![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ajax1 on July 12, 2009, at 21:55:32
I have BP2 with depression and am very sensitive to ADs. Even Lamictal causes me to become hypomanic. I also suffer from intense insomnia. I've gone through about everything--Lithium , Depakote, Trileptal etc. Has anyone with similar issues had a good response with any med combinations? All input would be appreciated.
ajax
Posted by SLS on July 13, 2009, at 5:12:21
In reply to Best Bipolar II with depression cocktail?, posted by ajax1 on July 12, 2009, at 21:55:32
> I have BP2 with depression and am very sensitive to ADs. Even Lamictal causes me to become hypomanic. I also suffer from intense insomnia. I've gone through about everything--Lithium , Depakote, Trileptal etc. Has anyone with similar issues had a good response with any med combinations? All input would be appreciated.
> ajax
Hi.You might want to do a quick trial of Zyprexa simply as an experiment to determine whether or not that type of drug helps stabilize you. You would most likely see results in 1-2 weeks.
- Scott
Posted by ajax1 on July 13, 2009, at 9:29:43
In reply to Re: Best Bipolar II with depression cocktail?, posted by SLS on July 13, 2009, at 5:12:21
Thanks Scott. I've just begun using a small amount of Seroquel with 600mg Neurontin and I do seem to be sleeping well. The problem I'm having is adding an antidepressant and I'll probably be needing a mood stabilizer to go with it. I should have been clearer with my question.
ajax
Posted by linkadge on July 13, 2009, at 10:05:17
In reply to Re: Best Bipolar II with depression cocktail?, posted by ajax1 on July 13, 2009, at 9:29:43
Seroquel has AD properties. The company was trying to get it approved as a treatment for unipolar depression. Try different doses to see how they affect your mood.
Linkadge
Posted by AJAX1 on July 13, 2009, at 11:38:45
In reply to Re: Best Bipolar II with depression cocktail?, posted by linkadge on July 13, 2009, at 10:05:17
I find that doses of Seroquel above 12.5 mg leave me depressed and fatigued. I've never been able to stay on a higher dose more than a couple of days. Does that side effect go away over time? I know the very high doses are supposed to be good for depression. Actually I have a more agitated/irritable depression. Thanks for your response.
ajax
Posted by Phillipa on July 13, 2009, at 12:01:04
In reply to Re: Best Bipolar II with depression cocktail?, posted by AJAX1 on July 13, 2009, at 11:38:45
Not to be redundant in my posts but a long acting benzo? Isn't wellbutrin for bipolar? Phillipa
Posted by AJAX1 on July 13, 2009, at 12:54:20
In reply to Re: Best Bipolar II with depression cocktail? » AJAX1, posted by Phillipa on July 13, 2009, at 12:01:04
I've taken Valium, Restoril and Xanax. They were all quite helpful, but in the long-term failed and were very hard to withdraw from.
ajax
Posted by floatingbridge on July 13, 2009, at 13:56:34
In reply to Re: Best Bipolar II with depression cocktail?, posted by AJAX1 on July 13, 2009, at 11:38:45
Ajax, I had adverse reaction to seroquel at very low dose and discontinued--agitated, jumping out of skin....
fb
Posted by AJAX1 on July 13, 2009, at 13:58:55
In reply to Re: Best Bipolar II with depression cocktail? » AJAX1, posted by floatingbridge on July 13, 2009, at 13:56:34
Yea, I feel a little hostility as it wears off.
Posted by bleauberry on July 13, 2009, at 17:26:39
In reply to Best Bipolar II with depression cocktail?, posted by ajax1 on July 12, 2009, at 21:55:32
First a disclaimer. No matter what me or anyone has for suggestions, prediction of results is impossible. So the best we can do is to try to narrow the list down to things that would fit the uniqueness of you. So for depression, bipolar, sleep, and med sensitivity, these are the things that came to the top of the list in my thinking:
Zyprexa + Nortriptyline; possibly a tiny amount zoloft added (3mg-12.5mg); naturals magnesium trial and bedtime baked potato; different food choices.
Zyprexa is the mood stabilizer, the antidepressant booster, and sleep friendly.
Nortriptyline is the antidepressant, pain reliever, and sleep friendly.
Being a sensitive patient myself, and having done poorly just like you on the meds you listed, the above meds are do-able.
No ssris. If anything at all, maybe a tiny bit of zoloft with the nortriptyline.
Doses. Zyprexa start at 2.5mg with a target of 5mg, going in 1.25mg or .6mg steps (by cutting pills). Nortriptyline. Start at 5mg (half of the smallest capsule 10mg). Increase both as tolerated, with your side effects and emotions as the guide, versus a predetermined schedule. Basically that will probably mean re-assessing what to do about every 4 to 7 days, and then either staying there for another 4-7 days or taking a small jump up.
I don't like seroquel and am puzzled why doctors use it so much. Zyprexa is by a million miles a much better all-around medication. Some people like their seroquel, but for most of them its benefits are in sleep but not anxiety or depression. I much prefer the sleep quality that nortriptyline gives.
Neither of the two meds I suggested have the knockout elephant dart punch that seroquel has. But they will allow you to drift off to sleep and experience a good quality sleep.
I cannot overstate...with med sensitivities, you gotta be extra cautious with the initial dose choices so as to be able to stay the course and not to be stopped early. No dose is too small. But it is very easy for any dose, no matter how small someone else might think it is, to be too much too fast for people like you and me. The secret for med sensitive patients is to ignore the doses of other people, ignore the manufacturer doses, ignore the clinical trial doses, ignore the doses of the doctor's other patients, and instead think in terms of 1/4 or 1/2 of those, especially in the first few weeks. You are not only sensitive to the negative sides of the meds, but the positive sides as well, which means you likely won't need as much as someone else.
Roaming through pubmed for relentless hours shows some interesting trends. 1) People who tolerate SSRIs poorly tolerate TCAs much better. 2) Older frail people tolerate TCAs better than SSRIs, and they are more effective. The one exception to the rule might be zoloft.
Natural things to do in order to address underlying problems. Try magnesium supplements. Start with low doses, increase as tolerated. They should provide some smoothness to life and better sleep. They can be antidepression for some people but pro-depresesion for others. A easy quick test is an epsom salts bath. A cup of epsom salts in a warm bath for 20 minutes near bedtime. You will directly absorb the magnesium. You can adjust doses by amount of salt and length of time. I find this method of magnesium delivery tolerable and helpful while supplements are not. Magnesium is sort of in the lithium family. Not sure if you have tried lithium, but low doses of it could be on your watch list, but only with a TCA and not SSRI.
For food choices, focus mostly on veggies and proteins. Very little sugars, very little caffeine, go easy on carbs such as breads, buns, pizzas. No dunuts or anything like that. It is a tough change for most people, but almost universally helpful no matter what the psychiatric problem is, given about two months. I had no choice since I found I was gluten intolerant. But now months later I must admit I prefer my current way of eating over the burgers and pizzas and donuts I used to eat all the time. I don't miss them anymore, but I missed them badly at first. Almost like breaking an addiction. Chocolate is my thing. So I eat it 85% dark to avoid most of the sugar.
And this will sound weird. But true. A baked potatoe with its skin each night about an hour before bed. Long story how it works. I think the book written about it "Potatoes Not Prozac" is a little aggressive in thinking this strategy is the answer to sleep and depression, and though it may not be a miracle cure, it is definitely worth a few points on a 1-10 scale.
Zyprexa, Nortriptyline, food choices, magnesium, bedtime baked potato. Really. :-) For emergency sleep issues, Amitriptyline first choice, Lunesta second choice. If nortriptyline should unexpectedly prove to be nonhelpful for sleep, then amitriptyline would be the choice.
I am very sensitive. So for me to mention any of these things at all says a lot about them.
Posted by SLS on July 13, 2009, at 18:00:09
In reply to Re: Best Bipolar II with depression cocktail?, posted by linkadge on July 13, 2009, at 10:05:17
> Seroquel has AD properties. The company was trying to get it approved as a treatment for unipolar depression. Try different doses to see how they affect your mood.
I think this a perfectly reasonable course of action. I am glad to see you acknowledge the possibility that Seroquel is good for something other than flushing down the toilet.
Unfortunately, I did not have much luck with Seroquel. I found that it caused me some dysphoria and irritability. My guess is that it is the NET inhibition produced by Seroquel's metabolite, norquetiapine, that was responsible for this effect. I have not yet seen Seroquel work as an antidepressant at low dosages. My guess is that 150-300mg is a good target range.
I always find Zyprexa to be a life-saver when I really need it. It has saved me from severe suicidal depressions as well as severe delusional manias. For me, it has more mood-brightening properties than Seroquel. Zyprexa would be a great drug were it not for weight gain and its potential to precipitate diabetes. These things are also possible outcomes with Seroquel, but the rate of incidence seems to be lower.
Wellbutrin + Seroquel is working well for a friend of mine who suffers from depression and mixed-states.
- Scott
Posted by AJAX1 on July 13, 2009, at 18:00:13
In reply to Re: Best Bipolar II with depression cocktail?, posted by bleauberry on July 13, 2009, at 17:26:39
thanks bleauberry. i'm going to print this out and go over it when i have more time (at work right now).
thanks again
ajax
Posted by ajax1 on July 13, 2009, at 20:09:44
In reply to Re: Best Bipolar II with depression cocktail?, posted by SLS on July 13, 2009, at 18:00:09
Scott-concerning your friend who takes Wellbutrin and Seroquel, does he take Seroquel during the day as well as night and perhaps you might know the mgs of each. That combination sounds pretty good to me.
thanks
ajax
Posted by SLS on July 13, 2009, at 21:21:57
In reply to Re: Best Bipolar II with depression cocktail?, posted by ajax1 on July 13, 2009, at 20:09:44
> Scott-concerning your friend who takes Wellbutrin and Seroquel, does he take Seroquel during the day as well as night and perhaps you might know the mgs of each. That combination sounds pretty good to me.
> thanks
> ajax
She takes:Wellbutrin 300mg
Seroquel 800mg
Neurontin 900mg
Abilify 30mgHer illness is bipolar with severe depression and psychotic mixed-states. I don't think she would need so much Seroquel if she weren't taking the Abilify. I think it possible that Abilify might antagonize the actions of other antipsychotics.
At one point, she was placed on Risperdal 3mg. That helped clear up the psychotic mixed-state, but left her depressed. I swear it only took the addition of 100mg of Seroquel to lift her out of depression completely. Take away the Risperdal, and she needed the 800mg of Seroquel to control the psychotic mixed-state.
What I glean from her case is that Seroquel can provide an antidepressant effect when combined with Wellbutrin and Neurontin. I don't usually consider Neurontin to be particularly effective as a mood stabilizer, but we can't at this point eliminate it from her equation.
Studies with Seroquel as an antidepressant have used dosages of 150-300mg.
- Scott
Posted by ajax1 on July 13, 2009, at 22:12:01
In reply to Re: Best Bipolar II with depression cocktail? » ajax1, posted by SLS on July 13, 2009, at 21:21:57
Thanks Scott-I take it that these doses are aren't taken all at once, but split up during the day and before bed? Sorry, if I seem med naive.
ajax
Posted by SLS on July 14, 2009, at 5:32:48
In reply to Re: Best Bipolar II with depression cocktail?, posted by ajax1 on July 13, 2009, at 22:12:01
> Thanks Scott-I take it that these doses are aren't taken all at once, but split up during the day and before bed? Sorry, if I seem med naive.
> ajaxSeroquel is usually divided up into two doses - evening and morning. A larger dose is sometimes taken at night. The new Seroquel XR requires only once-a-day dosing.
I wish you luck with this. Please post of your progress.
Even though I did not respond at all to Seroquel, I still respond partially to Zyprexa, Geodon, and Abilify. A failure to respond to Seroquel does not rule out an entire class of drug. Right now, another friend of mine is responding robustly to Wellbutrin + Lexapro + Geodon. Bipolar disorder runs in her family, but she has never had a manic episode. Both she and her sister respond partially to Parnate, but their doctors were resistant to adding anything to it.
- Scott
Posted by SLS on July 14, 2009, at 5:40:53
In reply to Re: Best Bipolar II with depression cocktail?, posted by bleauberry on July 13, 2009, at 17:26:39
I like your perspectives on treatment. The question is, of course, whether or not we can witness the methods you describe here work. I appreciate that your doctor reports having a high success rate with such minimal dosing. It reminds me a bit of Jay Goldstein's approach.
In any event, this was a great post. I wish I had the motivation to do as much research as you do now. I did for many many years, but I just got tired of it. Just show me the right treatment and let me go sell cars. I might play with magnetic therapy soon.
- Scott
> First a disclaimer. No matter what me or anyone has for suggestions, prediction of results is impossible. So the best we can do is to try to narrow the list down to things that would fit the uniqueness of you. So for depression, bipolar, sleep, and med sensitivity, these are the things that came to the top of the list in my thinking:
>
> Zyprexa + Nortriptyline; possibly a tiny amount zoloft added (3mg-12.5mg); naturals magnesium trial and bedtime baked potato; different food choices.
>
> Zyprexa is the mood stabilizer, the antidepressant booster, and sleep friendly.
>
> Nortriptyline is the antidepressant, pain reliever, and sleep friendly.
>
> Being a sensitive patient myself, and having done poorly just like you on the meds you listed, the above meds are do-able.
>
> No ssris. If anything at all, maybe a tiny bit of zoloft with the nortriptyline.
>
> Doses. Zyprexa start at 2.5mg with a target of 5mg, going in 1.25mg or .6mg steps (by cutting pills). Nortriptyline. Start at 5mg (half of the smallest capsule 10mg). Increase both as tolerated, with your side effects and emotions as the guide, versus a predetermined schedule. Basically that will probably mean re-assessing what to do about every 4 to 7 days, and then either staying there for another 4-7 days or taking a small jump up.
>
> I don't like seroquel and am puzzled why doctors use it so much. Zyprexa is by a million miles a much better all-around medication. Some people like their seroquel, but for most of them its benefits are in sleep but not anxiety or depression. I much prefer the sleep quality that nortriptyline gives.
>
> Neither of the two meds I suggested have the knockout elephant dart punch that seroquel has. But they will allow you to drift off to sleep and experience a good quality sleep.
>
> I cannot overstate...with med sensitivities, you gotta be extra cautious with the initial dose choices so as to be able to stay the course and not to be stopped early. No dose is too small. But it is very easy for any dose, no matter how small someone else might think it is, to be too much too fast for people like you and me. The secret for med sensitive patients is to ignore the doses of other people, ignore the manufacturer doses, ignore the clinical trial doses, ignore the doses of the doctor's other patients, and instead think in terms of 1/4 or 1/2 of those, especially in the first few weeks. You are not only sensitive to the negative sides of the meds, but the positive sides as well, which means you likely won't need as much as someone else.
>
> Roaming through pubmed for relentless hours shows some interesting trends. 1) People who tolerate SSRIs poorly tolerate TCAs much better. 2) Older frail people tolerate TCAs better than SSRIs, and they are more effective. The one exception to the rule might be zoloft.
>
> Natural things to do in order to address underlying problems. Try magnesium supplements. Start with low doses, increase as tolerated. They should provide some smoothness to life and better sleep. They can be antidepression for some people but pro-depresesion for others. A easy quick test is an epsom salts bath. A cup of epsom salts in a warm bath for 20 minutes near bedtime. You will directly absorb the magnesium. You can adjust doses by amount of salt and length of time. I find this method of magnesium delivery tolerable and helpful while supplements are not. Magnesium is sort of in the lithium family. Not sure if you have tried lithium, but low doses of it could be on your watch list, but only with a TCA and not SSRI.
>
> For food choices, focus mostly on veggies and proteins. Very little sugars, very little caffeine, go easy on carbs such as breads, buns, pizzas. No dunuts or anything like that. It is a tough change for most people, but almost universally helpful no matter what the psychiatric problem is, given about two months. I had no choice since I found I was gluten intolerant. But now months later I must admit I prefer my current way of eating over the burgers and pizzas and donuts I used to eat all the time. I don't miss them anymore, but I missed them badly at first. Almost like breaking an addiction. Chocolate is my thing. So I eat it 85% dark to avoid most of the sugar.
>
> And this will sound weird. But true. A baked potatoe with its skin each night about an hour before bed. Long story how it works. I think the book written about it "Potatoes Not Prozac" is a little aggressive in thinking this strategy is the answer to sleep and depression, and though it may not be a miracle cure, it is definitely worth a few points on a 1-10 scale.
>
> Zyprexa, Nortriptyline, food choices, magnesium, bedtime baked potato. Really. :-) For emergency sleep issues, Amitriptyline first choice, Lunesta second choice. If nortriptyline should unexpectedly prove to be nonhelpful for sleep, then amitriptyline would be the choice.
>
> I am very sensitive. So for me to mention any of these things at all says a lot about them.
>
>
>
Posted by ajax1 on July 14, 2009, at 11:02:33
In reply to Re: Best Bipolar II with depression cocktail?, posted by bleauberry on July 13, 2009, at 17:26:39
Thanks bleauberry-
You gave a very detailed set of options. I'm partial to a small amount of Wellbutrin because it's a bit pro-sexual. It can cause me to become agitated, but with the Zyprexa or Nortriptyline, wouldn't that be taken care of?
Thanks again
ajax
Posted by vicksnow on July 15, 2009, at 13:19:45
In reply to Re: Best Bipolar II with depression cocktail?, posted by SLS on July 13, 2009, at 5:12:21
i have bipolar and major depression and i am on the same cocktail for over 10 years now and on prozac since 86
here it is and it has worked for some of my friends who also go to a pdocprozac 40mg qd
wellbutrin 300mgXL qd
risperdol 2mg bid
klonopin 1mg qid
and Visteral 25mg bid prni remain pretty much stable, and happy about 95 % of the time. when under any stress thou i fall apart so i try for the most part to live a stress free life.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.