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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by fluffy on December 14, 2002, at 11:23:15
I have been prescribed 100mg Tegretol for treatment of Bipolar II. Within the past couple of weeks, I cycled again--going from a normal to hypomanic mood and slammed with depression again.
I wonder if I need to increase the dose of Tegretol (I see my pdoc on monday), or try another mood stabilizer. Anyone had success with Tegretol or Trileptal for Bipolar II? What doses are you on, and what was the starting dose?
If not, any successes with other mood stabilizers if Tegretol didn't work? I wonder if I should try good, old fashioned Lithium?
Confused and depressed w/ a tight-lipped, secretive pdoc,
fluffy
Posted by Mr Cushing on December 14, 2002, at 12:02:33
In reply to BP II peeps--Tegretol questions..., posted by fluffy on December 14, 2002, at 11:23:15
Hey Katy, missed you...Anyways, I'm sure Krysti will be able to give you some advice on Tegretol as soon as she "reappears". She's been on Trileptal now for several weeks and seems to be doing pretty good on it. Trileptal, as you know, is just a more modern form of Tegretol.
I'm on Depakote, 500mg per day now, and honestly, I feel the best that I've felt in years. Have to be very careful with what I do though. Lots of life changes, but in order to feel the way I feel now, I think those life changes are a reasonable sacrifice.
I'd also try just about any other MS before trying Lithium. Lithium, though it has a well documented track record, probably has the worst side effects out of every other MS currently available. I don't think I'd ever try that one out.
Anyways, you still didn't send me those pictures... still have no clue what you were talking about
Posted by fluffy on December 14, 2002, at 12:22:10
In reply to Re: BP II peeps--Tegretol questions... » fluffy, posted by Mr Cushing on December 14, 2002, at 12:02:33
DUDe--
I TOTALLY sent you two e-mails with that link!! What's the deal? I even copied your e-mail and copied it to the delivery address. I wonder what is going on with that?
ANYWAY--
So, yeah--I guess that I'm wondering if my pdoc is just "humouring" me b/c I found out that the usual starting dose for Tegretol is 400 mg per day (for BPII). I don't know if it's just paranoia again, but I really think he doesn't believe me when I tell him about my cycles. He never responds...just "hmmm". I HATE THAT!!! I really want a new doc, but again, I want to try to get stabilized on this one.So you are feeling better on Depakote MIke? You seemed really depressed the last i heard. Was it just a matter of dosage, time, all?
Posted by Mr Cushing on December 14, 2002, at 12:44:40
In reply to Re: BP II peeps--Krysti--WE MISS YOU!!, posted by fluffy on December 14, 2002, at 12:22:10
Hey Katy, what's your email? This "might" have happened... but Hotmail is probably the easiest email for me to use, and since it has a habit of flooding my inbox with junkmail, I have a number of @___.com addresses just blocked in general. That's what happened with me and Krysti.I know EXACTLY what you mean... I don't trust Doctors at all. The two that I'm with now though know this, so with them it's all good anyways. My PDoc I've known since I was like 4 years old (she's retiring this year *shivers*) and my MD, the first time I met him he asked me about my previous history with MDs and I'm like, ummmm... I haven't been to one in years, and he's like, why not? I'm like, because I don't trust them. I tell them something, and instead of telling me what's on their mind, they're always like oh, hmmmm... I'm like Sh!t... I'm taking time out to come here and tell you what's honestly going on with me, and you can't even give me a straight forward answer, so instead, for the last 6-7 years, whenever I needed a Doctor I just went to a Walk-In Clinic because at least they would treat me like a stranger and not just "pretend" to know me or that I really mattered.... So after that, he's been VERY honest with me, telling me exactly what's going on, what I should do next concerning my condition, what my maximum dosage should be, the different ADs that I could have tried after I went off of Effexor and started to fall back into a depression, etc. All in medical language, per say, but I'm intelligent enough to understand what he's talking about.
You know, some MS's don't work to stabilize you by themselves. Like right now, I'm on 500mg of Depakote, 20mg of Celexa, and 1.5mg of Klonopin per day. The Celexa, since I was at first taking it at night, was causing me insomnia. Now I've switched it to the mornings, and I feel really good.
I went out for a while last night... Need to really get it through my stubborn head, NO ALCOHOL AT ALL. I went to sleep and all at the regular time, but I just feel really "blah" and kind of PO'd today. That's happened the last few times that I've had even one drink. I had one beer last night... same thing...
Oh yeah, and Eva's boat came in alright. She was on this huge "sailboat" and what happened was that they ran out of wind.... The Captain took excellent care of them though while they were stuck at sea, and she's back in Ottawa. I was just talking to her yesterday. So that's kind of cheered me up quite a bit. When I heard that the boat came in alright, it was like I could actually breathe again.
K, enuff rambling.... where's Krysti???
Posted by fluffy on December 14, 2002, at 12:58:02
In reply to Re: BP II peeps--Krysti--WE MISS YOU!!, posted by Mr Cushing on December 14, 2002, at 12:44:40
Hi Mike--
I would give you my e-mail address here, but it has my full name, so I hesitate to dish it out.
Can I just send to another address?What am I to do since I do not trust this doc? Should I let him how I feel? He has quite a temper, I think. And like, NO bedside manner.
I'm just trying to make it to Monday. I have no appetite whatsoever, which seems to mark my low periods. I have also been feeling quite sorry for myself. Like--"why am I alive?" "Is there ANYTHING that will get me feeling back to normal?"
I hate this.
fluffy
Posted by Mr Cushing on December 14, 2002, at 13:13:18
In reply to Re: BP II peeps--Krysti--WE MISS YOU!!, posted by fluffy on December 14, 2002, at 12:58:02
Katy, what's the extension on your email? Such and such @ (what).com? That way I can just check to see if I have it blocked for some reason or another and unblock it.Ummmmm, honestly, your health is what matters most right now so you should be upfront to your Doctor about how you feel. That you need to feel like you can trust him so he should be more open to you about what you discuss. If not, maybe he should recommend another Doctor? That might be tough to confront him like that, but yeah, that's what I would recommend.
Did you stop taking your ummmm (Zoloft? Is that it) completely? When I quit my Effexor completely within a week my depression set in pretty deeply. I find that the MS's really help keep you from getting too high, but they don't do too much about your lows. Krysti has told me that with Trileptal she doesn't feel either too high or too low, but it's only been a few weeks now so...
Anyways, if you quit your AD completely, maybe you should start on another one at a very small dose. I'm taking 20mg of Celexa right now every morning and it really helps. I'm not depressed anymore, and I've only felt "slightly" hypomanic for the first few days I was on it. I have more energy than I did previously, but then again, I've been barely doing anything now for like 7 months... I'm starting to get restless dammit! and it's not from the medications lol
The appetite thing, I can totally relate to it. I still have almost zero appetite. Some days I just force myself to eat what I think is appropriate. Been really watching the types of foods I eat too. Other days, I'll smoke a nice spliff and then eat once the munchies set in. Either way though, I'm still getting enough in to keep me healthy.
Posted by Krysti on December 14, 2002, at 13:21:33
In reply to BP II peeps--Tegretol questions..., posted by fluffy on December 14, 2002, at 11:23:15
You guys are too great - thanks for missing me : )
It's hard sometimes to get on here with working during the day and then if I have things to do after work, but I'm always thinking of you : )
Fluffy - I would definitely look for another pdoc. The first one I went to was a complete jerk. Didn't listen to anything I had to say and was just always trying to rush me out of there to get onto his next patient. A pdoc should ALWAYS listen to what you have to say and base the treatment accordingly. After all, the only person that knows what is going inside your head is you. The pdoc I go to now is great. She is VERY knowledgable about all the meds and takes notes each time I'm in there about what I say so she can keep track of my moods and how they are corresponding with the meds we've tried. She ALWAYS listens to what I have to say and I feel very comfortable that she is trying her best to help me. It makes a big difference.
Here's a site I found on Tegratol. 100mg's is a very small dose - no wonder you are still cycling. Also, the level in your blood is supposed to be monitored - have you taken any tests? A test should show if you are in the therapeutic range.
http://www.healthyplace.com/medications/carbamazepine.htm
The Trileptal is still working very well. I don't remember all what my doctor said the differences were between Tegretol and Trileptal, but I know she said Trileptal is just a newer version and supposed to have fewer side effects and the level does not need to be monitored.
I agree with Mike about Lithium - personally I wouldn't want to be on at - only as a last resort. I wouldn't give up on the Tegretol yet - no medication is going to help if the pdoc doesn't put you on a sufficient dose. Again, I would see about finding a different pdoc, someone who really takes an interest in trying to help you. You might want to try to find the number of a bipolar support group in your area and call and ask them if they could recommend one to you. They would know best - that's how I found mine : )
Krysti
Posted by Krysti on December 14, 2002, at 13:28:01
In reply to I'm here, I'm here! » fluffy, posted by Krysti on December 14, 2002, at 13:21:33
Here's an excerpt from that link I gave you:
Tegretol -
Mania and Bipolar (Manic-Depressive) Disorders:
The initial daily dosage should be low, 200 to 400 mg/day, administered in divided doses, although higher starting doses of 400 to 600 mg/day may be used in acute mania. This dose may be gradually increased until patient symptomatology is controlled or a total daily dose of 1600 mg is achieved. Increments in dosage should be adjusted to provide optimal patient tolerability. The usual dose range is 400 to 1200 mg/day administered in divided doses. Doses used to achieve optimal acute responses and tolerability should be continued during maintenance treatment. When given in combination with lithium and neuroleptics, the initial dosage should be low, 100 to 200 mg daily, and then increased gradually. A dose higher than 800 mg/day is rarely required when given in combination with neuroleptics and lithium, or with other psychotropic drugs such as benzodiazepines. Plasma levels are probably not helpful for guiding therapy in bipolar disorders.
Posted by Mr Cushing on December 14, 2002, at 13:35:07
In reply to I'm here, I'm here! » fluffy, posted by Krysti on December 14, 2002, at 13:21:33
That's something that I can really use, a Bi-Polar Support Group in Ottawa, Ontario.... But you know, things are so freaking backed up here that it's taking me like months to find out anything other than what my 2 Docs know.The scary part is I think I'm running out of their education on the Bi-Polar condition. My PDoc submitted a request to a Bi-Polar Specialist in my area, but that could take months. You know, you can't even voluntarily submit yourself to a hospital here anymore? You basically have to try and kill yourself and then they'll take you in, probably stuff you full of Lithium, and place you back out on the streets in like 3 days.
Posted by fluffy on December 14, 2002, at 13:38:15
In reply to Re: I'm here, I'm here!, posted by Krysti on December 14, 2002, at 13:28:01
Hi guys--
To answer both your queries--
Nope--not on Zoloft anymore. And my e-mail address ends with yahoo.com...I'm not getting my blood levels monitored. I guess I'm on such a low dose--why bother?
About the doc just wanting to get on to the next patient--That's exactly what he's like. I think he is giving me low doses because he wants to see if i respond to a placebo effect. I don't understand!! I feel like crying right now.
Y'know-- He didn't even warn me about "the rash"!! I had to force him to tell me about possible side effects...and he didn't mention that at all.Maybe I'll take your advice Krysti about the BP support groups to find a good doc.
It's good to hear from you, and I'm truly glad you are feeling better.
*hugs* to the both of ye.fluffy
Posted by Mr Cushing on December 14, 2002, at 13:52:49
In reply to Re: I'm here, I'm here!, posted by fluffy on December 14, 2002, at 13:38:15
Katy, First, I did for some reason have yahoo.com blocked... weird... anyways, send again, problem fixed. Sometimes i just get frustrated with all the junk mail and just block everything.it's VERY important to get your blood levels tested. In fact, you should have had a baseline one done before you even started taking the MS. I thought your Doctor would have told you that?
Anyways, this is what my Docs have told me about getting the blood tests done. Within the first month of getting on the drug, get it tested every two weeks. Then every month for like 4 months. Then maybe 2-3 times a year. It's just to make sure that you're not taking too much, and in case you're taking too little, so they know how much further they can push your dosage before it starts to negatively effect you.
I want to know how to find myself a Bi-Polar support group. How do you go about doing that? But then again, different country... *shrugs* I think that would really interest me.
Posted by linkadge on December 16, 2002, at 14:23:34
In reply to BP II peeps--Tegretol questions..., posted by fluffy on December 14, 2002, at 11:23:15
Bad experiences with Tegrotol,
good experiences with depakoteLinkage
Posted by Ritch on December 16, 2002, at 22:29:06
In reply to Re: BP II peeps--Tegretol questions..., posted by linkadge on December 16, 2002, at 14:23:34
> Bad experiences with Tegrotol,
> good experiences with depakote
>
> LinkageI think that I may have to discontinue my recent Trileptal experiment. It is true that I haven't been as depressed as I normally am at this time of year, but it (trileptal) isn't helping with my ADHD symptoms and may be triggering hypomania and mild paranoia symptoms (it is a tricyclic compound). I am really starting to miss the superior relative stability of Depakote+Ritalin or Depakote+Neurontin+Dexedrine. I just don't want to sleep in all morning. I'm currently still taking Depakote at a reduced dose (125mg instead of 250mg/day). I just think that ditching the Trileptal and adding back in Neurontin+stimulant would be better.
Posted by Krysti on December 18, 2002, at 8:16:32
In reply to Re: BP II peeps--Tegretol questions... » linkadge, posted by Ritch on December 16, 2002, at 22:29:06
> mild paranoia symptoms (it is a tricyclic compound).
Tricyclics can cause paranoia???
Posted by Ritch on December 18, 2002, at 9:38:44
In reply to Re: BP II peeps--Tegretol questions... » Ritch, posted by Krysti on December 18, 2002, at 8:16:32
> > mild paranoia symptoms (it is a tricyclic compound).
>
> Tricyclics can cause paranoia???Hi Krysti, I just made that association because tricyclics are supposed to be the most likely antidepressant to trigger hypomanic symptoms in bipolars and yes, TCA's have been known to trigger psychotic episodes. However, newer AD's can do it too (in a susceptible individual). I once read a really scary story about someone who was an undiagnosed bipolar who got treated with high dose Effexor and had an intense delusional experience and was hospitalized. Trileptal does list "manic reaction" in the neuro-psychiatric s/e's section. I dropped it from 225mg down to 75mg and I have felt more depressed the last day or two (although the excessive suspiciousness nearly dissappeared). So, I am going to push it back up to 150mg and just hold it there for a while. I was really hoping it might be a possible replacement for Depakote (without the sleepiness), but I don't think that is going to happen. It is strange, but when I was taking 20mg of Ritalin with my Depakote I didn't experience any suspiciousness or paranoia at all, just some mild edginess (more of a physical thing than a mental one).
Posted by Krysti on December 18, 2002, at 12:58:48
In reply to Re: BP II peeps--Tegretol questions... » Krysti, posted by Ritch on December 18, 2002, at 9:38:44
Hi Ritch,
Thanks for the reply. I'm on 900mg of Trileptal. I haven't experienced any paranoia and I've been pretty stable. Going through a stressful time right now because I need to make a decision about something though (a pretty minor decision when you put it in context with the grand scheme of life, but seems major to me at this time if you know what I mean). Anyway, I think I'm doing pretty well so far, as far as remaining stable, but of course, since it hasn't been that long since I've been diagnosed - still questioning whether my moods/emotions/reactions are where they should be. I guess it doesn't even matter in the long run because I need to base the decision on how I'm feeling now anyway, not on if I am reacting how I should be. I tend to try to base my decisions on what my head tells me is right or wrong and it drives me nuts. I guess I need to just go with how I feel.
Sorry for the rambling...as you can see it's stressing me out : )
By the way, I also became manic and delusional from an AD - Paxil (before I was diagnosed). I went in and out of being delusional for about 3 weeks - luckily it wasn't serious enough to where I needed hospitalization though. Scary thing what the wrong meds can do to you when you are bipolar.
Depakote made me very sleepy as well, and then REALLY blah. Gabitril made me depressed and have crying spells. Lexapro on top of the Gabitril made me edgy and like the two meds were fighting each other - too up and down at the same time (I think that would be a mixed state).
Trileptal has been the best so far. The next two weeks will probably be a true test in just how good it's working. If I was trying to make this decision med free, I would have been wacko already : )
Krysti
Posted by Ritch on December 18, 2002, at 13:33:41
In reply to Re: BP II peeps--Tegretol questions... » Ritch, posted by Krysti on December 18, 2002, at 12:58:48
> Hi Ritch,
>
> Thanks for the reply. I'm on 900mg of Trileptal. I haven't experienced any paranoia and I've been pretty stable. Going through a stressful time right now because I need to make a decision about something though (a pretty minor decision when you put it in context with the grand scheme of life, but seems major to me at this time if you know what I mean). Anyway, I think I'm doing pretty well so far, as far as remaining stable, but of course, since it hasn't been that long since I've been diagnosed - still questioning whether my moods/emotions/reactions are where they should be. I guess it doesn't even matter in the long run because I need to base the decision on how I'm feeling now anyway, not on if I am reacting how I should be. I tend to try to base my decisions on what my head tells me is right or wrong and it drives me nuts. I guess I need to just go with how I feel.
>
> Sorry for the rambling...as you can see it's stressing me out : )
>
> By the way, I also became manic and delusional from an AD - Paxil (before I was diagnosed). I went in and out of being delusional for about 3 weeks - luckily it wasn't serious enough to where I needed hospitalization though. Scary thing what the wrong meds can do to you when you are bipolar.
>
> Depakote made me very sleepy as well, and then REALLY blah. Gabitril made me depressed and have crying spells. Lexapro on top of the Gabitril made me edgy and like the two meds were fighting each other - too up and down at the same time (I think that would be a mixed state).
>
> Trileptal has been the best so far. The next two weeks will probably be a true test in just how good it's working. If I was trying to make this decision med free, I would have been wacko already : )
>
> KrystiKrysti, I have a lot of problems at times second-guessing my emotional reactions to things (is it for real or is it bipolar, am I overreacting?, etc.). I hate having to rely on everybody ELSE to confirm (or disconfirm) my feelings about everything. Actually, the Trileptal may not be causing the paranoia after all. I talked to some coworkers and they are having the same suspicions that I am! Hey, I thought I was starting to lose it or something, but everybody else is starting to lose it too and are experiencing similar symptoms. So wheeeeww, that's a relief! I am more and more getting this feeling that I am going to have to bump the Depakote back up to 250mg and do WHATEVER it takes to stay awake all day. If I have to dig out the Wellbutrin again, I guess I will just have to. At least this crap will fade away after about three or four weeks, thank God.
Posted by fluffy on December 19, 2002, at 10:21:43
In reply to Re: BP II peeps--Tegretol questions... » Krysti, posted by Ritch on December 18, 2002, at 13:33:41
Hello medicated peeps...
Just wanted to update Mike and Krysti (esp.) about my pdoc. I had a good appointment the other day. Like you suggested, Mike, I decided to raise some issues with him. I just kinda snuck them in very stealthily in our conversation. He seemed happy that I brought it up. And he just LUVED talking about my medications in more scientific jibber-jabber. He upped my dose of Tegretol to 200mg (which still isn't much) and will schedule a blood test in two weeks.
At first, I was mad that he was taking such a conservative approach with me, but now I think it wasn't a bad idea. I know I would be just as angry about feeling "drugged".
I'm actually feeling good on this dose so far. No adverse side effects. And my teeth seem to be coming un-clenched. (which has been bugging me for the past few weeks).
Since I seem to be only "mildly bipolar", it's probably good to take this slow approach.
Oh--
And the depression I spoke of seemed to be directly linked to PMS.....Yeah, guys, it's real. When I looked at my mood log, it went down to poops-ville right before my girly bits kicked in.Hope you all are well.
lovins,
fluffy
This is the end of the thread.
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