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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 Kar on March 28, 2002, at 2:30:38
Hi all.
So for nearly all of the time since I was dx'ed with biplor (approx 16 years ago; I'm 32) I've been on combos of mood stabilizers and AD's of one sort or another. Got off the Nardil the summer before last because i had sinus probs and couldn't treat them effectively while on it. Since then we've tried combo after combo but always with an AD. Not much success- outta work since June. Haven't had a good few weeks in a row since I don't know when...
Ok, so now I've gotten off the Effexor and Wellbutrin (totally off since 2 weeks ago). All that's left is 1000 mg Tegretol XR and .075 mg Synthroid. This is day 5 of feeling fine. Just normal- fine. Doc wants to wait on the Nardil and add another MS if I "dip" (oh let's be serious; when I dip)...we've discussed the whole "AD's cause more cycling" philosophy many times but have never been able to be on "just" mood stabilizers for any length of time...Doc feels that the short periods of time that I've been off AD's (such as when i went off the Celexa and caaaarashed) weren't sufficient judges of that could be like off AD's.
Any thoughts?
Peppy for now,
Kar
Posted by Janelle on March 28, 2002, at 2:50:38
In reply to Off Ad's in prep for Nardil: Help?, posted by Kar on March 28, 2002, at 2:30:38
Hi there Kar! Nice to see you back on here!
So, you're another person out of work (sometimes I fear I'm the ONLY one on here who is UNable to work) -- I take it you had to quit your job due to your condition? What kind of work did you do?
I can relate to what you said about how you haven't had a good few weeks in a row since you don't know when - me neither.
Given the history you've described I'm not sure what to say about your doc's idea to wait on the Nardil and add another MS if you "dip" - since you're not working, perhaps you could just wait it out awhile longer with NO Nardil or MS and see if you continue to feel "peppy" (okay/fine/normal).
Then again, how long had you been off the Celexa before you crashed? Me, I was on a MS and the AD Effexor, my pdoc thought I could be on just the MS, so I tapered off Effexor and crashed 4 weeks later (after 4 weeks of no Effexor, just MS) - how about you - how long after you stopped Celexa did you crash?
And why did you stop Celexa? I had tried that one, but got nothing out of it but side effects. In a haze, headache, out-of-body type feelings.
Posted by Kar on March 28, 2002, at 19:06:45
In reply to Re: Off Ad's in prep for Nardil: Help?, posted by Janelle on March 28, 2002, at 2:50:38
Thanks, Janelle- yup, not working...i was part of the 'ole disability thread with BCat a week or two back...
I'm a pediatric speech therapist. I work with little ones in the Birth to Three population (usually closer to three!) With this population, therapy is very family-centered and we make home visits. I was lucky enough to have a very flexible schedule- could reschedule missed visits to later in the week, etc. But after a while it wasn't fair to me or my clients because I was unable to get to work so frequently.
>
Yes, what the doc had in mind was just that- to wait until I felt worse before we add anything. It didn't take long- maybe a day or two off the Celexa before I crashed. What PDoc thinks is that we didn't wait long enough for my body to readjust...I was just soo bad that it wasn't the time to say, "Let's wait a little longer"...He wonders if the AD's are making me worse off even tho it sounds counterintuitive. It's pretty well documented that it happens with bipolar patients...increased cycling. We've just never been in the position to see what happens just on mood stabilizers.
>
Stopped Celexa because I was more down than up. It seemed really promising at first- I got a little better each time we increased it. But then never "got me there"- even in combos of other drugs (no I can't remember what...)Hope you're doin ok...
kar
Posted by Janelle on March 30, 2002, at 2:17:10
In reply to Re: Off Ad's in prep for Nardil: Help? » Janelle, posted by Kar on March 28, 2002, at 19:06:45
My memory is shot and I can't remember - Kar, are you on SS disability or not?
Posted by Tye on March 30, 2002, at 13:41:23
In reply to Off Ad's in prep for Nardil: Help?, posted by Kar on March 28, 2002, at 2:30:38
Kar,
A minority of bipolars are able to get by on mood stablizers alone ..... usually classic bipolar I's. Most bipolar in reality do need an antidepressant. MAOIs have very low rates of inducing mania .... and parnate is know to probably be one of the best antidepressants for anergic bipolar depression.
Take care.
Tye
Posted by JohnX2 on March 30, 2002, at 23:30:02
In reply to Re: Off Ad's in prep for Nardil: Help?, posted by Tye on March 30, 2002, at 13:41:23
>MAOIs have very low rates of inducing mania .... and parnate is know to probably be one of the best antidepressants for anergic bipolar depression.
>
> Take care.
>
> TyeTye,
I would like to try parnate, as it sounds like a good party drug (just kidding). I have bpII with some ADD like symptoms and off/on mild atypical depressive symptoms. But the ADs like Wellbutrin and stimulants like Adderall make me manic, hook-line-and-sinker. So I really don't have a full grip on some of my symptoms, although I am not depressed. Do you really feel I could give Parnate a run and not have it drive me manic?
Currently Serzone, Lamictal, Topamax, and Klonopin are inducing hypomania. But I can't drop the Serzone. The Serzone's AD action is mild enough to be tolerated (unlike Wellbutrin or Adderall).
Could you please direct me to any information on the likelihood of MAOIs inducing mania?
Regards,
John
Posted by Tye on March 31, 2002, at 8:32:12
In reply to Re: Off Ad's in prep for Nardil: Help? » Tye, posted by JohnX2 on March 30, 2002, at 23:30:02
> Tye,
>
> I would like to try parnate, as it sounds like a good party drug (just kidding). I have bpII with some ADD like symptoms and off/on mild atypical depressive symptoms. But the ADs like Wellbutrin and stimulants like Adderall make me manic, hook-line-and-sinker. So I really don't have a full grip on some of my symptoms, although I am not depressed. Do you really feel I could give Parnate a run and not have it drive me manic?Probably not. I believe parnate and wellbutrin have similar switch rates, lower that most antidepressants. If you have switched on wellbutrin and stimulants, you probably will with parnate as well. Although, one can never predict! If you have good monitoring with your doctors, maybe it is worth a try.
> Currently Serzone, Lamictal, Topamax, and Klonopin are inducing hypomania. But I can't drop the Serzone. The Serzone's AD action is mild enough to be tolerated (unlike Wellbutrin or Adderall).
>
> Could you please direct me to any information on the likelihood of MAOIs inducing mania?
>I have forgotten where I got that info, let me try a dig it up. Some stuff is in my textbooks, not on line. Well, here is one:
"The Psychopharmacology Sourcebook" by Mark Zetin M.D. page 247 "It appears that cycling from depression into a manic episode is less frequent with wellbutrin, paxil and parnate than it is for the tricyclic antidepressant drugs."
Hope this helped.
Tye
Posted by Kar on April 1, 2002, at 11:15:05
In reply to Re: Off Ad's in prep for Nardil: Help?, posted by Tye on March 30, 2002, at 13:41:23
Tye- thanks for the info. The thing is, tho, since I've been on the Tegretol, I've never gotten an episode of antidepressant-induced mania. Ever. But the doc still thinks that my times of feeling normal then feeling bad classify as "cycling". What's the diff between cycling and "breakthrough depression"- do you know?
Thanks!
Kar
Posted by Kar on April 1, 2002, at 11:18:45
In reply to KAR: question 4 U! » Kar, posted by Janelle on March 30, 2002, at 2:17:10
Hey J- No I'm not on (SS) disability. I didn't have enough work credits to be elibible. Got turned down for SSI but am appealing...
Take care-
This is the end of the thread.
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