![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by willow02 on November 5, 2002, at 21:27:41
I was recently diagnosed (2mo.s ago). I am BP 1 Rapid Cycler.
Before I was diagnosed I was put on Paxil b/c I was severely depressed, and at 10mg/day for 4 days I was flying so high I just stopped taking it. Got too manic.
After diagnosed, I was put on Lithium which barely helps. And I had to deal with some uncomfortable ultra rapid cycling which I suspect is from the Paxil - this went away after about a month, I think.
The mild mania lasted for 2 months and was pretty bearable. Not severe. Got lots of work done. Didn't mind insomnia (more work hours, way more projects and creativity, and I didn't get tired) and had Klonopin just in case which helped.
Then I crashed again which was unbearable.
I knew how strongly Paxil affected me and told my temp pdoc that it probably wasn't a good idea though it was his first suggestion.
Now I have been on remeron 15mg 1 week and I hate it. No noticable improvement, and my day is now only 12 hours because of the drastic sleep.
My depressions generally only last 2 weeks anyway. Should I even be bothering with remeron? Or should I have tried the Paxil on the ultra-short term, knowing I was risking ultra rapid cycling/mixed states?
I'm still depressed and for me the remeron makes life worse. Paxil is a super quick fix for me. Should I go for it? My pdoc is temporary and encourages me to make my medication decisions. I am at the point now where I just want to switch from remeron to paxil without consulting them first - but I could probably put a call in tomorrow. I just don't want to sound irrational or be a nuisance.
It's just that I told them no to the paxil a week ago emphasizing the neg. side effects of rapid cycling and mania, but now I want that quick fix, and remeron seems a more long term thing, so why am i bothering to waste my time with it if my depressions are so short?
I am also on lithium and it is not working. this is so frustrating. We are going to work on the mood stabilizer after the anti-d. and I just feel like I made the wrong choice with the anti-d. How do you think my pdoc will feel if I call with a reversal after going to the trouble of starting on remeron? Because he's only temporary I am not sure if he knows my depressions are so short... and remeron definitely seems long term, so in effect I am suffering the side effects for a week while my depression should be petering out of its own accord. On the other hand, the paxil would abolish the depression but I don't know how drastic this high would be now that I'm on lithium or how severe the side effects afterwards. any advice?
Willow02
Posted by Shawn. T. on November 5, 2002, at 23:26:52
In reply to gershon: quick fix or ?, posted by willow02 on November 5, 2002, at 21:27:41
Have you considered adding Wellbutrin? It is an antidepressant that will not induce rapid cycling. No matter how long your depressions last, they are extremely important to avoid. Depression negatively affects the brain moreso than mania; risking depressive episodes is not in your best interest. You should definitely not take Paxil again. With regards to mood stabilizers, you might think about switching to valproic acid (Depakote) considering the fact that you have rapid cycling bipolar disorder. Most experts argue that Depakote is more effective than lithium for rapid cycling bipolar patients. Staying on Remeron probably wouldn't be a bad idea. One of the common findings in people with rapid cycling bipolar disorder is that they often have very abnormal circadian rhythms. You should make fighting insomnia and maintaining a regular sleep schedule a priority. The tiredness should go away in a week or two. If you can't take it in the meantime, you could talk to your doctor about halving your dosage until your body has become better adjusted to the drug. Adding Wellbutrin to the Remeron would probably give you more energy and motivation if you still feel just as tired after another week. For a compilation of the last five years of research into rapid cycling bipolar disorder, see
http://www.neurotransmitter.net/rapidcycling.htmlShawn
Posted by chad_3 on November 6, 2002, at 0:21:48
In reply to gershon: quick fix or ?, posted by willow02 on November 5, 2002, at 21:27:41
Question: Dr. Gernshon -
Do you think it is reasable to give atypicals a/p's to parkinsons' patients (exclude clozaril) - w/o warning them of movements - for the use of mood disorders (depression / anxiety depression)
Also same question for bipolar low.
Same question for those severe Social Phobics.
Same question for all bipolar spectrum disorders.
Thanks
Chad
http://www.socialfear.com/http://www.parkinsons-information-exchange-network-online.com/archive/093.html
Posted by willow02 on November 6, 2002, at 1:02:16
In reply to Re: gershon: quick fix or ?, posted by Shawn. T. on November 5, 2002, at 23:26:52
Thanks Shawn.
It's good advice.
Must note in personal exp. you are right about the lack of circadian rhythm. Lately went from a very late night schedule and sleeping at 4am to a sudden switch to 9p-6a! Usually feels like I have no circadian rhythm at all.Anyway will consider the wellbutrin, and the valproate is probably next in line. Thanks for the link also.
Interesting and valid point re: depression being more negative on the brain. At the same time I hesitate to take more drugs than necessary and hesitate at this point to stay on an anti-d. Am leaning towards the quick fix approach of taking an SSRI during an episode and going off it as depression ends. Maybe that's not what is best, but I guess I have to experiment to see what works.
Thanks
Willow02
Posted by egershon on November 6, 2002, at 11:03:46
In reply to gershon: quick fix or ?, posted by willow02 on November 5, 2002, at 21:27:41
> I was recently diagnosed (2mo.s ago). I am BP 1 Rapid Cycler.
>
> Before I was diagnosed I was put on Paxil b/c I was severely depressed, and at 10mg/day for 4 days I was flying so high I just stopped taking it. Got too manic.
>
> After diagnosed, I was put on Lithium which barely helps. And I had to deal with some uncomfortable ultra rapid cycling which I suspect is from the Paxil - this went away after about a month, I think.
>
> The mild mania lasted for 2 months and was pretty bearable. Not severe. Got lots of work done. Didn't mind insomnia (more work hours, way more projects and creativity, and I didn't get tired) and had Klonopin just in case which helped.
>
> Then I crashed again which was unbearable.
>
> I knew how strongly Paxil affected me and told my temp pdoc that it probably wasn't a good idea though it was his first suggestion.
>
> Now I have been on remeron 15mg 1 week and I hate it. No noticable improvement, and my day is now only 12 hours because of the drastic sleep.
>
> My depressions generally only last 2 weeks anyway. Should I even be bothering with remeron? Or should I have tried the Paxil on the ultra-short term, knowing I was risking ultra rapid cycling/mixed states?
>
> I'm still depressed and for me the remeron makes life worse. Paxil is a super quick fix for me. Should I go for it? My pdoc is temporary and encourages me to make my medication decisions. I am at the point now where I just want to switch from remeron to paxil without consulting them first - but I could probably put a call in tomorrow. I just don't want to sound irrational or be a nuisance.
>
> It's just that I told them no to the paxil a week ago emphasizing the neg. side effects of rapid cycling and mania, but now I want that quick fix, and remeron seems a more long term thing, so why am i bothering to waste my time with it if my depressions are so short?
>
> I am also on lithium and it is not working. this is so frustrating. We are going to work on the mood stabilizer after the anti-d. and I just feel like I made the wrong choice with the anti-d. How do you think my pdoc will feel if I call with a reversal after going to the trouble of starting on remeron? Because he's only temporary I am not sure if he knows my depressions are so short... and remeron definitely seems long term, so in effect I am suffering the side effects for a week while my depression should be petering out of its own accord. On the other hand, the paxil would abolish the depression but I don't know how drastic this high would be now that I'm on lithium or how severe the side effects afterwards. any advice?
>
> Willow02
>
Rapid cycling is usually managed with mood-stabilizing anticonvulsants. Lithium by itself is not as effective, although it may be used along with the anticonvulsants. Because of the possibility of inducing mania or worsening rapid cycling, it is better to try to avoid antidepressants if possible. However, this is not possible when the depression is severe and non-responsive to the Lithium or anticonvulsants. Lastly, some patients do better with atypical antipsychotic agents as well.
This is the end of the 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.