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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 Sheilac on May 19, 2012, at 6:17:15
I guess I understand that Trileptal and Lithium are keeping me stable and the depression just needs to be addressed.
Is Abilify the right med to do that?
I took it last night and I feel groggy this morning, like I need some Adderall.
Maybe I should have just tried to go down to 18mg of Wellbutin and work up from there?
I'm not used to feeling this drugged.
Posted by SLS on May 19, 2012, at 6:45:46
In reply to Scott- what to add?, posted by Sheilac on May 19, 2012, at 6:17:15
> I guess I understand that Trileptal and Lithium are keeping me stable and the depression just needs to be addressed.
Remember, though, that it often takes 600 mg of Trileptal in order to get the most out of it. Depakote made me feel more depressed. Trileptal was neutral, and probably the cleanest anticonvulsant mood-stabilizer I have tried.
> Is Abilify the right med to do that?
Maybe yes and maybe no. You never really know for sure. You just have to try it. It is a lifesaver for some people with depression.
> I took it last night and I feel groggy this morning, like I need some Adderall.I don't think you could come to any conclusions after the first dose. That "drugged" feeling could be a startup side effect that completely disappears within the first week. For you, I think that feeling groggy is better than experiencing hyperarousal or anxiety. Some people cannot tolerate Abilify because of these effects. Perhaps this initial grogginess is an indicator that Abilify will have anti-manic effects. Because you are bipolar, you might need 10 mg of Abilify to glean an antidpressant effect. I would keep this in mind if dosages of 5 mg and less don't work, AND you are tolerating the drug well.
What was it about Lamictal that you could not tolerate?
> Maybe I should have just tried to go down to 18mg of Wellbutin and work up from there?
Your reaction to Wellbutrin was so intense at a relatively low dosage, that I doubt you would feel well on it at any dosage.
> I'm not used to feeling this drugged.
Well, lets hope that this is only a startup effect.
Parnate is a drug worth considering for your type of depression. Even Emsam might help.
So, you can speak to your doctor about:
1. Returning to Wellbutrin at an extremely low dosage.
2. Increasing the Trileptal to 600 mg.
3. The grogginess that might eventually disappear.
4. Using higher dosages of Abilify if necessary.
5. Trying an MAOI like Parnate or Emsam.I really would like to know about your experience with Lamictal. What happened with it that caused you to abort your trial?
- Scott
Posted by sheilac on May 19, 2012, at 8:09:59
In reply to Re: Scott- what to add? » Sheilac, posted by SLS on May 19, 2012, at 6:45:46
> > I guess I understand that Trileptal and Lithium are keeping me stable and the depression just needs to be addressed.
>
> Remember, though, that it often takes 600 mg of Trileptal in order to get the most out of it. Depakote made me feel more depressed. Trileptal was neutral, and probably the cleanest anticonvulsant mood-stabilizer I have tried.
>
Scott, I like Trileptal, but at a higher dose I felt even flatter, with no personality and motivation. But I do wonder if just going higher on Trileptal if I could tolerate low dose Adderall better (I hate the come down effect of Adderall later in the day) or if I could tolerate a low dose of Wellbutrin. Then, maybe a higher dose of Trileptal would be worth it. If it would address the depression. Trileptal dose nothing for my depression.> > Is Abilify the right med to do that?
>
> Maybe yes and maybe no. You never really know for sure. You just have to try it. It is a lifesaver for some people with depression.
>
> > I took it last night and I feel groggy this morning, like I need some Adderall.
>
> I don't think you could come to any conclusions after the first dose. That "drugged" feeling could be a startup side effect that completely disappears within the first week. For you, I think that feeling groggy is better than experiencing hyperarousal or anxiety. Some people cannot tolerate Abilify because of these effects. Perhaps this initial grogginess is an indicator that Abilify will have anti-manic effects.Scott, I'm not sure I need anymore anti-manic effects at this point. The Trileptal and Lithium seem to be taking care of that. Will more anti-manic effects with Ablilify just make me more depressed?
Because you are bipolar, you might need 10 mg of Abilify to glean an antidpressant effect. I would keep this in mind if dosages of 5 mg and less don't work, AND you are tolerating the drug well.
>
> What was it about Lamictal that you could not tolerate?Lamictal made my mouth and gums break out in blisters. It was an awful experience. I tried this med several times in lesser and lesser doses and it still did it to me.
>
> > Maybe I should have just tried to go down to 18mg of Wellbutin and work up from there?
>
> Your reaction to Wellbutrin was so intense at a relatively low dosage, that I doubt you would feel well on it at any dosage.Scott, even if I went up on Trileptal and down on dose of Wellbutrin?
>
> > I'm not used to feeling this drugged.
>
> Well, lets hope that this is only a startup effect.
>
> Parnate is a drug worth considering for your type of depression. Even Emsam might help.
>
> So, you can speak to your doctor about:
>
> 1. Returning to Wellbutrin at an extremely low dosage.
> 2. Increasing the Trileptal to 600 mg.
> 3. The grogginess that might eventually disappear.
> 4. Using higher dosages of Abilify if necessary.
> 5. Trying an MAOI like Parnate or Emsam.
>
> I really would like to know about your experience with Lamictal. What happened with it that caused you to abort your trial?
>
>Soctt, why do you think 600mg of Trileptal would be better? Would it kick in some anti-depressant effects? I could go higher, I just don't want to feel flatter, with no motivation and still this lingering depression. I need some energy.
Thanks for all your input! I really appreciate your thoughts.
Sheila
> - Scott
Posted by SLS on May 19, 2012, at 9:33:47
In reply to Scott- what to add?, posted by sheilac on May 19, 2012, at 8:09:59
> Scott, I like Trileptal, but at a higher dose I felt even flatter, with no personality and motivation.
That is definitely not what we are looking for. So, it seems that 300 mg is an ideal dosage for you. It knocked out the mania and left you feeling great for awhile and without flattening.
> But I do wonder if just going higher on Trileptal if I could tolerate low dose Adderall better (I hate the come down effect of Adderall later in the day) or if I could tolerate a low dose of Wellbutrin. Then, maybe a higher dose of Trileptal would be worth it. If it would address the depression. Trileptal dose nothing for my depression.
I am guessing that going higher on Trileptal will still not allow you to take either of those two drugs without experiencing the psychiatric side effects that you describe. That is not to say that you cannot take antidepressants in general. With mood stabilizers in place, you might be okay with certain antidepressants. I like the idea of your being on Abilify before going the antidepressant route. If Abilify is of some help at lower dosages, I would consider optimizing the dosage and leaving it in place while you try other drugs. Personally, it has been my experience that MAOIs, Effexor, and nortriptyline help to treat my bipolar depression.
> Scott, I'm not sure I need anymore anti-manic effects at this point.
You would be using the Abilify for depression. It just so happens that it helps to prevent mania as well. It is not necessary that you feel flat by Abilify just because of this. It usually doesn't do that, especially at lower dosages (2 - 10 mg). I think that it really does stabilize dopamine systems as has been theorized.
> > What was it about Lamictal that you could not tolerate?
> Lamictal made my mouth and gums break out in blisters. It was an awful experience. I tried this med several times in lesser and lesser doses and it still did it to me.
I am sure you are aware that those are the symptoms of true Stevens-Johnson Syndrome (SJS). This reaction is serious, and can be fatal. It probably was not such a good idea to rechallenge you with Lamictal after displaying SJS.
> Soctt, why do you think 600mg of Trileptal would be better?I thought it would guarantee protection against mania and possibly allow antidepressants to work better. However, it sounds like 300 mg is optimal for you.
> Would it kick in some anti-depressant effects? I could go higher, I just don't want to feel flatter, with no motivation.
How long did you remain at 600 mg before deciding to return to a lower dosage?
I don't think you are at the point where you should feel desperate. You have several alternatives for treatment, and I think you should be optimistic that you will find a treatment regime that keeps you stabilized and euthymic. However, in order to give you the best chances of finding the right drugs and dosages for you, compliance to the treatment plans chosen is essential. If you are reacting badly to something, contact your doctor. It is important to be vigilant if side effects emerge that are likely to be startup effects that soon disappear. I get the feeling that you might be inadvertantly sabotaging your treatment if you experiment on yourself out of impulse. I wouldn't blame you for this. However, you should fight the urge to self-medicate and work with your doctor in making treatment decisions.
Oh, yes... and don't place too much faith in me to know exactly what is best for you. I am only guessing.
- Scott
Posted by sheilac on May 19, 2012, at 10:14:48
In reply to Re: Scott- what to add? » sheilac, posted by SLS on May 19, 2012, at 9:33:47
Scott, I will definitely stick with my Lithium and Trileptal since they are keeping me stable.
When I first woke up this morning I felt yucky and groggy and was questioning the Abilify. But now, after 4 hours of being awake (took Abilify last night), I feel fine. I think it might help with my depression.
I am going to stick with it and see if the morning grogginess goes away and if it truly helps my depression (since I have failed anti-depressants).
I will stick with this program and not change up my meds on my own.
Thanks for your input, it helps to have someone to bounce ideas and thoughts off of!
Posted by Phillipa on May 19, 2012, at 10:26:36
In reply to Scott- what to add?, posted by sheilac on May 19, 2012, at 10:14:48
Maybe this is your med combo? And Scott is right work closely with your doc. Phillipa
Posted by Christ_empowered on May 19, 2012, at 10:33:50
In reply to Scott- what to add?, posted by Sheilac on May 19, 2012, at 6:17:15
What happened to the tramadol solution? Personally, if I could just take PRN klonopin and some tramadol, I wouldn't screw with more hardcore psych meds. Unfortunately for me, I have a rather severe mental illness, so I can't do it.
But you could, and then you could worry less about your meds and just live.
Posted by SLS on May 19, 2012, at 13:10:22
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 19, 2012, at 10:33:50
> What happened to the tramadol solution?
Solution? It is a proposal. What evidence do you have that this proposal would have a greater chance of working than what her doctor is doing now? Actually, can you provide any scientific support for using a combination of tramadol and Klonopin to treat bipolar disorder, especially with an acute presentation?
> Personally, if I could just take PRN klonopin and some tramadol, I wouldn't screw with more hardcore psych meds.
Even though YOU take them - or have you stopped again?
> Unfortunately for me, I have a rather severe mental illness, so I can't do it.
Oh, I see. Bipolar disorder isn't severe enough for you to justify its treatment with the same drugs you treat yourself with.
Nice.
Would anyone with bipolar disorder like to lend Christ_Empowered their shoes for a few minutes? I'm sure he won't need to walk a full mile in them.
- Scott
Posted by Christ_empowered on May 19, 2012, at 21:33:31
In reply to Re: Scott- what to add? » Christ_empowered, posted by SLS on May 19, 2012, at 13:10:22
All I ws trying to say is that if you can get things under control with a couple of pleasant drugs, that beats cocktails with less-then-pleasant drugs. Since sheila doesn't seem to have full-blown mania, psychosis, agitation, etc., it just might be worth trying, if only for a little while.
As for me...psychosis. Mania. Agitation. I've tried keeping it under control with more pleasant drugs, but I'm stuck with Abilify. Not the worst situation in the world, but obviously not the best, either.
Posted by SLS on May 20, 2012, at 0:29:35
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 19, 2012, at 21:33:31
> All I ws trying to say is that if you can get things under control with a couple of pleasant drugs,
What things need to be controlled? Which of these things would tramadol be able to control?
> that beats cocktails with less-then-pleasant drugs.
That depends upon the objective. If the objective is to put out a forest fire, you don't show up with a tiny squirt-gun. The fire will surely spread and cause damage if the squirt-gun is tried first. So, I feel that the less-than-pleasant drugs that you refer to do indeed beat tramadol.
> Since sheila doesn't seem to have full-blown mania
How would you characterize it, then.
> psychosis
Psychosis is not a required symptom to make a diagnosis of mania. and is not necessary to justify its aggressive treatment.
> agitation
Even agitation is not a required symptom for diagnosis. There are very happy manics who are not psychotic or agitated who can function despite their delusions of grandeur and expansive, racing thoughts. Of course, their lives often fall apart. Not good.
I don't know what SC experiences, but, apparently, it is significant enough to require treatment with two mood-stabilizers that are currently judged to be effective for treating mania. Perhaps tramadol could be considered for the depressive symptoms of the illness. As I said, though, without control of the mania, affective stability is compromised, and depression will often emerge as a result.
- Scott
Posted by SLS on May 20, 2012, at 0:41:49
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 19, 2012, at 21:33:31
> As for me...psychosis. Mania. Agitation. I've tried keeping it under control with more pleasant drugs, but I'm stuck with Abilify. Not the worst situation in the world, but obviously not the best, either.
Do you think Abilify monotherapy is effective for treating schizoaffective disorder? It is an interesting drug for which there are no available analogs. However, one such drug may soon come out - cariprazine. Like Abilify, it is a potent D3/D2 dopamine receptor partial agonist. It has antipsychotic properties, as does Abilify. However, it is supposed to be pro-cognitive according to studies of its effects on rats. Perhaps cariprazine would allow you to establish a treatment for yourself that doesn't produce the cognitive dulling that you hate. Cariprazine is in phase III of development. We might see it next year. I might try substituting Abilify with cariprazine if it carries less of a metabolic liability. For me, this includes weight gain and elevated triglycerides.
http://www.ncbi.nlm.nih.gov/pubmed/21767587
- Scott
Posted by Christ_empowered on May 20, 2012, at 11:39:44
In reply to Re: Scott- what to add?, posted by SLS on May 20, 2012, at 0:41:49
I think Abilify monotherapy has been good for me, most of the time. Right now, I'm supposed to be on 300 Trileptal. I just didn't see the point in taking it...makes me stupid, and I'm way too prone to depression to go for something that, in my experience, functions better as an anti-agitation/anti-manic than as a mood elevator.
I think it depends on the person (I know, everyone says that). But seriously: for me, Abilify, plus the occasional SSRI or lamictal, has been great. Abilify+Depakote (both full dose)...not so much. I'm also kind of concerned about the widespread use of lower doses for non-psychotic depression in combination w/ antidepressants.
Anyway, I did read a couple abstracts online that seemed to indicate that Abilify can improve cognition in psychotic disorders at least as much as Zyprexa, maybe a bit more. Its not exactly the next clozapine, but it is more tolerable and safer in some respects than the alternatives.
Now that I have Medicaid, I can see my doc at her private practice (probably). Once that happens, I want to see about lowering the Abilify to 20 and adding in a low-dose, PRN benzo. We'll see how that goes.
Posted by SLS on May 20, 2012, at 17:49:04
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 20, 2012, at 11:39:44
> ... I want to see about lowering the Abilify to 20 and adding in a low-dose, PRN benzo. We'll see how that goes.
That sounds like a good plan. Which BZDs are you considering?
- Scott
Posted by Christ_empowered on May 20, 2012, at 22:12:35
In reply to Re: Scott- what to add? » Christ_empowered, posted by SLS on May 20, 2012, at 17:49:04
***IF*** my doc goes for it, I was thinking: xanax xr, Klonopin (both of those would be for daily use, since I find PRN klonopin impossible), or PRN valium, which is probably more of a long shot than a daily high-potency BZD, given how docs around here seem to prescribe.
Posted by Phillipa on May 20, 2012, at 22:56:49
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 20, 2012, at 22:12:35
CE it's the part of US we live in for sure. Phillipa
Posted by SLS on May 21, 2012, at 5:41:07
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 20, 2012, at 22:12:35
> ***IF*** my doc goes for it, I was thinking: xanax xr, Klonopin (both of those would be for daily use, since I find PRN klonopin impossible), or PRN valium, which is probably more of a long shot than a daily high-potency BZD, given how docs around here seem to prescribe.
What role would a BZD play in your treatment? I know that this questions sounds somewhat silly to ask. Ultimately, is it for anxiety only, or does it help prevent swings into mania? Are you classified as schizoaffecive disorder, bipolar type? I know someone with this illness who was able to bring her cycling under control with a combination of Risperdal and Xanax. Without the Xanax, her treatment just did not work. She searched and searched for a doctor who would believe her. She needed a fairly large amount. She ended up doctor-shopping and actually saw two different doctors to be able to get the amount she needed. With her, if mania were allowed to emerge and she swung into mania, the schizoid thinking and halluciations would emerge, including visual hallucinations. If she prevented the mania, she also prevented the schizoid and depressive episodes.
Her cycle:
euthymia > mania > schizoid > depression > euthymia
- Scott
Posted by Christ_empowered on May 21, 2012, at 6:27:18
In reply to Re: Scott- what to add? » Christ_empowered, posted by SLS on May 21, 2012, at 5:41:07
I think its bipolar I officially, maybe bipolar I w/psychotic features. My last shrink (I go to a public mental health place, so they come and go a lot) was European, so I don't think she's big on schizo-anything, unless you're really, really far out there.
I was thinking the benzo could control agitation if used PRN to prevent up, down, and mixed swings as I lower the neuroleptic to the 10-20 range. If I get a daily one, then it'd be more for social phobia, which leads to depression for me. Also, I figure one reason I need 30 abilify right now is to stay calm; with a BZD on board, I might get more mileage out of a slightly lower Abilify dose. Also, I read that this was a common strategy before the atypicals saturated the market, so I'm gonna try to bring it back.
Posted by Sheilac on May 21, 2012, at 7:28:26
In reply to Re: Scott- what to add? » Christ_empowered, posted by SLS on May 19, 2012, at 13:10:22
Ok, so I've read the different points of view.
I understand that trying to treat what maybe Bpii or anxiety/depression cycle with Klonopin and Tramadol may be too simplistic.
Since high doses of mood stabilizers make me feel suicidal, my doc uses low dose Trileptal and Lithium to help with mania like anger and rage and they work. The low dose Abilify was thrown in to help with depression.
Here's where I'm confused... Did someone say that if I were on higher doses of mood stabilizers (meds that make me want to kill myself) that I wouldn't need anything for depression? Wouldn't that just be true for someone that is truly a BPI?
Posted by SLS on May 21, 2012, at 13:14:46
In reply to Re: Scott- what to add?, posted by Christ_empowered on May 21, 2012, at 6:27:18
> I think its bipolar I officially, maybe bipolar I w/psychotic features. My last shrink (I go to a public mental health place, so they come and go a lot) was European, so I don't think she's big on schizo-anything, unless you're really, really far out there.
>
> I was thinking the benzo could control agitation if used PRN to prevent up, down, and mixed swings as I lower the neuroleptic to the 10-20 range. If I get a daily one, then it'd be more for social phobia, which leads to depression for me. Also, I figure one reason I need 30 abilify right now is to stay calm; with a BZD on board, I might get more mileage out of a slightly lower Abilify dose. Also, I read that this was a common strategy before the atypicals saturated the market, so I'm gonna try to bring it back.Back in the old, old days - before Depakote - mania was often treated with a combination of lithium and a BZD. Klonopin is probably the most effective BZD to use in this role. I would guess that Xanax would be second. I don't think Ativan is as effective for mania. If Klonopin doesn't depress you, you might want to look at it first as an antimanic / mood stabilizer.
I wish the best for you.
- Scott
Posted by Sheilac on May 21, 2012, at 15:56:57
In reply to Re: Scott- what to add? » Christ_empowered, posted by SLS on May 21, 2012, at 13:14:46
Klonopin is ok for anxiety and for a quick fix to mania, but it does depress me.
So you think I show more signs of BPI even though I feel depressed a lot?
I've tried to fix the depression for 20 years with antidepressants and they have caused mania.
Mood stabilizers depress me, so I don't know what I am.
I know I am med sensitive and a little bit of all 4 meds seems to work. Actually, since using the Trileptal I haven't needed to take Klonopin except for an as needed basis.
We'll see if the Abilify helps the depression.
Posted by Phillipa on May 21, 2012, at 20:53:31
In reply to Re: Scott- what to add?, posted by Sheilac on May 21, 2012, at 15:56:57
Sheila your question kind of got hyjacked. From only what have read here abilify can act as an antidepressant. Call your doc for clarification. Phillipa
Posted by SLS on May 22, 2012, at 6:42:30
In reply to Re: Scott- what to add?, posted by Sheilac on May 21, 2012, at 15:56:57
> So you think I show more signs of BPI even though I feel depressed a lot?
For BP I and BP II, more often than not, the majority of time is spent in the depressive phase.
http://www.ncbi.nlm.nih.gov/pubmed/17680925
- Scott
This is the end of the thread.
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