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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by holymama on January 28, 2006, at 12:21:52
What to try next??
I am in a mixed bipolar state, with severe agitation and suiciadl thoughts.
My doctor is trying to keep me out of the hospital (both of our ideas) and is talking to me everyday on the phone.
The seroquel she prescribed me three days ago is making me sleep 12 hours a night, but no change in my agitation.
I called her today and she is doubling my zoloft from 50 to 100 mg, but I don't understand how or why it would help, or when it might help.
I can't stand anything right now, and my husband just booked me a flight to stay with my parents so I can relax. I'm leaving tomorrow, but I just want to know when I might get some relief. What's next after seroquel??? I tried risperdal once and it brought me from 0 to 60 in 24 hours. I went from suicidal to manic as hell. These anti-psychotics don't work in the right ways for me.
Posted by blueberry on January 28, 2006, at 12:57:45
In reply to seroquel not working for agitation..., posted by holymama on January 28, 2006, at 12:21:52
I wonder why not something simple and cheap that works fast, like xanax or another benzo? Agitation can often be a sign of too much dopamine and/or norepinephrine activity. Xanax would slow that down within minutes, while antipsychotics and zoloft (with its weak dopamine enhancing effects) might actually make it worse.
The zoloft might work, but not likely until after several weeks. And it might actually make things worse in the meantime.
Seroquel and all the antipsychotics are complicated. They block some dopamine receptors partially, but they also increase dopamine release and levels. Increased release and levels of dopamine could be a contributing factor to the agitation. Seroquel also has alpha-2 antagonistic action, which means it causes the release of norepinephrine, possibly further increasing agitation. The receptor blocking action might not be strong enough to counter these things going on. But like I said, they are complicated, and these are just some rough theories that came to mind.
In any case, I wonder why a benzo wasn't used for immediate results while other meds were tried for longer term results? Or even a benzo for longterm.
Posted by holymama on January 28, 2006, at 14:01:07
In reply to Re: seroquel not working for agitation..., posted by blueberry on January 28, 2006, at 12:57:45
I take lorazapam (ativan) for sleep-- isn't that a benzo?
my pdoc recommended trying that during the day for agitation and it didn't do anything. She thought it wasn't strong enough, so tried the seroquel.
Posted by Phillipa on January 28, 2006, at 18:17:24
In reply to Re: seroquel not working for agitation..., posted by holymama on January 28, 2006, at 14:01:07
Yes ativan is a benzo. What about a mood stabalizer? Fondly, Phillipa
Posted by fenix on January 28, 2006, at 18:31:37
In reply to seroquel not working for agitation..., posted by holymama on January 28, 2006, at 12:21:52
Ok, hold on a moment and think back. Where you getting seroquel for agitation, or is it causing agitation and/or making it worse.
If yes to the latter, then it is most likely akathisia which is an unfortunately common thing from my experience. Benzodiazepines have been shown to be effective to an extent, as well as propranolol. However, I must ask, is the agitation painful, and is there an unbearable feeling of having to move all the time, especially a leg? If yes then it probably is akathisia.
Akathisia is often times cause by neuroleptics like Seroquel, and to a lesser extent SSRIs. There are several forms of akathisia (neuroleptic-induced being one of them), you may merely have a version of it that lasts as long as the causitive drugs are being given to you, and once these drugs are stopped then the akathisia would hopefully go away. Also, I would strongly suggest not stopping these medicines suddenly as it can cause withdrawal induced akathisia.
Akathisia is a uniquie form of torture when it is Tardive, which is what I have.
And by the way, anti-psychotics are severly dangerous, so you may want to do some research on your own to see if there is anything you can do in your environment that can change your psychological disposition. It is said that these drugs destroy many and help many, however, is this a good thing then?
Posted by holymama on January 28, 2006, at 18:38:27
In reply to Re: seroquel not working for agitation... » holymama, posted by Phillipa on January 28, 2006, at 18:17:24
Yes, I am taking Lithium too.
Posted by holymama on January 28, 2006, at 18:40:51
In reply to Re: seroquel not working for agitation..., posted by fenix on January 28, 2006, at 18:31:37
fenix, I started seroquel two days ago.
I am taking it for the agitation, which occured aftera a four month period of stability in which I did not make any med changes.
My doctor says it's a mixed episode, and it seems pretty resistant to meds and homeopathy and every else I have been trying.
Posted by fenix on January 28, 2006, at 19:01:24
In reply to Re: seroquel not working for agitation... » fenix, posted by holymama on January 28, 2006, at 18:40:51
> fenix, I started seroquel two days ago.
>
> I am taking it for the agitation, which occured aftera a four month period of stability in which I did not make any med changes.
>
> My doctor says it's a mixed episode, and it seems pretty resistant to meds and homeopathy and every else I have been trying.Has he ever given you a trial run of benzodiazepines, you know the stuff like Valium, Xanax, Klonopin? I still think it is akathisia, it can happen after a few months of taking neuroleptics and/or SSRIs, him giving you more neuroleptics/SSRIs may have a chance of helping the agitation, however, in the long run it would worsen the problem. This is what I have seen from my experience and a doctor I know who does research of this such over at Cambridge.
I just need to know a few things:
-Is the agitation/restlessness painful and very bothersome?
-Does it make you feel like you are going to jump out of your skin?
-Do you feel like you have to move around a lot and/or have trouble staying still and/or move one of your limbs constantly (usually one of your legs)? And if you do move around a lot, does it give some relief to the symptoms (if it does then it could be RLS (restless leg syndrome), which can be helped by benzodiazepines and/or iron pills if they find your iron levels are low or borderline-low.)If any of these symptoms sound like what you are experiencing, I suggest you discuss with your doctor the possibility you are suffering from some form of akathisia.
He will most likely start you on propranolol (a beta blocker) first, then probably benzos, then dopamine-depleters. This, of course, assumes you have a good doctor.
Posted by gardenergirl on January 28, 2006, at 21:12:58
In reply to Re: seroquel not working for agitation..., posted by fenix on January 28, 2006, at 18:31:37
>
> And by the way, anti-psychotics are severly dangerous...Please don't exaggerate or overgeneralize.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Regards,
gg acting as deputy for Dr. Bob
Posted by fenix on January 29, 2006, at 4:38:53
In reply to Please be civil » fenix, posted by gardenergirl on January 28, 2006, at 21:12:58
In giving fair warning to those that unfortunately don't get these side-effect warnings from their doctors most of the time, I'd say I am doing them a favor.
So, you think severely dangerous is an exaggeration?
Do you kno what the **** Tardive Dyskinesia is? Yeah it's pretty severe. Do you know what diabetes and pancreatis is? Yeah, those are just a little dangerous.Or how about akathisia? Especially when it is tardive akathisia? Have any idea maybe as to what that is?
With all reason, I would say these drugs are dangerous in the severe do to their side-effects. And not so much because of their side-effects but because of the number of times they happen each year do to these "medications".
Oh yeah, I got my facts pretty damn straight missy, spending these last few months working with a doctor who is on the Harvard Medical Board and trying to help him with research do to the supposedly "rare" affliction I have (do in part to these wonder drugs) has really opened my mind up a bit to the reality.
You want facts and not opinions, do your own research, and stop peddling around the empty "please be civil".
Giving people a realistic opinion based on knowledge from experience and research could not be more civil, if only it helps them. And help them it shall.
Posted by Dr. Bob on January 29, 2006, at 10:03:32
In reply to Re: Please be civil, posted by fenix on January 29, 2006, at 4:38:53
> So, you think severely dangerous is an exaggeration?
I think I could've accepted "are severely dangerous". But reasonable people can disagree. I know it's important for the administration here to be consistent, and that's even harder when it's not just me. This is something we'll discuss.
> You want facts and not opinions, do your own research, and stop peddling around the empty "please be civil".
>
> Giving people a realistic opinion based on knowledge from experience and research could not be more civil, if only it helps them. And help them it shall.It's great to help people, but please don't post anything that could lead others, including deputies, to feel accused or put down. Thanks,
Bob
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