Posted by Peter on October 26, 2003, at 5:40:12
In reply to Re: HELP: Very Confused » Peter , posted by galkeepinon on October 25, 2003, at 21:22:44
> Hi Peter, I am so very sorry that you are going through this. I went through the exact same thing for years. God, I know it feels AWEFUL feeling *somewhat* like a 'guinea pig'!
>>Exactly.
> It sounds to *me* that you have 'rapid cycling'. I was diagnosed with it in 1997 after I went through pretty much of what you post here regarding yourself.
>>But why doesn't my doctor just tell me that's what I have? The wierd thing about him is that he's considered one of the best and he sure acts and talks like he knows what he's doing. But every new med regime is like a 'TEST' to try to clarify my diagnosis. I realize that psychopharmacology requires a certain extent of trial and error. But THIS MUCH!? 8 years of putting my body through so many pharmacological roller-coasters? Hearing different things from different doctors. One very good doc even said I definitely do not have any bipolar disorder and recommended a TCA for what she called 'depressive anxiety' (and the TCA's are supposedly the worst in terms of inducing mania in BP patients).
> It seems that mania induced by SSRI's is something researchers and physicians alike are trying to 'solve' Most of the currently available antidepressant drugs appear able to induce hypomanic and manic reactions, but still, this is a serious concern for people taking the serotonin reuptake inhibitor group of antidepressants which includes the SSRI's such as fluoxetine but also the antidepressants such as nefazodone that have a combined effect on serotonin and norepinephrine reuptake. This reaction can be severe having psychotic features or requiring patients to be secluded for extreme agitation.
>>Well, that's the thing. My close family and friends have told me they have never seen me in a manic state. If I do have some form of Bipolar disorder, it is not severe; if it were, it would probably be easier for my doc to diagnose and treat.
> *The problem is that antidepressants are given together with mood stabilizers to prevent an 'overshoot' from occurring in the patient, for if used on their own in the treatment of bipolar disorder, antidepressants can push moods up too high causing hypomania, mania, or rapid cycling. IMHO,the following two types of antidepressants are pretty effective for bipolar patients: Wellbutrin, Prozac, Luvox, Paxil, and Zoloft.
>>I tried all of the above; they worked minimally for a while and then left me too emotionally numb and craving alcohol (probably due to dopamine-downregulation, which is 1 of the reasons we now combine stimulants with SSRI's). Why didn't you mention lexapro; is it not as good for bipolar patients?
There are many other choices if these do not work, or if they cause unpleasant adverse effects, Remeron, Nardil (talk to ace) :-), Parnate, Serzone, and tricyclic antidepressants such as Elavil, Norpramin, Tofranil, Pamelor, and Effexor.
>>My doc told me TCA's are the worst for bipolar patients. As for the MAOI's, well, yes, I have been considering Nardil or Parnate for a long time, but can't seem to get over the anxiety about tyramine and emergency rooms. My pdoc seeems to change his mind constantly about my tring an MAOI. One day, he'll say yes, definitely, they are the best, let's go for it; another day, he will say that it will be very difficult for me to adjust to a whole new set of side-effects and to deal with the anxiety of avoiding certain foods, etc. (I do have a hypochondriacal element to my anxiety). And last thing he said was that we should just stick with the lexapro and adjust things as needed instead of doing an entire new drug overhaul and getting me on an MAOI. I'm just sick of deciding what to do. I just don't know anymore.
> In 1999, I started my first trial of Lamictal and it did wonders for *me* How much were you taking?
>>Well Lamictal was interesting; of course we had to titrate it VERY SLOWLY because of the rash risk. I got up to 100-150mg after many months. But the problem is that my pdoc never gives a single med a sufficient trial, and he always combines multiple meds so that we end up having no idea what meds are working and what meds are not. When I was taking lamictal, he also had me taking adderall, prozac, strattera, and klonopin. It became a nightmare; I started getting anxious again, so he had me come off each med, 1 at a time, since he had no idea which was causing the problem. I really don't mean to talk negatively about him; he's a great guy and a great doc, but I just sometimes wonder if we are going about things in the right ways. Anyway, he used to be all enthusiastic about lamictal as being the ideal med for me, and now when I ask him how he thought it was for me, he says he has no idea.
> I wonder if your pdoc was or is trying to treat you from a psychiatrist's perspective when really, you need to see a psychiatrist?
>>True. He is purely a 'psychopharmacologist,' and he has recommended that I also see a therapist, which I plan to do ( I have seen many therapists, but have not found the right one for me).
> Sometimes bipolars cannot take SSRI's for the mere fact of causing more mania.
> *Re: chronis sinus infections: I get them a lot and the meds sometimes seem to make them worse.
> Sounds like the Dx of bipolar NOS, seems about the only thing docs can determine when all this is going on with us.
> The journal idea is a great idea, you're doing YOUR part, now you hopefully can concentrate on finding a psychiatrist that can help you. I know, it's such a drag going through all that searching, emotionally AND physically, but you need to get better and quit having all this stuff hanging over your head, it's not fair to you!
> Yes, it is overwhelming~you are not alone on that one! It shouldn't ALL be left up to you, a good psychiatrist will work with you, but it sounds as if you haven't had much success with your pdoc.
> *Re: the increase in Lexapro, it's a catch 22 for sure. It works well for some, but then some have the SE of sexual dysfunction and apathy, which I have found passed for me, as well as others who are taking Lexparo here on the message board. **Ironically, one of the kinds of depression that should not be treated with drugs is depression caused by other kinds of drugs. If someone is depressed and the depression started after beginning a new drug, it may well be drug-caused.
> I need to go make dinner, but I wanted to reply to your post.
> I hope this helped a little and I wish you all the best, if you have any more questions for me, I would be happy to try and help.
> Hang in there and use the board as part of support for yourself if you want, it has helped many a people:-)
> Best wishes:-)
>>> Thank you for all your support,
Peter
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poster:Peter
thread:273316
URL: http://www.dr-bob.org/babble/20031025/msgs/273567.html