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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by holymama on January 27, 2004, at 8:06:26
BUT, it works!!!
After getting manic on lexapro, I added trileptal in October to try to stabilize my moods. In general, I've been feeling great -- happy and strong, but once a month I get depressed. Almost like clockwork -- I realized that since taking lexapro in June, I went through a 3-4 day depression every 13th day of the month!!! Now it's spread out to every 5 weeks or so, and this last month the depression has lasted 7 days. I finally got sick of it yesterday as I was being a MONSTER to my 3 kids and husband, and decided to POP AN EXTRA LEXAPRO pill at noon to see if that would snap me out of it. By 8 PM I was back to feeling calm and happy. My husband noticed too. This morning I woke up feeling great too. I need to look through my journal, but I'm sure I've done this once or twice before and I recall it 'snapping me out' or a short depression. Does anyone else have any similar stories?
why would I go through a short depression each month? (my menstrual cycle does not seem to be related)
Why would an extra dose of seatonin snap me out of it?
Could I do the same thing with a dose of fish oil?
Thank you for anyone who has any advice/answers for me!! I don't think my doctor would agree with me doing this, but if it works, he doesn't need to know. :)
Posted by Bill LL on January 27, 2004, at 10:03:01
In reply to I'm probably going against my pdoc's advice..., posted by holymama on January 27, 2004, at 8:06:26
Forget the fish oil. Keep taking the extra Lexapro as needed. Let your doc know the next time you talk to him. I'm pretty sure that he would approve.
I personally take 30mg Lexapro each day.
Posted by Maxime on January 27, 2004, at 10:52:55
In reply to Re: I'm probably going against my pdoc's advice..., posted by Bill LL on January 27, 2004, at 10:03:01
You have determined that your menstrual cycle has nothing to do with it, have you checked the lunar cycle? I'm serious. The moon can do a lot to your mood. I'm bipolar and I go manic before a full moon. I also have a friend who works in an ER and she says there are more psych patients that night than any other.
You say your cycle has nothing to do with it, but are you on the pill? Maybe that has something to do with it.
Good luck to you .
Maxime
Posted by holymama on January 27, 2004, at 11:05:21
In reply to Re: I'm probably going against my pdoc's advice..., posted by Maxime on January 27, 2004, at 10:52:55
The lunar cycle is something that my doctor suggested too. I wish it were that simple. I looked for that connection and it really wasn't it. I think that is rather cool though. Crazy with the full moon!
I am not on the pill. Why do I have to be so complicated? :(
Posted by polarbear206 on January 27, 2004, at 12:37:53
In reply to I'm probably going against my pdoc's advice..., posted by holymama on January 27, 2004, at 8:06:26
It's probably due to fluctuating hormone levels related to your monthly cycle. What have your wake/sleep patterns like. Where are you in your cycle when this occurs? Keep a monthly mood chart so you can track this better. I have the same problem too. I tend to get LOTS of energy mid cycle when estrogen is at it's highest. I have increased my AD prior and during my period. You may be having some soft cycling and not even realize it. I'm BP II and my mood cycling is exacerbated more in the winter with my periods and when the seasons change, esp. when we turn the clocks back and forward.
Posted by holymama on January 27, 2004, at 12:53:34
In reply to Re: I'm probably going against my pdoc's advice..., posted by polarbear206 on January 27, 2004, at 12:37:53
thanks polarbear. I will try to chart my energy levels on a chart and see how/if they corrolate with my period and the lunar cycle. As I said before, I didn't think they corrolated, but it won't hurt to check again.
What is soft cycling? Is it mild cycling between hypomania and mild depression? Because I swear that this is what I do every month, even on an antidepressant and a mood stabilizer.
I wonder if going off the antidepressant would help stabilize me? I am just so sick of managing my moods on a daily basis. I sometimes joke (or maybe it's not a joke) to my husband that I should just go off all of the meds because before I started, at least I was mostly stabilized at depression. I didn't wake up in the morning and wonder where my moods would be!!!
I think that pre meds I had some bipolar tendancys, and they would probably classify as rapid cycling -- my moods were getting to be mainly depressed, with some breaks of hypomania that would last for a few weeks and then crash back into depression. Only when I started an antidepressant did I start to cycle more frequently (once a month) and also reach a mildly psychotic mania. (mildly psychotic??? :) )
Posted by flyingdreams on January 27, 2004, at 14:32:46
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 27, 2004, at 12:53:34
have you tried lithium instead? I've read if you have bi-p you should not take an anti-depressant because it will make you manic and just mess the situation up more. How long have you been on meds? Sometimes the effect wears off and you need to change meds. Getting off the meds isn't a bad idea if you have someone around you to supervise and make sure you are ok. So often bi-polar is misdiagnosed!
Posted by holymama on January 27, 2004, at 15:10:10
In reply to Re: I'm probably going against my pdoc's advice..., posted by flyingdreams on January 27, 2004, at 14:32:46
Hi! Thanks for all of the ideas. I've been on the antidepressant since June and the mood stabilizer for only the last 3 months. I'm still at pretty low doses of both so I have room to increase. I don't get the feeling that it is not working anymore, since it works great for most of the month. But I wonder if I need an increase in either -- sometimes as I've increased the dosage of my mood stabilizer I've felt more 'rooted' -- stronger, like I'm not going to slip either way. I also wonder if there is a better mood stabilizer for me, since trileptal is the first one I've tried. But lithium is off the list of possibilities, since it can destroy the thyroid, and I already have a thyroid problem. Bummer. I wonder if another mood stabilizer that works better for depression might work better. Trileptal is better for mania than depression.
The problem is that my doc is very calm and cautious about changing meds around. I've always liked that about him. He's patient and not apt to switch things all around on me. But I wonder if he would tell me to just put up with the short depressions (he did tell me that when they lasted 3 days a month, but a awhole week a month is different) and try this med longer.
Posted by flyingdreams on January 27, 2004, at 15:34:26
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 27, 2004, at 15:10:10
If YOU are uncomfortable with your drugs, PUSH your doctor to get what YOU want! It's what you want that counts, you are $$$$paying$$$$ him to help you. Get what you want!!!!! You live in your body, you know what you need more than he does!!! And if he doesn't, find another doctor, run don't walk!
Posted by holymama on January 27, 2004, at 15:59:49
In reply to Re: I'm probably going against my pdoc's advice..., posted by flyingdreams on January 27, 2004, at 15:34:26
I usually am confident in his abilities. And I've always liked the fact that he takes things slowly with me, and doesn't let my impulsiveness (oh my God! My medication isn't working!! I might need to try something else!!) run the show.
Does this sound like an incidence when I should be looking into other meds, or maybe tweaking the ones I'm already on? Go off the antidepressant? Or live with the depression and perhaps pop an extra lexapro when I need it??
Thanks all!!
Posted by polarbear206 on January 27, 2004, at 17:35:57
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 27, 2004, at 15:10:10
> Hi! Thanks for all of the ideas. I've been on the antidepressant since June and the mood stabilizer for only the last 3 months. I'm still at pretty low doses of both so I have room to increase. I don't get the feeling that it is not working anymore, since it works great for most of the month. But I wonder if I need an increase in either -- sometimes as I've increased the dosage of my mood stabilizer I've felt more 'rooted' -- stronger, like I'm not going to slip either way. I also wonder if there is a better mood stabilizer for me, since trileptal is the first one I've tried. But lithium is off the list of possibilities, since it can destroy the thyroid, and I already have a thyroid problem. Bummer. I wonder if another mood stabilizer that works better for depression might work better. Trileptal is better for mania than depression.
>
> The problem is that my doc is very calm and cautious about changing meds around. I've always liked that about him. He's patient and not apt to switch things all around on me. But I wonder if he would tell me to just put up with the short depressions (he did tell me that when they lasted 3 days a month, but a awhole week a month is different) and try this med longer.
How much lex and trileptil are you on?? When I have a mixed state, I feel wired and tired at the same time. Soft cycling can show up as changes in energy levels.
Posted by holymama on January 27, 2004, at 22:12:46
In reply to Re: I'm probably going against my pdoc's advice..., posted by polarbear206 on January 27, 2004, at 17:35:57
I'm taking 600 mg trileptal a day and 15 mg lexapro.
My energy level changes have stayed pretty high since starting the trileptal. Not 5 stars like when I was manic, not 1 star like when very depressed. I have been pretty consistently writing 4 stars in my journal through my stable moods, hypomanic and slightly depressed moods lately. No drastic changes. It's my agitation level and mood level that changes drastically for me.
I don't know about mixed states -- this is all pretty new for me, so I'm not sure.
Posted by girl1969 on January 28, 2004, at 4:26:03
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 27, 2004, at 22:12:46
I have BP1 and I tend to cycle rapidly. I have a long history of hypomania and full blown mania, but lots of depression, too.
I started on Lamictal at the end of November. It helped so much with the depressive thoughts and ruminations that I was able to drop my antidepressant (Celexa).
As someone already mentioned, there's a big debate going on in the psychiatric world as to whether or not people with BP should be on an antidepressant for maintenance therapy. It could be contributing to your cycling.
Like you, I feel that my moods have nothing to do with hormones or the lunar cycle. It would be nice if I could track things like that, but it's always just a mystery to me. Until meds, it was like a suprise party every morning. :)
It's good that your doctor is cautious, but you also want to make certain that you are getting the best treatment available. My pdoc is open to new meds, but won't allow me to act impulsively.
Good luck finding the right combination...I know how tiring the process is.
Take care,
Girl
Posted by holymama on January 28, 2004, at 16:12:23
In reply to Re: I'm probably going against my pdoc's advice..., posted by girl1969 on January 28, 2004, at 4:26:03
Dear Girl, you sound a lot like me.
I wonder if the antidepresaant is making me rapid cycle. I never used to rapid cycle like this before antidepreaants. I just to cycle once every few/6 months or so.
I saw my pdoc today! I told him about what I was experiencing and how I took an extra 10mg lexapro and that snapped me out of the depression. He said "It doesn't work like that. It doesn't work that quickly in the bloodstream and the idea is to get a consistent level...blah blah blah..." I said "But what if it does work?" Something along the lines of "But it doesn't work like that". Yet again I said " But what if it does work?"
He looked uncomfortable for a minute and said "I don't usually do this, but I do have one other patient who takes a higher dose of an AD during part of the month, so you could take 20 mg instead of your usual 15 mg when you experience depression"
Yahoo! I didn't back down! When I hear a psychiatrist say "But it doesn't work like that", It makes me question what I experienced ...(was it really the extra dose that helped me? Was it all in my head?). I stood my ground though and he acknowledged that someone else says the same thing. It just proves that I know more about the medication than my doctor does. He doesn't take it-- he just reads about it!!
It still doesn't solve the problem of my rapid cycling every month, but at least I'll be able to deal with the depressions. I will get hypomanic I'm sure, and even more so if I'm increasing the dosage of my lexapro for a few days every month. The hypomania is fun, but I get kind of obsessive and it's a bit of a hardship. So at some point I'm sure I will need to go off the antidepressant, increase my trileptal or try another mood stabilizer (like lamictal -- that's my next choice, especially since it works well for depression, and that was always my main problem pre-meds. How do you like the lamictal, Girl?)
Thanks everyone. :)
Posted by Keith Talent on January 28, 2004, at 18:46:18
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 28, 2004, at 16:12:23
I say stop the escitalopram (Lexapro). Start lithium (a thyroid problem is not an absolute contraindication for lithium treatment) and take it up to a decent concentration. The depression will probably come back with a vengeance. For this, use either a monoamine oxidase inhibitor (MAOI) like tranylcypromine or phenelzine, or a stimulant (e.g. dextroamphetamine, dexmethylphenidate). These classes of drugs are less likely to switch you into mania than others.
Often it will be very hard to see a link between an antidepressant and rapid cycling. You need to focus on the long term, and what I outlined above should help you achieve this. Best of luck.
Posted by sac on January 28, 2004, at 20:44:56
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 28, 2004, at 16:12:23
Sounds like we have the same doctor. I tinker with my prozac dose also when I feel I'm slipping into depression. He, too, says it doesn't work that quickly but I know that it does. Within 2-3 days of a dose increase (20mgs. to 30mgs) I will notice a lifting of the depression. I have developed a hard to treat rapid cycling problem since the birth of my last child three years ago. Trying to stabilize has been hell. I feel very much the same as you do and not knowing where my moods are going to be on a given day . I am trying to work with Lamictal for now. I did try Trileptal recently and was discouraged when I felt more depressed and nervous on it (doctor couldn't understand why). Did you have any trouble when you first tried Trileptal with side effects?
Posted by Girl1969 on January 29, 2004, at 8:09:13
In reply to Re: I'm probably going against my pdoc's advice..., posted by holymama on January 28, 2004, at 16:12:23
Holymama,
I'm glad that you were persistent with your pdoc and worked things out for the dosing. Sometimes, you have to be persistent to get the best care!
I am LOVING the lamictal. When I was working up to a therapeutic level, I was feeling kind of anxious and weird. Once I got to where I needed to be, everything evened out for a while. Last week, I started feeling hypomanic again and only took 200 mg for 2 days. That calmed me right down.
Like you, I find hypomania very thrilling. After a few days, though, the irritability sets in and I don't even want to hear my own voice anymore. I wear myself out running around, talking, and focusing on the most minute details.
At any rate, I am now taking 200 mg of Lamictal and I feel better than I have in months.
Best of luck to you :)
Girl
Posted by holymama on January 29, 2004, at 16:12:10
In reply to Re: I'm probably going against my pdoc's advice... » holymama, posted by sac on January 28, 2004, at 20:44:56
> Sounds like we have the same doctor. I tinker with my prozac dose also when I feel I'm slipping into depression. He, too, says it doesn't work that quickly but I know that it does. Within 2-3 days of a dose increase (20mgs. to 30mgs) I will notice a lifting of the depression. I have developed a hard to treat rapid cycling problem since the birth of my last child three years ago. Trying to stabilize has been hell. I feel very much the same as you do and not knowing where my moods are going to be on a given day . I am trying to work with Lamictal for now. I did try Trileptal recently and was discouraged when I felt more depressed and nervous on it (doctor couldn't understand why). Did you have any trouble when you first tried Trileptal with side effects?
I didn't have any of the same problems on Trileptal, just tiredness and a sedated feeling that have sinve worn off. No increase in depression and anxiety, but I am on an antidepressant also, so that is keeping me from depression most days.Sac, what were you like pre-kids? When were you diagnosed? Prekids I had always had bouts of depression and probably some hypomanic times too, but after having kids the depressions started to last longer, get deeper and be more often. After having kid #3 there was barely any break in the depression -- and when it would break, I would be the opposite -- euphoricly high, obsessive, talkative, excited...then I started feeling suicidal in my last big depression, and that's when I started meds. I'm kind of missing those days when I was at least predictabally depressed for 6 months or so. I think that I must be kidding. That sucked. :)
Posted by holymama on January 29, 2004, at 16:14:47
In reply to Re: I'm probably going against my pdoc's advice..., posted by Girl1969 on January 29, 2004, at 8:09:13
So is it common for mood stabilzer users to adjust their meds themselves according to their mood?
I was under this impression that a mood stabilizer would STABILIZE MY MOOD. Funny. I'm not what I would call stable, but at least more mild in my mood swings.
Posted by sac on February 1, 2004, at 20:35:17
In reply to Re: I'm probably going against my pdoc's advice... » sac, posted by holymama on January 29, 2004, at 16:12:10
I really hear where you are coming from. Pre-kids, I still sufferred from depression but it was relatively easy to treat (Prozac, imipramine, Serzone, paxil, one of these seemed to work find at one time or another). After my first child was born, I was off AD's and I was hypomanic for a year (didn't know it then just felt like superwoman with PMS) then I crashed into a major depression. Started Prozac again and was relatively stable until I became pregnant with baby #2. Went off Prozac and was doing ok with the pregnancy until month 7 when I developed a dysporic mania. I had no firsthand experience with bipolar prior to this but I was extremely frightened. I didn't sleep for 1 week, literally no sleep my mind was racing but I was terribly depressed (AND PREGNANT) My Pdoc started the Prozac (maybe this was a big mistake but because I was pregnant he thought it was the safest route to take). I struggled the remainder of my pregnancy with wild mood swings and pushed the Prozac to 40mgs. After the birth of my second child, I collapsed into a profound post-partum depression/psychosis and was becoming manic with the prozac. That was 3 years ago and I am still trying to find the right med combo to stabilize. My Pdoc and I know now that I am bipolar and need a mood stabilizer but for the longest time I just didn't know what was happening to me. I am going through another depression now and am re-trying lamictal with Prozac. I understand how you feel when you think back on earlier years and dealing with depression seemed relativley straight forward(although still profoundly painful). I am so totally confused by my moods now and am having a hard time with the bipolar dx. Sounds like you have mixed episodes like me which are really distressing especially being with the kids all the time, I don't like them to see me so activated and irritable. I hope I find a combo that works and I wish the best of luck to you. -Stacey
> Sac, what were you like pre-kids? When were you diagnosed? Prekids I had always had bouts of depression and probably some hypomanic times too, but after having kids the depressions started to last longer, get deeper and be more often. After having kid #3 there was barely any break in the depression -- and when it would break, I would be the opposite -- euphoricly high, obsessive, talkative, excited...then I started feeling suicidal in my last big depression, and that's when I started meds. I'm kind of missing those days when I was at least predictabally depressed for 6 months or so. I think that I must be kidding. That sucked. :)
>
Posted by holymama on February 1, 2004, at 20:52:28
In reply to Re: I'm probably going against my pdoc's advice... » holymama, posted by sac on February 1, 2004, at 20:35:17
Hi sac.
Yes, it sounds pretty similar to me. I've only been dealing with meds for about the last 9 months, and although I am not totally stable, I am am feeling much better. I am a HORRIBLE mother when depressed and a useless, out-there mother when hypomanic. It's hard to find the happy middle. :) I feel like a drug addict sometimes, like I need my drugs to preserve this perfectly happy state of mind. But then I remind myself that eithout drugs I am a weepy, suicidal, non-functioning MESS and I am of no use to my children.
I too am struggling with the bipolar diagnosis. I wonder if I am 'bipolar' -- if I should call myslef that, since I am not 100% sure that I was ever manic pre-drugs. I have heard that antidepressants may trigger mania in people who never had it previously and I wonder if I would get manic now if I went off al drugs. I think the antidepressants are a blessing and a curse. Treating the antidepressant's side effects (mania) with another drug (a mood stabilizer). What a mess. But I do feel much better most days.
And when it comes down to it, no matter what I choose to call myself -- bipolar, manic-depressive, depressive, moody, crazy...I need to take a mood stabilizer if I want to take an antidepressant. And I consider my antidepressant a medical necessity. I think without it I could be dead, or in a hospital right now.
Good luck to you. Let me know how the med search goes for you. I hate hearing about a mother struggling the way that I was. :)
Posted by sac on February 3, 2004, at 22:16:36
In reply to Re: I'm probably going against my pdoc's advice... » sac, posted by holymama on February 1, 2004, at 20:52:28
Well it took me (and my pdoc) about 3 years to figure out what the heck is wrong with me. I simply cannot be on an anti-depressant without a mood stabilizer or I will just continuously cycle between hypomania and severe depression. My Pdoc has not officially diagnosed me as BPII but from what I know about it, all the signs are there. I'm back to trying the Lamictal again, I will slowly increase to about 200mgs. It's definately on the activating side as far as Mood stabilizers go but so far has been the one that I feel most like myself (whatever that is) on. Ideally, if I ever got really stable on the Lamictal, I would want to start tapering the Prozac because I know that in the long run it probably adds to my cycling problem. I'll keep you posted on the progress with Lamictal. Take care.
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