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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Cybele on March 7, 2006, at 13:40:27
I've had a cyclic dysthymia (atypical depression) since I was 13 (am 44 now), which has only become major depressions a few times in my life after a period of extended life stress. My primary depression symptoms are difficulty concentrating and a flat mood. Previous family docs/therapists just called it dysthymia with double depression after extended periods of life stress. My current PDOC DX me with the sort of soft bipolar where you have only experienced hypomania in reaction to a medication. My half-sister has BP-I and takes Lamictal.
Here's my chronological history with antidepressants.
PAXIL: Took it 11 years ago for 6 weeks, made me feel much worse. Could not concentrate at all.
WELLBUTRIN: Took it after Paxil, initial hypomania seemed to help kick-start my recovery. Took it for a year. Felt great, but made a lot of positive changes in my life which may have helped more.
PREGNANCY: Had absolutely no problems with depression for the 4 years I was pregnant or breastfeeding
WELLBUTRIN: Tried it again 6 years ago for dysthymia, initial hypomania was milder than first time. Discontinued it after a month or so because I felt like I didn't need it. Felt fine for 3 years (exercised 5x a week), then another period of extended stress and tried it again. No hypomania, but I did have terrible Excessive Daytime Sleepiness and zero REM latency (would start dreaming as soon as my head hit the pillow). Tired of being sleepy and went off of it.
EFFEXOR: Tried it 2 years ago for dysthymia. Gained 20 pounds in 5 months even though I was not eating significantly more and I was exercising 5x a week. May or may not have helped mood. Exercise probably helped the most. Ffelt the same went I went off of it. No withdrawal problems at all.
LAMICTAL: Started seeing PDOC 8 months ago for double depression. He had me try LAMICTAL and I took it for 6 weeks. It made me feel increasingly angry, and even rageful at times. Mild improvement in ability to concentrate, but not enough to justify feeling angry all the time. Klonopin was my friend.
CYMBALTA: Took for 4 months. Felt significant improvement in ability to concentrate after 4 weeks. Double depression lifted. However, it caused Excessive Daytime Sleepiness. Provigil helped only a little. This is the only AD that I can say has truly helped with my depression; however, due to the sleepiness, I could not get anything done and stopped working out (too sleepy) and gained even more weight. I doubt I could have held down a job. (I am a stay at home mom.) No withdrawal problems at all.
Have been off all antidepressants for 2-1/2 months. Dysthymic feeling has been slowly creeping back. PDOC wants me to try another mood stabilizer. Possible weight gain is NOT an option.
Anyone have any thoughts on meds I might research before talking to my PDOC?
Posted by CareBear04 on March 7, 2006, at 15:24:13
In reply to PDOC wants me to try a mood stabilizer, posted by Cybele on March 7, 2006, at 13:40:27
HI-- Sounds like you've been on quite a list of meds. I might consider plain old lithium. Back when my dr wasn't sure whether I was bipolar or not, she started lithium, and it has been a lifesaver. It has antidepressant effects and keeps a floor under me so that my mood can't plummet. Maybe another suggestion might be low-dose Abilify. It's an antipsychotic, but at low doses, it's used for just about everything. Good luck! CB
Posted by yxibow on March 7, 2006, at 17:24:00
In reply to PDOC wants me to try a mood stabilizer, posted by Cybele on March 7, 2006, at 13:40:27
Trileptal, Lyrica ?
Trileptal has been more extensively tested and used.
Posted by Cybele on March 7, 2006, at 17:42:16
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by yxibow on March 7, 2006, at 17:24:00
Thanks, guys. How are Trileptal and Lithium for weight gain?
Posted by Emily Elizabeth on March 7, 2006, at 20:50:30
In reply to Re: PDOC wants me to try a mood stabilizer, posted by Cybele on March 7, 2006, at 17:42:16
I'd like to second the suggestion for Lithium. I don't have BP, I have treatment resistant depression, but Li has been a lifesaver for me. So, I think it might be a good choice whether you have BP or not.
Some people gain on Li, but not all. I did not. Also, they say that just b/c you gain on one drug, it doesn't mean you will gain on another. It might be worth the risk.
Best,
EE
Posted by fairywings on March 8, 2006, at 16:46:03
In reply to PDOC wants me to try a mood stabilizer, posted by Cybele on March 7, 2006, at 13:40:27
Since the Wellbutrin worked but made you sleepy, maybe try Strattera, since it was originally introduced as an anti-depressant, and is in the same family as Wellbutrin. (I could take Strattera at a very low dose, but the higher dose made me more depressed, just a thought.)Have you tried a trial of a stimulant instead of an antidepressant - maybe Adderall XR. Bi-polar and ADD are often misdx'd or co-morbid. ADD and depression are often co-morbid. Just a thought.
fw
Posted by Phillipa on March 8, 2006, at 17:52:19
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by fairywings on March 8, 2006, at 16:46:03
I've tried trileptal and it was weight neutral. Don't know that it helped my depression but it was at a low dose. Fondly, Phillipa
Posted by Racer on March 8, 2006, at 18:07:44
In reply to PDOC wants me to try a mood stabilizer, posted by Cybele on March 7, 2006, at 13:40:27
I don't know much about mood stabilizers, but I did have a revelation a couple of months ago when my brand spanking new pdoc said that she thought most comorbid depression and anxiety was actually bipolar. The revelation: it doesn't matter what the diagnosis is, if the drugs work...
That said, a number of mood stabilizers are being used for unipolar depression, either as augmenting agents or as the sole drug. They do seem to help a lot of people, so it's worth at try.
As far as weight goes, it might be that something like Effexor and Wellbutrin would kick you into remission, without major side effects, and without the weight gain. Alternately, it might be worth trying Topomax, which is increasingly being used both as a mood stabilizer, and to mitigate the weight gain from the other drugs. The rule, to avoid side effects with Topomax, is start very low, and go very slowly in titrating upwards. Also, taking bicarb might help with it, too.
Hope that helps, and good luck.
Posted by Cybele on March 8, 2006, at 19:39:10
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by Racer on March 8, 2006, at 18:07:44
Thanks for your reply!
> I don't know much about mood stabilizers, but I did have a revelation a couple of months ago when my brand spanking new pdoc said that she thought most comorbid depression and anxiety was actually bipolar. The revelation: it doesn't matter what the diagnosis is, if the drugs work...
Exactly!
> That said, a number of mood stabilizers are being used for unipolar depression, either as augmenting agents or as the sole drug. They do seem to help a lot of people, so it's worth at try.
>
> As far as weight goes, it might be that something like Effexor and Wellbutrin would kick you into remission, without major side effects, and without the weight gain. Alternately, it might be worth trying Topomax, which is increasingly being used both as a mood stabilizer, and to mitigate the weight gain from the other drugs. The rule, to avoid side effects with Topomax, is start very low, and go very slowly in titrating upwards. Also, taking bicarb might help with it, too.I suggested Cymbalta plus Ritalin, but my PDOC wouldn't go for it, ha ha. The sedating effect of Cymbalta for me was significant. Provigil didn't seem to help much. I can't take Wellbutrin at all ever again for the same reason as Cymbalta. For WB (the last time I took it), I am pretty sure the sedation was due to the short REM latency and lack of deep sleep (I've posted about this on here in the past), but I am not sure why Cymbalta was so sedating. I literally felt normal and alert 48 hours after my last dose. I didn't seem to have a short REM latency, but maybe I did and just wasn't woken up by my family so much right after going to bed. (This is how I knew my REM latency was short; my hubby or kids might wake me up 5-10 minutes after I went to bed and they'd wake me from a dream.)
Re: Effexor, it didn't seem to help much. I had ramped up my exercise level, and I think that helped more than anything. My Effexor weight gain was ***definitely*** due to lowered metabololic rate as I wasn't eating enough to justify it. WB might help me eat less (at first), but then I'd just be treading weight. I still need to lose 50 pounds.
My PDOC laughed when I suggested Topomax. He does not think it helps with BP. ALso, I did try it for 2 weeks three years ago right after the last time I took WB (my family doc at the time prescribed it for me when I asked her if I could give it a try), and it made my hair fall out. Not all, but enough to be worrying.
Posted by Cybele on March 8, 2006, at 20:00:40
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by fairywings on March 8, 2006, at 16:46:03
> Since the Wellbutrin worked but made you sleepy, maybe try Strattera, since it was originally introduced as an anti-depressant, and is in the same family as Wellbutrin. (I could take Strattera at a very low dose, but the higher dose made me more depressed, just a thought.)
>
> Have you tried a trial of a stimulant instead of an antidepressant - maybe Adderall XR. Bi-polar and ADD are often misdx'd or co-morbid. ADD and depression are often co-morbid. Just a thought.
I really don't know if WB worked. The first two times I went on it it did cause a hypomania which helped me kick-start my life. Subsequent to that, I'd just have the helpful anti-addictive benefits for a couple of weeks and then could get some momentum on following my eating plan (Weight Watchers) and losing weight, which would cheer me up. Shrug.My "depression" is like ADD, but when not depressed I am the polar opposite of ADD. My hubby is on the ADD-spectrum, so I'm the one in our family in charge of finances, appts., "to do" lists, etc., and I do a really good job when not depressed, lol.
Posted by Cybele on March 8, 2006, at 20:02:18
In reply to Re: PDOC wants me to try a mood stabilizer, posted by Emily Elizabeth on March 7, 2006, at 20:50:30
> I'd like to second the suggestion for Lithium. I don't have BP, I have treatment resistant depression, but Li has been a lifesaver for me. So, I think it might be a good choice whether you have BP or not.
>
> Some people gain on Li, but not all. I did not. Also, they say that just b/c you gain on one drug, it doesn't mean you will gain on another. It might be worth the risk.
>Thanks! I called my PDOC, and will give it a try. He had suggested Lithium, Depakote, or Trileptal.
Posted by 4WD on March 10, 2006, at 22:37:24
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by CareBear04 on March 7, 2006, at 15:24:13
> HI-- Sounds like you've been on quite a list of meds. I might consider plain old lithium. Back when my dr wasn't sure whether I was bipolar or not, she started lithium, and it has been a lifesaver. It has antidepressant effects and keeps a floor under me so that my mood can't plummet. Maybe another suggestion might be low-dose Abilify. It's an antipsychotic, but at low doses, it's used for just about everything. Good luck! CB
Hi CB,
I just got put on lithium yesterday. I've been having bad anxiety/depression/mixed states and was on Depakote for that (which helped some but caused bad headaches) so now we're trying lithium. Since you're on it, can I ask a few questions?
What dose do you take? Has it maintained its efficacy? What kind of side effects are you experiencing?
I'm on 300mg twice daily (just started it last night). I know nothing about it - my pdoc called it in for me and I don't see him til next week.
Marsha
Posted by 4WD on March 10, 2006, at 22:38:01
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by CareBear04 on March 7, 2006, at 15:24:13
> HI-- Sounds like you've been on quite a list of meds. I might consider plain old lithium. Back when my dr wasn't sure whether I was bipolar or not, she started lithium, and it has been a lifesaver. It has antidepressant effects and keeps a floor under me so that my mood can't plummet. Maybe another suggestion might be low-dose Abilify. It's an antipsychotic, but at low doses, it's used for just about everything. Good luck! CB
Hi CB,
I just got put on lithium yesterday. I've been having bad anxiety/depression/mixed states and was on Depakote for that (which helped some but caused bad headaches) so now we're trying lithium. Since you're on it, can I ask a few questions?
What dose do you take? Has it maintained its efficacy? What kind of side effects are you experiencing? Does it help with anxiety/hyper or jittery scared feelings?
I'm on 300mg twice daily (just started it last night). I know nothing about it - my pdoc called it in for me and I don't see him til next week.
Marsha
Posted by tizza on March 11, 2006, at 3:05:06
In reply to Re: PDOC wants me to try a mood stabilizer » Emily Elizabeth, posted by Cybele on March 8, 2006, at 20:02:18
Thanks! I called my PDOC, and will give it a try. He had suggested Lithium, Depakote, or Trileptal.
Hey cybele, the only mood stabliser I have tried was Epilim (Depakote, sodium valproate in the US) I found it turned me into a walking zombie but I must concede that I was chilled out too much but I felt like sh*t and it started to make me sick but I was on other meds at the time. If you do go on a mood stabliser including Lithium or what ever else it may be, make sure you have regular BLOOD TESTS to make sure you don't get a toxic level in your system. People aren't told about this and it's very important. I wish you all the best and a speedy recovery, Paul.
Posted by CareBear04 on March 13, 2006, at 8:14:25
In reply to Lithium » CareBear04, posted by 4WD on March 10, 2006, at 22:38:01
hi marsha,
i'm not on lithium anymore, unfortunately, but i recommend it highly. the reason i'm not on it is becuase it has a very narrow therapeutic window, so i kept getting sick from doses that shouldn't have made me toxic.
i've been on anywhere from 450mg of eskalith (long-acting lithium) to 1800mg a day. when i first started lithium, i had an easier time tolerating eskalith becuase i didn't get the upset stomach, nausea, and other GI side effects that generic lithium gave me. later, i was able to switch over to generic lithium. at a low dose, i don't think i noticed side effects at all. in fact, up till about 900mg, i could hardly tell i was on it. the only thing i noticed was a little bit of a tremor in my hands, which a bit of propranolol took care of. when i got up to the higher doses, the side effects were too much. i was thirsty all the time and only wanted to drink sweet, sugary juices, and i had to pee all the time. i felt more nauseated and tired.i think you'll do fine on lithium 600mg. it's a low enough dose that you don't need to worry about toxicity, and if you do end up having GI side effects, i would recommend trying Eskalith CR. it tends to be milder, plus it's long-acting. i prefer it over lithobid.
good luck and let me know if you have more questions!
CB
Posted by Cybele on March 13, 2006, at 8:24:46
In reply to Re: PDOC wants me to try a mood stabilizer » Cybele, posted by tizza on March 11, 2006, at 3:05:06
> Hey cybele, the only mood stabliser I have tried was Epilim (Depakote, sodium valproate in the US) I found it turned me into a walking zombie but I must concede that I was chilled out too much but I felt like sh*t and it started to make me sick but I was on other meds at the time. If you do go on a mood stabliser including Lithium or what ever else it may be, make sure you have regular BLOOD TESTS to make sure you don't get a toxic level in your system. People aren't told about this and it's very important. I wish you all the best and a speedy recovery, Paul.
Thanks, Paul. I also take Synthroid for hypothyroidism, and I'll want to make sure I get my TSH checked even more regularly. My PDOC is going to call me today to talk about it all. I missed his call to my cell phone on Friday by a fraction of a second, and he left a message then immediately split for the weekend. I hate it when that happens, lol.
This is the end of the thread.
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