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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by cache-monkey on March 4, 2005, at 13:28:44
Hey folks,
I've recently been diagnosed with likely soft bipolar. Depression and anxiety are predominant features when I'm "not feeling well". But I've gone through long and short stretches of feel really great (hypo-hypomanic). Add on a strongly hypomanic response to an SSRI and the DX makes sense.
I tried Lamictal, but it ended up destabilizing me, plus there were some other side effects that led me to stop. My doctor has me on lithium right now. Was at 600 mg/day, but only got a Li+ level of 0.22, so well below the therapeutic range. We're going to keep pushing up on the Lithium, as I've had no adverse effects yet.
I think Lithium is potentially good for the depressive side to my downs, and maybe some of the ups that are too up.
I'm starting to think, though, that maybe what I've been experiencing as "anxiety" is actually a "mixed state". I'm on Klonopin (1.5 mg/day) to deal with that, but I'm not finding it fully effective.
My understanding is that Lithium is less likely to work in people with mixed states predomninant. (Depakote being the drug of choice there.) But, what I'm wondering is whether it does sometimes (often?) work for people with strong mixed states.
I guess I'll only know once I hit the therapeutic window with Lithium, but if anyone out there has an experience to share, I'd be much obliged.
Thanks,
cache-monkey
Posted by HappyGirl on March 4, 2005, at 14:51:47
In reply to Lithium and mixed states, posted by cache-monkey on March 4, 2005, at 13:28:44
Hi:
Mixed State and Ultra-Rapid Cycler has some similarities in terms of 'cycling.' For this form of Bipolar is 'hard' to get a proper tx due to some 'trials & errors' to find a right med. combo.In my case, 'ultra-rapid cycler' Bipolar II, I've been on Lithium and Zyprexa combo. and am happy about its result, seeing both hypomanic and ultra cycler has been pretty much under control. Most of time, Lithium is more for 'manic' side, rather 'depressive' one. However, Lithium has, on the otherhand, augumentative property to boost anti-depressant effect if you're on both Lithium and an A.D.
In my opinion through the experience, you may need some form of atypical, such as Seroquel(mildest A.P.), Zyprexa, or Geodon (low dosage on both) along with Lithium. Because, the Lithium alone doesn't offer a 'good' relief you need on your daily life, such as work(stressful on some) and adequate social actitivies. However, if you could avoid any of those 'stressful' activities, then Lithium alone might be good enough for you to lead everyday's life. However, as far as I know, it's non-existence for Bper's with mixed states(or ultra-rapid-cycler) could get a benefitial result from taking Lithium alone. You may need an A.P., or some form of 'potent' med. in conjuction with the Lithium in order to get appropriate relief.
H.G.
Posted by Ritch on March 5, 2005, at 0:01:21
In reply to Lithium and mixed states, posted by cache-monkey on March 4, 2005, at 13:28:44
> Hey folks,
>
> I've recently been diagnosed with likely soft bipolar. Depression and anxiety are predominant features when I'm "not feeling well". But I've gone through long and short stretches of feel really great (hypo-hypomanic). Add on a strongly hypomanic response to an SSRI and the DX makes sense.
>
> I tried Lamictal, but it ended up destabilizing me, plus there were some other side effects that led me to stop. My doctor has me on lithium right now. Was at 600 mg/day, but only got a Li+ level of 0.22, so well below the therapeutic range. We're going to keep pushing up on the Lithium, as I've had no adverse effects yet.
>
> I think Lithium is potentially good for the depressive side to my downs, and maybe some of the ups that are too up.
>
> I'm starting to think, though, that maybe what I've been experiencing as "anxiety" is actually a "mixed state". I'm on Klonopin (1.5 mg/day) to deal with that, but I'm not finding it fully effective.
>
> My understanding is that Lithium is less likely to work in people with mixed states predomninant. (Depakote being the drug of choice there.) But, what I'm wondering is whether it does sometimes (often?) work for people with strong mixed states.
>
> I guess I'll only know once I hit the therapeutic window with Lithium, but if anyone out there has an experience to share, I'd be much obliged.
>
> Thanks,
> cache-monkeyGive the lithium a shot well into therapeutic range first for several weeks and see how it works for *you*. It might work quite well. Just because you get mixed stuff doesn't mean it wouldn't work. One thing that I have found for sure... is that there is MORE trouble with *offending* substances and meds aggravating and triggering "mixed" symptoms than there is a lack of efficacy in *treating* those symptoms. Gotta watch what else you are taking with the antimanic (in this case lithium) and chart it carefully. I did rather well on lithium and diazepam for several years at a subtherapeutic dose. If I could have *tolerated* a higher Li dose with the diazepam (w/o AD's or AP's), it might have worked better than Depakote + clonazepam that I now take currently. I can throw in an SSRI with either antimanic and I get mixed stuff (IF the SSRI goes above a very tiny low threshold dosage).
Posted by 4wd on October 14, 2005, at 21:40:48
In reply to Re: Lithium and mixed states » cache-monkey, posted by Ritch on March 5, 2005, at 0:01:21
When the anxiety/agitation becomes so great that you become suicidally depressed, is that a mixed state?
Or what if you are so agitated and anxious and hyper most of the day, especially in the morning and then have sinking spells of depression in the afternoon sometimes and sometimes not.
And then you are usually okay at night but sometimes still anxious and sometimes depressed.
What is that?
marsha
Posted by PrettyLady on November 29, 2012, at 0:17:03
In reply to Re: Lithium and mixed states, posted by 4wd on October 14, 2005, at 21:40:48
> When the anxiety/agitation becomes so great that you become suicidally depressed, is that a mixed state?
>
> Or what if you are so agitated and anxious and hyper most of the day, especially in the morning and then have sinking spells of depression in the afternoon sometimes and sometimes not.
>
> And then you are usually okay at night but sometimes still anxious and sometimes depressed.
>
> What is that?
>
> marshaI'm interested in the answer to (this) Marsha's question, because that's what's going on with me too and I haven't quite gotten a definite diagnosis yet.
Thanks and may we all be blessed to find our peace.
This is the end of the thread.
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