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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by SilentScream on December 20, 2015, at 19:36:11
Hello.
I've used several psychiatric medications, since childhood. The only one that seemed to work for me with no painful side effects was lithium carbonate 900mg. I tolerated it will and felt normal for the first time since puberty.
I have BPII, btw, with a lot of anxiety. lithium doesn't quite manage all the anxiety, intrusive thoughts and severe trouble concentrating, thoguh, so I gave Seroquel a go.
However, it truly wrecked my body. Hypothyroidism, a bad gastritis (caused by lack of motility and worsening of GERD, it seems) and dysautonomia.
This thread will focus on the dysautonomia, as it seem to be a comorbity among a lot of people with psychiatric issues. However, I do not believe my condition caused it - but more likely medication, and more specifically, antipsychotics. To be more specific, Geodon and Seroquel seemed to be the biggest culprits in bringing these symptoms up. Geodon I took for 1 year, when I was 21, and had mild dysautonomia during the whole course of it, but a severe one in the first month, until I got dosages correct. It never really worked for mood, just anxiety, and it made my glucose too high, so I ditched it too.
Then this year, I took Seroquel for about 3 months (100mg daily was my highest dose). I am 29 now, and had another encounter with severe dysautonomia symptoms back in 2012, when I had serotonin syndrome from mixing two antidepressants (back then I was clueless and just followed what doctor's said, and some arewnt very good..). The symptoms lasted for about 3 weeks (3 weeks of hell), and I read a lot about it and realized most serotonergic APs in high doses, antipsychotics and maybe lithium caused the dive in blood pressure and dysautonomia symptoms. The biggest offender was Seroquel, no doubt.
Seroquel gave me terrible orthostatic intolerance and fainting. Eventually I found out it gave me hypothyroidism. I read Seroquel does that by it's own sometimes, but no doubt lithium contributed to it, as I fel tsome minor hypothyroidism symptoms since I started a 900mg dose. Maybe lithium and Seroquel were too much for my thyroid to handle and I might have a permanent thyroid issue, now. However, I'm not totally upset with this, as it turns out, T4 hormones stabilize my moods awesomely - and also improve my dysautonomia symptoms greatly.
I'm not sure if the dysautonomia is caused by mere low blood pressure, as most of these medications interfere greatly with noradrenergic stuff in the body (amongst other things), or some other mechanism.. But I would advise caution with medication such as NRIs, APs and lithium - as it seems people with a propensity for orthostatic issues and dysautonomia all get more messed up with them.
I'm improving with time, both hypothyroidism and dysautonomia - it's been rough - I'm med free been 2 months, except for alprazolam and T4 hormones, but slowly I'm feeling my body going back to what it was. Funny thing, is, my bipolar and anxieyt symptoms were seemingly gone for all this time and I developed a strong intolerance to lithium even in minor doses. It's causing serotonergic toxicity (I knwo the symptoms. Feels like I'm on 800mg Zoloft or MDMA when i take even less than 300mg of lithium.).
Perhaps the dysautonomia can also be caused by lack of dopamine in the brain, as most people with Parkinson's disease also have dysautonomia - and a lot of the symptoms I've been having point also to neuroleptic malignant syndrome (albeit lighter and yet very long in duration), with spasms, incontrolable twitches and movements and excess serotonin.
Sorry if I'm confusing, as it is confusing to me also to pinpoint the actual cause and diagnosis of the constelattion of symptoms I've been having since starting the Seroquel.To summarize: antipsychotics can cause or worsen dysautonomia. Seroquel and Geodon, two AAPs that are very similar and on their own leage of AAPs alone with themselves, seemed to be the worst regarding dysautonomia for me; lithium and seroquel both are hard on the thyroid for various reasons and this should be monitored carefully; dysautonomia symptoms can be caused by low blood pressure and norepinephrine dysregulation, as well as lack of dopamine. Not only I've read studies claiming that people with Parkinson's usually have it and there seems to high comorbity between dopamine and motor control disorders and dysautonomia, I also had it when I had serotonin syndrome. Serotonin syndrome is excess serotonin, and as most of you know, dopamine and serotoin usually balance themselves. When one is higher, the other is lower.
I'm improving with time, T4 hormones, increase in salt and a vast effort to maintain myself well rested and hydrated. More salt and water is helping like nothing else. Simple carbohydrate control with Gatorade and maltodextrin, as well as reducing simple carbs severely from my diet is also helping. Over all, treating hypothyroidism, giving medications a break and managing dysautonomia and orthostatic intolerance/low blood pressure is helping me, and I'm glad it seems transient and really medication caused. I think in about two months I should be good as new (and bipolar as hell!), and will definetely take a break from any medication that messes with the thyroid or blood pressure/dysautonomia/noradrenergic and dopaminergic reduction.
Posted by baseball55 on December 20, 2015, at 20:00:13
In reply to Dysautonomia caused by Seroquel and other APs, posted by SilentScream on December 20, 2015, at 19:36:11
I don't know what dysautonmia is. Can you explain it to me/
Posted by SilentScream on December 20, 2015, at 20:21:14
In reply to Re: Dysautonomia caused by Seroquel and other APs » SilentScream, posted by baseball55 on December 20, 2015, at 20:00:13
http://www.dysautonomiainternational.org/page.php?ID=34
here's a good website about dysautonomia
Posted by rjlockhart37 on December 20, 2015, at 21:15:26
In reply to Dysautonomia caused by Seroquel and other APs, posted by SilentScream on December 20, 2015, at 19:36:11
dysautonomia is degeneration of the nervous system?
that would be more nuerological disorder, than psyhciatric, the only meds that could help through psychiatric wise would be to discontinue serotuel, and start namenda or aricept.
what are the symptoms are you having?
Posted by SLS on December 21, 2015, at 6:20:31
In reply to Dysautonomia caused by Seroquel and other APs, posted by SilentScream on December 20, 2015, at 19:36:11
Can you list all of those symptoms that you believe are manifestations of dysautonomia?
Is there any history of dysautonomia in your family?
- Scott
Posted by linkadge on December 21, 2015, at 11:09:33
In reply to Dysautonomia caused by Seroquel and other APs, posted by SilentScream on December 20, 2015, at 19:36:11
You may try adding something like valproate (a bipolar anticonvulsant) or gabapentin for anxiety.
Linkadge
Posted by linkadge on December 21, 2015, at 11:11:41
In reply to Re: Dysautonomia caused by Seroquel and other APs, posted by linkadge on December 21, 2015, at 11:09:33
Seroquel (owing to NE reuptake inhibition, and alpha-2 antagonism) can mess with blood pressure and blood pressure regulation.
I would come off of it, and try something like valproate. I have been on both lithium and valproate - which are both good for BP. Valproate is better for anxiety.
Linkadge
Posted by SLS on December 21, 2015, at 17:08:07
In reply to Re: Dysautonomia caused by Seroquel and other APs, posted by linkadge on December 21, 2015, at 11:11:41
> Seroquel (owing to NE reuptake inhibition, and alpha-2 antagonism) can mess with blood pressure and blood pressure regulation.
Yes. This is exactly why I asked the questions.
I would still like to know how dysautonomia was diagnosed. Certainly, mood disorders by themselves can affect autonomic function. However, dysautonomia proper is very unstable and can produce shifts in both directions. My guess is that depression shifts things in only one direction - a skewing toward increased sympathetic tone and reduced parasympathetic tone.
> I would come off of it, and try something like valproate. I have been on both lithium and valproate - which are both good for BP. Valproate is better for anxiety.
I found valproate to be a potent anti-manic, but it also worsened my depression to a moderate degree after a few weeks. Of course, other people might not experience this. At the time, anxiety was not a problem for me, so I can't comment on that. Perhaps Lyrica (pregabalin) would help. Actually, adding Lamictal to lithium might be an avenue to explore. Although not known as an anxiolytic, its antidepressant effects might reduce any anxiety that might be attendant to unrecognized residual depression.
How long do you think it would take valproate to exhibit anxiolytic effects?
- Scott
Posted by linkadge on December 21, 2015, at 20:01:54
In reply to Re: Dysautonomia caused by Seroquel and other APs » linkadge, posted by SLS on December 21, 2015, at 17:08:07
I would say valproate would work very quickly for anxiety - on par with a benzo. It depends on the type of anxiety however. It would be fairly effective for mixed states involving anxiety. I don't think it would be much good for phobic anxiety or social anxiety. I too noticed that it can cause depression. For me, this was reduced to some extent by using low doses (i.e. 125-250 mg) and adding folic acid.
But yeah, for bipolar and anxiety, I would first try adding an anticonvulsant or clonazepam before going to seroquel. Gabapentin or lamotrigine could be reasonable choices, although, for some lamotrigine can cause activation / insomnia. Tegrotol could also be effective for anxiety.
Linkadge
Posted by linkadge on December 21, 2015, at 20:02:59
In reply to Re: Dysautonomia caused by Seroquel and other APs » linkadge, posted by SLS on December 21, 2015, at 17:08:07
It might also be reasonable to add magnesium. Magnesium can go very well with lithium and add additional anxiety support.
Linkadge
Posted by SilentScream on December 23, 2015, at 22:48:53
In reply to Re: Dysautonomia caused by Seroquel and other APs, posted by linkadge on December 21, 2015, at 20:02:59
Hello, guys.
I've used many benzodiazepines in the past, currently on alprazolam only - my favorite, next to midazolam and bromazepam. However, the first is too strong and latter too weak. alprazolam sits nice in the middle with predictable time of dose peak and clearance.
I've tried gapapentin in the past, too. As well as topiramate and oxcarbazepine. Only saw potential on oxcarbazepine (Trileptal). Which I might go back to soon when it's all resolved with my thyroid and dysautonomia.
The dysautonomia was not diagnosed as a stand alone condition, but rather as likely side effect from seroquel and hypothyroidism. However, the symptoms were always there... since birth, maybe. As I said, geodon and seroquel were th ebiggest offenders on making it worse.
Plan is: wait for things to go back to normal, hang on with alprazolam to take the edge off and allow me to sleep. ( I dont want to treat emerging mania with benzos fully, I rather be hypomanic than go back on the high dose benzo wagon of doom!).
Then I might try oxcarbazepine. I rather not mess with lithium or antipsychotics for now, I need to give my body a break. If I need an antidepressant effect, I might take inositol and fish oil - works good enough.
Also, my endocrinologist will probably raise my T4 after I get some blood tests done. It seems that I'm one of those who's bipolar disorder responds well to levothyroxine supplementation and I need to lower my TSH a little more. Can't say how well I feel taking T4, I guess I've always had an off thyroid but it was barely noticeable most of the time.
Anyways, I've been recently through many emergency room visits and appointments with many specialists.... Most think my dysautonomia symptoms are psychiatric disorder related and not fully neurologic or cardiovascular. However they told me to watch out for those kinds of symptoms and keep a close eye on my heart, pressure and signs of neuron/nerve damage.
Thanks for all the posts.
It seems I was pulled back to the beginning of the journey on finding the right meds.. my body feels very different now, I don't know how I might respond to stuff I used to take. Oh well. I don't feel so bad overall, now, though, mentally. However, the physical symptoms never were so distressing, unpleasant and made me so dysfunctional. Hope time heals at least most of it.
Posted by SLS on December 30, 2015, at 12:33:08
In reply to Re: Dysautonomia caused by Seroquel and other APs, posted by SilentScream on December 23, 2015, at 22:48:53
> Hello, guys.
Hi.
Sorry I didn't notice your post earlier.
> The dysautonomia was not diagnosed as a stand alone condition, but rather as likely side effect from seroquel and hypothyroidism. However, the symptoms were always there... since birth, maybe. As I said, geodon and seroquel were th ebiggest offenders on making it worse.
Ouch. What symptoms in particular did these drugs make worse?
> Plan is: wait for things to go back to normal, hang on with alprazolam to take the edge off and allow me to sleep. ( I dont want to treat emerging mania with benzos fully, I rather be hypomanic than go back on the high dose benzo wagon of doom!).
Understandable. There are plenty of functional hypomanic people. Sometimes, it is better to not treat such individuals.
I found valproate to be a potent antimanic drug.
> Then I might try oxcarbazepine. I rather not mess with lithium or antipsychotics for now, I need to give my body a break. If I need an antidepressant effect, I might take inositol and fish oil - works good enough.
I apologize for not remembering, but have you tried Lamictal for bipolar depression?
> Also, my endocrinologist will probably raise my T4 after I get some blood tests done. It seems that I'm one of those who's bipolar disorder responds well to levothyroxine supplementation and I need to lower my TSH a little more. Can't say how well I feel taking T4, I guess I've always had an off thyroid but it was barely noticeable most of the time.
Cytomel (triiodothyronin / T3) was considered the thyroid hormone of choice when studies were first conducted combining it with tricyclic antidepressants. Cytomel made my bipolar depression much worse. I found thyroxine (T4) somewhat helpful.
> Anyways, I've been recently through many emergency room visits and appointments with many specialists.... Most think my dysautonomia symptoms are psychiatric disorder related and not fully neurologic or cardiovascular. However they told me to watch out for those kinds of symptoms and keep a close eye on my heart, pressure and signs of neuron/nerve damage.
Was somatization mentioned?
- Scott
This is the end of the thread.
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