![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by linkadge on July 27, 2007, at 15:18:54
The reason I don't think I am bipolar is that I did fine on celexa alone for almost 3 years.
The big problems started to occur when I stopped it, and tried to restart it. I think I had a psychotic like reaction to the withdrawl and reintroduction that I never got over.
Sure my mood was swinging around at that point.
So, my question is, are there any "bipolars" who did just fine on an antidepressant alone for a long time, before other symtpoms came in?
Linkadge
Posted by Phillipa on July 27, 2007, at 17:23:56
In reply to Any bipolars do well on AD alone for a long time?, posted by linkadge on July 27, 2007, at 15:18:54
Well with all the new categories how would a person even know if they were one of the bipolar spectrum? Too much overlap between depression/ anxiety to me. Love Phillipa
Posted by med_empowered on July 28, 2007, at 12:32:36
In reply to Any bipolars do well on AD alone for a long time?, posted by linkadge on July 27, 2007, at 15:18:54
I'm supposedly bipolar of some sort, but never had a problem with antidepressant monotherapy (aside from the lack of effectiveness..that was kind of lame).
Supposedly, antidepressants can flatten out your moods if you have bipolar-lite; I guess that makes sense, if you consider the effects on dopamine can be kind of neuroleptic-ish.
On the other hand, I know a guy who was more or less OK (recurrent depression) pre-SRIs; they kindled or cycled him straight into hardcore Bipolar I territory.
Posted by nellie7 on July 28, 2007, at 13:11:52
In reply to Any bipolars do well on AD alone for a long time?, posted by linkadge on July 27, 2007, at 15:18:54
Hi Linkadge,
I suspect that I suffer from some kind of bipolar disorder and have been keeping it under control using celexa alone.
Lately I have been having mild typical symptoms but adding vitamin D seems to be helping.Nellie.
Posted by Bonnie_CA on July 29, 2007, at 12:24:17
In reply to Any bipolars do well on AD alone for a long time?, posted by linkadge on July 27, 2007, at 15:18:54
I *thought* I was doing well on SSRIs alone for a long time. I have discovered recently that I could have been better. Being on a mood stabilizer has really helped me a lot. I always figure that if the medicine prescribed is successfully treating the condition it's trying to treat, then the diganosis must be right. In this case, past events also piece together my diagnosis. Had I come to this conclusion sooner, I could have found out sooner that life wasn't that grand on SSRI monotherapy.
-Bonnie
Posted by linkadge on July 29, 2007, at 12:57:00
In reply to Re: Any bipolars do well on AD alone for a long time? » linkadge, posted by Bonnie_CA on July 29, 2007, at 12:24:17
May I ask what you were taking before and after that relization?
The only reason I ask is that things only got worse for me after the addition of mood stabilizers.
Linkadge
Posted by dewdropinn on July 30, 2007, at 12:25:10
In reply to Any bipolars do well on AD alone for a long time?, posted by linkadge on July 27, 2007, at 15:18:54
My experience mirrors yours -- 3 years of glorious remission on Zoloft, followed by Zoloft pooping out on me, followed by a drug quest that encompassed almost every legally obtainable psycho-active substance known to man.
You may already be away of the "kindling" theory, but if not, here's the nickle tour -- if left untreated, epilepsy grows worse over time, with seizures becoming more frequent and severe -- a lot of researchers think the same thing is at work with bipolar -- cycling if left untreated becomes increasingly severe, eventually bringing very obvious bipolar symptoms to the fore. SSRIs are among the worse drugs for bipolars -- so it goes to folllow that SSRIs kick this whole process into hyper-drive. It makes you wonder whether or not the emergence of wide-spread bipolarity is associated with the wide-spread administration of SSRIs.
Mood stablizers are a tricky bunch. They all are capable of making you feel miserable, and they can all have nasty start-up side effects -- some can be downright vicious like depakote and lithium, although many are able to take both without serious problems. So, your response isn't at all abnormal, and it doesn't mean that mood stabilizers aren't the ticket to your recovery.
Anti-convulsants impact brain function in a broad fashion, but most target specific areas of the brain. So negative or positive responses can vary widely depending upon the primary location of your brain hyperactivity and the brain areas that are targeted by a particular medication.
For bipolar 1, antidepressants are usually problematic, but there's some controversy over whether or not this is the case with bipolar 2 and the softer varieties of the disorder. There's general agreement that you need to stabilize mood first -- which sometimes means an initial increase in depression -- but this can be treated with antidepressants later on. It's almost as if the anti-convulsant lays the foundation for successful anti-depressant therapy by counteracting the destabilizing aspects of anti-depressants. It was only when I hit upon the right mood stabilizer -- Lamictal -- at the right dosage -- 400mg -- that I was able to benefit from anti-depressant therapy -- EMSAM 9mg.
So, feeling bad on mood stabilizers is not necessarily a bad thing -- and if you suffer from a bipolar spectrum disorder, you will almost certainly need to take one.
Drew
> The reason I don't think I am bipolar is that I did fine on celexa alone for almost 3 years.
>
> The big problems started to occur when I stopped it, and tried to restart it. I think I had a psychotic like reaction to the withdrawl and reintroduction that I never got over.
>
> Sure my mood was swinging around at that point.
>
> So, my question is, are there any "bipolars" who did just fine on an antidepressant alone for a long time, before other symtpoms came in?
>
> Linkadge
Posted by linkadge on July 30, 2007, at 17:07:11
In reply to My Experience Mirrors Yours, posted by dewdropinn on July 30, 2007, at 12:25:10
>You may already be away of the "kindling" >theory, but if not, here's the nickle tour -- if >left untreated, epilepsy grows worse over time, >with seizures becoming more frequent and severe ->- a lot of researchers think the same thing is >at work with bipolar -- cycling if left >untreated becomes increasingly severe, >eventually bringing very obvious bipolar >symptoms to the fore.
I have heard of the kindling theory, but I don't really know if it really has all the answers. Not all epilepsy gets worse over time. Epilepsy in woman, for instance, can tend to get better after menopause.
>SSRIs are among the worse drugs for bipolars -- >so it goes to folllow that SSRIs kick this whole >process into hyper-drive. It makes you wonder >whether or not the emergence of wide-spread >bipolarity is associated with the wide-spread >administration of SSRIs.There could be a number of factors. I personally believe that the SSRI's antidepressants are inadequate for a lot of people. For the most part, a person has a choice between some sort of med with serotonin reuptake inhibition, or a mood stabilizer. Who says every depressed person has a too high level of the serotonin transporter? Infact the majority of studies suggest that there is a decreased level of serotonin transporter in depression!
I personally think that a patient could be unipolar, and yet still have an agitated response to an antidepressant. Even in healthy vaulenteers, SSRI's can induce akathesia, insomnia, etc etc. Animal models too, suggest that SSRI's can cause agitation, rapid cycling etc. It is my personal contention that a patient need not be bipolar to have a agitated type response to an SSRI. Some studies are showing that individuals with the SS varient of the serotonin transporter, have poor responses to SSRI's, and get all the nasty agitated side effects. I think that psychiatrty doesn't have all the answers, but they want to propose they have all the answers. As such, if you have a poor response to an SSRI, you must be bipolar. Perhaps there is yet some unidentified biochemical abnormalitity that would infact treat depressed patients who show poor response to SSRI's *and* poor response to mood stabilizers.
>Mood stablizers are a tricky bunch. They all are >capable of making you feel miserable, and they >can all have nasty start-up side effects -- some >can be downright vicious like depakote and >lithium, although many are able to take both >without serious problems. So, your response >isn't at all abnormal, and it doesn't mean that >mood stabilizers aren't the ticket to your >recovery.I have had it with mood stabilizers! Unless some real amazing mood stabilizers come around soon then I don't think I am going to go that route.
Mood stabilizers took me from depressed to more depressed. Lithium, depakote, tegretol, trileptal, even the so-called "magig bullit" lamotrigine made me feel so incredably lousy.The problem with me, is that after I fully withdrew from SSRI's, (ie say 4 months after), the cycling stoped. Ie, I only really had cycling upon withdrawl, not during treatment, and not some time after. After 4 months off AD's, I just sunk back into intollerable depression like before AD's. It was that 4 month period of what I consider wathdrawl induced rapid cycling which got me the diagnosis of bipolar.
>Anti-convulsants impact brain function in a >broad fashion, but most target specific areas of >the brain. So negative or positive responses can >vary widely depending upon the primary location >of your brain hyperactivity and the brain areas >that are targeted by a particular medication.I think thats overhyped. The so-called, temporal lobe selctivity of drugs like tegretol is not all that selective. Lamotrigine, for instance, affects sodium chanels througout the whole body. That is why it can, for instance, affect cardiac sodium chanels in higher doses. The drugs made me dumber than a bag of nails, they locked be into an intollerable depressive state. Lithium and depakote are certainly not limbic selective, they affect ion channels throughout the brain equally.
>For bipolar 1, antidepressants are usually >problematic, but there's some controversy over >whether or not this is the case with bipolar 2 >and the softer varieties of the disorder. >There's general agreement that you need to >stabilize mood first -- which sometimes means an >initial increase in depressionBut I am not really unstable. I have been drug free for almost 3 or 4 years. I have remained essentially stable (in a depressed state) the whole time.
> -- but this can >be treated with >antidepressants later on. It's almost as if the >anti-convulsant lays the foundation for >successful anti-depressant therapy by >counteracting the destabilizing aspects of anti->depressants.For me, antidepressants and anticonvulsants did not mix well at all. They did not restore response to antidepressants, they also did not have any antidepressant effect on their own. These were not really short trials either.
>It was only when I hit upon the right mood >stabilizer -- Lamictal -- at the right dosage -- >400mg -- that I was able to benefit from anti->depressant therapy -- EMSAM 9mg.
Thats great. I had been on lamotrigine up to 300mg. The higher I went the more lousy I felt. I couldn't think straght or thing straight, it gave me problems walking, sleeping eating, heart palpitions, strange paranoia. It did nothing for my depression if not made it worse.
>So, feeling bad on mood stabilizers is not >necessarily a bad thing -- and if you suffer >from a bipolar spectrum disorder, you will >almost certainly need to take one.
I don't think I can continue to take them. I think I have been misdiagnosed as bipolar based on a SSRI withdrawl induced manic/psychotic reaction from a abrupt dopamine rebound from SSRI withdrawl.
Thanks for the post. When you find something that works, it is easier to believe the accompanying theory. However, sufficiant trials of mood stabilizers have left me feeling consistantly worse.When antidepressants fail, and mood stabilizers don't help, you're kind a screwed.
Linakdge
Posted by dewdropinn on July 30, 2007, at 19:55:17
In reply to Re: My Experience Mirrors Yours, posted by linkadge on July 30, 2007, at 17:07:11
I think you're right on all counts -- and I definitely empathize with your frustrations and hope you can find a solution.
I can't tell you how much suffering I had to endure after a doc determined that under no circumstances could I take an antidepressant -- I spent about a year in mood stabilizer induced suspended animation. I've definitely taken my share of "magig bullits" (I love that one by the way.) Thankfully, I was able to consult with someone who had a contrary opinion regarding antidepressants and the treatment of soft bipolar spectrum disorders.
Ultimately, I don't think it's a question of believing or not believing a given theory. A theory is simply a construct that provides a way of explaining larger phenomena -- theories can suggest answers that lead to constructive solutions, but they can also be incredibly dangerous when people begin treating them as scientific facts rather than simply as a model for future investigation. And it seems like you are contending with the application of theories that are presented as "the answer" even though "the answer" clearly isn't "the answer." I lost many years contending with answers that weren't.
Ultimately, I think you seem to have a fairly reasonable immediate term solution. If the effect of a given treatment doesn't result in net benefits after a reasonable trial -- e.g. you felt better before taking it -- then it stands to reason that you're better off without it.
I really empathize with you and wish you all the best.
Drew
> >You may already be away of the "kindling" >theory, but if not, here's the nickle tour -- if >left untreated, epilepsy grows worse over time, >with seizures becoming more frequent and severe ->- a lot of researchers think the same thing is >at work with bipolar -- cycling if left >untreated becomes increasingly severe, >eventually bringing very obvious bipolar >symptoms to the fore.
>
> I have heard of the kindling theory, but I don't really know if it really has all the answers. Not all epilepsy gets worse over time. Epilepsy in woman, for instance, can tend to get better after menopause.
>
>
> >SSRIs are among the worse drugs for bipolars -- >so it goes to folllow that SSRIs kick this whole >process into hyper-drive. It makes you wonder >whether or not the emergence of wide-spread >bipolarity is associated with the wide-spread >administration of SSRIs.
>
> There could be a number of factors. I personally believe that the SSRI's antidepressants are inadequate for a lot of people. For the most part, a person has a choice between some sort of med with serotonin reuptake inhibition, or a mood stabilizer. Who says every depressed person has a too high level of the serotonin transporter? Infact the majority of studies suggest that there is a decreased level of serotonin transporter in depression!
>
> I personally think that a patient could be unipolar, and yet still have an agitated response to an antidepressant. Even in healthy vaulenteers, SSRI's can induce akathesia, insomnia, etc etc. Animal models too, suggest that SSRI's can cause agitation, rapid cycling etc. It is my personal contention that a patient need not be bipolar to have a agitated type response to an SSRI. Some studies are showing that individuals with the SS varient of the serotonin transporter, have poor responses to SSRI's, and get all the nasty agitated side effects. I think that psychiatrty doesn't have all the answers, but they want to propose they have all the answers. As such, if you have a poor response to an SSRI, you must be bipolar. Perhaps there is yet some unidentified biochemical abnormalitity that would infact treat depressed patients who show poor response to SSRI's *and* poor response to mood stabilizers.
>
>
> >Mood stablizers are a tricky bunch. They all are >capable of making you feel miserable, and they >can all have nasty start-up side effects -- some >can be downright vicious like depakote and >lithium, although many are able to take both >without serious problems. So, your response >isn't at all abnormal, and it doesn't mean that >mood stabilizers aren't the ticket to your >recovery.
>
> I have had it with mood stabilizers! Unless some real amazing mood stabilizers come around soon then I don't think I am going to go that route.
> Mood stabilizers took me from depressed to more depressed. Lithium, depakote, tegretol, trileptal, even the so-called "magig bullit" lamotrigine made me feel so incredably lousy.
>
> The problem with me, is that after I fully withdrew from SSRI's, (ie say 4 months after), the cycling stoped. Ie, I only really had cycling upon withdrawl, not during treatment, and not some time after. After 4 months off AD's, I just sunk back into intollerable depression like before AD's. It was that 4 month period of what I consider wathdrawl induced rapid cycling which got me the diagnosis of bipolar.
>
>
> >Anti-convulsants impact brain function in a >broad fashion, but most target specific areas of >the brain. So negative or positive responses can >vary widely depending upon the primary location >of your brain hyperactivity and the brain areas >that are targeted by a particular medication.
>
> I think thats overhyped. The so-called, temporal lobe selctivity of drugs like tegretol is not all that selective. Lamotrigine, for instance, affects sodium chanels througout the whole body. That is why it can, for instance, affect cardiac sodium chanels in higher doses. The drugs made me dumber than a bag of nails, they locked be into an intollerable depressive state. Lithium and depakote are certainly not limbic selective, they affect ion channels throughout the brain equally.
>
>
> >For bipolar 1, antidepressants are usually >problematic, but there's some controversy over >whether or not this is the case with bipolar 2 >and the softer varieties of the disorder. >There's general agreement that you need to >stabilize mood first -- which sometimes means an >initial increase in depression
>
> But I am not really unstable. I have been drug free for almost 3 or 4 years. I have remained essentially stable (in a depressed state) the whole time.
>
>
> > -- but this can >be treated with >antidepressants later on. It's almost as if the >anti-convulsant lays the foundation for >successful anti-depressant therapy by >counteracting the destabilizing aspects of anti->depressants.
>
> For me, antidepressants and anticonvulsants did not mix well at all. They did not restore response to antidepressants, they also did not have any antidepressant effect on their own. These were not really short trials either.
>
> >It was only when I hit upon the right mood >stabilizer -- Lamictal -- at the right dosage -- >400mg -- that I was able to benefit from anti->depressant therapy -- EMSAM 9mg.
>
> Thats great. I had been on lamotrigine up to 300mg. The higher I went the more lousy I felt. I couldn't think straght or thing straight, it gave me problems walking, sleeping eating, heart palpitions, strange paranoia. It did nothing for my depression if not made it worse.
>
> >So, feeling bad on mood stabilizers is not >necessarily a bad thing -- and if you suffer >from a bipolar spectrum disorder, you will >almost certainly need to take one.
>
> I don't think I can continue to take them. I think I have been misdiagnosed as bipolar based on a SSRI withdrawl induced manic/psychotic reaction from a abrupt dopamine rebound from SSRI withdrawl.
>
>
> Thanks for the post. When you find something that works, it is easier to believe the accompanying theory. However, sufficiant trials of mood stabilizers have left me feeling consistantly worse.
>
> When antidepressants fail, and mood stabilizers don't help, you're kind a screwed.
>
>
> Linakdge
>
>
Posted by linkadge on July 31, 2007, at 8:43:48
In reply to Re: My Experience Mirrors Yours, posted by dewdropinn on July 30, 2007, at 19:55:17
>think you're right on all counts -- and I >definitely empathize with your frustrations and >hope you can find a solution.
>I can't tell you how much suffering I had to >endure after a doc determined that under no >circumstances could I take an antidepressant -- >I spent about a year in mood stabilizer induced >suspended animation. I've definitely taken my >share of "magig bullits" (I love that one by the >way.)
Yeah, that was a typo. I hope that pointing this out wasn't an attempt to rectify my accusations on the propensity of mood stabilizers to cause "dumb as a bag of nails syndrome". :)
>Thankfully, I was able to consult with someone >who had a contrary opinion regarding >antidepressants and the treatment of soft >bipolar spectrum disorders.
Thats it. There is no conscensious on how antidepressants should be used to treat bipolar. I think they are afraid to say that it really depends on the patient. I think they're afraid to admit they don't have a solid answer. Some bipolars simply won't get well unless they are on an antidepressant. They might have some intracellular issues as well as monoamine issues.
>Ultimately, I don't think it's a question of >believing or not believing a given theory. A >theory is simply a construct that provides a way >of explaining larger phenomena -- theories can >suggest answers that lead to constructive >solutions, but they can also be incredibly >dangerous when people begin treating them as >scientific facts rather than simply as a model >for future investigation. And it seems like you >are contending with the application of theories >that are presented as "the answer" even >though "the answer" clearly isn't "the answer." >I lost many years contending with answers that >weren't.I can agree with that.
Although it makes it difficult when all you have available is the type of doctor that believes in the hardcore heuristics.
>Ultimately, I think you seem to have a fairly >reasonable immediate term solution. If the >effect of a given treatment doesn't result in >net benefits after a reasonable trial -- e.g. >you felt better before taking it -- then it >stands to reason that you're better off without it.
Thanks for the post.
Linkadge
Posted by dewdropinn on July 31, 2007, at 11:04:57
In reply to Re: My Experience Mirrors Yours, posted by linkadge on July 31, 2007, at 8:43:48
At the risk of volunteering advise that falls in the "of course I've considered that" category, I might advise trying to arrange for a consultation with a research psychiatrist at NIMH, John's Hopkins (their really on the front lines with this stuff), or another similarly hallowed hall of psychopharm research. This is what made all the difference for me. Like you, I had a doctor who approached the bipolar -- a steady diet of mood stabilizers and anti-psychotics. Fortunately, he was good friends with an equally old school, semi-retired, big time researcher who initiated some of the groundbreaking research at NIMH back in the 60's, 70's and 80's -- it was truly a situation where I was literally talking to one of the gods in psychiatry.
He started out by drawing this squiggly line diagram that was his cosmos of medications, including all the experimental ones and drugs of lore like Largactil and Dilantin -- he noted neurotransmitters, drew up and down lines depending upon whether a med increased or decreased neurotrasmitter activity, and he made a bunch of marvelous conceptual comments -- next to Lamictal he wrote "take your foot off the gas!" He was generally of the "psychopharm as art rather than science" -- it's not that there isn't a great deal of science, study and research involved with every drug, it's that it's very easy to get lost in the infinite minutia of known, unknown, possible activity of a given drug -- if you view it as an art, you prescribe drugs based on a conceptual understanding of how each drug works and interacts with other drugs -- it makes the whole cosmos of possibilities managable. Thin slicing at it's finest.
As for the bipolar issue, he was in generally in agreement with the treatment guidelines for classic bipolar, but he indicated that it wasn't uncommon to prescribe antidepressants in difficult cases -- I believe Wellbutrin and the MAOIs were the preferred options of choice. With softer bipolar, antidepressants were definitely a viable option, and commonly used, but almost always with some kind of mood stabilizer. So, he affirmed general accepted theories on the treatment of bipolar, but readily acknowledged that there are a whole lot of exceptions to the rule -- and many more with bipolar 2 and soft bipolar.
He came up with an A-H treatment algorithm, and sent me on my way. Option C turned out to be the winner -- Lamictal, up symbol + EMSAM or similiar up symbol. Fortunately, I had taken just about every antidepressant -- I knew what might work and what definitely didn't work -- I knew for instance that I could take wellbutrin, so long as I had a mood stabilizer onboard; I had a lot of success with selegiline, but only in combination with a mood stabilizer. I also knew what mood stabilizers worked, kind of worked, and definitely didn't work -- Lamictal was at the top of the list, Tegretol came in second, so long as it was taken with some kind of antidepressant, Trileptal came in third; and very low dose Depakote was the final viable option -- anything over 125mg was just brutal, but about 1/4 of the sprinkle cap was tolerable and beneficial. Note -- none of these mood stabilizers were effective by themselves, and most of them made depression worse without some kind of antidepressant add-on. The other thing that I knew from experience is that I couldn't take antidepressants without a mood stabilizer -- they were either totally ineffective, or they lost their efficacy over time, or they made me more anxious and made sleep virtually impossible. I was in a very similar situation to yours -- antidepressants and mood stabilizers didn't work by themselves, but when combined good things began happening.
One final note and then I'll then I'll stand back and say -- "I look forward to seeing how everything goes" -- because honestly, there's very little I could add. Finding a true research doc for a consultation appointment would be ideal, but may not be feasable due to financial and geographical issues -- my second suggestion would be to either work with your doctor to at least give antidepressants w/ mood stabilizers a try or to find one who's willing to explore alternatives -- mood stabilizers alone clearly isn't an option. As far as possible drug options to explore or at least inquire about, I would suggest discussing Tegretol and Trileptal with your doctor -- alone these drugs will make almost certainly make things worse, but in combination with Wellbutrin, Tricyclic or even an SSRI they may improve things tremedously (sadly, you can't take Tegretol with an MAOI.) One of the interesting aspects of Tegretol was it's effect on cognition -- I suddenly started thinking musically again, re-gained my writing chops, and re-gained much of the creativity that I thought I'd lost -- it made me more depressed, but it gave me something as well. Depakote sprinkles are another option well worth exploring, again make sure to take with an antidepressant, because I can almost assure you it will increase depression to some degree -- Depakote doesn't improve cognition, but it does have a noticable anti-anxiety component -- the key for me was pouring out a tinsy tiny amout from the 125mg sprinkle cap -- for me, the 250mg pills were a one way trip to total, complete and utter misery in every way imaginable. I think you've actually made some real discoveries -- recognizing that antidepressants and mood stabilizers alone are not beneficial may be a real insight into your particular condition, and may lead the way to finding an optimal combination -- I'm also guessing that you've had some positive responses to select antidepressants, so you may have already sorted out the most viable add-on options. I have a feeling that you're going to hit upon a combination that leads to improvement, if not total remission -- unfortunately, you've still got to go through the trial and error rodeo, but I think some pieces of the puzzle may already be on the board.
Best of luck -- and I look forward to hearing how everything goes.
Drew
> >think you're right on all counts -- and I >definitely empathize with your frustrations and >hope you can find a solution.
>
> >I can't tell you how much suffering I had to >endure after a doc determined that under no >circumstances could I take an antidepressant -- >I spent about a year in mood stabilizer induced >suspended animation. I've definitely taken my >share of "magig bullits" (I love that one by the >way.)
>
> Yeah, that was a typo. I hope that pointing this out wasn't an attempt to rectify my accusations on the propensity of mood stabilizers to cause "dumb as a bag of nails syndrome". :)
>
>
> >Thankfully, I was able to consult with someone >who had a contrary opinion regarding >antidepressants and the treatment of soft >bipolar spectrum disorders.
>
>
> Thats it. There is no conscensious on how antidepressants should be used to treat bipolar. I think they are afraid to say that it really depends on the patient. I think they're afraid to admit they don't have a solid answer. Some bipolars simply won't get well unless they are on an antidepressant. They might have some intracellular issues as well as monoamine issues.
>
>
> >Ultimately, I don't think it's a question of >believing or not believing a given theory. A >theory is simply a construct that provides a way >of explaining larger phenomena -- theories can >suggest answers that lead to constructive >solutions, but they can also be incredibly >dangerous when people begin treating them as >scientific facts rather than simply as a model >for future investigation. And it seems like you >are contending with the application of theories >that are presented as "the answer" even >though "the answer" clearly isn't "the answer." >I lost many years contending with answers that >weren't.
>
> I can agree with that.
>
> Although it makes it difficult when all you have available is the type of doctor that believes in the hardcore heuristics.
>
> >Ultimately, I think you seem to have a fairly >reasonable immediate term solution. If the >effect of a given treatment doesn't result in >net benefits after a reasonable trial -- e.g. >you felt better before taking it -- then it >stands to reason that you're better off without it.
>
> Thanks for the post.
>
> Linkadge
>
>
Posted by dewdropinn on July 31, 2007, at 11:55:52
In reply to Re: My Experience Mirrors Yours, posted by linkadge on July 31, 2007, at 8:43:48
As you are probably well aware, all anti-convulsants have proven effective augmentors of antidepressants, with the exception of Zonegran and Keppra (both of which are so new that I don't believe any studies have occured yet -- and I feel truly sorry for those depressives who participate in the Keppra study -- it reduced me to a raging, blubbering blob.) So, even if you proceed with the unipolar depression hypothesis, there's good reason to believe you will benefit from the addition of an anti-convulsant. There will almost certainly be some trial and error involved in finding the right med, but these anti-convulsants are all unique in their own fashion, so there's a good chance that you will ultimately find one that works for you. Last but not least, keep in mind that almost all anti-convulsants make a bad first impression and only become your friends after you get to know them -- which usually takes 2-4 weeks.
Best of luck.
Drew
> >think you're right on all counts -- and I >definitely empathize with your frustrations and >hope you can find a solution.
>
> >I can't tell you how much suffering I had to >endure after a doc determined that under no >circumstances could I take an antidepressant -- >I spent about a year in mood stabilizer induced >suspended animation. I've definitely taken my >share of "magig bullits" (I love that one by the >way.)
>
> Yeah, that was a typo. I hope that pointing this out wasn't an attempt to rectify my accusations on the propensity of mood stabilizers to cause "dumb as a bag of nails syndrome". :)
>
>
> >Thankfully, I was able to consult with someone >who had a contrary opinion regarding >antidepressants and the treatment of soft >bipolar spectrum disorders.
>
>
> Thats it. There is no conscensious on how antidepressants should be used to treat bipolar. I think they are afraid to say that it really depends on the patient. I think they're afraid to admit they don't have a solid answer. Some bipolars simply won't get well unless they are on an antidepressant. They might have some intracellular issues as well as monoamine issues.
>
>
> >Ultimately, I don't think it's a question of >believing or not believing a given theory. A >theory is simply a construct that provides a way >of explaining larger phenomena -- theories can >suggest answers that lead to constructive >solutions, but they can also be incredibly >dangerous when people begin treating them as >scientific facts rather than simply as a model >for future investigation. And it seems like you >are contending with the application of theories >that are presented as "the answer" even >though "the answer" clearly isn't "the answer." >I lost many years contending with answers that >weren't.
>
> I can agree with that.
>
> Although it makes it difficult when all you have available is the type of doctor that believes in the hardcore heuristics.
>
> >Ultimately, I think you seem to have a fairly >reasonable immediate term solution. If the >effect of a given treatment doesn't result in >net benefits after a reasonable trial -- e.g. >you felt better before taking it -- then it >stands to reason that you're better off without it.
>
> Thanks for the post.
>
> Linkadge
>
>
Posted by linkadge on July 31, 2007, at 13:07:23
In reply to Re: My Experience Mirrors Yours, posted by dewdropinn on July 31, 2007, at 11:04:57
Well, you've certainly said some stuff that makes some sense. However, I do think that there are disorders that simply do not fall into the rhelm of treatment with current medications.
For instance, the endocannabanoid system may have future application to mood disorders. Individuals suffering certain symptoms of melancholic depression appear to have deficiant endocannabanoid function. Marajuanna is kind of part antidepressant, part anxiolytic, part mood stabilizer. I would personally like to see the application of drugs like URB-597 on patients with marked insomnia, weight loss, anhedonia, agitation, psychomotor restlesness.
My mother too has some kind of inbetween disorder. She's seen doctors all across this country (Canada) and into the States. She's been hospitalized numerous times and really doesn't get a whole lot better. She saw a doctor in Michigan. She said to him, "I',m not your typical Bipolar". The doctor said to her "You're not typical anything!".
Unfortunately people like me often just get called complainers. Or that there is nothing wrong. Just because we have little that helps says their is nothing wrong?
I had more sucess with TCA's. Clomipramine and doxapin were helpful. My current doctor refused to prescribe them however! He said I would have a difficult time getting them filled at pharmacies. What a bunch of B.S. that is. (ALthough, I am partially to blame since I stopped taking clomiprmaine on my own on account of its genotoxicity.) Its not that it didn't help, I was just too afraid of developing cancer.
>I might advise trying to arrange for a >consultation with a research psychiatrist at >NIMH, John's Hopkins (their really on the front >lines with this stuff), or another similarly
>hallowed hall of psychopharm research.That'd be great, but I can't even find a regular psychiatrist. My current one left for a year break. He left me with a year of refills of drugs that are doing dittely.
>As for the bipolar issue, he was in generally in >agreement with the treatment guidelines for >classic bipolar, but he indicated that it wasn't >uncommon to prescribe antidepressants in >difficult cases -- I believe Wellbutrin and the >MAOIs were the preferred options of choice.
Suprisingly Wellbutrin is one I havn't tried. Probably on account of my symptoms of anxiety.
I tried parnate, but had a spontanious hypertensive crisis that landed me in the hospital. They took me off it although, I think it was doing something.The problem is that I am scared of mood stabilizers. Tegretol is directly neurotoxic to proliferating hippocampal neurons (possable source of exaserbating depression). Dilantin is neurotoxic. Sustained use of dilaintin with actually lead to skull thickening. Sustained exposure to tegretol often damamges the cerebellum. I am afraid of what long term treatment with psychiatric drugs can do based on how they have affected my mother.
>I had a lot of success with selegiline, but only >in combination with a mood stabilizer. I also >knew what mood stabilizers worked, kind of >worked, and definitely didn't work -- Lamictal >was at the top of the list, Tegretol came in >second, so long as it was taken with some kind >of antidepressant, Trileptal came in third; and >very low dose Depakote was the final viable >option -- anything over 125mg was just brutal, >but about 1/4 of the sprinkle cap was tolerable >and beneficial.
Depakote is heavy. I have tried lithium, depakote, trileptal, tegretol, and lamotrigine, in combination with various SSRI's, SNRI's, and some TCA's. The combinations were killers for me.
>Note -- none of these mood stabilizers were >effective by themselves, and most of them made >depression worse without some kind of >antidepressant add-on. The other thing that I >knew from experience is that I couldn't take >antidepressants without a mood stabilizer -- >they were either totally ineffective, or they >lost their efficacy over time, or they made me >more anxious and made sleep virtually >impossible.
See I have this too, but I hesitate to call it bipolar. A lot of these reactions are documented side effects of the drugs. I have never had a manic reaction to a drug. The only manic period I had was from SSRI withdrawl.
>One final note and then I'll then I'll stand >back and say -- "I look forward to seeing how >everything goes" -- because honestly, there's >very little I could add. Finding a true research >doc for a consultation appointment would be >ideal, but may not be feasable due to financial >and geographical issues -- my second suggestion >would be to either work with your doctor to at >least give antidepressants w/ mood stabilizers >atry or to find one who's willing to explore >alternatives -- mood stabilizers alone clearly >isn't an option. As far as possible drug options >to explore or at least inquire about, I would >suggest discussing Tegretol and Trileptal with >your doctor.
Been on them both with and without antidepressnats. They often lock me into a very dark place. I took tegretol with celexa for about half a year. I just slept, ate, cried, well you know the story.
>One of the interesting aspects of Tegretol was >it's effect on cognition -- I suddenly started >thinking musically again, re-gained my writing >chops, and re-gained much of the creativity that >I thought I'd lost -- it made me more depressed, >but it gave me something as well.
Strange, I had the opposite reaction. I developed abnormal pitch preception (where everything felt like it dropped a semitone). I also had to quit playing the organ at a church on account of numbness and loss of dexterity. I felt like I couldn't feel the music at all. I felt no desire to play.
>Depakote sprinkles are another option well worth >exploring, again make sure to take with an >antidepressant, because I can almost assure you >it will increase depression to some degree -- >Depakote doesn't improve cognition, but it does >have a noticable anti-anxiety component -- the >key for me was pouring out a tinsy tiny amout >from the 125mg sprinkle cap -- for me, the 250mg >pills were a one way trip to total, complete and >utter misery in every way imaginable. I think >you've actually made some real discoveries -- >recognizing that antidepressants and mood >stabilizers alone are not beneficial may be a >real insight into your particular condition, and >may lead the way to finding an optimal >combination.
I should have made it clear in previous posts that I have tried numerous antideprssant mood stabilizer combinations. The mood stabilizers usually make anhedonia much worse regardless of whether am on or off an antidepressant.
(granted I havn't taken all antidepressants)
> -- I'm also guessing that you've had some >positive responses to select antidepressants, so >you may have already sorted out the most viable >add-on options. I have a feeling that you're >going to hit upon a combination that leads to >improvement, if not total remission -- >unfortunately, you've still got to go through >the trial and error rodeo, but I think some >pieces of the puzzle may already be on the board.I wouldn't get my hopes up. I've seen my mother desintigrate in spite of the best and most dedicated effort of doctors. I know I am not my mother, I just have no faith in the efficacy of these treatments. Perhaps thats why I respond so poorly.
Linkadge
Posted by linkadge on July 31, 2007, at 13:19:55
In reply to Final Final Note, posted by dewdropinn on July 31, 2007, at 11:55:52
>As you are probably well aware, all anti->convulsants have proven effective augmentors of >antidepressants, with the exception of Zonegran >and Keppra (both of which are so new that I >don't believe any studies have occured yet -- >and I feel truly sorry for those depressives who >participate in the Keppra study -- it reduced me >to a raging, blubbering blob.)
In some studies yes. But again, it probably depends on the exact underlying biochemical abnormalties. Some depression may be a result of hyperactive limbic glutamatergic function, but some may be a result of hypofunction. SSRI's antidepressants and anticonvulsants may have effect where there is some sort of underlying gabaergic dysfunction. Lithium, for instance, doesn't really augment everybody's antidepressant. Lithium is also an atypical augmentor in that it probably enhances the serotonergic function of antidepressants via 5-ht1b. So lithium is actually has intracellular and monoaminergic functions. Lithium aside though, there is really only limited evidence of augmentation capability of anticonvulsants. Tegretol, and depakote have some, lamotrigine has some too, but thats about all.
Its funny, because you can go on the GSK website (where they have decided to disclose all clinical trial data). You will see a registry of trials lamotrigine. There are like 20 or so trials. I would say more than 90% of those trials are negative. These were studies of bipolar, unipolar, and schizophrenia augmentation. Yet, based on 1 out of 10 sucessfull trials lamotrigine has such a reputation? This is unwarranted in my opinion.
>So, even if you proceed with the unipolar >depression hypothesis, there's good reason to >believe you will benefit from the addition of an >anti-convulsant.
>keep in mind that almost all anti-convulsants >make a bad first impression and only become your >friends after you get to know them -- which >usually takes 2-4 weeks.You'd think then that they would be my friends after a year or so (?)
P.S. I don't mean to be pessimistic. I certainly appreciate your effort, but my web of negative bias goes far too deep.
Linkadge
Posted by dewdropinn on July 31, 2007, at 18:04:14
In reply to Re: My Experience Mirrors Yours, posted by linkadge on July 31, 2007, at 13:07:23
Yikes! What can I say man? I wouldn't worry too much about being a complainer -- it's the natural response to being presented with a negative scenario that doesn't have a readily available solution. I watched my mother go through a similar breakdown over the course of year -- on the downside, I think I inherented the whole genetic schmorgasborg from her -- on the upside, it's made me very proactive about finding solutions and trying every possible option available.
I've been officially diagnosed as having atypical major depression by one doctor and atypical bipolar by another -- which would seem to be an either/or maybe neither situation. At a certain point, the diagnosis becomes largely irrelevant -- the diagnosis determines the treatment, and if the treatment isn't effective, then the diagnosis doesn't mean a great deal. I don't think there are many doctors who can truly deal with the reality that many patients don't fit into any easily codified diagnosis parameters, and won't respond to conventional treatment algorithms -- there are very few truly creative doctors out their. There are few doctors who will adopt the "art rather than a science" approach. I was truly lucky -- the semi-retired psychopharm researcher I consulted with was a major figure in the development of many of the major psychoparm modalities currently in use -- so when I presented my insurance plan doc with these wacky drug combinations, her initial response was "there's no way in hell I would ever prescribe that!" -- but when she found out who devised the protocol, she immediately reached for the prescription pad. Now she's dispensing high dose Lamictal -- which she previously deemed only appropriate in cases of severe epilepsy -- like tick tacs and boasting about her newfound track record of success. Before you know it, she'll be officially recognized as specializing in treatment resistent disorders.
You've definitely done your time on the medication rodeo. Your concerns associated with toxicity issues, carcinogenetic potential, and brain damage are obviously based on documented evidence -- so they are valid, but I would consider re-thinking the situation for 2 reasons. 1) there are very few drugs that have been around as long as Dilantin and Tegretol, and they are among the very few drugs that people have sucessfully taken for entire lifetimes at heroic doses -- no one can truly say what the ramification of taking SSRIs for 30 years are, no one truly knows the impact of long-term administration of any psychiatric med produced in the past 20 years -- true long-term data doesn't exist. It goes to figure that a drug formulated in 1938 would have a rather lengthy list of possible side effects -- we've had almost 50 years to collect data, which is as much cause for comfort as it is concern. In many respects, some of the older anti-convulsants are among the only psychiatric meds (excepting the benzos) that you can feel some degree of comfort taking for 10, 20, 30 years because tens of millions of people have done exactly that. This isn't to say that people haven't suffered side effects associated with long-term administration of Dilantin or Tegretol -- it's just that the track record for long-term use is very well defined. Epileptics usually take these drugs at much higher doses than those suffering from mood disorders, which just makes the long term picture look rosier. Most of the really dreadful side effects you mention are linked to dose -- at high doses there are neurotoxicity issues, but there's a considerable amount of brain damage involved with untreated epilepsy, and there's a neuro-degenerative component to mood disorders, so there's still probably a net gain associated with taking anti-convulsants. Jack Dreyfuss, phenytoin's single greatest promoter, attributed his sanity and longevity to his low dose Dilantin protocol, and he lived well into his 90's. So, I think there's many reasons why you need not be overly concerned with the implications of long-term use of anti-convulsants -- and there's probably far greater cause for concern associated with the long-term administration of the newer antidepressants and antipsychotics because you're entering entirely uncharted territory. 2) Your dilemma also begs the old quality of life question -- is it better to live a long and miserable life, or a less lengthy but happy and productive one? If you die of a heart attack 30 years from now because of cardiotoxicity issues associated with long-term use of a tricyclic, will you have lived a happier and more productive life, than if you avoided the potential risks and consigned yourself to a lifetime of compromise? These are really heavy questions, but I think there the one's you're going to have to ask yourself. With treatment resistant mood disorders, I personally think that you have to be willing to assume some risks, because the consequences of not exploring options with potential long-term side effects can be absolutely tragic -- and it's a self-inflicted tragedy, which makes it all the worse.
That's about as morbid as a statement of encouragement can be, but I do think there is cause for hope, if only that there are untried possibilities and tried options that have provided some relief in the past. I know that you know you have some big questions to ask yourself, and hopefully you'll find the best answers. It sounds like your most immediate problem right now is simply finding a doctor, and preferably one who's somewhat competent. I've gotta believe there's somebody in the 2nd largest country in the world.
Again, I wish you all the luck in the world -- and I look forward to hearing how the situation evolves.
Drew
> Well, you've certainly said some stuff that makes some sense. However, I do think that there are disorders that simply do not fall into the rhelm of treatment with current medications.
>
> For instance, the endocannabanoid system may have future application to mood disorders. Individuals suffering certain symptoms of melancholic depression appear to have deficiant endocannabanoid function. Marajuanna is kind of part antidepressant, part anxiolytic, part mood stabilizer. I would personally like to see the application of drugs like URB-597 on patients with marked insomnia, weight loss, anhedonia, agitation, psychomotor restlesness.
>
> My mother too has some kind of inbetween disorder. She's seen doctors all across this country (Canada) and into the States. She's been hospitalized numerous times and really doesn't get a whole lot better. She saw a doctor in Michigan. She said to him, "I',m not your typical Bipolar". The doctor said to her "You're not typical anything!".
>
> Unfortunately people like me often just get called complainers. Or that there is nothing wrong. Just because we have little that helps says their is nothing wrong?
>
> I had more sucess with TCA's. Clomipramine and doxapin were helpful. My current doctor refused to prescribe them however! He said I would have a difficult time getting them filled at pharmacies. What a bunch of B.S. that is. (ALthough, I am partially to blame since I stopped taking clomiprmaine on my own on account of its genotoxicity.) Its not that it didn't help, I was just too afraid of developing cancer.
>
> >I might advise trying to arrange for a >consultation with a research psychiatrist at >NIMH, John's Hopkins (their really on the front >lines with this stuff), or another similarly
> >hallowed hall of psychopharm research.
>
> That'd be great, but I can't even find a regular psychiatrist. My current one left for a year break. He left me with a year of refills of drugs that are doing dittely.
>
> >As for the bipolar issue, he was in generally in >agreement with the treatment guidelines for >classic bipolar, but he indicated that it wasn't >uncommon to prescribe antidepressants in >difficult cases -- I believe Wellbutrin and the >MAOIs were the preferred options of choice.
>
> Suprisingly Wellbutrin is one I havn't tried. Probably on account of my symptoms of anxiety.
> I tried parnate, but had a spontanious hypertensive crisis that landed me in the hospital. They took me off it although, I think it was doing something.
>
> The problem is that I am scared of mood stabilizers. Tegretol is directly neurotoxic to proliferating hippocampal neurons (possable source of exaserbating depression). Dilantin is neurotoxic. Sustained use of dilaintin with actually lead to skull thickening. Sustained exposure to tegretol often damamges the cerebellum. I am afraid of what long term treatment with psychiatric drugs can do based on how they have affected my mother.
>
> >I had a lot of success with selegiline, but only >in combination with a mood stabilizer. I also >knew what mood stabilizers worked, kind of >worked, and definitely didn't work -- Lamictal >was at the top of the list, Tegretol came in >second, so long as it was taken with some kind >of antidepressant, Trileptal came in third; and >very low dose Depakote was the final viable >option -- anything over 125mg was just brutal, >but about 1/4 of the sprinkle cap was tolerable >and beneficial.
>
> Depakote is heavy. I have tried lithium, depakote, trileptal, tegretol, and lamotrigine, in combination with various SSRI's, SNRI's, and some TCA's. The combinations were killers for me.
>
> >Note -- none of these mood stabilizers were >effective by themselves, and most of them made >depression worse without some kind of >antidepressant add-on. The other thing that I >knew from experience is that I couldn't take >antidepressants without a mood stabilizer -- >they were either totally ineffective, or they >lost their efficacy over time, or they made me >more anxious and made sleep virtually >impossible.
>
> See I have this too, but I hesitate to call it bipolar. A lot of these reactions are documented side effects of the drugs. I have never had a manic reaction to a drug. The only manic period I had was from SSRI withdrawl.
>
> >One final note and then I'll then I'll stand >back and say -- "I look forward to seeing how >everything goes" -- because honestly, there's >very little I could add. Finding a true research >doc for a consultation appointment would be >ideal, but may not be feasable due to financial >and geographical issues -- my second suggestion >would be to either work with your doctor to at >least give antidepressants w/ mood stabilizers >atry or to find one who's willing to explore >alternatives -- mood stabilizers alone clearly >isn't an option. As far as possible drug options >to explore or at least inquire about, I would >suggest discussing Tegretol and Trileptal with >your doctor.
>
> Been on them both with and without antidepressnats. They often lock me into a very dark place. I took tegretol with celexa for about half a year. I just slept, ate, cried, well you know the story.
>
> >One of the interesting aspects of Tegretol was >it's effect on cognition -- I suddenly started >thinking musically again, re-gained my writing >chops, and re-gained much of the creativity that >I thought I'd lost -- it made me more depressed, >but it gave me something as well.
>
> Strange, I had the opposite reaction. I developed abnormal pitch preception (where everything felt like it dropped a semitone). I also had to quit playing the organ at a church on account of numbness and loss of dexterity. I felt like I couldn't feel the music at all. I felt no desire to play.
>
> >Depakote sprinkles are another option well worth >exploring, again make sure to take with an >antidepressant, because I can almost assure you >it will increase depression to some degree -- >Depakote doesn't improve cognition, but it does >have a noticable anti-anxiety component -- the >key for me was pouring out a tinsy tiny amout >from the 125mg sprinkle cap -- for me, the 250mg >pills were a one way trip to total, complete and >utter misery in every way imaginable. I think >you've actually made some real discoveries -- >recognizing that antidepressants and mood >stabilizers alone are not beneficial may be a >real insight into your particular condition, and >may lead the way to finding an optimal >combination.
>
> I should have made it clear in previous posts that I have tried numerous antideprssant mood stabilizer combinations. The mood stabilizers usually make anhedonia much worse regardless of whether am on or off an antidepressant.
>
> (granted I havn't taken all antidepressants)
>
>
> > -- I'm also guessing that you've had some >positive responses to select antidepressants, so >you may have already sorted out the most viable >add-on options. I have a feeling that you're >going to hit upon a combination that leads to >improvement, if not total remission -- >unfortunately, you've still got to go through >the trial and error rodeo, but I think some >pieces of the puzzle may already be on the board.
>
> I wouldn't get my hopes up. I've seen my mother desintigrate in spite of the best and most dedicated effort of doctors. I know I am not my mother, I just have no faith in the efficacy of these treatments. Perhaps thats why I respond so poorly.
>
> Linkadge
Posted by chiron on July 31, 2007, at 22:58:37
In reply to Re: My Experience Mirrors Yours, posted by dewdropinn on July 31, 2007, at 18:04:14
I just wanted to say I sympathize with your frustration. As I've mentioned before, my respected dr. said he has never had a patient that responds so paradoxically to drugs (stabilizers, anticonvulsants and antipsychotics) and he isn't really sure what to do. I am worn out.
I am now 34, and have been depressed for over 20 years. In my younger days I just usually took SSRIs, which did help somewhat (including pms). But more recently I have noticed I became worse when I increased my trials of Zoloft, Cymbalta, Emsam, or even Wellbutrin. And I definitely cycle (days) between not-great and major misery, which I don't remember doing when I was younger (or just didn't notice). So that, along with my 'agitated depression' I guess puts me in a bipolar-II-ish category. I don't know if the SSRIs played a role, or if it is because cycling is suppose to get worse as you age, or ?
I am still hoping for the day that I actually want to live. Currently I am trying very low doses: Lamictal for the 3rd time, Celexa, Synthroid, Xanax. The doses are put on hold why I try to get my hormones somewhat stable if that is even possible.
wishing you well,
chiron
Posted by Bonnie_CA on August 1, 2007, at 1:23:09
In reply to Re: Any bipolars do well on AD alone for a long time? » Bonnie_CA, posted by linkadge on July 29, 2007, at 12:57:00
> May I ask what you were taking before and after that relization?
>
> The only reason I ask is that things only got worse for me after the addition of mood stabilizers.
>
> LinkadgeI had been on Paxil, Celexa, Effexor, Prozac, Zoloft, and I'm still on Lexapro for now. I only got a lot better when I was put on Lamictal. The only downside is that it makes me a little anxious. I completely agree that I have BP2, because it really is the only dx that makes any sense.
-Bonnie
Posted by Netch on August 1, 2007, at 7:37:34
In reply to My Experience Mirrors Yours, posted by dewdropinn on July 30, 2007, at 12:25:10
I think bipolar is an underdiagnosed disease. Sometimes I get the feeling all mood disorders are bipolar of some degree but it takes longer time to perceive/acknowledge manic/hypomanic phases as an illness since it's usually associated with well being.
Posted by linkadge on August 1, 2007, at 14:45:52
In reply to Re: My Experience Mirrors Yours, posted by dewdropinn on July 31, 2007, at 18:04:14
>I watched my mother go through a similar >breakdown over the course of year -- on the >downside, I think I inherented the whole genetic >schmorgasborg from her -- on the upside, it's >made me very proactive about finding solutions >and trying every possible option available.
I too was fairly proactive myself. That has given me a bad record however. Some doctors consider this a sign of drug seeking, some doctors just don't like the fact that they can't take the same approach with me, ie telling me that drugs do things they don't or that they don't do things they do.
>At a certain point, the diagnosis becomes >largely irrelevant -- the diagnosis determines >the treatment, and if the treatment isn't >effective, then the diagnosis doesn't mean a >great deal. IWell thats the thing. I could list about 5 drugs which I think would help, but my doctor simply *will not* do anything I suggest. He doesn't like me playing doctor, and will go to the extent of almost prescribing the opposite to what I suggest.
I don't know how it works in the States. I don't know if you pay for any of the psychiatrist appointment out of your pocket. All the doctors I have seen have been absolutely adament on the fact that I will not be making any decisions.
>1) there are very few drugs that have been >around as long as Dilantin and Tegretol, and >they are among the very few drugs that people >have sucessfully taken for entire lifetimes at >heroic doses -- no one can truly say what the >ramification of taking SSRIs for 30 years areTrue, but that doesn't necessarily make the drugs any safer. My main concern is that strict compliance will send me down the same road as my mother. She is mentally 20 years older than she is. She is the only one in our distant family that has treated the disease as agressivly and as long term as she has. Even the episodes of mild lithium toxicity have left cognative scars that nobody in the family can deny.
>In many respects, some of the older anti->convulsants are among the only psychiatric meds
>(excepting the benzos) that you can feel some >degree of comfort taking for 10, 20, 30 years >because tens of millions of people have done >exactly that. This isn't to say that people >haven't suffered side effects associated with >long-term administration of Dilantin or >Tegretol -- it's just that the track record for >long-term use is very well defined.I agree that the record is well defined.
>Epileptics usually take these drugs at much >higher doses than those suffering from mood >disorders, which just makes the long term >picture look rosier.
Why? Epileptics have notorious histories of depression, cognative dysfunction and all sorts of crazy things that may be a result of treatment.
>and there's a neuro-degenerative component to >mood disorders, so there's still probably a net >gain associated with taking anti-convulsants.
I would still argue that this is an unknown.
It may depend on the type of mood disorder.
We only really have evidence that these treatments supress symptoms. We don't know if they are supressing the underlying pathology or not. Dr. Manjii, a molecular biologist who is a head researcher for the NIMH in bipolar says that of the mood stabilizers, only lithium and valproate show any ability to upregulate markers of neuronal placticity. Lamictal, tegretol, trileptal, gabapentin, topomax, had no ability to modify targets such as PKC, BCL-2, GSK-3b, BDNF etc. Sometimes anticonvulsants actually lower such markers. The benzodiazapines, for instance, lower BDNF, FGF-2, NGF, and other growth factors, which is probably a cause of some of induction of depression.>Jack Dreyfuss, phenytoin's single greatest >promoter, attributed his sanity and longevity to >his low dose Dilantin protocol, and he lived >well into his 90's. So, I think there's many >reasons why you need not be overly concerned >with the implications of long-term use of anti->convulsants
Yeah, and old Uncle Dwayne smoked 5 packs a day and lived to 120! Doesn't mean smoking is good for you, or that good ol' Dwayne might not have lived that long anyway.
>Your dilemma also begs the old quality of life >question -- is it better to live a long and >miserable life, or a less lengthy but happy and >productive one?But thats the thing. I would need to find a treatment that works before I could make that comparison acurately. Most medication regiments I have taken have made me significantly less productive. My mother, for instance, had to quit as a teacher as lithium made keeping up with the students too difficult.
>If you die of a heart attack 30 years from now >because of cardiotoxicity issues associated with >long-term use of a tricyclic, will you have >lived a happier and more productive life
Perhaps, but the end would sure suck, and at that point, I'd probably wish I hadn't taken the meds. I might wish, at that point that I'd rather be alive and miserable.
>With treatment resistant mood disorders, I >personally think that you have to be willing to >assume some risks, because the consequences of >not exploring options with potential long-term >side effects can be absolutely tragic
Somtimes such disorders resolve without treatment more completely than they do with treatment. Although I feel like crap, for the most part I feel better off meds than I do on them.
Linkadge
Posted by linkadge on August 1, 2007, at 14:56:37
In reply to Re: My Experience Mirrors Yours, posted by Netch on August 1, 2007, at 7:37:34
>I think bipolar is an underdiagnosed disease. >Sometimes I get the feeling all mood disorders >are bipolar of some degree but it takes longer >time to perceive/acknowledge manic/hypomanic >phases as an illness since it's usually >associated with well being
I think thats a pretty extreme statement. I also think that it is likey a statment that a bipolar individual would be more comfortable making.
I really don't think there is anything I need to admit though. You can ask friends, family, teachers, classmates etc. I don't know of any who would know me as being a bipolar.
Theres nothing I am really hiding. My initial response to SSRI's was nothing fantastic, it was just simply a drug which helped me get over the worst symtpoms of depression, and get back to school and certain daily activities. I certainly didn't feel great, and I thought about getting off of it all the time (hence the foolish self withdrawl)
If you know somebody who has had a lifelong chronic unipolar manifestation, with no history of mania, hypomania, etc. I would hesitate to call them bipolar.
Linkadge
Posted by dewdropinn on August 1, 2007, at 18:32:26
In reply to Re: My Experience Mirrors Yours » Netch, posted by linkadge on August 1, 2007, at 14:56:37
The only time I had anything remotely resembling a hypomanic episode occured while I was taking a superstar anti-depressive combo that included celexa, low dose selegiline and dexedrine -- I tended to spend money and party excessively, but given the superstar powers that selegiline and dexidrine can impart when taken together, I was about as even keeled as would be humanly possible. The combo would have lifted anyone remotely bipolar into the upper stratosphere. No one would ever expect that I had anything remotely resembling bipolar, and I think this was a big part of the problem with establishing the right approach to treatment -- the assumption was that I had unipolar major depression, and the course of treatment followed doggedly on the heals of that assumption.
My very soft bipolar diagnosis emerged because of a few of factors. The first was associated with the fact that I'd taken every antidepressant imaginable without attaining anything resembling sustained relief. The second was associated with one of my free-wheeling self medication experiments -- I found that low dose dilantin -- half of one of the 50mg Infatabs -- canceled out my chronic low grade anxiety, so there was clearly something positive associated with taking an anti-convulsant.
When I consulted with a more research oriented doc, he basically looked at the overall pattern of symptoms and reactions to drugs: antidepressants alone are somewhat effective but don't yield long-term benefits, anti-convulsants are beneficial, and depression with marked anxiety and insomnia. No mania, hypomania or anything of the kind. I do not know whether or not I have a bipolar spectrum disorder -- and I don't think it matters all that much. I think the value of the bipolar diagnosis is that it enables psychiatrists to explore options that hadn't been considered or tried before -- and many of the medications traditionally reserved for manic-depression are proving beneficial for a whole range of mood disorders that extend well beyond bipolar depression as it was once defined. I'm not entirely sure whether it's a question of bipolar being underdiagnosed or bipolar treatments being under-utilized -- either way, it means that doctors are exploring options, and the more options you have, the greater your chances of hitting upon something that works. So, I think there is value in being diagnosed bipolar, even if you technically don't fit neatly within the diagnostic parameters.
Drew
> >I think bipolar is an underdiagnosed disease. >Sometimes I get the feeling all mood disorders >are bipolar of some degree but it takes longer >time to perceive/acknowledge manic/hypomanic >phases as an illness since it's usually >associated with well being
>
> I think thats a pretty extreme statement. I also think that it is likey a statment that a bipolar individual would be more comfortable making.
>
> I really don't think there is anything I need to admit though. You can ask friends, family, teachers, classmates etc. I don't know of any who would know me as being a bipolar.
>
> Theres nothing I am really hiding. My initial response to SSRI's was nothing fantastic, it was just simply a drug which helped me get over the worst symtpoms of depression, and get back to school and certain daily activities. I certainly didn't feel great, and I thought about getting off of it all the time (hence the foolish self withdrawl)
>
> If you know somebody who has had a lifelong chronic unipolar manifestation, with no history of mania, hypomania, etc. I would hesitate to call them bipolar.
>
> Linkadge
Posted by linkadge on August 2, 2007, at 15:30:16
In reply to Re: My Experience Mirrors Yours, posted by dewdropinn on August 1, 2007, at 18:32:26
One thing I don't think some people realize though, is that these are drugs.
I mean, is not uncommon for amphetamines to cause euphoria in many normal people. Combining it with selegiline might cause more euphoria. (simultanious DAT and MAO-B inhibitition + dopamine release). When one is playing with drug combinations that mimic the activities of drugs of abuse, there is always the chance of inducing euphoria even in normal healthy individuals.
There are people who have come on this board reporting on the euphoria inducing effects of celexa + ritalin for example.
(celexa + ritalin = serotonin + dopamine uptake inhibiton + monoamine release = cocaine)
I mean, regular people abuse drugs like amphetamines to get high. This does not mean they are bipolar, or even soft bipolar, they are just human beings reacting to some hardcore stimulation of the neucleus accumbens.
There are schools of thought that state that bipolar disorder is only present when individuals have unprevoked, non drug induced manic highs.
Psychiatry doesn't want to take the rap for making a whole bunch of people bipolar. They will not admit that their drugs can induce mood swings or euphoria. So, they twist things around (like psychiatry has a nack for), and rephrase it in terms of: "these drugs only unleashed an underlying latent bipolar disorder".
Well that bias is certainly more in favor of psychiatry. You see, in psychiatry, there is never anything wrong with the drugs. If there is a problem, it is the patients problem. Thats the first rule of protecting the establishment.
Linkadge
Posted by dewdropinn on August 2, 2007, at 17:16:02
In reply to Re: My Experience Mirrors Yours, posted by linkadge on August 2, 2007, at 15:30:16
There's a marvelous passage in the Wade Davis book "Serpent and the Rainbow" about Voodoo in Hati that sums up the dark and light side of pharmaceuticals -- the voodoo priest tells Wade that "poison saves, poison kills." I think all of the above applies to psychiatry -- it's dealing with psychoactive substances that can save lives, but they can also kill in various and sometimes brutal ways. It's just one of the realities of the current state of the quasi-science.
Psychiatry has struggled since it's inception with the fact that the main diagnostic tool is a guy in glasses sitting in an easy chair across from the patient -- it is influenced by science, but is based on highly subjective observations. There's has always been a need among psychiatrists to validate that the practice is indeed a true science, and some practitioners tend to overcompensate for the scientific shortcomings by treating by presenting theory and hypotheses as unassailable, objective, scientific facts.
Your posts are full of marvelous insights and you've clearly done a great deal of study and thinking about psychiatry and pharmacology. I do wonder if you may be looking for an ideal treatment that simply doesn't exist right now (which doesn't mean we shouldn't continue looking for better options and alternatives.) This may be part of the frustration, and it was something that frustrated me for years. You're damned if you do, and damned if you don't -- there's the reality of the illness, and there's the reality of the risks and side effects associated with the medications. I'm not sure these are separable right now. What do you think?
Drew
> One thing I don't think some people realize though, is that these are drugs.
>
> I mean, is not uncommon for amphetamines to cause euphoria in many normal people. Combining it with selegiline might cause more euphoria. (simultanious DAT and MAO-B inhibitition + dopamine release). When one is playing with drug combinations that mimic the activities of drugs of abuse, there is always the chance of inducing euphoria even in normal healthy individuals.
>
> There are people who have come on this board reporting on the euphoria inducing effects of celexa + ritalin for example.
>
> (celexa + ritalin = serotonin + dopamine uptake inhibiton + monoamine release = cocaine)
>
> I mean, regular people abuse drugs like amphetamines to get high. This does not mean they are bipolar, or even soft bipolar, they are just human beings reacting to some hardcore stimulation of the neucleus accumbens.
>
> There are schools of thought that state that bipolar disorder is only present when individuals have unprevoked, non drug induced manic highs.
>
> Psychiatry doesn't want to take the rap for making a whole bunch of people bipolar. They will not admit that their drugs can induce mood swings or euphoria. So, they twist things around (like psychiatry has a nack for), and rephrase it in terms of: "these drugs only unleashed an underlying latent bipolar disorder".
>
> Well that bias is certainly more in favor of psychiatry. You see, in psychiatry, there is never anything wrong with the drugs. If there is a problem, it is the patients problem. Thats the first rule of protecting the establishment.
>
>
>
> Linkadge
Posted by linkadge on August 2, 2007, at 21:06:40
In reply to Re: My Experience Mirrors Yours, posted by dewdropinn on August 2, 2007, at 17:16:02
You're probably right. Thats why I am here.
Well, thats why most of us are here I suppose.
Most people wouldn't be here if they were completely satisfied with the course of their treatment.
I'm here to try an keep in touch with options, past, present, future etc. Its theraputic to spend some time finding out what can be done.
I personally think we all diserve better, not just myself.
Reading and learning about such treatments may be my best friend or my worst enemy.
I just think it is the safest choice for me right now not to take many of these meds.
I can avoid the worst with omega-3, taurine, magnesium, SJW etc.
Linkadge
Posted by Netch on August 3, 2007, at 5:43:06
In reply to Re: My Experience Mirrors Yours, posted by linkadge on August 2, 2007, at 21:06:40
Link, what does taurine do for you?
Netch
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