![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by catmint on January 29, 2005, at 7:22:15
I can't seem to avoid the number one trigger for mania-lack of sleep. I've always had insomnia; it sucks. I'ts 4 in the morning right now.
I'm trying to come off Lamictal. I feel like I'm really not well.Lamictal has helped with my depression. I'm just having too many side effects, even 2 years later.
When I'm manic, or rather hypo-manic, I have really bizarre thoughts, I feel other people's energy too much, I scowl and glare at people who look at me wierd. I suppose I'm more in a mixed state when that happens. I have such a heightened perception of my environment that I sometimes feel like I'm tripping on acid.
I also get really sexually charged up, but unsuccessfully so, I am tripping about the whole experience; I lose track of my body, my mind won't cooperate. I won't let myself go because I'm afraid.
I hold back the mania as much as I can and I get really pent up. I'm causing a lot of problems in my relationship.
If I could only get on the right med. I've tried every damn one for bipolar disorder.
Thanks for reading,
Amy
Posted by alienatari on January 29, 2005, at 8:12:43
In reply to I hate being manic, posted by catmint on January 29, 2005, at 7:22:15
I really hate being manic too, it does suck.
I really hope you get some releif soon for your mania and insomnia. I hope you find the right med(s)Take care
Chris.
Posted by HappyGirl on January 29, 2005, at 10:21:36
In reply to I hate being manic, posted by catmint on January 29, 2005, at 7:22:15
Hi Amy:
I truly understand your frustration NOT able to function because of Bipolar Disorder. Only I can think of is that you may need MORE potent med., like Zyprexa. Normally, at the beginning of dx with Bp, most of pdos. does not rx any of A.P.s even they seem to know you NEED one. In my guess, ... probably they want to keep you on traditional M.S., such as yours, the Lamictal. However, like any other Bper's including me, most of Bp symptoms progress within first one to two years. Or, simply there are some changes in your brain-chemical AFTER an introduction of those 'foreign' components in your system. Therefore, there needs to be some 'overhaul' on your med. regimen including detailed dx on your Bp symptoms,... in other word, 'how serious/degree your Bp'is to be classified. For instance, my Bp seemed to be 'milder' form in the beginning after prolonged depressive episode, ... however as the time went by along with the Depakote(first line of M.S. med. for me), my Bp started(?) developed to the point where I needed more potent med., Zyprexa for both 'manic' and 'ultra-rapid-cycler.'Besides this above, ... if you have REALLY 'mixed state that has both 'manic' and 'depressive' episodes concurrently, you CERTAINLY need med. mix., NOT mono-therapy/Lamictal you've been on. In my case, I have four different meds., Zyprexa 5 mg., Lithium 900 mg., two different classes of Anti-depressants that FINALLY made my Bp stabilized, not perfect, but around 85 - 90% range. Some saying this, at 90% point is MAXIMUM for Bpers to reach. Thus, I've been doing some 'life-change' to adjust my Bp since the Bp does NOT adjust 'me' (laugh).
In my suggestion, try to talk with your pdoc. at your next appt. or make an appt. ASAP., before the things become out of control.
Good luck on med. search!!!
H.G.
Posted by Phillipa on January 29, 2005, at 17:22:36
In reply to Re: I hate being manic/Catmint,, 'Amy', posted by HappyGirl on January 29, 2005, at 10:21:36
I could use a little "mania" about now. Phillipa
Posted by Ron Hill on January 29, 2005, at 18:00:38
In reply to I hate being manic, posted by catmint on January 29, 2005, at 7:22:15
Amy,
I'm on the road and I've noticed your message while I'm using the computer at the hotel. I felt compelled to write to you (despite the fact that I'm not supposed to be posting 'til February).
I want to briefly talk to you again about Trileptal. The two things that I love about Trileptal are:
1) It gives me GREAT sleep!!
2) It takes away my hypomania quickly and thoroughly.
If I had a med that would treat the atypical depressive side of my BP II as well as Trileptal treats the hypomanic side, I'd be as good as new!
I remember that you tried Trileptal briefly a couple of years ago (before starting your Lamictal), but I don't recall the details of your response to the med. And to make matters worse, I don't fully remember what you told me recently about your Trileptal trial.
As an aside, Dr Bob has done great things with this site, and many patients (such as myself) have been greatly helped because of the untold number of hours (and dollars) that he has put into this endeavor. IMHO, another great addition to this site would be a board containing a brief blog from each willing participant. Each blog would contain a brief summary of participant's dx (dx’s), the meds tried, and the participant’s response to each of the med trials. Then when I forget the dx and/or med history of a poster, I could simply click on his or her blog.
Back to Trileptal. I've been taking it for about nine months. I asked my pdoc for it primarily because Dr Jim Phelps thinks very highly of the med for BP II patients like you and me. I'm sure you've seen his web site. Here is the page from his site that discusses moodstabilizers:
http://www.psycheducation.org/depression/meds/moodstabilizers.htm
Be well my friend!
-- Ron
---------------------------> I can't seem to avoid the number one trigger for mania-lack of sleep. I've always had insomnia; it sucks. I'ts 4 in the morning right now.
> I'm trying to come off Lamictal. I feel like I'm really not well.
>
> Lamictal has helped with my depression. I'm just having too many side effects, even 2 years later.
>
> When I'm manic, or rather hypo-manic, I have really bizarre thoughts, I feel other people's energy too much, I scowl and glare at people who look at me wierd. I suppose I'm more in a mixed state when that happens. I have such a heightened perception of my environment that I sometimes feel like I'm tripping on acid.
>
> I also get really sexually charged up, but unsuccessfully so, I am tripping about the whole experience; I lose track of my body, my mind won't cooperate. I won't let myself go because I'm afraid.
>
> I hold back the mania as much as I can and I get really pent up. I'm causing a lot of problems in my relationship.
>
> If I could only get on the right med. I've tried every damn one for bipolar disorder.
>
> Thanks for reading,
>
> Amy
Posted by Ron Hill on January 30, 2005, at 15:27:48
In reply to I hate being manic, posted by catmint on January 29, 2005, at 7:22:15
Amy,
I did not specifically say it in my post yesterday, but I'd suggest adding Trileptal to your current Lamictal (100 mg/day?) as opposed to using Trileptal by itself. As I've mentioned to you before, Lamictal and Trileptal play well with each other in the liver (i.e.; they don't adversely affect each other).
Are the side effects from the Lamictal still bothersome at 100 mg/day? You are still at 100 mg/day, correct? What are the specific side effects that are bothersome?
-- Ron
BP II and OCPD
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal (level limited by rash)
5 or 10 mg Adderall XR prn to pull out of an atypical depressive episode; use rarely and only for one day per episode (more frequently causes "pstim burnout" symptoms)
------------------------> I can't seem to avoid the number one trigger for mania-lack of sleep. I've always had insomnia; it sucks. I'ts 4 in the morning right now.
> I'm trying to come off Lamictal. I feel like I'm really not well.
>
> Lamictal has helped with my depression. I'm just having too many side effects, even 2 years later.
>
> When I'm manic, or rather hypo-manic, I have really bizarre thoughts, I feel other people's energy too much, I scowl and glare at people who look at me wierd. I suppose I'm more in a mixed state when that happens. I have such a heightened perception of my environment that I sometimes feel like I'm tripping on acid.
>
> I also get really sexually charged up, but unsuccessfully so, I am tripping about the whole experience; I lose track of my body, my mind won't cooperate. I won't let myself go because I'm afraid.
>
> I hold back the mania as much as I can and I get really pent up. I'm causing a lot of problems in my relationship.
>
> If I could only get on the right med. I've tried every damn one for bipolar disorder.
>
> Thanks for reading,
>
> Amy
Posted by catmint on January 30, 2005, at 23:50:50
In reply to Re: I hate being manic/Catmint,, 'Amy', posted by Phillipa on January 29, 2005, at 17:22:36
Hi,
You mustn't forget what inevitably follows the mania. That's why I hate it.
Amy
Posted by catmint on January 31, 2005, at 0:57:18
In reply to Re: Trileptal: Great sleep, no hypomania » catmint, posted by Ron Hill on January 29, 2005, at 18:00:38
Hi Ron,
It makes me smile whenever you post lately. You only have one or two more days, and you can't resist!
I have been feeling better since I dropped from 200 to 100 mg. Lamictal. I see my pdoc tomorrow and will discuss three options with her (in order of my preference):
1)Decrease Lamictal to 75mg. Use melatonin at night.
3)Add Depakote, decrease Lamictal to 25-50 mg.(doesn't Depakote increase levels of Lamictal)?
3)Add Trileptal (not sure about where to keep Lam.)
Ron, I tried Tripetal a couple years ago. It didn't do much for me although I probably didn't give it enought time because it upset my stomach considerably. Maybe I'll give it another go. I'm intrigued by it's ability to promote a good nights sleep. I can only remember one good nights sleep in the past 3 months.
Depakote is A #1 for my irritablity which is one of my main symptoms. I not thrilled about weight gain or PCOS (polycystic ovarian syndrome), not to mention worsening depression and not able to get my *ss out of bed in the morning! Do you have trouble rising in the morning on Trileptal?
I gave Lithium a trial this summer and had the driest, bad taste in my mouth and constipation. I felt pretty slammed on it. I gave it 2 weeks. I was taking a low dose of Lithobid I believe. I was still irritable and wouldn't increase the dose.
You asked what my symptoms are. I am primarily BPII now but when I was younger I had a couple full blown manic episodes. My doctor has also diagnosed me as dysphoric and I supposedly have a personality disorder NOS (whatever).
The mixed state and manic sypmtoms that are marked with a * are what I have constantly and have only responded to Depakote. The depressive sypmtoms have responded to Lamictal, although only in the beginning of treatment and maybe half the time now.
I was on Depakote before Lamictal three years ago and until now had never considered combining the two.
Mixed state symptoms:
*Agitation
*Irritablity
Pressured speech
*Hypersensitivity
*Racing thoughts
*Insomnia
Paranoia
Rage (suppressed, because ya know I'm a sweet girl really).Manic symptoms:
*Increased awareness
Active and obssessed
Agitation
*Heightened perception
Delusions
Auditory hallucinations (very rarely, once every 3 months).
*Thought disorder
Inappropriate behaviour
Poor judgemnentDepressive sypmtoms:
*Anger
*Despair
Hopeless
Suicidal ideation
*Crying spells
Severe agitation
*Increased appetite
*Insomnia
Sleep all the time
*Sad
Substance abuseThanks for your support Ron.
Amy
Posted by catmint on January 31, 2005, at 0:58:31
In reply to Re: I hate being manic, posted by alienatari on January 29, 2005, at 8:12:43
Thanks Chris.
Posted by catmint on January 31, 2005, at 1:11:39
In reply to Re: I hate being manic/Catmint,, 'Amy', posted by HappyGirl on January 29, 2005, at 10:21:36
Hi H.G.
Thanks a lot for your post.
Is it possible that the Lamictal monotherapy has made my illness worse?
I tried Zyprexa and was pretty slammed on it. I didn't like it. I felt llke a zombie and my appetite was huge.
I like your insight, please, give us more!
Amy
Posted by HappyGirl on January 31, 2005, at 8:48:13
In reply to Re: I hate being manic » HappyGirl, posted by catmint on January 31, 2005, at 1:11:39
Hi Amy:
I, too had a 'bad' experience due to 'mono-therapy'/Depakote ONLY, then I totally understand your view on this, 'one mood-stabilizer' alone.In regard to 'Zyprexa,' I have NO problem as to 'weight' issue. Just I started to crave 'sweetend' drinks, but there is NO big deal, because I seem to be basically 'thin' metabolism except my toddler-ages.
In my opinion, ... probably 'Risperdal' that is close to the Zyprexa and NO weight gain for majority of its takers. As far as I know, Risperdal is more potent A.P. than Zyprexa as to 'efficacy.' Then, probably you may get a benefit from taking a small-dosage Risperdal. However, I have no good clue whether Risperdal and Lamictal(seem you are successful on the depressive sides, then better to stay on?).
Lastly, .... in my personal view on Bipolar, it's VERY tough to challenge even on the right med. combo. because it takes awhile for your system to adjust but in the long run it's well worth. Beside this, Anxiety, some OCD and few more are all due to Bipolar. Then, once Bipolar getting under the control, all of those symptoms subside, at least 'lessen' symptoms eventually.
H.G.
Posted by Ron Hill on February 8, 2005, at 23:47:37
In reply to Re: Trileptal: Great sleep, no hypomania, posted by catmint on January 31, 2005, at 0:57:18
Amy,
Sorry to take so long to get back to you. I just returned home.
> It makes me smile whenever you post lately. You only have one or two more days, and you can't resist!I like it when you smile!
> I have been feeling better since I dropped from 200 to 100 mg. Lamictal. I see my pdoc tomorrow and will discuss three options with her (in order of my preference):
>
> 1)Decrease Lamictal to 75mg. Use melatonin at night.You know that melatonin can cause depression, right? The usual dosage of off-the-shelf melatonin is much too high. When I used to take melatonin, I took about 1 mg/night of the Source Natural's sublingual product. But even at this dose level, I could only take it ocassionally or else it would cause depression. Amy, if you decide to take melatonin, please talk to Larry Hoover. The topic best fits on the PB-ALT board, so you could flag him down over there.
> 3)Add Depakote, decrease Lamictal to 25-50 mg.(doesn't Depakote increase levels of Lamictal)?Yes, here is a link to the Lamictal prescribing information. The interaction of Depakote with Lamictal is detailed in the document. Also, the interaction of many of the other AED's with Lamictal are also discussed:
http://us.gsk.com/products/assets/us_lamictal.pdf
> 3)Add Trileptal (not sure about where to keep Lam.)According to the document linked above, Trileptal and Lamictal do not interfer with each other. If it were me, I'd probably keep the current 100 mg/day of Lamictal on board and add Trileptal. Further, I'd ramp up the Trileptal slowly at first to minimize any side effects. You'd have to play it by ear to determine how high to go. Typical Trileptal dosages for BP II patients are around 1800 mg/day. YMMV.
What did your pdoc say? Which option?
> Ron, I tried Tripetal a couple years ago. It didn't do much for me although I probably didn't give it enought time because it upset my stomach considerably.
Have you ever tried ginger to treat the nausa? I buy crystallized ginger in the bulk foods section of a local grocery store. The crystallized form tastes GREAT and just a small piece takes away the Trileptal induced nausa. YMMV. It costs about seven bucks a pound, but it works for me.
> Maybe I'll give it another go. I'm intrigued by it's ability to promote a good nights sleep. I can only remember one good nights sleep in the past 3 months.
I can't overstate how much Trileptal benefits my sleep. I go to sleep quickly (i.e.; within minutes), I sleep soundly, and I wake up feeling refreshed (unless I've cycled into a depressive phase, in which case, I don't want to get up).
The other thing that greatly helps my sleep is magnesium. Have you ever tried it? I take 600 mg (measured as elemental magnesium) at bedtime. There are many good chelates to choose from. I usually take magnesium malate, but that's just me. If you take too much magnesium, it will cause diarrhea. Magnesium and Trileptal are the key elements in my magic sleep potion.
> Depakote is A #1 for my irritablity which is one of my main symptoms. I not thrilled about weight gain or PCOS (polycystic ovarian syndrome), not to mention worsening depression and not able to get my *ss out of bed in the morning! Do you have trouble rising in the morning on Trileptal?
So long as I'm not depressed, I jump right out of bed. On Depakote, I gained weight, lost hair, became depressed, and it caused other problems that I don't remember right off.
> I gave Lithium a trial this summer and had the driest, bad taste in my mouth and constipation. I felt pretty slammed on it. I gave it 2 weeks. I was taking a low dose of Lithobid I believe. I was still irritable and wouldn't increase the dose.
>
> You asked what my symptoms are. I am primarily BPII now but when I was younger I had a couple full blown manic episodes. My doctor has also diagnosed me as dysphoric and I supposedly have a personality disorder NOS (whatever).
>
> The mixed state and manic sypmtoms that are marked with a * are what I have constantly and have only responded to Depakote. The depressive sypmtoms have responded to Lamictal, although only in the beginning of treatment and maybe half the time now.
>
> I was on Depakote before Lamictal three years ago and until now had never considered combining the two.
>
> Mixed state symptoms:
> *Agitation
> *Irritablity
> Pressured speech
> *Hypersensitivity
> *Racing thoughts
> *Insomnia
> Paranoia
> Rage (suppressed, because ya know I'm a sweet girl really).Yes, I know you are, Sweetie.
> Manic symptoms:
> *Increased awareness
> Active and obssessed
> Agitation
> *Heightened perception
> Delusions
> Auditory hallucinations (very rarely, once every 3 months).
> *Thought disorder
> Inappropriate behaviour
> Poor judgemnentAmy, have you every tried a low dose of an antipsychotic? If so, what were your results? I'm not necessarily advocating an AP, just curious if you've ever tried one.
> Depressive sypmtoms:
> *Anger
> *Despair
> Hopeless
> Suicidal ideation
> *Crying spells
> Severe agitation
> *Increased appetite
> *Insomnia
> Sleep all the time
> *Sad
> Substance abuseAt my current Trileptal dosage (see below) in conjunction with my other mood stabilizers, my anger and irritability have virtually disappeared. My wife is particularly happy about this and she hopes that it lasts.
As I mentioned previously, if I could only figure out a solution to my periodic bouts of atypical depression, I'd be good to go. Currently, I'm able to chase away the depression demons (when they show up once every week-and-a-half or so) with a very low one-day dose (5 or 10 mg) of Adderall XR. However, I have a hunch that this pstim approach will stop working at some point. So I'm thinking about Selegiline or Parnate, but time will tell.
> Thanks for your support Ron.
You bet! I really want you to get better and have a good life. Nobody benefits when you are "Grumpy Girl".
-- RonBP II and OCPD
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal (level limited by rash)
5 or 10 mg Adderall XR prn to pull out of an atypical depressive episode; use rarely and only for one day per episode (more frequently causes "pstim burnout" symptoms)
Posted by catmint on February 9, 2005, at 0:48:54
In reply to Re: Trileptal: Great sleep, no hypomania » catmint, posted by Ron Hill on February 8, 2005, at 23:47:37
> > Hey Ron!
I have decided to go on 250 mg. of Depakote. I started 4 days ago. I am sleeping so well. My pdoc thinks I might only need it for a month or so to get me out of this mixed state. I'm not sure what her rationale is; I will stay on it as long as I am benefitting from it. Maybe she is afraid I will get depressed on it, as I did in the past.
> >
> You know that melatonin can cause depression, right? The usual dosage of off-the-shelf melatonin is much too high. When I used to take melatonin, I took about 1 mg/night of the Source Natural's sublingual product. But even at this dose level, I could only take it ocassionally or else it would cause depression. Amy, if you decide to take melatonin, please talk to Larry Hoover. The topic best fits on the PB-ALT board, so you could flag him down over there.> I talked to her about that and she said most people with insomnia need something stronger.
> The interaction of Depakote with Lamictal is detailed in the document. Also, the interaction of many of the other AED's with Lamictal are also discussed:
>
> http://us.gsk.com/products/assets/us_lamictal.pdf>Thank you
> I can't overstate how much Trileptal benefits my sleep. I go to sleep quickly (i.e.; within minutes), I sleep soundly, and I wake up feeling refreshed (unless I've cycled into a depressive phase, in which case, I don't want to get up).> That's wonderful. I'm happy for you.
> The other thing that greatly helps my sleep is magnesium. Have you ever tried it? I take 600 mg (measured as elemental magnesium) at bedtime. There are many good chelates to choose from. I usually take magnesium malate, but that's just me. If you take too much magnesium, it will cause diarrhea. Magnesium and Trileptal are the key elements in my magic sleep potion.
I do take a Magnesium supplement at night. I have the Source Naturals one, malate I think.
>> >
> Amy, have you every tried a low dose of an antipsychotic? If so, what were your results? I'm not necessarily advocating an AP, just curious if you've ever tried one.I have tried Zyprexa and felt like a truck hit me.
>
> At my current Trileptal dosage (see below) in conjunction with my other mood stabilizers, my anger and irritability have virtually disappeared. My wife is particularly happy about this and she hopes that it lasts.
>That's so good to hear. I hope my relationships with my boyfriend and my son will improve once my anger and irritabiliy are resolved.
> As I mentioned previously, if I could only figure out a solution to my periodic bouts of atypical depression, I'd be good to go. Currently, I'm able to chase away the depression demons (when they show up once every week-and-a-half or so) with a very low one-day dose (5 or 10 mg) of Adderall XR. However, I have a hunch that this pstim approach will stop working at some point. So I'm thinking about Selegiline or Parnate, but time will tell.By atypical do you mean increased appetite, and fatigue?
>
It's nice to have all of you here who understand that my anger and irritablity are part of my illness and not a character defect.
Ron, I am happy to hear that you are doing so well, despite the bouts of atypical depression. Get back to me on your symptoms. I'm sure there is something that will help whether pharmaceutical of alternative.See ya,
Amy
Posted by Ron Hill on February 9, 2005, at 11:19:59
In reply to Re: Starting Depakote with Lamictal » Ron Hill, posted by catmint on February 9, 2005, at 0:48:54
Amy,
> I have decided to go on 250 mg. of Depakote. I started 4 days ago. I am sleeping so well.Great! Please keep us informed of your status as time goes on. I've never heard of a pdoc prescribing Depakote for a short time duration, but there is a lot I've not heard of. Please stay in touch.
> I hope my relationships with my boyfriend and my son will improve once my anger and irritabiliy are resolved.
It's bound to help. "Sweetie Girl" is much easier to get along with than is "Grumpy Girl"
> By atypical do you mean increased appetite, and fatigue?
Yes. Low energy, low motivation, loss of enjoyment of life, increased sleep, etc. I'm convinced that my atypical depression is related to problems in my dopaminergic pathways. And now my pdoc is onboard with this idea. The use of Adderall XR instantly pulls me out of the depression. Literally, within one hour of taking a 5 mg capsule, the depression is gone. And it stays gone for a week or so by taking it for just the one day. I can't take it everyday because it burns me out (I call it "pstim burnout"). I have a feeling that Adderall will eventually poopout on me.
Adderall is a dopamine reuptake inhibitor and a norepinphrine reuptake inhibitor. So, the good news is that my pdoc is focusing on the right neurotransmitter (dopamine), but the bad news is that I think he might be using the wrong med to do so. Time will tell.
> It's nice to have all of you here who understand that my anger and irritablity are part of my illness and not a character defect.Most of us have been there, done that. We can relate. Thanks for your involvememt here.
-- Ron
BP II and OCPD
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal (level limited by rash)
5 or 10 mg Adderall XR prn to pull out of an atypical depressive episode; use rarely and only for one day per episode (more frequently causes "pstim burnout" symptoms)
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
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