Posted by Peter on January 21, 2003, at 2:38:26
In reply to Re: Very Confused-need some advice, posted by Ilene on January 20, 2003, at 12:37:12
> I used to think I was just a treatment-resistant atypical depressive, but after reading up on bipolar II disorders I realize I have symptoms of "soft" bipolarity. Part of it is genetic (I'll go into this later if anyone is interested). Now I think SSRIs can be dangerous for some people and wonder if all those years on prozac, celexa, and some that I can't remember whether I actually took (zoloft? paxil?) made me worse. Prozac worked at first. It was great while it lasted. However, prozac threw a cyber-friend into psychosis.
> Yep-the SSRI's are certainly mysterious. For those of us w/soft bipolar-which is sometimes even difficult to distinguish from 'normal' mood swings-the SSRI's can be effective to an extent, even if only temporarily, and especially for those with comorbid anxiety, social phobia, etc..But many pdocs who believe in the 'bipolar spectrum' theory find that one's response to SSRI therapy can be a tell-tale sign of their being bipolar or no-i.e, if you flip out or get too impulsive, or, as one doctor put it to me 'too confident' (how ridiculous is that!) than you're immediately labled as bipolar; and if your swings aren't very evident, you get the DSMIV 'bipolar otherwise unspecified' diagnosis.
> So I think you shouldn't take SSRIs if there is *any *indication you are bipolar. It can be very hard to diagnose. You may not have overt mood swings. Dr. Phelps has a good site about this. (http://www.psycheducation.org/)
> I've heard of that site-gonna check it out. Thanks.
> I was incapacitated for 3 days coming off Effexor. It doesn't seem that withdrawal from heroin could be any worse (don't know, never done it). Never had a problem w/ any other AD.
> Yes, I've been fortunate enough to not experience full-blown withdrawal from effexor (only had a short trial with it), but I've heard it's the most difficult to come off of.
> Now I'm doing 450 mg. wellbutrin, small doses of neurontin & amitryptyline at bedtime, and slowly increasing doses of lamictal. Tonight I go up to 100 mg. So far I haven't had any sides, but I'm not exactly the most functional human on the planet.
> I tried Wellbutrin for a very short period, but gave it up 'cause I just felt agitated from it-perhaps it wasn't a fair trial. I just went up to 75mg lamictal today; BTW, do you find that with each dose increment there's an increase in irritability? I've heard this from others and I experience it myself-pretty annoying.
> Oh yeah, I take 200 mg. provigil. Used to do dexedrine, but it eventually made me feel too disordered. Ritalin was the *worst*. It was like having squirrels in the brain.
> I'm very curious about the provigil-I've really heard great things about it. I've taken stimulants and their extended-release versions (ritalin/concerta, adderall/adderallXR). I'm still taking 30mg adderall, but, while it's been beneficial in many ways, it seems that it agitates me when my mood is low-it sometimes just adds to my instability! I've mentioned provigil to my pdoc, and I don't think he's too keen on letting me check it out, though I've heard it's much smoother and 'cleaner' than 'mainstream' stims. What has your experience with it been like? Have you been taking it for ADD?
> The horrible skin condition that lamictal causes is really really really horrible, but it's fairly rare. Also, use of lamictal as a mood stabilizer is still off-label AFAIK, and I think the dosages that epilectics (I think) use are much higher. I think.
> Yes, the rash is supposed to be terrible, and for the first few months my hypochondriacal tendencies kicked in and I was paranoid at the slightest sign of rash. But, as you said, it's very rare; the chances of it occuring are greatly reduced with slow, gradual titration and a small starting dose. Also, to my relief, I learned that the really bad one covers the whole body and it's nasty-hives and sores all over. But if it doesn't happen within the first few weeks, all is usually well-especially for those using it off-label in lower-than-epilepsy doses, as you said. Once it works, I've heard great things about it, as being a real breakthrough for many for depression (bipolar or even treatment-resistant unilateral) and associated comorbid conditions (anxiety, SP), and, of course, mixed moods, cyclothymia, rapid-cycling and all those wonderful hard-to-treat elements of the bipolar realms.-I'm just waiting for the damn thing to kick in!
> Good to hear from you. Welcome!
> Peter
poster:Peter
thread:136494
URL: http://www.dr-bob.org/babble/20030119/msgs/136849.html