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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 lizardk on February 10, 2005, at 12:57:00
My doc has recently recommended i try depakote because of the reactions I've had on AD's.I was wondering if anyone had any positive or negative stories about depakote and whether it is effective at all with anxiety and panic disorder.
Posted by Ritch on February 10, 2005, at 13:11:49
In reply to Depakote, posted by lizardk on February 10, 2005, at 12:57:00
> My doc has recently recommended i try depakote because of the reactions I've had on AD's.I was wondering if anyone had any positive or negative stories about depakote and whether it is effective at all with anxiety and panic disorder.
Positive: It settles down agitation. Slows down my racey thinking IF I'm having manic symptoms. Works Ok for irritability.
Negative: Doesn't do much for depression, not that helpful for good sleep architecture-tends to just make me tired generally. *Somewhat* helpful for anxiety/panic, but not as good as other stuff. Makes me very hungry.
Suggestion: Combine some Neurontin with it for bad anxiety/sleep maintenance issues. It seems to work well with Neurontin. If you've got bad panic disorder, try Depakote+Neurontin+ a little clonazepam or lorazepam.
What "reactions" to AD's are you getting that your pdoc doesn't like?
Posted by Phillipa on February 10, 2005, at 17:33:09
In reply to Re: Depakote » lizardk, posted by Ritch on February 10, 2005, at 13:11:49
Neurotin helps with sleep and anxity? Fondly, Phillipa
Posted by Ritch on February 10, 2005, at 23:25:44
In reply to Re: Depakote » Ritch, posted by Phillipa on February 10, 2005, at 17:33:09
> Neurotin helps with sleep and anxity? Fondly, Phillipa
Yes, in my case it has. I was on Depakote+Celexa+clonazepam and still having breakthrough depressions, mixed symptoms, and sleep disruption. When I first tried Neurontin added to that mix I felt much better depression and anxiety wise. But, I stopped everything but the Neurontin and things worsened. I've tried Neurontin (gabapentin) again off and on several times since then and it seems that it only works well in combo with Depakote and a tad of SSRI and clonazepam. My pdoc doesn't want me to take it because it seems to induce a mild hypomania without dysphoria. Doesn't appear to affect *cycling* one way or another, however. I would call Depakote+gabapentin+(low-dose)SSRI+clonazepam a "golden" combo for me. I want to restart it, but expect an argument about it. May have to see about different pdoc.
Posted by MM on February 11, 2005, at 1:04:25
In reply to Depakote, posted by lizardk on February 10, 2005, at 12:57:00
How old are you and are you male or female? You don't have to tell that here, but Depakote CAN cause or is implicated or whatever the PC way to say it is...it can be involved in causing PCOS (Polycystic Ovarian Syndrome) and should be given to women under 20 with caution (I have learned this after I took it at 17, of course). It + Paxil also made me (yes MADE me) gain 50-60 lbs. I can't say which med, or if it was the combo, but when I got off of them, the weight flew off. Other than those warnings, Depakote was calming and I didn't have other side effects that I can remember. It might have made me a little tired. My advice would be if you decide to take it, just keep an eye on changes and if something starts, don't assume it will go away...don't wait too long, take yourself seriously if you notice something. It could be a great drug for some people. I don't mean to talk it down, just wish I had known then what I know now. It, and Lithium are the standard/approved treatments for Bipolar so it's probably worth a try. I've also read something about needing blood tests with it, so you might want to ask your pdoc about that.
What reaction did you have on AD's, if I may ask?
It could help with the panic/anxiety, but it might not be the first thing you want to try...
MM
Posted by gromit on February 11, 2005, at 2:21:13
In reply to Re: Depakote » lizardk, posted by MM on February 11, 2005, at 1:04:25
I agree with MM, I had some truly horrible side effects from Depakote but I had new doc and didn't want to seem difficult. I don't think you will have to wait too long to see if this drug will be a good fit for you.
Rick
Posted by lizardk on February 11, 2005, at 10:22:07
In reply to Re: Depakote » lizardk, posted by Ritch on February 10, 2005, at 13:11:49
My reaction to paxil and lexapro was bouncing off the walls with panic,anxiety,restlessness, and racing thoughts.It felt like i needed and elephant tranquilizer dart to calm me down.I'm not sure if that suggest bipolar or just substance induced mania, but my doc seems to think bipolar.
Posted by Ritch on February 11, 2005, at 10:42:05
In reply to Re: Depakote, posted by lizardk on February 11, 2005, at 10:22:07
> My reaction to paxil and lexapro was bouncing off the walls with panic,anxiety,restlessness, and racing thoughts.It felt like i needed and elephant tranquilizer dart to calm me down.I'm not sure if that suggest bipolar or just substance induced mania, but my doc seems to think bipolar.
Have you tried any other class of antidepressants such as MAOI, Wellbutrin, trazodone, or tricyclics? If you get manic reactions to SSRI's (and probably Effexor and Cymbalta as well), the others might not provoke the problems you describe and might work rather well for you (perhaps without Depakote). You didn't mention euphoria or irritability in your description of the reactions.
Posted by lizardk on February 11, 2005, at 11:24:58
In reply to Re: Depakote - substance induced mania » lizardk, posted by Ritch on February 11, 2005, at 10:42:05
> > My reaction to paxil and lexapro was bouncing off the walls with panic,anxiety,restlessness, and racing thoughts.It felt like i needed and elephant tranquilizer dart to calm me down.I'm not sure if that suggest bipolar or just substance induced mania, but my doc seems to think bipolar.
>
> Have you tried any other class of antidepressants such as MAOI, Wellbutrin, trazodone, or tricyclics? If you get manic reactions to SSRI's (and probably Effexor and Cymbalta as well), the others might not provoke the problems you describe and might work rather well for you (perhaps without Depakote). You didn't mention euphoria or irritability in your description of the reactions.I've tried wellbutrin with no effects, but none of the other classes.I was extremely irritable but hard to tell if that was just from being completely agitated and panicking.I had no euphoria at all.I would be interested to try MAOI's or tricyclics but my doc seems to be convinced I have bipolar spectrum or bipolar NOS and keeps prescribing my AP's and suggests mood stabilizers, which i haven't tried yet.I just called today because I've been feeling almost suicidal theses last few days and he prescribed me Geodon.I have my reservations about Geodon too but I don't know what to do.
Posted by MM on February 11, 2005, at 12:27:52
In reply to Re: Depakote - substance induced mania, posted by lizardk on February 11, 2005, at 11:24:58
I posted on another thread about this same thing happening to me when I was on SSRI's....extreme agitation, restlessness. I had suicidal ideation too (something I didn't have, at least not in that way, or not that much...it became almost a constant ...compulsion?). I am now diagnosed Bipolar II and I take a mood stabilizer and have been on an antipsychotic before. Wellbutrin is the AD they recommend as the first AD to try in Bipolar as it is less likely to cause mania. It hasn't caused agitation with me, but that could be because of the mood stabilizer, because I've taken SSRI's with the mood stabilizer and all they do is make me feel "tripped out"..like I'm on acid. Anyway...I don't know how bad you feel, so it's your decision (obviously), but you might want to think about other options before you start down this route. I regret ever taking an AD because I feel like it changed my brain chemistry and I am scared to get off the other meds because of that. They have helped in their ways, helped with what the AD caused, but they have also caused some sucky side effects (weight gain is my least favorite, I think). An antipsychotic will knock you right out, so if that's what you want, go for that one, but research it carefully. A mood stabilizer will make you feel kind of flat and apathetic (in most cases I think) but I am told it helps with anxiety...(my brain is kind of mush and sometimes it's hard to tell what does what). What has helped with anxiety for me is Klonopin/Clonazepam, and possibly the Wellbutrin by helping with depression. I'm not totally negative to meds, and I'm not telling you not to take them, but I hope that you will try to explore some other options (like cognitive behavioral therapy, fish oil, light therapy...the alternative board has other suggestions too). Have you ever had mania or hypomania or just the agitation? Anything like that happen off meds? Agitation, irritability, anxiety/panic, restlessness while sometimes indicative of Bipolar (I guess) are also side effects of the SSRI's for some people. The Bipolar road isn't a straight one, so I'm just trying to be a voice of caution. What are the symptoms you have right now that you are having trouble with? (Depression? Anxiety?)
Sorry this is so long.
MM
Posted by Ritch on February 11, 2005, at 13:16:04
In reply to Re: Depakote - substance induced mania, posted by lizardk on February 11, 2005, at 11:24:58
> > > My reaction to paxil and lexapro was bouncing off the walls with panic,anxiety,restlessness, and racing thoughts.It felt like i needed and elephant tranquilizer dart to calm me down.I'm not sure if that suggest bipolar or just substance induced mania, but my doc seems to think bipolar.
> >
> > Have you tried any other class of antidepressants such as MAOI, Wellbutrin, trazodone, or tricyclics? If you get manic reactions to SSRI's (and probably Effexor and Cymbalta as well), the others might not provoke the problems you describe and might work rather well for you (perhaps without Depakote). You didn't mention euphoria or irritability in your description of the reactions.
>
> I've tried wellbutrin with no effects, but none of the other classes.I was extremely irritable but hard to tell if that was just from being completely agitated and panicking.I had no euphoria at all.I would be interested to try MAOI's or tricyclics but my doc seems to be convinced I have bipolar spectrum or bipolar NOS and keeps prescribing my AP's and suggests mood stabilizers, which i haven't tried yet.I just called today because I've been feeling almost suicidal theses last few days and he prescribed me Geodon.I have my reservations about Geodon too but I don't know what to do.
>I don't want to have to take any antipsychotics ever again. I've been on conventionals and atypicals and while they seem to have been helpful at times on a short term basis I've gotten either restless, depressed, or dystonic reactions from them and I don't like the idea of taking them chronically. Symptom-wise you did experience some irritability with the racing thoughts so that sounds like a mixed episode with anxiety, however ... agitated GAD-like depressions with panic can definitely happen in nonbipolar people.. probably folks that have a *primary* anxiety disorder that get depressed and wigged out from the anxiety. SSRi's are the "first line" treatment for an anxiety problem now and if you are unlucky to be one of those people who are genetically hypersensitive to them you might get a bipolar dx that is inappropriate. That said.. Depakote is generally good for "mixed" bipolar states and I think it would better to be on something like Depakote chronically rather than an antipsychotic, but that's just my opinion. Your pdoc is already suggesting it.. I would give it a try and see how you do on it. I've heard a couple of anecdotal stories here about Geodon triggering hypomania.. so maybe it would be a good idea to talk to your pdoc about starting either the Geodon or Depakote but not *both* at the same time. Otherwise it might be hard to tell what is helping or possibly worsening any of your symptoms. I hope you get better soon!
Posted by lizardk on February 12, 2005, at 14:35:59
In reply to Re: Depakote - substance induced mania » lizardk, posted by MM on February 11, 2005, at 12:27:52
> I posted on another thread about this same thing happening to me when I was on SSRI's....extreme agitation, restlessness. I had suicidal ideation too (something I didn't have, at least not in that way, or not that much...it became almost a constant ...compulsion?). I am now diagnosed Bipolar II and I take a mood stabilizer and have been on an antipsychotic before. Wellbutrin is the AD they recommend as the first AD to try in Bipolar as it is less likely to cause mania. It hasn't caused agitation with me, but that could be because of the mood stabilizer, because I've taken SSRI's with the mood stabilizer and all they do is make me feel "tripped out"..like I'm on acid. Anyway...I don't know how bad you feel, so it's your decision (obviously), but you might want to think about other options before you start down this route. I regret ever taking an AD because I feel like it changed my brain chemistry and I am scared to get off the other meds because of that. They have helped in their ways, helped with what the AD caused, but they have also caused some sucky side effects (weight gain is my least favorite, I think). An antipsychotic will knock you right out, so if that's what you want, go for that one, but research it carefully. A mood stabilizer will make you feel kind of flat and apathetic (in most cases I think) but I am told it helps with anxiety...(my brain is kind of mush and sometimes it's hard to tell what does what). What has helped with anxiety for me is Klonopin/Clonazepam, and possibly the Wellbutrin by helping with depression. I'm not totally negative to meds, and I'm not telling you not to take them, but I hope that you will try to explore some other options (like cognitive behavioral therapy, fish oil, light therapy...the alternative board has other suggestions too). Have you ever had mania or hypomania or just the agitation? Anything like that happen off meds? Agitation, irritability, anxiety/panic, restlessness while sometimes indicative of Bipolar (I guess) are also side effects of the SSRI's for some people. The Bipolar road isn't a straight one, so I'm just trying to be a voice of caution. What are the symptoms you have right now that you are having trouble with? (Depression? Anxiety?)
> Sorry this is so long.
> MMRight now what I am experiencing is a constant physical anxiety all over my body, but primarily in my chest.Deep breathing, meditation, going to sleep, taking xanax, nothing seems to get rid of it.I'm currently in CBT with only minimal success so far.I've also tried fish oil and jog 2 or 3 miles a day.Nothing seems to squash the physical anxiety and i think that is where most of my depression and obsessive thoughts come from, but the SSRI's definitelt amplified every problem i have.
Posted by ed_uk on February 12, 2005, at 14:38:36
In reply to Re: Depakote - substance induced mania, posted by lizardk on February 12, 2005, at 14:35:59
Hi,
Please can you describe your symptoms of physical anxiety in more detail. What medication are you on at the moment apart from Xanax?
Ed.
Posted by Ritch on February 12, 2005, at 15:08:35
In reply to Re: Depakote - substance induced mania, posted by lizardk on February 12, 2005, at 14:35:59
> Right now what I am experiencing is a constant physical anxiety all over my body, but primarily in my chest.Deep breathing, meditation, going to sleep, taking xanax, nothing seems to get rid of it.I'm currently in CBT with only minimal success so far.I've also tried fish oil and jog 2 or 3 miles a day.Nothing seems to squash the physical anxiety and i think that is where most of my depression and obsessive thoughts come from, but the SSRI's definitelt amplified every problem i have.
>Would you describe what you are experiencing as a mixture of feelings of impending doom/intense dread (with no clear object) coupled with super hyper-vigilance where your muscles are all tight and rigid (unable to relax/sit still)? Sorry for the questioning, but I go through that at times myself and somatic problems/muscle tension/vigilance are MAJOR components to the anxiety associated with my bipolar depressions and those also strongly run in my family. As far as the SSRI's go... have you taken several different ones? Did you respond differently to any of them or were they all pretty much the same? Just wondering.. I *have* found that lowering the dose way down has helped. But I can't seem to completely get off them. It is like a little helps, but very much makes things much worse.
Posted by lizardk on February 12, 2005, at 16:13:05
In reply to Re: Physical symptoms » lizardk, posted by Ritch on February 12, 2005, at 15:08:35
> > Right now what I am experiencing is a constant physical anxiety all over my body, but primarily in my chest.Deep breathing, meditation, going to sleep, taking xanax, nothing seems to get rid of it.I'm currently in CBT with only minimal success so far.I've also tried fish oil and jog 2 or 3 miles a day.Nothing seems to squash the physical anxiety and i think that is where most of my depression and obsessive thoughts come from, but the SSRI's definitelt amplified every problem i have.
> >
>
> Would you describe what you are experiencing as a mixture of feelings of impending doom/intense dread (with no clear object) coupled with super hyper-vigilance where your muscles are all tight and rigid (unable to relax/sit still)? Sorry for the questioning, but I go through that at times myself and somatic problems/muscle tension/vigilance are MAJOR components to the anxiety associated with my bipolar depressions and those also strongly run in my family. As far as the SSRI's go... have you taken several different ones? Did you respond differently to any of them or were they all pretty much the same? Just wondering.. I *have* found that lowering the dose way down has helped. But I can't seem to completely get off them. It is like a little helps, but very much makes things much worse.I've been on Paxil and Lexapro, and both sent me into a tailspin very quickly on a low dose.(I think 20 mg)I would definitely describe it as being totally unable to relax with a general feeling of impending doom and also hypervigilance in respect to my physical sensations and any perceived mental errors i might make.I had tried Paxil before and it seemed semi-effective in some areas, like not having as many panic attacks.But i tried just 20 mg for a few days and it really took me to the edge, as did Lexapro.
Posted by lizardk on February 12, 2005, at 16:20:18
In reply to Re: Physical symptoms » lizardk, posted by ed_uk on February 12, 2005, at 14:38:36
> Hi,
>
> Please can you describe your symptoms of physical anxiety in more detail. What medication are you on at the moment apart from Xanax?
>
> Ed.
I would describe it as having exercised heavily for awhile and keeping that feeling in your chest even while at rest.The mental anxiety is more like I'm pulling the rug out from under myself by constantly questioning my sanity and cognition.Lots of feelings of unreality too.
Posted by ed_uk on February 12, 2005, at 16:25:54
In reply to Re: Physical symptoms, posted by lizardk on February 12, 2005, at 16:20:18
>I would describe it as having exercised heavily for awhile and keeping that feeling in your chest even while at rest.
Have you ever tried propranolol (Inderal) for this symptom? You can't take propranolol if you've got asthma though.
Ed.
Posted by Ritch on February 12, 2005, at 17:18:28
In reply to Re: Physical symptoms, posted by lizardk on February 12, 2005, at 16:13:05
> > > Right now what I am experiencing is a constant physical anxiety all over my body, but primarily in my chest.Deep breathing, meditation, going to sleep, taking xanax, nothing seems to get rid of it.I'm currently in CBT with only minimal success so far.I've also tried fish oil and jog 2 or 3 miles a day.Nothing seems to squash the physical anxiety and i think that is where most of my depression and obsessive thoughts come from, but the SSRI's definitelt amplified every problem i have.
> > >
> >
> > Would you describe what you are experiencing as a mixture of feelings of impending doom/intense dread (with no clear object) coupled with super hyper-vigilance where your muscles are all tight and rigid (unable to relax/sit still)? Sorry for the questioning, but I go through that at times myself and somatic problems/muscle tension/vigilance are MAJOR components to the anxiety associated with my bipolar depressions and those also strongly run in my family. As far as the SSRI's go... have you taken several different ones? Did you respond differently to any of them or were they all pretty much the same? Just wondering.. I *have* found that lowering the dose way down has helped. But I can't seem to completely get off them. It is like a little helps, but very much makes things much worse.
>
> I've been on Paxil and Lexapro, and both sent me into a tailspin very quickly on a low dose.(I think 20 mg)I would definitely describe it as being totally unable to relax with a general feeling of impending doom and also hypervigilance in respect to my physical sensations and any perceived mental errors i might make.I had tried Paxil before and it seemed semi-effective in some areas, like not having as many panic attacks.But i tried just 20 mg for a few days and it really took me to the edge, as did Lexapro.Wow, I get similar reactions from SSRI's at higher doses. 20mg would definitely flip me out big time. I'm just taking 1/2mg of Celexa (liquid) every other day now and even that is associated with some impulse control loss (anger). It is like I feel a "calming" effect, a "well-whatever" effect, less obsessive, but at the same time an agitation. The first SSRI was Prozac and I *did* start right off at 20mg, but after about a week I had to start halving the dose every few days. Got to the point where my pupils were dilated, couldn't sleep, if I suddenly walked into a dark room it would be full of wavy colors, etc. I settled on 2.5mg-5.0mg/day for several years, but with time it seems that I'm becoming more and more sensitized to all of them. But, if I try to totally stop.. after about a week or two I start getting panic symptoms returning. Anyhow.. it sounds like you have got a range of possibilities: 1) You are bipolar and can't take SSRI's period, 2) You are bipolar and might be able to take other classes of AD's for panic with no trouble, 3) You just have panic disorder and the stress triggers your depressions and you probably would do well on an MAOI or TCA plus a benzo. It is really a tough thing trying to figure out. I just personally haven't had any success with just a mood stabilizer. I would be willing to put up with some increased depression as long as *panic* didn't creep back in. The Depakote I take (at this dose anyhow) doesn't seem to keep it away. Gabapentin (Neurontin) added to it seemed to help, but my pdoc doesn't like it. I wish you luck finding out what's going on.. hope you respond back with any success with meds, or dx changes, etc..
Posted by MM on February 12, 2005, at 18:08:37
In reply to Re: Depakote - substance induced mania, posted by lizardk on February 12, 2005, at 14:35:59
Does anything at all help? Like even alcohol? That would suggest that taking a drug that helps GABA would help, not that I know about that stuff really. Have you looked into Buspar? I heard it was good for physical anxiety symptoms. Do you get enough sun? I'm just throwing things out because of the drugs I know, I'm not sure which ones are best for a physical anxiety, other than a benzo, which doesn't work for you. All the mood stabilizers work on GABA too (like the benzos) and adding one might help to calm that stuff, but I don't know if you have to be bipolar for one to do that. Anyway, a site I really find helpful is mcmanweb.com You can look through the articles section, and maybe read the neurotransmitters article, and the antidepressant articles...has lots of bipolar stuff too. I hope you find something that works for you.
MM
Posted by Phillipa on February 12, 2005, at 19:57:11
In reply to Re: Depakote - substance induced mania » lizardk, posted by MM on February 12, 2005, at 18:08:37
This is exactly what I experienced on the SSRI's and Effexor, etc. I would get so agitated that I was constantly on the phone with my pdoc. I was also taking xanax. The xanax stopped relaxing me last spring, and began to sedate me, and the SSRI's including taking up to 60mg of cymbalta did nothing to me. Evidently my chemistry changed. I do know that I am very addicted to benzos now, and chloral hydrate. I remember when the only med I took was 5mg of valium three times a day. That used to really relax me and relieve any of the depressive feelings. Now I'm afraid to see how much I would need to achieve the same effect. I know I'm going to ask the new pdoc on Monday to try and detox me on valium and I don't care how high a dose she rx's. I need some relief. Of course, I don't know if she will do this. Fondly, Phillipa
Posted by Spriggy on February 13, 2005, at 22:32:31
In reply to Re: Depakote - substance induced mania, posted by Phillipa on February 12, 2005, at 19:57:11
I am just relieved that SOMEBODY else totally wigged out on SSRI's in the same way as I did.
I wigged out big time on Lexapro- the same exact symptoms as you describe. Totally agitated and anxious on the inside, wondering if I was going nuts, felt so UNREAL it was terrifying.i've been off for almost 2 weeks and still feeling this way. Help me Jesus.
I've been trying to explain this feeling to people here and for some reason, everyone keeps thinking I'm bipolar- although the pdoc has ruled that out.
Maybe some of us just can't handle our seratonin being messed with without wiggin' out??
I'm in the same boat as you Lizard. My doctor even prescribed me Geodon which I refused to take.
So here I sit, suffering in silence (okay, not so silent since I keep coming here and ranting and raving.).
I am feeling being sent to a neurologist and getting a CAT scan. If nothing shows up, I fear I will definitely end up in the psych ward.
Posted by MM on February 14, 2005, at 2:00:35
In reply to OKAY LIZARDK... FINALLy somebody else, posted by Spriggy on February 13, 2005, at 22:32:31
How did you get an appointment with a neurologist? I've been wanting one for so long but I don't know how to get one. And, if you quit the lexapro without tapering, some of those effects could be withdrawl effects, and since it's only been two weeks, it's VERY possible the symptoms will go away with time. Hope it does for you.
MM
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