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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by smart.drug on January 16, 2009, at 20:28:15
Alright, Bipolar 2. Currently on these:
Lamictal 300 mg
Provigil 200 mg
Lovaza 4 caps
Cerefolin NAC 1 capI was on Cymbalta, but it made me flip. I had some Seroquel lying around; the high dose made the agitation worse. I'm so scared of Seroquel now that I'll never touch it again. You see, while taking the Cymbalta, I was switching over from Seroquel to Zyprexa. The plan was to go from 200 mg Seroquel to 5 mg Zyprexa. My agitation was so bad that I took 10 mg of Zyprexa. But in less than four weeks, I gained ten pounds; the amount of weight isn't the problem, but the rate at which I gained it. If that wasn't enough, I went to my regular MD for my yearly physical and found that my LDL had shot up to 160! There's no way I can keep taking the Zyprexa.
Let's backtrack a step. Seroquel made me feel sedated, while Zyprexa made me feel refreshed in the morning; so I liked the Zyprexa better, and that was why I was trying to switch over. The Cymbalta was prescribed because I had anxiety and bodily fatigue and all-over aches and pains.
Now, let's put it all together. Physically, I can tolerate Seroquel, but I hate the way it makes me feel. I like the way Zyprexa improves my sleep quality (I don't like the way it causes cognitive deficits), but I can't physically tolerate it. I was willing to wait around for the Cymbalta to kick in, but it made me agitated (mixed episode.)
And now, here's what I need. A strong mood stabilizer, an anxiolytic, and sleep-enhancer. The agent or agents cannot have the capacity to cause large amounts of weight gain, interfere with memory or cognition, or have additive potential. Am I asking for the impossible?
I've been thinking about a combination of low-dose fluoxetine (5-10 mg), buspirone, guanfacine, and Rozerem (or possibly melatonin itself.) At low doses, fluoxetine is a 5-ht2c antagonist, like olanzapine, and in combination with melatonin agonism may enhance sleep quality. And I'm hoping that the combo of buspirone and guanfacine can be both anxiolytic and focus-enhancing for me.
Any better ideas?
P.S. Oh, wait... no mood stabilizer. I haven't thought of a mood stabilizer.
Posted by desolationrower on January 18, 2009, at 5:30:56
In reply to Update, and Please Help, posted by smart.drug on January 16, 2009, at 20:28:15
Seems like you are thinking about doing lots of meds all at once? Its good to know ahead where you're going so you don't start a med that interfers with one you want to add, but keep in mind its not likely that all 4 meds will work for you. also its not a great shot but geodon might to all those things.
-d/r
Posted by SLS on January 18, 2009, at 6:20:01
In reply to Update, and Please Help, posted by smart.drug on January 16, 2009, at 20:28:15
> Any better ideas?
From me, not really. Yours are impressive.
> P.S. Oh, wait... no mood stabilizer. I haven't thought of a mood stabilizer.
If you became agitated with anger or poor impulse control with Seroquel, Trileptal might be worth a try.
- Scott
Posted by SLS on January 18, 2009, at 6:25:40
In reply to Re: Update, and Please Help, posted by desolationrower on January 18, 2009, at 5:30:56
> also its not a great shot but geodon might to all those things.
Nice choice. I have become more impressed recently with Geodon as an antidepressant adjunct. It's like an AP and AD all wrapped up in one.
The Seroquel may have caused an increase in agitation because its metabolite (norquetiapine) is a potent norepinephrine reuptake inhibitor. Perhaps this is a disincentive to try other drugs with this property, ALTHOUGH, you never know, and I would not make this a rule to follow.
For example, reboxetine almost killed me by producing anxiety and a severe suicidal state. Desipramine has saved me by helping to produce a robust improvement in combination with my other medications.
- Scott
Posted by mav27 on January 18, 2009, at 6:40:15
In reply to Re: Update, and Please Help » desolationrower, posted by SLS on January 18, 2009, at 6:25:40
>
> For example, reboxetine almost killed me by producing anxiety and a severe suicidal state. Desipramine has saved me by helping to produce a robust improvement in combination with my other medications.
>
>
> - ScottDo you know if reboxetine effected your blood pressure at all ? For me it increased laying BP whilst dropping severly whilst standing making me feel faint.
Interesting about the anxiety state... for me reboxetine actually makes me relaxed and sleepy.
No wonder mental health is so tricky to treat when you have drugs that will have the complete opposite reaction between people.
Posted by SLS on January 18, 2009, at 7:34:24
In reply to Re: Update, and Please Help » SLS, posted by mav27 on January 18, 2009, at 6:40:15
Hi.
> > For example, reboxetine almost killed me by producing anxiety and a severe suicidal state. Desipramine has saved me by helping to produce a robust improvement in combination with my other medications.
> Do you know if reboxetine effected your blood pressure at all ?
I never checked it, but I don't remember having a problem with dizziness.
> For me it increased laying BP whilst dropping severly whilst standing making me feel faint.
>
> Interesting about the anxiety state... for me reboxetine actually makes me relaxed and sleepy.
> No wonder mental health is so tricky to treat when you have drugs that will have the complete opposite reaction between people.It almost relieves us of the burden of having to know anything technical. Trial-and-error is still the modus operendi in psychiatry. I do think that, through knowledge and experience, one can produce educated guesses that validly help choose drugs to trial in an order of precedence. The Black Box is gradually becoming dimly lit inside.
- Scott
Posted by Neal on January 19, 2009, at 20:50:03
In reply to Update, and Please Help, posted by smart.drug on January 16, 2009, at 20:28:15
I don't know if what you were taking are seritonergic or not, but too much serotonin can cause agitation, or serotonin syndrome.
This is the end of the thread.
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