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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by jay on October 28, 2002, at 16:35:36
Roo:I know this is for Dinah..but..I feel I have some very useful information you can use. According to some great research I have been reading, for those who fall into BPII category, adding a small dose of an antidepressant, and MAYBE even ANOTHER mood stabilizer, are needed to prevent the depression part of the problem. It's VERY tricky.
I too was once just on a mood stabilizer...and I went DOWN..really fast. If you can pick an a.d. you did best on, try it with the mood stabilizer. You will need some time to adjust doses, but believe me, you will feel almost 100 percent better. I have also found the occasional use of a good dose of a benzo, especially at the start of the two or three new drugs, makes things move along quicker.
Somebody posted an excellent website about how being BP is more of a 'degree'...and we all fall on different parts of this spectrum. In fact, the author even suggest we treat ALL depression in this fashion, and it may seem like 'too much', but it really does seem like the majority of us has even the slightest tendency to fall into manic symptoms, even if drug induced. A mood stabilizer WITH an antidepressant may just make ALL a.d. users feel more 'balanced'.
For those who can't tolerate or find mood stabilizers don't work, a couple of the new atypical antipsychotics seem to work *excellent*, and appear very safe.
I have come close to having this all worked out and figured out for myself. It is VERY much a tricky use of medications, and the combination of a few is the ONLY thing that keeps me stable and feeling like the 'old me'...much better actually..like a new person with the wisdom of living and surviving some of the deepest darkest points in life. There IS hope..and things CAN and WILL get better with some creative med tinkering. Ya, I know what you are thinking..telling me to "Shut up with your stupid happiness.."..heh. That's what I might have said anyways...heh.
Let me know what you think..
Best wishes,
Jay> If I may have to add a damn antidepressant to
> the old mood stabilizer....I'm stable...not suicidal...
> but I often think dark thoughts and life seems depleted a
> and bleak....I lack joy....I don't know what to think...I hate
> the side effects....but I don't like these feelings either....
> what do you think....tell me what to do...how to live my life...
> (just kidding)....there's this feeling I get when I know I'm clinically
> depressed...it's this feeling that we're all just these amoeba's (spelling?)...
> really existential...just these bags of blood and tissue and nerves and cells moving
> through life....and that's how I kind of feel lately....I know that when I take
> an antidepressant and the ole seratonin gets pumping those feelings go away and I
> feel peace and some joy again...but then there's the price....
> I feel really torn....
> Part of it is circumstantial....I'm really at a job that is completely unhealthy for me....
> mind deadening and isolating...then I come home and i'm alone....my life is really isolating....
> so that contributes ALOT...my psychiatrist says to do things that NURTURE me, that feed me, etc...but
> I don't have the energy...I mean I hardly have the energy sometimes to even put a cd in the stereo!! That's
> bad! That seems really depressed to me....
>
> Any insight?
>
> Thanks for listening...
>
> I'm glad not to be in the suicidal pits of hell...but this isn't exactly what I had in mind either...
Posted by ROO on October 28, 2002, at 17:26:47
In reply to Re: Dinah...I'm wondering..about BP redirected... » ROO, posted by jay on October 28, 2002, at 16:35:36
Thanks Jay--that was helpful (and hopeful)...
What do you take? I'm taking topamax right now...that's
it....have been avoiding taking an AD, but may just add one on
because obviously it's not taking care of the depression end enough,
although it has stabilized me quite a bit for which I am thankful.
Tell me about your experience....and thanks for responding :-)
(cute pic on yahoo by the way :-) )Roo
Posted by jay on October 29, 2002, at 2:01:50
In reply to Re: Jay--Add Antidepressant to Mood stabilizer?, posted by ROO on October 28, 2002, at 17:26:47
Haha..thanks for the compliment..even though I look like Bucky the Beaver..hehee. ;-)I am very glad I can help...and with my years of experimentation, I think there is a fair amount of hope. My pdoc say's "If it act's like depression..treat it." In this case, a mood stabilizer increases your depression, and an antidepressant will likely very well stop it. In fact, I have had even better luck with two mood stabilizers and an antidepressant. But, I don't know if your doctor will go with that. You may want to add Depakote to the Topomax, and add the best antidepressant you have tried. (The one you had *some* response to.) This is actually a method I read by a doctor on the internet...and his site was posted here before.
As I also said...a benzo for the short term can really help in the transition. I find that antidepressants in *anybody* need to be balanced out, and a mood stabilizer seems to do that. The atypical antipsychotics also seem to do this, but I don't know if you are comfortable with going that route. It's going to take some experimentation with your doctor, so I hope he/she is open to it. If not, you should find another one.
BTW..I *know* how depressing a mood stabilizer, and even Topomax, can be. I found myself in an even deeper depression then ever when just using a mood stabilizer.
I *firmly* believe you have a good chance at striking a balance away from the depression and any anxiety of even manic symptoms. It seems to lie in that middle point between the antidepressants and mood stabilizers. Get back to your doc ASAP, and I will even put my word on the worthiness of trying this. Any more questions..please let me/us know!
Best wishes,
Jay :-)> Thanks Jay--that was helpful (and hopeful)...
>
> What do you take? I'm taking topamax right now...that's
> it....have been avoiding taking an AD, but may just add one on
> because obviously it's not taking care of the depression end enough,
> although it has stabilized me quite a bit for which I am thankful.
> Tell me about your experience....and thanks for responding :-)
> (cute pic on yahoo by the way :-) )
>
> Roo
Posted by ROO on October 29, 2002, at 8:09:00
In reply to Re: Jay--Add Antidepressant to Mood stabilizer? » ROO, posted by jay on October 29, 2002, at 2:01:50
Thanks Jay...just curious though...what did YOU try? Do tell!
Posted by jay on October 29, 2002, at 10:04:08
In reply to Re: Jay--Add Antidepressant to Mood stabilizer?, posted by ROO on October 29, 2002, at 8:09:00
> Thanks Jay...just curious though...what did YOU try? Do tell!
Well, I try not to mention specific meds because I don't want people to try it and be dissapointed. BUT, this was a great little combo, which was Depakote, Topomax, and a bit larger dose of Effexor XR at bedtime. My doc wasn't crazy about Topomax though..and didn't like the tests needed with Depakote. (Stupid..I know..but I found a good alternative.) I am on a small dose of Risperdal, and 150mg of Effexor at bedtime, and a benzo prn. I must say..it REALLY turned me from a suicidal paranoid back to my relaxed self. Mind you, this is individual, so it's different for all folks off course.
But..I REALLY mean this..as I had suffered with horid side effects for 10+ years, and I *know* when something good comes along. Be creative...and treat ALL symptoms..be them depression, anxiety, AND agitation/dysphoria. (One I think doctors UNDER treat.)
I honestly think there are the proper meds out there for all of us, but we haven't hit many of the right combinations. I emphasize *right* combinations...because just adding a bunch of drugs without research on them is pointless. That's why I mentioned "two" mood stabalizers, as many doctors have mentioned, and utilizing small doses of antipsychotics WITH antidepressants. I will also mark my word with Effexor WITH mood stabalizers (atleast 2) and/or an atypical antipsychotic in small doses to be an excellent combination. I think SSRI's are too 'weak' to balance out these other meds.
Anyhow...my thoughts...and you have nothing to lose, and a ton to gain by trying. Have some faith too..I know it is hard as hell too, but with a right med mix, your world can turn around like you never believed. Make some goals for yourself too if you can...and you will find you actually *want* to do things. I am not Mr. Social Butterfly, but I now am like my old selfffff..with a new twist...in that I seek out others..plan with happiness for the future.
I know one thiing..I will NEVER go off my medicatioon..ever. I will take it at the SAME high dose until the day I die. That is what EVERYONE should be doing. We don't ask people with heart problems or diabetes to cut back and end their medication. Same thing! So, life is too DAMN short.
Anyhow..best as always...please keep me updated as to how you are doing..and any questions please fire away! I will likely still need myy support too...medication doesn't make us 'non-human'..despite what the Scientologists dream about.
Peace,
Jay
Posted by ROO on October 29, 2002, at 13:20:17
In reply to Re: Jay--Add Antidepressant to Mood stabilizer? » ROO, posted by jay on October 29, 2002, at 10:04:08
Thanks Jay....maybe I will add at least an AD to the
mood stabilizer...I guess I can't be in denial forever that
I am indeed depressed and it doesn't seem to be going away. I hate
to add on yet another drug, but if it'll make me feel better, than it
will be worth it, I'm sure. I forgot to mention that I also do take
a small dose of a AP with the topamax. About a year ago I was taking an
AD, a mood stabilizer, and a low dose AP and was feeling pretty good, but I
went off the mood stabilizer (b/c of not being able to sleep and weight gain), slowly
decreased the AD (because of sexual side effects), and man, it was all down hill
from there...then I decided it was a good idea to go off meds and try the alternative
scene (acupuncture)....slipped into a suicidal depression...took some AD's which exerabated it...went
off the AD's and got on the Topamax and have now stabilzed....but now I'm just depressed...and trying
to get back some sense of joy and normalcy again....so I guess it's time to decide which
AD to try. Well anyway, thanks for the food for thought...and the support...good luck with
the romance issues :-)
Posted by McPac on October 30, 2002, at 1:40:07
In reply to Re: Jay--Add Antidepressant to Mood stabilizer?, posted by ROO on October 29, 2002, at 13:20:17
Roo,
DO definitely look into adding an AD to go along with your mood stabilizer. It can make a HUGE difference. If dreaded anxiety still exists, look for a benzo such as Klonopin. You'll be feeling fantastic again. Take care!
Posted by catmint on October 31, 2002, at 1:50:19
In reply to Re: Jay--Add Antidepressant to Mood stabilizer? » ROO, posted by jay on October 29, 2002, at 10:04:08
Thanks for all your info.
I am really sick of this. I desperately need to be on the right meds. Sometimes I feel like my doctor really doesn't care about me that much. She has over 100 patients (state doctor) I live close to the poverty level, am a single mother, and am hating my life a lot of the time.some how I know things will get better though.
I recently switched from Lamictal to Depakote. This will be my third try at Depakote, this time I'm starting with 125 mg. 500 was way too much before.
Anyway, I have been really depressed, sudden crying spells, hoplessness. I know I need to add an AD. I am going to try Sam-e and see how that goes. I'm scared to add a traditional AD even though I have had a marginal reponse to wellbutrin and prozac in the past (at the time I was on Neurontin which had no mood stabilizing effects so the wellbutrin pushed me into a mixed-state and severe agitated depression that caused me to lose my job.)
Since I started the Depakote, I have been having non-stop wild dreams, some headaches, and bad depression.You said that a benzo can help when adding an AD to a mood stabilizer. How so? Also, what if pdoc is super hesistant to prescribe one because I once told her that I used to drink and smoke some pot before I even knew I was bipolar. She thinks I am an addict because I told her I went to a couple of AA meetings. (but really I was just going to get any support I could at the time)
Thanks, Amy
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