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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by danibell25 on June 1, 2002, at 20:39:19
I was diagnosed bipolar II and borderline personality disorder. I've been on Lithium, Depakote, Geodon, Zyprexa and now Tegretol. I've been researching it today and wonder if I messed up by suggesting it to the doctor. I haven't read very many good posts about it and the other things I've read make it sound good for the mania or highs of BP I not II. Bipolar II has more depression and borderlines have depression problems too. I stay suicidal almost all the time unless I'm hypomanic or in a "normal" phase. I also have serious problems with self-injury. From what I've read all the meds I've been on are good for BP I. Has anyone heard of anything good for BPII? If you have please respond. I got so desperate to see a doctor that I'm seeing a regular family doctor who of course knows next to nothing about BP or BPD or how to treat it. I can't see a psychiatrist until August so any advice would be greatly appreciated.
Posted by JohnX2 on June 1, 2002, at 21:09:55
In reply to Need lots of advice, posted by danibell25 on June 1, 2002, at 20:39:19
> I was diagnosed bipolar II and borderline personality disorder. I've been on Lithium, Depakote, Geodon, Zyprexa and now Tegretol. I've been researching it today and wonder if I messed up by suggesting it to the doctor. I haven't read very many good posts about it and the other things I've read make it sound good for the mania or highs of BP I not II. Bipolar II has more depression and borderlines have depression problems too. I stay suicidal almost all the time unless I'm hypomanic or in a "normal" phase. I also have serious problems with self-injury. From what I've read all the meds I've been on are good for BP I. Has anyone heard of anything good for BPII? If you have please respond. I got so desperate to see a doctor that I'm seeing a regular family doctor who of course knows next to nothing about BP or BPD or how to treat it. I can't see a psychiatrist until August so any advice would be greatly appreciated.
Hi There,
Sorry to here about the med swizzle game..
This is what I know from my experience.
I am DX'd with BP2 with mostly depression.
Take my knowledge for what it is worth.Lithium is the biggie for Bipolar I.
But all the other meds are good for bipolar II, including Tegetrol.
They may however require adjunctive medication (polypharmacy), which
is more the rule than the exception in any bipolar patient.
This may include multiple mood stabilizers, add on APs, an
antidepressant.The APs (atypical antipsychotics) like Geodon,Zyprexa, etc
can be helpful for both the anxiety, depression, and hypomania,
as well as other conditions.Of the mood stabilizers generally Li is gold standard for
the highs of bipolar I (but a lot of data shows it
can be a good booster to antidepressants).The other mood stabilizers are statistically better
for cycling patterns, but that doesn't imply that they
won't help with depressions for any given individual.
Were just dealing with a trend. FWIW, I did try a medication
called Trileptal (a new improved Tegetrol), and found it
gave a nice AD boost.The one you left out is Lamictal. This mood stabilizer is
thought to be extremely effective for bipolar II and probably
has the best antidepressant properties. I use it as my core
medication.As far as treatments for borderline and self-injury, I'm sorry
I don't have much information.I hope you get more feedback.
Please Take Care,
John
Posted by katekite on June 1, 2002, at 21:41:09
In reply to Need lots of advice, posted by danibell25 on June 1, 2002, at 20:39:19
Here is a big question: do you have an idea of which of the meds you have taken has helped the most, completely without reference to any side effects?
Can you specifically say how you felt (besides nauseated etc) on each drug? That would help.
And when I say helped I'm asking specifically about mood levelling effect. It's tempting to ask which one made you feel the best, but that might be hypomanic... so maybe not the best question. Sedation could really interfere, so during your most awake moments on any of those, which seemed the most mood-levelling, and the most likely to stay stable through a stress such as rejection?
Not in any way saying you would want to go back to them, just it would be good to have a direction in which to turn (as you've tried a couple classes of drugs).
In a general answer, bpd responds 'in general' to either antipsychotics or mood stabilizers or anti-anxiety agents or ssris or a combination, and bp II usually responds to mood stabilizers. But each person is a true individual so only on the basis of past response can you make a prediction.
Luckily you've already accumulated some evidence on what class of drugs might help you the most.
Good for you to forge ahead with your GP. No time like the present.... maybe by the time you can see the pdoc you will have found something that makes you feel good and stable, and will only need the expert to oversee it for the long-term.
Also, do you have a psychologist too?
kate
Posted by danibell25 on June 1, 2002, at 22:53:47
In reply to Re: Need lots of advice, posted by katekite on June 1, 2002, at 21:41:09
On Lithium I didn't feel any good or bad side effects. The last time I took it people said it actually made me worse. But I think it's because Lithium doesn't affect me and I was just going through a rough time already. The Geodon made me nauseous, severe headaches, and very suicidal. The Serefem (Prozac) made me agitated, suicidal and left me with 3 stitches in my arm. Zyprexa helped when I wasn't a zombie. I gained a lot of weight and was a zombie almost all the time which I hated. Tegretol so far has seemed to be the best but hasnt helped the insomnia, nightmares, panic and anxiety attacks, suicidal thoughts or self-injury.
Posted by katekite on June 2, 2002, at 10:19:07
In reply to Re: Need lots of advice, posted by danibell25 on June 1, 2002, at 22:53:47
what about the depakote? how long were you on it and what did it do?
Sounds like prozac sent you into a mixed or dysphoric hypomania.
When weren't you a zombie on xyprexa? Beginning? Higher dose? lower dose? in combination with something?
kate
Posted by danibell25 on June 2, 2002, at 15:48:21
In reply to Re: Need lots of advice, posted by katekite on June 2, 2002, at 10:19:07
He only gave me about 1 week sample of Depakote. I didn't notice any change except it got rid of my migraines.
Zyprexa did turn me into a zombie. I was on 5 mg and then bumped up to 10 mg. Everyone hated me on it.
Posted by katekite on June 2, 2002, at 21:13:51
In reply to Re: Need lots of advice, posted by danibell25 on June 2, 2002, at 15:48:21
sorry to seem so picky asking all these questions....just don't want to give bad advice if I can give less bad advice.
So the week on depakote? how did it compare to so far on tegretol?
do either of them make you feel a little less prone to feeling suicidal?
kate
Posted by Chloe on June 2, 2002, at 21:57:14
In reply to Re: Need lots of advice, posted by katekite on June 2, 2002, at 21:13:51
It sounds like you are going to need a few different meds to manage the mood instability you experience. But I think Tegretol is a fine med to start with. What dose are you at? Perhaps you need more to get some of it's calming effect? But, Tegretol does take about a month or so to "kick in." So maybe you just have to hang in there for a while.
Since you are tolerating the Tegretol and it's not making you "worse", perhaps adding depakote would be a good next step. Depakote is terrific for anger outbursts, agitation and might even help with some impulse control.
I take low doses of 3 mood stabilizers to keep my BP2 in line (depakote, lithium and neurontin)! And it took years of trial and error to find the mix that works, for now....Best of luck
Chloe
Posted by danibell25 on June 2, 2002, at 23:04:45
In reply to Re: Need lots of advice, posted by katekite on June 2, 2002, at 21:13:51
Either a medicine makes me suicidal or it does nothing. Depakote, Lithium, Zyprexa and Tegretol did absolutely nothing for panic attacks, insomnia, suicidal thoughts and self injury. Prozac, Geodon made me very suicidal with panic attacks and racing thoughts. I even had 3 stitches thanks to Prozac. No medicine has yet helped with my major symptoms at all.
Posted by danibell25 on June 2, 2002, at 23:10:44
In reply to Re: Need lots of advice, posted by Chloe on June 2, 2002, at 21:57:14
I take 200mg of Tegretol around bedtime. I still sleep 1-3 hrs a night, have nightmares, self-injure and have suicidal thoughts almost constantly. I was on a one week sample of Depakote but didn't notice any improvement. I also wasn't having as many problems then as I am now. It's strange I do fine through the fall and winter but around daylight savings time I started going downhill pretty quick. I hate it. I thought it was needing glasses but they don't seem to help. Sorry, lost my train of thought, I wonder if Depakote would work if put in combination with Tegretol. I have never been on more than one med at a time. Glad I switched doctors. Right now I'm seeing a regular doctor so it may take a while to get the right meds at the right doses.
Posted by Chloe on June 3, 2002, at 9:25:31
In reply to Re: Need lots of advice-Chloe, posted by danibell25 on June 2, 2002, at 23:10:44
> I take 200mg of Tegretol around bedtime. I still sleep 1-3 hrs a night, have nightmares, self-injure and have suicidal thoughts almost constantly. I was on a one week sample of Depakote but didn't notice any improvement. I also wasn't having as many problems then as I am now. It's strange I do fine through the fall and winter but around daylight savings time I started going downhill pretty quick. I hate it. I thought it was needing glasses but they don't seem to help. Sorry, lost my train of thought, I wonder if Depakote would work if put in combination with Tegretol. I have never been on more than one med at a time. Glad I switched doctors. Right now I'm seeing a regular doctor so it may take a while to get the right meds at the right doses.
Danibell,
I am sorry you are having such a struggle with meds. But I think perhaps you are undermedicated or not giving meds a long enough trial. Unfortunately, most meds take weeks before one can reach an adequate dose, or the effect begins to help the symptoms.200 mgs of Tegretol is a VERY low dose. And you are taking it all at night. So you are not getting any of it's benefit during the day. Some people take 1000 mgs or more in divided doses to help with the anxiety, insomnia and anguish.
Also a one week trial in NOT long enough to determine if a med is working or not. Especially when you are having such unpredictable variations in your mood. Depakote is a med that you should try for at least 6 weeks after you have titrated up to at least 500 to 1000 mgs/day, depending on blood levels.
You talk about nightmares and panic. Have you ever tried an SSRI like paxil? Or a benzo? These might be useful in your cocktail of meds.
Lastly, with you diagnosis, and amount of pain and suicidal/self injurious tendencies, I think it's vital you get a psychiatrist who specializes in such things.
I hope things improve soon.
Chloe
Posted by katekite on June 3, 2002, at 10:53:59
In reply to Re: Need lots of advice » danibell25, posted by Chloe on June 3, 2002, at 9:25:31
Thanks, beliala for answering all my picky questions.
I agree absolutely with the last poster.
One week is not long enough. How would you even know what dose you can tolerate?
Stick with the tegretol, or switch to the near cousing trileptal, and continue upping the dose until you reach side effects that won't go away, then drop it down to a level you can tolerate. Then wait 3 weeks or so to see if it really truly does help symptoms. (so this takes at least 6 weeks). Then if it does help symptoms, but isn't enough, consider adding a low dose of a second mood stabilizer. You didn't give depakote an adequate trial so that is high on the list.
After getting the dose of tegretol right, I would recommend lamictal for its mood boosting properties, but again, don't try it until you've found the best dose of tegretol for you. Depakote would be the other one to try early on. At the moment you are not looking for happiness, you are looking for decreased serious suicide feelings and decreased anger/agitation. You sound like you are in a mixed hypomanic episode at the moment (the decreased sleep but very unhappy, agitated).
It does sound like the antipsychotics will not do the job alone for you. Maybe someday it will turn out that a low dose of one or another will help, but I wouldn't start there.
One way to get a psychiatrist sooner than August would be the next time you feel suicidal to visit your local emergency room (that being what they are there for). You of course don't have to agree to being admitted, but they will darn well find you a psychiatrist to see.
After you've given depakote, tegretol (or you could switch to trileptal if side effects are too much from tegretol), and lamictal, then there are others. Since adequate trials of those will take 18 weeks if you did it back to back, there's plenty of time to research other drugs for down the road and no need to even be thinking about them now.
Lastly, you need to be seeing a therapist at least once a week if not more often at this point, given your sleep deficit is dangerous and your continual feelings of suicidal-ness are not good. Just because you have bpd does not make your suicidal feelings less dangerous than any other person without bpd. You need someone watching over you and checking in with you on a daily basis. If you don't have any professional doing that, get one right away.
kate
Posted by panthers!!! on June 16, 2005, at 13:03:32
In reply to Need lots of advice, posted by danibell25 on June 1, 2002, at 20:39:19
Hi. I read your thread and I just want you to know that there are many more options and meds for this. My 10 year old son has BiPolar Disorder (depression), BPD, Anxiety. Yes, it's rough.
We tried so many meds, many of the same as yours to find they generally did'nt work. As a matter of fact, some anti-depressants and meds increase suicide thoughts, as my son can tell you.
For now, first things first... Are you getting your Lithium Levels tested frequently? That med needs to be adjusted very often especially in the beginning. This can be serious. If they have taken you off, they still need to check the levels to see if it affecting your emotional state. Secondly, I also hope you will be attempting to get some hands on therapy, especially for the suicidal thoughts...I am surprised your doctor didn't send you to what we call here Behavioral Healthcare Facility, generally a 3 to 14 day program in-patient. How old are you? How long have you been diagnosed? What type of facility did you go to for the treatments you referenced?
You can also call your county health department and see if they have any openings for therapy sessions and w/ psychiatrist. Family doctors are generally NOT qualified to handle mood disorders, especially BIPOLAR. Many do not even know what BPD is!!
Also, are you taking any vitamins? Herbs? MEDS?
There are some nutritional products you can take that will possibly help with some of the issues, though it is no quick fix, over time, it makes a difference.
Omega 3's Fish Oil - 2000mg per day. Studies have shown this to be highly effective in BiP Management.
TAKE A MULTI-VITAMIN. Meds deplete some of our necessary nutrients.My son is now on these, and you can inquire about them at the next doctor you see:
(These are usually used as anti-seizure meds, but has also been effective for BiP: ( doses will vary depending on age and size)
Lamictal, Trileptal
Also, Risperdal- This is a fabulous med. Ask ASAP about this as it helps stop mood swings, a superior mood stabilizer. My son stopped suicidal thoughts within 1 1/2 months of taking this.
He also takes Clonadine- this is a blood pressure med, however, it is used to prevent hyper episodes.
Please feel free to Babble Mail me if you need further questions answered (or at least a starting point).
PLEASE BE GOOD TO YOURSELF. YOU ARE JUST LIKE MY SON, AND IF I DID NOT HAVE HIM TODAY I WOULD BE CRUSHED. YOU WOULD BE GREATLY MISSED BY MANY YOU PROBABLY DON'T EVEN KNOW, WE ALL TOUCH LIVES IN WAYS WE NEVER EXPECTED. YOU ARE WORTH LIVING FOR!!! GOOD LUCK-
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