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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Chloe on February 24, 2002, at 19:49:51
I am bp 2 and have had a hell of a time trying to get my mood right. I seem to need alot of small doses of mood stabilizers and just a spinkle of AD or I get hypo-agitated, agressive, and/or mixed states. I feel like I am on a lot of meds. But my pdoc says low doses of all of them helps me tolerate the side effects better...But I hope it's ok to take all of these.
I have been having dizziness during the early evening hours about 7 hours after my morning 200 mgs dose of Neurontin. I take another 200 at bedtime. I am wondering if it's related to the spacing of the dosing of N. But since I started depakote, I was needing less neurontin during the day. The dep. seemed to make the N last longer.
BUT I got very flat and deeply depressed from the depakote so my pdoc added on the smallest bit, 112 mgs of Eskilith. Now I am still kinda flat, but not so depressed! But since adding that I get dizzy/anxious mid N dosing...
Do I need to space out the N more evenly now that I have added Li? Or add in another mid day dose? I really liked having the twice a day dosing...But the evening anxiety and dizziness is a bit disconcerting. I tend to be kinda slow and tired till mid afternoon, then the anxiety starts to creep in and remain for the rest of the day.Here is my current cocktail..
112 mgs Eskilith CR am (AD/stabilization)
200 mgs Neurontin am/pm (calming/stabilization)
250 mgs Depakote pm (anti-anger/stabilization)
1.4 mgs Celexa am (AD)
20 mgs Amitriptyline pm (for neuropathic pain)
5-10 mgs DiazapamAnyone have any thoughts on taking subtherapuetic doses of lots of meds?
And about the timing or dosing of the neurontin with the depakote?
Comments?
Thanks for letting me ramble. Sorry if it's a little incoherent...Sometimes hard to think straight:)
Chloe
Posted by spike4848 on February 24, 2002, at 20:19:33
In reply to Too many meds for bp 2?/neurontin dosing, posted by Chloe on February 24, 2002, at 19:49:51
> Anyone have any thoughts on taking subtherapuetic doses of lots of meds?
> And about the timing or dosing of the neurontin with the depakote?
> Comments?
> Thanks for letting me ramble. Sorry if it's a little incoherent...Sometimes hard to think straight:)
> ChloeThis is from a physician's perspective ... In the old days, we use to treat diseases like hypertension with one medication and raise to dose to maximum. Unforunately, patients would get all sorts of side effects and need to stop the medication. Now we treat with low to medium doses of 2 or 3 medications. This has two benefits- 1. Patients have little or no side effects 2. The disease is better controlled, by using several meds you attack the disease at several different levels.
This is the trend in psychiatry .... use 2,3,4,5 meds at low to medium doses. This reduces side effects and controls the disease better.
Hope this helped.
Spike, (M.D.)
PS I use to take high dose nardil and had aweful side effects and had to stop. Now I am on zoloft/neurontin/klonopin and will add selegine soon.
Posted by JohnX2 on February 24, 2002, at 20:22:02
In reply to Too many meds for bp 2?/neurontin dosing, posted by Chloe on February 24, 2002, at 19:49:51
Personally I might get some anxiety just trying to keep
track of all those medicines. Its quite a job. I've played
the ball game too.As far as the neurontin goes, I think the concensus opinion
on this board will be that a 3x a day dosing is required to
keep the medicine from being "bumpy". The medicine is metabolized
very quickly through the kidney. So when I took it I found that
I needed to space the dosing about 8 hrs apart 3x a day to keep a
steady level in my body. Personally I believe that it is very
important to try to keep our medicines at a constant level in
our body as best we can, especially for bipolars. The Neurontin
is a mood stabilizer, with the blood levels going up and down in
your brain during the day you are bound to be wishy washy.
Do you take a multiple dosing of Diazepam? I'm not
sure on the 1/2 life of that medicine. I take Klonopin
2 times a day and this insures that the medicines maintains
a consistent level in my body.Generally I would say it is ok to juggle a lot of medicines.
I'm a little suspicious that you would want to have them
circulating in and out of your bodies during different times
of the day. Some medicines only require once a day dosing
(like maybe celexa), so it probably doesn't matter when you
take it. But other medicines like neurontin are important.
I don't remember about Depakote. But if the standard regimen
requires multiple daily dosing and your pdoc has you just
taking a little at night, I think that is odd.Being bipolar (as I am) its best to try to keep
a solid base of medicines in the brain around the
clock instead of trying to shuffle different medicines
in and out. I don't think there is anything wrong with
trying to keep a small dash of a lot of medicines in the
head as long as they are around the clock. This is
just my philosophy and others may disagree.-John
> I am bp 2 and have had a hell of a time trying to get my mood right. I seem to need alot of small doses of mood stabilizers and just a spinkle of AD or I get hypo-agitated, agressive, and/or mixed states. I feel like I am on a lot of meds. But my pdoc says low doses of all of them helps me tolerate the side effects better...But I hope it's ok to take all of these.
>
> I have been having dizziness during the early evening hours about 7 hours after my morning 200 mgs dose of Neurontin. I take another 200 at bedtime. I am wondering if it's related to the spacing of the dosing of N. But since I started depakote, I was needing less neurontin during the day. The dep. seemed to make the N last longer.
>
> BUT I got very flat and deeply depressed from the depakote so my pdoc added on the smallest bit, 112 mgs of Eskilith. Now I am still kinda flat, but not so depressed! But since adding that I get dizzy/anxious mid N dosing...
> Do I need to space out the N more evenly now that I have added Li? Or add in another mid day dose? I really liked having the twice a day dosing...But the evening anxiety and dizziness is a bit disconcerting. I tend to be kinda slow and tired till mid afternoon, then the anxiety starts to creep in and remain for the rest of the day.
>
> Here is my current cocktail..
> 112 mgs Eskilith CR am (AD/stabilization)
> 200 mgs Neurontin am/pm (calming/stabilization)
> 250 mgs Depakote pm (anti-anger/stabilization)
> 1.4 mgs Celexa am (AD)
> 20 mgs Amitriptyline pm (for neuropathic pain)
> 5-10 mgs Diazapam
>
> Anyone have any thoughts on taking subtherapuetic doses of lots of meds?
> And about the timing or dosing of the neurontin with the depakote?
> Comments?
> Thanks for letting me ramble. Sorry if it's a little incoherent...Sometimes hard to think straight:)
> Chloe
Posted by chloe on February 25, 2002, at 10:03:01
In reply to Polypharmary is hip!, posted by spike4848 on February 24, 2002, at 20:19:33
> This is the trend in psychiatry .... use 2,3,4,5 meds at low to medium doses. This reduces side effects and controls the disease better.
>
> Hope this helped.
>
> Spike, (M.D.)
>
> PS I use to take high dose nardil and had aweful side effects and had to stop. Now I am on zoloft/neurontin/klonopin and will add selegine soon.Spike,
I am glad to hear that an MD thinks lots of meds and lowish doses is ok, and even hip!
So far, it has been very beneficial, and I have been the quite compliant, which can be hard for me.For example, I really like Li, but at therapuetic doses I get terrible skin problems, dryness, pain. I physically become so miserable, that the emotional benefits of the med get tossed out the window, and I go off the med. Then the side effects clear up, but my life goes back into raging caos and pain.
So, I guess my pdoc isn't as crazy as I might think adding a little here, little there...And my side effect profile, really is minimal. Hence, compliance.
Can I ask how you are taking your neurontin? TID or BID? How does it benefit you? I find it's best for "calming" or smoothing rough edges. But for me it's not so good as a stabilizer on it's own. But with Li or depakote, it's very useful, imo.
Neurontin is one med I wouldn't mind cutting out since I have Li and depakote on board. But everytime I try to go off it, I really crash into an anergic depression. I also get some miserable joint pain. So I guess it's a keeper!Best of luck creating a cocktail that really works well for you. So glad you are exploring other options than high dose Nardil and it's debilitating side effects.
Chloe
Posted by LiLi80 on February 25, 2002, at 10:12:48
In reply to Too many meds for bp 2?/neurontin dosing, posted by Chloe on February 24, 2002, at 19:49:51
Hey,
I take Neurontin too. Apparently the highest dosage for it is 4000mg. I take about 900mg a day. When I first started, I would have take a nap around 5 or 6 oclock at night. I felt dizzy and my eyes hurt and I just couldnt stay awake. After awhile it got better. Personally I think I am taking it for nothing cause it doesnt seem to do anything for me. I am still tired alot and take naps frequently, but I cant say if it is directly from the Neurontin because i am taking other meds.
Hope this helps
Posted by Chloe on February 25, 2002, at 10:30:17
In reply to Re: Too many meds for bp 2?/neurontin dosing » Chloe, posted by JohnX2 on February 24, 2002, at 20:22:02
> Personally I might get some anxiety just trying to keep
> track of all those medicines.John,
Yes, this does cause some anxiety! I have to write everything down, so I know i have taken all that I is prescribed...My memory can't be relied on when I am juggling 6 different meds.
> As far as the neurontin goes, I think the concensus opinion
> on this board will be that a 3x a day dosing is required to
> keep the medicine from being "bumpy". The medicine is metabolized
> very quickly through the kidney.I think I figured out why adding the lithium has decreased the half life of Nuerontin, that seemed to be extended by the depakote.
The lithium increases diuresis, so I imagine that the Neurontin is getting washed out faster...Humm that must be the reason. So I need to go back to the TID dosing that I was on before I started the depakote (Depakote seemed to increase N half life. Because I was finding I was not needing my mid day dose. I would just completely forget about it, because my body wasn't calling for it.). Wow, thanks for helping the lightbulb go off in my head!
> Do you take a multiple dosing of Diazepam? I'm not
> sure on the 1/2 life of that medicine. I take Klonopin
> 2 times a day and this insures that the medicines maintains
> a consistent level in my body.Diazapam has quite a long half life. But I take 2.5 mgs am, 2.5 mgs evening prn, and 5 mgs hs. You are right, that a smooth level of benzos is very important.
> Generally I would say it is ok to juggle a lot of medicines.
> I'm a little suspicious that you would want to have them
> circulating in and out of your bodies during different times
> of the day. Some medicines only require once a day dosing
> (like maybe celexa), so it probably doesn't matter when you
> take it. But other medicines like neurontin are important.
> I don't remember about Depakote. But if the standard regimen
> requires multiple daily dosing and your pdoc has you just
> taking a little at night, I think that is odd.My pdoc seems to think that low doses of depakote (under 500 mgs) can be taken all at bedtime, esp since it's supposed to help with sleep. I believe the half life of dep. is about 14-20 hours. So I think after you achieve your steady state of a particular dose, one time dosing is fine. Though, I might consider breaking it into BID since I do NOT find it helps me sleep, unlike most people.
> Being bipolar (as I am) its best to try to keep
> a solid base of medicines in the brain around the
> clock instead of trying to shuffle different medicines
> in and out. I don't think there is anything wrong with
> trying to keep a small dash of a lot of medicines in the
> head as long as they are around the clock. This is
> just my philosophy and others may disagree.Thank you for sharing your opinion. And generally speaking I totally agree. I think I will tweek the timing of some of my dosings, and see if I can smooth out my day a bit. Thanks..
Chloe
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