![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 82. This is the beginning of the thread.
Posted by JohnX2 on March 25, 2002, at 1:19:54
I thought the prevailing wisdom on td was that d2 upregulation hypothesis was outdated and bunk?John
1: Psychopharmacology (Berl) 2000 Oct;152(2):174-80 Related Articles, Books, LinkOut
Increased dopamine D2 receptor binding after long-term treatment with antipsychotics in humans: a clinical PET study.Silvestri S, Seeman MV, Negrete JC, Houle S, Shammi CM, Remington GJ, Kapur S, Zipursky RB, Wilson AA, Christensen BK, Seeman P.
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
RATIONALE: Dopamine D2 receptor upregulation in the striatum is regularly seen in response to the administration of traditional antipsychotics in animal experiments. This is associated with hyperactivity and, for this reason, D2 receptor upregulation has long been postulated as central to tardive dyskinesia (TD). OBJECTIVE: Using positron emission tomography (PET), the present study attempted to determine whether antipsychotic-induced D2 receptor up-regulation also occurs in humans. METHODS: The long-term effects of traditional and novel antipsychotics on dopamine D2 receptors were investigated in nine subjects meeting DSM-IV criteria for schizophrenia who were deemed eligible for temporary treatment washout. Subjects had been treated with traditional antipsychotics (haloperidol n=3, perphenazine n=1) and novel antipsychotics (risperidone n=3, olanzapine n=2) in the moderate to high dosage range. Fourteen days after treatment withdrawal, the binding potentials (BPs) of dopamine D2 receptors were measured using 11[C] raclopride. The obtained BPs were compared to the BPs from antipsychotic-naive control subjects with schizophrenia. RESULTS: There was a significant increase in the D2 BP in both groups combined that reached 34%. The increases in the D2 BPs in the groups treated with conventional and novel antipsychotics were 37% and 31%, respectively. Significantly, the patients showing the highest degree of D2 receptor upregulation (98%) developed severe and persistent TD shortly after being started on a new antipsychotic with low affinity for D2 receptors. CONCLUSION: This study demonstrates for the first time, using in vivo neuroreceptor imaging, that dopamine D2 receptor binding is increased after long-term treatment with antipsychotics in humans. The data suggest that both traditional and novel antipsychotics with high affinity for dopamine D2 receptors are associated with a substantial increase in D2 receptor binding. The present data in humans agree well with animal data that implicate D2 receptor-mediated mechanisms in motor hyperactivity.
PMID: 11057521 [PubMed - indexed for MEDLINE]
Posted by JohnX2 on March 25, 2002, at 1:45:34
In reply to TD and d2 receptor upregulation?, posted by JohnX2 on March 25, 2002, at 1:19:54
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9689480&dopt=Abstract1: Brain Res 1998 Jun 15;796(1-2):291-5 Related Articles, Books, LinkOut
Failure to down regulate NMDA receptors in the striatum and nucleus accumbens associated with neuroleptic-induced dyskinesia.Hamid EH, Hyde TM, Baca SM, Egan MF.
Clinical Research Services, National Institute of Mental Health, St. Elizabeth's Hospital, Washington, DC, USA.
The syndrome of vacuous chewing movements (VCMs) in rats is similar in many respects to tardive dyskinesia (TD) in humans. Both syndromes are characterized by delayed onset of persistent orofacial dyskinesias in a sub-group of subjects chronically treated with neuroleptics. Using the rat model, we examined the role of NMDA receptor-mediated corticostriatal neurotransmission in the expression of VCMs. Rats were treated for 36 weeks with haloperidol decanoate or vehicle and then withdrawn for an additional 28 weeks. Chronic persistent VCMs were induced in one subgroup of treated animals (+VCM), but not in another group (-VCM). Rats from +VCM, -VCM groups and vehicle-treated controls were selected for post mortem studies (n = 12 to 14 per group). NMDA receptor levels were assessed using [3H]-MK-801 binding in sections from the mid-striatum and nucleus accumbens. Chronic haloperidol treatment produced a marked reduction of NMDA receptor binding levels throughout the striatum and nucleus accumbens. Post hoc comparisons demonstrated that -VCM rats had lower NMDA receptor binding levels than +VCM and vehicle-treated controls. Ventromedial striatum and nucleus accumbens core were the most affected areas. These findings suggest that down-regulation of striatal NMDA receptor binding levels may protect against the expression of neuroleptic-induced dyskinesia.
PMID: 9689480 [PubMed - indexed for MEDLINE]
Posted by JohnX2 on March 25, 2002, at 1:59:58
In reply to TD and d2 receptor upregulation?, posted by JohnX2 on March 25, 2002, at 1:19:54
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8904651&dopt=Abstract
Br J Pharmacol 1996 Oct;119(4):751-7 Related Articles, Books, LinkOut
Inhibition by memantine of the development of persistent oral dyskinesias induced by long-term haloperidol treatment of rats.Andreassen OA, Aamo TO, Joorgensen HA.
Department of Physiology, Section Sandviken Hospital, University of Bergen, Norway.
1. Tardive dyskinesia (TD) is a serious side-effect of long-term treatment with neuroleptics. To investigate if neuroleptic-induced excessive stimulation of striatal glutamate receptors may underlie TD development, the effect of the NMDA antagonist, memantine (1-amino-3,5-dimethyladamantane), was studied in a rat model of TD. 2. In an acute experiment, six groups of rats were treated daily for 1 week with either vehicle or memantine 20 or 40 mg kg-1 day-1, and on the seventh day they received one injection of either haloperidol 1.0 mg kg-1 i.p. or saline i.p. In a subsequent long-term experiment lasting 20 weeks, the same treatment was continued, except that haloperidol was injected i.m. as decanoate (38 mg kg-1 every 4 weeks) and control rats received sesame oil. The behaviour was videotaped and scored at intervals during both experiments, and for 16 weeks after cessation of the long-term treatment. 3. In the acute experiment, haloperidol decreased motor activity and memantine increased moving and tended to attenuate the immobility induced by haloperidol. Memantine also enhanced the haloperidol-induced increase in the putative TD-analogue vacuous chewing movements (VCM). 4. In the long-term experiment, the most marked effect of haloperidol was a gradual increase in VCM and the increase persisted significantly for 12 weeks after cessation of treatment. Memantine dose-dependently increased VCM and moving during long-term treatment. However, only one week after stopping treatment, both these effects of memantine disappeared. In contrast to rats previously treated with haloperidol alone, rats co-treated with memantine (both doses) and haloperidol had VCM at the level of controls two weeks after stopping treatment. The blood levels of drugs were within the therapeutic range achieved in human subjects. 5. These results suggest that long-lasting changes induced by haloperidol are prevented by memantine, which supports the theory that excessive NMDA receptor stimulation may be a mechanism underlying the development of persistent VCM in rats and maybe also TD in human subjects.
PMID: 8904651 [PubMed - indexed for MEDLINE]
Posted by JohnX2 on March 25, 2002, at 2:09:19
In reply to TD and d2 receptor upregulation?, posted by JohnX2 on March 25, 2002, at 1:19:54
Behav Pharmacol 2001 Jun;12(3):209-16 Related Articles, Books, LinkOut
Excitatory mechanisms in neuroleptic-induced vacuous chewing movements (VCMs): possible involvement of calcium and nitric oxide.Naidu PS, Kulkarni SK.
University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
Tardive dyskinesia (TD) is a serious motor side-effect of chronic neuroleptic therapy. Chronic treatment with neuroleptics leads to the development of oral abnormal movements in rats known as vacuous chewing movements (VCMs). Vacuous chewing movements in rats have been widely accepted as an animal model of tardive dyskinesia. Chronic blockade of D2 inhibitory dopamine (DA) receptors localized on glutamatergic terminals in the striatum leads to the persistent enhanced release of glutamate that kills the striatal output neurons. The object of the present study was to explore the role of glutamatergic modulation on the neuroleptic-induced VCMs. Rats were chronically (for 21 days) treated with haloperidol (1.5 mg/kg, i.p.) to produce VCMs. The neuroleptic-induced VCMs viz., vertical jaw movements, tongue protrusions and bursts of jaw tremors, were counted during a 5 min observation period. Dizocilpine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, dose dependently (0.02 and 0.05 mg/kg) reduced haloperidol-induced VCMs. Felodipine (5 and 10 mg/kg), an L-type calcium-channel blocker, also significantly reduced the VCM count. N-omega-nitro-L-arginine methyl ester (L-NAME) (25 and 50 mg/kg), a nitric oxide synthase inhibitor, also reduced the VCM count in an L-arginine-sensitive manner. In conclusion, the findings of the present study indicated NMDA receptor involvement in haloperidol-induced VCMs, and also suggested the possible involvement of calcium and nitric oxide in haloperidol-induced VCMs.
PMID: 11485057 [PubMed - indexed for MEDLINE]
Posted by OldSchool on March 26, 2002, at 22:43:57
In reply to TD and d2 receptor upregulation?, posted by JohnX2 on March 25, 2002, at 1:19:54
Bilateral ECT fixes TD the best of any treatment I read. ECT has anti-parkinsons but anti-psychotic properties at the same time...cool huh? ECT does something to change the supersensitivity of dopamine receptors around, decreasing TD levels.
So besides getting rid of the neuroleptic, taking lots of vitamin E...bilateral ECT is probably the best thing a person with TD can do for themselves. Plus bilateral ECT fights psychosis without causing movmement disorders like neuroleptics cause.
Old School
Posted by JohnX2 on March 27, 2002, at 0:33:48
In reply to Re: ECT fixes TD, posted by OldSchool on March 26, 2002, at 22:43:57
Old School,That's pretty cool. It seems once those dopamine receptor couplings get fouled up, its tough to reset things. Maybe just need a good "shock" to shake things up! I tell you at my job I work with new age computer technology and I probably shake shit to get it to work as often as I microanalyze it. ;)
I really look forward to some positive results.
Best Wishes,
John> Bilateral ECT fixes TD the best of any treatment I read. ECT has anti-parkinsons but anti-psychotic properties at the same time...cool huh? ECT does something to change the supersensitivity of dopamine receptors around, decreasing TD levels.
>
> So besides getting rid of the neuroleptic, taking lots of vitamin E...bilateral ECT is probably the best thing a person with TD can do for themselves. Plus bilateral ECT fights psychosis without causing movmement disorders like neuroleptics cause.
>
> Old School
Posted by Chloe on May 27, 2003, at 22:17:01
In reply to Re: ECT fixes TD » OldSchool, posted by JohnX2 on March 27, 2002, at 0:33:48
Hi,
I can personally attest to the fact that ECT "cures" TD. I had several treatments last year, and during that time began to notice the *lack* of the constant movement of my tongue wagging back and forth along my back teeth. And the horrible clenching of my jaw stopped...I think the seizure acts like a reset button to the neurotransmitters in the brain. Hence releaving TD and EPS.I know this because several months after ending ECT treamtments, I had a really bad episode where I need seroquel again, low dose for about two weeks. Unfortunately the wagging and clenching are back, if I am taking seroquel or not. It was so nice to be movement free for a time. And no, I don't want to sign up for more treatments, even as painless and helpful as they were. I am very treatment resistant, and about a month after I stopped ECT, the depression and mood disorder crept back.
I need to find a lasting cure...I think ECT usually lasts longer for most people. What a happy time I experienced during the sessions. Boy I got a lot done and felt very productive, clear and upbeat.
Take care,
Chloe
> Old School,
>
> That's pretty cool. It seems once those dopamine receptor couplings get fouled up, its tough to reset things. Maybe just need a good "shock" to shake things up! I tell you at my job I work with new age computer technology and I probably shake shit to get it to work as often as I microanalyze it. ;)
>
> I really look forward to some positive results.
>
> Best Wishes,
> John
>
>
>
> > Bilateral ECT fixes TD the best of any treatment I read. ECT has anti-parkinsons but anti-psychotic properties at the same time...cool huh? ECT does something to change the supersensitivity of dopamine receptors around, decreasing TD levels.
> >
> > So besides getting rid of the neuroleptic, taking lots of vitamin E...bilateral ECT is probably the best thing a person with TD can do for themselves. Plus bilateral ECT fights psychosis without causing movmement disorders like neuroleptics cause.
> >
> > Old School
>
>
Posted by Pfinstegg on May 27, 2003, at 23:11:59
In reply to Re: ECT fixes TD, posted by Chloe on May 27, 2003, at 22:17:01
Hi Chloe.. I'm very glad to see your name again, although sorry to hear that the ECT didn't provide you with a lasting remission. At about the time you had ECT, I had TMS. I think it is about the same in effectiveness, although the TMS, not being FDA-approved, is not as easy to get. It was so free of side-effects- not any short-term memory loss, and not even a headache afterwards- and so easy, because , since no anesthesia was required, I could drive myself there and back. Each treatment took 20 minutes- I had one daily for three weeks. So far, I have been lucky, as I do have a four-month remission (after a 10-year AD-resistant depression). But, if and when I need to, I would definitely return for whatever maintenance treatment I needed- there just isn't a down-side to it.
I wanted to tell you this, as you do not seem to want maintenance ECT, and TMS, with maintenance, might seem more reasonable to you- if you could obtain it near where you live.
Pfinstegg
Posted by Ritch on May 28, 2003, at 9:31:43
In reply to Re: ECT fixes TD, posted by Chloe on May 27, 2003, at 22:17:01
Hi Chloe, did you end the maintenance ECT, or did your doctors tell you they were stopping it? Just wondering, because you seemed to be doing so well on it. So what meds do they have you on now? Sorry, for the questions-just haven't heard a peep from you in a while. OK, here's another one :), have you tried Lamictal yet? ----Mitch
> Hi,
> I can personally attest to the fact that ECT "cures" TD. I had several treatments last year, and during that time began to notice the *lack* of the constant movement of my tongue wagging back and forth along my back teeth. And the horrible clenching of my jaw stopped...I think the seizure acts like a reset button to the neurotransmitters in the brain. Hence releaving TD and EPS.
>
> I know this because several months after ending ECT treamtments, I had a really bad episode where I need seroquel again, low dose for about two weeks. Unfortunately the wagging and clenching are back, if I am taking seroquel or not. It was so nice to be movement free for a time. And no, I don't want to sign up for more treatments, even as painless and helpful as they were. I am very treatment resistant, and about a month after I stopped ECT, the depression and mood disorder crept back.
> I need to find a lasting cure...I think ECT usually lasts longer for most people. What a happy time I experienced during the sessions. Boy I got a lot done and felt very productive, clear and upbeat.
> Take care,
> Chloe
>
>
>
>
> > Old School,
> >
> > That's pretty cool. It seems once those dopamine receptor couplings get fouled up, its tough to reset things. Maybe just need a good "shock" to shake things up! I tell you at my job I work with new age computer technology and I probably shake shit to get it to work as often as I microanalyze it. ;)
> >
> > I really look forward to some positive results.
> >
> > Best Wishes,
> > John
> >
> >
> >
> > > Bilateral ECT fixes TD the best of any treatment I read. ECT has anti-parkinsons but anti-psychotic properties at the same time...cool huh? ECT does something to change the supersensitivity of dopamine receptors around, decreasing TD levels.
> > >
> > > So besides getting rid of the neuroleptic, taking lots of vitamin E...bilateral ECT is probably the best thing a person with TD can do for themselves. Plus bilateral ECT fights psychosis without causing movmement disorders like neuroleptics cause.
> > >
> > > Old School
> >
> >
>
>
Posted by Chloe on May 28, 2003, at 20:05:54
In reply to Re: ECT fixes TD » Chloe, posted by Pfinstegg on May 27, 2003, at 23:11:59
> Hi Chloe.. I'm very glad to see your name again, although sorry to hear that the ECT didn't provide you with a lasting remission. At about the time you had ECT, I had TMS. I think it is about the same in effectiveness, although the TMS, not being FDA-approved, is not as easy to get. It was so free of side-effects- not any short-term memory loss, and not even a headache afterwards- and so easy, because , since no anesthesia was required, I could drive myself there and back. Each treatment took 20 minutes- I had one daily for three weeks. So far, I have been lucky, as I do have a four-month remission (after a 10-year AD-resistant depression). But, if and when I need to, I would definitely return for whatever maintenance treatment I needed- there just isn't a down-side to it.
Hi
I am so glad you found your treatments so useful and without side effects. I haven't heard of TMS being done in my area. I will keep an eye and ear out for it.
>
> I wanted to tell you this, as you do not seem to want maintenance ECT, and TMS, with maintenance, might seem more reasonable to you- if you could obtain it near where you live.Thanks alot.
Chloe
>
> Pfinstegg
Posted by Chloe on May 28, 2003, at 20:37:31
In reply to Re: ECT fixes TD » Chloe, posted by Ritch on May 28, 2003, at 9:31:43
Hi Mitch,
Nice to hear from you. I guess I have been gone for a while. I had a really good stretch with the ECT.
My docs were really laid back about my treatments and I swear I would still be having them if I didn't ask to stop. I was having two per month (all my insurance would cover in the end) for a couple months and that wasn't quite frequent enough. I was starting to have minor mood swingings and irritable outbursts. So I, not the docs decided to end it because the insurance wouldn't pay for say...three a month. Unfortunately, my mood disorder has kinda come back and I am living day to day again. I miss my stability and reliability. But some things are alot better...I learned so much with ECT. Things about my emotional life became so clear...Though probably obvious to those close to me! But I learned that my mood is NEVER going to remain even or constant. I can pine and wish and pray for that, but it's not going to come. So now if I am really elated and productive, and I think I am cured, I know now that that mood is not going last. A crash is around the corner. Seems silly, but I never realized that til ECT wiped out my cycling.Anyhoo...Yes, I have tried Lamictal and depakote, neurontin, Tegretol, trileptal, topamax, and any others out there. All the antiepileptics give me bad rashes and scalp burning pain. I get miserable side effects and minimal relief. Lamictal made me feel very blah and just crumby all over. Have you tried it or are you thinking of trying it?
Now I take
900 mg Eskilith CR
40 mgs Doxepin
10 mgs Valium
5 mcgs T3 (thyroid)
(25 mgs Seroquel prn)When I first started T3 it was helping with my cycling. Then, I think my thyroid shut off because I got massive hair loss, lethargy, chronic unbearable constipation, etc. I just could not live that way, so I cut my dose in half waiting for a endocrin appointment. It's been almost 6 months trying to get an appointment. My BF wants me to go back up on the T3, but hypothyroid side effects SUCK. I can't face it. I think cycling is better at this point. Have you ever tried any thyroid stuff? There might be something to that. But I am afraid to mess with it until I can be monitored properly.
Hope you are doing ok...
Chloe
Posted by Ritch on May 28, 2003, at 22:11:19
In reply to Re: ECT fixes TD » Ritch, posted by Chloe on May 28, 2003, at 20:37:31
> Hi Mitch,
> Nice to hear from you. I guess I have been gone for a while. I had a really good stretch with the ECT.
> My docs were really laid back about my treatments and I swear I would still be having them if I didn't ask to stop. I was having two per month (all my insurance would cover in the end) for a couple months and that wasn't quite frequent enough. I was starting to have minor mood swingings and irritable outbursts. So I, not the docs decided to end it because the insurance wouldn't pay for say...three a month. Unfortunately, my mood disorder has kinda come back and I am living day to day again. I miss my stability and reliability. But some things are alot better...I learned so much with ECT. Things about my emotional life became so clear...Though probably obvious to those close to me! But I learned that my mood is NEVER going to remain even or constant. I can pine and wish and pray for that, but it's not going to come. So now if I am really elated and productive, and I think I am cured, I know now that that mood is not going last. A crash is around the corner. Seems silly, but I never realized that til ECT wiped out my cycling.
>
> Anyhoo...Yes, I have tried Lamictal and depakote, neurontin, Tegretol, trileptal, topamax, and any others out there. All the antiepileptics give me bad rashes and scalp burning pain. I get miserable side effects and minimal relief. Lamictal made me feel very blah and just crumby all over. Have you tried it or are you thinking of trying it?
>
> Now I take
> 900 mg Eskilith CR
> 40 mgs Doxepin
> 10 mgs Valium
> 5 mcgs T3 (thyroid)
> (25 mgs Seroquel prn)
>
> When I first started T3 it was helping with my cycling. Then, I think my thyroid shut off because I got massive hair loss, lethargy, chronic unbearable constipation, etc. I just could not live that way, so I cut my dose in half waiting for a endocrin appointment. It's been almost 6 months trying to get an appointment. My BF wants me to go back up on the T3, but hypothyroid side effects SUCK. I can't face it. I think cycling is better at this point. Have you ever tried any thyroid stuff? There might be something to that. But I am afraid to mess with it until I can be monitored properly.
>
> Hope you are doing ok...
> ChloeChloe, it seems that you have gotten a bunch of important insight about your cycling from all of your recent ECT experience. For me it is just like a tribal seasonal songdance of sorts. That makes it predictable-which is helpful-but it makes you feel fatalistic about things and sometimes I discount good news too much. That's weird about your meds-lithium+doxepin+diazepam were the first three meds in different classes that I had been on simultaneously-but that was in the early '80's! Depression-wise the lithium worked better than Depakote, but it was a little mean on my thyroid and I only have 1/3 of a thyroid left. I've been quite wirey (predictably) the last few weeks and my pdoc wanted to add some lithium (but I can't handle it very well). We tried some Zonegran and it made me very irritable with insomnia (yuck), and then tried Keppra and that just made me listless and increased my anxiety/depression (slept better though). I haven't tried Lamictal yet.. I'm thinking about bringing it up in a very formal way at my next appt. though. I think if I follow the titration guidelines (despite being on Depakote), that I will be OK. But before I do that I want to add just a *tiny* bit of Buspar (2.5-5.0mg/day) to my current meds of
Depakote 250mg
Klonopin .5-.75mg
Effexor approx. 4-6mg
Fishoil 1-2G EPA
I got a very good antianxiety response to Buspar previously-I'm just med sensitive and it made me dysphoric at higher doses (but it causes dysphoria in practically anybody in overdose). Thyroid stuff.... I would like to try that at some point because.... stimulants have been so successful in the past, and I think that adding something that could reduce the cycling and reduce depression/anergia would be a good route to follow.=====take care===Mitch
Posted by Jack Smith on May 28, 2003, at 22:55:00
In reply to Re: ECT fixes TD » Chloe, posted by Ritch on May 28, 2003, at 22:11:19
> Depakote 250mg
> Klonopin .5-.75mg
> Effexor approx. 4-6mg
> Fishoil 1-2G EPA
> stimulants have been so successful in the past,Why no stimulants now?
I am curious about your effexor dose and its relation to your BP II. I know you are bipolar II and I have a terrible understanding of this diagnosis but I am curious about one thing--does the fact that I can take 225 mg of Effexor and 400 mg Wellbutrin without any sort of EXTRA anxiety or agitation tend to show that I am not BP II. I have a lot of free floating agitation and anxiety and I have wondered if this makes me BP II but then I have always been able to handle high doses of AD meds without exacerbating these symptoms, but they hardly help them except to the extent AD's lift my mood and keep me from getting down about it. I guess it doesn't matter because what works for some doesn't work for others regardless of dx. I think I am leaning towards trying Lamictal as well. I want to cut down the WB. And I am thinking Lamictal may help with anergia and agitation but who knows? It is an interesting med.
One more q: Why do you go by Ritch when you call yourself Mitch?
Thanks,
JACK
Posted by Ritch on May 29, 2003, at 10:07:15
In reply to Mitch, several Q's » Ritch, posted by Jack Smith on May 28, 2003, at 22:55:00
> > Depakote 250mg
> > Klonopin .5-.75mg
> > Effexor approx. 4-6mg
> > Fishoil 1-2G EPA
> > stimulants have been so successful in the past,
>
> Why no stimulants now?Anxiety. It seems I have two or three conditions simultaneously and although stims work magically (and at low doses)for bipolar depression (sleep quality improves as well-no early morning awakenings!), and even seem to flatten out some of my cycling-they have this tendency to bring back my panic disorder symptoms (not right away-but after a few weeks/months on them). Dexedrine was the easiest to tolerate, with the least amount of anxiety. If I ever get really depressed again-that one might be brought back short-term (maybe three or four weeks).
>
> I am curious about your effexor dose and its relation to your BP II. I know you are bipolar II and I have a terrible understanding of this diagnosis but I am curious about one thing--does the fact that I can take 225 mg of Effexor and 400 mg Wellbutrin without any sort of EXTRA anxiety or agitation tend to show that I am not BP II. I have a lot of free floating agitation and anxiety and I have wondered if this makes me BP II but then I have always been able to handle high doses of AD meds without exacerbating these symptoms, but they hardly help them except to the extent AD's lift my mood and keep me from getting down about it. I guess it doesn't matter because what works for some doesn't work for others regardless of dx. I think I am leaning towards trying Lamictal as well. I want to cut down the WB. And I am thinking Lamictal may help with anergia and agitation but who knows? It is an interesting med.
I think it is just an issue of med sensitivity for me combined with the flat dose-response curve of serotonergic meds. Any of the SRI's can have a very beneficial effect (on anxiety/panic) at very tiny doses I've found. Prozac or Celexa 2mg/day has definite effects. Effexor is my fav. because of convenience (the XR is a "sprinkle" cap and that makes taking it easy and VERY cheap) and if I get really under I can boost the dose and I always get a positive response at a "higher" dose (12.5-25mg i.e.)-it's flexible and effective, in short. Yeah... 400mg of Wellbutrin would probably flip me to BP-I with enough time. I tolerated 150mg a day (that's the most I've ever tried) for about three weeks and the anxiety was godawful (far worse than stims-got off it before I started to panic). This is just my opinion, but if you don't have clearcut manic symptoms SOMETIME or other you may as well be treating mixed anxiety/depression and not complicate things. I don't know whether you've taken that test at psycheducation.org or not, but if you haven't taken it, you might give it a rip.
>
> One more q: Why do you go by Ritch when you call yourself Mitch?Computer crash-lost my password-had to start over-new screen name. I had a chance to fix it-but thought something else might go wrong! Hey man, when something is working I don't mess with it if at all possible!
>
> Thanks,
>
> JACK
>
Posted by Chloe on May 29, 2003, at 19:51:46
In reply to Re: ECT fixes TD » Chloe, posted by Ritch on May 28, 2003, at 22:11:19
> Chloe, it seems that you have gotten a bunch of important insight about your cycling from all of your recent ECT experience. For me it is just like a tribal seasonal songdance of sorts. That makes it predictable-which is helpful-but it makes you feel fatalistic about things and sometimes I discount good news too much. That's weird about your meds-lithium+doxepin+diazepam were the first three meds in different classes that I had been on simultaneously-but that was in the early '80's! Depression-wise the lithium worked better than Depakote, but it was a little mean on my thyroid and I only have 1/3 of a thyroid left. I've been quite wirey (predictably) the last few weeks and my pdoc wanted to add some lithium (but I can't handle it very well). We tried some Zonegran and it made me very irritable with insomnia (yuck), and then tried Keppra and that just made me listless and increased my anxiety/depression (slept better though). I haven't tried Lamictal yet.. I'm thinking about bringing it up in a very formal way at my next appt. though. I think if I follow the titration guidelines (despite being on Depakote), that I will be OK. But before I do that I want to add just a *tiny* bit of Buspar (2.5-5.0mg/day) to my current meds of
> Depakote 250mg
> Klonopin .5-.75mg
> Effexor approx. 4-6mg
> Fishoil 1-2G EPA
> I got a very good antianxiety response to Buspar previously-I'm just med sensitive and it made me dysphoric at higher doses (but it causes dysphoria in practically anybody in overdose). Thyroid stuff.... I would like to try that at some point because.... stimulants have been so successful in the past, and I think that adding something that could reduce the cycling and reduce depression/anergia would be a good route to follow.=====take care===MitchHey Mitch,
Can you give me refresher on Zonegran and Keppra? I don't recall their class or what they are used for.
And why the resurgence of Lamictal? There seems to be alot of people wanting to try it. What is your reason, if you don't mind me asking? Is Depakote not working so well? Too bad about the lithium, and your thyroid. I am sorry you lost some of your thyroid. I am glad what you have is working!
I am very happy with lithium as a mood stabilizer. It seems to agree with me. I just wish it helped with the cycling. Nothing touches that. And frankly I am so tired of putting my body through med trials. Way too hard on my little body. So this is it until I can find a better AP for prn use, or I get someone to take my thyroid issues...
Thanks
Chloe
Posted by Ritch on May 29, 2003, at 23:39:59
In reply to Re:Q for Mitch » Ritch, posted by Chloe on May 29, 2003, at 19:51:46
>
> > Chloe, it seems that you have gotten a bunch of important insight about your cycling from all of your recent ECT experience. For me it is just like a tribal seasonal songdance of sorts. That makes it predictable-which is helpful-but it makes you feel fatalistic about things and sometimes I discount good news too much. That's weird about your meds-lithium+doxepin+diazepam were the first three meds in different classes that I had been on simultaneously-but that was in the early '80's! Depression-wise the lithium worked better than Depakote, but it was a little mean on my thyroid and I only have 1/3 of a thyroid left. I've been quite wirey (predictably) the last few weeks and my pdoc wanted to add some lithium (but I can't handle it very well). We tried some Zonegran and it made me very irritable with insomnia (yuck), and then tried Keppra and that just made me listless and increased my anxiety/depression (slept better though). I haven't tried Lamictal yet.. I'm thinking about bringing it up in a very formal way at my next appt. though. I think if I follow the titration guidelines (despite being on Depakote), that I will be OK. But before I do that I want to add just a *tiny* bit of Buspar (2.5-5.0mg/day) to my current meds of
> > Depakote 250mg
> > Klonopin .5-.75mg
> > Effexor approx. 4-6mg
> > Fishoil 1-2G EPA
> > I got a very good antianxiety response to Buspar previously-I'm just med sensitive and it made me dysphoric at higher doses (but it causes dysphoria in practically anybody in overdose). Thyroid stuff.... I would like to try that at some point because.... stimulants have been so successful in the past, and I think that adding something that could reduce the cycling and reduce depression/anergia would be a good route to follow.=====take care===Mitch
>
> Hey Mitch,
> Can you give me refresher on Zonegran and Keppra? I don't recall their class or what they are used for.
> And why the resurgence of Lamictal? There seems to be alot of people wanting to try it. What is your reason, if you don't mind me asking? Is Depakote not working so well? Too bad about the lithium, and your thyroid. I am sorry you lost some of your thyroid. I am glad what you have is working!
> I am very happy with lithium as a mood stabilizer. It seems to agree with me. I just wish it helped with the cycling. Nothing touches that. And frankly I am so tired of putting my body through med trials. Way too hard on my little body. So this is it until I can find a better AP for prn use, or I get someone to take my thyroid issues...
> Thanks
> Chloe
>
>Zonegran and Keppra.... Well, they are the newest anticonvulsants that have been approved (for epilepsy). Of course, pdocs are trying them off-label for bipolar in some of their patients. I have heard little that is positive. I definitely got very irritable on the Zonegran-no doubt. Keppra was very tolerable (physically), and I noticed decreased pain, better sleep, less GI disturbance (which I definitely liked!), but it seemed to slowly make me more and more depressed. That's the trouble with many AED's-they can aggravate or cause psychosis and depression. However, Lamictal (another AED), has a track record for helping bipolar depression specifically. Folks with epilepsy like it because they feel more "normal" or "like themselves" (fewer behavioural side effects). Lamictal is in Phase III trials for an FDA indication for bipolar depression. IOW, it's got the empirical science going for it, it is just the potential rash issues that freak people out (including me). It seems like Lamictal by itself may not be a very good antimanic and probably does little for psychotic symptoms (like lithium can). So it often combined with lithium or Depakote. I am interested in Lamictal as a possible means of getting through my bipolar depressions without needing AD's or not needing to increase the dose of the AD I currently take for anxiety(Effexor) to the point where it aggravates cycling. You might look into Abilify. It has some troubles with insomnia, akathisia, and some irritability in some-so I don't know how it would set with you. The nice thing is that it seems to have little dystonia-and I think that is one thing you have a lot of trouble with AP's---Mitch
Posted by Chloe on May 30, 2003, at 22:00:59
In reply to Re:Q for Mitch » Chloe, posted by Ritch on May 29, 2003, at 23:39:59
> Zonegran and Keppra.... Well, they are the newest anticonvulsants that have been approved (for epilepsy). Of course, pdocs are trying them off-label for bipolar in some of their patients. I have heard little that is positive. I definitely got very irritable on the Zonegran-no doubt. Keppra was very tolerable (physically), and I noticed decreased pain, better sleep, less GI disturbance (which I definitely liked!), but it seemed to slowly make me more and more depressed. That's the trouble with many AED's-they can aggravate or cause psychosis and depression. However, Lamictal (another AED), has a track record for helping bipolar depression specifically. Folks with epilepsy like it because they feel more "normal" or "like themselves" (fewer behavioural side effects). Lamictal is in Phase III trials for an FDA indication for bipolar depression. IOW, it's got the empirical science going for it, it is just the potential rash issues that freak people out (including me). It seems like Lamictal by itself may not be a very good antimanic and probably does little for psychotic symptoms (like lithium can). So it often combined with lithium or Depakote. I am interested in Lamictal as a possible means of getting through my bipolar depressions without needing AD's or not needing to increase the dose of the AD I currently take for anxiety(Effexor) to the point where it aggravates cycling. You might look into Abilify. It has some troubles with insomnia, akathisia, and some irritability in some-so I don't know how it would set with you. The nice thing is that it seems to have little dystonia-and I think that is one thing you have a lot of trouble with AP's---Mitch
Hi Mitch,
What you talk about is fascinating...Most of the AED's I have tried make me feel irritable and blah at the same time. I think that "mixed" kinda state is what lead me to ECT. Thank god for Li in my case. It is interesting though that lamictal is being tried for BP depression. If I remember right, Lamictal had a lot of physical things I really hated, like feeling so achy and uncomfortable in my body. I think it gave me headaches too, and this was all before I reached therapuetic dose! That was hard for me, titrating up so slowly. But you don't want to get that rash. If you do try it, I really hope it's beneficial to you...
Thanks, my pdoc mention abilify to me. But when I did a smallest amount of research, I say the side effects you mentioned. Irritability is one of my biggest problems. I have an extremely short fuse. And so I don't want to try a med that might work like gasoline. I also fear insomnia. Some days are so hard and so long, the thought of not being able to sleep through part of it is terrifying. But so are these tongue and jaw problems. I wish I knew if it's ok to even take Seroquel if it exacerbates my movements. Is there any way to know if the movements will get worse? They don't seem to be worse than when I was on Thorazine/Mellaril. The movements kinda stopped at the level where I d/c'd those typical AP's. Oh, back when Clozaril first came out I was put on that. It worked so great, no tongue stuff, no chronic suicidal thoughts. But I got the dreaded agranularcytosis. Go figure.
Well, I guess I am just rambling. I hope you like Lamictal-if you go for it.
Take care
Chloe
Posted by Ritch on May 30, 2003, at 22:33:52
In reply to Re:Q for Mitch » Ritch, posted by Chloe on May 30, 2003, at 22:00:59
> Hi Mitch,
> What you talk about is fascinating...Most of the AED's I have tried make me feel irritable and blah at the same time. I think that "mixed" kinda state is what lead me to ECT. Thank god for Li in my case. It is interesting though that lamictal is being tried for BP depression. If I remember right, Lamictal had a lot of physical things I really hated, like feeling so achy and uncomfortable in my body. I think it gave me headaches too, and this was all before I reached therapuetic dose! That was hard for me, titrating up so slowly. But you don't want to get that rash. If you do try it, I really hope it's beneficial to you...
> Thanks, my pdoc mention abilify to me. But when I did a smallest amount of research, I say the side effects you mentioned. Irritability is one of my biggest problems. I have an extremely short fuse. And so I don't want to try a med that might work like gasoline. I also fear insomnia. Some days are so hard and so long, the thought of not being able to sleep through part of it is terrifying. But so are these tongue and jaw problems. I wish I knew if it's ok to even take Seroquel if it exacerbates my movements. Is there any way to know if the movements will get worse? They don't seem to be worse than when I was on Thorazine/Mellaril. The movements kinda stopped at the level where I d/c'd those typical AP's. Oh, back when Clozaril first came out I was put on that. It worked so great, no tongue stuff, no chronic suicidal thoughts. But I got the dreaded agranularcytosis. Go figure.
> Well, I guess I am just rambling. I hope you like Lamictal-if you go for it.
> Take care
> ChloeChloe, It seems that lithium is definitely the right antimanic/antipsychotic med for you. I had some decent response in the past with Mellaril (10-30mg hs), but I have a cataract and one pigmented retina from just three years of use. So I really don't want any AP's at all of any kind. I've never been able to hack taking any one of them long term. Headache can be a big side effect for Lamictal users from what I've read here. I will get into that probably sooner or later.---Mitch
Posted by Chloe on May 31, 2003, at 10:36:11
In reply to Re:Q for Mitch » Chloe, posted by Ritch on May 30, 2003, at 22:33:52
> > Hi Mitch,
> > What you talk about is fascinating...Most of the AED's I have tried make me feel irritable and blah at the same time. I think that "mixed" kinda state is what lead me to ECT. Thank god for Li in my case. It is interesting though that lamictal is being tried for BP depression. If I remember right, Lamictal had a lot of physical things I really hated, like feeling so achy and uncomfortable in my body. I think it gave me headaches too, and this was all before I reached therapuetic dose! That was hard for me, titrating up so slowly. But you don't want to get that rash. If you do try it, I really hope it's beneficial to you...
> > Thanks, my pdoc mention abilify to me. But when I did a smallest amount of research, I say the side effects you mentioned. Irritability is one of my biggest problems. I have an extremely short fuse. And so I don't want to try a med that might work like gasoline. I also fear insomnia. Some days are so hard and so long, the thought of not being able to sleep through part of it is terrifying. But so are these tongue and jaw problems. I wish I knew if it's ok to even take Seroquel if it exacerbates my movements. Is there any way to know if the movements will get worse? They don't seem to be worse than when I was on Thorazine/Mellaril. The movements kinda stopped at the level where I d/c'd those typical AP's. Oh, back when Clozaril first came out I was put on that. It worked so great, no tongue stuff, no chronic suicidal thoughts. But I got the dreaded agranularcytosis. Go figure.
> > Well, I guess I am just rambling. I hope you like Lamictal-if you go for it.
> > Take care
> > Chloe
>
> Chloe, It seems that lithium is definitely the right antimanic/antipsychotic med for you. I had some decent response in the past with Mellaril (10-30mg hs), but I have a cataract and one pigmented retina from just three years of use. So I really don't want any AP's at all of any kind. I've never been able to hack taking any one of them long term. Headache can be a big side effect for Lamictal users from what I've read here. I will get into that probably sooner or later.---MitchWow, AP's really are the devil. I am sorry you developed eye problems. It's very scary that a med class that is so effective on symptoms, can be so potentially dangerous in terms of *permanant* side effects. I just wish so badly, that there was a med out there that would help with the intermitant rage, distorted thinking and suicidal ideation "attacks." There doesn't seem to any substitute for me so far. I'm just thankful I don't need AP's that often.
Good luck finding the right cocktail. I admire your stick-to-itness!
Take care,
Chloe
Posted by Ritch on June 1, 2003, at 9:54:38
In reply to Re: AP's.. » Ritch, posted by Chloe on May 31, 2003, at 10:36:11
> > Chloe, It seems that lithium is definitely the right antimanic/antipsychotic med for you. I had some decent response in the past with Mellaril (10-30mg hs), but I have a cataract and one pigmented retina from just three years of use. So I really don't want any AP's at all of any kind. I've never been able to hack taking any one of them long term. Headache can be a big side effect for Lamictal users from what I've read here. I will get into that probably sooner or later.---Mitch
>
> Wow, AP's really are the devil. I am sorry you developed eye problems. It's very scary that a med class that is so effective on symptoms, can be so potentially dangerous in terms of *permanant* side effects. I just wish so badly, that there was a med out there that would help with the intermitant rage, distorted thinking and suicidal ideation "attacks." There doesn't seem to any substitute for me so far. I'm just thankful I don't need AP's that often.
> Good luck finding the right cocktail. I admire your stick-to-itness!
> Take care,
> ChloeChloe, they really help a lot of people though. I remember when I was taking Mellaril my pdoc was always asking me stuff like: "Do you think you could take a little *more*?" ;) Usually 10mg at bedtime was all I ever took, and mainly just for anxiety and sleep. Getting up the next day was really pleasant-much less foggy-headed than with the newer ones I've tried. For me, lithium just didn't get onto the cycling like Depakote does. It just takes a lot of work NOT to be on them!--Mitch
Posted by maryhelen on June 1, 2003, at 14:36:06
In reply to Re: AP's.. » Chloe, posted by Ritch on June 1, 2003, at 9:54:38
I feel so discouraged by what I read in other posts about Lamitcal. It seems that most people are getting a great response and then it poops out.
I am on 90 mg of Parnate and had to augment because it started to lose it's effect. I augmented it with Lithium but when I went to 1200 mg. the side effects began. Even going back down I was left with tremors, twitching, hair loss, but worst of all my mind was dull and I wasn't getting things. I have just returned to work and I could not tolerate these side effects.
Unfortunaley, the Lithium did have an anti-depressant effect. The doctor put me on Lamitcal and I now am at 100 mg. after a month. I have never felt better. I have treatment resistant depression and have tried more meds than I can name, including 2 separate rounds of ECT. Now I am scared that the Lamitcal will poop out and I cannot go back into that depression and keep my job.Anyone had good, long lasting results with Lamitcal.
Thanks,
maryhelen
Posted by Ritch on June 1, 2003, at 16:59:09
In reply to Re: AP's.., posted by maryhelen on June 1, 2003, at 14:36:06
> I feel so discouraged by what I read in other posts about Lamitcal. It seems that most people are getting a great response and then it poops out.
>
> I am on 90 mg of Parnate and had to augment because it started to lose it's effect. I augmented it with Lithium but when I went to 1200 mg. the side effects began. Even going back down I was left with tremors, twitching, hair loss, but worst of all my mind was dull and I wasn't getting things. I have just returned to work and I could not tolerate these side effects.
> Unfortunaley, the Lithium did have an anti-depressant effect. The doctor put me on Lamitcal and I now am at 100 mg. after a month. I have never felt better. I have treatment resistant depression and have tried more meds than I can name, including 2 separate rounds of ECT. Now I am scared that the Lamitcal will poop out and I cannot go back into that depression and keep my job.
>
> Anyone had good, long lasting results with Lamitcal.
>
> Thanks,
>
> maryhelen
Maryhelen, I've been closely reading posts about Lamictal as well, because I would like to go for a trial myself at some point in the future. However, I wouldn't get prematurely discouraged about the "poop-out" phenomenon. I can't remember a post from a unipolar depressive on Lamictal that found a quick success then a poopout. Everything I'm reading relates to bipolar's experience with the stuff. I'm beginning to wonder whether some of the poop-out phenomenon you are hearing about may be the "mood stabilizing" or antimanic effects of Lamictal becoming more prominent with time being on the drug. If my "highs" were *totally* gone-I would feel deprived in some ways. I also wonder if there is a tricky dose range that people may be going past as well. Or to complicate matters-an optimum relatively narrow dose range that "moves around". I hope things continue to work for you-remember it still IS a success!
Posted by maryhelen on June 1, 2003, at 19:16:02
In reply to Re: Lamictal success stories?? » maryhelen, posted by Ritch on June 1, 2003, at 16:59:09
Thank you so much for responding to my post Ritch. There was so much information and I was wondering and selfishing hoping that this wasn't so much referring to my treatment resistant depression. You have given me an instant boost and hope. I will just go with the good feeling I have and pray for the best.
The knowledge and support you share is incredible and I thank you so much.
maryhelen
Posted by colin wallace on June 3, 2003, at 9:07:59
In reply to Re: Lamictal success stories for Ritch, posted by maryhelen on June 1, 2003, at 19:16:02
Maryhelen,
I've been taking Lamictal now for almost a year, and yes, it can be a tricky med. to get to grips with.Titrating can be difficult at first,with many experiencing a degree of irritability which can be managed by making smaller increments.
Then, strangely there comes a point(round about 50mg) where dose increases become easy, and any irritability can be managed by 25mg increases!
200mg seems to yield good results(some here have reached 500mg or so-I hit 400mg myself),although the 'poop-out' phenomenon(which I ran into aswell)can simply mean that you'll need an additional antidepressant thrown in.
I now take 250mg Lamictal, and 10mg Prozac has reinforced the Lam. effect-I'm still doing very well indeed.
(I've been diagnosed BP11 and was previously treatment resistant, and unable to tolerate even tiny doses of most antidepressants.)
Hope this helps a little.It's a great med overall.Best,
Col.
Posted by Ritch on June 3, 2003, at 9:19:51
In reply to Re: Lamictal success stories for Ritch » maryhelen, posted by colin wallace on June 3, 2003, at 9:07:59
> Maryhelen,
>
>
> I've been taking Lamictal now for almost a year, and yes, it can be a tricky med. to get to grips with.Titrating can be difficult at first,with many experiencing a degree of irritability which can be managed by making smaller increments.
> Then, strangely there comes a point(round about 50mg) where dose increases become easy, and any irritability can be managed by 25mg increases!
> 200mg seems to yield good results(some here have reached 500mg or so-I hit 400mg myself),although the 'poop-out' phenomenon(which I ran into aswell)can simply mean that you'll need an additional antidepressant thrown in.
> I now take 250mg Lamictal, and 10mg Prozac has reinforced the Lam. effect-I'm still doing very well indeed.
> (I've been diagnosed BP11 and was previously treatment resistant, and unable to tolerate even tiny doses of most antidepressants.)
> Hope this helps a little.It's a great med overall.
>
> Best,
>
> Col.Colin, I'm glad that you're doing well! I noticed that you *decreased* the dosage of the Lamictal from 400mg down to 250mg. Was it because you found that 250mg was plenty enough and that more didn't seem to make much difference? Just wondering... I've read some of your other posts about irritability.. did the Prozac wind up helping with the irritability or did it resolve on its own by being on the Lamictal? thanks in advance for any resonses, thinking about trying this sometime soon... maybe start getting ramped up on it in time for wintertime!
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.