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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by akc on December 10, 2001, at 11:38:41
Along with the klonopin request just above, I wuold lke to repeat an earlier request t get some feedback. Currently, I am taking:
75 mg Effexor XR
50 mg/50 mg Topomax
200 mg/200 mg Seroquel
600 mg/600 mg lithium
1 mg/1 mg klonopin
50-150 prn of trazadone (have been taking 100 here lately)My diagnosis is Bipolar II (mixed state -- agitation/depression), PTSD and alcoholim. Up until the klonopin was added, I was in a horrible mixed state. Now I am in a horrible depression.
My doctor is thinking of changing some stuff -- depakote for lithium (scared to death on this one) and gedeon for seroqel.
I would like any insight.
akc
Posted by Greg on December 10, 2001, at 12:10:49
In reply to Repeat request, posted by akc on December 10, 2001, at 11:38:41
> Along with the klonopin request just above, I wuold lke to repeat an earlier request t get some feedback. Currently, I am taking:
>
> 75 mg Effexor XR
> 50 mg/50 mg Topomax
> 200 mg/200 mg Seroquel
> 600 mg/600 mg lithium
> 1 mg/1 mg klonopin
> 50-150 prn of trazadone (have been taking 100 here lately)
>
> My diagnosis is Bipolar II (mixed state -- agitation/depression), PTSD and alcoholim. Up until the klonopin was added, I was in a horrible mixed state. Now I am in a horrible depression.
>
> My doctor is thinking of changing some stuff -- depakote for lithium (scared to death on this one) and gedeon for seroqel.
>
> I would like any insight.
>
> akcakc,
So I can kind of get my brain wrapped around this, do you know which meds are being used to treat which symptoms? I'm sure the klonopin is for the anxiety, but I'd like to know the others.
Tx,
Greg
Posted by akc on December 10, 2001, at 12:28:52
In reply to Re: Repeat request » akc, posted by Greg on December 10, 2001, at 12:10:49
Greg,
75 mg Effexor XR -- depression
50 mg/50 mg Topomax -- mood stabilizer
200 mg/200 mg Seroquel -- thought distortion
600 mg/600 mg lithium-- mood stabilizer/depression
1 mg/1 mg klonopin -- anxiety
50-150 prn of trazadone (have been taking 100 here lately) -- sleepakc
Posted by Greg on December 10, 2001, at 12:38:43
In reply to Re: Repeat request, posted by akc on December 10, 2001, at 12:28:52
Thanks, let me disgest this for a bit and I'll get back to you this afternoon with some thoughts.
Greg
> Greg,
>
> 75 mg Effexor XR -- depression
> 50 mg/50 mg Topomax -- mood stabilizer
> 200 mg/200 mg Seroquel -- thought distortion
> 600 mg/600 mg lithium-- mood stabilizer/depression
> 1 mg/1 mg klonopin -- anxiety
> 50-150 prn of trazadone (have been taking 100 here lately) -- sleep
>
> akc
Posted by akc on December 10, 2001, at 12:43:21
In reply to Re: Repeat request » akc, posted by Greg on December 10, 2001, at 12:38:43
I sure would like to get a lot of different opinions (Elizabeth, Cam, . . . . )
Posted by Noa on December 10, 2001, at 18:06:44
In reply to As much as I love Greg . . . , posted by akc on December 10, 2001, at 12:43:21
One thought I have is that since you are on lithium, get your thyroid checked out. I took lithium briefly a couple of years ago and it worsened my hypothyroidism very rapidly. I chose to go off of the lithium, but really could have stayed on it and just adjusted the thyroid meds upward to compensate.
Posted by susan C on December 10, 2001, at 18:07:20
In reply to Re: Repeat request, posted by akc on December 10, 2001, at 12:28:52
Hi akc,
just a note, to say, 'if it were me':
I would check my records as to why and what happened when i started them
I would get more opionions and go in asking, why am I taking six different medications.
Similar situation is going on with me re asthma...I have thought, and gotten opinions that I do have asthma, but I looked one day and it dawned on me I was taking four different meds...so I went to specialist for check up and said, why am i taking four different meds, show me...that i need to take these that they are making a difference.
Long story short...Second visit, dr admitted the spirometer wasnt working right, so it showed i had a response, when in reality, i did not...(I need to ask for my money back) I am now off the two inhalers, with a plan for the next med to drop off in the next month, then then next...the dr i am seeing asks good questions and expresses puzzlement and is able to describe to me what is going on...which is an accomplishment all it of itself.
My question to you, my response to your list, is why so many different medications?
I have another comment which i will try to remember to share when we meet on chat.
susan C
mouse contemplating stone soup
Posted by Elizabeth on December 10, 2001, at 19:44:38
In reply to Repeat request, posted by akc on December 10, 2001, at 11:38:41
Hi akc.
> My doctor is thinking of changing some stuff -- depakote for lithium (scared to death on this one) and gedeon for seroqel.
Why scared of switching from lithium to Depakote? Depakote is usually a better mood stabilizer than lithium if you have mixed or rapid-cycling states as opposed to traditional mania. If what you're scared of is going off the lithium, I think you can take it and Depakote together.
You might try a different benzo such as Xanax or Ativan if you think that the Klonopin is causing the depression. A possible alternative explanation is that the Klonopin is relieving the manic part of your mixed state but not the depression, and if that's the case then something you might try would be (cautiously) raising the Effexor.
Another thing you might consider, if you haven't tried it, is Lamictal, a mood stabilizer that can also help with mania.
I think your doctor's ideas are good although it would be best not to make two changes at the exact same time.
As other people say, one question to be asking is: are all these medications helping? Does each one have a purpose that it's serving? And also, of course, consider whether any of them might be making some of your problems worse.
It's not necessarily "too many" meds, especially for a complicated case (bipolar + alcoholism + PTSD is "complicated" IMO), but it's important to know what's doing what and be sure that they're all contributing.
-elizabeth
Posted by Chloe on December 10, 2001, at 19:48:53
In reply to Repeat request, posted by akc on December 10, 2001, at 11:38:41
Akc,
IMHO, switching meds is hell. But if you are having a problem with a med, I know how important it feels to make the switch. I just loathe the instability while I make changes. I have bp2, major depression, mood dyregulation stuff like that)
Li to Depakote, hum. For me, Lithium had a much better AD effect than Depakote. Dep made me a little flat mood wise. But it was very effective in controlling anger and keeping me relatively stable. They are both first line MS's. And if you are concerned about your thyroid, it's definitely worth a try. You do have to monitor your liver functions on dep, and weight gain can be an issue. But I see you are on Topamax. that is often used to offset the weight gain associated with dep. (I think I mentioned this to you in another query you posted)
Seroquel to Geodon, well...I really like seroquel because of it's sedating qualities. And is my first choice of all the Atypical AP's. I always sleep so well and find it a very nice quieting med. (I wish I could take it other than emergencies. But I have persistant TD probs)
Geodon, for me is extremely activating. it did have some nice AD qualities too. But I was hypomanic for the first 4 or 5 days on it. I never stopped talking during that time! After I settled down on Geodon, I found it helped with distorted thinking and gave me energy. But I had chronic sleeping problems. (Then of course the TD started so I had to end my trial.) But since you have added klonipin and have trazodone prn, this may not be an issue for you...But in my experience seroquel(calming) and geodon(activating!) are so different. I think you would have to switch extremely gradually, not to upset things too much.
This is purely just my personal experience. And of course YMMV. If you do start to make some adjustments, i do hope you do it very slowly and carefully.
HOpe this helps
C> Along with the klonopin request just above, I wuold lke to repeat an earlier request t get some feedback. Currently, I am taking:
>
> 75 mg Effexor XR
> 50 mg/50 mg Topomax
> 200 mg/200 mg Seroquel
> 600 mg/600 mg lithium
> 1 mg/1 mg klonopin
> 50-150 prn of trazadone (have been taking 100 here lately)
>
> My diagnosis is Bipolar II (mixed state -- agitation/depression), PTSD and alcoholim. Up until the klonopin was added, I was in a horrible mixed state. Now I am in a horrible depression.
>
> My doctor is thinking of changing some stuff -- depakote for lithium (scared to death on this one) and gedeon for seroqel.
>
> I would like any insight.
>
> akc
This is the end of the thread.
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