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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SLS on September 20, 2005, at 23:37:33
Hi.
I'm using Keppra as a mood-stabilizer / antidepressant to treat bipolar depression. I've been taking it for about 6 weeks.
How long should I give this stuff? I think it is making me feel worse.
- Scott
Posted by med_empowered on September 21, 2005, at 0:04:33
In reply to How long should I give Keppra to work?, posted by SLS on September 20, 2005, at 23:37:33
Hey! Mood-stabilizers are kind of tricky. If you're trying to control a full-blown manic episode, or intense hypomania or a mixed-episode, its probably time to give up and switch out keppra or add something (keppra plays well with other meds, so either of those options could work). If you're more or less stable, and just looking for long-term improvements in mood-stability,then it really depends...I'd say if you're experiencing significant distress *right now* that you think is more or less related to your disorder and the Keppra either isnt helping or is making the situation worse, then you should probably talk to your doc about switching up the meds. One big problem with some people on Keppra seems to be dosing; since its new, and the dosing recommendations are based on those with Epilepsy (where its much easier to tell if a med is working or not based on seizure activity as opposed to mood-swings), some people end up on too much or too little...its hard to find the right dosage. I guess if it were me I'd probably give up if the dose had already been tweaked upward and/or downward. If it hasn't yet been adjusted, and if you respond poorly to other mood-stabilizers and/or have bad reactions to them, it might be a good idea to try dose adjustment before you give up on Keppra, unless you're in a bad spot right now. Some people seem to experience drug-induced depression or worsening of depression on Keppra (while others get relief from depression when its combined with an antidepressant). If your primary problem is depression, and its not getting any better (or its getting worse), you might want to switch or add something...lamictal and symbyax are both relatively new options for bipolar depression that might help you, and there are other options too (stimulants, sleep deprivation, MAOIs, etc.). Sorry this was so long...Good luck!
Posted by SLS on September 21, 2005, at 7:37:09
In reply to Re: How long should I give Keppra to work?, posted by med_empowered on September 21, 2005, at 0:04:33
Thanks M_E!
I appreciate your brainstorming my situation. You described thoroughly several different scenarios for me to ponder. My doctor made a similar remark regarding Keppra making some people with depression feel worse. Although bipolar, I suffer only from depression. My bipolar diagnosis is based upon my displaying episodes of severe mania in association with antidepressant use.
This is what I am currently taking:
Lamictal 150mg
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Keppra 2000mgI actually began to taper Keppra a few days ago. I will discuss with my doctor tomorrow the possibility to further experiment with lower dosages. I wouldn't think twice about staying with a drug if it weren't making things worse. At the moment, I don't fully understand how this drug is behaving with me. I really can't afford to abort any trial prematurely. I have no standard treatments left to explore, I don't think.
When I first added Keppra to my regime, I experienced a significant antidepressant response at 1000mg that lasted for a few days before disappearing. After several more weeks, I went up to 2000mg. I was at 2000mg for only 3 weeks before deciding to discontinue it. If I hadn't experienced episodic worsening in the absence of improvement, I would still be taking it. I am dubious that reducing the dosage would recapture an antidepressant effect, but I don't discount it.
I have been impressed with your clinical knowledge. How did you acquire it?
Thanks again. Your advice was valuable.
- Scott-------------------------------------------------
> Hey! Mood-stabilizers are kind of tricky. If you're trying to control a full-blown manic episode, or intense hypomania or a mixed-episode, its probably time to give up and switch out keppra or add something (keppra plays well with other meds, so either of those options could work). If you're more or less stable, and just looking for long-term improvements in mood-stability,then it really depends...I'd say if you're experiencing significant distress *right now* that you think is more or less related to your disorder and the Keppra either isnt helping or is making the situation worse, then you should probably talk to your doc about switching up the meds. One big problem with some people on Keppra seems to be dosing; since its new, and the dosing recommendations are based on those with Epilepsy (where its much easier to tell if a med is working or not based on seizure activity as opposed to mood-swings), some people end up on too much or too little...its hard to find the right dosage. I guess if it were me I'd probably give up if the dose had already been tweaked upward and/or downward. If it hasn't yet been adjusted, and if you respond poorly to other mood-stabilizers and/or have bad reactions to them, it might be a good idea to try dose adjustment before you give up on Keppra, unless you're in a bad spot right now. Some people seem to experience drug-induced depression or worsening of depression on Keppra (while others get relief from depression when its combined with an antidepressant). If your primary problem is depression, and its not getting any better (or its getting worse), you might want to switch or add something...lamictal and symbyax are both relatively new options for bipolar depression that might help you, and there are other options too (stimulants, sleep deprivation, MAOIs, etc.). Sorry this was so long...Good luck!
Posted by Nickengland on September 21, 2005, at 15:39:28
In reply to Re: How long should I give Keppra to work? » med_empowered, posted by SLS on September 21, 2005, at 7:37:09
Hello Scott,
>Although bipolar, I suffer only from depression.
Without medication, am I right in thinking your illness would follow the diagnosis of unipolar depression?
>My bipolar diagnosis is based upon my displaying episodes of severe mania in association with antidepressant use.
That must be a tricky situation to say the least ~ with regards to treating depression with standard antidepressant medication which then produces symptoms to that of mania which a bipolar person would have?
(I'm kind of answering my own questions, hope you'll be able to correct me if i'm wrong lol)
In essence, would your illness be seen as unipolar depression, but when treated with antidepressants in effect your symptoms then present as drug induced mania? ~ therefore warrent the diagnosis of bipolar 3?
I've always wondered about the bipolar 3 diagnosis because its like without the use of antidepressants, the illness would not exist, but of course there is the depression to treat and when treating it - that is when the induced mania presents...but the mania is man made so to speak by the medical industry itself that treats depression - kind of like a drug induced depression from an antimanic.. Or even (slightly wacky lol) but when one would have a drug induced psychosis from lsd!
Looking back, I think when I took lamictal I had a drug induced mania to some extent, but a very unplensent experience to say the least and the SSRI's caused some kind of mixed state...its a real pain in the *ss when these medications can make you worse off than you was without them...
Thought i'd mention that I increased the Topamax to 37.5mg a couple weeks ago and had an immediate antidepressant effect (it did where off slightly after a few days once by system had adjusted) but I think the extra 12.5mg has given me extra benefits with regards to relieving depression. I plan to make the final increase to 50mg in about a week or so and will leave the dose there I think. I know topamax is something you'd probably like to avoid, but I thought i'd update you on my progress as I know you're always on the look out for antidepressant efficiency within the bipolar area :-) ~ I now realise I do have some cognitive impairment, but all in all i'm happy with the way the drug performs in general vs side effects compared to that of the other mood stabilisers i've taken..
Kind regards
Nick
Posted by Phillipa on September 21, 2005, at 18:03:00
In reply to Re: How long should I give Keppra to work? » SLS, posted by Nickengland on September 21, 2005, at 15:39:28
Scott, so no more trileptal? Fondly, Phillipa
Posted by SLS on September 22, 2005, at 7:49:09
In reply to Re: How long should I give Keppra to work?, posted by Phillipa on September 21, 2005, at 18:03:00
> Scott, so no more trileptal? Fondly, Phillipa
Hi Phillipa.
I discontinued Trileptal about two months ago, in part because it wasn't really helping, and it was producing a side-effect that produced an excema-like condition that spread over my hands, ears, and scalp. These lesions still have not healed.
- Scott
Posted by susanC on October 3, 2005, at 21:44:59
In reply to Re: How long should I give Keppra to work? » Phillipa, posted by SLS on September 22, 2005, at 7:49:09
http://www.dr-bob.org/babble/20010725/msgs/72416.html
I know you saw this, but it was a while ago.
Mouse
Posted by SLS on October 6, 2005, at 9:19:56
In reply to Re: How long should I give Keppra to work?, posted by susanC on October 3, 2005, at 21:44:59
> http://www.dr-bob.org/babble/20010725/msgs/72416.html
>
> I know you saw this, but it was a while ago.
>
> MouseThanks, Susan.
Yes, I do remember your journal, but I had forgotton what drug you were journalling about.
I gave Keppra about 6 weeks. Within the first 2 weeks, it definitely improved my depression to a degree I hadn't felt in years. After 5 days or so, this improvement faded and left me feeling noticeably worse. I continued for a few more weeks at 2000mg, but felt I would do better to discontinue it. It only took a few days for me to recover back to where I had started.
- Scott
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