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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by cara52 on January 22, 2002, at 12:07:50
what is your personal opinion or if you know what is the prevailing drug that psychiatrists prescribe most in terms of an anti- depressant that causes the least amount of cycling in BP 2?
Or maybe it would be called a mixed state?
Depending on the drug I get manic and non- depressed or manic and very depressed - these states are not commplete mania though like in a full blown bipolar mania- well any opinions on the best drug?
Posted by OldSchool on January 22, 2002, at 12:51:50
In reply to Anti-depressant Least Likely to cause cycling?(BP, posted by cara52 on January 22, 2002, at 12:07:50
> what is your personal opinion or if you know what is the prevailing drug that psychiatrists prescribe most in terms of an anti- depressant that causes the least amount of cycling in BP 2?
> Or maybe it would be called a mixed state?
> Depending on the drug I get manic and non- depressed or manic and very depressed - these states are not commplete mania though like in a full blown bipolar mania- well any opinions on the best drug?
The antidepressant least likely to induce mania is Wellbutrin. Wellbutrin is the preferred AD in bipolar disorder.Old School
Posted by MB on January 22, 2002, at 15:19:46
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by OldSchool on January 22, 2002, at 12:51:50
If Wellbutrin is the best for not inducing mania, I wonder why my thoughts raced more on Wellbutrin than on any SSRI ever. I wonder if this is diagnostic. I mean, I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar.
MB
Posted by cara52 on January 22, 2002, at 16:34:32
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP » OldSchool, posted by MB on January 22, 2002, at 15:19:46
> If Wellbutrin is the best for not inducing mania, I wonder why my thoughts raced more on Wellbutrin than on any SSRI ever. I wonder if this is diagnostic. I mean, I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar.
>
> MBI had a poor experience with wellbutrin as well
It was my sole drug however and I was on no mood stabilizer so I guess It at least helped my depression more than other drugs
Posted by Krazy Kat on January 22, 2002, at 17:49:19
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP » OldSchool, posted by MB on January 22, 2002, at 15:19:46
"I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar."
- IMHO, absolutely not!! I got extrememly agitated on Well., and have heard this is not uncommon for BP's.
Why do you think it's the best, Old School?
I have been O.K. on Prozac as long as I have a stabilizer. Celexa did nothing, Serzone made me tired.
Posted by Dinah on January 22, 2002, at 18:08:36
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by OldSchool on January 22, 2002, at 12:51:50
Add me to the people on the bipolar spectrum who have had a horrible (and in my case life-threatening) experience with Wellbutrin. I have read it is recommended for those with bipolar, but for the life of me I can't understand it.
Dinah
Posted by OldSchool on January 22, 2002, at 20:44:14
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP » MB, posted by Krazy Kat on January 22, 2002, at 17:49:19
> "I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar."
>
> - IMHO, absolutely not!! I got extrememly agitated on Well., and have heard this is not uncommon for BP's.
>
> Why do you think it's the best, Old School?
>
> I have been O.K. on Prozac as long as I have a stabilizer. Celexa did nothing, Serzone made me tired.Well, Im not bipolar but all the literature Ive ever read has said that Wellbutrin is the preferred antidepressant in bipolar disorder. One of the things about Wellbutrin is that while it is a mild dopamine reuptake inhibitor, it simultaneously restricts the release of dopamine. And thats good for holding back mania or psychosis. So thats one of the reasons why Wellbutrin is good for bipolar.
There is info right here on this website in the tips section that will tell you Wellbutrin is preferred for bipolar.I have also read that if SSRIs are to be used, the SSRIs with short half lives like Paxil or Luvox should be used because IF they induce mania as SSRIs sometimes do, Paxil has such a short half life its out of your system in no time at all. Whereas if you use Prozac and that induces mania, Prozac takes forever to get out of your system, prolonging the mania/psychosis.
Prozac, due to its extremely long half life and its stimulating nature is considered to be one of the least desireable antidepressants for bipolar disorder.
Old School
Posted by Krazy Kat on January 22, 2002, at 21:20:40
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by OldSchool on January 22, 2002, at 20:44:14
I guess this I'm a good example of why following the textbook can be harmful.
- KK
Posted by cara52 on January 22, 2002, at 22:07:00
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP » OldSchool, posted by Krazy Kat on January 22, 2002, at 21:20:40
> I guess this I'm a good example of why following the textbook can be harmful.
>
> - KKAnyone here try an MAOI for their bipolar?
Posted by spike4848 on January 22, 2002, at 23:08:14
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by OldSchool on January 22, 2002, at 20:44:14
> Well, Im not bipolar but all the literature Ive ever read has said that Wellbutrin is the preferred antidepressant in bipolar disorder. One of the things about Wellbutrin is that while it is a mild dopamine reuptake inhibitor, it simultaneously restricts the release of dopamine. And thats good for holding back mania or psychosis. So thats one of the reasons why Wellbutrin is good for bipolar.> > Old School
Hey There,
Yes .... I heard the net effect of Wellbutrin on dopamine is zilch. Like you mentioned, it is a *VERY* mild ... if not negible dopamine re uptake inhibitor ... there maybe some inhibition of dopamine release by wellbutrin or one its metabolites as well. And maybe this is why lower incidence of cyclicing.
I alway wondered if this is why SSRIs may have a reduced incidence of cyclicing. The elevation of serotonin level inhibit dopamine release .... thus less induction of mania .... thus apathy in many individuals at high doses .... thus sexual dysfunction.
Thanks Old School.
Spike
Posted by Blue Cheer 1 on January 22, 2002, at 23:13:53
In reply to Anti-depressant Least Likely to cause cycling?(BP, posted by cara52 on January 22, 2002, at 12:07:50
> what is your personal opinion or if you know what is the prevailing drug that psychiatrists prescribe most in terms of an anti- depressant that causes the least amount of cycling in BP 2?
> Or maybe it would be called a mixed state?
> Depending on the drug I get manic and non- depressed or manic and very depressed - these states are not commplete mania though like in a full blown bipolar mania- well any opinions on the best drug?http://www.mhsource.com/bipolar/bp0108anti.html
http://www.mhsource.com/bipolar/antifig2.gif
I think Dr. Ghaemi says it as well as anyone. Avoid antidepressants; they'll worsen your course. If you're mixed, forget about antidepressants. If you must use them, then discontinue them about two months after an antidepressant effect is achieved.
Wellbutrin, in my opinion, is too stimulating. I've done alright (short-term) on Celexa.
blue
Posted by Blue Cheer 1 on January 22, 2002, at 23:47:37
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by Blue Cheer 1 on January 22, 2002, at 23:13:53
> > what is your personal opinion or if you know what is the prevailing drug that psychiatrists prescribe most in terms of an anti- depressant that causes the least amount of cycling in BP 2?
> > Or maybe it would be called a mixed state?
> > Depending on the drug I get manic and non- depressed or manic and very depressed - these states are not commplete mania though like in a full blown bipolar mania- well any opinions on the best drug?
>
> http://www.mhsource.com/bipolar/bp0108anti.html
>
> http://www.mhsource.com/bipolar/antifig2.gif
>
> I think Dr. Ghaemi says it as well as anyone. Avoid antidepressants; they'll worsen your course. If you're mixed, forget about antidepressants. If you must use them, then discontinue them about two months after an antidepressant effect is achieved.
>
> Wellbutrin, in my opinion, is too stimulating. I've done alright (short-term) on Celexa.
>
> blue
Also, MAOIs used to be the treatment of choice in bipolar depression. They're still a good choice..Ritalin is a consideration, too.
http://people.ne.mediaone.net/pmbrig/BP_pharm.html#stimulants
http://www.psychoeducation.org/bipolar/controversy.htm
Blue
Posted by Mr. Scott on January 22, 2002, at 23:48:02
In reply to Anti-depressant Least Likely to cause cycling?(BP, posted by cara52 on January 22, 2002, at 12:07:50
Most of the research I've seen supports Wellbutrin, then Paxil, then Effexor.
Obviously individual differences are key..
Posted by Blue Cheer 1 on January 22, 2002, at 23:57:27
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by Blue Cheer 1 on January 22, 2002, at 23:47:37
> > > what is your personal opinion or if you know what is the prevailing drug that psychiatrists prescribe most in terms of an anti- depressant that causes the least amount of cycling in BP 2?
> > > Or maybe it would be called a mixed state?
> > > Depending on the drug I get manic and non- depressed or manic and very depressed - these states are not commplete mania though like in a full blown bipolar mania- well any opinions on the best drug?
> >
> > http://www.mhsource.com/bipolar/bp0108anti.html
> >
> > http://www.mhsource.com/bipolar/antifig2.gif
> >
> > I think Dr. Ghaemi says it as well as anyone. Avoid antidepressants; they'll worsen your course. If you're mixed, forget about antidepressants. If you must use them, then discontinue them about two months after an antidepressant effect is achieved.
> >
> > Wellbutrin, in my opinion, is too stimulating. I've done alright (short-term) on Celexa.
> >
> > blue
>
>
> Also, MAOIs used to be the treatment of choice in bipolar depression. They're still a good choice..
>
> Ritalin is a consideration, too.
>
> http://people.ne.mediaone.net/pmbrig/BP_pharm.html#stimulants
>
> http://www.psycheducation.org/bipolar/controversy.htm
>
> Blue
Posted by Mr. Scott on January 22, 2002, at 23:59:53
In reply to Anti-depressant Least Likely to cause cycling?(BP, posted by cara52 on January 22, 2002, at 12:07:50
I think this whole issue is still very controversial and individual. Despite the latest theories I have never meet a single person who was chronically and seriously depressed (BPII) who responded soley to mood stabilizers.. particularly Depakote.
Please share with me experience to the contrary if I'm dead wrong.
Posted by spike4848 on January 23, 2002, at 0:16:03
In reply to Slight side Note, posted by Mr. Scott on January 22, 2002, at 23:59:53
> I think this whole issue is still very controversial and individual. Despite the latest theories I have never meet a single person who was chronically and seriously depressed (BPII) who responded soley to mood stabilizers.. particularly Depakote.
>
> Please share with me experience to the contrary if I'm dead wrong.Hey,
I totally agree Mr Scott... Many people think Akiskal, Ghaemi and Phelps are too extremely in their ideas concerning diagnosing and treating depression/bipolar illness. Dr. Phelps is great .... on his web site he admits that some people disagree we his views and even give article *citations* which argue against him. He does see a skewed patient population .... mainly patients thay are unsucessful with mainstream therapies and have already seen 3 to 4 pdocs. Many BPIIs do require an antidepressant of some sort.
Spike
Posted by Blue Cheer 1 on January 23, 2002, at 0:34:05
In reply to Slight side Note, posted by Mr. Scott on January 22, 2002, at 23:59:53
> I think this whole issue is still very controversial and individual. Despite the latest theories I have never meet a single person who was chronically and seriously depressed (BPII) who responded soley to mood stabilizers.. particularly Depakote.
>
> Please share with me experience to the contrary if I'm dead wrong.Lamictal has been used as monotherapy, but the message from Dr. Ghaemi and other experts is to use extreme caution when using ADs in bipolar disorder (no matter the type), and to discontinue them as soon as the depressive episode has resolved. Amsterdam et al. have studied Effexor and Prozac as monotherapy for bipolar depression (type II), but the studies were methodologically flawed, in my opinion, and short-term as well.
Blue
Posted by Blue Cheer 1 on January 23, 2002, at 0:59:35
In reply to Re: Slight side Note » Mr. Scott, posted by spike4848 on January 23, 2002, at 0:16:03
> > I think this whole issue is still very controversial and individual. Despite the latest theories I have never meet a single person who was chronically and seriously depressed (BPII) who responded soley to mood stabilizers.. particularly Depakote.
> >
> > Please share with me experience to the contrary if I'm dead wrong.
>
> Hey,
>
> I totally agree Mr Scott... Many people think Akiskal, Ghaemi and Phelps are too extremely in their ideas concerning diagnosing and treating depression/bipolar illness.
Dr. Ghaemi is extreme? In what sense? I know he doesn't subscribe to the views of Dr. Akiskal. It's Dr. Akiskal's opinion that a diagnosis of unipolar depression cannot be made until bipolar disorder has been ruled out. (That, and his endless subcategorization and dilution of the bipolar concept is extreme.)Blue
Posted by bob on January 23, 2002, at 2:08:25
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by OldSchool on January 22, 2002, at 20:44:14
Luvox has a short half-life? I was under the impression that the two "new-generation" ADs with nasty withdrawal syndromes were Paxil and Effexor. I experienced Effexor and don't want to go through that again. I am now on Luvox, will I be facing the same thing again if I taper down???
Bob
Posted by OldSchool on January 23, 2002, at 10:49:38
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by Blue Cheer 1 on January 22, 2002, at 23:13:53
> I think Dr. Ghaemi says it as well as anyone. Avoid antidepressants; they'll worsen your course. If you're mixed, forget about antidepressants. If you must use them, then discontinue them about two months after an antidepressant effect is achieved.
>This is what Ive always heard/read about bipolar disorder. Avoid antidepressants whenever possible, as taking them increases your chances of setting off mania/hypomania. Ive got one of Stephen Stahl's books and in his bipolar combo section, only one of the possible combos he lists include mood stabiliser plus antidepressant. Here are the combos Stahl lists in this book Ive got:
1)First line monotherapy: lithium or depakote
2)Second line monotherapy: atypical anti-psychotics
3)Third line monotherapy: carbamazepine, lamictal, Neurontin and Topomax
4) Atypical combo: lithium or depakote PLUS atypical anti-psychotic
5)Benzo "assault weapon" combo: lithium or depakote PLUS benzo
6)Neuroleptic "nuclear weapon" combo: lithium or depakote PLUS neuroleptic
7)Mood stabiliser combo: two or more mood stabilisers combined
8)Antidepressant combo: mood stabilizer or atypical anti-psychotic plus antidepressant
Also remember that ECT is one of the most effective treatments for bipolar disorder. ECT has strong anti-convulsant properties (it pushes up the seizure threshhold and makes it harder to have seizures).
Old School
Posted by spike4848 on January 23, 2002, at 12:21:53
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by OldSchool on January 23, 2002, at 10:49:38
> > I think Dr. Ghaemi says it as well as anyone. Avoid antidepressants; they'll worsen your course. If you're mixed, forget about antidepressants. If you must use them, then discontinue them about two months after an antidepressant effect is achieved.
This is a very appealing theory .... avoid all antidepressants for individuals with bipolar disorder. Unforunately, in clinical practice, many bipolars are extremely depressed and remain depressed for years on mood stablizers alone .... even on triple combo mood stablizers. At that point, do you still recommend avoiding antidepressants? Would you subject the individual to ECT? It is a very tough decision ... I think many clinician are actually prescribing low dose antidepressants.Spike
Posted by Elizabeth on January 23, 2002, at 15:12:14
In reply to Anti-depressant Least Likely to cause cycling?(BP, posted by cara52 on January 22, 2002, at 12:07:50
I think Wellbutrin is relatively safe. The TCAs are probably the most dangerous. MAOIs seem to cause hypomania a lot, but TCAs are more likely to cause dysphoric hypomania. SSRIs are less likely to cause mania than TCAs and possibly MAOIs. I'm not sure about the newer ADs. My pdoc says he think Effexor may be worse than the SSRIs for causing mania.
Ideally, it might be best to avoid ADs altogether. But some people find that mood stabilizers alone aren't enough. Some mood stabilizers, such as lithium and Lamictal, often have antidepressant effects, and others can as well, but some people need ADs too. I think that doctors who refuse to prescribe ADs to bipolars (or only do so very rarely) are doing their patients a disservice.
Also, a note to MB:
> If Wellbutrin is the best for not inducing mania, I wonder why my thoughts raced more on Wellbutrin than on any SSRI ever. I wonder if this is diagnostic. I mean, I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar."Racing thoughts," by itself, isn't diagnostic of mania. Wellbutrin can cause a lot of anxiety (this was its effect on me, and I'm not bipolar) which can lead to racing thoughts. Also, while WB is less likely to cause switching in bipolar patients than other ADs, that doesn't mean that it is more likely to *work* in bipolar d/o than other ADs!
Posted by Blue Cheer 1 on January 25, 2002, at 6:26:20
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by Elizabeth on January 23, 2002, at 15:12:14
> I think Wellbutrin is relatively safe. The TCAs are probably the most dangerous. MAOIs seem to cause hypomania a lot, but TCAs are more likely to cause dysphoric hypomania. SSRIs are less likely to cause mania than TCAs and possibly MAOIs. I'm not sure about the newer ADs. My pdoc says he think Effexor may be worse than the SSRIs for causing mania.
>
> Ideally, it might be best to avoid ADs altogether. But some people find that mood stabilizers alone aren't enough. Some mood stabilizers, such as lithium and Lamictal, often have antidepressant effects, and others can as well, but some people need ADs too. I think that doctors who refuse to prescribe ADs to bipolars (or only do so very rarely) are doing their patients a disservice.I doubt if you could find a psychiatrist who would even hesitate to Rx ADs for bipolar depression.
Blue
>
> Also, a note to MB:
> > If Wellbutrin is the best for not inducing mania, I wonder why my thoughts raced more on Wellbutrin than on any SSRI ever. I wonder if this is diagnostic. I mean, I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar.
>
> "Racing thoughts," by itself, isn't diagnostic of mania. Wellbutrin can cause a lot of anxiety (this was its effect on me, and I'm not bipolar) which can lead to racing thoughts. Also, while WB is less likely to cause switching in bipolar patients than other ADs, that doesn't mean that it is more likely to *work* in bipolar d/o than other ADs!
Posted by petters on January 25, 2002, at 6:59:03
In reply to Re: Anti-depressant Least Likely to cause cycling?(BP, posted by Blue Cheer 1 on January 25, 2002, at 6:26:20
> > I think Wellbutrin is relatively safe. The TCAs are probably the most dangerous. MAOIs seem to cause hypomania a lot, but TCAs are more likely to cause dysphoric hypomania. SSRIs are less likely to cause mania than TCAs and possibly MAOIs. I'm not sure about the newer ADs. My pdoc says he think Effexor may be worse than the SSRIs for causing mania.
> >
> > Ideally, it might be best to avoid ADs altogether. But some people find that mood stabilizers alone aren't enough. Some mood stabilizers, such as lithium and Lamictal, often have antidepressant effects, and others can as well, but some people need ADs too. I think that doctors who refuse to prescribe ADs to bipolars (or only do so very rarely) are doing their patients a disservice.
>
> I doubt if you could find a psychiatrist who would even hesitate to Rx ADs for bipolar depression.
>
> Blue
>
> >
> > Also, a note to MB:
> > > If Wellbutrin is the best for not inducing mania, I wonder why my thoughts raced more on Wellbutrin than on any SSRI ever. I wonder if this is diagnostic. I mean, I wonder if my horrible experience with Wellbutrin is an indication that I'm not bipolar.
> >
> > "Racing thoughts," by itself, isn't diagnostic of mania. Wellbutrin can cause a lot of anxiety (this was its effect on me, and I'm not bipolar) which can lead to racing thoughts. Also, while WB is less likely to cause switching in bipolar patients than other ADs, that doesn't mean that it is more likely to *work* in bipolar d/o than other ADs!Hi...
Most expert share the opinion that bupropion and venlafaxine is the med that are last likely to cause mania. Bipolar often respond better and safer on venlafaxine. It is not associated to increase anxiety as bupropion often makes during the treatment.
Best Wishes...//Petters
Posted by BarbaraCat on January 28, 2002, at 13:07:16
In reply to Slight side Note, posted by Mr. Scott on January 22, 2002, at 23:59:53
I think I might be considered a potential example. I've been on most SSRI's as well as buproprion, and most recently on Remeron which pooped after 3 months of excellent response and spiraled into a major suicidal depression. Am now on 300 mg. of lithium and 7.5mg on Remeron and titrating off completely. I felt immediate help on the lithium and better with each dosage decrease of Remeron. The real proof will be how I'm doing when the Remeron is completely out of my system. This may be an augmentation response for the Remeron, but I don't think so.
> I think this whole issue is still very controversial and individual. Despite the latest theories I have never meet a single person who was chronically and seriously depressed (BPII) who responded soley to mood stabilizers.. particularly Depakote.
>
> Please share with me experience to the contrary if I'm dead wrong.
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