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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by AnneL on October 26, 2003, at 1:20:33
Hi P-Babblers,
After 3 years on Effexor and Klonapin after a depressive episode, I find myself with a diagnosis of bipolar disorder of the "softer" variation, my guess would be II. I have been given 4 options:
1. Stay on my currents meds and see what happens, or
2. Try Valproic acid (sp) and taper off klonapin; or
3. Try Lamictal.
Because I do not feel depressed and the hypomanic phase seems to have passed (it lasted for about 5 weeks and was very pleasant with the exception of only sleeping 4 hours a night and spending money), it just does not seem too urgent or pressing to start on another medication that may cause a potentially fatal rash (Lamictal) or make my hair fall out and increase weight (Val acid).
Can anyone offer me some rationale as to why it might be a good idea to try a mood stabilizer and do I need to be concerned with being on an unopposed SNRI? Thanks AnneL
Posted by galkeepinon on October 26, 2003, at 1:28:03
In reply to Questioning BPII Diagnosis and Treatment, posted by AnneL on October 26, 2003, at 1:20:33
Hi, I still blame Effexor for being 'labeled' as BP II the 'softer' version. That med helped with my depression, BUT I got so manic at times that I had to lower the dosage. I finally discontinued it.
I can just speak from my experience:
Lamictal has helped my moods tremendously. I never got the 'rash'.
I lost a lot of hair and gained 30 in a MONTH while on Depakote. I don't currently nor will I ever take that med again.
As far as being concerned with being on an unopposed SNRI~Mirtazapine has no direct reuptake inhibition of norepinephrine, serotonin, or dopamine and it doesn't produce as many gastrointestinal disturbances as do the SSRIs.
Maybe check into the NaSSA's.
*Only you can decide what's best for you, but I'm sure you'll get other posters' responses:-)
Hang in there and best of luck!> Hi P-Babblers,
>
> After 3 years on Effexor and Klonapin after a depressive episode, I find myself with a diagnosis of bipolar disorder of the "softer" variation, my guess would be II. I have been given 4 options:
> 1. Stay on my currents meds and see what happens, or
> 2. Try Valproic acid (sp) and taper off klonapin; or
> 3. Try Lamictal.
> Because I do not feel depressed and the hypomanic phase seems to have passed (it lasted for about 5 weeks and was very pleasant with the exception of only sleeping 4 hours a night and spending money), it just does not seem too urgent or pressing to start on another medication that may cause a potentially fatal rash (Lamictal) or make my hair fall out and increase weight (Val acid).
> Can anyone offer me some rationale as to why it might be a good idea to try a mood stabilizer and do I need to be concerned with being on an unopposed SNRI? Thanks AnneL
Posted by Viridis on October 26, 2003, at 3:08:33
In reply to Questioning BPII Diagnosis and Treatment, posted by AnneL on October 26, 2003, at 1:20:33
It seems like "bipolar II" is the fashionable diagnosis right now (not that it isn't real, but I wonder if that many people really have it... I could easily be diagnosed with this too, with a different pdoc).
I'm no expert, but if Klonopin works, why not stay with it? It's very safe, tolerance seems rare, and it does have some mood-stabilizing properties (for me, at least).
I've heard some very positive things about Lamictal and know someone whose life has definitely been changed by it (he's BP I, and I do believe this after having known him for many years). That one may be worth the gradual titration it requires, especially if you're not in a state of crisis right now and can afford the time. I'm thinking of trying it myself, and my pdoc seems quite impressed by it.
As for Effexor, I can't comment except to say be careful based on comments from others here.
Posted by AnneL on October 26, 2003, at 14:02:46
In reply to Re: Questioning BPII Diagnosis and Treatment » AnneL, posted by galkeepinon on October 26, 2003, at 1:28:03
>>Thank you so much for your very insightful reply. I am sure Effexor has not helped my perpensity towards some of the BP II diagnostic criteria. I think the only thing that has "saved" me for the last 3 years by being on an unopposed SSRI/SSNI from going full-tilt is a nightly dose of Klonapin. Question: Mirtipazine (sp) isn't that Remeron? Dosen't Remeron cause tremendous increase in Appetite due to its histamine properties? I've heard it's really sedating as well. Are you taking Remeron? Tomorrow is the "big" consult day with my psychopharmacologist who feels he has all the evidence he needs to support his BP II or whatever diagnosis. Now I know why this diagnosis can be missed so easily. The only times I saw my Pdoc were when I was in the dumps, not when I was feeling "great" (I mean feeling Good, almost to the point of feeling bad). I like your rationale behind Lamictal, meaning, I can take my time to slowly titrate up as I am not in crisis. I'll keep you posted. Thank you again for your input! Anne :)
> Hi, I still blame Effexor for being 'labeled' as BP II the 'softer' version. That med helped with my depression, BUT I got so manic at times that I had to lower the dosage. I finally discontinued it.
> I can just speak from my experience:
> Lamictal has helped my moods tremendously. I never got the 'rash'.
> I lost a lot of hair and gained 30 in a MONTH while on Depakote. I don't currently nor will I ever take that med again.
> As far as being concerned with being on an unopposed SNRI~Mirtazapine has no direct reuptake inhibition of norepinephrine, serotonin, or dopamine and it doesn't produce as many gastrointestinal disturbances as do the SSRIs.
> Maybe check into the NaSSA's.
> *Only you can decide what's best for you, but I'm sure you'll get other posters' responses:-)
> Hang in there and best of luck!
>
>
>
> > Hi P-Babblers,
> >
> > After 3 years on Effexor and Klonapin after a depressive episode, I find myself with a diagnosis of bipolar disorder of the "softer" variation, my guess would be II. I have been given 4 options:
> > 1. Stay on my currents meds and see what happens, or
> > 2. Try Valproic acid (sp) and taper off klonapin; or
> > 3. Try Lamictal.
> > Because I do not feel depressed and the hypomanic phase seems to have passed (it lasted for about 5 weeks and was very pleasant with the exception of only sleeping 4 hours a night and spending money), it just does not seem too urgent or pressing to start on another medication that may cause a potentially fatal rash (Lamictal) or make my hair fall out and increase weight (Val acid).
> > Can anyone offer me some rationale as to why it might be a good idea to try a mood stabilizer and do I need to be concerned with being on an unopposed SNRI? Thanks AnneL
>
>
Posted by AnneL on October 26, 2003, at 14:12:48
In reply to Re: Questioning BPII Diagnosis and Treatment » AnneL, posted by Viridis on October 26, 2003, at 3:08:33
Hi Viridis,
I think that many people with this diagnosis function well in society and tend to be creative. Why see your pdoc when you are top of the world, getting a big promotion at work and generally feeling Great?!! I personally never saw my pdoc during those times. Klonopin is a great med and helps me to sleep when I am going full-speed ahead. Now, in retrospect, I know that I would have had a much earlier diagnosis and probably been in a whole lot of financial trouble if I had been on Effexor without K. I will give Lamital a try. Getting off Effexor is another issue. I've tried about 14 times and get so darn frustrated with discontinuation syndrome that I go right back on it. I'll keep you posted.
Thank you again. Anne :)
> It seems like "bipolar II" is the fashionable diagnosis right now (not that it isn't real, but I wonder if that many people really have it... I could easily be diagnosed with this too, with a different pdoc).
>
> I'm no expert, but if Klonopin works, why not stay with it? It's very safe, tolerance seems rare, and it does have some mood-stabilizing properties (for me, at least).
>
> I've heard some very positive things about Lamictal and know someone whose life has definitely been changed by it (he's BP I, and I do believe this after having known him for many years). That one may be worth the gradual titration it requires, especially if you're not in a state of crisis right now and can afford the time. I'm thinking of trying it myself, and my pdoc seems quite impressed by it.
>
> As for Effexor, I can't comment except to say be careful based on comments from others here.
Posted by karen_kay on October 28, 2003, at 8:48:05
In reply to Questioning BPII Diagnosis and Treatment, posted by AnneL on October 26, 2003, at 1:20:33
Anne, I was on Lamictal with no side effects. I did not develope the rash and my doctor even started me at 100 mgs, even though I repeatedly asked him if that was a high dosage to begin with. We eventually got that mess figured out and yes, I am now seeing a different doc. I eventually discontiuned the Lamictal because I was on it in combonation with several others and was too "doped" up to leave my house. I really think you should look into beginning a mood stabilizer, as the depressions will only worsen as you age. The hypomanias may be good, but the depressions probably will not be tollareable. I have never taken Valproic acid. A really good book you may want to invest in is caled "The Bipolar Disorder Survival Guide" It is about $20 and it is very down-to earth. Good luck hun, and you should really know that havign bipolar disorder is more of a gift than a burden. I feel that it makes me more compassionate and empathetic. Plus, sometimes when you are hypomanic you are a blast to be around, just ask your friends! karen
Posted by platinumbride on October 28, 2003, at 11:36:00
In reply to Questioning BPII Diagnosis and Treatment, posted by AnneL on October 26, 2003, at 1:20:33
potentially fatal rash (Lamictal)
This is soooooooo rare.... Very few people get it, really.
It hasn't done much for my hypomania as a mood stablizer (Bipolar II here as well)
I'm not sure it has done anything but the doc thinks it has.....also he thinks it has antidepressant properties.
Personally, Klon is a fave of mine, but I tend to abuse it when Im bored adn then I pay big time the next day! Like a hangover!Lamic. didnt make me tired either......
Diane
Posted by McPac on October 28, 2003, at 23:49:45
In reply to Re: Questioning BPII Diagnosis and Treatment » AnneL, posted by Viridis on October 26, 2003, at 3:08:33
Can Klonopin be used long term for terrible insomnia?
Low-dose Remeron works great for my insomnia (but does little for anxiety)...Klonopin would help, no doubt, for my anxiety but does it work for bad insomnia?
Also, does Klonopin really have mood-stabilizing properties?
Thnx!
Posted by Viridis on October 29, 2003, at 3:18:07
In reply to Viridis, posted by McPac on October 28, 2003, at 23:49:45
Well... here's the weird thing. Benzos like Klonopin aren't recommended for long-term insomnia relief because, supposedly, they undermine "sleep architecture" and induce tolerance to the sleep-inducing effects. But, Klonopin seems to be a favorite for long-term anxiety treatment, because it tends to remain effective at the same dosage without tolerance to the anti-anxiety effects.
So, if your insomnia results from anxiety, Klonopin probably is a good treatment (it is for me). If you're not anxious but use Klonopin for insomnia, then the effects are supposed to wear off (or require higher and higher doses).
If I were you I'd just try it, but maybe take it in the AM and see if your insomnia improves. Mine certainly did, yet I don't feel sleepy during the day. And yes, it can be a mild mood stabilizer (according to my pdoc and my experience).
BTW, I posted a link to a review article on sleep disorders here a couple of weeks ago. The general consensus among sleep docs seemed to be that most of the benzos are good for insomnia, indefinitely regardless of the general advice that they should only be used briefly. Ambien seemed to be the favorite, and I know people who have taken it for long periods for insomnia with no problems despite the vague warnings.
The bottom line is that you should try these meds, and keep your doctor posted on how you're doing. If he/she has any sense, they'll know if there's a problem and advise you accordingly.
This is the end of the thread.
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