Posted by susan C on August 8, 2001, at 18:25:31
In reply to Should first line mood stabilizers be tried first?, posted by Kingfish on August 8, 2001, at 16:57:38
I recall my pdocs reasoning was to try the newest, least apparent side effect mood stablizer/anticonvulsant first. He deduces a possible seizure related issue along with my previous reactions to other meds in addition to my symptoms. I think Some pdocs are more willing to go along with offlable first, if your history indicates non-responsiveness. I think some pdocs are more comfortable with pharmacology and tinkering around with the chemistry of everything.
Here are some questions your question brought up for me, that I am still trying to sort out:
> I have a question re: mood stabilizers for those diagnosed as manic depressive.
Which type of manic depressive? I have been seeing pdocs approach the med issue differently if you are a I or a II or a rapid cycler. If you are psychotic or hallucinating.
For example. I am now identified as a rapid cycler (some times up and down several times a day) When pdoc and I talked about my fifth (?) next choice, after depakote kind of helped, and what to add, I said, litium could be added, he said yes, that is the regular course but it only helps 20% of rapid cyclers, and you had uncomfortable side effects when you took it before.(10 years ago) and I asked, it hasn't changed-so, the odds are it won't help? I decided to go with something completely new. Notice the operative word: I ....(I feel like I am trying on a pair of shoes or something....)
and after two weeks, I am not sure....Keppra, makes me a disconnected kind of tired. Every once in a while, there is a break through of clarity, then, it fogs over.
How hard it is for us who have a disorder/illness that affects our thinking and we have to make decisions...it is like asking some one with two broken legs to walk a mile for help.
>
> Should first line meds, such as lithium, or depakote or some of the others I can't think of right now, be tried before more recent and "popular" meds such as Topamax and Lamictal?I had already tried lithium. I know my new pdoc posponed depakote because of its side effect profile (weight gain, hair loss) that pdoc had observed. and didn't want to put me through that if it could be avoided (I am already 30 lbs overweight).
When the others Topamax (dope-a-max couldn't find words, was struck dumb) and lamictal (swollen gland) and others put me totally to sleep for days, itched all over, etc.) didn't work, we were left with Depakote. I said I would live at the club, exercise, walk, and I have actuallly lost weight, at times. I have not gained. My hair sort of fell out, but I took zinc and Selium as recommended (dr bob tips, too)and it is lessening, but my mood still, tho not as much, goes up and down.
My question is now, after this obvious choices, where do you go from there? My pdoc is a tinkerer, an experimenter, an examiner. So far, I know it is a matter of wait and see, trial and error.
>
> Same with AD's? Should Prozac come ahead of, say, Celexa?Should they be taken at all? I know from my experience, and multiple pdoc recommendation, I can not take Anti depressants. Prozac, rx under dx of depression by old pdoc, after 5 years, stopped working and probably caused the crash and worsening of my symptoms. Serzone helped for a while, but I crashed in the end.
>
> I ask because I'm still cycling pretty badly, in fact almost more so, and am wondering why I wasn't placed on first line meds to begin with, then switched to second or third line if the side effects from those were too much to tolerate.
>
> Any opinions greatly appreciated.
>
> Thanks!
>
> - K.This cycling pretty badly is the pits. My concern for you first off, is why are you taking AD? It could, from my reading here, make things worse.
Be sure and take your questions to your pdoc. He should be able to explain to you.
I hope I haven't rambled too much and there is a grain of something here...
-s
poster:susan C
thread:74220
URL: http://www.dr-bob.org/babble/20010804/msgs/74231.html