Psycho-Babble Medication Thread 406776

Shown: posts 1 to 10 of 10. This is the beginning of the thread.

 

Mitch: Dysphoric Mania vs Anxiety

Posted by smith562 on October 24, 2004, at 20:03:26

Hey Mitch,

Still having great luck using sleep as indicator of my mild hypomanias. If I can't sleep, then increase the lithium from 450 to 600. Sleep too much, decrease lithium to 300.

Sometime when my mind is racing and I am anxious ... I am not sure if I am experience mild panic/anxiety or mild dysphoric hypomania. Mitch, do you know a good way to differientate between the two? (I have been trying to use my resting heart rate ... if above 90 beat/minute, I think it is more anxiety and I take an extra .25 of klonopin ... if below 90, then increase lithium). Thanks.

Smith

 

Re: Mitch: Dysphoric Mania vs Anxiety » smith562

Posted by Ritch on October 25, 2004, at 9:58:32

In reply to Mitch: Dysphoric Mania vs Anxiety, posted by smith562 on October 24, 2004, at 20:03:26

> Hey Mitch,
>
> Still having great luck using sleep as indicator of my mild hypomanias. If I can't sleep, then increase the lithium from 450 to 600. Sleep too much, decrease lithium to 300.
>
> Sometime when my mind is racing and I am anxious ... I am not sure if I am experience mild panic/anxiety or mild dysphoric hypomania. Mitch, do you know a good way to differientate between the two? (I have been trying to use my resting heart rate ... if above 90 beat/minute, I think it is more anxiety and I take an extra .25 of klonopin ... if below 90, then increase lithium). Thanks.
>
> Smith

Panic anxiety vs. dysphoric hypomania that's the question. I guess it depends on whether you have a true co-existing anxiety disorder, or if it is just bipolar presenting itself differently. I was on a TCA and lithium when I started meds, then went off the TCA because of excess sedation and I started having panic attacks later. My doc thought it was just bipolar and increased my lithium and it didn't help, so that would tend to lead one to see it as two different disorders. Now I'm taking Depakote instead of lithium and increasing the Depakote when I get panicky *does* help. In fact, it helps better than increasing a benzo (I don't feel more depressed). I think the *type* of bipolar I experience may have something to do with that.

 

Re: Mitch: Dysphoric Mania vs Anxiety » Ritch

Posted by smith562 on October 26, 2004, at 15:14:56

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » smith562, posted by Ritch on October 25, 2004, at 9:58:32

Sorting that panic versus hypomania gets complicated (and I have to remember alot of my emotions are *normal* too ... not everything I feel is a *disorder*). I know I have a true panic/anxiety component to my mood disorder. The dysphoria/bp III is the more questionable diagnosis (I have had to suggest it to all of my pdocs except one young pdoc who said bp II one the first visit). I probably was hypo on nardil and maybe zoloft and my father and grandfather *are* bipolar II's (although my mother is unipolar with panic).

Do you think alittle depakote instead of lithium would be in order? (I too have a strange reaction to neurontin ... great for anxiety, but I basically feel drunk ... very disinhibited!). I also need something for motivation that won't leave me anxious ... ritalin, wellbutrin, desipramine all get me panicky.

Mitch, you are lifesaver .. (not the "candy type")

Smith

> Panic anxiety vs. dysphoric hypomania that's the question. I guess it depends on whether you have a true co-existing anxiety disorder, or if it is just bipolar presenting itself differently. I was on a TCA and lithium when I started meds, then went off the TCA because of excess sedation and I started having panic attacks later. My doc thought it was just bipolar and increased my lithium and it didn't help, so that would tend to lead one to see it as two different disorders. Now I'm taking Depakote instead of lithium and increasing the Depakote when I get panicky *does* help. In fact, it helps better than increasing a benzo (I don't feel more depressed). I think the *type* of bipolar I experience may have something to do with that.

 

Re: Mitch: Dysphoric Mania vs Anxiety » smith562

Posted by Ritch on October 27, 2004, at 10:22:18

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » Ritch, posted by smith562 on October 26, 2004, at 15:14:56

..thanks. Lithium has the edge for treating depression and is a bit better also for mild psychotic symptoms. Depakote tends to work better for rapid cyclers and mixed states. I guess it depends on how much you think lithium is helping and how well you are tolerating it. If I could tolerate it (Li) I would try to take it with my Depakote and forget antidepressants altogether (since they create as many problems for me as they seem to solve). I would suggest adding Depakote to the lithium first to see how you get along with it before tapering or stopping the lithium. There are side effects with everything-you might not like the sfx of Depakote at all and find the lithium sfx quite tolerable. Hope this helps.

 

Oh one more thing... » smith562

Posted by Ritch on October 27, 2004, at 13:36:43

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » Ritch, posted by smith562 on October 26, 2004, at 15:14:56

... you don't want to mix Depakote and Lamictal together without the close supervision of a really good doctor that you trust. The combo can cause some nasty side effects, levels of drugs fluctuating wildly, lamictal rash, etc. Just thought I would let you know that..

 

Re: Mitch: Dysphoric Mania vs Anxiety » Ritch

Posted by smith562 on October 29, 2004, at 9:36:00

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » smith562, posted by Ritch on October 27, 2004, at 10:22:18

Well, before I found out bipolar and depression were spectrum illnesses, I thought I would put to rest whether I was bipolar or not by dropping all ads and jack up the lithium. I was stable, but still depressed. I do seem to do better with 450mgs of lithium with any antidepressant. I stopped lamictal, really wasn't helping much so I am down to lithium 450mgs, klonopin 1mg, zoloft 100mgs.

I think I would like to try a little depakote instead of the lithium and hopefully to take down the klonopin. To much klonopin makes me forgetful and a little disinhibited ... but without it I am short of breath, heart racing, panicing.

Wish me luck ... thanks Mitch!

Smith

 

Re: Mitch: Dysphoric Mania vs Anxiety » smith562

Posted by Ritch on October 29, 2004, at 10:28:39

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » Ritch, posted by smith562 on October 29, 2004, at 9:36:00

> Well, before I found out bipolar and depression were spectrum illnesses, I thought I would put to rest whether I was bipolar or not by dropping all ads and jack up the lithium. I was stable, but still depressed. I do seem to do better with 450mgs of lithium with any antidepressant. I stopped lamictal, really wasn't helping much so I am down to lithium 450mgs, klonopin 1mg, zoloft 100mgs.
>
> I think I would like to try a little depakote instead of the lithium and hopefully to take down the klonopin. To much klonopin makes me forgetful and a little disinhibited ... but without it I am short of breath, heart racing, panicing.
>
> Wish me luck ... thanks Mitch!
>
> Smith

I would like to ditch clonazepam too at some point, but anytime I reduce it I either get anger issues or get very panicky. Would rather find alternatives first, then consider dropping it. Fortunately, I am not taking much to get off of. Depakote unfortunately doesn't address depression worth a hoot. If you can tolerate the lithium you might be better off on it instead. I certainly slept better on it and had more energy during the day than being on Depakote. 450mg of Li was the 'magic' dose for me as well, when I was taking it. More made me too foggy headed, less didn't seem to work well enough. Just a thought, but maybe it would best to just add 125mg of depakote to your current mix and see how it affects you. If you get all flattened out and feel somewhat more depressed, then maybe it's not the best one... if you feel your anxiety going down and feel more relaxed, then maybe consider some form of cross-taper? Good luck!

 

Re: Mitch: Dysphoric Mania vs Anxiety » Ritch

Posted by smith562 on October 29, 2004, at 12:54:13

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » smith562, posted by Ritch on October 29, 2004, at 10:28:39

That is what I was thinking. I have picked up the 250mg depakote tabs and try a half this weekend. Hey Mitch, I really appreciate your help .... your posts always so informative and helpful. Thanks a million!

Your Friend,

Smith

 

Don't crack the tabs because... » smith562

Posted by Ritch on October 29, 2004, at 13:10:40

In reply to Re: Mitch: Dysphoric Mania vs Anxiety » Ritch, posted by smith562 on October 29, 2004, at 12:54:13

> That is what I was thinking. I have picked up the 250mg depakote tabs and try a half this weekend. Hey Mitch, I really appreciate your help .... your posts always so informative and helpful. Thanks a million!
>
> Your Friend,
>
> Smith

You'd be better off to take the whole tab... if you crack it in half you'll defeat the enteric coating and you could get nausea and GI upset from that. My pdoc in the past has mentioned taking 250mg every other day as an option instead of going down to 125mg tabs (during winter depressions). I've never tried that though, so I don't know how that would work. Just thought I'd let you know about that enteric coating thing. It might not be that big of a deal at that low of a dose-it would be similar to taking Depakene instead. good luck!

 

Re: Don't crack the tabs because... » Ritch

Posted by smith562 on October 31, 2004, at 22:54:43

In reply to Don't crack the tabs because... » smith562, posted by Ritch on October 29, 2004, at 13:10:40

Hey Mitch,

Have you ever tried to get rid of the klonopin all together and just increase the depakote to cover the panic?

Smith

I tried 125 of depakote last night ... pretty apathetic and flat


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