![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by sheilac on August 1, 2012, at 16:51:29
I have been through all the mood stabilizers and have never been able to reach even close to therapeutic dose. A small dose effects me.
I've had numerous docs tell me I have some sort of mood disorder - anxiety, some depression, ADD. Antidepressants make me nuts (bipolar from meds?)
Now I am taking 450mg of Lithium, 2mg Klonopin and 5mg of Adderall.
I seem very stable on this dose of Lithium. No outbursts of anger or rage, no screaming, etc.
How, if I am truly bipolar, can such a small dose make an effect? Am I really bipolar or do I just have an anxiety issue that gets out of hand to the point that I might scream at you?
If 450mg of Lithium is keeping me stable, why couldn't I just replace that with 3mg a day of Klonopin? Sounds safer.
I've been happy. Not too keen on being on Lithium with the thyroid, liver and kidney issues. Plus, it has blunted some of my creativity. When I was just on the Adderall, I was much more creative.
Maybe in time I will get used to that? Or maybe mood stabilizers just blunt your mood a little. It sucks.
I used to be able to write for hours and now I can't seem to sit at the computer and be creative.
Are there any answers to this? My sister is the same way, except she doesn't believe she is bipolar and only suffers from anxiety and keeps Valium on hand for that, yet she does have screaming, raging fits that make her look like a nut job.
Posted by bleauberry on August 2, 2012, at 18:05:09
In reply to Really bipolar? Or What?, posted by sheilac on August 1, 2012, at 16:51:29
My personal opinion is that the actual name of the diagnosis is of little value. It can sort of help to point in a certain direction when starting meds, but other than that it really doesn't predict what meds will work for you. I wouldn't worry about it. You've got some mood swings that come with rage and agitation and maybe it's got an anxiety component to it. There. I guess a single word or two to describe that is easier. So how about bipolar with anxiety. Now what. Doesn't really change anything, ya know? It does not tell you that a particular ssri would be magic for you, or that a stimulant might smooth things out nicely. I'm not at all saying those things would happen, just that they could, and sometimes the diagnosis name we become attached to prevents us from encountering the right med. For example in my case getting more psychiatric help from antibiotic and antinflammatory strategies rather than antidepressant strategies. Bipolar with anxiety, ok, so we're automatically thinking mood stabilizers and tranquilizers. But what if it's actually a true SNRI that you need, such as Savella or a combination of ssri+nortriptyline? You'll never find out if confined by a label, because that would be taboo if labeled bipolar. The label itself can sometimes keep people sick and prevent their own recovery.
Posted by phidippus on August 2, 2012, at 21:01:01
In reply to Really bipolar? Or What?, posted by sheilac on August 1, 2012, at 16:51:29
Your taking your rage as a sign of bipolar disorder. Many mental disorders feature anger bouts as part and parcel of the diiagnosis. ADHD, depression, Schizophrenia...All these braain cooties can feature anger outbursts/problems with anger and irritaability.
Lithium is often prescribed for aggression issues. This may be the only thing you're treating. The best way to determine if your bipolar is to go off any and all mood stabilizers and antipsychotics and see what happens. Racing thoughts (so fast they confuse you) is the first and best clue you are bipolar.
Lithium affects the kidneys, but not really in a permanent way. Lithium does not aaffect th eliver in any significant manner. Hypothyroidism is a manageable side effect of Lithium use and goes away once the druug is stopped. I have been on Lihthium for 10 years and my long term health has in no way been affected by Lithium.
>Or maybe mood stabilizers just blunt your mood a >little.
This they can do. Too much Depakote left me perfectly flat.
Eric
Posted by SLS on August 3, 2012, at 6:03:27
In reply to Re: Really bipolar? Or What? » sheilac, posted by phidippus on August 2, 2012, at 21:01:01
> Your taking your rage as a sign of bipolar disorder. Many mental disorders feature anger bouts as part and parcel of the diiagnosis. ADHD, depression, Schizophrenia...All these braain cooties can feature anger outbursts/problems with anger and irritaability.
>
> Lithium is often prescribed for aggression issues. This may be the only thing you're treating. The best way to determine if your bipolar is to go off any and all mood stabilizers and antipsychotics and see what happens. Racing thoughts (so fast they confuse you) is the first and best clue you are bipolar.
>
> Lithium affects the kidneys, but not really in a permanent way. Lithium does not aaffect th eliver in any significant manner. Hypothyroidism is a manageable side effect of Lithium use and goes away once the druug is stopped. I have been on Lihthium for 10 years and my long term health has in no way been affected by Lithium.
>
> >Or maybe mood stabilizers just blunt your mood a >little.
>
> This they can do. Too much Depakote left me perfectly flat.
I found Trileptal (oxcarbazepine) to be pretty clean. I did not experience flat affect while taking it. If anything, it was slightly stimulating. I did not gain weight during the six weeks I was on it.What dosage of lithium are you taking, if you don't mind my asking? My doctor indicated that kidney and thyroid effects were dosage-dependent. He was not terribly concerned with my taking 300 mg/day.
- Scott
Posted by Sheilac on August 3, 2012, at 6:20:33
In reply to Re: Really bipolar? Or What? » phidippus, posted by SLS on August 3, 2012, at 6:03:27
I'm taking 450mg of Lithium a day. Just had my bloodwork done. Won't find out about it until next week.
I still have diarrhea.
I'm only taking 1 5mg Adderall XR a day. My regular doc wants me to take 10mg. Thing is, I am more jumpy and hyper in the morning if I take the Adderall and coffee. BUT, of I do take 5mg Adderall twice a day the 2nd dose tend to chill me out. But that might be that the Lithium has kicked in or the caffeine had worn off. Don't know. I tried going to half-caf coffee with the Lithium and Adderall but I was exhausted from lack of caffeine.
Posted by phidippus on August 3, 2012, at 22:48:13
In reply to Scott: Really bipolar? Or What?, posted by Sheilac on August 3, 2012, at 6:20:33
I don't even see how 5 mg of Adderall can be therapeutic. I wouldn't be surprised if all your getting is side effects. Same with the Lithium. I strongly suggest you go to 600 mg on the Lithium and get that adderall up to 20 mg.
And stop worrying about caffeine. Look it it up: there are no interactions between coffee and any of tthe drugs you are taking. And, no Caffeine doesn't really 'add' up with the Adderall to make you more kamikaze. The two drugs stimulate very ddifferentt regions of the brain, so really what you get is awake in a coupleof differentt ways.
Eric
Posted by phidippus on August 3, 2012, at 22:57:34
In reply to Re: Really bipolar? Or What? » phidippus, posted by SLS on August 3, 2012, at 6:03:27
Trileptal affected my thinking too strongly, plus it did nothing to treat my depression, which is very important as I struggle with depression much more than I struggle with manic features.
I am taking:
1200 mg Lithium
10 mg Abilify
60 mg Viibryd
2 mg Clonazepam
Seroquel PRNKidney and thyroid issues are dose dependent. I've had imaging of my kidneys done recently and they are quite healthy despite 10 years of Lithium therapy.
Eric
Posted by jane d on August 4, 2012, at 0:41:07
In reply to Re: Scott: Really bipolar? Or What? » Sheilac, posted by phidippus on August 3, 2012, at 22:48:13
> And stop worrying about caffeine. Look it it up: there are no interactions between coffee and any of tthe drugs you are taking. And, no Caffeine doesn't really 'add' up with the Adderall to make you more kamikaze. The two drugs stimulate very ddifferentt regions of the brain, so really what you get is awake in a coupleof differentt ways.
Which adds up. Sorry but my experience with stimulants (including adderall) and caffeine was like Sheila's. I found that I had to adjust my caffeine consumption which, I will grant you, was pretty high. Those standard interaction tables you find all over the web describe only one kind of interaction.
Posted by SLS on August 4, 2012, at 3:45:47
In reply to Re: Scott: Really bipolar? Or What?, posted by jane d on August 4, 2012, at 0:41:07
>
> > And stop worrying about caffeine. Look it it up: there are no interactions between coffee and any of tthe drugs you are taking. And, no Caffeine doesn't really 'add' up with the Adderall to make you more kamikaze. The two drugs stimulate very ddifferentt regions of the brain, so really what you get is awake in a coupleof differentt ways.
>
>
> Which adds up. Sorry but my experience with stimulants (including adderall) and caffeine was like Sheila's. I found that I had to adjust my caffeine consumption which, I will grant you, was pretty high. Those standard interaction tables you find all over the web describe only one kind of interaction.
It never ceases to amaze me the variability in the spectrum of reactions that occur among different people to the same drugs. For me, a moderate dosage of caffeine acts more like a depressant than a stimulant. Higher dosages put me to sleep. Also, the let-down that occurs as the caffeine disappears from my system leaves me feeling worse the whole next day. For me, the brief increases in mental energy and cognitive function that caffeine can bring me when taken in small amounts are not worth the deleterious effects that follow. Interestingly, I get more of a stimulating effect from low dosages of caffeine than I do with any dosage of amphetamine (Dexedrine or Adderal).
- Scott
Posted by phidippus on August 4, 2012, at 7:07:26
In reply to Re: Scott: Really bipolar? Or What?, posted by SLS on August 4, 2012, at 3:45:47
Did you know caffeine has beeen studied as a treatment for OCD with surprising results. I love my coffee.
Eric
Posted by sheilac on August 4, 2012, at 12:04:33
In reply to Re: Scott: Really bipolar? Or What? » SLS, posted by phidippus on August 4, 2012, at 7:07:26
I have found that the Adderall has increased my OCD symptoms. Why is that?!
Posted by phidippus on August 4, 2012, at 20:02:29
In reply to P: OCD symptoms, posted by sheilac on August 4, 2012, at 12:04:33
That's really odd. Probably becuase the drugs in adderall cause glutamate levels to increase in the nucleus accumbens. Alone, dextroamphetamine doesn't do this, but adderall has added salts.
Eric
Posted by SLS on August 5, 2012, at 2:52:45
In reply to Re: P: OCD symptoms » sheilac, posted by phidippus on August 4, 2012, at 20:02:29
> That's really odd. Probably becuase the drugs in adderall cause glutamate levels to increase in the nucleus accumbens. Alone, dextroamphetamine doesn't do this, but adderall has added salts.
Many of the glutamate circuits afferent to the nucleus accumbens (reward center) modulate dopamine release in that structure. The higher the glutamate, the lower the dopamine. Glutamate normally puts the "brakes" on dopamine release there. To reduce the glutamatergic innervation of these inhibitory circuits results in disinhibition and yields higher levels of dopamine. A number of years ago, I theorized (perhaps wrongly) that Lamictal does exactly this via glutamate release inhibition in the thalamus. At the time, no explanation had surfaced in the medical literature as to how Lamictal could exert antiidepressant effects. I'm not sure what the current consensus is on this. The bottom line is that Lamictal produces an antidepressant effect without directly affecting the neurons responsible for reward and pleasure.
- Scott
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.