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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 43. Go back in thread:
Posted by linkadge on November 29, 2006, at 21:23:38
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 29, 2006, at 17:18:56
Like I said, we cannot base the experience of many doctors on just one case. We could ask other people on this board. Its not just an old wives tale. I'm sure SLS has heard of the phenomina.
Again, I am in no way saying that this is a guarenteed thing, there is just a possability that it will not work if you discontinue and start again.
I don't think that valproate has gained this reputation. Ie, I don't think there are a substantial number of cases suggesting that valproate looses effect if discontinued and restarted.
Lithium is acutally proconvulsant. It is not good in cases of epileptiform brain activity. I was under the impression that my rage reaction to lithium was due to some sort of temporal lobe proconvulsant activity. The rage was even more pronounced if I combined it with an SSRI. Lithium made the music in my head much worse, it also worsened my insomnia, wherase valproate did not.
Tegretol also did not worsen isomnia,When I restarted lithium, I would have taken it for nearly a year the second time. Although, I never regained the state of wellness that I had when I took it the first time.
Antidepressants were added to no avail.
At this point valproate worked better.
This is not a lithum bashing session on my part, its just my experience thats all.
>So, valproate is not necessarily proof of >superiourity to lithium but rather appropriate >dampening of a brain state, which lithium will >correct given a concurrent dose of benzos.Well, possably. If the lithium benzo combination is working for you than great, no worries.
I had taken lithium + clonazepam, or lithium + lorazepam, but adding the benzos just made depression worse. At this point, like I said, valproate worked better.
This is not a matter of valproate being a better drug, just that it does work better in certain cases, (for instance, valproate is often superior to lithium when it comes to rapid cycling.)
Linkadge
Posted by linkadge on November 29, 2006, at 21:25:52
In reply to Re: Maybe all drugs are like this » linkadge, posted by Crazy Horse on November 29, 2006, at 18:52:10
I don't think cobain was actually bipolar. I think that hollywood was too much pressure for him, I also think his heroin use was what killed him.
Bipolar or not, maybe lithium would have helped.
Linakdge
Posted by linkadge on November 29, 2006, at 21:30:01
In reply to Re: Maybe all drugs are like this, posted by Phillipa on November 29, 2006, at 19:23:24
My mother has been on and off lithium for 30 years. She has also had a number of toxic blood levels due to accidental (I hope) overdoses.
While it still is of some theraputic value, she has been in a deep depression for ~8 years despite theraputic lithium dose.
Doctors are hesitant to add antidepressants since she has such a history of rapid cycling.
She is on,
lithium 1050mg
risperidal 1mg
bromazepam 6mgOverall, I think the lithium is doing something, but she is not well.
Linkadge
Posted by Crazy Horse on November 29, 2006, at 21:44:38
In reply to Re: Maybe all drugs are like this » Crazy Horse, posted by linkadge on November 29, 2006, at 21:25:52
> I don't think cobain was actually bipolar. I think that hollywood was too much pressure for him, I also think his heroin use was what killed him.
>
> Bipolar or not, maybe lithium would have helped.
>
>
> LinakdgeYea, he definitely liked Heroin (self-medication?). What a waste of a life of a young, very talented man!
-MJ
Posted by Phillipa on November 29, 2006, at 21:48:29
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 21:30:01
Link is your Mother no better I'm so sorry. But she's able to care for herself isn't she? Love Jan ps I get so scared when I hear of what's happened long term to others even younger than me.
Posted by Squiggles on November 30, 2006, at 8:08:52
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 21:23:38
> Like I said, we cannot base the experience of many doctors on just one case. We could ask other people on this board. Its not just an old wives tale. I'm sure SLS has heard of the phenomina.
>
>
.............I respect your experience. I am sorry you had
such troule upon stopping and not regaining
stability. I agree, that this is the kind of
issue that is best tested with large samples
of people and not just on the basis of hypotheses
on the nature of lithium and valproate -- they
are different drugs, but as i have read, actually effect the same areas of the brain. Perhaps dose and speed of reinstatement are variables too.Squiggles
Posted by Squiggles on November 30, 2006, at 8:11:39
In reply to Re: Maybe all drugs are like this » Crazy Horse, posted by linkadge on November 29, 2006, at 21:25:52
> I don't think cobain was actually bipolar. I think that hollywood was too much pressure for him, I also think his heroin use was what killed him.
>
> Bipolar or not, maybe lithium would have helped.
>
>
> LinakdgeI read in a pulp magazine that he was just out of
rehab, when he was found with a bullet in his
head, and something like 10x the amount of heroin
to kill seasoned users. No lithium was mentioned.Squiggles
Posted by Squiggles on November 30, 2006, at 8:15:34
In reply to Re: Maybe all drugs are like this » linkadge, posted by Phillipa on November 29, 2006, at 21:48:29
> Link is your Mother no better I'm so sorry. But she's able to care for herself isn't she? Love Jan ps I get so scared when I hear of what's happened long term to others even younger than me.
It might be good to get a general check-up,
and if facilities permit, an EEG.Squiggles
Posted by linkadge on November 30, 2006, at 10:12:14
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 30, 2006, at 8:08:52
>actually effect the same areas of the brain
Lithium and valproate are similar on certain domains. Their ability to inhibit PKC-epsilon, GSK-3b, and increase BCL-2, and BDNF, but they are *not* identical in all their actions.
If they were identical in their actions, then lithium would be effective for epilepsy which it is not. They have similarities, but the sum of a lot of experience says that the two are usefull for different varients.
There are people who respond to one and not the other, for instance.
Linkadge
Posted by linkadge on November 30, 2006, at 10:14:41
In reply to Re: Maybe all drugs are like this » Phillipa, posted by Squiggles on November 30, 2006, at 8:15:34
The sees doctors all the time. There is nothing medically wrong except bipolar.
Each member of my family can attest to the fact that there were clear cut deteriorations in her state after each toxic lithium event.
Linkadge
Posted by Squiggles on November 30, 2006, at 10:51:22
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 30, 2006, at 10:12:14
> >actually effect the same areas of the brain
>
> Lithium and valproate are similar on certain domains. Their ability to inhibit PKC-epsilon, GSK-3b, and increase BCL-2, and BDNF, but they are *not* identical in all their actions.
>
> If they were identical in their actions, then lithium would be effective for epilepsy which it is not. They have similarities, but the sum of a lot of experience says that the two are usefull for different varients.
>
> There are people who respond to one and not the other, for instance.
>
>
>
>
>
>
>
> Linkadge
>I can't argue with that :-)
How about a combination of lithium and
valproate? Right now, i think the clinical
guidelines are to give lithium with clonazepam,
which present serious problems upon withdrawal,
or maybe even displacement in dose fluctuations.
I read in the Merck that one drug can displace another. Excuse my layman's understanding.
Clonazepam presents serious withdrawal, like
epileptic fits upon "displacement[if that is
what is happening in lithium dose fluctuation];Squiggles
Posted by Squiggles on November 30, 2006, at 11:03:44
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 30, 2006, at 10:14:41
> The sees doctors all the time. There is nothing medically wrong except bipolar.
>
> Each member of my family can attest to the fact that there were clear cut deteriorations in her state after each toxic lithium event.
>
> LinkadgeThat's not good. Why are her doctors still
keeping her on lithium, given that deterioration?Squiggles
Posted by Squiggles on November 30, 2006, at 11:20:48
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 30, 2006, at 10:14:41
I thought Dr. Bob's Forum was private;
this looks too public for my liking.http://www.neurotransmitter.net/wiki/tiki-index.php?page=Psycho-Babble+by+Dr.+Bob
Squiggles
Posted by linkadge on November 30, 2006, at 16:47:23
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 30, 2006, at 10:51:22
If the combination of lithium and clonazepam is keeping you stable don't change it.
Yeah, benzo withdrawl or anticonvulsant withdrawl can cause status epilepticus.
Linkadge
Posted by linkadge on November 30, 2006, at 16:51:52
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on November 30, 2006, at 11:03:44
Well, lithium has been the only one that worked to any degree in the past.
She went toxic a few times by double or tripple dosing.
She would forget that she had taken the drugs and then take them again.
Thats what she said. It could have been a suicide attempt as she has made actual attepts in the past.
Linkadge
Posted by linkadge on November 30, 2006, at 16:53:20
In reply to NOT SURE I LIKE WHAT I FOUND ON THE NET » linkadge, posted by Squiggles on November 30, 2006, at 11:20:48
Yeah, strange.
Linkadge
Posted by Squiggles on November 30, 2006, at 17:02:43
In reply to Re: NOT SURE I LIKE WHAT I FOUND ON THE NET » Squiggles, posted by linkadge on November 30, 2006, at 16:53:20
> Yeah, strange.
>
> LinkadgeYour ears are too big. I'm going to have
to speak softly and carry a big stick. :-)Squiggles
Posted by gardenergirl on November 30, 2006, at 17:03:50
In reply to Re: NOT SURE I LIKE WHAT I FOUND ON THE NET » linkadge, posted by Squiggles on November 30, 2006, at 17:02:43
Dr. Bob's site is indexed by Google. It's only as private as anything else on the internet. That's why it's important to be cautious when disclosing any personal, private, or otherwise identfiying information.
gg
Posted by squiggles on November 30, 2006, at 17:07:09
In reply to Re: NOT SURE I LIKE WHAT I FOUND ON THE NET, posted by gardenergirl on November 30, 2006, at 17:03:50
Thank you for the information gardenergirl.
Squiggles
Posted by Phillipa on November 30, 2006, at 18:59:03
In reply to Re: NOT SURE I LIKE WHAT I FOUND ON THE NET » gardenergirl, posted by squiggles on November 30, 2006, at 17:07:09
Yes once I posted my e-mail and then asked Dr. Bob to remove which he graciously did. I'd only give it out via babblemail. Love Phillipa
Posted by naughtypuppy on December 1, 2006, at 10:43:41
In reply to Re: Maybe all drugs are like this, posted by linkadge on November 29, 2006, at 16:43:30
> I don't know who argued that lithium will make you kill yourself because it does have a documented antisuicide effect.
>
> Infact, lithium and clozapine are the only two psychiatric medications that have a statisically significant proven anti-sucide effect.
>
>
> >First of all, you *do* get back to normal
> >after getting off lithium, but it is very
> >painful, for me at least.
>
> I'm not saying that everybody who discontinues the drug fails to regain theraputic effect, but it has been documented that some people do fail to regain theraputic effect after discontinuation.
>
> Linkadge
>
>
>
>
>
I read somewhere that about 10% of people that stop Parnate, find it effective and then restarted it at a later time had found that it had lost it's effectiveness. IMHO this is absolutely true. I found Parnate to be the best AD that I had tried so far, but had to discontinue because of allergic reactions. I went back on it several months later with the addition of very powerful antihistamines to combat the allergic reactions but the Parnate had lost all it's effectiveness. I see no obvious reason to belive that this would not occure with other medications as well.
Posted by Squiggles on December 2, 2006, at 19:39:02
In reply to Re: Maybe all drugs are like this » linkadge, posted by naughtypuppy on December 1, 2006, at 10:43:41
> I read somewhere that about 10% of people that stop Parnate, find it effective and then restarted it at a later time had found that it had lost it's effectiveness. IMHO this is absolutely true. I found Parnate to be the best AD that I had tried so far, but had to discontinue because of allergic reactions. I went back on it several months later with the addition of very powerful antihistamines to combat the allergic reactions but the Parnate had lost all it's effectiveness. I see no obvious reason to belive that this would not occure with other medications as well.
>
>I am sceptical about this idea as applied to more
than your experience. Take a look at this:From PubMed:
ABSTRACT:
1: Drugs. 1996 Apr;51(4):552-70. Related Articles, Links
Causes and problems of nonresponse or poor response to drugs.
Salva Lacombe P, Garcia Vicente JA, Costa Pages J, Lucio Morselli P.
Clinical Pharmacology Department, Uniersity Hospital, Germans Trias
i Pujol, Badalona, Spain.The lack of (or poor) response to drugs has very important medical,
social and economic consequences today. An unsatisfactory response to
treatment implies not only a worsening or prolongation of the
pathological state, but also prolonged hospitalisation, longer
withdrawal from social and active life, and waste of community
resources. Poor response to drugs has many and varied causes, among
which 4 major categories can be identified: pharmacokinetic, cellular,
genetic and medical. After a brief description of the terminology, the
phenomena of tachyphylaxis, tolerance and drug resistance are analysed
and critically described on the basis of the available evidence.
Whenever possible, alternative or operative behaviours aimed at reducing
the incidence of the above phenomena are commented on. On the question
of medical causes, irrational prescriptions and poor compliance with the
prescribed regimen stand as two major issues whose prevalence is
worrying. In order to limit the waste of professional responsibility and
economic resources, efforts aimed at reducing the present
insufficiencies are needed at organisational and educational levels.------------
I am more inclined to this interpretation.Squiggles
Posted by linkadge on December 3, 2006, at 9:32:04
In reply to Re: Maybe all drugs are like this » naughtypuppy, posted by Squiggles on December 2, 2006, at 19:39:02
>After a brief description of the terminology, the
>phenomena of tachyphylaxis, tolerance and drug >resistance are analysed
>and critically described on the basis of the >available evidence.This is the same interpratation. The abstact you gave provides no quantification of the incidence, nor does it dismiss the occurence.
Linkadge
Posted by Squiggles on December 3, 2006, at 10:02:02
In reply to Re: Maybe all drugs are like this » Squiggles, posted by linkadge on December 3, 2006, at 9:32:04
>
> >After a brief description of the terminology, the
> >phenomena of tachyphylaxis, tolerance and drug >resistance are analysed
> >and critically described on the basis of the >available evidence.
>
> This is the same interpratation. The abstact you gave provides no quantification of the incidence, nor does it dismiss the occurence.
>
> Linkadge
>
>
>I don't have access to the full article, but
this is a general explanation. You have not
provided statistical quotes on drugs stopping
to work either.
"On the question of medical causes, irrational prescriptions and poor compliance with the
prescribed regimen stand as two major issues whose prevalence is worrying. In order to limit the waste of professional responsibility and
economic resources, efforts aimed at reducing the present insufficiencies are needed at organisational and educational levels."As I said before, the above provides a wider
spectrum of possible errors in prescribing, with
the "apparent" result of the drug not working
anymore... for example, the loading speed, dose
and time; the possible change in brand or generic;
the introduction of another drug; the short or long wash-out period, a medical change in the patient -- all these variables should
be considered before putting the onus on the drug alone, as if it has a mysterious self-regulating end.Squiggles
Posted by SLS on December 3, 2006, at 10:50:08
In reply to Re: Maybe all drugs are like this » linkadge, posted by Squiggles on December 3, 2006, at 10:02:02
In the mid 1990s, there were several reports similar to the abstract I included here regarding lithium. There was some debate on the matter at the time, but there has been little interest in follow up.
A friend of mine had been maintained on lithium monotherapy for eight years before her doctor allowed her to discontinue it. She relapsed into depression within a few months. Restarting lithium therapy was ineffective in recapturing the antidepressant effect.
It is my thought that antidepressants produce long-term changes in the brain. Afterall, that is how they work. They do not produce remission upon acute administration. I can imagine that some changes in the system persist beyond the discontinuation of a drug. There might even be a rebound effect once the drug is removed. The net effect of these persistent changes might be to leave the system less "vulnerable" to the antidepressant reaction that needs to take place in order for remission to occur.
It has long been counseled by psychopharmacologists to avoid "pulsing" antidepressants so as to prevent non-response. This recommendation has been given since the age of the tricyclics. If one were to take at face value the reports of people posting on psychobabble, this phenomenon of non-response upon re-exposure to a previously effective drug is fairly common.
- Scott
------------------------------------1: Am J Psychiatry. 1992 Dec;149(12):1727-9. Links
Comment in:
Am J Psychiatry. 1993 Nov;150(11):1756.
Am J Psychiatry. 1994 Oct;151(10):1522.Lithium-discontinuation-induced refractoriness: preliminary observations.
* Post RM,
* Leverich GS,
* Altshuler L,
* Mikalauskas K.Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.
The authors used a systematic life-chart methodology to observe four patients with bipolar disorder in whom long periods (6-15 years) of effective lithium prophylaxis were followed by relapses on lithium discontinuation. Once the drug was reinstituted, it was no longer effective. The incidence, predictors, and mechanisms underlying this phenomenon all require further systematic study. The current preliminary observations suggest an additional reason for caution when lithium discontinuation in the well-maintained patient is considered.
PMID: 1443252 [PubMed - indexed for MEDLINE]
------------------------------------
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