![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by SheilaC on November 18, 2009, at 16:53:21
What do most folks take to deal with their BPII?
I have failed most all antidepressants. They all seem to have side effects that are just plain intolerable. Pristiq seems ok, but I have gastro-intestinal issues (gas, bloating, pain).
I cannot take Lamictal due to the rash.
Do any BPII folks just take mood stabilizers or antipsychotics to manage their BPII? If so, which ones?
My main symptoms are irritability, anxiety, some depression.
There has to be an easier way.
Posted by SLS on November 18, 2009, at 18:02:30
In reply to BP II meds?, posted by SheilaC on November 18, 2009, at 16:53:21
> I cannot take Lamictal due to the rash.
Did you use the manufacturer's starter-pack to begin Lamictal therapy?
It sounds like you might benefit from Depakote or Topamax.
I am a weird kind of bipolar. Some of the non-antidepressant drugs that I found helpful were:
Depakote
Zyprexa
Lamictal
Abilify
Geodon
Trileptal
Topamax
lithiumYou still might need an antidepressant. Parnate, Effexor (or Pristiq), and Wellbutrin are worth a look at.
How does your irritability manifest?
You know, irritability and anxiety can be symptoms of unipolar depression, especially early in the course of the illness or during adolescence. If you are bipolar, you might experience episodes of unmitigated rage, pressured speech, racing thoughts, and the sensation that the people around you are not able to think or move as fast as you, leading to frustration. Some people also experience grandiosity and hypersexuality.
The problem in identifying bipolar II disorder is that it can look quite different from person to person. Pure hypomania can be very energizing, pleasant, and exhilarating. Mixed states can be pressured, rageful, and uncomfortable. There is a bipolar spectrum of presentations that includes various combinations and severities of symptoms.
What is it about your symptomatology that indicates bipolar disorder?
- Scott
Posted by SLS on November 18, 2009, at 18:22:13
In reply to Re: BP II meds? » SheilaC, posted by SLS on November 18, 2009, at 18:02:30
Oh. I forgot to mention that my best results came from combinations of antidepressants. I find that adding nortriptyline to either Parnate or Effexor is helpful. Others have found that adding Wellbutrin to either Effexor or Lexapro effective. Some doctors will not want to give a tricyclic antidepressant (TCA) like nortriptyline to a bipolar patient for fear of producing a manic switch. I really liked Effexor + nortriptyline. Unfortunately, my doctor at that time failed to properly dose the nortriptyline. I was only taking half of what I needed. He should have ordered blood tests that assay drug level. I was underdosed. I wouldn't mind revisiting that treatment in the future if necessary.
Currently, I am taking:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mgLithium monotherapy probably won't help you. It seems to be most effective for bipolar I. However, a lower dose (300-600mg) is sometimes effective as an augmenter of antidepressants in unipolar depression. My guess is that the same is true for bipolar II.
Most people do not feel that Topamax is worth using in bipolar disorder. However, I have seen Topamax monotherapy work a miracle for a young woman who would enter bipolar II mixed-states. She was like a different person. She only needed 100mg. If you start Topamax at a low dosage and work up slowly (25mg per week), you can avoid the precipitation of cognitive side effects. I experienced no side effects whatsoever with this drug.
- Scott
Posted by Phillipa on November 18, 2009, at 21:10:16
In reply to Re: BP II meds?, posted by SLS on November 18, 2009, at 18:22:13
Scott please see the thread I posted for Liongirl29 below new poster. Thanks Phillipa
Posted by SheilaC on November 19, 2009, at 12:09:49
In reply to Re: BP II meds? » SheilaC, posted by SLS on November 18, 2009, at 18:02:30
Geodon made my heart race, made me hyper.
Tegretol didn't really do anything for me.
Pristiq does seem to help with depression, but causes some really bad, painful stomach/gastro issues. Plus, I hate numbness below the waist. No desire or feelings for sex.
Wellbutrin made me rageful, irritable and downright manic. Can't take. I even tried adding Wellbutrin to PRistiq, but still got the short fuse rage effect.
My doc suggested Parnate, but I really don't want to mess with diet restrictions.
This is all so complicated. I guess you can't just take one pill and expect everything to be alright.
I get good results with Seroquel and Klonopin for sleep. But am still struggling with motivation and depression.
I did try the starter pack of Lamictil, failed it. I even tried a baby dose of 5mg or 10mg of Lamictial, but got the rash, fever and mouth/gum issues rather quickly.
I'm at my wits end. Right now I am very depressed. And, to top it all off, my doc no longer excepts my insurance, so I need to find a new doc and start all over.
I want to med that doesn't cause weight gain, will help with depression, that isn't very serotonergic and that doesn't cause sexual side effects.
Really, is it that hard?
Posted by ricker on November 19, 2009, at 12:26:29
In reply to Re: BP II meds?, posted by SheilaC on November 19, 2009, at 12:09:49
How about low dose lithium along with cymbalta?
Regards, Rick
Posted by SLS on November 19, 2009, at 12:44:54
In reply to Re: BP II meds?, posted by SheilaC on November 19, 2009, at 12:09:49
> I want to med that doesn't cause weight gain, will help with depression, that isn't very serotonergic and that doesn't cause sexual side effects.
>
> Really, is it that hard?Yes, especially when you exclude Parnate from consideration. Perhaps you could revisit MAOIs later should nothing else work.
You could try using a tricyclic and add lithium or thyroid hormone if you don't respond adequately to it. Nortriptyline is popular because its anticholinergic side effects are milder than most of the others. Given your reaction to Wellbutrin, you might find desipramine and protriptyline too harsh.
Is there any history of bipolar disorder in your family?
- Scott
Posted by SheilaC on November 21, 2009, at 17:55:00
In reply to Re: BP II meds? » SheilaC, posted by SLS on November 19, 2009, at 12:44:54
> > I want to med that doesn't cause weight gain, will help with depression, that isn't very serotonergic and that doesn't cause sexual side effects.
> >
> > Really, is it that hard?
>
> Yes, especially when you exclude Parnate from consideration. Perhaps you could revisit MAOIs later should nothing else work.
>
> You could try using a tricyclic and add lithium or thyroid hormone if you don't respond adequately to it. Nortriptyline is popular because its anticholinergic side effects are milder than most of the others. Given your reaction to Wellbutrin, you might find desipramine and protriptyline too harsh.
>
> Is there any history of bipolar disorder in your family?
>
>
> - Scott
>Yes, Scott, my Dad had BPI and committed suicide when he was 41. My sister is also BP, but in total denial and she cycles up and down. She does ok if she will stay on an AD (she gets suicidal otherwise) and she will take valium if things get too out of hand, but she really needs much bigger meds.
I have always been afraid of taking lithium.
Posted by james_ukglasgow on November 23, 2009, at 0:41:57
In reply to Re: BP II meds?, posted by SheilaC on November 21, 2009, at 17:55:00
I used to be afraid of lithium until I got over the fear and tried it. I took it at night and put down a basin in case I was sick, and was expecting to wake up sometime in the following week feeling like I had had a chlorpromazine injection.
I was pleasantly surprised, the following day I was fine and it never sedated me that much. It simply put my mind back together. It took about 7 days to do that.
The only problems I had were acne and my beard hair fell out in circular patches, but I still keep it at hand in case my friends say "James, you are off again".
Hope this is of some help.
Posted by hopefullynow on November 23, 2009, at 6:25:55
In reply to Re: BP II meds?, posted by james_ukglasgow on November 23, 2009, at 0:41:57
> I was pleasantly surprised, the following day I was fine and it never sedated me that much. It simply put my mind back together. It took about 7 days to do that.
> Hope this is of some help.Hy James, I'm glad to hear that you're stabilised on lithium.May I ask you at what dosage you began/you're now and how long it took to stabilise you and to feel better?Do you spread it, or you take it at bedtime?I'm on lithium carbonate too, 400 mg/day and I dunno if i should rise it,.I'm afaraid of weight gaining and muscular weakness.
Regards
Posted by james_ukglasgow on November 25, 2009, at 0:43:49
In reply to Re: BP II meds? » james_ukglasgow, posted by hopefullynow on November 23, 2009, at 6:25:55
Hi there
I also take 400mg, I am just looking at the box and it is sustained release and contains 10.8mmol of Li (Priadel is the brand name). I take the tablet at bedtime.
When I first started it it only took a week to "put me back together". There is a thread at the top of the page about Lithium in which someone describes it saving their life. But I think it is a definite case of YMMV, everyone seems to need a different amount to get to the same blood level and/or start to get better. My blood level is currently 0.4
I understand your fears about it, in particular weight gain and muscle weakness. I am already overweight from the need to take oral corticosteroids, which I cant do much about but I dont think you would gain much at 400mg. It has not affected my muscles so far.
Hope you find something that helps soon.
I have tried just about every medicine in the book and this must be one of the best, for me at least. It does to me, the same as the poster at the top of the page, cause my hair to fall out (circular patches of beard hair), which is annoying. But, in the end I had to decide what was more important, which is very difficult, especially when you are used to living in your body only to find it changed by medication. I tried other things to avoid lithium's side effect but eventually went back to it.
Posted by hopefullynow on November 29, 2009, at 13:02:38
In reply to Re: BP II meds?, posted by james_ukglasgow on November 25, 2009, at 0:43:49
Hy James,
Thank you for responding.Besides 400mg/day lithium (non sustained release) im also on Anafranil which is known to produce muscle weakness, increased hunger and sexual disfunction.I did a test, lowering for three days the lithium and i've felt an drastic improvement in the side effects that i mentioned.The dose that i feel it helps me, is minimum 400 mg/day, so maybe with time my body will adapt.Also the hair problem that you relate sounds weird, i must agree, sometimes you have to choose for being fatter, bald, sedated but sane.Its hard for me to accept and make compromises, i live in an sportish environment where everybody is in top shape, strong, ripped and athletic.
Best regards> Hi there
>
> I also take 400mg, I am just looking at the box and it is sustained release and contains 10.8mmol of Li (Priadel is the brand name). I take the tablet at bedtime.
>
> When I first started it it only took a week to "put me back together". There is a thread at the top of the page about Lithium in which someone describes it saving their life. But I think it is a definite case of YMMV, everyone seems to need a different amount to get to the same blood level and/or start to get better. My blood level is currently 0.4
>
> I understand your fears about it, in particular weight gain and muscle weakness. I am already overweight from the need to take oral corticosteroids, which I cant do much about but I dont think you would gain much at 400mg. It has not affected my muscles so far.
>
> Hope you find something that helps soon.
>
> I have tried just about every medicine in the book and this must be one of the best, for me at least. It does to me, the same as the poster at the top of the page, cause my hair to fall out (circular patches of beard hair), which is annoying. But, in the end I had to decide what was more important, which is very difficult, especially when you are used to living in your body only to find it changed by medication. I tried other things to avoid lithium's side effect but eventually went back to it.
>
>
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.