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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 rjlockhart37 on August 15, 2016, at 23:10:47
browsing through other sites similar to babble, there are some posters that take litterly 4-5 diffrent mood stablizers: topamax, lithium, lamotragaine, nuerontin, trileptal
you would really think the withdrawl from that is going to be hell.....that or they have to stay on that for the rest of life
i just take lamotragine 200mg with 20mg zyprexa, my doc was going to add lithium but decided not too......
i wonder if they could see how much 5 mood stablizers would alter brain chemistry, altering it too much
Posted by linkadge on August 16, 2016, at 9:26:17
In reply to excess mood stablizers, posted by rjlockhart37 on August 15, 2016, at 23:10:47
I would tend to agree with you. There is little evidence that there is meaningful improvement beyond 3 medications. That doesn't mean more won't help, but the data does not support it.
I see some peoples' lists of (like you say) multiple mood stabilizers, antidepressants, antipsychotics, stimulants all at once. Its likely counterproductive.
The neuron can only do two things - fire or don't fire. A kazillion medications is not going to help the brain better make those decisions.
Linkadge
Posted by Tabitha on August 16, 2016, at 11:07:22
In reply to excess mood stablizers, posted by rjlockhart37 on August 15, 2016, at 23:10:47
I have the impression pdocs are afraid to discontinue any meds until the patient is stable. So if they're not getting a good result on the current meds, the pdoc is likely to just keep adding until they improve.
At least that's what mine did. I wanted to swap a med that didn't seem to be helping, instead he wanted me to add the new one, wait a couple months, then taper off the old one. I don't think he would have ever tapered me off one if I hadn't pushed for it.
When you consider that so much of psych med prescribing is off-label, and there's not much evidence for combining multiple meds, it doesn't give you a great confidence in the approach.
Posted by SLS on August 16, 2016, at 13:05:45
In reply to Re: excess mood stablizers, posted by Tabitha on August 16, 2016, at 11:07:22
I take six drugs to treat bipolar depression. For each one, I tested its utility by attempting to discontinue it, and then titrating a second time to establish the lowest effective dosage. Each of the drugs I take is critical to the therapeutic improvement I glean from treatment.
Parnate (tranylcypromine) - 80 mg/day
Pamelor (nortriptyline) - 150 mg/day
Lamictal (lamotrigine) - 300 mg/day
Lithium (lithium carbonate) - 300 mg/day
Abilify (aripiprazole) - 10 mg/day
Minipress (prazosin) - 30 mg/dayThe brain is a universe of structures, physiology, and chemical reactions. There are a myriad of things that control the excitability and firing of neurons and their routing to produce functioning circuits.
- Scott
Posted by Christ_empowered on August 16, 2016, at 13:40:42
In reply to Re: excess mood stablizers, posted by SLS on August 16, 2016, at 13:05:45
wow. I take 2 anticonvulsants (trileptal and lamictal) and a high dose of Abilify. I thought my doc had gone a lil crazy with the 2 antiepileptics. I can't imagine 3, 4, 5 of those at a time...my brain would just stop working.
Seems that combos and cocktails are a time honored tradition in psychiatry. Back in the day, there were lots of combo pills...uppers+downers in one pill, a sedative and a neuroleptic in one pill, even one (I look at vintage psych drug ads...weird, I know...) or two with reserpine and additional meds...meprobamate, ritalin.
I think a lot of psychiatric prescribing is more intuitive than scientific. Patient is psychotic...neuroleptic. Now the patient is too sedated from the neuroleptic...add ritalin. Stelazine has gotten patient 2/3 there...add Thorazine. On and on it goes.
I will say that I benefit from my lil cocktail, so I can't complain too much. I do worry...a lot of these meds can deplete vitamins and minerals. Anticonvulsants, in particular, can deplete c, calcium, and b complex vitamins. I don't think most people supplement, so...that's going to cause additional problems over the long haul.
Posted by linkadge on August 16, 2016, at 14:48:57
In reply to Re: excess mood stablizers, posted by Christ_empowered on August 16, 2016, at 13:40:42
I would more be concerned about cumulative toxicity to brain cells.
Drugs may bring relief for depression in the short term, but we don't know how they affect the brain in the long term, especially in combinations.
Linkadge
Posted by rjlockhart37 on August 16, 2016, at 22:42:43
In reply to Re: excess mood stablizers, posted by Christ_empowered on August 16, 2016, at 13:40:42
i kinda think....like if a person is seriously off balance with no medications, and their chemical imbalance was there before any medications, and if it was to point where it's severe, then adding multiple medications seems logical, it's just taking depakote, topamax, lamictal, all similar (mood stablizers) it's like the mood stablizers are the main thing that the brain operates on.....but if the brain is not working properly then medication does need to be intervened.....
but how i see it taking 4-5 mood stablizers makes all the brain not natural functioning, it's all checmical controlled, using multiple nueron stablization meds......
but if the person is in a position where they need medications and have add to them, i guess that's logical, but why i said that is i've seen some people just go to a doctor and get put on 5 stablizers whhen their condition is really not needing it.....like patty that goes to the doctor for anxiety and the doctor puts her on 4 stablizers and 3 antidepressants.....when her condition is not in a place needing that many medications, i've seen alot of doctors throw medication into a cocktail ....
i guess the term would be over medicated......
Posted by SLS on August 16, 2016, at 22:45:09
In reply to Re: excess mood stablizers, posted by linkadge on August 16, 2016, at 14:48:57
> I would more be concerned about cumulative toxicity to brain cells.
>
> Drugs may bring relief for depression in the short term, but we don't know how they affect the brain in the long term, especially in combinations.
Why especially in combinations?How long must a short-term improvement be before it becomes long-term?
There are people who have taken antidepressants for decades and have remained alive and well in a continuous state of remission. One can speculate that there are long-term changes in brain function that are not needed to produce that remission. However, if they do not produce any clinically significant adverse effects, what difference does it make?
If you want things to be simple, try intranasal ketamine taken every few days. Of course, we don't know what the effects will be in the long-term. You can say that about most anything. If intranasal ketamine doesn't work, then one may be forced to use a strategy that involves the manipulation of multiple sites. If one drug can do this, then polypharmacy isn't necessary. However...
We just aren't there yet. I don't understand the science behind setting an arbitrary number as to how many drugs is too much. You may feel that 6 drugs is too much for me. However, I have been improving steadily with this regime. As I mentioned in a prior post, each drug has been tested to ascertain its role in my treatment as well as its minimum effective dosage.
I'll wait until I am 100 years old to begin to worry about unknown adverse effects of my drug therapy. In the meantime, I'm going to extract from life my best self-actualization so as to experience joy and fulfillment. I've waited long enough. The time is now.
- Scott
Posted by Tabitha on August 16, 2016, at 23:36:08
In reply to Re: excess mood stablizers, posted by SLS on August 16, 2016, at 13:05:45
> I take six drugs to treat bipolar depression. For each one, I tested its utility by attempting to discontinue it, and then titrating a second time to establish the lowest effective dosage. Each of the drugs I take is critical to the therapeutic improvement I glean from treatment.
Hi Scott, I'm really curious about how this works. How do you do the timing? I would think you'd need to wait several weeks after discontinuing, to make sure you're no longer experiencing effects of discontinuation. Then how long do you give each titration? What's your criteria for whether the med is working or not?
I am asking since I am not sure how to evaluate whether meds are working, for myself. Since I have so many short-term changes, I have to watch over a period of weeks or months to see if I'm experiencing more good days, or less severe bad days. It's never a really clear improvement except for the short period on a new med that's working.
Any details you'd be willing to share would be appreciated.
>
> Parnate (tranylcypromine) - 80 mg/day
> Pamelor (nortriptyline) - 150 mg/day
> Lamictal (lamotrigine) - 300 mg/day
> Lithium (lithium carbonate) - 300 mg/day
> Abilify (aripiprazole) - 10 mg/day
> Minipress (prazosin) - 30 mg/day
>
> The brain is a universe of structures, physiology, and chemical reactions. There are a myriad of things that control the excitability and firing of neurons and their routing to produce functioning circuits.
>
>
> - Scott
Posted by linkadge on August 17, 2016, at 16:29:25
In reply to Re: excess mood stablizers, posted by rjlockhart37 on August 16, 2016, at 22:42:43
I just think that a lot of doctors like adding medications, but rarely suggest taking them away.
For instance, if remission was achieved after the addition of a third mood stabilizer, would the last mood stabilizer work alone, or does it only work in combination with one or more of the previous ones?
No too many docs would want to try the remaining combinations, to see how little medication would be required.
A fail
AB fail
ABC responseIs is?
AC?
BC?
C?
ABC?Linkadge
Posted by linkadge on August 17, 2016, at 16:48:39
In reply to Re: excess mood stablizers, posted by SLS on August 16, 2016, at 22:45:09
I agree that some people take a med for years will no (apparent) ill effects.
However, when somebody is taking 5,6,7 + medication, we have no idea whether this is improving their long term mental health or whether it could be leading to some form of neurotoxicity (mild or severe). I am not trying to be alarmist, I am just stating the simple fact that we don't know.
Linkadge
Posted by rjlockhart37 on August 18, 2016, at 1:03:51
In reply to Re: excess mood stablizers, posted by linkadge on August 17, 2016, at 16:48:39
just wanted to make sure, i was talking mainly about mood stablizers ... i know people take antidepressants and i wasnt referring to others, it was mainly just mood stabilzers like lithium, lamotragine, topamax, depakote, tegretol
it's like too much stabilization that it blunts out the spontaneous personality of a person
Posted by rjlockhart37 on August 18, 2016, at 1:06:58
In reply to Re: excess mood stablizers, posted by rjlockhart37 on August 18, 2016, at 1:03:51
this is a site on mood stabilizers and info on withdrawal from them, the pros and cons of them
This is the end of the thread.
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