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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 82. This is the beginning of the thread.
Posted by SLS on August 6, 2005, at 8:37:17
I am thinking about trying Keppra next.
Any comments?
Thanks.
- Scott
Posted by med_empowered on August 6, 2005, at 10:27:18
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
hey! I read a study (maybe two?) that found it was good...well, good as "mood-stabilizers" go...it beat placebo by a good margin, and played nice with the other meds the subjects were taking. The study I read found a pretty good degree of success for both Bipolar Disorder and treating people with excessive aggression. The National Institute of Mental Health is, I believe, running a much bigger, better study focusing solely on those with Bipolar Disorder...this study will have specific rules about dosage, administration of other meds, etc. From what I understand, the study is going on right now, but the NIMH hasn't released any data yet and probably won't for a while. Sigh. I'm not taking anything right now, but even I'm interested in Keppra--nice side effect profile, plays nice with other meds (and your liver), leaves cognition intact...who *wouldn't* be interested? Plus, Keppra is apparently related to some meds that have neuroprotective qualities, so it may *theoretically* stabilize mood and protect the brain from any ill-effects of mood swings/psychosis. We'll just have to see. In the meantime...from what I understand, Keppra is being RX'd in certain situations: 1) patients who've done anything else, and, for whatever reason (side effects, lack of efficacy, etc.) need something besides the old stand-bys and the neuroleptics and 2) cases where the mood swings are severe enough to warrant medication, but mild enough that the patient can "risk" a new, not-so-well studied medication...3) since it plays well with other meds, it can be used as an "add-on" instead of being used as the sole mood-stabilizer. I imagine that when this is done, a good response might lead to tapering of harsher meds, but who knows? If I find any other information, I'll make it a point to post it. Good luck!
Posted by Nickengland on August 6, 2005, at 12:28:09
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Hi Scott :-)
I'm afraid I really cannot offer much information on the use of Keppra (levetiracetam)but of course I always like to keep an open mind myself to future potential mood stabilisers for bipolar disorder and all I say is that so far I have not heard anything bad about the medication as of yet.
I know you've tried many medications in the past (I remember your list you posted of what you have tried before) I'm curious, as you haven't yet tried Topamax (Topiramate) in your line of treatments for bipolar depression.
I wonder if this would be of any benefit for you?...
also what has kept you from trying it in the past? (I imagine the cognitive side effects have been a factor in preventing you in using it?)
You know i'm presently using it and I can speak well of it in terms for helping with depression for sure. The intial response was that of very much a similar response of an anti-depressant medication which one would expect from a mood stabiliser. Of interest as well, I've read that Tegretol, Trileptal and Topamax are the main 3 medications that effect the Temperal Lobes. *If* for instance you have any problems in your temoral lobes then Topamax could be very good for this, seeing as you have had fairly good results with Trileptal - although I know they may not have benn the *best* results you were expecting.
The final advantage with Topamax which i know of, is that it would be a very easy medication for you to rule out in terms of if it will be effective for your needs. As in, its very much an either, you love the stuff, or your hate it. Theres not much middle ground and so if for what ever reason if you decided to take it you didn't think it was helping, you would certainly know straight away and would maybe not have to waste so much time waiting for a response - eg it'll hit your temperal lobes so hard you won't want to pop another pill. Avantages are also of course no blood tests required, and if anything the healthy weightloss factor, if of course weightloss would be an advantage as so many see weightgain as a disadvantage. I've taken the dosage increase very slowly, 12.5mg increases using the 'springle capsules' to separate dosing - for me this has had a major advantage in limiting side effects.
Sorry, I've waffled hugely about a drug which was not in your subject header! lol
Silly question maybe, but is the Trileptal likely to be discontinued, hence the Keppra question?
Kind regards
Nick
Posted by ed_uk on August 6, 2005, at 12:48:41
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by Nickengland on August 6, 2005, at 12:28:09
>I've taken the dosage increase very slowly, 12.5mg increases using the 'springle capsules' to separate dosing - for me this has had a major advantage in limiting side effects.
Hey Nick, the sprinkle caps are pretty cool! Sometimes I'm glad for the NHS, the sprinkle caps are even more expensive than the tablets!
Kind regards
~Ed
Posted by emme on August 6, 2005, at 12:52:59
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Hey. I tolerated it pretty well (a miracle). It killed agitation fairly nicely. It caused brain fog and not-caring when I took too high a dose. It was fine at a lower dose. I haven't used it in a while, but I'd consider using it again if the need arose.
So...what are your plans for Trileptal? Is it still working well enough to keep it?
emme
Posted by Nickengland on August 6, 2005, at 13:49:42
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by ed_uk on August 6, 2005, at 12:48:41
>Hey Nick, the sprinkle caps are pretty cool! Sometimes I'm glad for the NHS, the sprinkle caps are even more expensive than the tablets!
Hello there Ed!
Yes, its a great feeling to know that sometimes you can get something good out of the NHS!..lol..Funnily enough, I was thinking when I hit the target dose (only 50mg) and next see the doctor i'll change back to plain old tablets lol...I'm at 37.5mg now by the way almost there!
I hope all is well in the Pharmacy...and also with the Ciprimil :-) I didn't watch myself (but wish I did) last Monday I think it was on Channel 4 at 9pm was a programme all about OCD...not sure whether or not they will be repeating it or further still continuing the series this Monday - Thought it might be of interest? I hope to watch if I can.
Kind regards
Nick
Posted by Nickengland on August 6, 2005, at 13:53:50
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Hi Scott..
After all my waffle about Topamax and not much said about Keppra I thought this may be of some interest...
-------------------------------------------------
Levetiracetam in the treatment of acute mania: an open add-on study with an on-off-on design.
Grunze H, Langosch J, Born C, Schaub G, Walden J.
Department of Psychiatry at the University of Munich, Germany. grunze@psy.med.uni-muenchen.de
BACKGROUND: Levetiracetam is a novel antiepileptic drug with a broad spectrum of efficacy in epilepsy. We have tested the antimanic properties of the drug as an add-on to haloperidol in an open trial. METHOD: After giving informed written consent, 10 bipolar I acutely manic (DSM-IV) inpatients were investigated in an on-off-on study design. All patients were treated with 5 to 10 mg/day of haloperidol, depending on tolerability, throughout the investigation. Levetiracetam (up to 4000 mg/day) was added until day 14, then discontinued and reintroduced at day 21. The psychopathologic changes were assessed with the Young Mania Rating Scale (YMRS). RESULTS: After a mean decrease of the YMRS scores from 29.6 to 17.2 during the first "on" phase, manic symptoms worsened during the "off" period (YMRS score 20.9) and ameliorated again during the second "on" phase, with a decrease of the mean YMRS score to 14.7 at the end of the study. The mean dose of levetiracetam was 3125 mg/day. At day 14, only 2 (20%) of 10 patients were responders (defined as a decrease in YMRS scores of 50%) compared with 7 (70%) of 10 responders at the end of the study at day 28. CONCLUSION: The results from this open on-off-on add-on study suggest that levetiracetam exhibited additional antimanic effects. Controlled studies are clearly required.
Posted by ed_uk on August 6, 2005, at 14:10:04
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by Nickengland on August 6, 2005, at 13:49:42
Hi Nick!
>.......when I hit the target dose (only 50mg).......
Why 50mg? The optimum dose cannot be predicted in advance - you'll need to experiment with different doses until you find the dose which provides the best balance between side effects and efficacy.
Kind regards
~Ed
Posted by SLS on August 6, 2005, at 14:53:26
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by med_empowered on August 6, 2005, at 10:27:18
Thanks M_E.
Do you recall where you came across the NIMH study? If not, I'll try to find out more about it through their clinical trials postings (If I can find them).
I appreciate your time in checking things out for me.
Be well.
- Scott
Posted by Nickengland on August 6, 2005, at 15:01:10
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by ed_uk on August 6, 2005, at 14:10:04
Hi Ed!
>Why 50mg? The optimum dose cannot be predicted in advance - you'll need to experiment with different doses until you find the dose which provides the best balance between side effects and efficacy.
Totally agree! What I mean by 50mg being the target dose, is just that its all i've been prescribed so far from the psychiatrist...So far now 50mg is all I have to work with. Side effects permitting, I'd be willing to go higher of course if/when the need should arise.
25mg was providing benefits too (the best i've had so far) since i've been on 37.5mg (last wednesday) things have been ok, but I got a slight flu at around about the same time, so what with that and slight side effect increase my mood has been a little sensitive lol
Ahhh...another good thing about the NHS you might like to here...My GP said, when I leave to go to Australia (afew months still planning) he should only provide me with 3months medication - But, he will provide me with *6 months* medications! - Hey now that is what I call being generous :-) First prioroty of course when I arive there will be to get a new doctor though - make sure when that 6 months is up I have more medication!
Kind regards
Nick
Posted by SLS on August 6, 2005, at 15:05:38
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by Nickengland on August 6, 2005, at 12:28:09
Hi Nick.
> I know you've tried many medications in the past (I remember your list you posted of what you have tried before) I'm curious, as you haven't yet tried Topamax (Topiramate) in your line of treatments for bipolar depression.
>
> I wonder if this would be of any benefit for you?...
:-)I can't believe you went back and checked that out! Yes, I have avoided Topamax because of its cognitive side effects. How silly, right? Considering the severity and refractoriness of my condition, it doesn't make sense to avoid it forever. I guess I should go ahead and put it back near the top of my list of things to try. Thanks. One more ray of hope to cling to.
> You know i'm presently using it and I can speak well of it in terms for helping with depression for sure.
>
> The intial response was that of very much a similar response of an anti-depressant medicationThat is a pretty compelling testimonial. Did the antidepressant effect fade with time?
> Of interest as well, I've read that Tegretol, Trileptal and Topamax are the main 3 medications that effect the Temperal Lobes.
Hmm.
> *If* for instance you have any problems in your temoral lobes then Topamax could be very good for this, seeing as you have had fairly good results with Trileptal - although I know they may not have benn the *best* results you were expecting.
Things with Trileptal certainly started out well enough. Damned tachyphylaxis!
> The final advantage with Topamax which i know of, is that it would be a very easy medication for you to rule out in terms of if it will be effective for your needs.
The titration period would be protracted if I were to go low-and-slow. How long and at what dosage do you feel I should wait before passing judgment?
Thanks!
- Scott
Posted by ed_uk on August 6, 2005, at 15:20:01
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » med_empowered, posted by SLS on August 6, 2005, at 14:53:26
>Do you recall where you came across the NIMH study? If not, I'll try to find out more about it through their clinical trials postings (If I can find them).
Please post if you find anything :-)
~Ed
Posted by ed_uk on August 6, 2005, at 15:25:18
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by Nickengland on August 6, 2005, at 15:01:10
Hi Nick!
>Totally agree! What I mean by 50mg being the target dose, is just that its all i've been prescribed so far from the psychiatrist...
Oh I see! LOL, sorry!
>Hey now that is what I call being generous :-)
£6.50 for about £100 worth medication isn't bad!
Kind regards
~Ed
Posted by Nickengland on August 6, 2005, at 18:04:30
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by SLS on August 6, 2005, at 15:05:38
Hi Scott,
>I can't believe you went back and checked that out! Yes, I have avoided Topamax because of its cognitive side effects. How silly, right? Considering the severity and refractoriness of my condition, it doesn't make sense to avoid it forever. I guess I should go ahead and put it back near the top of my list of things to try. Thanks. One more ray of hope to cling to.
I have another surprise for you..lol I didn't need to go and check the list as I remembered specifically that Topamax wasn't on it! :-) I have a very good longterm memory for things that interest me - quite literally they stay in mind. that said my everyday short-term memory is a joke, I forget everything, but longterm I have the memory of an elephant lol On a serious note, it maybe of interest (I read somewhere a couple of years ago, memory again, see lol) that one of the benefits, yep benefits of manic-depressives, is that they quite often have very good longterm memories..Good and bad I guess, but mine are often based on factual information.
Anyway, i'm waffling again lol
To be perfectly honest with you, I really havent found the cogitive effects that bad at all. In fact carbamazepine, lithium and sodium valproate I found had worse cognitive side effect compared with Topamax so far. That said, like yourself, before trying Topamax, the 'Dopamax' fear was the thing that held me back.
I always looked at it like this aswell, interms of firstline and order of what should be tired first for a mood stabilser (this is in order of what I tired first to get to Topamax)
Sodium Valproate
Lamotrigine
Lithium
Lamotrigine (shortly again)Carbamazepine
Oxcarbazepine
Gabapentin
Topiramate
Finally ending with Topiramate and Gabapentin so far (plus omega 3 fish oils & Taurine - taurine is one great supplement, proven anticonvulsant properties and great calming effect)
*Experimental - Niacinamide & Tyrosine (vitamin C and vitamin b complex thrown in just for good measure!
I'm possibly wondering about a gabba supplement, but somehow don't see the point, although that Amen psychiatirst thinks its good..Hmmm Blood brain barrier has got me on that one, seeing as it doesn't cross it.>Did the antidepressant effect fade with time?
Like most medication that had a great intial response (for me Trileptal & Gabapentin) the first few days, first week was the best. My body then adapted and of course this did fade alittle. That said, the effects (positive) have still remained and I would say have leveled off to some extent. Nothing perfect, but i'm coping you know, take away the medication and i'd have to deal with the illness and that far, far worse. So all in all I'd say the benefits are still there. The anti-depressant response from this for me, has been alot more pronouced than that of Trileptal, that for sure. It works so differently from Trileptal, I mean side effects wise, not so much drowsyness and no blurred vision. Its different, a whole new ball game. I will say there are side effects and in some repects its not as 'smooth' as Trileptal. I really like the stuff though. Given the choice now if I didnt have the kidney thing with Trileptal, you know id probably stay with Topamax. Oh its great for headaches as well as an added bonus - if you get these, I do and now with this I do not anymore, well very rarely.
> Of interest as well, I've read that Tegretol, Trileptal and Topamax are the main 3 medications that effect the Temperal Lobes.
>Hmm.
I know, lol i'm no expert on the Temeral Lobe area of the brain and i'll adit I got this information from 'crazymeds.org' Thats said, there are pubmed studies that confirm topamax was shown to work on areas of the temeral lobes. (I think) that study may have been on rats lol hmmm No seriously, I've heard its good for temperal lobe epilepsy, there must be a link somewhere. Tegretol is a first line medication for temeral lobe epilepsy, trileptal related. Topamax would be second line for Temperal lobe epilepsy I think. Dr Amen speaks about bipolar being a Temperal lobe condition on his site from what I can gather with responds to anticonvulsants. There could be a link somewhere?
>Damned tachyphylaxis!
Im not sure what tachyphylaxis is?..does not sound good though! :-(
>How long and at what dosage do you feel I should wait before passing judgment?
Thats a very difficult question for me to answer Scott. Its my understanding that huge un-wanted side effects would be the limiting factor in you continuing with Topamax. That and the fact, that because of these side effects you would be getting no real benefit. If that was the case then dosage would only be small, perhaps only in the region of 25-75mg, thats if what I am saying would be true for you and it then could only be a matter for a few weeks, 1 month tops. This could be an unfair judement though based on my experience of medications and more so topamax...I wouldn't want to add anymore as I know there are many more factors with yourself. Bearing in mind your on other medications and you will no doubtly react differently somewhat to me. In general though, I think and feel with this medication, you'll either love it or hate it. I know its hard, but try not to think about quiting it, before you try it :-)
Go low and slow is definately the key if you decide. When I first started it was at 25mg for afew weeks and I had some word finding problems but funnily enough could laugh them off (see what I mean either love it or hate it) anyway, due to some circumstances I re-started the medication and this time at 12.5mg. It certianly made a difference with those word finding skills, when I reached 25mg and now i'm at 37.5mg I dont even have that originally problem that I had back then when I jumped straight in at 25mg, if you get what I mean.
I hope that helps
:-)
Kind regards
Nick
Posted by Nickengland on August 6, 2005, at 18:12:58
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by ed_uk on August 6, 2005, at 15:25:18
Hi Ed!
>Oh I see! LOL, sorry!
No need to be sorry Ed ..Acutally you gave me a good reminder that indeed its not as easy as just keeping the medication at one dosage - it has to meet the needs of your moods! Thanks for the reminder :-)
>£6.50 for about £100 worth medication isn't bad!
Its a great exchange rate!...So when someone buys generic prozac at £2.00, they are being made to pay £6.50!...and then I get that all that, man I feel guilty lol I've often wondered how they balance the accounts in pharmacy's over here, but maths are not my strong point!
Kind regards
Nick
Posted by Slinky on August 6, 2005, at 20:19:57
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » ed_uk, posted by Nickengland on August 6, 2005, at 15:01:10
But, he will provide me with *6 months* medications! - Hey now that is what I call being generous :-)
Blimey Nick...
One suitcase just full of meds..
Slinky
Posted by EERRIICC on August 6, 2005, at 20:56:26
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Hey Scott,
Did you ever get a chance to try this drug?
It's interesting stuff, e-mail me at ericaroundtheclock@hotmail.com.
Posted by Nickengland on August 7, 2005, at 8:34:47
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » Nickengland, posted by Slinky on August 6, 2005, at 20:19:57
>Blimey Nick...
>One suitcase just full of meds..
Hello Slinky lol
Yeah I know that has crossed my mind too!
Its quite strange, he said really is only supposed to give me 3 months worth, if i'm to leave the counrty for a such a long period of time, but then he said (with a weird look on his face :-o) i'll give you 6 months worth.. Hmm, no worries, thanks very much, I replyed!
Honestly though he's quite an intersting GP, sometimes when I see him he can be really nervous, stuttering, and just seem quite unconfident and in a low mood. Other times he really focused, switched on and extreamly confident - I do sometimes wonder if he's Bipolar!...he once admited to me in a round-about way they he get depressed. Must of caught him in quite a funny mood that day, thats for sure!
Good to know he'll trust me with that amount of medication anyway, never been any problems with me in that department before so, I guess that was something he took into consideration, and the fact I havent worked for a year, I could do with some extra help. Top man :-)
Kind regards
Nick
Posted by platinumbride on August 8, 2005, at 14:22:07
In reply to Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 6, 2005, at 8:37:17
Scott,
I wish I could say more positive things than that keppra was one of the most expensive placebos I ever tried.....
Then again, so was trileptal.Sorry for the bad news, but of course, only my experience.
Diane
> I am thinking about trying Keppra next.
>
> Any comments?
>
> Thanks.
>
>
> - Scott
Posted by SLS on August 13, 2005, at 12:35:00
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by platinumbride on August 8, 2005, at 14:22:07
I began taking Keppra yesterday. I will be at 500mg until I see my doctor on Tuesday.
I decided to discontinue the Trileptal, as the excema-like lesions have continued to spread. I'm disappointed. It was helping a bit.
Right now, I'm taking:
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Keppra 500mgI am expecting to feel worse because the Lamictal and Trileptal have been removed from the regime. I guess I can add back the Lamictal if things get tough.
- Scott
Posted by ed_uk on August 13, 2005, at 18:08:08
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 13, 2005, at 12:35:00
Hi Scott :-)
I really hope the Keppra helps. Perhaps it will have some positive cognitive effects?
Kind regards
~Ed
Posted by SLS on August 14, 2005, at 8:55:13
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by ed_uk on August 13, 2005, at 18:08:08
> Hi Scott :-)
>
> I really hope the Keppra helps. Perhaps it will have some positive cognitive effects?
>
> Kind regards
>
> ~EdAt 500mg / day, I'm not expecting very much. My guess is that 1000-2000mg is the range most people would find helpful to treat bipolar depression. This is still uncharted territory.
Because I have discontinued both Trileptal and Lamictal, I am deteriorating rather quickly. Psychomotor retardation and fatigue are becoming more prominent, and I doubt I will be able to function very well without either of those two drugs. I don't know whether or not to ride it out and hope that some portion of the worsening is due to rebound and will eventually be recovered. I wouldn't have hesitated continuing with the Trileptal had the eczema not continued to spread. I call it eczema for lack of a true indentification. The eruptions and dry patches do not itch and do not exude serous fluids, but they do look eczematous. All of my fingers are affected as well as my scalp and ears. Not pretty.
- Scott
Posted by ed_uk on August 14, 2005, at 9:37:21
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 14, 2005, at 8:55:13
Hi Scott,
>Because I have discontinued both Trileptal and Lamictal, I am deteriorating rather quickly.
I was worried because you weren't posting. Perhaps you could restard Lamictal? I don't think you were having any major side effects from Lamictal, were you?
~Ed
Posted by theo on August 14, 2005, at 10:15:29
In reply to Re: Keppra (levetiracetam) for bipolar disorder?, posted by SLS on August 13, 2005, at 12:35:00
Hello Scott!
I hope the Keppra works for you. I'm very close, after taking Keppra for a year and being off now for about 6 months, to starting it again. The only reason I stopped was the quest for something new and better.
I've tried Topamax, Lamictal and Keppra and it seemed to be the most user friendly for me as far as fast adjustment to dosing. Usually within a couple of days of dose increase you feel the change, and side effects (mainly muscle weakness, slight headache) diminish. I don't know how med sensitive you are but if you are going in 500mg increments, you might try going up in 250mg increments instead. You really have to fine tune this med. If you get angry, agressive for longer than 4 days, chances are you need to back down 250mg.
My pdoc doc started me this way: 250mg bedtime for 4 days, then add another 250mg morning. Then after 4 days add another 250mg bedtime, then 4 days another 250mg morning, etc.
Hopefully for convenience, twice daily dosing will work for you. I actually split my dosing three times daily for a while because my morning dose at 7:00am seemed to wear off about 3:00pm.
Once you increase the dose, are you on a twice daily schedule? Keep me posted on your progress with Keppra and I hope the withdrawal from Triliptal and Lamictal isn't to harsh.
Posted by SLS on August 14, 2005, at 14:26:09
In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 14, 2005, at 10:15:29
Hi Theo.
Thanks for the information. You have given me much insight as to the personality of this drug.
I did experience the headaches you referred to. So far, they have been minor and short-lived.
Are you bipolar, Theo?
How would you describe the therapeutic effects of Keppra? Did it act as an antidepressant? Did it work well at first and then fade? Anything else you could offer me regarding Keppra would be much appreciated.
Thanks again.
- Scott
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