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Dr. Bob is Robert Hsiung, MD,
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Posted by Anna P. on May 26, 2002, at 0:08:45
In reply to Keppra for hard-to-treat Bipolar Disorder, posted by Psydoc on May 25, 2002, at 22:12:30
Hello Dr Goldberg,
I have the treatment-resistant depression with SAD (twice a year episodes)at the top of it. I've tried all medications available from all around the world. The problem is that I respond to them, and they loose response with time. This includes mood stabilizers such as Neurontin, Topamax or Geodon, Revia, Sulpiride.
I've also tried Keppra and Zonegran. I need energizing medication because of my anergy. Keppra "put me down", slowed me down and made me feel anergic within few days.
I saw some bests doctors in USA, tried ECT and rTMS with no results. Does it mean I'm incurable?
What would you suggest?
Anna P.
Posted by Psydoc on May 26, 2002, at 8:59:48
In reply to Re: Keppra for hard-to-treat Bipolar Disorder, posted by Anna P. on May 26, 2002, at 0:08:45
Hi, Anna . . .
When it comes to people who cycle and have low energy I have had the best experience treating them with a combination of lithium and high dose Parnate. Doses of Parnate well over 100 mg/day are sometimes needed.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
> Hello Dr Goldberg,
>
> I have the treatment-resistant depression with SAD (twice a year episodes)at the top of it. I've tried all medications available from all around the world. The problem is that I respond to them, and they loose response with time. This includes mood stabilizers such as Neurontin, Topamax or Geodon, Revia, Sulpiride.
>
> I've also tried Keppra and Zonegran. I need energizing medication because of my anergy. Keppra "put me down", slowed me down and made me feel anergic within few days.
>
> I saw some bests doctors in USA, tried ECT and rTMS with no results. Does it mean I'm incurable?
> What would you suggest?
>
>
> Anna P.
Posted by katekite on May 26, 2002, at 21:15:31
In reply to Keppra for hard-to-treat Bipolar Disorder, posted by Psydoc on May 25, 2002, at 22:12:30
Do you think keppra could have utility in the treatment of anxiety? -- I became 'allergic' to neurontin.
kate
Posted by Psydoc on May 26, 2002, at 22:27:33
In reply to Re: Keppra for hard-to-treat Bipolar Disorder, posted by katekite on May 26, 2002, at 21:15:31
Hi . . .
There is some animal evidence that Keppra has anti-anxiety activity. See: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11937098&dopt=Abstract
But, I have no idea how well is works as a treatment for people with anxiety disorders.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> Do you think keppra could have utility in the treatment of anxiety? -- I became 'allergic' to neurontin.
>
> kate
Posted by Anna P. on May 27, 2002, at 13:56:12
In reply to Re: Keppra for hard-to-treat Bipolar Disorder » Anna P., posted by Psydoc on May 26, 2002, at 8:59:48
Dr Goldberg, thank you for your suggestion. Unfortunately, I've developed the tolerance to medications, which means the dose increase doesn't help. I already tried Parnate and Lithium as well.
My problem is: once the combo of drugs is working, how to sustain the response.
Can you recommend a specialist/clinic that can help with that problem?
Is there any hope?
Also, I read about two European drugs such as Memantine and Acamprosate that can prevent the poop-out. Unfortunately none of the doctors in U.S. is familiar with these drugs.
Anna P.
Posted by katekite on May 27, 2002, at 15:52:09
In reply to Re: Keppra for hard-to-treat Bipolar Disorder » katekite, posted by Psydoc on May 26, 2002, at 22:27:33
Posted by susan C on May 27, 2002, at 20:28:06
In reply to Keppra for hard-to-treat Bipolar Disorder, posted by Psydoc on May 25, 2002, at 22:12:30
http://www.dr-bob.org/babble/20010725/msgs/72416.html
Hello, this is the beginning of an online journal I kept last year during a 'trial'. In retrospect I think the top things taking it did were, one- cause more sleepiness, dizziness and unsteadiness, two- a feeling of 'idontcare' and three- I stopped eating. I have never had that experience before. The 'working' dx is bipolr II.
sc
Posted by Psydoc on May 27, 2002, at 21:32:10
In reply to fyi, posted by susan C on May 27, 2002, at 20:28:06
Many thanx for calling my attention to your Keppra Journal.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> http://www.dr-bob.org/babble/20010725/msgs/72416.html
>
> Hello, this is the beginning of an online journal I kept last year during a 'trial'. In retrospect I think the top things taking it did were, one- cause more sleepiness, dizziness and unsteadiness, two- a feeling of 'idontcare' and three- I stopped eating. I have never had that experience before. The 'working' dx is bipolr II.
> sc
Posted by Anna P. on May 29, 2002, at 0:22:31
In reply to Re: Why tolerance? Please help!!!, posted by Anna P. on May 27, 2002, at 13:56:12
Dr Goldberg, so there is no hope for my case?
I've read the hypothesis that the body builds the immunity to drugs, that's why they don't work anymore.Anna P.
Posted by Psydoc on May 30, 2002, at 4:47:49
In reply to Re: Dr Goldberg, so there is no hope?, posted by Anna P. on May 29, 2002, at 0:22:31
Feeling hopeless about the possibility of finding a solution to the problem of an ongoing depression is common and is the result of a frustrating series of failed drug trials plus the "negative thinking' of someone who is depresed.
I have seen many patients who have developed resitance to many drugs but who eventually find a combination of medications that provide ongoing relief. Such combinations are often complex and involve two or three antidepressants plus one or two mood stabilizers or low doses of an antipsychotic. Very often such successful "cocktails" involve the use of medication that had failed when used singly or in less complex combinations in the past.
Best regards . . .
Ivan
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> Dr Goldberg, so there is no hope for my case?
> I've read the hypothesis that the body builds the immunity to drugs, that's why they don't work anymore.
>
> Anna P.
Posted by JohnX2 on May 30, 2002, at 19:11:56
In reply to Keppra for hard-to-treat Bipolar Disorder, posted by Psydoc on May 25, 2002, at 22:12:30
Hi Dr. Goldberg,I was wondering if you could give a feeler for
the profile (cycling patterns, which meds did good/bad
on) of hard to treat bipolars that have
done well on Keppra? I know this is a very generic
question, but it would be useful.Also do you know if Keppra may be useful in the
treatment of facial neuralgia/myofascial pain/med
incuded tension headaches?Thanks,
John> I have recently had good expereinces when treating a number of people with hard-to-treat Bipolar Disorder with Keppra.
>
> I would be interested in hearing fron individuals who have had good and bad experiences when taking with this medication.
>
> Best regards . . .
>
> Ivan Goldberg
> psydoc@psycom.net
> %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Posted by Anna P. on May 31, 2002, at 1:21:13
In reply to Re: Dr Goldberg, so there is no hope? » Anna P., posted by Psydoc on May 30, 2002, at 4:47:49
Dr Goldberg, thank you again. I realize that my case is unique and doesn't happen every day. I've tried everything and lost in the battle with depression. I'm still looking for answers. I'm willing to try anything possible.
Anna P.
Posted by Psydoc on May 31, 2002, at 4:46:48
In reply to Re: Keppra for hard-to-treat Bipolar Disorder » Psydoc, posted by JohnX2 on May 30, 2002, at 19:11:56
Hi . . .
The people for whom I have prescribed Keppra have been individuals with Bipolar Disorder not adequately controlled by other treatments. Typically they have not improved on combinations of mood stabilizers such as Lithium + Depakote or Lamictal + Topamax. Generally these are people with rapid cycling or severe mixed states.
As yet I have not been able to identify anything that allows me to predict who will do well or who will do poorly with Keppra.
As yet there are no reports on the succesful or unsuccessful use of Keppra as a treatemnt for people with pain syndromes.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
> Hi Dr. Goldberg,
>
> I was wondering if you could give a feeler for
> the profile (cycling patterns, which meds did good/bad
> on) of hard to treat bipolars that have
> done well on Keppra? I know this is a very generic
> question, but it would be useful.
>
> Also do you know if Keppra may be useful in the
> treatment of facial neuralgia/myofascial pain/med
> incuded tension headaches?
>
> Thanks,
> John
Posted by polarbear206 on May 31, 2002, at 8:37:26
In reply to Re: Dr Goldberg, so there is no hope? » Anna P., posted by Psydoc on May 30, 2002, at 4:47:49
Anna,
Have you tried each mood stabilizer with an MAOI? If so, how high did you go with the MAOI'S?
Laura.
Posted by SLS on May 31, 2002, at 8:52:13
In reply to Re: Dr Goldberg, so there is no hope? » Anna P., posted by Psydoc on May 30, 2002, at 4:47:49
> Feeling hopeless about the possibility of finding a solution to the problem of an ongoing depression is common and is the result of a frustrating series of failed drug trials plus the "negative thinking' of someone who is depresed.
> I have seen many patients who have developed resitance to many drugs but who eventually find a combination of medications that provide ongoing relief. Such combinations are often complex and involve two or three antidepressants plus one or two mood stabilizers or low doses of an antipsychotic. Very often such successful "cocktails" involve
Dear Dr. Goldberg,
Have you ever heard of the use of memantine (Akatinol - Germany) or acamprosate (Campral) to help prevent the development of "tolerance" or "medication break-through" relapse during the treatment of depression? Memantine is the one I am most interested in, and is currently under development in the US for the indication of Alzheimer's Dementia.
I have experienced robust responses to TCAs, MAOIs, nomifensine, and Lamital. This state of nearly complete remission lasts exactly three days before it disappears abruptly. Since memantine has been reported to obviate the development of tolerance to the psychostimulating effects of amphetamine, I a wondering if you have ever heard of its use in treating depression.
Is there any other drug that comes to mind when treating someone who experience such transient responses to drugs?
It's always nice to have hope. I was very happy to read your reply to Anna. It is a monumental achievement to maintain hope after so many treatment failures. Depression is a hideous and oppressive altered state of consciousness. It is a dark and dank prison cell without windows to the outside world.
Thanks.
- Scott
Posted by Seamus2 on June 1, 2002, at 9:28:01
In reply to Re: Dr Goldberg, so there is no hope? » Psydoc, posted by SLS on May 31, 2002, at 8:52:13
Hi Scott,
Have you done a Medline on amantadine for the same use? I think they are chemical cousins and iirc, amantadine is a DA agonist.
Seamus
Posted by SLS on June 1, 2002, at 16:21:07
In reply to Memantine / Amantadine, posted by Seamus2 on June 1, 2002, at 9:28:01
Posted by JohnX2 on June 1, 2002, at 20:23:52
In reply to Memantine / Amantadine, posted by Seamus2 on June 1, 2002, at 9:28:01
> Hi Scott,
>
> Have you done a Medline on amantadine for the same use? I think they are chemical cousins and iirc, amantadine is a DA agonist.
>
> SeamusThe two medicines are are almost molecularly identical.
Memantine has 2 extra CH3 groups.I don't know how the physiological properties compare.
Are they apples-to-apples?The molecular weight of memantine is greater than
amantadine. But the therapeutic dose for memantine
off the top of my head is around around 30mg and
amantadine is 200-400 mg. Supposedly amantadine is
much more intolerable.John
Posted by Cecilia on June 2, 2002, at 1:06:21
In reply to Re: Dr Goldberg, so there is no hope? » Anna P., posted by Psydoc on May 30, 2002, at 4:47:49
I`ve been noticing how people from the UK find that their doctors give up on them after a few trials, whereas in the US they keep trying ever more complicated regimes (at least if the patient has good insurance). Sometimes I wonder which is better, hope is good, sure, but so many people can`t tolerate the side effects of high dose multi-med regimes. Doctors like Dr. Goldberg don`t see them because they finally give up on their own and decide depression without side effects is better than depression with them. I`d be curious to know what percent of people are actually able to tolerate some of these elaborate cocktails-doctors say such and such percentage inprove on such and such regime, but they never say what percent was never able to get to therapeutic doses on said regime. A Discouraged Cecilia
Posted by JonW on June 2, 2002, at 12:12:36
In reply to Hope, posted by Cecilia on June 2, 2002, at 1:06:21
Hi Cecilia,
If you are disabled and want to die with every breath you take, isn't *any* chance of improvement better than no chance? You describe people that have taken an existential view of themselves. Why not do both this and medication? With an experienced psydoc the side-effects don't have to be a major problem.
Persistent for better or for worse,
Jon> I`ve been noticing how people from the UK find that their doctors give up on them after a few trials, whereas in the US they keep trying ever more complicated regimes (at least if the patient has good insurance). Sometimes I wonder which is better, hope is good, sure, but so many people can`t tolerate the side effects of high dose multi-med regimes. Doctors like Dr. Goldberg don`t see them because they finally give up on their own and decide depression without side effects is better than depression with them. I`d be curious to know what percent of people are actually able to tolerate some of these elaborate cocktails-doctors say such and such percentage inprove on such and such regime, but they never say what percent was never able to get to therapeutic doses on said regime. A Discouraged Cecilia
Posted by Anna P. on June 2, 2002, at 15:11:25
In reply to Hope, posted by Cecilia on June 2, 2002, at 1:06:21
Hi Cecilia,
If you are "really" depressed, disabled or dysfunctional, believe me, you would take anything possible to reduce suffering.
Anna P.
Posted by Psydoc on June 2, 2002, at 21:06:01
In reply to Hope, posted by Cecilia on June 2, 2002, at 1:06:21
To give you an example of how a complex "cocktail" of meds can be useful, a few months ago I saw a severely depressed lawyer who had been too depresed to practice law for 2-years. He had been diagnosed with Bipolar-II Disorder. He came to me taking:
Effexor-XR 150 mg 3X a day
Klonopin 1/2 mg 3X a day
Ritalin 5 mg 3X a day
Wellbutrin-XR 150 mg 3X a day
Zyprexa 2.5 mg at bed
Depakote 1500 mg at bedHe had been on this combination for over 3-months without significant benefit. As I usually consider Klonopin to be part of the problem rather than the solution, I gradually stopped it, and I VERY gradually introduced Lamictal which was slowly increased to 100 mg/day. Within three weeks of reaching 100 mg/day his depression remitted sufficiently for him to return to work. Over the next few months he was weaned off of the Depakote, the Zyprexa and the Ritalin. The Lamictal was gradually increased to 200 mg/day.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
> I`ve been noticing how people from the UK find that their doctors give up on them after a few trials, whereas in the US they keep trying ever more complicated regimes (at least if the patient has good insurance). Sometimes I wonder which is better, hope is good, sure, but so many people can`t tolerate the side effects of high dose multi-med regimes. Doctors like Dr. Goldberg don`t see them because they finally give up on their own and decide depression without side effects is better than depression with them. I`d be curious to know what percent of people are actually able to tolerate some of these elaborate cocktails-doctors say such and such percentage inprove on such and such regime, but they never say what percent was never able to get to therapeutic doses on said regime. A Discouraged Cecilia
Posted by JennyJen on June 2, 2002, at 23:35:02
In reply to Re: Hope and complex drug cocktails » Cecilia, posted by Psydoc on June 2, 2002, at 21:06:01
Dear Dr Goldberg,
I have been thinking I am bipolar II. As I understood it, shouldn't individuals with bipolar II be taken off antidepressants? I noticed the example you provided, the patient was doing well with 2 antidepressants and lamictal. Thank You.
Jenny
Posted by Cecilia on June 3, 2002, at 2:48:40
In reply to Re: Hope, posted by Anna P. on June 2, 2002, at 15:11:25
For me, it`s about being able to function, at least at work-I don`t really have a life outside work. There are so many meds that make working impossible-running to the bathroom with diarrhea every 10 minutes(Effexor) or sleeping only 2 hours a night(Parnate). I`m not talking about (to me) trivial side effects like sexual dysfunction; whenever people write in saying they`ve quit an effective AD for that I want to scream "Are you crazy-depression is 24/7-just how much time do you spend having sex"? I`ve spent nearly my whole life in severe depression, basically my "life" has been about hiding it. Nothing has ever helped my depression, therapy or meds, and I`ve tried over 30 different meds or combos. I don`t have the courage to kill myself, so I`m stuck until I die.
Posted by JonW on June 3, 2002, at 12:07:15
In reply to Re: Hope and complex drug cocktails » Cecilia, posted by Psydoc on June 2, 2002, at 21:06:01
> He had been on this combination for over 3-months without significant benefit. As I usually consider Klonopin to be part of the problem rather than the solution, I gradually stopped it,
Dr. Goldberg,
Would you say this is true of just Klonopin or all of the benzodizepines in general?
Jon
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