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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by hopko on March 22, 2003, at 13:18:06
I am extremely worried about a friend who recently was released from the psych hospital in our community. I know she has been diagnosed as BP but I do not know her other specific illnesses. She was most recently admitted for suicidal thoughts. She gave me her list of current meds today and I am astounded at what she is taking and at the mixture of meds. I am asking for others opinions (either positive or negative) on her meds before I jump to any conclusions and advise her to seek help elsewhere. I must tell you she is extremely unstable and really needs some excellent help. Here is her list:
Lithium: 300mg X2 a day
Geodon: 40mg X2 a day
Lamictal: 100mg X2 a day
Klonopin: .5mg X4 a day
Seroquel: 50mg X2 a day plus 300mg at night
Trileptal: 150 a day
Lexapro: 20mg a day
Sectral: 200mg X2 a dayI am interested to hear what any of you think. Thanks in advance.
Posted by utopizen on March 22, 2003, at 14:10:38
In reply to Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 13:18:06
Are you concerned about her meds or her?
If the meds are helping, I wouldn't worry. Some of those meds will take three weeks, so you won't see her stablize immediately. The Klonopin is good, that's a safe and mild med and at a low dose.
Remember that not all of us are born with the chemistry to walk around without meds. Some require more assistance than others just to do everyday things, and these meds help that. It's astounding how far we've come, we can release someone from a hospital because of these meds.
Posted by hopko on March 22, 2003, at 14:18:38
In reply to Re: Mixture of Drugs/Comments Please, posted by utopizen on March 22, 2003, at 14:10:38
Thanks for your comments. I am worried about her and her meds. She has been hospitalized several times and she is never in "good" shape, just sometimes worse than others. I am really wondering about the mixture of the drugs she is taking. I firmly believe she needs to be on meds...but not combinations that will make her worse or counter-act each other. Is this is common mixture of drugs for serious psychiatric conditions?
Posted by Krissy P on March 22, 2003, at 15:44:39
In reply to Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 13:18:06
What a nice friend you are to care about your friend so much!
Just from my experience:
1)Lithium-no
2)Never taken Geodon
3)I take Lamictal rioght now at 50mg-my wonder med, hoping to increase if need be per pdocs orders Friday
4)I take 2mg Klonopin for sleep and PRN 2mg at times
5)I take 100mg Seroquel, gained weight from it, but helps, and now that I only take 100mg-losing a little weight:-)
6)Never taken Lexapro or Sectral
**Sometimes people need a combo of yeah, a lot of different meds, IMHO, I say the less the better-and have always felt that way and work with my pdoc on that issue. It does sound like your friend is on quite a bit.
How is it going now?
Please keep me posted, hope this helped.
Kristen:-)
--------------------------------------------------------------------------------------------------I am extremely worried about a friend who recently was released from the psych hospital in our community. I know she has been diagnosed as BP but I do not know her other specific illnesses. She was most recently admitted for suicidal thoughts. She gave me her list of current meds today and I am astounded at what she is taking and at the mixture of meds. I am asking for others opinions (either positive or negative) on her meds before I jump to any conclusions and advise her to seek help elsewhere. I must tell you she is extremely unstable and really needs some excellent help. Here is her list:
Lithium: 300mg X2 a day
Geodon: 40mg X2 a day
Lamictal: 100mg X2 a day
Klonopin: .5mg X4 a day
Seroquel: 50mg X2 a day plus 300mg at night
Trileptal: 150 a day
Lexapro: 20mg a day
Sectral: 200mg X2 a day
I am interested to hear what any of you think. Thanks in advance.
Posted by Krissy P on March 22, 2003, at 15:47:29
In reply to Re: Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 14:18:38
Hi again,
You ask:
>>Is this is common mixture of drugs for serious psychiatric conditions?IMHO, I think it is a common mixture, but like I said, your frined's MMV. I'm sure once your friend finds the right med combo-it will be ok.
Hoping, Kristen
--------------------------------------------------------------------------------------------------Thanks for your comments. I am worried about her and her meds. She has been hospitalized several times and she is never in "good" shape, just sometimes worse than others. I am really wondering about the mixture of the drugs she is taking. I firmly believe she needs to be on meds...but not combinations that will make her worse or counter-act each other. Is this is common mixture of drugs for serious psychiatric conditions?
Posted by utopizen on March 22, 2003, at 15:58:38
In reply to Re: Mixture of Drugs/Comments Please » hopko, posted by Krissy P on March 22, 2003, at 15:47:29
I understand you are concerned about your friend, but please realize this is only a message board in which people can relate their anecdotal understanding of medicines to others. If one person doesn't like how she responds to Lithium, you shouldn't take that as signifigant evidence for telling your friend to stop taking Lithium.
I'm not going to say doctors know everything, but they wouldn't be prescibing these meds to your friend unless they thought she needed them.
Let her stick to this combo, have her follow the doc's orders, and give it some time. Some of them won't even show their effect for another 2-4 weeks.
Also, some people need things like Lithium more than others, some don't. It's great if someone can get away without a bunch of meds, but not everyone has that liberty.
Posted by Krissy P on March 22, 2003, at 16:04:39
In reply to Re: Mixture of Drugs/Comments Please, posted by utopizen on March 22, 2003, at 15:58:38
Posted by jane d on March 23, 2003, at 1:06:26
In reply to Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 13:18:06
> I am extremely worried about a friend who recently was released from the psych hospital in our community. I know she has been diagnosed as BP but I do not know her other specific illnesses. She was most recently admitted for suicidal thoughts. She gave me her list of current meds today and I am astounded at what she is taking and at the mixture of meds. I am asking for others opinions (either positive or negative) on her meds before I jump to any conclusions and advise her to seek help elsewhere. I must tell you she is extremely unstable and really needs some excellent help. Here is her list:
>
> Lithium: 300mg X2 a day
> Geodon: 40mg X2 a day
> Lamictal: 100mg X2 a day
> Klonopin: .5mg X4 a day
> Seroquel: 50mg X2 a day plus 300mg at night
> Trileptal: 150 a day
> Lexapro: 20mg a day
> Sectral: 200mg X2 a day
>
> I am interested to hear what any of you think. Thanks in advance.Hopko,
The number of meds is not in itself reason to assume she's not getting good treatment. Many doctors, especially non psychiatrists I think, are strongly opposed to using multiple drugs. There is this widely circulated story of someone suffering mild side effects from one drug, taking medication to counter those side effects, which in turn causes other problems for which another drug is prescribed, etc. In the end they are taking a dozen meds when they could just have replaced the first one. This is not necessarily what's happening here.
Prescribing multiple drugs is fairly common in psychiatry. No one knows exactly what goes wrong in all the various parts of the brain of someone with mental illness. And all of the drugs available work in more than one part of the brain so you get this situation where drug 1 is doing the right thing at points A and B, and the wrong thing at C, drug 2 does the right thing at A and C, nothing at B, and the wrong thing at D, drug 3 cancels the effect of drug 2 at A & D, etc, etc. And different from person to person too. No drug is precise enough to work at only one point, and even if it were we probably wouldn't know which point to choose.
It does seem like a long list, with some overlap, but there could be a reason for this. Lithium, Lamictal & Trileptal are mood stabilizers, Seroquel and Geodon are antipsychotics, Lexapro is an antidepressant, Klonopin a benzodiazepine and Sectral a beta blocker. All of these drugs can be prescribed to people with bipolar. It's pretty standard to take a mood stabilizer, antidepressant, and antipsychotic at the same time. It is not even unusual to take 2 drugs within one class such as two mood stabilizers. Different drugs within a class often don't have exactly the same effect (remember points A,B, &C) and sometimes a combination works better than either drug alone. She may also be in the process of switching to or from some of these drugs. Having an overlap period where you are taking both the old and the new drug at the same time is also fairly common.
It may be that your friend doesn't need all of these drugs but it could be that she does. And with bipolar, the risk to her if she stops taking a drug that she needs is probably greater than the risk from continuing to take a drug she doesn't need. Be very careful about suggesting to her that she is taking too many drugs. If you are really concerned, you can ask her instead if she has a psychiatrist that she is happy with, and suggest that she review all the drugs with her. If she doesn't have one she trusts, she needs to find one.
Jane
Posted by hopko on March 23, 2003, at 8:21:12
In reply to Re: How many drugs is too many? » hopko, posted by jane d on March 23, 2003, at 1:06:26
Thank-you all for your very thoughtful follow-ups to my question...especially you, Jane. I have not said anything to her about her meds or her treatment and now, for sure, I will not. That is why I wanted to check here first. If this list of drugs sent off alarm bells with some of you, I would have considered having a talk with her. She has been through six different Psychiatrists, the newest one only recently, and like I said before, if she gets better even a little, it is only because she appears a little calmer. Never happy or really ok. I just feel that she should not have to live her life like this, (and she says this as well) either so out of it that she can hardly function or so suicidal that she has to be stopped from running into the street in front of the next car she sees. I am still hoping that she can get help to just give her a sense of stability without making her a zombie and barely able to function. I was afraid that all of these drugs together might be the problem rather than the answer but I can see that they might be the answer and I hope they are. She has no money or insurance and so is at the mercy of a system that sees the indigent...I am afraid not always the best or most thoughtful care around here. I just hope that whatever doc she is seeing now knows what meds she is on and is not just prescribing “something else” for every new episode she experiences. Again, thanks for all the input. I appreciate it.
Posted by Ritch on March 23, 2003, at 10:18:37
In reply to Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 13:18:06
> I am extremely worried about a friend who recently was released from the psych hospital in our community. I know she has been diagnosed as BP but I do not know her other specific illnesses. She was most recently admitted for suicidal thoughts. She gave me her list of current meds today and I am astounded at what she is taking and at the mixture of meds. I am asking for others opinions (either positive or negative) on her meds before I jump to any conclusions and advise her to seek help elsewhere. I must tell you she is extremely unstable and really needs some excellent help. Here is her list:
>
> Lithium: 300mg X2 a day
> Geodon: 40mg X2 a day
> Lamictal: 100mg X2 a day
> Klonopin: .5mg X4 a day
> Seroquel: 50mg X2 a day plus 300mg at night
> Trileptal: 150 a day
> Lexapro: 20mg a day
> Sectral: 200mg X2 a day
>
> I am interested to hear what any of you think. Thanks in advance.
>
Hi, a lot depends on her specific diagnosis. She is taking two AP's instead of just one. Maybe one AP would be better? BTW, I have heard a few posters here talk about Geodon inducing mania (just an FYI). If she is bipolar and rapid-cycling the Lexapro could be aggravating it (especially at a standard dosage). The lithium at 600mg/day usually stabilizes most folks, but you said she had been hospitalized. She might need a higher lithium dose-she may not be in the therapuetic range even at 600mg. The Trileptal even at 150mg *could* be potentiating any toxic effects of the lithium/Lamictal since all three affect sodium channels. Seroquel and esp. Lithium can depress thyroid function or lower thyroid hormones that could aggravate cycling. Do you know her specific diagnosis? Was she hospitalized for an acute manic episode? Was she experiencing psychosis (other than manic symptoms)?
Posted by hopko on March 23, 2003, at 11:05:44
In reply to Re: Mixture of Drugs/Comments Please » hopko, posted by Ritch on March 23, 2003, at 10:18:37
> Hi, a lot depends on her specific diagnosis. She is taking two AP's instead of just one. Maybe one AP would be better? BTW, I have heard a few posters here talk about Geodon inducing mania (just an FYI). If she is bipolar and rapid-cycling the Lexapro could be aggravating it (especially at a standard dosage).<
The Lexapro is the newest addition to all of the other meds. She was prescribed this after her last hospitalization. To my knowledge she has been on all of the rest of them for a while, each one added to the next as her condition has worsened. I WAS worried when I heard that she had been prescribed Lexapro because of what I have read on this board about it inducing mania.
>The lithium at 600mg/day usually stabilizes most folks, but you said she had been hospitalized. She might need a higher lithium dose-she may not be in the therapuetic range even at 600mg. The Trileptal even at 150mg *could* be potentiating any toxic effects of the lithium/Lamictal since all three affect sodium channels. Seroquel and esp. Lithium can depress thyroid function or lower thyroid hormones that could aggravate cycling. Do you know her specific diagnosis? Was she hospitalized for an acute manic episode? Was she experiencing psychosis (other than manic symptoms)?>
I know she is on thyroid meds and a cardiac med, perhaps because of the toxic effects of the other drugs. I know she has been diagnosed as BP but I do not know any other specific diagnosis. She cuts herself daily and this last episode that landed her in the hospital was because she was beating her head against a wall and then threatening to jump in front of moving vehicles or drive into a semi. She said she did not want to live the way she feels...and I have to tell you, I understand that. She is seriously mentally ill and I cannot believe this is the best it can be. I feel very helpless about getting her the help she needs. If some hospital somewhere, anywhere in this country would take her and keep her until she was stabilized and helped, I would pay to get her there but I cannot pay for her medical treatment.
If this is how she is going to be, I know she will end up killing herself. Right now she is calmer but pretty much zombied out. I guess there is probably not much I can do but I wish there was.
Posted by utopizen on March 23, 2003, at 11:28:40
In reply to Re: Mixture of Drugs/Comments Please, posted by hopko on March 23, 2003, at 11:05:44
Any antidepressant can induce mania. That's why bipolars are prescribed them with mood stabilizers. SInce she's on mood stablizers, it shouldn't be a concern. It's a problem when it's taken without the mood stabilizer, which isn't the case here.
Posted by lauran on March 23, 2003, at 12:05:13
In reply to Re: Mixture of Drugs/Comments Please » hopko, posted by Ritch on March 23, 2003, at 10:18:37
Hi Ritch. You gave me some encouragement with my akathesia a couple of weeks ago. I had a very bad experience with it after being on Abilify for 4 weeks. I stopped the Abilify and restarted my Seroquel the same day. The akathesia got a bit better than came back full force on the Seroquel. I'd never had akathesia with the Seroquel prior after 15 months use.
I stopped the Abilify 2 weeks ago and the Seroquel 4 days ago. My pdoc knows this. I don't any physical symptoms, but the inner anxiety is very strong. Have you stopped AP's and had a similar reaction? Have you heard of how long it takes for the akathesia to go away after the Abilify is stopped?
Thanks!
Posted by Krissy P on March 23, 2003, at 12:12:53
In reply to Re: Mixture of Drugs/Comments Please, posted by utopizen on March 23, 2003, at 11:28:40
Hi utopizen,
I have also heard that sometimes BP patients do NOT need an AD because of possibly creating mania. What do you think?
--------------------------------------------------------------------------------------------------> Any antidepressant can induce mania. That's why bipolars are prescribed them with mood stabilizers. SInce she's on mood stablizers, it shouldn't be a concern. It's a problem when it's taken without the mood stabilizer, which isn't the case here.
Posted by Ritch on March 23, 2003, at 13:43:14
In reply to Re: Mixture of Drugs/Comments Please, posted by hopko on March 23, 2003, at 11:05:44
> > Hi, a lot depends on her specific diagnosis. She is taking two AP's instead of just one. Maybe one AP would be better? BTW, I have heard a few posters here talk about Geodon inducing mania (just an FYI). If she is bipolar and rapid-cycling the Lexapro could be aggravating it (especially at a standard dosage).<
>
> The Lexapro is the newest addition to all of the other meds. She was prescribed this after her last hospitalization. To my knowledge she has been on all of the rest of them for a while, each one added to the next as her condition has worsened. I WAS worried when I heard that she had been prescribed Lexapro because of what I have read on this board about it inducing mania.
>
> >The lithium at 600mg/day usually stabilizes most folks, but you said she had been hospitalized. She might need a higher lithium dose-she may not be in the therapuetic range even at 600mg. The Trileptal even at 150mg *could* be potentiating any toxic effects of the lithium/Lamictal since all three affect sodium channels. Seroquel and esp. Lithium can depress thyroid function or lower thyroid hormones that could aggravate cycling. Do you know her specific diagnosis? Was she hospitalized for an acute manic episode? Was she experiencing psychosis (other than manic symptoms)?>
>
> I know she is on thyroid meds and a cardiac med, perhaps because of the toxic effects of the other drugs. I know she has been diagnosed as BP but I do not know any other specific diagnosis. She cuts herself daily and this last episode that landed her in the hospital was because she was beating her head against a wall and then threatening to jump in front of moving vehicles or drive into a semi. She said she did not want to live the way she feels...and I have to tell you, I understand that. She is seriously mentally ill and I cannot believe this is the best it can be. I feel very helpless about getting her the help she needs. If some hospital somewhere, anywhere in this country would take her and keep her until she was stabilized and helped, I would pay to get her there but I cannot pay for her medical treatment.
>
> If this is how she is going to be, I know she will end up killing herself. Right now she is calmer but pretty much zombied out. I guess there is probably not much I can do but I wish there was.Oh my, I am so sorry about that situation. It obviously is very, very, complicated and appears to be intractable. The only other two things I can think of would be to get a 2nd opinion (if she hasn't already) to get a reappraisal of her situation. Also, perhaps there is a hidden general medical condition that has not been discovered (epilepsy, tumor, etc.)? Also, ECT might be something to consider at this point. I hope this turns out positive in some way.
Posted by utopizen on March 23, 2003, at 13:45:42
In reply to Re: Mixture of Drugs/Comments Please » utopizen, posted by Krissy P on March 23, 2003, at 12:12:53
> Hi utopizen,
> I have also heard that sometimes BP patients do NOT need an AD because of possibly creating mania. What do you think?I frankly haven't read up enough on bipolar to know. I am only social phobia and ADD-inattentive. I tend to have cycles of high productivity followed by cycles of low productivity in my school work, and my doctor is unsure whether it may be related to a bipolar condition.
I've taken many ADs and haven't felt any differently on them. I'm naturally happy, so my theory is my serotonin is fine, and it's just my GABA that needs tweaking. But I take Paxil 20mg (just started) just in case I'm wrong. I've tried Effexor, Wellbutrin, Celexa in the past.
I've never heard anyone on this board claim "this SSRI AD didn't work, but then I tried this AD, and it did!" so I'm skeptical since Celexa didn't do anything.
Posted by Ritch on March 23, 2003, at 13:50:34
In reply to Re: Mixture of Drugs/Comments Please » Ritch, posted by lauran on March 23, 2003, at 12:05:13
> Hi Ritch. You gave me some encouragement with my akathesia a couple of weeks ago. I had a very bad experience with it after being on Abilify for 4 weeks. I stopped the Abilify and restarted my Seroquel the same day. The akathesia got a bit better than came back full force on the Seroquel. I'd never had akathesia with the Seroquel prior after 15 months use.
>
> I stopped the Abilify 2 weeks ago and the Seroquel 4 days ago. My pdoc knows this. I don't any physical symptoms, but the inner anxiety is very strong. Have you stopped AP's and had a similar reaction? Have you heard of how long it takes for the akathesia to go away after the Abilify is stopped?
>
> Thanks!
Hi, it is kind of tough to tell sometimes whether it is restlessness that will fade that is true akathisia from the AP, or if it is a rebound anxiety due to DA receptors being unoccupied by the AP. I've gotten rebound anxiety from AP's when stopping them in the past that didn't feel like akathisia to me-I just felt TENSE. This faded after a few days-weeks in most cases. You might want to ask your pdoc about some Klonopin or Ativan to settle the anxiety for awhile until your body readjusts to not having the drug. In the meantime you can always take a little OTC Benadryl to see if it will help. If you get a marked improvement with the Benadryl then you may indeed be treating some lingering akathisia. Benadryl is also sedative and anxiolytic for some folks and it might help with the rebound anxiety-if that's what it is. Hope this helps some.
Posted by lauran on March 23, 2003, at 14:08:06
In reply to Re: Mixture of Drugs/Comments Please » lauran, posted by Ritch on March 23, 2003, at 13:50:34
Hi Ritch. You helped me tremedously. I had a feeling this wasn't akathesia. I truly believe the answer to what I am feeling is rebound anxiety to the receptors being unoccupied from stopping the Seroquel. I didn't know what terms to put that in but it fits quite well. And the feeling is TENSE (I liked the caps.) Not akathesia but tenseness.
I believe my brain will adjust. I hope it is days and not weeks but I can deal with it if I know what to call it. I'll discuss this with my pdoc, but I know that answer fits. It is just encouraging to know it does improve over time. One gets frightened that maybe this will last forever, especially when right in the middle of it. I also tried Benadryl and it didn't help the tenseness which just confirms my belief about it being DA receptors having to adjust. I'll talk to him about the Ativan possibility.Thanks for responding. Have a great weekend.
Posted by hopko on March 23, 2003, at 14:08:44
In reply to Re: Mixture of Drugs/Comments Please » hopko, posted by Ritch on March 23, 2003, at 13:43:14
Thanks Rich. My husband saw her this morning and she said she likes her new doc, so perhaps I will suggest to her that she reveiw all of her medications with him. Maybe it is a starting point.
Posted by Ritch on March 23, 2003, at 20:13:20
In reply to Re: Mixture of Drugs/Comments Please » Ritch, posted by lauran on March 23, 2003, at 14:08:06
> Hi Ritch. You helped me tremedously. I had a feeling this wasn't akathesia. I truly believe the answer to what I am feeling is rebound anxiety to the receptors being unoccupied from stopping the Seroquel. I didn't know what terms to put that in but it fits quite well. And the feeling is TENSE (I liked the caps.) Not akathesia but tenseness.
>
>
> I believe my brain will adjust. I hope it is days and not weeks but I can deal with it if I know what to call it. I'll discuss this with my pdoc, but I know that answer fits. It is just encouraging to know it does improve over time. One gets frightened that maybe this will last forever, especially when right in the middle of it. I also tried Benadryl and it didn't help the tenseness which just confirms my belief about it being DA receptors having to adjust. I'll talk to him about the Ativan possibility.
>
> Thanks for responding. Have a great weekend.
I think it will probably be just days, not weeks so don't get discouraged. The rebound anxiety I experienced the most was when low-dose Stelazine wore off the next day and when I stopped low-dose Mellaril. It was the worst just a couple of days afterwards and then it got better.
Posted by Ritch on March 23, 2003, at 20:20:52
In reply to Re: Mixture of Drugs/Comments Please, posted by hopko on March 23, 2003, at 14:08:44
> Thanks Rich. My husband saw her this morning and she said she likes her new doc, so perhaps I will suggest to her that she reveiw all of her medications with him. Maybe it is a starting point.
That's really good news, that sounds encouraging!
Posted by lauran on March 24, 2003, at 9:28:41
In reply to Re: Mixture of Drugs/Comments Please » lauran, posted by Ritch on March 23, 2003, at 20:13:20
Hi Ritch. I woke up this morning with 90% of that tense feeling gone. I feel the akathesia has passed and the rebound anxiety from stopping the low dose Seroquel has begun to resolve. It was so disconncerting to be in the middle of all that and not have answers for it. Sharing your experiences with me really helped. Thanks and best wishes.
Posted by Ritch on March 24, 2003, at 11:39:57
In reply to Re: Mixture of Drugs/Comments Please » Ritch, posted by lauran on March 24, 2003, at 9:28:41
Posted by missliz on March 25, 2003, at 2:33:58
In reply to Mixture of Drugs/Comments Please, posted by hopko on March 22, 2003, at 13:18:06
I didn't read the whole thread, but that is a just wacko med regimen. Way too many drugs, and not enough of the mood stabilizers to really do any good. Your freind needs to see a better psychiatrist, and quickly.
Thats just freakish. Even if those were big enough doses of mood stabilizer, how can anybody that sick keep up with all those pills? And she's on an awful lot of antipsychotics. This is scary.missliz
Posted by hopko on March 25, 2003, at 8:07:46
In reply to Re: Mixture of Drugs/Comments Please, posted by missliz on March 25, 2003, at 2:33:58
I think so as well. She is seeing a new doc only recently and I am going to suggest to her that she reveiw all her meds with him. Hopefully, he will get things under control. Thanks for your answer.
This is the end of the thread.
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