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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by cpallen79 on July 26, 2004, at 14:37:44
Hello all,
I am thinking of adding an anticonvulsant into my med cocktail. At first I resisted this suggestion from my PDOC as we both beleive that I am not bipolar. However, she says it can really help with agitation and anxiety and don't have physical dependence like benzos. I've looked up a few and found some promising ones. I know that Depakote has a really really heavy side effect profile, but perhaps at nice small dose, it may just what I need to level me off. Another option I was considering was Topamax as it does nto cause weight gain and also stabilizes mood.
There's only one thing that I'm terrified of with medication... Akathisia. I have anxiety and ADHD/ADD problems as it is, and my PDOC tried to put me on a small dose of Seroquel for sleep... it drove me through the roof... and seroquel is supposed to be sedating. Which anticonvulsants are notorious for causing akathisia/agitation(if any of them do). Any insight would be great as to what I should look into and what to watch out for in terms of anxiety/akathisa. Thanks
Posted by linkadge on July 26, 2004, at 15:03:57
In reply to thinking of adding an anticonvulsant- Need help, posted by cpallen79 on July 26, 2004, at 14:37:44
depakote generally does not cause akathesia, it is probably one of the better ones for anxiety.
Linkadge
Posted by cpallen79 on July 26, 2004, at 15:07:43
In reply to Re: thinking of adding an anticonvulsant- Need help, posted by linkadge on July 26, 2004, at 15:03:57
Hi Linkadge,
Have you heard anything about Topamax at all?> depakote generally does not cause akathesia, it is probably one of the better ones for anxiety.
>
> Linkadge
Posted by cpallen79 on July 26, 2004, at 20:31:13
In reply to Re: thinking of adding an anticonvulsant- Need help » linkadge, posted by cpallen79 on July 26, 2004, at 15:07:43
Hello you two... I was thinking about adding in an anticonvulsant to augment my depression/anxiety and OCD. My PDOC suggested it at our last session as an add-on for anxiety/agitation and I told her I'd think about it (she suggested Lamitcal... not crazy abotu with that nasty rash, I'd be so hypervigilant that it's not even funny). I've been doing research and am still thinking about it. It may be a good idea to do a mood stabilizer/anti convulsant as I get really bad tension headaches and I've heard that anticonvulsants are great for this. So far, two that stick out are Topamax and Depakote. Both seem to have very very harsh side effects. What do you guys think? Should I pursue this or hold off? There is only one side effect that I absolutely cannot stand, and that's Akathisia and anxiety. I don't know if these cause this, but given my last experience with just a tiny bit of Seroquel, I'm very reluctant to try anything that may potentially cause this. I'm also scared of gaining a ton of weight from these meds. I'm currently taking Adderal XR 5mgs, Trazedone 50 mgs, and Luvox 100 MGS. What do my esteemed co-posters think?
Posted by chemist on July 26, 2004, at 21:04:23
In reply to chemist or Sad Panda- your thoughts, posted by cpallen79 on July 26, 2004, at 20:31:13
> Hello you two... I was thinking about adding in an anticonvulsant to augment my depression/anxiety and OCD. My PDOC suggested it at our last session as an add-on for anxiety/agitation and I told her I'd think about it (she suggested Lamitcal... not crazy abotu with that nasty rash, I'd be so hypervigilant that it's not even funny). I've been doing research and am still thinking about it. It may be a good idea to do a mood stabilizer/anti convulsant as I get really bad tension headaches and I've heard that anticonvulsants are great for this. So far, two that stick out are Topamax and Depakote. Both seem to have very very harsh side effects. What do you guys think? Should I pursue this or hold off? There is only one side effect that I absolutely cannot stand, and that's Akathisia and anxiety. I don't know if these cause this, but given my last experience with just a tiny bit of Seroquel, I'm very reluctant to try anything that may potentially cause this. I'm also scared of gaining a ton of weight from these meds. I'm currently taking Adderal XR 5mgs, Trazedone 50 mgs, and Luvox 100 MGS. What do my esteemed co-posters think?
hello there, chemist here....i did the topamax routine for a while after trileptal, and found that it was less effective for me. i enjoyed the weight-loss - i didn't need to lose any, truthfully, but you can never be too rich or too thin, and i am not rich - but it did not address the anxiety: valium did. i did have a run with 25 mg seroquel at bedtime for a stint, and did not have any untoward effects; however, others on this board have reported that they are sensitive (as you indicate you are) even to small doses of seroquel. in my opinion, a higher dose of luvox or, for that matter, a lower dose might do the trick. keep in mind that luvox has a very, very wide dosing range and you need to be open to exploring different doses. now, if you are satisfied at 100 mg, fine. i am leary of the anticonvulsants (with the exception of trileptal) as well as the antipsychotics (as you note in your comment about seroquel, you are to). so, back to the anticonvulsants. in that they are being prescribed off-label for mood disorders, i am not sure if you would gain additional relief from anxiety by using them. an indirect lessening of anxiety via mood stabilization is possible, i suspect, and lamictal is what everybody is talking about these days. the punch line: in consult with your doctor, in my opinion, i would play around with the luvox, eliminate the adderall (or take half of it) and see what happens. if the anxiety goes away, you can eliminate the adderall and readjust the luvox. next up is (in my opinion) 0.5 mg klonapin qd. this will do the trick, allow you to keep the adderall, and lessen the trazodone. i hate to keep coming back to benzo/beno derivatives, but in my experience (personal) they do the job. i realize my answer is not as complete as you (or i) would like, but i do not feel that the efficacy of the anticonvulsants/antipsychotics are worth the risk if a low dose of a drug that has been around and in use specifically for anxiety management is available, such as klonopin. let it sit for a while and get some other opinions. sad panda, sls, king vultan, and others tend to lean toward certain TCAs, and know their stuff. remeron might be a suitable alternative for the trazodone, killing two birds with one stone (i.e., addressing sleep and some mood stabilization). give a shout to the others, as you have my take. regardless, please keep us informed. all the best, chemist
Posted by Sad Panda on July 26, 2004, at 22:27:50
In reply to chemist or Sad Panda- your thoughts, posted by cpallen79 on July 26, 2004, at 20:31:13
I'm not an authority on mood stabilizers but Neurontin seems to be the choice when anxiety relief is wanted.
Cheers,
Panda.
Posted by SLS on July 26, 2004, at 22:29:47
In reply to thinking of adding an anticonvulsant- Need help, posted by cpallen79 on July 26, 2004, at 14:37:44
Neurontin might not be the strongest mood stabilizer for bipolar disorder, but it does possess significant anxiolytic properties. It sounds like it would meet your needs nicely. Neurontin is usually a benign drug with few if any side effects.
Good luck.
- Scott
Posted by theo on July 26, 2004, at 23:15:23
In reply to Re: thinking of adding an anticonvulsant- Need help » cpallen79, posted by SLS on July 26, 2004, at 22:29:47
The only problem with Neurontin is the short half life and the fact that every few days you have to up the dose for any results and before you know it your taking 1200mgs 3 times a day.
Just my opinion, I'm on Lamictal now and actually feel the smooth effect of mood stablization without cognitive impairment like Topamax and even Neurontin can cause.
Doctors love to prescribe Neurontin because the manufacturers claim it's a cure all, good for anxiety, migraines, clean your fuel injection system, whatever.
Few people claim it's good and maybe you are one of the lucky few it could help, but I've not heard and personally think Neurontin has a low success rate and has only made the stockholders very happy.
Posted by Emme on July 27, 2004, at 5:50:09
In reply to thinking of adding an anticonvulsant- Need help, posted by cpallen79 on July 26, 2004, at 14:37:44
Scott's got good points about neurontin. I found Neurontin to be very helpful for anxiety. It worked very nicely when my nerves were on edge and raw. It helped tone down noise sensitivity. As Scott said, it's not the strongest MS and probably wouldn't stand alone, but I did lose some mood control when I stopped it.
I was able to adjust the dose up and down depending on whether I was going through a calmer time or a more anxious period. I liked that flexibility. I had very few SEs.
Posted by chemist on July 27, 2004, at 8:27:29
In reply to thinking of adding an anticonvulsant- Need help, posted by cpallen79 on July 26, 2004, at 14:37:44
Posted by cpallen79 on July 27, 2004, at 11:18:35
In reply to i told you they were the experts!... (nm), posted by chemist on July 27, 2004, at 8:27:29
There's been some great info presented to me here, thanks all. It sounds like Neurontin is either a hit or miss with many people... many cliam it does nothing whereas others swear by it!. I've also heard that one requires a drug holiday every now and again as well to make sure it keeps its effectiveness. Topamax interests me because apparently it quiets things down alot, and for a constant worrier with a mind going all the time, it may be just what the doctor ordered, then again, I'm just so scared of having an increase in anxiety. I'll have to do some more digging around to find out about Topamax on the board and on other sites.
Does anyone know what the withdrawals are like on Neurontin and Topamax?
Posted by Emme on July 27, 2004, at 11:31:09
In reply to all this info, where do I start! :), posted by cpallen79 on July 27, 2004, at 11:18:35
> There's been some great info presented to me here, thanks all. It sounds like Neurontin is either a hit or miss with many people... many cliam it does nothing whereas others swear by it!. I've also heard that one requires a drug holiday every now and again as well to make sure it keeps its effectiveness. Topamax interests me because apparently it quiets things down alot, and for a constant worrier with a mind going all the time, it may be just what the doctor ordered, then again, I'm just so scared of having an increase in anxiety. I'll have to do some more digging around to find out about Topamax on the board and on other sites.
> Does anyone know what the withdrawals are like on Neurontin and Topamax?Zero neurontin withdrawal for me personally. Just a moderate taper with no discontinuation symptoms. I don't know if that's true for everyone. I did not need any holidays from it.
This is the end of the thread.
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