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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 capricorn on August 7, 2004, at 5:32:05
Is it possible to come off meds and stay relatively stable to the extent
you never need to start taking them again or will there inevitably be
negative repercussions sooner or later a la 'how long is a piece of
string?' I have been virtually meds non compliant since getting mixed
messages about my dx,severity of illness etc(approx 2 years) and though
things haven't been totally smooth mood wise etc i do not see the
swings as warranting taking meds again.I had been taking mood stabiliser(lithium) on a regular though not 100%
basis before then, ie periodic forgetting to take a dose/not taking dose
when had the flu etc,for 20 years before a switch to tegretol.
When i first took a mood stabiliser i admit it did make a noticable
difference but now i am seriously questioning whether i need to take a
mood stabiliser. Is it possible to get too used to mood levels as a
result of being on a mood stabiliser that you can underestimate the
level of lability(hope that's the right word!)that you are experiencing?
Posted by crazychickuk on August 7, 2004, at 5:36:34
In reply to Meds or not?, posted by capricorn on August 7, 2004, at 5:32:05
whats your dx?
Posted by capricorn on August 7, 2004, at 6:33:21
In reply to Re: Meds or not?, posted by crazychickuk on August 7, 2004, at 5:36:34
> whats your dx?
Therein lies the £64,OOO question. I was originally dxed as sz but sometime later put on lithium and bipolar or schizoaffective was put on blood test forms.In May 2002 sought more help from my local mh team because i was going through stressful period and was told 'government says help is to be prioratised to severely mentally ill' and that wasn't me.I then asked 'Isn't there bipolar or schizoaffective written down there?'' To which got reply 'no only dependent personality disorder'. This got me thinking as to why i had been on a mood stabiliser all those years seeing how treatment for DPD as far as i know is not meds eg mood stabiliser etc.
Some weeks later i had out patient appointment and asked SHO i saw re dx and she said 'All you need to know is it's a psychotic type disorder .'In other words has psychotic component.
On one hand they seem to be saying i don't have much of a problem but on the other hand..
I used to be ok about taking the meds before this but now I'm mixed up about it.
Posted by crazychickuk on August 7, 2004, at 6:41:41
In reply to Re: Meds or not? » crazychickuk, posted by capricorn on August 7, 2004, at 6:33:21
ok my advice to you would be to look up your symptoms mental health symproms, your in the uk right? i am to and mental health service is rediculous.. i am going to be sticking with my doctor from now on (gp) go to your doctors and tell him whats going on after you have reaearched up on what you think you may have and also you should come accross the medications treatment for the dx you have.. hopefully that will do the trick.. also i would advice y ou to complain about the mental health check out nhs direct if you are in the uk, i complained and within a few days i had 2 nurses here..
good luck keep me posted
Posted by linkadge on August 7, 2004, at 9:59:13
In reply to Re: Meds or not?, posted by crazychickuk on August 7, 2004, at 6:41:41
It is not uncommon for symptoms of bipolar disorder to rimit and warrent a medication discontinuation (temporaraly or permanently)
IF you honestly think you do better off meds then by all means don't take them
Linkadge
Posted by woolav on August 7, 2004, at 11:09:35
In reply to Re: Meds or not?, posted by linkadge on August 7, 2004, at 9:59:13
Here's my 2 cents....
We all want to put labels on everything in society. I myself have questioned my pdoc about what i have, whats the real problem. I have been told, yeah, you have social phobia, you may have BP2, you have depression, you have panic disorder...I have decided that no matter what I "have" Its up to me to figure out what makes me feel better. If I take meds that are typically for someone with BP, and i feel good, then who cares. Its totally up to you. If you feel you dont need the medication now, stop. I took zyprexa, depokote, paxil and xanax for 5 years, i eventually got fed up with the side effects (plus a bad doctor) and stopped. Cold Turkey. (i know that's not good) but I did...And i was alright for about 2 years. Then, I realized I needed help with severe depression/anxiety. But I was the one who decided when to stop and when to seek help. Thats just my story..
S
Posted by SLS on August 7, 2004, at 12:03:43
In reply to Meds or not?, posted by capricorn on August 7, 2004, at 5:32:05
I think to help answer your question, you might want to put together a life chart documenting your mental status over your history. This way, you can get a better idea of whether or not you are bipolar and how recurrent your episodes are. This can help you make a decision. How old are you? How old were you when you had your first episode? What makes you bipolar? Is there any history in the family? How often did you get depressed before starting mood stabilizers? You know, it might not be a bad idea to think about using Lamictal if you want to get rid of the lithium for some reason.
You can use the chart used by the NIMH:
http://sl.schofield3.home.att.net/medicine/mood_chart_nimh_r.pdf
You'll need the Adobe Acrobat Reader to open it and print it. If you don't have it, go here:
http://www.adobe.com/products/acrobat/readstep2.html
- Scott
Posted by capricorn on August 7, 2004, at 13:32:52
In reply to Re: Meds or not? » capricorn, posted by SLS on August 7, 2004, at 12:03:43
You know, it might not be a bad idea to think about using Lamictal if you want to get rid of the lithium for some reason.
>
> You can use the chart used by the NIMH:
>
> http://sl.schofield3.home.att.net/medicine/mood_>>;
> - ScottScott,
I am currently prescribed tegretol 800mgs but do not take for reasons previously described also olanzapine 10 mgs. The olanzapine is supposed to help with the irritability,anxiety etc or what i describe sometimwes as ' war zone in my head' but i do not take it very often as i find the side effects difficult to handle ie lethargic come spaced out feeling .Have also been on risperidone and seroquel with same effects.
Years back i was prone to depression on one hand feeling useless/guilty,thoughts slowed/ no energy etc and on the other hand 'I'm so much better/miles ahead of everyone else/ silly and impulsive/excitable just coming out and saying things cos i felt like it, but over time it's developed more into combo of depression,irritability,anxiety/nervous anticipation,feeling useless,feeling guilty,feeling of being wound up inside/like a
tightened coil about to spring lose,difficulty switching thoughts off ie difficulty switching mind off/mind busy but a lot of it much ado about nothing,also bouts of impatience and authoritarian 'Do what i say/listen to what i tell you' and over reacting to things' getting wound up because i think i am being ignored,also find it difficult to handle criticism or prerceived critiicism ie getting emotionally churned up inside about it and over reacting/lashing out verbally.In terms of functioning i get by on a fairly low level ie have only one friend(wife), poor professional/family/other support network(Family wise= brother hiv+/cocaine and marijuana(pardon spelling) addiction/,mother problem drinker/alcoholic ie drunk heavily for over 30 years-verbally abusive with it, often complains she is depressed,sister was bulimic as teenager and has recently been on ADS and receiving therapy for depression,) and have never worked since being first admitted to hospital at 18 (am now47) but think this may be as much to do with social problems/as mood problems.
Family background dysfunctional ie Parents always arguing/verbally adept as a family but not a great deal of being able to talk about things on an emotional level.Mother prone to negative comments especially about my brother and myself ie 'you were an awkward child/teenager etc' 'you 'll never be as good as your father' ' you've never done anything worthwhile with your life ' and a whole lot more in similar vein and worse. Father somewhat distant and 'bury head in the sand' when it comes to emotional issues type.
Posted by SLS on August 7, 2004, at 14:37:02
In reply to Re: Meds or not?, posted by capricorn on August 7, 2004, at 13:32:52
Hi Capricorn.
> Years back i was prone to depression on one hand feeling useless/guilty,thoughts slowed/ no energy etc and on the other hand 'I'm so much better/miles ahead of everyone else/ silly and impulsive/excitable just coming out and saying things cos i felt like it, but over time it's developed more into combo of depression,irritability,anxiety/nervous anticipation,feeling useless,feeling guilty,feeling of being wound up inside/like a tightened coil about to spring lose,difficulty switching thoughts off ie difficulty switching mind off/mind busy but a lot of it much ado about nothing,also bouts of impatience and authoritarian 'Do what i say/listen to what i tell you' and over reacting to things' getting wound up because i think i am being ignored,also find it difficult to handle criticism or prerceived critiicism ie getting emotionally churned up inside about it and over reacting/lashing out verbally.
Your description pretty much sounds like a textbook case of bipolar II with a dysphoric hypomania or mixed-state. It would probably be a good idea to establish a consistent treatment with mood stabilizers. Depakote is usually the one most often chosen for these cases. There are a few newer ones to experiment with, though. (Lamictal, Neurontin, Topamax, Zonegran, Keppra)http://www.mentalhealth.com/dis1/p21-md05.html
Do you think you would be more compliant with taking Lamictal as a mood stabilizer? In most cases, it is a very clean drug. It usually doesn't produce sedation or impair thinking. The major issue with Lamictal is that it must be started at a very low dosage and increased gradually. This is done in order to prevent a reaction that can develop as a rash. Lamictal offers antidepressant properties with very little risk of inducing mania. It is also thought to be helpful in cases of rapid cyclicity. However, it is not usually effective to treat severe mania. Perhaps Lamictal alone would be sufficient for you. It's a trial and error process, of course.
I don't know if Abilify (an antipsychotic) is as effective at handling mania as Zyprexa, but you might find it cleaner and less sedating. I would look at Abilify before Geodon, though, as I believe Geodon is more apt to produce a manic reaction.
I guess my recommendation for you is to come to a reasonably firm conclusion about the identity of your illness and commit to finding an optimized treatment regime for it. I'll be interested to know what you decide.
Good luck.
- Scott
Posted by SLS on August 7, 2004, at 14:45:15
In reply to Re: Meds or not?, posted by capricorn on August 7, 2004, at 13:32:52
Sorry. I guess I really didn't answer your original question.
From your description of your history, I would say that it is likely that you will need indefinite treatment with medication until a better alternative is discovered. You can try to prove to yourself now that you don't need medication, but if you do relapse, you should make a bargain with yourself that at that point, you are to be considered a member of a very elite club (of which I would prefer not to be a member) and pursue an optimized treatment regime.
- Scott
Posted by Racer on August 7, 2004, at 17:38:45
In reply to Re: Meds or not? » capricorn, posted by SLS on August 7, 2004, at 14:45:15
Aside from saying that SLS knows his stuff, and I'd listen carefully to his advice, I just wanted to add one thing to this discussion -- that the diagnosis isn't as important as the treatment outcome.
I've recently been through a Diagnostic Nightmare, which thoroughly demoralized me, and has left me unmedicated for months now. At this point, I don't care if they decide I'm suffering from black spot and feline leukemia -- as long as they prescribe something that will address the depression.
I guess what I want to say is that it's not worth getting tied up in knots about what your Officially Sanctioned Diagnosis is, if the treatment outcome is satisfactory. It sounds as if you're resisting compliance with your meds because of the diagnostic folderol, which isn't worth it. Having been on and off these dang things for years myself, I recommend that you decide one way or the other -- either comply, if the meds are helping and you feel relief from them, or stop them entirely if you are absolutely, positively sure that you don't need them. If you do stop, though, be prepared for a relapse. (Again, been there, done that -- and because of side effect issues, at that.)
If I were in any state to offer advice, though -- and I'm not, so I won't -- it would be to work with your doctor to find a medication routine that works and is as free from adverse effects as possible. That's my goal, at least. It's very unfortunate that these drugs, which can be lifesavers, come with such a high price at times. It does make compliance difficult.
Posted by capricorn on August 8, 2004, at 6:45:31
In reply to Re: Meds or not?, posted by SLS on August 7, 2004, at 14:37:02
> Hi Capricorn.
>
> > Years back i was prone to depression on one hand feeling useless/guilty,thoughts slowed/ no energy etc and on the other hand 'I'm so much better/miles ahead of everyone else/ silly and impulsive/excitable just coming out and saying things cos i felt like it, but over time it's developed more into combo of depression,irritability,anxiety/nervous anticipation,feeling useless,feeling guilty,feeling of being wound up inside/like a tightened coil about to spring lose,difficulty switching thoughts off ie difficulty switching mind off/mind busy but a lot of it much ado about nothing,also bouts of impatience and authoritarian 'Do what i say/listen to what i tell you' and over reacting to things' getting wound up because i think i am being ignored,also find it difficult to handle criticism or prerceived critiicism ie getting emotionally churned up inside about it and over reacting/lashing out verbally.
>
>
> Your description pretty much sounds like a textbook case of bipolar II with a dysphoric hypomania or mixed-state. It would probably be a good idea to establish a consistent treatment with mood stabilizers. Depakote is usually the one most often chosen for these cases. There are a few newer ones to experiment with, though. (Lamictal, Neurontin, Topamax, Zonegran, Keppra)
>
> http://www.mentalhealth.com/dis1/p21-md05.html
>
> Do you think you would be more compliant with taking Lamictal as a mood stabilizer? In most cases, it is a very clean drug. It usually doesn't produce sedation or impair thinking. The major issue with Lamictal is that it must be started at a very low dosage and increased gradually. This is done in order to prevent a reaction that can develop as a rash. Lamictal offers antidepressant properties with very little risk of inducing mania. It is also thought to be helpful in cases of rapid cyclicity. However, it is not usually effective to treat severe mania. Perhaps Lamictal alone would be sufficient for you. It's a trial and error process, of course.
>
> I don't know if Abilify (an antipsychotic) is as effective at handling mania as Zyprexa, but you might find it cleaner and less sedating. I would look at Abilify before Geodon, though, as I believe Geodon is more apt to produce a manic reaction.
>
> I guess my recommendation for you is to come to a reasonably firm conclusion about the identity of your illness and commit to finding an optimized treatment regime for it. I'll be interested to know what you decide.
>
> Good luck.
>
>
> - Scott
Scott,
Have been looking at http://www.mcmanweb.com/article-5.htm and from my knowledge of how i am Group 4 seems to define me best''Group 4 (21.4 percent) had the highest ratings of dysphoria and the lowest of hedonic activation. Corresponding with Kraepelin’s depressive or anxious mania, these patients were marked by prominent depressed mood, anxiety, suicidal ideation, and feelings of guilt, along with high levels of irritability, aggression, psychosis, and paranoid thinking.''
I experience plenty of anxiety and irritability and paranoid thinking(this has grown worse over the years)a modicum of guilt feelings though secondary to the anxiety-irritability-paranoia(sometimes crossing over into what i would describe as a degree of 'homocidal ideation') and bouts of suicidal ideation a la ' i would be better off dead'. Aggression wise i'm prone to verbal aggression which for me is often part of
the over reaction process.I am very much a 'bottler up' ie 'can't say x because it will upset y ' and it all gets contained within the 'pressure cooker' and then when the lid comes of i am reacting out of proportion to the trigger event.Thanks very much for your advice and help.
This is the end of the thread.
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