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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by bert99 on September 8, 2008, at 2:21:52
Hi there,
I haven't posted here in years, I think the last time was in 2000/2001.
In that time I have been on almost 32 different medications for BPII and I am still having difficulty in finding a combination that works for me.
I am taking Topamax 400mg and Lamictal 300 mg. I have been on this combo for about three weeks now.
The symptoms that remain are a constant background obsessive thinking/racing thoughts where basically I will have conversations in my mind, arguments, etc. about past events, or think about things to do, or ideas, etc. etc. Basically my mind won't shut up and it drives me insane. It almost keeps me 'in my head' and away from reality at times.The other problem is irritability. I am extremely irritable and everything just bugs the heck out of me. It doesn't make for much fun of a life to live.
Do you think that the Lamictal is making me agitated? I had the same problem when I took Lithium. It made my depression go away but I then became extremely agitated all the time and didn't want to be around ANYBODY.
I love the topamax as I am now finally losing the 100+ lbs that I gained thanks to the AD's of the past.Thank you immensely for any help or insight you could offer.
Posted by yxibow on September 8, 2008, at 6:23:56
In reply to Med for obsessive thinking, rage, irritability, posted by bert99 on September 8, 2008, at 2:21:52
> The symptoms that remain are a constant background obsessive thinking/racing thoughts where basically I will have conversations in my mind, arguments, etc. about past events, or think about things to do, or ideas, etc. etc. Basically my mind won't shut up and it drives me insane. It almost keeps me 'in my head' and away from reality at times.
I can concur with this -- I can get into this state at times.I will have conversations with people who wouldn't remember it 10 years ago or 10 hours ago. I will talk to myself and also there is intrusive and unwanted thoughts of self-antisemitism, the state of the country....
You can't be Atlas.
Also remember -- everyone has these thoughts, while they're talking to you they may be thinking, oh gee I should buy some toilet paper -- mm... what did I say to so and so an hour ago... [returning to personal conversation.. blah, blah].
Its just that some circuitry in your system is out of balance to stop the gate that people have to dismiss these things, and it is much amplified.
The more one fights OC thoughts the more it becomes entrenched.The best remedy is to keep active and busy, to immerse oneself in social activities, anything to distract.
That being said, an adjunct to the above would probably be high dose Luvox and maybe some admixture of Seroquel, if necessary. Anafranil possibly as well.
Its hard to say where the rage comes from, whether it is concomitant to the diagnosis, or whether it is your frustration with OC thoughts. As for rage, Clonidine is used in children with ADHD, I don't know the success in adults.
-- best wishes
Jay
Posted by SLS on September 8, 2008, at 6:46:58
In reply to Re: Med for obsessive thinking, rage, irritability » bert99, posted by yxibow on September 8, 2008, at 6:23:56
> Its hard to say where the rage comes from, whether it is concomitant to the diagnosis, or whether it is your frustration with OC thoughts. As for rage, Clonidine is used in children with ADHD, I don't know the success in adults.
If impulse control is a problem, Trileptal might help.
- Scott
Posted by Racer on September 8, 2008, at 10:52:39
In reply to Re: Med for obsessive thinking, rage, irritability, posted by SLS on September 8, 2008, at 6:46:58
Depakote seems to be a pretty effective choice for that sort of irritable bipolar, but I don't know if it would help with the OCD. If you haven't tried it, though, it's probably worth trying. (And I'm told -- and believe, based on my experience with other medications -- that the OTC acid controllers help mitigate weight gain.)
Posted by Phillipa on September 8, 2008, at 12:02:57
In reply to Re: Med for obsessive thinking, rage, irritability, posted by SLS on September 8, 2008, at 6:46:58
Took low dose trileptal for boosting an ad and was fine no side effects. Funny did take lamictal to 50mg and didn't corrolate throwing plastic bottles at buildings that it might be the med. Trileptal seems to work well only reason stopped was money. It's expensive. Well guess if your're off ad's no problem with weight gain congrats on losing 100 lbs that's amazing. Phillipa
Posted by Bob on September 8, 2008, at 15:50:51
In reply to Re: Med for obsessive thinking, rage, irritability, posted by Racer on September 8, 2008, at 10:52:39
> Depakote seems to be a pretty effective choice for that sort of irritable bipolar, but I don't know if it would help with the OCD. If you haven't tried it, though, it's probably worth trying. (And I'm told -- and believe, based on my experience with other medications -- that the OTC acid controllers help mitigate weight gain.)
Irritability, anger and obsessiveness have been a comorbid feature of my MDD since the beginning. I have found that I can indeed tamp down these symptoms with meds like Depakote and Seroquel, but the inevitable result is apathy, fatigue, and sedation. Depakote was especially insidious, producing stunning drowsiness that quickly became intolerable. The only way I was able to survive it was with simultaneous doses of Welbutrin. Eventually that wore off and I couldn't stay on the Depakote. I have never been able to find the combo that would supress my "active" problems while also treating the negative aspects of my depression.- Bob
Posted by bert99 on September 9, 2008, at 16:36:10
In reply to Re: Med for obsessive thinking, rage, irritability » Racer, posted by Bob on September 8, 2008, at 15:50:51
Hi, thanks for your response (and for all of the previous responses as well, I really appreciate you all taking the time to answer my questions).
I guess I should expand a bit on my post since I posted it in a bit of a rush.I am a mom of two small children, so the meds that I take can't be sedating as I have to be able to function and drive.
I tried tegretol before and gave up after three weeks as I:
1. lost almost all sensation of fullness and ate almost everything in sight, could not stop eating
2. couldn't walk straight, had to walk my daughter to school pushing a stroller just to keep myself from falling over
3. overly giddy
4. sound, music sounded 'slowed down' half way if that makes any sense
and this was after like three weeks, and I gave up.Is tripetal (sp??) any different?
I won't even go near antipsychotics, BTDT.
I have not tried geodon.
I have rapid cycling bipolar II where my condition changes daily. I have never had any period of my life where I have had any form of stability.
I go from depressed to normal with bits of irritability. The 'manic' part of me just spends money, that's about it. No hallucinations, no god-like tendencies, just irritability.I have never, ever had any stability in my mood longer than a few days or weeks if lucky.
I have been going through this ride since my dx in 2000 of BPII but I was initially dx with depression in 1993.
Thank you for any suggestions, greatly appreciated.
:)
Posted by Racer on September 9, 2008, at 17:11:28
In reply to Re: Med for obsessive thinking, rage, irritability, posted by bert99 on September 9, 2008, at 16:36:10
My turn to be in a hurry -- the bottomless stomach thing improves a lot with the OTC acid controllers. Something like ranitidine -- Zantac? Pepcid? one of those -- helps much more than you'd think, since it doesn't feel as though your stomach is upset...
Good luck
Posted by Ron Hill on September 15, 2008, at 5:11:58
In reply to Med for obsessive thinking, rage, irritability, posted by bert99 on September 8, 2008, at 2:21:52
Bert,
At times, I have racing thoughts when I'm hypomanic. For me, Trileptal quiets my thoughts and greatly reduces my other symptoms of hypomania. Your mileage may vary.
Do your racing thoughts get more pronounced when you are hypomanic? If so, you might try adding about 900 mg/day of Trileptal. Ramp up slowly. Trileptal recently became available as a generic.
To me, your irritability sounds like a mixed state. Do you agree?
Your rapid mood swings cause me to believe that you have ultra (or ultradian) rapid cycling. Let me guess; prior to your bipolar dx you were given an antidepressant without any moodstablizers on board, true?
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild OCPD
300 mg/day Trileptal
200 mg/day Lamictal
250 mg/day Keppra
60 mg/day Nardil
Posted by SLS on September 15, 2008, at 6:43:10
In reply to Re: Med for obsessive thinking, rage, irritability » bert99, posted by Ron Hill on September 15, 2008, at 5:11:58
Hi Bert.
I agree with Ron that Trileptal (oxcarbazepine) is worth a try as it is good for impulse control and explosive anger as well as bipolar disorder. I don't know if it would help with the obsessive thinking. It just might. You might not have OCD, though. You might, instead, have ruminating thoughts. If you are depressed, these thoughts might subside if you take an antidepressant along with the Trileptal.
What does your case history look like? Family history? Hypomania? Drug treatment?
- Scott
Posted by Nadezda on September 15, 2008, at 9:30:08
In reply to Re: Med for obsessive thinking, rage, irritability, posted by bert99 on September 9, 2008, at 16:36:10
You said you don't want to try antipsychotics, but in case you change your mind, a small dose of abilify helps me with that..
Nadezda
Posted by Bob on September 15, 2008, at 11:57:57
In reply to Re: Med for obsessive thinking, rage, irritability, posted by SLS on September 15, 2008, at 6:43:10
You might, instead, have ruminating thoughts. If you are depressed, these thoughts might subside if you take an antidepressant along with the Trileptal.> - Scott
Scott,How does one tell if someone has ruminating thoughts rather than OCD?
- Bob
Posted by bert99 on September 15, 2008, at 12:23:43
In reply to Re: Med for obsessive thinking, rage, irritability » bert99, posted by Ron Hill on September 15, 2008, at 5:11:58
>
> Your rapid mood swings cause me to believe that you have ultra (or ultradian) rapid cycling. Let me guess; prior to your bipolar dx you were given an antidepressant without any moodstablizers on board, true?
>
> -- RonHi Ron, yes, very true, years of A/D use, and bloating of 100+ lbs.... (coming off though thanks to dopamax!!!).
Posted by Phillipa on September 15, 2008, at 20:02:25
In reply to Re: Med for obsessive thinking, ----))) Ron Hill, posted by bert99 on September 15, 2008, at 12:23:43
If trileptal is now generic it has no weight gaining at least my trial of 150 no weight gain. I'd give some thought to trying it seriously. Phillipa
Posted by bert99 on September 15, 2008, at 20:51:13
In reply to Re: Med for obsessive thinking, ----))) Ron Hill » bert99, posted by Phillipa on September 15, 2008, at 20:02:25
> If trileptal is now generic it has no weight gaining at least my trial of 150 no weight gain. I'd give some thought to trying it seriously. Phillipa
Looks like it is available in Canada...I'll suggest it to my physician.... he shot it down the last time I was there, but then again nothing he has tried on me before has worked well... nothing any doctor has tried on me has worked well either..
Posted by SLS on September 15, 2008, at 21:01:39
In reply to Re: Med for obsessive thinking, rage, irritability » SLS, posted by Bob on September 15, 2008, at 11:57:57
> > You might, instead, have ruminating thoughts. If you are depressed, these thoughts might subside if you take an antidepressant along with the Trileptal.
> How does one tell if someone has ruminating thoughts rather than OCD?
It is NOT easy or straight forward. I'm going to recommend that you take a look at:
Navigate to "Disorders" on the left pane and look at the European Definition.
Something not mentioned is that with true OCD, there is great inner tension (anxiety) that can only be relieved when a person allows themselves to follow through with the intrusive thought or compulsive behavior.
Perhaps you could be more specific in your description after reading through the website I referred to.
Which emerged first, the depression or the obsessional thinking? Sometimes, this can be an important indicator.
- Scott
Posted by Phillipa on September 15, 2008, at 21:10:19
In reply to Re: Med for obsessive thinking, rage, irritability » Bob, posted by SLS on September 15, 2008, at 21:01:39
Scott of what haven't read it yet? Love Jan
Posted by Phillipa on September 15, 2008, at 21:21:33
In reply to Re: Med for obsessive thinking, rage, irritability » Bob, posted by SLS on September 15, 2008, at 21:01:39
Okay so first I had tics as a kid I was aware of like wrinkleing up my nose and it would keep me safe and my Mother wouldn't be sicker. Now it's much drink water a certain amount like four sips so some counting. The low dose luvox has eliminated a lot of that. Or I have to ride my bike each day whether I want to or not, or have to stay busy even if tired during the day. Things done in an exact order each day. So is this OCD or what? I was always told it was of the anxiety spectrum and treated with antianxiety meds. Love Jan
Posted by Fletcher on September 17, 2008, at 19:16:20
In reply to Med for obsessive thinking, rage, irritability, posted by bert99 on September 8, 2008, at 2:21:52
I had similar symptoms-- hypersensitivity that would lead to rages, obsessive thinking, internal conversations (often like they were with a child that would keep repeating words and then rhyming them with nonsense words).. I ~think~ I may know just what you're going through.
I didn't read all of the follow-ups to your original post, so I don't know if Neurontin was mentioned, but it was suggested to me about ten years ago as a treatment for a suspected mild bi-polar condition. For about the.. hmm.. first week or so, I was on it, it was like floating on a cloud-- not high or spacey, but just SOOOOO RELIEVED to not have all that stuff going on in my head. I stopped being hypersensitive, etc., etc.-- all of the symptoms I outlined above went away. It also cured me of my panic attacks (they're of an odd variety that only occur if I'm in a romantic relationship). Anyway, I was on it continually for about five years and then went off of it and those symptoms never did return.
I would seriously suggest trying Neurontin-- it's the only medication I've ever called a "miracle drug". Obviously it may need to be shuffled with your other BP medications (as it's used to treat BP also).
Keep me posted.
Posted by bert99 on September 18, 2008, at 5:06:18
In reply to Re: Med for obsessive thinking, rage, irritability » bert99, posted by Fletcher on September 17, 2008, at 19:16:20
> I had similar symptoms-- hypersensitivity that would lead to rages, obsessive thinking, internal conversations (often like they were with a child that would keep repeating words and then rhyming them with nonsense words).. I ~think~ I may know just what you're going through.
>
> I didn't read all of the follow-ups to your original post, so I don't know if Neurontin was mentioned, but it was suggested to me about ten years ago as a treatment for a suspected mild bi-polar condition. For about the.. hmm.. first week or so, I was on it, it was like floating on a cloud-- not high or spacey, but just SOOOOO RELIEVED to not have all that stuff going on in my head. I stopped being hypersensitive, etc., etc.-- all of the symptoms I outlined above went away. It also cured me of my panic attacks (they're of an odd variety that only occur if I'm in a romantic relationship). Anyway, I was on it continually for about five years and then went off of it and those symptoms never did return.
>
> I would seriously suggest trying Neurontin-- it's the only medication I've ever called a "miracle drug". Obviously it may need to be shuffled with your other BP medications (as it's used to treat BP also).
>
> Keep me posted.Thanks Fletcher ... I will consider that if the next med doesn't work!
Posted by bert99 on September 18, 2008, at 5:09:52
In reply to Re: Med for obsessive thinking, rage, irritability » Fletcher, posted by bert99 on September 18, 2008, at 5:06:18
Just a follow up ... I got the script for Trileptal, will start it tomorrow.
He said I was a classic case of being heavily hypomanic.
He also gave me some Zyprexa which I toom 2.5 mg of earlier tonight. Man, that stuff is HEAVY!! I actually really like it. It made me really *happy* if that makes sense.... I calmed right down and actually sat down and watched Iron Chef on TV with the girls and laughed and enjoyed myself, rather than pacing around in the house dwelling on something as usual.
Wish me luck on starting the Trileptal tomorrow... :)
Robby
Posted by yxibow on September 18, 2008, at 5:21:03
In reply to Re: Med for obsessive thinking, rage, irritability, posted by bert99 on September 18, 2008, at 5:09:52
> Just a follow up ... I got the script for Trileptal, will start it tomorrow.
>
> He said I was a classic case of being heavily hypomanic.
>
> He also gave me some Zyprexa which I toom 2.5 mg of earlier tonight. Man, that stuff is HEAVY!! I actually really like it. It made me really *happy* if that makes sense.... I calmed right down and actually sat down and watched Iron Chef on TV with the girls and laughed and enjoyed myself, rather than pacing around in the house dwelling on something as usual.
>
> Wish me luck on starting the Trileptal tomorrow... :)
>
> RobbyI just wanted to jump in and say best wishes too and also to say that rage and anger can be a natural part of depression, unipolar or otherwise -- self-anger from lack of self worth, etc -- but that's just one view on things.
-- tidings
Jay
Posted by butternut on September 18, 2008, at 17:57:04
In reply to Re: Med for obsessive thinking, rage, irritability, posted by bert99 on September 18, 2008, at 5:09:52
Glad the zyprexa gave some relief, and good luck with the Trileptal! Let us know how it goes.
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