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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 Slabicki on August 14, 2012, at 16:30:35
Hi everyone,
I just saw my Pdoc today. He said I have mixed states, depression and anxiety. Since we are out
of options, we both agreed on ECT.The symptoms are horrible.
Is anybody here in desperation just like me right now?
I just wonder if anyone can e-mail me on Babblemail,
so we could talk. That could be helpful.Slabicki
Posted by bleauberry on August 14, 2012, at 18:34:32
In reply to Mixed states! Is anybody in desperation now?, posted by Slabicki on August 14, 2012, at 16:30:35
What meds have you been on? What combos?
Posted by Phillipa on August 14, 2012, at 19:01:32
In reply to Re: Mixed states! Is anybody in desperation now?, posted by bleauberry on August 14, 2012, at 18:34:32
Looks like your babblemail isn't on. Phillipa
Posted by Slabicki on August 14, 2012, at 20:20:54
In reply to Re: Mixed states! Is anybody in desperation now?, posted by Phillipa on August 14, 2012, at 19:01:32
Hi Philipa,
I really don't know how to use Babblemail,
since I have never use it before.Are there any steps to follow?
Thanks for replying.
Slabicki
Posted by Phillipa on August 14, 2012, at 21:37:46
In reply to Re: Mixed states! Is anybody in desperation now? » Phillipa, posted by Slabicki on August 14, 2012, at 20:20:54
Go back to where you regisitered should be an option to turn on babblemail. Then your name will not appear black as is now. Mine is blue or purpleish as babblemail on. Then you click on poster name and screen appears to write a private message. Hit enter and it will say send successfully if done correctly. Phillipa
Posted by SLS on August 14, 2012, at 22:11:50
In reply to Mixed states! Is anybody in desperation now?, posted by Slabicki on August 14, 2012, at 16:30:35
> Hi everyone,
>
> I just saw my Pdoc today. He said I have mixed states, depression and anxiety. Since we are out
of options, we both agreed on ECT.
I think we all would like to help you and your doctor come up with alternatives to ECT. However, it will take quite a bit of Q & A from babblers to learn what drugs and drug combinations you have tried.A single illness - bipolar disorder - can account for the expression of mixed-states and the attendant depression and anxiety.
What mood stabilizers have you tried?
Do you experience explosive rage?
ECT is often used when someone is acutely depressed and actively suicidal because it can work so rapidly. Do you feel that you have reached this point of crisis? Sometimes, lithium or Zyprexa can provide relief and reduce the severity of a suicidal state. Zyprexa often works within hours. You don't have to commit to taking this drug in the long term. It can be used temporarily while you work on putting together a treatment plan.
Be persistent.
You'll get well.
I hope you feel better soon.
- Scott
Posted by phidippus on August 15, 2012, at 12:47:27
In reply to Mixed states! Is anybody in desperation now?, posted by Slabicki on August 14, 2012, at 16:30:35
I don't know how helpful ECT is going to be for mixed states. You'll be on maintenance therapy forever.
Have you ever tried Depakote?
Eric
Posted by SLS on August 15, 2012, at 13:40:18
In reply to Re: Mixed states! Is anybody in desperation now? » Slabicki, posted by phidippus on August 15, 2012, at 12:47:27
> I don't know how helpful ECT is going to be for mixed states.
> Have you ever tried Depakote?
That's a good idea, especially for bipolar II mixed-states.
I'm not absolutely sure that ECT would be helpful in treating a mixed-state, however, it has been used to treat acute mania with some success. My guess is that it would be. I'm not in favor of using ECT except when all other evidence-based treatments have failed and there is an urgent need for relief. Zyprexa and Depakote would probably work faster than ECT. Of course, if those drugs have already been tried without success, ECT might look more attractive.
Do you think Klonopin would serve some purpose in a situation like this? It would certainly work fast enough. It had been used quite often in conjunction with lithium to treat this sort of thing prior to the availability of Depakote.
With Depakote, one can administer loading doses of 1000 mg or more, even if the target dose is to be significantly lower. When I needed quick relief of a mixed-state, I used two loading doses of 1000 mg each on the first day. I was okay within 48 hours, after which I maintained a dosage of 1000 mg/day.
http://www.ncbi.nlm.nih.gov/pubmed/15882770
http://www.ncbi.nlm.nih.gov/pubmed/12934987
Interestingly, I have seen Topamax 100 mg/day work to bring into remission a young woman who was experiencing a mixed-state. I wouldn't recommend it as an acute treatment because it takes too long to titrate, but it might be worth a try if other mood stabilizers have failed.
- Scott
Posted by phidippus on August 15, 2012, at 22:56:00
In reply to Re: Mixed states! Is anybody in desperation now? » phidippus, posted by SLS on August 15, 2012, at 13:40:18
I think Klonopin would be a novel approach to the problem at hand, I'm just worried about the kind of dosing would be needed in an acute state. Then you have to worry about disinhibition and paradoxical effects.
There is a study out off Germany which observed about 100 patients in mixed state. Treatment with Keppra and Haldol proved quite effective for most of the patients.
Eric
Posted by SLS on August 16, 2012, at 6:54:41
In reply to Re: Mixed states! Is anybody in desperation now? » SLS, posted by phidippus on August 15, 2012, at 22:56:00
> I think Klonopin would be a novel approach to the problem at hand, I'm just worried about the kind of dosing would be needed in an acute state. Then you have to worry about disinhibition and paradoxical effects.
Ah. Those are reasonable worries. In 1987, Klonopin saved me from an acute mania induced by antidepressants. Lithium was of little help, and Depakote had not been made available yet. For me, Depakote works almost immediately to extinguish mania.
> There is a study out off Germany which observed about 100 patients in mixed state. Treatment with Keppra and Haldol proved quite effective for most of the patients.
Do you think Keppra is underutilized in psychiatry?
- Scott
Posted by phidippus on August 16, 2012, at 12:28:17
In reply to Re: Mixed states! Is anybody in desperation now? » phidippus, posted by SLS on August 16, 2012, at 6:54:41
Keppra gets a bad rap because some of the earliest side effect reports. They ranged from worsened depression, to hallucinations and straight out psychosis. Because of this early reputation for psychiatric side effects, most doctors shied away from using it as treatment for psychiatric disorders. Its a shame really, because studies have shown it can work well as a mood stabilizer, anxiolytic and OCD treatment. So, yeah, I think its underutilized, definitely.
Eric
Posted by alchemy on August 20, 2012, at 19:10:29
In reply to Mixed states! Is anybody in desperation now?, posted by Slabicki on August 14, 2012, at 16:30:35
> I just saw my Pdoc today. He said I have mixed states, depression and anxiety. Since we are out
> of options, we both agreed on ECT.Are you defining your mixed states as depression & anxiety? Or depression and agitation? Has it just recently increased?
I have had the agitation & depression combo.
I don't know what you have tried, but I assume most everything if you are to the ECT point. Without knowing what you have tried...
- Xanax/anti-anxiety (asap): for anxiety or agitation
- Zyprexa is that standard for mixed states (dep + agitation) Didn't help me though.For me, I have never been able to get rid of depression, but I have been able to ease the agitation with Lamictal. Strangely it initially increased agitation and then decreased it (also happens with others).
- fyi, ECT was good to pull me out of a deep depression. You dont always need to choose maintenance, but I would if it helps. Otherwise, you can go the med route again (ya, fun)
Posted by Slabicki on August 24, 2012, at 18:25:32
In reply to Re: Mixed states! Is anybody in desperation now? » Slabicki, posted by alchemy on August 20, 2012, at 19:10:29
Hi Alchemy,
I was wondering how are you doing?
From your other posts I assume that some medications
are still working for you.
Unfortunately for me this is not the case anymore.
So I have to hang in there, and take one day at the time.
What is agitation? Is it restlessness?My depression was induced by antifungal med Ketoconazole, and I'm already in this condition
for the past two months, so I have to do something
about it. It's depression and anxiety,
and mood swings.
How are you doing now? What meds are you taking?Slabicki
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