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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by sheilac on August 6, 2012, at 18:32:24
I haven't told my family that I dropped the Trileptal that was severely depressing me and have gone up on my Lithium. BUT - everyone has made comments about how much better I seem. Guess I must have really been bad.
Trying to keep meds low - which is usually all I can take anyway. Down to 2mg of Klonopin a day. And if I dropped the Adderall, I could probably use the Klonopin as needed. Not sure.
First 2 weeks on Adderall rocked. Great for depression - still is, but I do wonder/think that maybe it has increased my irritability.
I already struggle with irritability. The Lithium has leveled the playing field, which is awesome.
I am wondering if a low dose of an antidepressant could help instead of relying on Adderall.
Keeping my doses low - would 25mg of zoloft help with anxiety and depression? I don't want to take an AD that makes me tired and lethargic. I don't want to be speedy, but I don't want to be tired and fat.
Maybe between the low dose zoloft and lithium I could be golden and only use Klonopin as needed.
I used to love Lexapro back in the day, but the generic hurts my stomach too bad and prozac makes me anxious.
The only reason I suggested zoloft is because my family doc said zoloft is good for anxiety. Of course, my family doc wants me to take BOTH zoloft and adderall. Maybe just 5mg XR of Adderall and zoloft and lithium would work? Too much?
Any other antidepressants that would be good if/when I drop the Adderall?
I just worry about dropping Adderall and gaining weight from an antidepressant + lithium. I gained 30 lbs on celexa. Another reason to hate antidepressants.
Posted by Phillipa on August 6, 2012, at 23:43:22
In reply to Lithium good now what..., posted by sheilac on August 6, 2012, at 18:32:24
Why not wait awhile before other changes if doing well. Seriously Phillipa
Posted by Sheilac on August 7, 2012, at 5:50:56
In reply to Re: Lithium good now what... » sheilac, posted by Phillipa on August 6, 2012, at 23:43:22
The only change I wonder about is the Adderall. Great for depression, but bad for OCD and unable to chill out and relax in evening. I feel like I'm on speed. But it works. Just wish it were smoother and didn't last as long.
Going to talk to doc today.
For now I'm keeping lithium, Klonopin, Adderall and will discuss with her if I need to add Zoloft or other AD for Adderall anxiety and irritability.
Who knows. But, lithium is good.
Posted by brynb on August 7, 2012, at 14:34:30
In reply to AD and Lithium..., posted by Sheilac on August 7, 2012, at 5:50:56
> The only change I wonder about is the Adderall. Great for depression, but bad for OCD and unable to chill out and relax in evening. I feel like I'm on speed.
That's because it is, LOL!
> But it works. Just wish it were smoother and didn't last as long.
I'm not a fan of stims for depression (especially when it's with anxiety and/or irritability), but I found Dexedrine to be much smoother than Adderall.
> Going to talk to doc today.
I would defer to your pdoc for all of the meds; family docs are occasionally well-versed in psych meds, but typically I find them helpful w/ the basics or garden variety depression. As in, prescribe Zoloft, Celexa, etc. w/ 6 refills and the patient is fine like that for years.
> For now I'm keeping lithium, Klonopin, Adderall and will discuss with her if I need to add Zoloft or other AD for Adderall anxiety and irritability.
I think a low-dose of an SRI is good for anxiety (and mood).
Hope you're able to find a good solution =).
Posted by phidippus on August 7, 2012, at 21:19:05
In reply to Lithium good now what..., posted by sheilac on August 6, 2012, at 18:32:24
Zoloft works just fine with Lithium.
Why do you want to do everything in small doses that aren't really therapeutic?
Eric
Posted by SLS on August 8, 2012, at 16:01:15
In reply to Lithium good now what..., posted by sheilac on August 6, 2012, at 18:32:24
How does Adderall help you?
Zoloft has been used in the past to treat irritability, anger and aggression. However, it seems that in a minority of people, it can actually cause these things. I have seen it work, though.
I would explore increasing the lithium to 600 mg/day first based upon your partial response to lower dosages. Hopefully, the side effects will subside. I think it makes sense to then try to discontinue the Adderal, but only if your irritability continues - understanding that you might temporarily feel depressed and lethargic as a result. I would leave Zoloft for last since its effects can be unpredictable when treating bipolar disorder.
It's too bad that you don't react well to Trileptal. Most people do not feel more depressed as a side effect. By comparison, some people do feel more depressed while taking Depakote. However, it can be a good drug to treat bipolar II mixed-states.
Lithium seems to be a good drug for you. Try to make it work. Perhaps you could increase the dosage by half a pill for a few days before moving up to 600 mg/day. Perhaps being patient on 450 mg/day is the answer. Give it a chance to work.
- Scott
Posted by sheilac on August 8, 2012, at 17:15:09
In reply to Re: Lithium good now what... » sheilac, posted by SLS on August 8, 2012, at 16:01:15
I have been taking the Lithium Carbonate capsules 150mg. I take 2 in the morning and 1 at night.
So with the capsules I would have to just jump from 450mg to 600mg.
Is there another form of Lithium I should consider taking? I don't mind taking it twice a day.
I'm not sure how the extended version would be for me. With my luck, I would take it in the morning with breakfast and it wouldn't kick in until after I ate lunch. I need a form that will kick in quickly in the morning or maybe my nighttime dose would still be in effect.
I've had to cut down my caffeine. That has helped.
But, since dropping Trileptal, and being back on Adderall, I am feeling more manic. Just the small dose of Adderall makes me happy, focused and motivated, but also very obsessive and manic.
I know Trileptal depressed me, but maybe I should try adding back 150mg of Trileptal in the morning. If I take Trileptal at night I wake up depressed.
Maybe then I could get away with 450mg of Lithium.
Also - the lithium is only going to work if I am able to stop having bathroom issues. My doc said my level was probably low due to all the diarrhea. Don't know if 600mg would stop that or increase that.
Also - I hate the hair loss and dry skin.
I know, I bitch about ALL the side effects.
But, I'm sure there is an answer.
What do you think?
Posted by SLS on August 8, 2012, at 17:47:41
In reply to SLS - Lithium good now what..., posted by sheilac on August 8, 2012, at 17:15:09
Hi Sheila.
> I know, I bitch about ALL the side effects.
The side effects that you are experiencing are substantial and impact greatly on the quality of your life. You have every right to bitch about them.
Have you ever tried Depakote (valproate)? Depakote can produce weight gain, hair loss, and worsened depression. However, it can also squash bipolar hypomanic mixed-states and leave people feeling pretty well. You won't know how it would affect you unless you try it. You can certainly stop taking it if you are unhappy with it. You wouldn't have to stop taking lithium to perform this experiment. As is often the case with medications, not everyone experiences side effects with Depakote.
- Scott
Posted by phidippus on August 8, 2012, at 17:56:07
In reply to SLS - Lithium good now what..., posted by sheilac on August 8, 2012, at 17:15:09
There's only one form of Lithium-Lithium carbonate. Studies show blood levels remain steady even if the drug is taken once a day-so, you can take your whole dose at night or morning. No need to dose twice daily.
Explain how you feel when you say you are manic. In other words what does mania feel like to you?
Combining Trileptal with Lithium would require you take one in a therapeutic range. That's about 900mg to 2700 mg for trileptal. There's no reason against doing this. I used to takke Trilepal and Lithium together.
Eric
Posted by sheilac on August 8, 2012, at 19:39:58
In reply to Re: SLS - Lithium good now what... » sheilac, posted by phidippus on August 8, 2012, at 17:56:07
I guess what I mean by feeling manic is that I have taken up a new hobby - one that is making me a little money. But, I have become obsessed and super-focused on it to the point of barley eating or eating on the run and shopping for this hobby (spending money I shouldn't).
I can't take that much Trileptal, so there's probably no use in trying that. Thank you.
My doc mentioned an extended version of Lithium that might help with the bathroom issues and help get my level up.
I've always heard that you should dose your Lith regular capsules 2x a day so that you keep a steady state. I was afraid if I took all 600mg at night it would lessen during the day. I MUST make sure the Lith works during the day.
Posted by phidippus on August 9, 2012, at 21:47:52
In reply to Eric - Lithium good now what..., posted by sheilac on August 8, 2012, at 19:39:58
I'm glad you have a new hobby! I don't think you're new obsession qualifies as a symptom. I think you're just really getting into something. I can actually relate with you-when I get a new hobby it can become my world quickly.
I take 1200 mg all at night. I keep a steady state all day long. I've had my levels checked. Trust me, you can take all 600 mg at night or in the morning. If you feel more comfortable taking it twice a day, don't let me stop you.
Eric
This is the end of the thread.
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