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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Sheilac on September 27, 2013, at 13:37:23
I have lost my mind!
Today was the 1st day I did not take Adderall and I've flown into 2 rages. Totally not me. It's been terrible. Little things.
Adderall (and stimulants) has caused mood instability in the past.
Is it that I'm not stable enough? Since the 2 rage incidents, I've taken Klonopin & Trileptal (my doc would be pleased).
Was I just kidding myself taking Geodon (which has caused mood instability) and Adderall without a proper stabilizer what caused it?
Was it the fact that I didn't take Adderall what caused the rage episodes?
I swear, I'm a nice person, but I feel like after such a great week, I have suddenly lost my mind.
Maybe I fooled myself into thinking Geodon & Adderall were the answer.
My doc did ask me yesterday if I was taking the Buspar & Trileptal and she wasn't crazy about the 80mg dose. She would prefer I low dosed the Geodon and get better sleep. She said something about stage 2 sleep being very important.
What has happened to me?
Posted by SLS on September 27, 2013, at 14:51:54
In reply to Rage episodes today..., posted by Sheilac on September 27, 2013, at 13:37:23
Maybe exercise some patience and not change drugs on a daily basis?
You know that Trileptal helps you with rage episodes. Why don't you take it at a moderate dosage (600 mg/day) and treat the residual depression with other drugs. This strategy may take some time, but time is what is necessary for the brain to react to medication changes.
Just as an aside, I have seen Topamax 100 - 200 mg/day work well for a bipolar II mixed state with rage episodes. If you start low and titrate slowly, you might avoid cognitive side effects. Topamax might not make your depression worse.
As far as Trileptal making your depression worse, is it possible that the removal of mania unmasks a more chronic depression? In other words, you might be depressed all of the time, except when the emergence of mania offsets the depression such that the mania predominates. When the mania subsides, you feel pure depression until the mania emerges again.
- Scott
Posted by Phillipa on September 27, 2013, at 14:59:24
In reply to Rage episodes today..., posted by Sheilac on September 27, 2013, at 13:37:23
Sheliac I'm so sorry. Did something trigger it other than thoughts? Phillipa
Posted by Sheilac on September 27, 2013, at 17:51:06
In reply to Re: Rage episodes today... » Sheilac, posted by Phillipa on September 27, 2013, at 14:59:24
No nothing caused the rage episodes. I just went from 0-60 in no time flat. Weird because I didn't even take the Adderall today. I forgot.
Scott - you're right. The Trileptal at 600mg does it's job. Maybe going back to either Buspar or my old standby of 40mg of Geodon would help the constant depression. And, like my doc told me yesterday, 40mg might knock me out, but maybe it's giving me the deep sleep that I must have. I don't think she was crazy about me using only 80mg of Geodon. It was great hypomania for a week. Oh well. Back to normal now. I'm adding back my 600mg Trileptal. I will not explode like that.
Perhaps the mania I love with even a tiny dose of Adderall isn't worth it and it's just an explosion waiting to happen? Especially combined with Geodon & coffee?
Posted by Phillipa on September 27, 2013, at 20:52:48
In reply to Re: Scott + Phillipa, posted by Sheilac on September 27, 2013, at 17:51:06
Can you not drink the coffee? Coffee caused my panic attacks. Phillipa
Posted by Sheilac on September 28, 2013, at 5:47:40
In reply to Re: Scott + Phillipa » Sheilac, posted by Phillipa on September 27, 2013, at 20:52:48
Actually, the tiny 5mg dose of Adderall causes more mood instability than a cup of light coffee.
I love Adderall, but I guess I just can't have it unless I go waaaay up on Trileptal.
I feel much better this morning after dropping Geodon back to my old 40mg dose (great sleep) and 600mg Trileptal yesterday. I also needed 3mg of Klonopin!
I'll have to stay on this regime until I see my doc. She may want to raise the Trileptal if we choose to add a tiny dose if Adderall XR.
Stability before stimulants.
Too bad you can't just slap me, huh?!
Posted by SLS on September 28, 2013, at 6:29:07
In reply to Re: Scott + Phillipa, posted by Sheilac on September 27, 2013, at 17:51:06
> Scott - you're right. The Trileptal at 600mg does it's job. Maybe going back to either Buspar or my old standby of 40mg of Geodon would help the constant depression.
This strategy makes sense to me.
Try to remain on the Trileptal religiously for now and increase the dosage if necessary. The remaining depression can then be attacked aggressively while the mania remains under control. By the way, if you can control the mania, you will often see the depression become easier to treat. If you will notice, the depression is probably most severe immediately after the mania dissipates. This is an example of the bipolar cycle that occurs when someone is rapid cycling or exposed episodically to psychotropic drugs.
I am not a big fan of Geodon. It is a rather unpredictable drug. If you can get it to work for you as an antidepressant, then that's all that counts. Stay with it. Your doctor might want to order occasional ECG to screen for prolonged cardiac Qt wave intervals.
I know it's hard, but try to explore one drug at a time and give it time to work. It is good to research other treatments so that you can develop a list of alternatives to try in the future. You might find hope in knowing that there are things left for you to try.
Stimulants can sometimes help in bipolar disorder and even mitigate the mania. Is this true in your case?
After you come to a conclusion regarding Geodon, you might consider two other AAPs, Latuda or Saphris if necessary. Saphris can be energizing in bipolar depression.
It is my layman suggestion that you might need to slow down just a bit. Try to develop a treatment plan and stick to it. Don't worry how you feel on an hourly or daily basis. Think more in terms of weeks or months. AAPs sometimes work during week 1, but should be given 2 - 3 weeks. Antidepressants sometimes work by week 2 or 3, but really should be tried for 4 - 6 weeks.
There are a great many people looking to help you arrive at a better place. Personally, I think you have a good chance of feeling significantly better. Be logical and keep trying.
- Scott
Posted by Sheilac on September 28, 2013, at 14:47:18
In reply to Re: Scott + Phillipa » Sheilac, posted by SLS on September 28, 2013, at 6:29:07
Wow, thank you so much Scott. Yes, the Trileptal is helping, but my husband told me today that I was manic. Had to supplement with Klonopin. I have permission from my pdoc to go up further than 600mg of Trileptal if I need to.
I'm not wild about Geodon, I think it's just a weird med. In time, once stable on Trileptal and the impending depression hits, I may be able to switch to a low dose of Lamictal for depression. Lamictal did nothing for my stability, but did help with depression & ADD. Plus, maybe Lamictal is safer at 50mg than any dose of Geodon.
Adderall is probably not a good choice for my depression because it makes me hypomanic. Maybe with enough Trileptal it could work for my depression & ADD.
Thank you for your input.
Getting off Trileptal in July was a really stupid thing on my part. The mania has been great, until the rage hit.
Posted by SLS on September 28, 2013, at 15:30:50
In reply to Re: Scott, posted by Sheilac on September 28, 2013, at 14:47:18
Hi Sheila.
Your thought processes are clear, and I think you are headed in the right direction. Congratulations!
The wisdom of patience comes in knowing that one must give Time time to work.
If you don't follow some type of plan to experiment with different drugs, you might accidentally skip over the one that would have worked.
I'm sorry that you have had a difficult time with your illness. Mental illness is so unfair.
- Scott
Posted by phidippus on October 1, 2013, at 9:08:47
In reply to Rage episodes today..., posted by Sheilac on September 27, 2013, at 13:37:23
I'd like to see you stay ona med regime for more thana week...
Eric
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