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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by jimmygold70 on August 31, 2001, at 14:56:27
First, I would like to say that I take Risperdal, Ixel (similar to Effexor?). Both are used to treat my symptoms of BPD (Borderline Personality Disorder) and dysthimia. Both are better on this combination, but still my affect is not stable and dysthimic.
Now, to make things more complex, I use Xanax or Klonopin on an as-needed basis for anxiety.
So my PDoc added Depakote. I did notice some (but not overwhelming) improvement, but this made me so badly sedated when I use benzodiazepines.
He changed it now to Tegretol, since he thinks that it is less sedating when combined with BDZs. I think it's about the same, and has its own side effects. Yes, I feel more stable, but I still look sad (dysthimic affect).
Now, we're left with lithium. I fear the irreversible side effect with the incapacity of the kidneys to concentrate urine. I like to drink (water) a lot and I urinate a lot, so I fear lithium will make it worse.
1) Is that true? Is it possible that Lithium will make me a very frequent toilet user for the rest of my life?
2) Is it really much better than Tegretol when used with BDZs? I mean - can I stay awake and concentrated while taking both?
3) Is it really more likely than Tegretol to make my dysthimic affect any happier?Please don't offer any newer mood stabilizer, since my PDoc is very skeptical about them.
Thanks,
Jimmy
Posted by SalArmy4me on August 31, 2001, at 15:46:10
In reply to Choice of a mood stabilizer + BDZs ? Lithium ?, posted by jimmygold70 on August 31, 2001, at 14:56:27
Apparently, problems with urination (largely non-serious ones) occur in only about one-third of patients on Lithium:
Price, Lawrence H.. Heninger, George R.. Drug Therapy: Lithium In The Treatment Of Mood Disorders. New England Journal of Medicine. 331(9):591-598, Sep 1, 1994:
"Excessive thirst and urination occur in about one third of patients, reflecting an impaired renal concentrating ability due to the inhibitory effect of lithium on intracellular cyclic AMP formation in renal tubules..."
Tegretol:
Post et al (1986) reported in a double blind, placebo-controlled trial that in 35 dysthymic patients, most had some improvement with carbamazepine. Interestingly, in the on-off-on design most patients failed to relapse on placebo.
(From: Post RM, Uhde TW, Roy-Byrne PP, Joffe RT (1986). Antidepressant effects of carbamazepine. Am J Psychiatry 143:29-34).
-----------------------------------------------
Does he really love you? Clue: True Love Waits
http://www.lifeway.com/tlw/tns_adv_home.asp
Posted by Mitch on August 31, 2001, at 18:02:53
In reply to Choice of a mood stabilizer + BDZs ? Lithium ?, posted by jimmygold70 on August 31, 2001, at 14:56:27
> First, I would like to say that I take Risperdal, Ixel (similar to Effexor?). Both are used to treat my symptoms of BPD (Borderline Personality Disorder) and dysthimia. Both are better on this combination, but still my affect is not stable and dysthimic.
>
> Now, to make things more complex, I use Xanax or Klonopin on an as-needed basis for anxiety.
>
> So my PDoc added Depakote. I did notice some (but not overwhelming) improvement, but this made me so badly sedated when I use benzodiazepines.
>
> He changed it now to Tegretol, since he thinks that it is less sedating when combined with BDZs. I think it's about the same, and has its own side effects. Yes, I feel more stable, but I still look sad (dysthimic affect).
>
> Now, we're left with lithium. I fear the irreversible side effect with the incapacity of the kidneys to concentrate urine. I like to drink (water) a lot and I urinate a lot, so I fear lithium will make it worse.
>
> 1) Is that true? Is it possible that Lithium will make me a very frequent toilet user for the rest of my life?
> 2) Is it really much better than Tegretol when used with BDZs? I mean - can I stay awake and concentrated while taking both?
> 3) Is it really more likely than Tegretol to make my dysthimic affect any happier?
>
> Please don't offer any newer mood stabilizer, since my PDoc is very skeptical about them.
>
> Thanks,
> JimmyThe most often cited "mood-stabiizer" that is helpful for BPD that I have heard of us Neurontin.
Sorry, I just mentioned a "newer" mood stabilizer.
BUT, if I am not mistaken there isn't ONE med that has an FDA approval for BPD. So, where's your doctor's logic?
Posted by chloe on August 31, 2001, at 20:16:10
In reply to Re: Choice of a mood stabilizer + BDZs ? Lithium ? » jimmygold70, posted by Mitch on August 31, 2001, at 18:02:53
Jimmy,
In my humble opinion, Tegretol, Depakote and Lithium are all horrible. And I don't think one will make you feel less tired than the next when a benzo is added. (But if I have to chose one for me and my BP 2 and BPD, I would go with Dep., since for me the side effects are the least awful.)You will not know how you feel on Lithium unless you try it. But frequent urination is a hallmark of this drug, along with hand tremor, nausea, etc. For some it has some AD effect, though I would say the majority of folks I have talked to on it, say they just feel "blah". That was definitely my experience!
Fortunately for me, after years on all three of the AC's above (at different times), I have successfully weaned off them, and am now on Neurontin for mood stabilization. It by no means if perfect, but in the side effect department, it is so much easier to tolerate! It's is mildly sedating and calming, and may even allow you to decrease your benzo dose. Though your doctor is not into the newer AC's, hopefully he would consider this one...
I wish everyday there were some better options out there. I think the old AC's are tough to tolerate, and not terrible effective over the long term for BPD.
Best of luck to you...
chloe
Posted by Dr. Bob on August 31, 2001, at 20:29:44
In reply to Re: Choice of a mood stabilizer + BDZs ? Lithium ? » jimmygold70, posted by SalArmy4me on August 31, 2001, at 15:46:10
> -----------------------------------------------
> Does he really love you? Clue: True Love Waits
> http://www.lifeway.com/tlw/tns_adv_home.aspYou may have already, but in case you haven't, please see my recent post about tag lines:
http://www.dr-bob.org/babble/admin/20010718/msgs/1854.html
Thanks,
Bob
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