![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 45. This is the beginning of the thread.
Posted by alchemy on October 22, 2010, at 16:20:53
I am now to the point that I seem to have a rotation every 3-4 days; sometimes a dip or two during the day, and sometimes minutes or seconds.
I look for page after page for any research or treatments. And this is all that I find:
~ It is very difficult to treat & has a poor prognosis
~ Theories that antidepressants contribute
~ Mostly women
~ Lamictal is probably the best med to try
~ mid-90's studies: Nimodipine (a dihydropyridine calcium channel blocker for high blood pressure.) probs & got no where
~1998 A possible gene: Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele.
Posted by Tomatheus on October 22, 2010, at 17:18:19
In reply to ultra, ultra, and ultra rapid cycling, posted by alchemy on October 22, 2010, at 16:20:53
> I am now to the point that I seem to have a rotation every 3-4 days
Alchemy,
What are you currently taking? I used to experience the exact same type of rotation when I took SSRIs. Adding lithium didn't do anything for the cycling; to stop the cycling I had to stop the SSRI. Of course, your case may be different.
Tomatheus
Posted by alchemy on October 22, 2010, at 17:28:55
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by Tomatheus on October 22, 2010, at 17:18:19
Thanks for responding. With the 400 Lamictal:
30 mg Celexa, 2mg Xanax; 300mg Wellbutrin; synthroid.One of the issues is that I think my mood would be lowered if I only took Lamictal. And I am guessing that the Celexa may be helping my agitated depression...?
Posted by Tomatheus on October 22, 2010, at 18:00:32
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by alchemy on October 22, 2010, at 17:28:55
Alchemy,
See below for my responses...
> One of the issues is that I think my mood would be lowered if I only took Lamictal.
You're probably right. I know that I'm just one example, but I couldn't even tolerate 25 mg of Lamictal because of the depression that I experienced at that dose. I would suspect that the Wellbutrin, Celexa, and possibly the Synthroid may be elevating your mood, but I'd also implicate the Celexa in the cycling.
> And I am guessing that the Celexa may be helping my agitated depression...?
Quite possibly. I know that with me, SSRIs definitely improved my mood at times, but it was too inconsistent. After doing quite well (and sometimes too well) for a few days, the inevitable crash would always follow. If I were in your position, I'd probably be questioning whether the benefits that you get on your good days are worth the instability that being on an SSRI could bring.
Tomatheus
Posted by Phillipa on October 22, 2010, at 19:27:07
In reply to Re: ultra, ultra, and ultra rapid cycling » alchemy, posted by Tomatheus on October 22, 2010, at 18:00:32
Alchemy I'd question the thyroid med? What kind you take? Hormones can cause mood swings if off. Phillipa
Posted by Ron Hill on October 23, 2010, at 12:01:36
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by alchemy on October 22, 2010, at 17:28:55
alchemy,
I have very good news. I think we can stop your ultra rapid cycling. The med is Valdoxan (agomelatine). Are you famillar with it?
It is an antagonist of 5-HT2c, causing a release of DA and NE in the prefrontal cortex. Further, it is an agonist of M1 and M2.
The med provides a mild antidepressant effect due the DA and NE release, and it stops rapid cycling by synchronizing the circadian rhythm of the patient, via the agonizing M1 and M2.
Do you live in the U.S.?
Novartis does not plan to submit their application for agomelatine to the U.S. FDA until 2012. However, Valdoxan is readily available on-line. The FDA allows patients to order up to three months worth of a medication from outside the U.S. In other words, you order 3 months worth, take the meds for 3 months, buy another 3 months worth, and on and on.
For a relatively new med (2009), it is very inexpensive. Only eighty five dollars per 28 count of 25 mg tabs; plus shipping costs. However, insurance companies will not pay for meds that are not U.S. FDA approved. So, ya gotta pay the full price of the med. I don't understand the reason for 28 counts per box instead of 30 or 31.
May I take a couple minutes to tell you how I started ultra rapid cycling? Was that a yes? I'll assume so.
My very first p-doc was inept. Without any screening tests, he misdiagnosed me as ADHD instead of bipolar II. Further, he wrote scripts for Ritalin and Paxil, two of the worst meds that can be given to a bipolar patient. Especially if there are not fully ramped up moodstabilizers on-board first.
Long story short, he pushed me into a full blown mania, and turned me into an ultra rapid cycler. I lost my engineering job, and as it turns out, I've got such a huge hole in my resume that I suspect I've lost my engineering career.
All of this happened in 1996, so for the past 14 years I had been ultra rapid cycling; 6 days of debilitating depression followed by 9 days of normal mood. This repeated without stop for the 14 years.
I track my moods by recording the level of depression each day. I enter these data into an Excel spreadsheet and Excel graphs these data. The graph was incredibly consistent, six days of depression, followed by nine days of normal. I wish I could somehow post a pic of the graph. I could accurately predict the day that I would cycle into depression. The severity of my depressive episodes varied, but the timing of the episodes was very consistent.
I have been on 25 mg of Valdoxan for three months and I have never rapid cycled during the three months. Start-up side effects lasted 5 days and consisted of nightmares and choppy sleep. Every since my start-up side effects ended, my sleep has been excellent.
Two problems that lingered, was amotivation and anergy. I fixed the problem by adding 2.5 mg/day of Adderall XR. It works GREAT!
I AM SOOOOO HAPPY TO BE WELL. And, I think Valdoxan is worth you conducting a trial.
Okay, let's talk about you.
You're bipolar II, correct?
If so, I'm very concerned about you having an SSRI on-board. Have you ever tried Parnate as your antidepressant? MAOIs work best on atypical depression.
Do you have the atypical type of depression? Do you answer yes to five or more of these questions?
Do you crave sweets or other carbohydrates?
Do you tend to gain weight?
Are you tired for no obvious reason?
Do your arms or legs feel heavy?
Do you tend to feel sleepy or groggy much of the time?
Are your feelings easily hurt by the rejection of others?
Did your depression begin before the age of 30?Wow, 400 mg/day of lamotrigine! Does it cause cognitive issues?
Are you really attached to your benzo?
Do you take any vitamins and supplements?
Above and beyond and in addition to your lamotrigine, when you get hypomanic do you ever question if you would benefit by adding another moodstabilizer that has more antimanic efficacy?
Alchemy, I'll have more questions, after you reply to this post.
Here is the link to the Valdoxan Prescribing Information document:
http://www.valdoxan.com/index.php/summary-of-product-characteristics/#
Also, this one is even more in depth:
http://www.valdoxan.co.uk/landing.aspx?redirect=/frequently-asked-questions-about-Valdoxan.aspx
Take a look at the list below of my meds, vitamins, and supplements
-- Ron
Ron Hills dx and tx:dx: Bipolar II and mild OCPD
600 mg/day Trileptal (oxcarbazepine)
200 mg/day Lamictal (lamotrigine)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
25 mg/day Valdoxan (agomelatine)
2.5 mg/day Adderal XR (soon to be 2.5 mg/day Dexedrine Spansule)3.75 mg/day Deplin
2500 mcg/day of sublingual methyl B-12
12.5mg/day of sublingual P-5-P45 ml/day of Carlsons Bottled Fish Oil
200 mg/day phosphatidylserene
Multi-vitamin/day; Only 100% of all the usual vitamins; NO VANADIUM!!
2000 IU/day Vitamin D-3
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
200 mcg/day GTF Chromium
600 mcg/day Cromium Picolinate
200 mg/day Co-Q10
1000 mg/day Cinnamon
480 mg/day Milk Thistle
2 g Vitamin CWhats next to add?:
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
Dark therapy via LowBlueLight glasses
Posted by alchemy on October 23, 2010, at 13:42:26
In reply to Ultra Rapid Cycling Stopped Using Valdoxan » alchemy, posted by Ron Hill on October 23, 2010, at 12:01:36
OMG, that gives me so much hope. Thanks Ron. Unfortunatly I live in the U.S., but I would be willing to order it online.
Did the Valdoxan help with your depression as well? At least it sounds like I could take the dexadrine with it. I also chart my moods in excel, and the ultra ultra rapid cycling has become worse with the dex. But I have always had variability over an avg. of 3-5 days. Some are worse than others with no pattern at all (not even related to my menstrual cycle).
It sounds promising that it works on circadian rhyths. I have been doing even more detailed research & know what M1 & M2 are!
Ya, bipolar II is what fits me best- without the "ups". But I'm not really the atypical type as far as wanting to just stay in bed. I go through the tired cycling, but I usually kinda freak out about getting out of the house even if I don't feel like doing anything. Before this med combination I had mixed agitated depression. I am very sensitive to others, depression started in my early teens. One think that SSRIs have seemed to help in the past is lessening my sweet cravings (I almost had an eating disorder), and helped with the weight. But the dexadrine would take away those problems. I have always felt like I needed an SSRI, but they definintely may have contributed to the changes over a few days that have been going on forever.
Wow, I wish I could afford all of those supplements. I was actually at the store yesterday contemplating getting phosphatidylserene, but it was $20. I'm pretty regular about taking b-vitamins, magnesium, zinc, calcium w/ vit D, and fish oil.I tried Tegretal forever ago & thought I didn't like it, but that is the only thing I would give another try as an adjunct.
I also have been often having a point where I get brain fatigue, where I can't handle thinking or doing anything anymore. That is especially not good on the job. Sometimes only an hour.
I have been unemployed for a couple of months and have made a reasonable amount of money in the past. I do often worry that I am just not mentally stable & functional enough to handle work. But I usually miserably make myself.
Posted by Phillipa on October 23, 2010, at 19:29:06
In reply to Ultra Rapid Cycling Stopped Using Valdoxan » alchemy, posted by Ron Hill on October 23, 2010, at 12:01:36
Ron you are well and you didn't post a thread about it!!!! That is just fabulous!!!!!!! Congratulations!!!!!!! Phillipa
Posted by maxime on October 23, 2010, at 23:12:35
In reply to ultra, ultra, and ultra rapid cycling, posted by alchemy on October 22, 2010, at 16:20:53
I just want to learn more about ultra, ultra, and utra rapid cycling. Is it the same as mood swings? During the day it's common to have different moods, so how do you know when it's part of an illness. How do they diagnose. For the record I am not questioning whether or not you have this illness. I just want to understand it better. Oh, and do all psychiatrists recognize that this can happen and that it is a form of bipolar?
Thanks. I am sorry that you are going through this.
Posted by maxime on October 23, 2010, at 23:17:15
In reply to Ultra Rapid Cycling Stopped Using Valdoxan » alchemy, posted by Ron Hill on October 23, 2010, at 12:01:36
Sorry, I don't want to highjack the thread but ... Ron, do you find that keppra helps you and if so, how? Not many on the board take it and I was wondering how it effective it was. I also take 600 mg of trileptal.
Posted by polarbear206 on October 24, 2010, at 11:07:46
In reply to Ultra Rapid Cycling Stopped Using Valdoxan » alchemy, posted by Ron Hill on October 23, 2010, at 12:01:36
> alchemy,
>
> I have very good news. I think we can stop your ultra rapid cycling. The med is Valdoxan (agomelatine). Are you famillar with it?
>
> It is an antagonist of 5-HT2c, causing a release of DA and NE in the prefrontal cortex. Further, it is an agonist of M1 and M2.
>
> The med provides a mild antidepressant effect due the DA and NE release, and it stops rapid cycling by synchronizing the circadian rhythm of the patient, via the agonizing M1 and M2.
>
> Do you live in the U.S.?
>
> Novartis does not plan to submit their application for agomelatine to the U.S. FDA until 2012. However, Valdoxan is readily available on-line. The FDA allows patients to order up to three months worth of a medication from outside the U.S. In other words, you order 3 months worth, take the meds for 3 months, buy another 3 months worth, and on and on.
>
> For a relatively new med (2009), it is very inexpensive. Only eighty five dollars per 28 count of 25 mg tabs; plus shipping costs. However, insurance companies will not pay for meds that are not U.S. FDA approved. So, ya gotta pay the full price of the med. I don't understand the reason for 28 counts per box instead of 30 or 31.
>
> May I take a couple minutes to tell you how I started ultra rapid cycling? Was that a yes? I'll assume so.
>
> My very first p-doc was inept. Without any screening tests, he misdiagnosed me as ADHD instead of bipolar II. Further, he wrote scripts for Ritalin and Paxil, two of the worst meds that can be given to a bipolar patient. Especially if there are not fully ramped up moodstabilizers on-board first.
>
> Long story short, he pushed me into a full blown mania, and turned me into an ultra rapid cycler. I lost my engineering job, and as it turns out, I've got such a huge hole in my resume that I suspect I've lost my engineering career.
>
> All of this happened in 1996, so for the past 14 years I had been ultra rapid cycling; 6 days of debilitating depression followed by 9 days of normal mood. This repeated without stop for the 14 years.
>
> I track my moods by recording the level of depression each day. I enter these data into an Excel spreadsheet and Excel graphs these data. The graph was incredibly consistent, six days of depression, followed by nine days of normal. I wish I could somehow post a pic of the graph. I could accurately predict the day that I would cycle into depression. The severity of my depressive episodes varied, but the timing of the episodes was very consistent.
>
> I have been on 25 mg of Valdoxan for three months and I have never rapid cycled during the three months. Start-up side effects lasted 5 days and consisted of nightmares and choppy sleep. Every since my start-up side effects ended, my sleep has been excellent.
>
> Two problems that lingered, was amotivation and anergy. I fixed the problem by adding 2.5 mg/day of Adderall XR. It works GREAT!
>
> I AM SOOOOO HAPPY TO BE WELL. And, I think Valdoxan is worth you conducting a trial.
>
> Okay, let's talk about you.
>
> You're bipolar II, correct?
>
> If so, I'm very concerned about you having an SSRI on-board. Have you ever tried Parnate as your antidepressant? MAOIs work best on atypical depression.
>
> Do you have the atypical type of depression? Do you answer yes to five or more of these questions?
>
> Do you crave sweets or other carbohydrates?
> Do you tend to gain weight?
> Are you tired for no obvious reason?
> Do your arms or legs feel heavy?
> Do you tend to feel sleepy or groggy much of the time?
> Are your feelings easily hurt by the rejection of others?
> Did your depression begin before the age of 30?
>
> Wow, 400 mg/day of lamotrigine! Does it cause cognitive issues?
>
> Are you really attached to your benzo?
>
> Do you take any vitamins and supplements?
>
> Above and beyond and in addition to your lamotrigine, when you get hypomanic do you ever question if you would benefit by adding another moodstabilizer that has more antimanic efficacy?
>
> Alchemy, I'll have more questions, after you reply to this post.
>
> Here is the link to the Valdoxan Prescribing Information document:
>
> http://www.valdoxan.com/index.php/summary-of-product-characteristics/#
>
> Also, this one is even more in depth:
>
> http://www.valdoxan.co.uk/landing.aspx?redirect=/frequently-asked-questions-about-Valdoxan.aspx
>
> Take a look at the list below of my meds, vitamins, and supplements
>
>
> -- Ron
>
>
> Ron Hills dx and tx:
>
> dx: Bipolar II and mild OCPD
>
> 600 mg/day Trileptal (oxcarbazepine)
> 200 mg/day Lamictal (lamotrigine)
> 500 mg/day Keppra (levetiracetam)
> 90 mg/day Nardil (phenelzine)
> 25 mg/day Valdoxan (agomelatine)
> 2.5 mg/day Adderal XR (soon to be 2.5 mg/day Dexedrine Spansule)
>
> 3.75 mg/day Deplin
> 2500 mcg/day of sublingual methyl B-12
> 12.5mg/day of sublingual P-5-P
>
> 45 ml/day of Carlsons Bottled Fish Oil
> 200 mg/day phosphatidylserene
> Multi-vitamin/day; Only 100% of all the usual vitamins; NO VANADIUM!!
> 2000 IU/day Vitamin D-3
> 850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
> 200 mcg/day GTF Chromium
> 600 mcg/day Cromium Picolinate
> 200 mg/day Co-Q10
> 1000 mg/day Cinnamon
> 480 mg/day Milk Thistle
> 2 g Vitamin C
>
> Whats next to add?:
> NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
> Dark therapy via LowBlueLight glasses
>
>
>Hi Ron, So glad your doing well. I've been very interested in Valdoxan and plan to trial it when it hits the market in the states. I meet all of the criteria, except rejection sensitivity. Prior to Lamictal, these symptoms were worse in the winter months. Still there, but not as pronounced. My main problem is periods of foggyness, concentration problems, and some residual fatigue. Motivation in the morning is a problem too at times. Currently taking effexor 300mg and Lamictal 200mg. I'm going to try and cut back on the effexor very slowly and add a low dose of Focolin. P-doc wants me to try this first vrs Provigal. Anyone have experiences with Focolin? Also Ron, have you ever tried to add Inositol to your mix? 12-18 gms/day from info I have gathered. Plan to trial this at some point.
Depression dominated mild bipolar.
Posted by alchemy on October 24, 2010, at 12:26:42
In reply to Re: ultra, ultra, and ultra rapid cycling » alchemy, posted by maxime on October 23, 2010, at 23:12:35
hi maxime! I liked trying to answer your question because I learned more about it.
- Yes, they are basicially mood swings and are considered a type of bipolar. People with regular bipolar can develop rapid cycling.
- It is also believed that antidepressants can increase the incidence and so there needs to be a mood stabilizer.I always thought "Rapid Cycling" was a very recent diagnosis, but the term is in the DSM-IV. The "ultra" types are not in there, but are generally accepted.
"In the early 1970s, publications began to appear suggesting that patients with more than four cycles of bipolar disorder per year did not respond very well to lithium. Rapid-cycling Bipolar dsiorder was therefore recognized as a lithium-resistant subgroup of bipolar disorder and alternative modes of treatment were tried."RAPID: four or more mood swings or episodes in a twelve-month period
ULTRA-RAPID: cycle through episodes within a month or less.
ULTRA-ULTRA (or ultradian): within 24-hours
- All kinds of different patterns are all mixed up together under the heading of "rapid cycling."
- "Because symptoms of depression dominate in most people with rapid cycling bipolar disorder, treatment is usually aimed toward relieving depression."My experiences:
I think I have had a ultra-cycling for a long time. I don't notice a sudden change. But I do have to remind myself that when I am in a really down "episode", it won't be as bad a few days.
When I tried Adderall (without a stabilizer), I started to go really up & down. Further ups, but further downs. It may have contributed to my hospital stay.For what I think is my ultra-ultra, I have gone through times where I know my morning depression will improve later during the day, but it is gradual. Then there are the times I have sudden changes - it is maybe less than a half-hour period. I am doing nothing different, and I just feel my mood just fall/switch. Why does it only go down?
There doesn't seem to be a term for cycling within minutes or seconds. I think of mine as "waves" or intervals. I don't think they really recongnize this, but there are some experiences I found on the web. For me, this is a weird feeling, and they may be unique to just me. It only started AFTER starting dexadrine, but even Lamictal (but I'm sure it would be worse off without it.) They aren't a terrible thing, and the dexadrine is still worth it. I am just worried it will get worse. Sometimes they are subtle and barely noticable. Sometimes they are quicker or worse. For an example of one type of this for me is like saying the word "ta-da", ta(down)-da(back up)
My oppinion with my "waves" is that there is some correlation with epilepsy. It's like I have a messed up chemical/neuron firing. There are some doctors out there that believe there is close association between epilepsy & bipolor.
There is interesting graph of the different cycle intervals at: http://www.psycheducation.org/depression/Waves.htm
Posted by maxime on October 24, 2010, at 13:54:47
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by alchemy on October 24, 2010, at 12:26:42
That was interesting. I would fit into one of the ultra's as well but I haven't decide which one yet. It's hard because my mood changes in response to other people. For instance I can be doing fine and then I see my brother. He doesn't even have to open his mouth and mood dips. He talks to me and it dips even more. He leaves the house and my mood goes up. But I guess that wouldn't count as cycling since it is in response to someone?
It's something I want to read more about.
Thanks for helping me understand.
Posted by bleauberry on October 25, 2010, at 17:58:00
In reply to ultra, ultra, and ultra rapid cycling, posted by alchemy on October 22, 2010, at 16:20:53
Well, my moods usually flip in terms of hours and minutes, not days or weeks, so what is that? Ultra ultra ultra ultra ultra?
Whatever someone wants to call it, it doesn't matter. The name is simply a fancy way to say "gee, my mood doesn't stay the same very long". Big deal, thank you name, didn't help me at all. Still have no idea what is going on or what to do about. I find names fairly useless.
Whatever is going on, it is physical, not psychiatric. The psychiatric part you feel is the end result of it. So it appears like all the world to be a psychiatric condition. Very deceiving.
If you would like some ideas, let me know. They won't involve meds, except perhaps maybe very low dose lithium, which is actually a salt not a med. There are ideas that can truly get you feeling better.
Been there done that. I can relate to your post. It would not surprise me though if you have a hard time relating to mine. But of course psych meds are the only thing we can do, right? They are the best thing we can do, right? Wrong on both counts.
Food for thought. I had an entire genetic test. Very expensive. It showed all the mutations, snippets, and such in so many groups of genes, including the one you mentioned in your post. There are a few experts that are becoming well versed in knowing how to piece these clues together and choose supplements that "bridge the roadblock" where genetic flaws exist. In my case, some of them were not good for me and some were fantastic. Like meds, took some experimenting. For someone who doesn't have a genetic test, it doesn't matter. The things you would experiment with can be counted on ten fingers.
> I am now to the point that I seem to have a rotation every 3-4 days; sometimes a dip or two during the day, and sometimes minutes or seconds.
>
> I look for page after page for any research or treatments. And this is all that I find:
>
> ~ It is very difficult to treat & has a poor prognosis
> ~ Theories that antidepressants contribute
> ~ Mostly women
> ~ Lamictal is probably the best med to try
> ~ mid-90's studies: Nimodipine (a dihydropyridine calcium channel blocker for high blood pressure.) probs & got no where
> ~1998 A possible gene: Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele.
Posted by Ron Hill on October 27, 2010, at 22:59:03
In reply to Re: Ultra Rapid Cycling Stopped Using Valdoxan » Ron Hill, posted by alchemy on October 23, 2010, at 13:42:26
> OMG, that gives me so much hope.
Your Mileage May Vary, but it stopped my ultra rapid cycling.
> Did the Valdoxan help with your depression as well?Yes, by and large, Valadoxan stopped my depression. But, Valdoxan caused some noticeable amotivation and anergy during the day. This is odd since it releases DA and NE in the prefrontal cortex due to the antagonism of 5-HT2c. So, I added 2.5 mg of dexedrine spanules to take away the amotivation and anergy. The addition of the dex worked.
Since I take Nardil, I have to keep my p-stim dosage low for safety sake. Further, higher dosages of a p-stim might make me start rapid cycling. Also, p-stims eventually make me very irritable (GRRRRRRRRR!) over time even at dosages as low as 5 mg/day.
It should be noted that if I do not take my vitamins, I get depressed. If I skip one day, I'm okay; but anymore than that, and I get depressed.
> At least it sounds like I could take the dexadrine with it. I also chart my moods in excel, and the ultra ultra rapid cycling has become worse with the dex.
> But I have always had variability over an avg. of 3-5 days. Some are worse than others with no pattern at all (not even related to my menstrual cycle).
> It sounds promising that it works on circadian rhyths. I have been doing even more detailed research & know what M1 & M2 are!
> Ya, bipolar II is what fits me best- without the "ups". But I'm not really the atypical type as far as wanting to just stay in bed. I go through the tired cycling, but I usually kinda freak out about getting out of the house even if I don't feel like doing anything. Before this med combination I had mixed agitated depression. I am very sensitive to others, depression started in my early teens. One think that SSRIs have seemed to help in the past is lessening my sweet cravings (I almost had an eating disorder), and helped with the weight. But the dexadrine would take away those problems. I have always felt like I needed an SSRI, but they definintely may have contributed to the changes over a few days that have been going on forever.If I were you, which I'm not, I'd dump the SSRI immediately and add a good moodstabilizer. I really like Trileptal (oxcarbazapine). Further, Valdoxan is worth a trial.
> Wow, I wish I could afford all of those supplements. I was actually at the store yesterday contemplating getting phosphatidylserene, but it was $20. I'm pretty regular about taking b-vitamins, magnesium, zinc, calcium w/ vit D, and fish oil.
You are taking some good vitamins. Please do this: Add 600-800 mcg of chromium picolinate and 2500-5000 mcg of sublingual methylcobalamin. Both are very affordable and can really help. Methylcobalamin is the endogenous form of B12. Further, it is VERY IMPORTANT to take B12 sublingually because if it is merely swallowed, only 1% is absorbed. However, when B12 is taken sublingually, 99% is absorbed.
Phosphatidyl Serine is great for the brain, but like you say, it's spendie.
> I tried Tegretal forever ago & thought I didn't like it, but that is the only thing I would give another try as an adjunct.Forget about Tegretol; Trileptal is a much cleaner medication.
> I also have been often having a point where I get brain fatigue, where I can't handle thinking or doing anything anymore. That is especially not good on the job. Sometimes only an hour.
Hmmmm.
> I have been unemployed for a couple of months and have made a reasonable amount of money in the past. I do often worry that I am just not mentally stable & functional enough to handle work. But I usually miserably make myself.Good Girl!
-- Ron
Posted by Ron Hill on October 27, 2010, at 23:17:57
In reply to Re: Ultra Rapid Cycling Stopped Using Valdoxan » Ron Hill, posted by maxime on October 23, 2010, at 23:17:15
> Sorry, I don't want to highjack the thread but ... Ron, do you find that keppra helps you and if so, how? Not many on the board take it and I was wondering how it effective it was. I also take 600 mg of trileptal.
I started taking Keppra back in 2004. At the time there were some anecdotal open studies showing the Keppra might help in the tx of rapid cycling.
At 1000 mg/day it caused depression for me, but at 500 mg/day I felt that it helped. Now that I'm taking Valdoxan, I might discontinue it. I'm inclined to keep it on-board because I only have Trileptal and Keppra as moodstabilizers (not counting Lamictal, a very weak moodstabilizer).
I send all my best to you, Maxime. You have it tough, and I care about you.
-- Ron
Posted by morgan miller on October 28, 2010, at 0:25:29
In reply to Ultra Rapid Cycling Stopped Using Valdoxan » alchemy, posted by Ron Hill on October 23, 2010, at 12:01:36
>You're bipolar II, correct?
>If so, I'm very concerned about you having an SSRI on-board.
Let's not make the same mistake psychiatrists make and put all us bipolars in a box. I'm bipolar(don't know if it's I or II, don't know if it matters, and I don't really care) and I had been on an SSRI by itself for years and did pretty damn good. I was able to escape all the possible mind numbing/cognition wrecking side effects of mood stabilizers. I was able to live a full life.
Posted by morgan miller on October 28, 2010, at 0:27:52
In reply to Re: Ultra Rapid Cycling Stopped Using Valdoxan » Ron Hill, posted by alchemy on October 23, 2010, at 13:42:26
>Wow, I wish I could afford all of those supplements.
You can afford many of them. Things like CoQ10 are expensive, but things like vitamin D3(oil based softgel is likely best absorbed) are dirt freakin cheap.
Posted by morgan miller on October 28, 2010, at 0:29:52
In reply to Re: Ultra Rapid Cycling Stopped Using Valdoxan, posted by polarbear206 on October 24, 2010, at 11:07:46
>My main problem is periods of foggyness, concentration problems, and some residual fatigue.
Some of this could be Lamictal, especially the concentration problems and the fogginess.
Posted by morgan miller on October 28, 2010, at 0:32:27
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by alchemy on October 24, 2010, at 12:26:42
>My oppinion with my "waves" is that there is some correlation with epilepsy.
It was also likely exacerbated by and developed in part due to childhood neglect, stress, and trauma.
Posted by Ron Hill on October 28, 2010, at 0:34:43
In reply to Re: Ultra Rapid Cycling Stopped Using Valdoxan, posted by polarbear206 on October 24, 2010, at 11:07:46
PolarBear (I like that name!),
> Hi Ron, So glad your doing well.
Thank you.
> I've been very interested in Valdoxan and plan to trial it when it hits the market in the states.
What causes your interest in Valdoxan? What symptom(s) would you hope to treat with it?
If you think it might help you, there is no need to wait for 2+ years. You and your p-doc can legally and safely order Valdoxan off of the internet.
> I meet all of the criteria, except rejection sensitivity.
So, you have atypical depression, correct?
> Prior to Lamictal, these symptoms were worse in the winter months.
Seasonal Affective Disorder (SAD) is very common for bipolar patients with atypical depression. I am of the opinion that most bipolar patients have atypical depression.
> Still there, but not as pronounced. My main problem is periods of foggyness, concentration problems, and some residual fatigue. Motivation in the morning is a problem too at times. Currently taking effexor 300mg and Lamictal 200mg. I'm going to try and cut back on the effexor very slowly and add a low dose of Focolin. P-doc wants me to try this first vrs Provigal. Anyone have experiences with Focolin?
Have you been tested to make sure that you are bipolar? Does your p-doc believe that you are bipolar?
If so, why in the world would your p-doc add Focalin without first having a moodstabilizer (or moodstabilizers) FULLY RAMPED UP? Are you comorbid ADHD?
Is your p-doc trying to tx your foggyness, concentration problems, fatigue, and morning amotivation with Focalin?
Who was the ido*t that originally put you on the SNRI Effexor without any moodstabilizers on-board? Your current p-doc?
Polarbear, I'll hold my tongue, but boy do I disagree with the meds your p-doc has you on!!
How much of the time are you depressed and how much of the time are you hypomanic?
> Also Ron, have you ever tried to add Inositol to your mix? 12-18 gms/day from info I have gathered. Plan to trial this at some point.
I tried inositol many moons ago, but it made me depressed. But, everyone is different, so it might help you. I think you'd be better off focusing on getting some more appropriate meds on-board suitable for a bipolar.
> Depression dominated mild bipolar.-- Ron
Posted by morgan miller on October 28, 2010, at 0:39:55
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by bleauberry on October 25, 2010, at 17:58:00
>Whatever is going on, it is physical, not psychiatric.
It's sad when people continue to ignore and underestimate the power of our damaged psyche to influence the development of physiological conditions and illnesses. I think saying something is physical is dangerous. If everyone believes all of our problems are physical, they will never feel the need to take the steps to better nurture themselves to health the way their parents should have. They may also never feel the need to take the steps as parents themselves to fulfill all of their children's needs in order to minimize chances of the development of disruptive psychiatric(or physical, whatever you want to call it) illnesses/conditions.
Posted by Ron Hill on October 28, 2010, at 0:51:39
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by alchemy on October 24, 2010, at 12:26:42
Alchemy,
You know that you need one or more strong moodstabilizers on-board asap, correct?
-------------------> My experiences:
> I think I have had a ultra-cycling for a long time. I don't notice a sudden change. But I do have to remind myself that when I am in a really down "episode", it won't be as bad a few days.
> When I tried Adderall (without a stabilizer), I started to go really up & down. Further ups, but further downs. It may have contributed to my hospital stay.
> For what I think is my ultra-ultra, I have gone through times where I know my morning depression will improve later during the day, but it is gradual. Then there are the times I have sudden changes - it is maybe less than a half-hour period. I am doing nothing different, and I just feel my mood just fall/switch. Why does it only go down?
> There doesn't seem to be a term for cycling within minutes or seconds. I think of mine as "waves" or intervals. I don't think they really recongnize this, but there are some experiences I found on the web. For me, this is a weird feeling, and they may be unique to just me. It only started AFTER starting dexadrine, but even Lamictal (but I'm sure it would be worse off without it.) They aren't a terrible thing, and the dexadrine is still worth it. I am just worried it will get worse. Sometimes they are subtle and barely noticable. Sometimes they are quicker or worse. For an example of one type of this for me is like saying the word "ta-da", ta(down)-da(back up)
> My oppinion with my "waves" is that there is some correlation with epilepsy. It's like I have a messed up chemical/neuron firing. There are some doctors out there that believe there is close association between epilepsy & bipolor.
> There is interesting graph of the different cycle intervals at: http://www.psycheducation.org/depression/Waves.htm
Posted by Ron Hill on October 28, 2010, at 1:10:43
In reply to Re: ultra, ultra, and ultra rapid cycling, posted by bleauberry on October 25, 2010, at 17:58:00
Hi bleauberry,
I'm interested. Will you please list the 10 or so things that I can experiment with? Thank you.
-- Ron
--------------> Well, my moods usually flip in terms of hours and minutes, not days or weeks, so what is that? Ultra ultra ultra ultra ultra?
>
> Whatever someone wants to call it, it doesn't matter. The name is simply a fancy way to say "gee, my mood doesn't stay the same very long". Big deal, thank you name, didn't help me at all. Still have no idea what is going on or what to do about. I find names fairly useless.
>
> Whatever is going on, it is physical, not psychiatric. The psychiatric part you feel is the end result of it. So it appears like all the world to be a psychiatric condition. Very deceiving.
>
> If you would like some ideas, let me know. They won't involve meds, except perhaps maybe very low dose lithium, which is actually a salt not a med. There are ideas that can truly get you feeling better.
>
> Been there done that. I can relate to your post. It would not surprise me though if you have a hard time relating to mine. But of course psych meds are the only thing we can do, right? They are the best thing we can do, right? Wrong on both counts.
>
> Food for thought. I had an entire genetic test. Very expensive. It showed all the mutations, snippets, and such in so many groups of genes, including the one you mentioned in your post. There are a few experts that are becoming well versed in knowing how to piece these clues together and choose supplements that "bridge the roadblock" where genetic flaws exist. In my case, some of them were not good for me and some were fantastic. Like meds, took some experimenting. For someone who doesn't have a genetic test, it doesn't matter. The things you would experiment with can be counted on ten fingers.
>
> > I am now to the point that I seem to have a rotation every 3-4 days; sometimes a dip or two during the day, and sometimes minutes or seconds.
> >
> > I look for page after page for any research or treatments. And this is all that I find:
> >
> > ~ It is very difficult to treat & has a poor prognosis
> > ~ Theories that antidepressants contribute
> > ~ Mostly women
> > ~ Lamictal is probably the best med to try
> > ~ mid-90's studies: Nimodipine (a dihydropyridine calcium channel blocker for high blood pressure.) probs & got no where
> > ~1998 A possible gene: Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele.
>
>
Posted by Ron Hill on October 28, 2010, at 2:11:32
In reply to Re: Ultra Rapid Cycling Stopped Using Valdoxan » Ron Hill, posted by morgan miller on October 28, 2010, at 0:25:29
Morgan,
I made the statement to a patient who is ultra ultra rapid cycling. Giving an antidepressant to a bipolar patient is controversial, with research on both sides of the aisle. However, giving an ultra ultra rapid cycling pt an SSRI without any anti-manic medication is like pouring fuel on the fire.
I'm very happy to hear that you are doing well.
-- Ron
----------------> >You're bipolar II, correct?
>
> >If so, I'm very concerned about you having an SSRI on-board.
>
> Let's not make the same mistake psychiatrists make and put all us bipolars in a box. I'm bipolar(don't know if it's I or II, don't know if it matters, and I don't really care) and I had been on an SSRI by itself for years and did pretty damn good. I was able to escape all the possible mind numbing/cognition wrecking side effects of mood stabilizers. I was able to live a full life.
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