanks again - you are great!
Posted by Maung on August 9, 2001, at 21:37:17
In reply to Re: bipolar meds and anxiety, posted by cb on August 9, 2001, at 19:17:09
> > Thanks for such a quick response! His problem with antidepressants is that they tend to make him manic. Zoloft was great for the depression but always led to manic episodes. He's tried Paxil and Celexa as well. Same results. After each manic episode he tries to get by without an AD but gets very depressed. Before his hospitalization he was on depakote and celexa - he ended up suicidal (mixed state?). Dr said no more SSRIs - the nurses at the hopital swear that the SSRIs lead to mania regularly.
> His wellbutrin was lowered from 400 mg a day to 300 mg but it doesn't seem to have reduced the anxiety. Dr. thinks synthroid may be contributing to it? SHouldn't the klonopin have helped.
> Thanks again - you are great!A general rule that my pdoc follows, especially when, like your son, you are taking several mediciations and then suddenly begin experiencing bad side effects, is to try and determine which drug was added most recently; or if no drug was added,what dosage increased or decreased...that often is the "culprit"; that may be why your pdoc suspects the synthroid. Is that the medication most recently added to your son's drug regimen? I am surprised the klonopin didn't help alleviate his anxiety...perhaps your son could benefit from a higher dose. Let us know how your son is doing.
Posted by Ted on August 9, 2001, at 21:47:39
In reply to Re: bipolar meds and anxiety, posted by cb on August 9, 2001, at 19:28:10
Well, the doctors and nurses are right -- SSRIs will often trigger mania -- but that shouldn't happen if a mood suppressor is prescribed properly. That is how my bipolar disorder was discovered in fact. But in my opinion, if the mania is still happening with a mood suppressor, then I think the mood suppressor needs a dose increase.
I would drop the wellbutrin quite a lot, maybe even eliminate it. Then jump to an SSRI in low dose (probably zoloft or celexa -- they seem the weakest) and simultaneously raise the mood suppressor (neurontin or depakote or lithium) to maintain stability. If SSRIs are totally out of the question, even at low doses, then try a tricyclic like desipramine, but I think tricyclics have the same problem as SSRIs when it comes to triggering mania.
>he ended up suicidal (mixed state?).
Possibly. That is how I was a few years ago, without meds.
>Synthroid cause?
I doubt it, but others can probably provide better info.
>SHouldn't the klonopin have helped.
Eventually, yes, if enough is taken. But that is the wrong tool for this problem.
Ted
> > Thanks for such a quick response! His problem with antidepressants is that they tend to make him manic. Zoloft was great for the depression but always led to manic episodes. He's tried Paxil and Celexa as well. Same results. After each manic episode he tries to get by without an AD but gets very depressed. Before his hospitalization he was on depakote and celexa - he ended up suicidal (mixed state?). Dr said no more SSRIs - the nurses at the hopital swear that the SSRIs lead to mania regularly.
> His wellbutrin was lowered from 400 mg a day to 300 mg but it doesn't seem to have reduced the anxiety. Dr. thinks synthroid may be contributing to it? SHouldn't the klonopin have helped.
> Thanks again - you are great!
Posted by Cam W. on August 9, 2001, at 21:49:10
In reply to bipolar meds and anxiety, posted by cb on August 9, 2001, at 17:58:22
Mom - Sometimes the Klonopin (and other benzodiazepines), in younger people, has an idiosyncratic effect; where it can cause hostility and anxiety, rather than having the relaxing effect that it should have, possibly something to do with a maturing neurotransmitter system in a teen. It is best to call his doc and tell him/her about the increase in his symptoms.
Hang in there mom; we're cheering for you. - Cam
Posted by cb on August 9, 2001, at 23:00:26
In reply to Re: bipolar meds and anxiety, posted by Ted on August 9, 2001, at 21:47:39
> Thanks for all of your input. I will get him to the doc tomorrow and will share this info. He has a great relationship with the doctor but he admits that they (the medical profession) don't always have the right answers! The hospital doc sees a lot of kids and is a bipolar expert but the combination of all of these meds at the doses he had prescribed left my son pretty "drugged" and not too functional. His regular doc is trying to get it figured out. My son is worried about "doing the academics" in this state. We keep hoping for the right combo but I recognize that it is getting frustrating for him - high school is tough enough without dealing with all of these med switches. I really appreciate your input - we'll let you know what they do next! Thanks again.
Posted by Mitch on August 9, 2001, at 23:54:25
In reply to bipolar meds and anxiety, posted by cb on August 9, 2001, at 17:58:22
> Please help! My 16 yr. old son, diagnosed bipolar 2 yrs ago spent a few months in the hospital this spring. He was discharged on wellbutrin, lithium, neurontin, zyprexa and synthroid. For the last few months he has been suffering from severe anxiety (anxiety was not a problem before these meds.. His dr. has reduced the wellbutrin and zyprexa and discontinued the neurontin. Still severely anxious. Two nights ago, he started on Klonopin - with no improvement in the anxiety - In fact, he seems more anxious and hostile. He will be going back to high school in a couple of weeks but only if he can get this pervasive anxiety under control. I've been reading on this site for the last couple of months and I think you all are the experts. Please help!
> --anxious Mom
AnxMom,What is his dose of synthroid? His pdoc may be trying to quell his cycling with it and may be dosing him too high. Has he had a TSH level drawn recently?
Mitch
Posted by ChrisK on August 10, 2001, at 5:13:55
In reply to bipolar meds and anxiety, posted by cb on August 9, 2001, at 17:58:22
Mom,
My first reaction would be that the Wellbutrin may be the culprit at a high level like 400 mg/day but you may also want to talk to his doctor about the Zyprexa. Some people get very anxious on it. ( I am not one of them). The pdoc may want to consider a trial of another antipsychotic like Risperdal if this is the case.
I wish the best for you both.
Chris
Posted by Maung on August 10, 2001, at 6:46:48
In reply to Re: bipolar meds and anxiety » cb, posted by Cam W. on August 9, 2001, at 21:49:10
> Mom - Sometimes the Klonopin (and other benzodiazepines), in younger people, has an idiosyncratic effect; where it can cause hostility and anxiety, rather than having the relaxing effect that it should have, possibly something to do with a maturing neurotransmitter system in a teen. It is best to call his doc and tell him/her about the increase in his symptoms.
>
> Hang in there mom; we're cheering for you. - CamAs usual, Cam, your expertise as a community pharmacist, is invaluable
Posted by Lorraine on August 10, 2001, at 10:46:33
In reply to Re: bipolar meds and anxiety, posted by Maung on August 9, 2001, at 19:01:19
> > Please help! My 16 yr. old son, diagnosed bipolar 2 yrs ago spent a few months in the hospital this spring. He was discharged on wellbutrin, lithium, neurontin, zyprexa and synthroid. For the last few months he has been suffering from severe anxiety (anxiety was not a problem before these meds.. His dr. has reduced the wellbutrin and zyprexa and discontinued the neurontin. Still severely anxious. Two nights ago, he started on Klonopin - with no improvement in the anxiety - In fact, he seems more anxious and hostile.
My 2 c: I was on Wellbutrin. It made me want to crawl out of my skin the anxiety was so bad. I discontinued it. I'm surprised that he elected to discontinue the Neurontin, which is calming (I take it).
Posted by kid47 on August 10, 2001, at 16:51:02
In reply to bipolar meds and anxiety, posted by cb on August 9, 2001, at 17:58:22
Hi. Sorry about you & your sons troubles. My experience: Neurontin is very subtle but had a calming & stabilizing effect dosing 800mgx4/day. Wellbutrin SR very energizing & helped me to focus but at just 150mg/day sent panic/anxiety through the roof. Didn't help much with my depression. Why Synthroid?-Make sure thyroid levels are checked. Can cause all sorts of crazys. Klonopoin was my savior but I am a 48 yr old. & I have read where children my have paradoxical response i.e. might make anxiety worse. Dont know much about Zyprexa. Unless lithium seems to be the only mood stabilizer that works well, I would look at(IMO) Topamax, Lamictal, & Neurontin for less side fx and no blood tests. Effexor XR might also be something to consider for depression/anxiety although there is considerable controversy concerning FXR discontinuation problems. As always check with your doc & YMMV. Hope this is some help. Good luck. Take care.
kid
> Please help! My 16 yr. old son, diagnosed bipolar 2 yrs ago spent a few months in the hospital this spring. He was discharged on wellbutrin, lithium, neurontin, zyprexa and synthroid. For the last few months he has been suffering from severe anxiety (anxiety was not a problem before these meds.. His dr. has reduced the wellbutrin and zyprexa and discontinued the neurontin. Still severely anxious. Two nights ago, he started on Klonopin - with no improvement in the anxiety - In fact, he seems more anxious and hostile. He will be going back to high school in a couple of weeks but only if he can get this pervasive anxiety under control. I've been reading on this site for the last couple of months and I think you all are the experts. Please help!
> --anxious Mom
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