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Dr. Bob is Robert Hsiung, MD,
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Posted by Sheilac on September 5, 2015, at 15:05:49
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 5, 2015, at 14:44:34
Thank you so much Eric. I'm going to really talk to my doctor about this.
I've responded well to other anticonvulsants, I've just had a few bad side effects which caused me to stop them. Possibly Keppra, could work.
I'll never stop looking for the right add-on.
Posted by Sheilac on September 5, 2015, at 15:36:35
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 5, 2015, at 14:44:34
Are there any other meds I should look at?
I have a terrible bladder issue call interstitial cystitis (very painful bladder, urinary frequency, etc.) some of the medications I've tried have side effects of cystitis, like Depakote or Topamax.
Trileptal just causes painful, stiff muscles & joints. I can take small doses and it works great for anxiety, but higher doses are painful.
Both Depakote & Topamax worked great for me mentally, but caused terrible cystitis. Lamictal & Wellbutrin made me manic. Lamictal also caused ulcers in my mouth & on my gums. It was terrible. Lithium caused a thyroid nodule to grow (which had to be biopsied).
I'm kinda hard to treat. For some reason Geodon is awesome for me. No side effects. Abilify made me fat, risperdal caused rediculous swelling.
I feel like I've tried everything, but that can't be possible. I will mention Keppra, but I'm interested in anything else that might be an option.
Thanks for your brain power!
Posted by phidippus on September 5, 2015, at 16:33:54
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 5, 2015, at 15:36:35
Geodon is working well for you. Can you tell me what symptoms you are still having that you would like to treat?
Eric
Posted by Sheilac on September 5, 2015, at 17:03:06
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 5, 2015, at 16:33:54
Geodon at 160mg is great for me, but I still have some anger, short fuse issues. It's better now that I've gone from 120mg to 160mg, but still not as "stable" and even tempered as I would like to be.
I don't care if I'm a little goofy at this point, something more would be worth it. Klonopin is like eating M&Ms, 1mg of Klonopin just doesn't cut it.
Posted by phidippus on September 5, 2015, at 17:48:01
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 5, 2015, at 17:03:06
The irritability and anger issues may be untreated mania. You're looking for an agent that will calm you down and round those edges. You mention you add Trileptal to calm things a little and that works but you get unwanted side effects. I know of a couple of agents that might work to treat your slight mania like Trileptal:
Keppra - has been shown to be an effective mood stabilizer and has especially strong anti-manic effects. Also has some anxiolytic properties.
Zonegran - Can be useful as a mood stabilizer, but especially useful in treating bipolar depression.
Verapamil - High doses of this calcium channel blocker have shown to have mood stabilizing properties.
Nimodipine - may have particular benefits for those diagnostic subclasses of bipolar disorder most resistant to therapy, e.g., ultra-rapid-cycling bipolars and brief recurrent depressions.
These agents may help to take the edge off. You mentioned in the past Zyprexa was very helpful for you. It wouldn't hurt to combine the Geodon with the Zyprexa in a low dose.
Eric
Posted by Sheilac on September 5, 2015, at 19:04:51
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 5, 2015, at 17:48:01
Those sound like great options for me to discuss with my doc.
I did love zyprexa, only used a small dose for about 10 days. I just wonder about using 2 AAPs at one time?
I wonder also how low I can go without weight gain on it.
Posted by Christ_empowered on September 6, 2015, at 8:13:43
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 5, 2015, at 19:04:51
Sometimes, 2 AP/AAP drugs are used together. I think its fairly common in schizophrenia and schizoaffective, less so w/ bipolar I.
Anyway, over the long haul, probably not the best idea, but for short term use, I can see it being helpful. Me, I take 30mgs/Abilify and then when/if I feel agitated, I take a low dose of risperidone on top, at night. I only do that for a little while and then I stop.
Posted by phidippus on September 6, 2015, at 20:37:45
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 5, 2015, at 19:04:51
There really isn't a problem with using two AAPs at once. I've known many patients who have been on two antipsychotics at once-my favorite example is this one gentleman who had bipolar disorder and temporal lobe epilepsy. Besides the load of anticonvulsants he was on, he was also on haloperidol AND clozaril, two of the most powerful antipsychotics available.
I imagine the Geodon is working well to treat your symptoms from the bottom up-it can be remarkably effective as an antidepressant. But it might activate you a little. Adding a little Zyprexa might calm things down-Zyprexa has no antidepressant qualities and will kind of bring down things a bit. You can start in 5mg increments and see how you respond.
Since you have problems with conventional mood stabilizers, treating your illness with two aaps may be the best way to go.
Eric
Posted by Sheilac on September 7, 2015, at 6:45:17
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 6, 2015, at 20:37:45
Would going any higher than my current 160mg of Geodon help take the edge off? I'm BP.
Posted by Lamdage22 on September 7, 2015, at 7:30:29
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 7, 2015, at 6:45:17
You sure are on a lot of stuff and you wanna try even more stuff.
I dont know if it would be a good thing if your doctor cooperates with this.
Posted by Lamdage22 on September 7, 2015, at 7:36:10
In reply to Re: AAPs as mood stabilizers/failed traditional, posted by Lamdage22 on September 7, 2015, at 7:30:29
Can you share what is angering you?
Posted by Sheilac on September 7, 2015, at 9:38:47
In reply to Re: AAPs as mood stabilizers/failed traditional, posted by Lamdage22 on September 7, 2015, at 7:36:10
Usually my husband stresses me out because he is quick to temper (he takes risperdal) and my mother has terminal cancer and I'm one of her caregivers. It's very stressful and sometimes my stress makes me lose my temper or blow or become overly irrational. Also, to add to my stresses, my husband has decided we are moving again (2nd time this year), I've had 2 surgeries and I live in almost constant pain when my Interstitial Cystitis flares up.
I've been through years of counseling, yoga, deep breathing, meditation, but Geodon has really helped. Klonopin used to help, but not so much anymore. I noticed when I was taking Depakote (which flared my IC) Klonopin worked better. Unfortunately, I've failed anticonvulsants. Cross them off my possible med list.
It is imperative that I basically keep it together. Im not trying to drug myself into being constantly numb, I'm just trying to keep my BP in check and react like any other person would. I can't start screaming at a bad driver in the grocery store parking lot, or become so enraged I want to physically attack someone. That's just wrong.
Don't get me wrong, I have my times when I react correctly to the stresses, like crying, but my BP makes stress particularly hard to handle sometimes.
Posted by Sheilac on September 7, 2015, at 9:43:22
In reply to Re: AAPs as mood stabilizers/failed traditional, posted by Lamdage22 on September 7, 2015, at 7:30:29
Actually, I'm only taking 160mg of Geodon and 2mg of Klonopin and 10mg of Adderall XR. I don't think I'm on a lot of meds.
I've had to drop Trileotal (again) due to the edema and chronic muscle & joint pain. I've basically failed all the anticonvulsants. I react pretty well to the AAPs. I've failed both Lithium & Depakote as mood stabilizers.
It's tough to rely on 1 AAP as my antidepressant AND mood stabilizer.
I guess my life would be a lot easier if I could just take a mood stabilizer.
Posted by phidippus on September 7, 2015, at 13:36:56
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 7, 2015, at 6:45:17
I've pushed Geodon to 240 mg and didn't notice a heck of a lot of difference but that was with lithium. If you push it that high it might make more of a difference for you.
Eric
Posted by phidippus on September 7, 2015, at 14:35:10
In reply to Re: AAPs as mood stabilizers/failed traditional » Lamdage22, posted by Sheilac on September 7, 2015, at 9:38:47
I'm here for you. I won't ever give up on you.
Eric
Posted by phidippus on September 7, 2015, at 14:37:09
In reply to Re: AAPs as mood stabilizers/failed traditional » Lamdage22, posted by Sheilac on September 7, 2015, at 9:43:22
Have you considered Clozaril?
Eric
Posted by Sheilac on September 7, 2015, at 16:31:12
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 7, 2015, at 13:36:56
I'm not sure what the next push up from 160mg is, I was thinking pushing to 180mg, or even 200mg.
Posted by Sheilac on September 7, 2015, at 16:36:44
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 7, 2015, at 14:37:09
No, I've never heard of Clozaril. I have a feeling my pdoc will want to push Geodon higher. Which in fine with. But adding a little of something else shouldn't be out of the realm.
Geodon has been a very reliable med for me for years, at varying doses. I didn't really find stability until I hit 120mg. I'm even better at 160mg. Maybe a little higher would be great. We'll see.
Posted by Sheilac on September 7, 2015, at 16:41:03
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 7, 2015, at 14:35:10
Thanks, Eric. I appreciate the input and helping me think of things to discuss with my pdoc. I'm never giving up either. I have no choice. I know for sure that I must always be on medication and stay as stable as possible to continue being a contributing member of society. I'm not a quitter, even on my darkest most stressful days.
Thank you for your support! It means a lot!
Posted by phidippus on September 7, 2015, at 16:47:46
In reply to Re: AAPs as mood stabilizers/failed traditional » phidippus, posted by Sheilac on September 7, 2015, at 16:36:44
The only thing to be careful with is it can cause QT prolongation. Have your doctor do an EKG when you move up to a higher dose.
Eric
Posted by Lamdage22 on September 8, 2015, at 6:47:37
In reply to Re: AAPs as mood stabilizers/failed traditional » Sheilac, posted by phidippus on September 7, 2015, at 16:47:46
I am sorry you have been through so much trouble.
Well, you are on uppers and downers at the same time, thats what i meant with "a lot".
Posted by Lamdage22 on September 8, 2015, at 6:49:41
In reply to Re: AAPs as mood stabilizers/failed traditional, posted by Lamdage22 on September 8, 2015, at 6:47:37
Check the side effects and risks and decide if its really worth it for you.
Posted by Sheilac on September 8, 2015, at 11:17:13
In reply to Re: AAPs as mood stabilizers/failed traditional, posted by Lamdage22 on September 8, 2015, at 6:47:37
By uppers and downers you mean the Adderall and Geodon?
Posted by Lamdage22 on September 9, 2015, at 6:03:27
In reply to Re: AAPs as mood stabilizers/failed traditional » Lamdage22, posted by Sheilac on September 8, 2015, at 11:17:13
Yes but only based on my personal experience. I realize that you may be different.
Posted by Christ_empowered on September 9, 2015, at 12:51:47
In reply to Re: AAPs as mood stabilizers/failed traditional, posted by Lamdage22 on September 9, 2015, at 6:03:27
before lithium..and, actually, for a long time...AP drugs were used a good bit in Bipolar. Of course, those drugs were/are harsh, and Bipolar people apparently get TD more often than those with Schizophrenia, so...sad times for manic depressives. Not that many of the older alternatives were much better...kidney damage, liver damage, drug-drug interactions.
The atypicals are supposed to cause much less TD. I don't know if that's actually true or not, but it does seem that they're more tolerable than the older drugs, especially since the older drugs were often dosed too heavily in the past (and still are, many times).
Anyway, my concern is that you (sheila) might be more likely to get TD. Full dose antipsychotic, female, mood disorder, additional meds. Have you considered taking antioxidants? I know...I push orthomolecular on everybody, lol. The OM docs say that high doses of certain vitamins can significantly reduce the risk of TD. Based on my own experience, I think they're right.
Good luck!
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