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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by CA 2 NJ on April 18, 2007, at 7:25:48
Hello everyone! I hope you all are doing well and have a wonderful day! LOL I sound like Mr. Rogers... (for those of you old enough to remember the PBS TV Show Mr. Roger's Neighborhood.)
I would like to know what the best antidepressant is for someone with Bipolar. I currently take Prozac but notice that in the literature it lists mania and hypomania as side effects.I should mention that I have just started taking Depakote ER at 500mg at bedtime so that should help with any wild mood swings. And if all goes well with the 500mg, My Psychiatrist mentioned going up to 1,000mg of the ER Version. In addition, I take 100mg of Seroquel at bedtime which is also supposed to help.
I am sure there are MANY of you out there who have Bipolar and have had to take an antidepressant with or without a mood stabilizer. So I am wondering, which one(s) have worked best for you? Or have you heard of working best?
I have a friend who has Bipolar among many other things that are similar to me, and she swears by Effexor. I have taken Effexor, but that was years ago before I was diagnosed with Bipolar. When they said I had Major Depression and Panic Disorder. And I have to say it made my Panic Attacks vanish and I was able to tolerate it for 3 years. The longest I've ever been on ANY med. But it was the only med I was on, so I don't know how it would do in a combo.
Also I should mention that I have only been with my current Psychiatrist for about 3 weeks now and have only been on Prozac (now 10 mgs, was on 20 for a few days) for that amount of time. I'm not sure if it's working as I started taking it at the same time as Geodon. But I quit taking that yesterday because it seemed to give me extreme anxiety and insomnia. It was bad.
When I started seeing my new Psychiatrist, he gave me the choice of either Prozac or Effexor. He told me that Prozac is better for Anxiety and Effexor better for depression, so I went with Prozac because my anxiety has been horrible for months. Although I always thought Prozac is the most stimulating???
I can't say whether or not the Prozac is working or will work at 10mg or even 20mg, so I am not against it at all. And it does seem to help with my appetite, so I like that. But not enough to not feel my best on a day-to-day basis.
I just want to get some opinions from people who have been where I am. So if any of you have any information you'd be willing to share, I would be very grateful as I'm to go see my Psychiatrist soon and he wants to discuss this then.
Thanks so much for reading my lengthy post. I hope someone out there will give me something to go on as I NEED to get better. I've been out of work for almost 2 years because of all this! :( Before I even knew I was Bipolar!
Take good care everyone. I hope to hear from you soon! Have a great day! :)
Hugs,
CA 2 NJ
Posted by polarbear206 on April 18, 2007, at 9:20:53
In reply to ADVICE NEEDED: Best Antidepressant for Bipolar I?, posted by CA 2 NJ on April 18, 2007, at 7:25:48
> Hello everyone! I hope you all are doing well and have a wonderful day! LOL I sound like Mr. Rogers... (for those of you old enough to remember the PBS TV Show Mr. Roger's Neighborhood.)
>
>
> I would like to know what the best antidepressant is for someone with Bipolar. I currently take Prozac but notice that in the literature it lists mania and hypomania as side effects.
>
> I should mention that I have just started taking Depakote ER at 500mg at bedtime so that should help with any wild mood swings. And if all goes well with the 500mg, My Psychiatrist mentioned going up to 1,000mg of the ER Version. In addition, I take 100mg of Seroquel at bedtime which is also supposed to help.
>
> I am sure there are MANY of you out there who have Bipolar and have had to take an antidepressant with or without a mood stabilizer. So I am wondering, which one(s) have worked best for you? Or have you heard of working best?
>
> I have a friend who has Bipolar among many other things that are similar to me, and she swears by Effexor. I have taken Effexor, but that was years ago before I was diagnosed with Bipolar. When they said I had Major Depression and Panic Disorder. And I have to say it made my Panic Attacks vanish and I was able to tolerate it for 3 years. The longest I've ever been on ANY med. But it was the only med I was on, so I don't know how it would do in a combo.
>
> Also I should mention that I have only been with my current Psychiatrist for about 3 weeks now and have only been on Prozac (now 10 mgs, was on 20 for a few days) for that amount of time. I'm not sure if it's working as I started taking it at the same time as Geodon. But I quit taking that yesterday because it seemed to give me extreme anxiety and insomnia. It was bad.
>
> When I started seeing my new Psychiatrist, he gave me the choice of either Prozac or Effexor. He told me that Prozac is better for Anxiety and Effexor better for depression, so I went with Prozac because my anxiety has been horrible for months. Although I always thought Prozac is the most stimulating???
>
> I can't say whether or not the Prozac is working or will work at 10mg or even 20mg, so I am not against it at all. And it does seem to help with my appetite, so I like that. But not enough to not feel my best on a day-to-day basis.
>
> I just want to get some opinions from people who have been where I am. So if any of you have any information you'd be willing to share, I would be very grateful as I'm to go see my Psychiatrist soon and he wants to discuss this then.
>
> Thanks so much for reading my lengthy post. I hope someone out there will give me something to go on as I NEED to get better. I've been out of work for almost 2 years because of all this! :( Before I even knew I was Bipolar!
>
> Take good care everyone. I hope to hear from you soon! Have a great day! :)
>
>
> Hugs,
> CA 2 NJ
>Hi,
I'm back to answer your questions. I'll help you out with my experiences. I am a psychiatric nurse from Pa. I have what is called "soft" bipolar II. I am on a drug regime of Effexor, Lamictal and Lithium. In my own opinion, Effexor is one of the best AD's on the market. I have been on it for years, and have been highly functional. I am very passionate about helping those seek out proper diagnosis and treatment. It's very sad that many bipolars walk around for 10 years or so before being diagnosed. My illness erupted after the birth of my son 18 years ago. I threw myself into gaining as much knowledge about my illness. I basically diagnosed myself. My life turned around when I started Lamictal. I've been on it for about 10 years now. I still have some soft cycling around my time of the month and when the seasons change (this is very common with bipolar). My bipolar is depression dominated with atypical features. I have some mixed states and I get irritable, anxious and have anxiety. My ups consist of good energy, goal directed activity, and and the dreaded sleep disturbances. I absolutely love effexor, can't say enough good things about it. I've been on many AD's. To name some; imipramine, prozac, paxil, desipramine, rememron, parnate (made me hypomanic) wellbutrin (gave me anxiety, did nothing for depression). The best I did before Effexor came on the market was combining an SSRI with a tricyclic. So,as you can see, the Effexor was the perfect choice for my situation. The only drawback is sexual side effects. Since adding Lithium, I lowered my dose and this is much improved.
Right now the most impportant thing is to stop you cycling and regain a normal sleep/wake cycle. As I said in the above post, Depakote will help you. You have to be very careful with AD's and Bipolar I. Take the least amt. possible to prevent mood cycling. Once you feel stable, as far as the cycling goes, and the depression is still lingering, you can play around with you dosages. Keep it low and go slow is my motto.
>
Polarbear,
Effexor, 225mg
Lamictal 200mg
Lithium 300mg
Posted by CA 2 NJ on April 18, 2007, at 9:41:10
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I? » CA 2 NJ, posted by polarbear206 on April 18, 2007, at 9:20:53
> > Hello everyone! I hope you all are doing well and have a wonderful day! LOL I sound like Mr. Rogers... (for those of you old enough to remember the PBS TV Show Mr. Roger's Neighborhood.)
> >
> >
> > I would like to know what the best antidepressant is for someone with Bipolar. I currently take Prozac but notice that in the literature it lists mania and hypomania as side effects.
> >
> > I should mention that I have just started taking Depakote ER at 500mg at bedtime so that should help with any wild mood swings. And if all goes well with the 500mg, My Psychiatrist mentioned going up to 1,000mg of the ER Version. In addition, I take 100mg of Seroquel at bedtime which is also supposed to help.
> >
> > I am sure there are MANY of you out there who have Bipolar and have had to take an antidepressant with or without a mood stabilizer. So I am wondering, which one(s) have worked best for you? Or have you heard of working best?
> >
> > I have a friend who has Bipolar among many other things that are similar to me, and she swears by Effexor. I have taken Effexor, but that was years ago before I was diagnosed with Bipolar. When they said I had Major Depression and Panic Disorder. And I have to say it made my Panic Attacks vanish and I was able to tolerate it for 3 years. The longest I've ever been on ANY med. But it was the only med I was on, so I don't know how it would do in a combo.
> >
> > Also I should mention that I have only been with my current Psychiatrist for about 3 weeks now and have only been on Prozac (now 10 mgs, was on 20 for a few days) for that amount of time. I'm not sure if it's working as I started taking it at the same time as Geodon. But I quit taking that yesterday because it seemed to give me extreme anxiety and insomnia. It was bad.
> >
> > When I started seeing my new Psychiatrist, he gave me the choice of either Prozac or Effexor. He told me that Prozac is better for Anxiety and Effexor better for depression, so I went with Prozac because my anxiety has been horrible for months. Although I always thought Prozac is the most stimulating???
> >
> > I can't say whether or not the Prozac is working or will work at 10mg or even 20mg, so I am not against it at all. And it does seem to help with my appetite, so I like that. But not enough to not feel my best on a day-to-day basis.
> >
> > I just want to get some opinions from people who have been where I am. So if any of you have any information you'd be willing to share, I would be very grateful as I'm to go see my Psychiatrist soon and he wants to discuss this then.
> >
> > Thanks so much for reading my lengthy post. I hope someone out there will give me something to go on as I NEED to get better. I've been out of work for almost 2 years because of all this! :( Before I even knew I was Bipolar!
> >
> > Take good care everyone. I hope to hear from you soon! Have a great day! :)
> >
> >
> > Hugs,
> > CA 2 NJ
> >
>
> Hi,
>
> I'm back to answer your questions. I'll help you out with my experiences. I am a psychiatric nurse from Pa. I have what is called "soft" bipolar II. I am on a drug regime of Effexor, Lamictal and Lithium. In my own opinion, Effexor is one of the best AD's on the market. I have been on it for years, and have been highly functional. I am very passionate about helping those seek out proper diagnosis and treatment. It's very sad that many bipolars walk around for 10 years or so before being diagnosed. My illness erupted after the birth of my son 18 years ago. I threw myself into gaining as much knowledge about my illness. I basically diagnosed myself. My life turned around when I started Lamictal. I've been on it for about 10 years now. I still have some soft cycling around my time of the month and when the seasons change (this is very common with bipolar). My bipolar is depression dominated with atypical features. I have some mixed states and I get irritable, anxious and have anxiety. My ups consist of good energy, goal directed activity, and and the dreaded sleep disturbances. I absolutely love effexor, can't say enough good things about it. I've been on many AD's. To name some; imipramine, prozac, paxil, desipramine, rememron, parnate (made me hypomanic) wellbutrin (gave me anxiety, did nothing for depression). The best I did before Effexor came on the market was combining an SSRI with a tricyclic. So,as you can see, the Effexor was the perfect choice for my situation. The only drawback is sexual side effects. Since adding Lithium, I lowered my dose and this is much improved.
>
> Right now the most impportant thing is to stop you cycling and regain a normal sleep/wake cycle. As I said in the above post, Depakote will help you. You have to be very careful with AD's and Bipolar I. Take the least amt. possible to prevent mood cycling. Once you feel stable, as far as the cycling goes, and the depression is still lingering, you can play around with you dosages. Keep it low and go slow is my motto.
>
>
> >
> Polarbear,
> Effexor, 225mg
> Lamictal 200mg
> Lithium 300mg
>Oh thank you, thank you, thank you! I am SO HAPPY about your response! And I believe you're 100% correct with Effexor being a good choice for those with Bipolar. I also remember it helping with my anxiety which even now is a problem with all the "sedating" drugs I take. At this very moment I feel it coming on stronger and stronger. :(
I know this Prozac is doing it to me. This darned anxiety. Either that or it's the Xanax and I really doubt that one! :)
Since My Psychiatrist wants me to stay where I'm at with my meds until my appointment in a week & 1/2, I called My General Physician as they know all about me and my history. I wanna see if they will give me a script for 37.5 of Effexor XR. I believe they will. I hope so anyway!
Also I am in total agreement with you about starting low and going slow. I say that myself! LOL And I like to take the least amount of medication needed. It seems like my new Psychiatrist just can't wait to ramp up the dosage even though I've told him I am very sensitive to meds and a little goes further with me than most.
He just laughed and said that all of his Anxiety patients are the same way. Well duh! Doesn't that mean maybe he should stop going by the PDR and take this into consideration? I dunno. Kind of irritates me when Doctors don't listen to me...
I am actually considering finding a new Psychiatrist as this one is an hour away and I don't like how he wouldn't change the Prozac to Effexor when I spoke to his office yesterday. He's the one who gave me a choice of the 2 in the 1st place. And the ONLY reason I chose Prozac is because he said it was better for anxiety and Effexor is better for depression.
Anyway, I apologize for my rant. I'm just irritated and anxious about this whole situation. But thanks to you I now know I do want to try the Effexor again. Thank you so much! Your post has inspired me. :)
Take good care and I wish you all the best. Today and everyday. :)
Hugs,
CA 2 NJ
Posted by Phillipa on April 18, 2007, at 11:15:06
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I? » CA 2 NJ, posted by polarbear206 on April 18, 2007, at 9:20:53
Good advise polarbear and so glad you found a working combo. I've always been under the impression also that prozac is the most activating ad. Am I correct? Love Phillipa
Posted by CA 2 NJ on April 18, 2007, at 11:44:23
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I? » polarbear206, posted by Phillipa on April 18, 2007, at 11:15:06
> Good advise polarbear and so glad you found a working combo. I've always been under the impression also that prozac is the most activating ad. Am I correct? Love Phillipa
Thanks again for your kind response. I really appreciate it! :) And I also believe it is the most stimulating.
Yes I agree with PolarBear all the way. Now I have a problem though... I'm totally Manic and Panicky as heck right now and have been since a while after taking my stupid Prozac. It's bad! :(
I have called my Primary Care Physician's Office 3x already today trying to talk to someone to get me some Effexor until my next appointment with My Psychiatrist. And maybe something else to calm me down as I am extremely agitated and ANXIOUS!!!
Also I called another Psychiatrist which is about 1/2 hour away from here to make an appointment, but the earliest I can get in is May 29. The Psychiatrist I am seeing now is an hour away and a crappy commute. Plus I don't feel he's any better than any other psychiatrist I've seen since I AM THE ONE who had to beg to get on a true mood stabilizer as the Geodon he prescribed didn't do it for me.
Does anyone have any ideas? I am already taking 4mg of Xanax XR a day, 500 MG of Depakote (just started), 100mg of Seroquel and 3mg of Lunesta. I am no longer going to take the Prozac. I may give the Geodon another shot in the future but not while on Prozac!
I thought it was the Geodon that was doing this to me, but I think it's the Prozac because the other times I have taken it I got all whacked out too and it lasts for a long time since it has such a long half-life. Ughhh.
I am so desperate right now! I feel like crying but I'm too riled up to. Not sure why that is effecting it, but I can't cry! LOL It's weird.
Also one more thing... could the Xanax XR actually be stimulating me a bit? Sometimes I feel like it does. Would Klonopin do that? I am willing to switch to anything just so I can feel better!
If anyone has any answers for me, I beg you please to write me as I'm goin' crazy over here. I may page my Psychiatrist even though I have already done that a couple of times in the past week and 1/2. Help!
Thanks everyone for your support. It means more than you'll ever know. :)
Hugs,
CA 2 NJ
Posted by polarbear206 on April 18, 2007, at 13:40:37
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I? » polarbear206, posted by Phillipa on April 18, 2007, at 11:15:06
> Good advise polarbear and so glad you found a working combo. I've always been under the impression also that prozac is the most activating ad. Am I correct? Love Phillipa
Yes, Prozac is more activating in my opinion. The one thing you have to be careful with using prozac with Bipolar I is that if it throws you into mania,hypomania or mixed states, it has a long half-life, where as a drug like Paxil has a half-life of about 3 days. Many p-docs feel its more safe to use a AD with a short half-life, esp. if they want to discontinue d/t severe cases of cycling and psychotic mania.Thanks,
Polarbear
Posted by polarbear206 on April 18, 2007, at 14:04:34
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I? » Phillipa, posted by CA 2 NJ on April 18, 2007, at 11:44:23
> > Good advise polarbear and so glad you found a working combo. I've always been under the impression also that prozac is the most activating ad. Am I correct? Love Phillipa
>
> Thanks again for your kind response. I really appreciate it! :) And I also believe it is the most stimulating.
>
> Yes I agree with PolarBear all the way. Now I have a problem though... I'm totally Manic and Panicky as heck right now and have been since a while after taking my stupid Prozac. It's bad! :(
>
> I have called my Primary Care Physician's Office 3x already today trying to talk to someone to get me some Effexor until my next appointment with My Psychiatrist. And maybe something else to calm me down as I am extremely agitated and ANXIOUS!!!
>
> Also I called another Psychiatrist which is about 1/2 hour away from here to make an appointment, but the earliest I can get in is May 29. The Psychiatrist I am seeing now is an hour away and a crappy commute. Plus I don't feel he's any better than any other psychiatrist I've seen since I AM THE ONE who had to beg to get on a true mood stabilizer as the Geodon he prescribed didn't do it for me.
>
> Does anyone have any ideas? I am already taking 4mg of Xanax XR a day, 500 MG of Depakote (just started), 100mg of Seroquel and 3mg of Lunesta. I am no longer going to take the Prozac. I may give the Geodon another shot in the future but not while on Prozac!
>
> I thought it was the Geodon that was doing this to me, but I think it's the Prozac because the other times I have taken it I got all whacked out too and it lasts for a long time since it has such a long half-life. Ughhh.
>
> I am so desperate right now! I feel like crying but I'm too riled up to. Not sure why that is effecting it, but I can't cry! LOL It's weird.
>
> Also one more thing... could the Xanax XR actually be stimulating me a bit? Sometimes I feel like it does. Would Klonopin do that? I am willing to switch to anything just so I can feel better!
>
> If anyone has any answers for me, I beg you please to write me as I'm goin' crazy over here. I may page my Psychiatrist even though I have already done that a couple of times in the past week and 1/2. Help!
>
> Thanks everyone for your support. It means more than you'll ever know. :)
>
> Hugs,
> CA 2 NJ
HiI forgot to mention that I have taken klonopin on and off for 18 years. Good drug! It is approved by the FDA for bipolar mania. However, do not use it as adjunctive therapy with your Depakote for long term. Use on a as needed basis. In your situation, it would benefit you better than the Xanax. Of course you can use it daily to get you over the hump, then just use when needed.
Thanks for the kind words.
Polarbear
Posted by CA 2 NJ on April 18, 2007, at 16:22:32
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I? » CA 2 NJ, posted by polarbear206 on April 18, 2007, at 14:04:34
> > > Good advise polarbear and so glad you found a working combo. I've always been under the impression also that prozac is the most activating ad. Am I correct? Love Phillipa
> >
> > Thanks again for your kind response. I really appreciate it! :) And I also believe it is the most stimulating.
> >
> > Yes I agree with PolarBear all the way. Now I have a problem though... I'm totally Manic and Panicky as heck right now and have been since a while after taking my stupid Prozac. It's bad! :(
> >
> > I have called my Primary Care Physician's Office 3x already today trying to talk to someone to get me some Effexor until my next appointment with My Psychiatrist. And maybe something else to calm me down as I am extremely agitated and ANXIOUS!!!
> >
> > Also I called another Psychiatrist which is about 1/2 hour away from here to make an appointment, but the earliest I can get in is May 29. The Psychiatrist I am seeing now is an hour away and a crappy commute. Plus I don't feel he's any better than any other psychiatrist I've seen since I AM THE ONE who had to beg to get on a true mood stabilizer as the Geodon he prescribed didn't do it for me.
> >
> > Does anyone have any ideas? I am already taking 4mg of Xanax XR a day, 500 MG of Depakote (just started), 100mg of Seroquel and 3mg of Lunesta. I am no longer going to take the Prozac. I may give the Geodon another shot in the future but not while on Prozac!
> >
> > I thought it was the Geodon that was doing this to me, but I think it's the Prozac because the other times I have taken it I got all whacked out too and it lasts for a long time since it has such a long half-life. Ughhh.
> >
> > I am so desperate right now! I feel like crying but I'm too riled up to. Not sure why that is effecting it, but I can't cry! LOL It's weird.
> >
> > Also one more thing... could the Xanax XR actually be stimulating me a bit? Sometimes I feel like it does. Would Klonopin do that? I am willing to switch to anything just so I can feel better!
> >
> > If anyone has any answers for me, I beg you please to write me as I'm goin' crazy over here. I may page my Psychiatrist even though I have already done that a couple of times in the past week and 1/2. Help!
> >
> > Thanks everyone for your support. It means more than you'll ever know. :)
> >
> > Hugs,
> > CA 2 NJ
>
>
> Hi
>
> I forgot to mention that I have taken klonopin on and off for 18 years. Good drug! It is approved by the FDA for bipolar mania. However, do not use it as adjunctive therapy with your Depakote for long term. Use on a as needed basis. In your situation, it would benefit you better than the Xanax. Of course you can use it daily to get you over the hump, then just use when needed.
>
> Thanks for the kind words.
>
> Polarbear
>You are so very welcome. :) I just call 'em like I see 'em. Hee hee
Yes I actually wouldn't mind looking into weaning off the Xanax and onto Klonopin. It's funny you mention this because before I read your message, I was talking to My Fiance about this. LOL
As for switching to Effexor (or anything else), I called my Psychiatrist and he told me it's not the Prozac making me anxious/have insomnia/manic. And that he thinks I'm "JUST" anxious. I didn't like that as I was really freaking out and he seemed to make light of it. I feel only those who experience panic attacks and mixed states truly understand how horrible it is.
He also told me that I will have the same problem if I switch to Effexor and that will be of no help. Also he said that I should either up My dosage of Prozac (yeah right!) or go inpatient until I stabilize because there's been too many medication changes. Even though he gave me the choice of either Effexor or Prozac just 3 weeks ago... I dunno... Sounds like he's throwing in the towel already.
Well after that lovely conversation, I called My Primary Care Clinic where I see either the Nurse Practitioner or a Doctor. I spoke with the Nurse Practitioner and told her that I am in between Psychiatrists and that all I want is a prescription of Effexor XR 37.5mg to take once per day until I can see my New Psychiatrist.
Well she said she didn't feel comfortable prescribing to me because I am on so many meds, but that she feels I should talk to the Doctor. So she made me an appointment tomorrow at 11 AM. And knowing him, he probably will help me out. Hopefully.
Anyway all I know is I have had a hard time since being diagnosed with Bipolar (and Borderline PD.) I have actually been turned away by more than a few Doctors and Clinics because my condition is "too complex and difficult" to treat. That's a terrible feeling and scary because it makes me wonder if anyone will ever help me.
I hope I didn't make myself sound like I overreacted because I promise I really haven't. When a patient is in a Agitated/Anxious/Manic (or shall I say, mixed) state, I don't think their Psychiatrist should basically chew them out for not wanting to take what he said I should take even though it's causing such severe symptoms.
So anyway that's been my day so far. LOL How has everyone else's been? Hopfully better than mine! :) I'm just extremely grateful for My Doctor and Nurse Practitioner. Even if they don't give me a prescription. At least they didn't make light of my feelings and situation and took me seriously.
I have 1 question... Do any of you think I was wrong in not wanting to take something I know good and well is making me a nervous wreck even though My Psychiatrist disagrees? And do you think I am wrong in wanting to seek help elsewhere because he doesn't seem to "get" me?
Thanks again for your support and replies. I hope to hear back from some of you soon as I would like to know what you think of what transpired today.
Take good care and have a great day/night! :)
Hugs,
CA 2 NJP.S. And I do plan on going to my current Psychiatrist once more to get my medications for a month until my appointment with my new Doc. :)
Posted by Sebastian on April 21, 2007, at 23:38:27
In reply to Re: ADVICE NEEDED: Best Antidepressant for Bipolar I?, posted by CA 2 NJ on April 18, 2007, at 16:22:32
When I find something that does not work, I generaly stop taking it. And call docs voice mail and explain why. He is more understanding when I actualy stop on my own.
This is the end of the thread.
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