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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by ricker on November 5, 2008, at 18:34:17
I've got a p/doc appointment next Monday. I am bipolar 2 with anxiety/social phobia.
I am on zoloft 50mgs and clonazepam 0.5/2xday.
I was feeling good on Lithium but could only get to 600mg and my tremors were quite severe.
I was then given Lamictal, worked good as well, actually better than the Lithium but I am having problems with skin issue, facial flushing...red hot face, severe acne and have been taking antibiotic for a month now! I have reduced my dose from 150 down to 50 mgs untill I see my p/doc. I am not feeling well, extreme hypo mania, depressive episodes etc. I've increasd my clonazepam to get me through untill my appointment. I have been acting quite irrational at work! I'm contemplating staying home untill my appointment. No phycosis, strictly bipolar 2 with anxiety.
I would really appreciate your suggestions as many of you have experienced this and may have some insight as to mood stabilizer options. I'm feeling quite distressed over the lamictal and lithium not working. I think my p/doc wants to try me on a A/P but I'm nervous about that. I've heard they may help if used with a "true" mood stabilizer? But I've also read some horror stories about the A/P's. The zoloft does help somewhat with my anxiety/socialphobia/mild OCD. I just can't handle this constant mind race! mind rage! mind confusion and depression. Please help me!Thanks, Rick
Posted by Maxime on November 5, 2008, at 19:08:09
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
Check out this site:
http://home.comcast.net/~pmbrig/BP_pharm.html
Posted by azalea on November 5, 2008, at 21:17:49
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
Perhaps a low dose of Lithium combined with a low dose of Lamictal? That way you could avoid the side effects you experienced at high doses.
I recommend this site for a discussion of mood stabilizer options.
http://www.psycheducation.org/depression/meds/moodstabilizers.htm
In the long term, you might want to consider slowly tapering off the Zoloft as SSRIs can cause mood destabilization in bipolar 2.
> I've got a p/doc appointment next Monday. I am bipolar 2 with anxiety/social phobia.
> I am on zoloft 50mgs and clonazepam 0.5/2xday.
> I was feeling good on Lithium but could only get to 600mg and my tremors were quite severe.
> I was then given Lamictal, worked good as well, actually better than the Lithium but I am having problems with skin issue, facial flushing...red hot face, severe acne and have been taking antibiotic for a month now! I have reduced my dose from 150 down to 50 mgs untill I see my p/doc. I am not feeling well, extreme hypo mania, depressive episodes etc. I've increasd my clonazepam to get me through untill my appointment. I have been acting quite irrational at work! I'm contemplating staying home untill my appointment. No phycosis, strictly bipolar 2 with anxiety.
> I would really appreciate your suggestions as many of you have experienced this and may have some insight as to mood stabilizer options. I'm feeling quite distressed over the lamictal and lithium not working. I think my p/doc wants to try me on a A/P but I'm nervous about that. I've heard they may help if used with a "true" mood stabilizer? But I've also read some horror stories about the A/P's. The zoloft does help somewhat with my anxiety/socialphobia/mild OCD. I just can't handle this constant mind race! mind rage! mind confusion and depression. Please help me!
>
> Thanks, Rick
Posted by sunshine25 on November 5, 2008, at 23:13:16
In reply to Re: Mood Stabilizer recommendations... Please! » ricker, posted by azalea on November 5, 2008, at 21:17:49
I have had good results with topamax
lithium gave me horrible acne, made me gain weight and I hated all the bloodwork.
I have heard good things about abilify, but have not tried it personally.
Posted by sam K on November 5, 2008, at 23:37:12
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
abilify made me soo stable. I just moved on no matter what happened. But I stopped it because this strange strange feeling I get on APs. I find APs extremly relaxing in anxiety.
Posted by Phillipa on November 6, 2008, at 0:25:03
In reply to Re: Mood Stabilizer recommendations... Please! » ricker, posted by azalea on November 5, 2008, at 21:17:49
Azalea thanks for that site very interesting. Phillipa Ricker maybe the tapering of zoloft and low dose lamictal 50mg might just work. Phillipa
Posted by Phillipa on November 6, 2008, at 0:28:41
In reply to Re: Mood Stabilizer recommendations... Please! » ricker, posted by azalea on November 5, 2008, at 21:17:49
Website when reading about lamictal sounded to me a lot like the crazy meds site? Language. Is it from there? Love Phillipa
Posted by JadeKelly on November 6, 2008, at 3:31:49
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
Hi Ricker,
Mood stabalizing drugs I'm familiar with:
Anti/psych: Abilify, Risperdal, seroqel
Other: Dapakote (valproic Acid)
Have not taken these myself but have person close to me that has/does. Abilify and Risperdal I/he really didn't like, especially at Bi-polar doses. Not himself at all. Maybe better at very small doses, don't know. Depakote works very well with seroquel. Especially for "racing mind" "anger" that sort of thing. In my experience, ssri's not good for type of symptoms your refering to. Mood stablizers will make you tired in the beginning so be prepared to be fatigued in the morning on any of these. This combo is used a lot and will stop the mind race/aggressive type behavior if you have that. I'd add A/D after mood stablizers so you know whats doing what.Good Luck on Monday, hope that helps!
Jade
Posted by JadeKelly on November 6, 2008, at 3:42:06
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
Ricker, I reread your post. If you have anxiety and social phobia, just my opinion, I'd stay away from Abilify and Risperdal. Also, if your in a bi-polar state, won't your Pdoc see you early? If not are you safe at home? Oh, also, I'd say this is NOT a good time to drop klonopin. Adding klon withdrawal to your situation I think would be mistake. Good luck,
Jade
Posted by softheprairie on November 6, 2008, at 5:19:39
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
I would like to throw in the possibility of perphenazine for you and your pdoc to consider. It is an old antipsychotic. I take it as an adjunct for depression. It is thought to perhaps have some mood stabilizing effect. I think it went out of favor because it can cause tardive dyskinesia, and the newer APs were so heavily pushed when they were new and the manufacturers of the newer ones were not as forthcoming about their own risks. Perphenazine is also sedating; I take mine at night now, but used to split dosing. Perphenazine did pretty well compared to other, newer APs in CATIE trials, which were NIH or NIMH-sponsored a few years ago.
Abilify gave me akathisia, the only psych med that has done that to me.
Posted by JadeKelly on November 6, 2008, at 11:45:51
In reply to Re: Mood Stabilizer recommendations... Please! » ricker, posted by JadeKelly on November 6, 2008, at 3:31:49
> Hi Ricker,
>
> Mood stabalizing drugs I'm familiar with:
>
> Anti/psych: Abilify, Risperdal, seroqel
>
> Other: Dapakote (valproic Acid)
>
> Have not taken these myself but have person close to me that has/does. Abilify and Risperdal I/he really didn't like, especially at Bi-polar doses. Not himself at all. Maybe better at very small doses, don't know. Depakote works very well with seroquel. Especially for "racing mind" "anger" that sort of thing. In my experience, ssri's not good for type of symptoms your refering to. Mood stablizers will make you tired in the beginning so be prepared to be fatigued in the morning on any of these. This combo is used a lot and will stop the mind race/aggressive type behavior if you have that. I'd add A/D after mood stablizers so you know whats doing what.
>
> Good Luck on Monday, hope that helps!
>
> Jade
Hi Rick,Jade again. I was just posting to see if you're feeling better today. Maybe you stayed home or got into the Doc's office. I hope so!
Also, I noticed you're already on an A/D, Zoloft, scratch my earlier comment on adding one at some point.
So how about posting today and letting us know how're doing today?
I'll be expecting everyone to be asking/posting about me when I've had a bad day! Take care,
:^) Jade
>
Posted by azalea on November 6, 2008, at 15:32:48
In reply to Re: Mood Stabilizer recommendations... Please! » azalea, posted by Phillipa on November 6, 2008, at 0:28:41
It's possible that the crazy meds site used the psych education site for information. Dr. Phelps is a psychiatrist in Oregon and he maintains www.psycheducation.org. It's a great site!
> Website when reading about lamictal sounded to me a lot like the crazy meds site? Language. Is it from there? Love Phillipa
Posted by ricker on November 6, 2008, at 18:00:26
In reply to Re: Mood Stabilizer recommendations... Please!, posted by JadeKelly on November 6, 2008, at 11:45:51
> So how about posting today and letting us know how're doing today?
Hi All, thanks so much to everyone for taking time to offer your suggestions. I really appreciate it. My family doc told me to stop Lamicatal today? He said it can increase mania in "some" people, not often, but it can? He thought it worked better on the depression end of bipolar? I am to double, and if need be, triple my clonazepam untill I see my p/doc on Monday.
I'm beginning to get a dull tension-like headache and will take 1mg of clonazepam 3 or 4 times a day as needed.Theres's lots of good suggestions and I will certainly review with my p/doc. I was never aware that A/D's could induce mania but I'm going to continue my zoloft untill I see my p/doc. I also take 15mg remeron for sleep.... maybe that is not helping with the stabilizing as well?
Again, thanks to all for your helpful advise and support.
Regards, Rick
Posted by bleauberry on November 6, 2008, at 18:01:35
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
Five suggestions to consider:
Depakote.
Zyprexa low dose.
Risperdal low dose.
Seroquel low to medium dose.
Pramipexole.Depakote and the antipsychotics are obvious mood stabilizers and and when combined with a serotonin antidepressant work synergistically against depression. Kind of like 1+1=3.
I mentioned pramipexole, though it is off label and not commonly talked about, because there is actually a pretty sizable scientific body behind it in support of its use in both unipolar and bipolar depression and anxiety. It has even served as a mood stabilizer and antidepressant all by itself.
Posted by Phillipa on November 6, 2008, at 18:38:00
In reply to Re: Mood Stabilizer recommendations... Please! » Phillipa, posted by azalea on November 6, 2008, at 15:32:48
Thanks azalea. Good thought. Love Phillipa
Posted by azalea on November 6, 2008, at 20:47:33
In reply to Re: Mood Stabilizer recommendations... Please!, posted by ricker on November 6, 2008, at 18:00:26
There are a few reports of Lamictal causing mania, but it is extremely rare compared to antidepressant-induced mania and cycling. It's possible though. Lamictal is generally thought to stabilize mood from the bottom up, while some other mood stabilizers (like Depakote) work more from the top down.
>
> > So how about posting today and letting us know how're doing today?
>
> Hi All, thanks so much to everyone for taking time to offer your suggestions. I really appreciate it. My family doc told me to stop Lamicatal today? He said it can increase mania in "some" people, not often, but it can? He thought it worked better on the depression end of bipolar? I am to double, and if need be, triple my clonazepam untill I see my p/doc on Monday.
> I'm beginning to get a dull tension-like headache and will take 1mg of clonazepam 3 or 4 times a day as needed.
>
> Theres's lots of good suggestions and I will certainly review with my p/doc. I was never aware that A/D's could induce mania but I'm going to continue my zoloft untill I see my p/doc. I also take 15mg remeron for sleep.... maybe that is not helping with the stabilizing as well?
>
> Again, thanks to all for your helpful advise and support.
>
> Regards, Rick
>
>
>
Posted by Ricker on November 10, 2008, at 21:29:22
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
> I've got a p/doc appointment next Monday. I am bipolar 2 with anxiety/social phobia.
> I am on zoloft 50mgs and clonazepam 0.5/2xday.
> I was feeling good on Lithium but could only get to 600mg and my tremors were quite severe.
> I was then given Lamictal, worked good as well, actually better than the Lithium but I am having problems with skin issue, facial flushing...red hot face, severe acne and have been taking antibiotic for a month now! I have reduced my dose from 150 down to 50 mgs untill I see my p/doc. I am not feeling well, extreme hypo mania, depressive episodes etc. I've increasd my clonazepam to get me through untill my appointment. I have been acting quite irrational at work! I'm contemplating staying home untill my appointment. No phycosis, strictly bipolar 2 with anxiety.
> I would really appreciate your suggestions as many of you have experienced this and may have some insight as to mood stabilizer options. I'm feeling quite distressed over the lamictal and lithium not working. I think my p/doc wants to try me on a A/P but I'm nervous about that. I've heard they may help if used with a "true" mood stabilizer? But I've also read some horror stories about the A/P's. The zoloft does help somewhat with my anxiety/socialphobia/mild OCD. I just can't handle this constant mind race! mind rage! mind confusion and depression. Please help me!
>
> Thanks, RickDoc has prescribed zyprexa! Kinda suprised, thought he'd let me try seroquel but he's been seeing me for 13 years and says zyprexa is a better fit for me?
I asked for a mood stabilizer as well, depakote or tegretol and he said nope! one change at a time.
Okay, 0 for 2 now. I am to remain on zoloft 50 mg, clonazepam 0.5/2x and start zyprexa 5mg and may go to 10mg? I see him again in 3 weeks. He did explain about the weight gain and diabetes potential, but said he believes I will see a big improvement overall.
Nothing to lose at the moment as I feel terrible.
If anyone has any "positive" zxprexa experiences, please share. I really don't want to hear negative reactions, I'm sure there's lots, as with any med.Thanks for your support. Rick
Posted by JadeKelly on November 10, 2008, at 22:17:06
In reply to Back from pdoc!!!!!, posted by Ricker on November 10, 2008, at 21:29:22
Hi Rick,
Sorry I don't have experience with Zyprexa, other than I know its prescribed a lot I believe. Seems it treats a lot of symptoms/illnesses. So good luck with that!
My PDoc is same way (saw him today too), he won't prescribe more than one med at a time which is a pain, but probably makes sense as you will know which med is doing what.
Let us know how the zyprexa works out for you.
Take Care
~Jade
Posted by B2chica on November 11, 2008, at 8:12:32
In reply to Back from pdoc!!!!!, posted by Ricker on November 10, 2008, at 21:29:22
Time and Time again, zyprexa is my ONE saving grace.
i cant tell you how when i am as bad off as i could possibly be, give me zyprexa and within one day i noticed a little difference by one week i'm pretty d@mn stable.after my pregnancy i went downhill pretty fast and was bawling constantly, i went into the hospital (per doctors request) and they gave me zyprexa that night, the next day the depression was still there but the crying stopped.
i still need a little augment (using pristiq this time) but i can't tell you how wonderful zyprexa has been for me.
though usually i need 10mg to work it's wonders.
becareful of going up to fast, could get swollen tongue and other weirdness.i'm only on 5 now (that's why i need the augment). just because i was overweight due to the pregnancy and didn't want any extra help gaining more.
*****************************
the first two times they put me on zyprexa i didn't gain any weight...or maybe a pound or two.
my key then was drinking LOTS of water with it. and when you think your hungry at night, drink water first, usually does the trick.this last time i did gain weight...but to be honest, i was so bad off...i'll take the weight to being dead.
*****************************
point being, worry about the weight later (you may or may not gain it), get stable now.BEST WISHES!!
b2c.
Posted by that_guy23 on November 13, 2008, at 10:04:31
In reply to Re: Mood Stabilizer recommendations... Please!, posted by softheprairie on November 6, 2008, at 5:19:39
is lyrica a good drug to use with nardil?
Posted by bulldog2 on November 13, 2008, at 12:06:55
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
> I've got a p/doc appointment next Monday. I am bipolar 2 with anxiety/social phobia.
> I am on zoloft 50mgs and clonazepam 0.5/2xday.
> I was feeling good on Lithium but could only get to 600mg and my tremors were quite severe.
> I was then given Lamictal, worked good as well, actually better than the Lithium but I am having problems with skin issue, facial flushing...red hot face, severe acne and have been taking antibiotic for a month now! I have reduced my dose from 150 down to 50 mgs untill I see my p/doc. I am not feeling well, extreme hypo mania, depressive episodes etc. I've increasd my clonazepam to get me through untill my appointment. I have been acting quite irrational at work! I'm contemplating staying home untill my appointment. No phycosis, strictly bipolar 2 with anxiety.
> I would really appreciate your suggestions as many of you have experienced this and may have some insight as to mood stabilizer options. I'm feeling quite distressed over the lamictal and lithium not working. I think my p/doc wants to try me on a A/P but I'm nervous about that. I've heard they may help if used with a "true" mood stabilizer? But I've also read some horror stories about the A/P's. The zoloft does help somewhat with my anxiety/socialphobia/mild OCD. I just can't handle this constant mind race! mind rage! mind confusion and depression. Please help me!
>
> Thanks, Rickdid you follow the standard titration schedule of increasing 25 mg every two weeks?
Posted by karinamarie on November 14, 2008, at 0:52:59
In reply to Mood Stabilizer recommendations... Please!, posted by ricker on November 5, 2008, at 18:34:17
Dear RickI am sorry to hear that you are feeling so unwell. My drugs were changed in April to Tegratol and Lithium and things are going very well. I was taken off my anti-depressant because my new doctor feels that I should not be left on them all the time. He feels they are harming rather than helping me. He will only put me on them for short bursts if my depression becomes acute. Anyway I feel better than I have in years..... This started at 14 and I am know 39 so this new combination is a blessing!
No hypomania
No rapid fire cycling between moods during the day
No OCD
Depression much better only the odd bad day
Calmer and more balanced
Sleeping at night
Went to a party last Saturday night and enjoyed myself which is amazing because I have a social phobia only had a little anxietyNote: I have also had therapy for Social Phobia and OCD.
My drugs are older drugs which seem to work well while others just did not do the job. I am also taking 2000mg of Salmon Oil and 1000mg of Borage Seed Oil which is also helping.
I wish you well Rick and hope that you find the right medication for you. Sometimes it just takes time to get it right. I know it is frustrating and horrible when you are feeling so unwell.
Don't give up! Smiles :-) Karina
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