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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Sheilac on October 12, 2011, at 16:14:35
Since the 120mg of Geodon does keep me stable, but blah feeling, I kind of feel flat and depressed. I have tried going down on my dose to 100mg or even 80mg, and feel a little more alert, but still feel a little underlying depression - probably from the drop in dose.
My insurance only like generics of antidepressants so my doc suggested generic Celexa (which made me gain 30 lbs about 8 years ago), so I won't be getting that filled.
I seem to remember getting an antidepressant feel from low dose lithium.
Since I am concerned about the heart issues with Geodon, would low dosing both be an option? I know some docs are big on low dose combos to reach an effect.
I was hoping if I lowered my Geodon, maybe that would lower my risk of doing damage to my heart. Don't know if that is true though.
Since I can't take Lamictal or Wellbutrin, would low dose (150 - 300mg) Lithium in combo with Geodon help?
I hate the side effects of antidepressants, but feel like I need something. 120mg of Geodon is making me too flat and maybe causing some depression?
Would a lower dose of Geodon cut my risk of doing damage to my heart?
Posted by emmanuel98 on October 12, 2011, at 19:20:05
In reply to Antidepressant to Geodon..., posted by Sheilac on October 12, 2011, at 16:14:35
Where did you read that geodon causes heart damage? I've never heard of this before.
Posted by Zyprexa on October 13, 2011, at 0:00:45
In reply to Antidepressant to Geodon..., posted by Sheilac on October 12, 2011, at 16:14:35
I don't think geodon creates heart damage. It could increase the length of the Qt interval, which would cause sudden death. But I don't think it has been a problem since geodon has been on the market. The original verson that was not aproved had a slight risk of it, but they refomulated it. Because of that they still had to put the warning on it. If your heart has not stoped yet it probably is not a problem. I took geodon for 2 years and have not heart problems.
Posted by sheilac on October 13, 2011, at 6:50:23
In reply to Re: Antidepressant to Geodon..., posted by Zyprexa on October 13, 2011, at 0:00:45
Thanks, Zyprexa! I have read all the literature that comes with Geodon and it all warns of the heart issues.
I haven't had any issues so far and I hope not to since it is working to stabilize me.
Posted by SLS on October 13, 2011, at 7:57:54
In reply to Re: Antidepressant to Geodon..., posted by sheilac on October 13, 2011, at 6:50:23
> Thanks, Zyprexa! I have read all the literature that comes with Geodon and it all warns of the heart issues.
If I recall, I think the risk attributed to Geodon for lengthening the QT-interval is more theoretical than clinical. As noted, this effect has rarely, if ever, been seen in real life.
- Scott
Posted by Solstice on October 13, 2011, at 8:20:39
In reply to Re: Antidepressant to Geodon..., posted by SLS on October 13, 2011, at 7:57:54
My teenage daughter who has taken Geodon for two years now actually has a prolonged QT interval, caught two years ago when her doctor ordered an EKG due to her fast heart rate. After two holter-monitors, they also found she also has 700 premature ventricular beats every hour. Autonomic dysfunction is the Dx. Anyway, since being on Geodon, along with taking prescribed salt tablets every day, her heart beat has stabilized and although her QT interval has stayed on the borderline, the Geodon certainly has not caused her any trouble or exacerbated it.
Solstice
> > Thanks, Zyprexa! I have read all the literature that comes with Geodon and it all warns of the heart issues.
>
> If I recall, I think the risk attributed to Geodon for lengthening the QT-interval is more theoretical than clinical. As noted, this effect has rarely, if ever, been seen in real life.
>
>
> - Scott
Posted by Phillipa on October 13, 2011, at 10:16:44
In reply to Re: Antidepressant to Geodon..., posted by Solstice on October 13, 2011, at 8:20:39
So it was already an existing problem and not caused by meds? Does she take any meds for the heart issues? Even though it's stabalized? Phillipa
Posted by floatingbridge on October 13, 2011, at 13:13:23
In reply to Antidepressant to Geodon..., posted by Sheilac on October 12, 2011, at 16:14:35
Sheila,
If 150-300mg of lithium might give you a lift, why not try that? To me that seems safe, though did you have side effects from 450 lithium? I can't recall what your dosage was before.
How long until the antidepressant effects of lithium are felt?
There is also lexapro. I don't know how that would differ for you regarding weight gain or tolerability. Did Celexa work okay for you mood wise?
Seems you have worked hard to stabilize on geodon. I'm sorry to hear you are feeling flat. I was feeling flat on risperdone a little while back but was encouraged by people here and my pdoc to preserve, and I am glad I did because I have gotten used to feeling less intensely and have also 'recovered', somehow, from the overbearing feeling of
flatness. Our situations are very different, of course.I really like feeling more stable.
Posted by herpills on October 13, 2011, at 14:46:32
In reply to Antidepressant to Geodon..., posted by Sheilac on October 12, 2011, at 16:14:35
Hi Sheilac- I used to take Geodon. My pdcos said when it first came out there was a potential risk for heart problems and so it usually wasn't prescribed long term, however she said they now know that it is safe for the heart. I think if it is helping you stick with it, but be sure to discuss your concerns with your doctor. herpills
Posted by Solstice on October 13, 2011, at 19:10:17
In reply to Re: Antidepressant to Geodon... » Solstice, posted by Phillipa on October 13, 2011, at 10:16:44
> So it was already an existing problem and not caused by meds? Does she take any meds for the heart issues? Even though it's stabalized? Phillipa
Yes, it was pre-existing. She has autonomic dysfunction. This affects all of her autonomic systems, including heart rate, blood pressure, sweating (she'll sweat on one side and not the other, or be cold when it's hot and vice-versa). Our autonomic system also controls digestion, and it affected her esophageal sphincter to the point that as early as age 4, she had acid reflux a couple dozen times each day. The esophagus normally only opens when food hits it, then it closes tightly, but hers would open and close randomly throughout the day, allowing stomach acid to rise into her throat. She took PPI's for ten yeas - been on every single one of them - twice a day. In 2009 it broke through the PPI's and became intolerable, plus putting her at risk for esophageal cancer. She begged her GI for the fundoplication he told her about when she was nine or ten. So that's what they did. They pulled the top of her stomach up and wrapped it around the bottom of her esophagus, and she hasn't had a single reflux since. It was like a miracle to her.
There really aren't meds for her issues. Salt tablets and drinking a lot of water helps stabilize the symptoms. Apparently part of the autonomic dysfunction is a problem with the body staying hydrated. Being under-hydrated exacerbates all these other symptoms. It's funny - because if she skips her salt tabs - it only takes hours for the symptoms to pop up :-)
Sol
Posted by Solstice on October 13, 2011, at 19:25:04
In reply to Re: Antidepressant to Geodon... » Sheilac, posted by floatingbridge on October 13, 2011, at 13:13:23
> I was feeling flat on risperdone a little while back but was encouraged by people here and my pdoc to preserve, and I am glad I did because I have gotten used to feeling less intensely and have also 'recovered', somehow, from the overbearing feeling of flatness. Our situations are very different, of course.
>
> I really like feeling more stable.Fb.. my daughter had the same experience when she started Geodon. 'Normal' ranges of emotion felt very flat to her, compared to her hypomania. She grieved the loss of hypomania, and complained and pitched fits about hating the geodon because she felt like she was not near as lively and fun to be with (important to a teen :-). But after about six months, her new 'norm' started to feel good. About a year and a half after she started Geodon, she told me that she was so glad I made her stick with it, because she would not want to go back to being hypomanic for anything in the world now. As she's grown, her Geodon has had to be adjusted, and we recognize it because she starts having trouble slipping into hypomania. Now she *hates* feeling hypomanic, and is the first one to start begging me to get her in to see her psychiatrist for a med adjustment. She tells me that in retrospect, she realizes that the hypomania held hands with impulsivity, and she fears doing something she'll regret. She also does Not like feeling like she doesn't have conscious control of herself. I'm hoping that these are signs that she will be med-compliant as an adult, which tends to be a a real problem for those with bipolar.
So I think the experience of going from a norm of hypomania to a 'normal' norm of emotions is not so much a matter of going from having emotions to being flat, as it is a matter of it taking some time to adjust to a normal range of emotions. At first, it feels like going from 10 to 0, but after a while you realize you only went from 10 to 5 - which is the 'norm'.. and it feels good.
Solstice
Posted by Phillipa on October 13, 2011, at 19:37:02
In reply to Re: Antidepressant to Geodon..., posted by Solstice on October 13, 2011, at 19:10:17
Sol your poor Daughter and you and husband also. I have not heard of this even though did the nursing. I will have to google this as honestly have no idea what this illness is. Was this also responsible for mental issues? you don't have to answer very sensitive question. Love to you all Phillipa
Posted by floatingbridge on October 13, 2011, at 21:58:11
In reply to Re: Antidepressant to Geodon..., posted by Solstice on October 13, 2011, at 19:25:04
>She tells me that in retrospect she realizes that the hypomania held hands with impulsivity, and she fears doing something she'll regret. She also does Not like feeling like she doesn't have conscious control of herself. I'm hoping that these are signs that she will be med-compliant as an adult, which tends to be a a real problem for those with bipolar.
>
> So I think the experience of going from a norm of hypomania to a 'normal' norm of emotions is not so much a matter of going from having emotions to being flat, as it is a
matter of it taking some time to adjust to a normal range of emotions. At first, it feels like going from 10 to 0, but after a while you realize you only went from 10 to 5 - which is the 'norm'.. and it feels good.
>
> SolsticeSol, these seem like pretty amazing statements for a teen to be making and important realizations. I imagine you are very proud of her. It does sound like she is very likely to be med compliant which I would think would be such a relief to you as a parent. I wonder if she is proud of you for towing the line for her while she struggled with such difficult, introspective issues. I congratulate you on this :-).
Posted by Solstice on October 13, 2011, at 22:48:49
In reply to Re: Antidepressant to Geodon... » Solstice, posted by Phillipa on October 13, 2011, at 19:37:02
> Sol your poor Daughter and you and husband also. I have not heard of this even though did the nursing. I will have to google this as honestly have no idea what this illness is. Was this also responsible for mental issues? you don't have to answer very sensitive question. Love to you all Phillipa
Oh No! She's not a 'poor daughter' :-) She is great! As long as she takes her salt tabs and drinks lots of water, anyway. Autonomic dysfunction can accompany illnesses that are common as people age. My daughter's autonomic dysfunction is entirely independent of anything else. It is a nervous system malfunction originating in the brain I think I remember reading somewhere along the way that it can tend to be comorbid with other brain functioning disorders, such as bipolar. I'll tell you one thing for sure - she won't go anywhere without her geodon, intuniv, vyvanse, and salt tabs. She gets quite irritated if I don't stay on top of her refills well enough to keep any of them from getting too low.
But she is really in good shape. She's very smart, beautiful, a gifted musician, has lots of friends, and is a very astute problem-solver. She's kind and generous-spirited (more so with everyone but me - but she's a teen and I'm her mom :-).
Posted by Solstice on October 13, 2011, at 23:18:30
In reply to Re: Antidepressant to Geodon... » Solstice, posted by floatingbridge on October 13, 2011, at 21:58:11
> >She tells me that in retrospect she realizes that the hypomania held hands with impulsivity, and she fears doing something she'll regret. She also does Not like feeling like she doesn't have conscious control of herself. I'm hoping that these are signs that she will be med-compliant as an adult, which tends to be a a real problem for those with bipolar.
> >
> > So I think the experience of going from a norm of hypomania to a 'normal' norm of emotions is not so much a matter of going from having emotions to being flat, as it is a
> matter of it taking some time to adjust to a normal range of emotions. At first, it feels like going from 10 to 0, but after a while you realize you only went from 10 to 5 - which is the 'norm'.. and it feels good.
> >
> > Solstice
>
> Sol, these seem like pretty amazing statements for a teen to be making and important realizations. I imagine you are very proud of her. It does sound like she is very likely to be med compliant which I would think would be such a relief to you as a parent. I wonder if she is proud of you for towing the line for her while she struggled with such difficult, introspective issues. I congratulate you on this :-).I agree. Before her bipolar was diagnosed, I was in despair about her future. Her impulsivity was so intense, and the hypomania was so distorting, that she did not have the capacity to give any thought to others.. at all. Her intelligence was apparent from the beginning, which made it all the more difficult to deal with. After she started accepting the effect geodon had on her mood, she told me it was an odd sensation for her to feel things about other people - simple things that we all take for granted like feeling empathy for others. Initially, it was hard for her because the very small discomforts of other people would have her in tears. It was a strange thing for her to feel affection for others, and it felt clumsy to her for a while. It was like she had an arrested development with respect to her relational/emotional functioning. Successfully treating the bipolar might be similar to someone who had never walked suddenly had the ability to walk. But she is very creative and positive, a genuinely delightful person, so she figured it out and caught up.
So yes, I am very proud of her, and am relieved to have the despair I once felt for her future, turn into such confidence in how she's developing.
and.. thank you for your compliment :-)
Solstice
Posted by Phillipa on October 14, 2011, at 18:46:36
In reply to Re: Antidepressant to Geodon..., posted by Solstice on October 13, 2011, at 22:48:49
So true. I did google but will have to again as didn't read your response til now. I do get confused with add meds and then geodon and bipolar. Will she require add meds when older? Or does this need remain? Congrats on having a talented gifted Daughter. Teens are turbulant times for sure. Phillipa
Posted by Solstice on October 15, 2011, at 13:22:21
In reply to Re: Antidepressant to Geodon... » Solstice, posted by Phillipa on October 14, 2011, at 18:46:36
> So true. I did google but will have to again as didn't read your response til now. I do get confused with add meds and then geodon and bipolar. Will she require add meds when older? Or does this need remain? Congrats on having a talented gifted Daughter. Teens are turbulant times for sure. Phillipa
ADHD was diagnosed first. Treating it helped some, but her impulsiveness was still through the roof. When she had some manic episodes after being taken off all of her medications while she went through a series of cardiac workups. Her high heart rate prompted her psychiatrist to order an EKG, which led to recognition of the long QT interval. She was off meds for about a month, and during that time (which coincided with puberty), her behaviors escalated rapidly and became extreme. That's when her psychiatrist said "THIS is bipolar." She'd been considering it for a while, butwanted to hold off until the evidence was overwhelming. I think treatment for ADHD kept the bipolar symptoms suppressed just enough to make it difficult to be sure of. After it was determined (by a leading pediatric cardiologist) that she could safely resume medications, she resumed treatment for both ADHD and Bipolar. I initially wondered if Bipolar didn't explain ALL of her symptoms (including those attributed to ADHD), but it didn't take long for us to all see that if she even missed her afternoon booster stimulant, she was a mess. It was like she was on a tightrope of sorts between ADHD and Bipolar (which are often comorbid). She still struggles mightily with distractibility, but her impulsiveness is very nicely addressed, and her irritability is much suppressed. It pops up, but doesn't take her to the point of no return. But if she misses her stimulant, it all goes out the window. Same with Geodon. Missing intuniv makes it more difficult - but it doesn't throw everything out of whack.
Anyway, you're right. There is an overlap of bipolar/ADHD symptoms. That's why it's not uncommon for those with bipolar to be misdiagnosed as either having ADHD if they are hypomanic, or as ADHD and MDD if they have depression.
Solstice
upon reaching puberty that provoked extreme behaviors, her psychiatrist (who has treated her since age 5)said "THIS is bipolar." She'd been considering it for a while, but held off that diagnosis until the evidence was overwhelming. Initially, I questioned whether all her symptoms might actually be biplar rather than ADHD. She had to go off all her meds while she went through cardiac
Posted by Phillipa on October 15, 2011, at 20:18:07
In reply to Re: Antidepressant to Geodon..., posted by Solstice on October 15, 2011, at 13:22:21
I had no idea that add and bipolar were related or is it just in children and teens? Seems like opposite response but then that is typical for add. The meds calm. What a viscious circle. Phillipa
Posted by Solstice on October 15, 2011, at 22:49:37
In reply to Re: Antidepressant to Geodon... » Solstice, posted by Phillipa on October 15, 2011, at 20:18:07
> I had no idea that add and bipolar were related or is it just in children and teens? Seems like opposite response but then that is typical for add. The meds calm. What a viscious circle. Phillipa
They aren't 'related.' It's just not uncommon for them to be comorbid. ADHD is comorbid with a lot of things, including tourettes and aspergers.
ADHD and Biopolar are not 'opposites.' Although they are not the same thing, they do have several core symptoms in common, impulsivity, distractibility and hyperactivity in particular. In my daughter's case, those symptoms are extreme - beyond what is normally seen in ADHD pts. Her doctor says that it's the bipolar that makes those three symptoms so extreme. Her racing thoughts, though, are purely bipolar - which is probably the biggest contributor to her distractibility.
Solstice
Posted by Phillipa on October 16, 2011, at 19:40:36
In reply to Re: Antidepressant to Geodon..., posted by Solstice on October 15, 2011, at 22:49:37
Thanks I truly appreciate the information. So glad your Daughter has a parent like you!!!! Phillipa
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