![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Emme on January 11, 2004, at 20:20:28
Hello All,
I'm trying to brainstorm on ideas for improving my meds. My pdoc usually has some thoughts, but I like to have some ideas percolating also.
Dx: Bipolar spectrum. Mostly evil hideous depression. Little hypomania - the excess energy turns up as anxiety, edginess, noise hypersensitivity.
I'm on 350 mg Lamictal, 25 mg atenolol (to control physical symptoms of anxiety), clonazepam and xanax (at the moment, low doses as needed. Occasional crumb of seroquel. Intermittent selegiline (5-10 mg).
I'm more level on the Lamictal - less bouncy, and partial remission from depression. I need to acheive better remission of depression. But medicating me is like trying to walk a tightrope between the sluggish "eeyore" depression and the anxiety. And I am sensitive to side effects. When I'm really depressed, I need perking up and *motivation*. But something too activating makes me jittery, so I need anxiety control that doesn't zombify me (alternatives to clonazepam?).
The Lamictal seems to be stimulating - I don't feel anxious per se, but my pulse is running high even with the atenolol. It would be nice to have new ideas for something to "balance" out the Lamictal and calm my system as well as ideas for improving depression.
The most optimistic-feeling/motivated days I've had have been on 5 or 10 mg selegiline. But I was also kind of revved - the stuff is stimulating. I've had awful days on it too - so I worry it may induce cycling. I may continue to use it on an as-needed basis when I'm immobilized, but I'm notdecided.
Have tried:
Li
SSRIs out of the picture
neurontin (great but dropped WBC count)
Effexor
Gabitril
Remeron
Trileptal.Others:
Standard MAOIs. I know they make pharmacologic sense for me. But I'm unwilling to assume the worry with the diet (I *know* I'd obsess). I'm a vegetarian and I eat too many questionable things, especially ethnic foods.Risperidol: Just trying a few days. I'm not sure it's doing anything that seroquel didn't do.
Provigil: low dose has helped sometimes when I'm really sluggish. Sometimes it sends me into orbit. Sometimes I don't even feel it.
Strattera: tried it briefly, neither bad nor good. Probably didn't try it long enough. (keep that as an option?)
Keppra: I didn't hate it. But it made me feel simultaneously emotionally edgy and apathetic. And my brain didn't produce any thoughts.
Topomax: seemed to make me more depressed. Of course I wasn't taking Lamictal then... revisit it....? Will it make my hair fall out?
Zonegran: Well, I was sleepless and very depressed on it after about 5 days. Scary. But then I was also very depressed a few days after stopping it. So maybe I felt awful by coincidence and I was premature on nixing that? Anyone find it helped depression? Anxiety?
That's probably most of it. I think my doc has stayed away from depakote and tegretol because of their side effect profiles and as I understand it, depakote is better suited for controlling mania.
Okay, if anyone has any thoughts, I'll be interested to hear them. Thank you.
Emme
Posted by SLS on January 11, 2004, at 20:35:49
In reply to Can you all give me some feedback?, posted by Emme on January 11, 2004, at 20:20:28
> Zonegran: Well, I was sleepless and very depressed on it after about 5 days. Scary. But then I was also very depressed a few days after stopping it. So maybe I felt awful by coincidence and I was premature on nixing that?
Zonegran has a half-life of about 70 hours. It would take a few days to leave your system, so there may be a cause and effect association between it and your worsened depression.
I would seriously consider Nardil. Why not thoroughly research the diet and see if it is not to difficult for you to stick to? I know it is a difficult decision to make.Why are SSRIs out?
- Scott
Posted by Emme on January 11, 2004, at 21:04:55
In reply to Re: Can you all give me some feedback?, posted by SLS on January 11, 2004, at 20:35:49
Hi Scott,
> > Zonegran: Well, I was sleepless and very depressed on it after about 5 days. Scary. But then I was also very depressed a few days after stopping it. So maybe I felt awful by coincidence and I was premature on nixing that?
>
> Zonegran has a half-life of about 70 hours. It would take a few days to leave your system, so there may be a cause and effect association between it and your worsened depression.Okay. Thanks. I think I'll look on my calendar and double check how many days after stopping it I was still in bad shape - I'm guessing it was within those few days.
>
> I would seriously consider Nardil. Why not thoroughly research the diet and see if it is not to difficult for you to stick to? I know it is a difficult decision to make.Yeah, I know....Ace's posts are persuasive. I'd have to do some serious research because there are questionable/probably fermented ingredients in a lot of veggie foods and that stuff isn't listed in the usual diet guides. Sounds like I'm making a lot out of something that lots of people do fine with. It's just that so much of my life and lifestyle (and associated social life) have been devastated that I'd like to keep at least a shred of it.
Plus, there's family issues related to my mood disorder and my food choices. I won't elaborate.
>
> Why are SSRIs out?Paxil: worked great as the first med I ever tried. It pooped out. Tried it at a later time with serzone. I cycled up and down on 2-week intervals. Tried it quite a bit later with a MS in place - I flew into rages and threw baby carrots down the hall at work, and then it just made me a zombie.
Zoloft. all it did was make me jittery.
Celexa. I only took 2 - 4 mg. My moods were erratic. And the stuff made me so freezing cold I was practically sitting *in* the fireplace.
So my pdoc says I shouldn't take SSRIs.
BTW, I keep seeing amisulpride mentioned, but I confess I haven't read enough to get a sense of how this drug is for depression and whether it's calming or stimulating. (Not avail. in U.S., is it?).
Emme
Posted by brussell on January 11, 2004, at 21:08:11
In reply to Can you all give me some feedback?, posted by Emme on January 11, 2004, at 20:20:28
I agree that MAOIs make an awful lot of sense for someone with your symptoms. Parnate was the first drug I ever took that succesfully nailed the worst of my depression and anxiety.
My most recent life change had caused secondary borderline hypertension due to chronic, torturous anxiety. Soon after I started the Parnate, my bp readings dropped twenty points each! I think Nardil is supposed to be even better for anxiety and depression (but it is less activating, and can have more side-effects).
Mainly, I wanted to say that the diet is not overly restrictive for most people. I don't notice it at all, really. I ate a vegetarian mozzerella cheese pizza (no aged cheeses or meats) with no problems, and I eat Chinese food regularly. After over a month of use, I have not had any problems with hypertension.
I want to emphasize that people's sensitivity to tyramine seems to vary a great deal. I have heard of people on MAOIs eating all kinds of borderline-forbidden foods with no problems, while another poster experienced mild hypertension on Nardil while on a perfect MAOI diet.
My point is that you should not obsess about the diet. People on MAOIs get a feel for what is good and bad to eat and don't even have to think about it after a while. If a MAOI works for you, any dietary restrictions will seem like a pretty insignificant sacrifice.
Good luck to you!
Posted by Emme on January 11, 2004, at 22:15:11
In reply to Re: Can you all give me some feedback?, posted by brussell on January 11, 2004, at 21:08:11
Scott and Brussell,
Okay, I'll do a little diet digging. Maybe someone's got the tyramine contents for things like tofu and tempe and soy milk and the like.
Brussell, how do you manage Chinese food with the soy sauce??
My pdoc had said something similar about me not minding the diet if I felt better. I have been afraid that it would be more damaging to my psyche if I had to miss out on being with friends. Often the only time to get people together is for dinner and it's always at a place with Asian or Indian cuisine. There just aren't that many vegetarian options when you eat out. But you are probably right that I should give it more thought.
Posted by prozacpuppet on January 12, 2004, at 3:35:13
In reply to I'll give it some thought, posted by Emme on January 11, 2004, at 22:15:11
god, you make me SICK! you've tried all them meds huh? and what else do you want? do you want to be just completely sedated so you have no thoughts what so ever? because that's all you're looking for, being medded up on a bunch of different meds at one time is so STUPID! I can't believe how you Americans (im australian) take so many different meds at the one time! and still want more! yeah life is full of pain and anguish: GET OVER IT! you need to start facing your problems instead of dulling out your mind baby..start exercising more, drink more water, get a spa bath, realax, learn to control your mind and not have drugs control you maybe you'll feel better???
"But you are probably right that I should give it more thought."
yes! i think SO.
> Scott and Brussell,
>
> Okay, I'll do a little diet digging. Maybe someone's got the tyramine contents for things like tofu and tempe and soy milk and the like.
>
> Brussell, how do you manage Chinese food with the soy sauce??
>
> My pdoc had said something similar about me not minding the diet if I felt better. I have been afraid that it would be more damaging to my psyche if I had to miss out on being with friends. Often the only time to get people together is for dinner and it's always at a place with Asian or Indian cuisine. There just aren't that many vegetarian options when you eat out. But you are probably right that I should give it more thought.
>
Posted by brussell on January 12, 2004, at 6:22:29
In reply to I'll give it some thought, posted by Emme on January 11, 2004, at 22:15:11
Hmm... Something happened to my previous post.
You're right about soy sauce being the sort of thing you want to be careful with. I use it sparingly, and watched carefully for any reaction the first time. I'm sure I would be in trouble if I drank a bottle, but the amounts I use haven't caused problems.
Personally, I was very strict with the diet at first, and then would experiment with small amounts of foods I had heard others on MAOI's had used without problems. If I didn't get any warning signs (headache, elevated bp) I would assume I could try some more.
I still won't touch foods very high in tyramine, like aged cheeses and meats, tap, foreign, or homemade beer, and red wine. I also avoid old leftovers and make sure what I'm eating is fresh.
Generally the common quality in dangerous foods is that they have all been "aged for flavoring purposes." Tofu isn't aged, is it? It's probably fine. I'm sure there are lists available of safe and unsafe foreign foods.
I wouldn't want to give up eating with my friends, either! (If only I had some in this new city!) I'm certain, though, that you with some research and caution at first you will be able to continue eating many ethnic foods.
Best of luck to you.
Posted by Dinah on January 12, 2004, at 7:03:46
In reply to Re: I'll give it some thought, posted by prozacpuppet on January 12, 2004, at 3:35:13
> god, you make me SICK! you've tried all them meds huh? and what else do you want? do you want to be just completely sedated so you have no thoughts what so ever? because that's all you're looking for, being medded up on a bunch of different meds at one time is so STUPID!
Dinah here, acting as deputy for Dr. Bob.
Please don't jump to conclusions about others or post anything that could lead others to feel accused or put down.
Http://www.dr-bob.org/babble/faq.html#civil
Thanks,
Dinah
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Ame Sans Vie on January 12, 2004, at 7:40:42
In reply to Re: I'll give it some thought, posted by prozacpuppet on January 12, 2004, at 3:35:13
> god, you make me SICK!
Please don't put down or discourage others. I feel that was extremely uncalled for.
> you've tried all them meds huh? and what else do you want?
Normalcy? A productive, meaningful life? The chance to wake up each morning feeling ready to take on the world, after many years of anguish and misunderstanding from even those whom we love?
> do you want to be just completely sedated so you have no thoughts what so ever?
I believe Emme wants to kick bipolar disorder in the a**; nothing more. Emme sounded completely lucid to me -- not braindead as you seem to be implying. And I have yet to meet an individual with a disorder as serious as this who wouldn't trade their suffering for a little sedation.
And do I seem sedated and braindead to you? I take five different psychiatric medications, yet here I am, awake since 5:00AM after a wonderful night's sleep, feeling great and ready to start my newly productive days as a recording engineer in my own studio. That would be a rather difficult thing to do if I were still a complete agoraphobic shut-in, as I was for two years straight. It would also put a damper on the situation had I used the 30 grams of pentobarbital I had stashed in my mattress as recent as last summer, just waiting for that day that I could gather the courage to take my own life.
> because that's all you're looking for,
Please don't jump to conclusions about the motives of others.
> being medded up on a bunch of different meds at one time is so STUPID!
Please don't say anything that could lead others to feel put down. And please don't imply that the decisions of myself, Emme and many others on these boards to lead normal lives are "STUPID".
> I can't believe how you Americans (im australian) take so many different meds at the one time! and still want more!
I find this beyond offensive. Severe, debilitating mental illness is not indigenous and restricted to the U.S. Nor is aggressive drug therapy to improve quality of life. Many Aussies are in the same boat we are -- as are many Brits, French, Dutch, Japanese, Chinese, Koreans, Russians, Greeks, Arabs, Indians, Africans, Scandinavians, Hispanics, etc. ad nauseam. I may adamantly disagree with my country's current administration, but I am most certainly fortunate to live in a land wherein mental illness is rapidly dropping that old stigma and where I can speak openly and frankly concerning my illnesses (*and* medications) without fear of non-acceptance, judgment, or ridicule.
To me, what you said is tantamount to saying that Americans are simply a nation of lazy, hypochondriacal, pill-popping screw-ups. Besides, Emme never even mentioned in this thread which nation she hails from -- so are you just assuming she's American?
> yeah life is full of pain and anguish: GET OVER IT!
Sure, life is full of pain and anguish. But that's a far cry from the self-hatred, resentment, thoughts/plans of suicide, lack of compassion, lack of companionship, hopelessness, etc. experienced by many or most people still struggling to find a way through the hell that is mental illness.
> you need to start facing your problems instead of dulling out your mind baby..
Some problems can be dealt with head-on... problems at work, financial issues... but problems hardwired into one's brain that run this emotionally and neurologically deep require a bit more. Mania and psychosis in particular can't and won't be reasoned with. Desperate times -- desperate measures.
> start exercising more, drink more water, get a spa bath, realax,
It's just not that simple. Any of us who are serious about surmounting our problems have tried all these things and then some. Not to say that they don't help some people, nor that these suggestions aren't something that we all shouldn't adhere to. But breaking a sweat every day, drinking lots of water, and visiting a spa occasionally simply isn't going to arrest the ever-persistent complications of extreme mental dysfunction -- once again, particularly mania and psychosis.
> learn to control your mind.....
Okay, once again, not a bad suggestion in and of itself, but some things can't be controlled. Not to mention that very, very few people in the general "normal" population possess the patience, perseverance, and discipline to master such a skill as your basic, run-of-the-mill stress reduction techniques. So I imagine that the percentage of the mentally ill population that lacks this capacity is much higher, and the goals sought by psychiatric patients (those that stand a chance in hell of being achieved through mind power; i.e. mild-moderate anxiety disorders, dysthymia, some personality disorders) take a heck of a lot more work, and time, to achieve. Many of us *do not have time* and will not hesitate to commit that dreaded final act if things don't improve quickly. We especially do not have time to focus our disorganized, ailing brains on transcendental meditation, hypnosis, CBT, biofeedback and so on and so forth -- methods which are useless to many of the certifiably mentally ill and can take a lifetime to create an ounce of change. Then there's the issue that I doubt one would be capable of giving such methods a shot while in a state of psychosis, mania, melancholic depression, and/or neurotic anxiety.
> .....and not have drugs control you maybe you'll feel better???
I don't want to put words in Emme's mouth, but I believe it was her pre-medication misery that brought her to psychiatry in the first place. Why on earth would she intentionally sentence herself back to such a horrid existence? Bipolar disorder doesn't just *poof* disappear one day. While the jury's still out on this one, I'd bet money that it (as well as schizophrenia) is an primarily genetic disorder, due to the nature of its symptom set.
Posted by Ame Sans Vie on January 12, 2004, at 8:19:28
In reply to Can you all give me some feedback?, posted by Emme on January 11, 2004, at 20:20:28
> Hello All,
Hiya. :-)
> I'm trying to brainstorm on ideas for improving my meds. My pdoc usually has some thoughts, but I like to have some ideas percolating also.
lol, yup, I know the feeling.
> Dx: Bipolar spectrum. Mostly evil hideous depression. Little hypomania - the excess energy turns up as anxiety, edginess, noise hypersensitivity.
>
> I'm on 350 mg Lamictal, 25 mg atenolol (to control physical symptoms of anxiety), clonazepam and xanax (at the moment, low doses as needed. Occasional crumb of seroquel. Intermittent selegiline (5-10 mg).
>
> I'm more level on the Lamictal - less bouncy, and partial remission from depression. I need to acheive better remission of depression. But medicating me is like trying to walk a tightrope between the sluggish "eeyore" depression and the anxiety. And I am sensitive to side effects. When I'm really depressed, I need perking up and *motivation*. But something too activating makes me jittery, so I need anxiety control that doesn't zombify me (alternatives to clonazepam?).As far as benzodiazepines are concerned, many people find Xanax to be minimally sedating and more uplifting than most others in this class. You mentioned you already take it though... how does it compare with clonazepam for you?
Some other benzos that may be less zombifying are Ativan (lorazepam), Serax (oxazepam), and Paxipam (halazepam). If you're outside the U.S., Lexotan (bromazepam) may be worth a try.
If you're just using anxiolytics on an as-needed basis, then maybe you would be better off with phenobarbital (Luminal/Solfoton -- a long-acting [about 12 hours] barbiturate that works well for anxiety and can also increase energy levels). Amobarbital (Amytal), secobarbital (Seconal), amobarbital/secobarbital (Tuinal), and pentobarbital (Nembutal) are also barbiturates and can have a phenobarbital-like effect, but they may be better if you need something shorter-acting. Equanil (meprobamate) or Soma (carisoprodol) are also good options for as-needed use. Equanil is specifically touted as an anti-anxiety medication, while Soma is a muscle-relaxant which partially metabolizes into meprobamate in your system. I've always found Soma to be wonderful at eradicating anxiety and inducing a sort of easy-going, happy-go-lucky feeling. Again though, these drugs are usually only a good idea if they're used intermittently
> The Lamictal seems to be stimulating - I don't feel anxious per se, but my pulse is running high even with the atenolol. It would be nice to have new ideas for something to "balance" out the Lamictal and calm my system as well as ideas for improving depression.
I also felt quite over-stimulated with Lamictal... it felt very Paxil-like, too. I discontinued it the very day I began feeling SSRI-type side effects. The benzos, barbs, meprobamate, and carisoprodol I mentioned above are all possible candidates, I feel, to counterract the Lamictal stimulation. Depakote is another possibility.
As for your heart rate, that's something you absolutely should discuss with your doctor. Perhaps a higher dose of atenolol, a switch to another beta-blocker (i.e. propranolol), or the addition of an alpha-adrenergic agonist like clonidine or guanfacine is in order.
> The most optimistic-feeling/motivated days I've had have been on 5 or 10 mg selegiline. But I was also kind of revved - the stuff is stimulating. I've had awful days on it too - so I worry it may induce cycling. I may continue to use it on an as-needed basis when I'm immobilized, but I'm notdecided.
Of course you have to exercise extreme caution when administering stimulants to bipolars, but how about trading in the selegiline for a very low dose of methylphenidate (2.5mg prn), magnesium pemoline (56.25mg), or an amphetamine (5mg prn) to see how that fares you?
> Have tried:
> Li
> SSRIs out of the picture
> neurontin (great but dropped WBC count)
> Effexor
> Gabitril
> Remeron
> Trileptal.
>
> Others:
> Standard MAOIs. I know they make pharmacologic sense for me. But I'm unwilling to assume the worry with the diet (I *know* I'd obsess). I'm a vegetarian and I eat too many questionable things, especially ethnic foods.I very much agree with the others who've suggested giving an MAOI a shot, but, even more so than with more typical antidepressants, you have to be careful about the drug inducing mania. MAOIs have been known to lift mood even in non-depressed folks -- something that can't be said for SSRIs, TCAs, or atypicals.
> Risperidol: Just trying a few days. I'm not sure it's doing anything that seroquel didn't do.
I'd probably stick with Seroquel... I may be mistaken, but I believe research shows that Risperdal and Zyprexa are more likely than other antipsychotics to cause diabetes.
> Provigil: low dose has helped sometimes when I'm really sluggish. Sometimes it sends me into orbit. Sometimes I don't even feel it.
>
> Strattera: tried it briefly, neither bad nor good. Probably didn't try it long enough. (keep that as an option?)Perhaps... Strattera and Wellbutrin are two meds I forgot earlier that may be useful for treating the benzo zombification. Again though, there is the risk of induction of mania.
> Keppra: I didn't hate it. But it made me feel simultaneously emotionally edgy and apathetic. And my brain didn't produce any thoughts.
>
> Topomax: seemed to make me more depressed. Of course I wasn't taking Lamictal then... revisit it....? Will it make my hair fall out?I'd put Topamax on the "should all else fail" list if I were you... the fact that it caused depression once before doesn't really work in its favor.
> Zonegran: Well, I was sleepless and very depressed on it after about 5 days. Scary. But then I was also very depressed a few days after stopping it. So maybe I felt awful by coincidence and I was premature on nixing that? Anyone find it helped depression? Anxiety?
Sorry -- no experience here.
> That's probably most of it. I think my doc has stayed away from depakote and tegretol because of their side effect profiles and as I understand it, depakote is better suited for controlling mania.
That's true -- though, as I mentioned above, Depakote may also be a good MS to reduce stimulation caused by lamotrigine. And Tegretol is nothing more than Trileptal with an extra oxygen atom tacked on (Tegretol--carbamazepine; Trileptal--oxcarbazepine). I haven't heard personally of any cases where Tegretol worked when Trileptal did not, or vice versa -- they're basically the same drug, though Trileptal is safer.
Posted by Ame Sans Vie on January 12, 2004, at 8:28:07
In reply to I'll give it some thought, posted by Emme on January 11, 2004, at 22:15:11
Normally I would agree with Scott about going with the Nardil, but it seems that everyone is complaining lately that the new version isn't effective... perhaps Parnate would be better. Fewer side effects as well (usually).
According to an article in the Journal of Clinical Phsychopharmacology (vol. 16, pages 383-388), soy sauce contains 0.941 mg/ml of tyramine, tofu contains 0.80 mg of tyramine per 100 g of tofu, and soy milk contains 0.5 mg tyramine per 250 ml. Of course, the article recommends soy sauce be avoided while taking MAOIs. Tofu and soy milk are fine, but, as they are fermented, tempe, miso, sufu, and natto are probably best avoided.
Posted by Emme on January 12, 2004, at 9:35:59
In reply to Re: I'll give it some thought, posted by prozacpuppet on January 12, 2004, at 3:35:13
> god, you make me SICK! you've tried all them meds huh? and what else do you want? do you want to be just completely sedated so you have no thoughts what so ever? because that's all you're looking for, being medded up on a bunch of different meds at one time is so STUPID!
I expressed my wish to avoid oversedation. You seem to me to be so angry that you are not reading posts carefully.
> I can't believe how you Americans (im australian) take so many different meds at the one time! and still want more!
Slurs about people in other countries are uncalled for.
> yeah life is full of pain and anguish: GET OVER IT!
Those with mood disorder want *normal* pain, not the unmitigated hell of major depression.
> you need to start facing your problems
I am facing them. I'm getting treated by a good doctor.
> instead of dulling out your mind baby..start exercising more,
Already doing it. All that is great but not entirely sufficient. Are you familiar with any of the work documenting the the biological underpinnings of mood disorders? Treatment requires a multi-pronged approach and many people require medication as part of the regimen.
> "But you are probably right that I should give it more thought."
> yes! i think SO.I was referring to trying a specific class of drugs. Again, you seem to me to be so angry that you are not reading attentively.
This board is for discussion of medications and exchange of information. You are providing neither. You are not likely to find sympathetic readers here if you continue this way.Have you experienced a mood disorder? Are you in extreme pain? If there is help that you want from us, state it so we can provide it. Otherwise, please stop being mean to others and respect our efforts to seek appropriate treatment for serious medical conditions.
I think your post is one of the most viscious things ever addressed to me. I will not respond to any more posts from you unless they are offered in a spirit of support.
Emme
Posted by Emme on January 12, 2004, at 9:57:56
In reply to Re: Can you all give me some feedback? » Emme, posted by Ame Sans Vie on January 12, 2004, at 8:19:28
> > Hello All,
>
> Hiya. :-)Hello.
> As far as benzodiazepines are concerned, many people find Xanax to be minimally sedating and more uplifting than most others in this class. You mentioned you already take it though... how does it compare with clonazepam for you?
The Xanax is fine, but I find clonazepam to be a smoother ride. I eased off the clonazepam for a while to just see if I thought it was making me more depressed. I don't think it is. I'm thinking about going back to more regular use of a low dose of clonazepam and see if the sedating effects ease up. I did okay on it for quite a while. But I'll ask my pdoc about the benzos you mention below. She's brought up Ativan but we haven't acted on it yet.
> Some other benzos that may be less zombifying are Ativan (lorazepam), Serax (oxazepam), and Paxipam (halazepam). If you're outside the U.S., Lexotan (bromazepam) may be worth a try.
> If you're just using anxiolytics on an as-needed basis, then maybe you would be better off with phenobarbital (Luminal/Solfoton -- a long-acting [about 12 hours] barbiturate that works well for anxiety and can also increase energy levels). Amobarbital (Amytal), secobarbital (Seconal), amobarbital/secobarbital (Tuinal), and pentobarbital (Nembutal) are also barbiturates and can have a phenobarbital-like effect, but they may be better if you need something shorter-acting. Equanil (meprobamate) or Soma (carisoprodol) are also good options for as-needed use. Equanil is specifically touted as an anti-anxiety medication, while Soma is a muscle-relaxant which partially metabolizes into meprobamate in your system. I've always found Soma to be wonderful at eradicating anxiety and inducing a sort of easy-going, happy-go-lucky feeling. Again though, these drugs are usually only a good idea if they're used intermittently
Good lord! I didn't know there were so many options! Hmmm...maybe some of these might be options in the case of that extra breakthrough or situational anxiety.
> I also felt quite over-stimulated with Lamictal... it felt very Paxil-like, too. I discontinued it the very day I began feeling SSRI-type side effects. The benzos, barbs, meprobamate, and carisoprodol I mentioned above are all possible candidates, I feel, to counterract the Lamictal stimulation. Depakote is another possibility.
Stimulating effects aside, I've been able to tolerate it better than many other things. Thanks for the suggestions for calming agents.
> As for your heart rate, that's something you absolutely should discuss with your doctor. Perhaps a higher dose of atenolol, a switch to another beta-blocker (i.e. propranolol), or the addition of an alpha-adrenergic agonist like clonidine or guanfacine is in order.
My pulse isn't running *dangerously* high, and I don't have palpitations, but I'd certainly like to get it a bit lower. I may try a higher dose of atenolol. I tolerate it well except that I think it makes me feel cold. Is propanolol cardio-selective? I don't know about the other two. I'll look them up.
> Of course you have to exercise extreme caution when administering stimulants to bipolars, but how about trading in the selegiline for a very low dose of methylphenidate (2.5mg prn), magnesium pemoline (56.25mg), or an amphetamine (5mg prn) to see how that fares you?I'll look those up too. It may be that whatever energizing drug I use, it'll have to be on an as-needed basis. I hate symptom-chasing, but...
> I'd probably stick with Seroquel... I may be mistaken, but I believe research shows that Risperdal and Zyprexa are more likely than other antipsychotics to cause diabetes.
That's my thinking too.
> Perhaps... Strattera and Wellbutrin are two meds I forgot earlier that may be useful for treating the benzo zombification. Again though, there is the risk of induction of mania.
Oh yeah. I forgot about the Wellbutrin. Too simulating, especially on top of the Lamictal. I'm not going there again.
> I'd put Topamax on the "should all else fail" list if I were you... the fact that it caused depression once before doesn't really work in its favor.
I was reading those posts a short while ago about topomax helping depression and was starting to wonder...
> That's true -- though, as I mentioned above, Depakote may also be a good MS to reduce stimulation caused by lamotrigine.She's held off pushing for it, but I suppose it's possible that my pdoc might bring it up. I feel nervous about it because I've read about the side effects: weight gain, hair loss... Am I being overly nervous? Maybe most people don't have these problems?
> I haven't heard personally of any cases where Tegretol worked when Trileptal did not, or vice versa -- they're basically the same drug, though Trileptal is safer.
Thanks for putting so much thought in to replying.
Emme
Posted by Emme on January 12, 2004, at 9:59:21
In reply to Re: I'll give it some thought » Emme, posted by Ame Sans Vie on January 12, 2004, at 8:28:07
> Normally I would agree with Scott about going with the Nardil, but it seems that everyone is complaining lately that the new version isn't effective... perhaps Parnate would be better. Fewer side effects as well (usually).
>
> According to an article in the Journal of Clinical Phsychopharmacology (vol. 16, pages 383-388), soy sauce contains 0.941 mg/ml of tyramine, tofu contains 0.80 mg of tyramine per 100 g of tofu, and soy milk contains 0.5 mg tyramine per 250 ml. Of course, the article recommends soy sauce be avoided while taking MAOIs. Tofu and soy milk are fine, but, as they are fermented, tempe, miso, sufu, and natto are probably best avoided.Cool. I adore tofu.
Posted by gardenergirl on January 12, 2004, at 10:27:14
In reply to Re: I'll give it some thought » prozacpuppet, posted by Ame Sans Vie on January 12, 2004, at 7:40:42
Posted by Emme on January 12, 2004, at 10:57:28
In reply to Re: I'll give it some thought » prozacpuppet, posted by Emme on January 12, 2004, at 9:35:59
It occurred to me that I didn't express myself as well as I could have. In an effort to remain consistent with the civility rules, I offer the following changes to my reply to Prozacpuppet.
> I expressed my wish to avoid oversedation. You seem to me to be so angry that you are not reading posts carefully.This may be better written as: I am not sure whether or not you read my post carefully.
> Are you familiar with any of the work documenting the the biological underpinnings of mood disorders?
This might be better written as: We know that there are biological underpinnings for mood disorders.....
> Again, you seem to me to be so angry that you are not reading attentively.
Might be better written as: Perhaps you misread my post.
> You are providing neither. You are not likely to find sympathetic readers here if you continue this way.
I hadn't seen the post further down where PP tries to offer advice about tapering. This might better be written as: This particular post provides neither. Other readers may feel put down if you continue this way.
> Have you experienced a mood disorder? Are you in extreme pain? If there is help that you want from us, state it so we can provide it. Otherwise, please stop being mean to others and respect our efforts to seek appropriate treatment for serious medical conditions.
Might be better written starting as: Are you in a lot of pain? If there is help that you want, please let us know. Otherwise, please respect our efforts.....
> I think your post is one of the most viscious things ever addressed to me.
Might be better written as: Your post makes me feel as though you are hostile towards me.
> Emme
Posted by Dr. Bob on January 12, 2004, at 23:20:56
In reply to I'd like to make edits to my reply to PP, posted by Emme on January 12, 2004, at 10:57:28
Posted by Ame Sans Vie on January 13, 2004, at 6:21:26
In reply to Re: Can you all give me some feedback? » Ame Sans Vie, posted by Emme on January 12, 2004, at 9:57:56
Hi Emme,
> Good lord! I didn't know there were so many options!
Yeah, doctors don't generally like to let people know about the "old-fashioned" anxiolytics. But the fact of the matter is, some people respond well to Zoloft -- in some it causes hostile psychotic episodes. Those same people may respond to an old-fashioned antidepressant (i.e. Nardil or Parnate) and achieve great success with it. So benzodiazepines just may not be completely for you; a barbiturate, carbamate (meprobamate/carisoprodol), or other (chloral hydrate, hydroxyzine pamoate) anxiolytic may just mesh better with your unique brain chemistry.
Side note: Does anyone know if ethchlorvynol (Placidyl) is still on the U.S. market? I've heard conflicting reports...
> Hmmm...maybe some of these might be options in the case of that extra breakthrough or situational anxiety.
That's definitely the idea. Barbs, carbamates, and the other assorted tranquilizers usually don't function very well as tolerance builds over a week or two of daily use. But prn use, even up to five times weekly, will assure that you have that safety blanket when you need it.
Getting a doctor to prescribe one of these "dangerous" drugs is another issue entirely, though. The vast majority of psychiatrists shy away from barb/carbamate anxiolytics entirely, which makes no sense. They'll readily hand out amphetamines and methylphenidate (in my experience, anyway) which are Schedule II controlled substances, along with most narcotics, cocaine, and various others. Short-acting barbiturates are also Schedule II (i.e. Seconal, Amytal, Tuinal, Nembutal, Butisol -- Pentothal [aka "truth serum"] is Schedule III, while Brevital, a general anaesthetic, is Schedule IV due to the fact that it is only available as a powder for injection). Phenobarbital, Equanil, and chloral hydrate are Schedule IV -- the same risk-class as benzodiazepines. Mebaral (mephobarbital, aka methylphenobarbital) is also Schedule IV and may be an even better alternative that I failed to mention in my last post. And carisoprodol is not even federally classified as a controlled substance! Some states have placed it in Schedule IV or V, though.
> My pulse isn't running *dangerously* high, and I don't have palpitations, but I'd certainly like to get it a bit lower. I may try a higher dose of atenolol. I tolerate it well except that I think it makes me feel cold.
Yep, always better safe than sorry. No reason to allow any amount of stress on your cardiovascular system if it can be avoided.
I'd be very careful about raising the atenolol dose -- beta-adrenergic blockers such as atenolol, propranol, pindolol, et al. are notorious for causing extreme depression. And the cold feeling is very common, especially in the hands. Over time, this can actually become permanent -- a disorder known as Raynaud's phenomenon. I had the cold hands on propranolol, and I developed *horrid* depression after two or three days at 60mg/day. Very unpleasant. Even still, slowly increasing the atenolol dosage is probably the way to go, as you're already taking it. Should you run into problems, I very highly recommend using one of the alpha-adrenergic agonists.
> Is propanolol cardio-selective? I don't know about the other two. I'll look them up.As far as I know, none of the antihypertensives are cardio-selective. All beta-blockers antagonize beta-adrenergic receptors in the CNS. Reduced heart rate and blood pressure are *some* effects of beta-adrenergic antagonism, but it's much more widespread than that (as you can tell from the cold feeling, altered mental status, fatigue, etc.).
Clonidine is sold under the brand name Catapres, and guanfacine under the name Tenex. Both are alpha-adrenergic agonists and, like the beta-blockers, have body-wide effects. Another occasionally useful (though rather outdated) antihypertensive is reserpine, which can also provide useful tranquilizing effects.
> > Of course you have to exercise extreme caution when administering stimulants to bipolars, but how about trading in the selegiline for a very low dose of methylphenidate (2.5mg prn), magnesium pemoline (56.25mg), or an amphetamine (5mg prn) to see how that fares you?
>
> I'll look those up too. It may be that whatever energizing drug I use, it'll have to be on an as-needed basis. I hate symptom-chasing, but...Well, the symptoms are the issue, if you ask me. Nothing wrong with taking this pill for this, and that pill for that. :-)
> > That's true -- though, as I mentioned above, Depakote may also be a good MS to reduce stimulation caused by lamotrigine.
>
> She's held off pushing for it, but I suppose it's possible that my pdoc might bring it up. I feel nervous about it because I've read about the side effects: weight gain, hair loss... Am I being overly nervous? Maybe most people don't have these problems?Most people don't experience alopecia due to Depakote, but unfortunately weight gain is an extremely common side effect (it's about on par with Zyprexa in that area). Depakote also causes "brain fog" in many people. I never experienced a single side effect during the six months I took high-dose Depakote, however, and it worked beautifully at keeping my anger and impulsivity in check. So I guess it's a matter of weighing the risks and benefits, but I wouldn't cross it off the list due to concerns which may be unfounded. If we all did that, none of us would be taking any of these meds at all. :-)
> Thanks for putting so much thought in to replying.
No problem whatsoever -- I hope you get something useful out of this. Take care!
Michael
Posted by Ame Sans Vie on January 13, 2004, at 6:32:38
In reply to Well put! [cheers], re prozacpuppet, Ame Sans Vie (nm), posted by gardenergirl on January 12, 2004, at 10:27:14
This is the end of the thread.
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