Posted by SLS on December 9, 2003, at 9:15:24
In reply to Re: The Joys of Being Bipolar » SLS, posted by Ron Hill on December 8, 2003, at 19:53:23
Hi Ron.
Nice to see you again.
> Are you continuing with your add-on trial of Gabitril?
Thanks for keeping an eye on me. Gabitril was a bust. It made my depression somewhat worse, gave me anxiety, and helped contribute to the appearance of suicidal ideation. I stopped it last Friday. I feel better now.
> What’s next on your “must-try” list?
At the top of the list is duloxetine (Cymbalta), Eli Lilly's new SNRI. That I'm partially responsive to Effexor gives me hope that it might work. Unfortunately, its approval date keeps getting pushed backwards. Now, it is not due be approved until next summer. My doctor wants me to try Aricept (donepezil) next. I'm worried that this drug, too, will make things worse, so I'm going to wait awhile before starting it. Pro-cholinergic drugs sometimes produce depression. Aricept is a ACh cholinesterase inhibitor. It's like an MAOI for cholinergic neurons.
I have a somewhat radical idea that involves the pulsing of TCA on top of MAOI, allowing for an exaggerated TCA-discontinuation rebound improvement. I wish I didn't have to go to such lengths, though.
> In answer to your question, I do really well when I cycle into my "normal phase" (which is where I am today). My BP II cycling goes like this: I begin to fall into a subtle atypical depression. Then I stop exercising and start sleeping excessively both of which cause me to spiral into a very deep atypical depression within about two days. It’s easy to spiral down, but it feels impossibly difficult to climb out of the pit. The depressive phase typically lasts about five days and I just watch TV and sleep. The depression is immediately followed by a dysphoric mood phase (GRRRRRRR!), which I hate even more than I hate the depression. However, in my dysphoric mood state I get back some energy (albeit negative energy), and if I use this energy to engage in rigorous exercise, I cycle into my normal mood state (which is excellent!!).
> I suspect that I will always cycle to some degree,
What was your reaction to Lamictal?
No more TMG?
> 400 mg/day L-theanine (increases dopamine and GABA, reduces cortisol; treats irritability)
Where can I find more information on L-theonine? I'd love to try it.
> In addition to what I’ve identified above, there is one more mood state associated with my BP II disorder. I call it hypomania (or euphoric hypomania) and it is characterized by flight of ideas, distractibility, creativity, talkativeness, insomnia, etc.
I know what that feels like. I had a brief hypomanic reaction to Nardil. It can be a lot of fun, but can also be disruptive. I found myself not only talking more, but talking louder.
> However, I’m able to control my hypomania by chasing the symptoms with increased amounts of lithium.
Lamictal is not a good anti manic agent per se, but is supposed to help stabilize rapid cyclicity. Lithium is a good antimanic agent, but is not usually of any value to prevent or mitigate depressive episodes, despite its occasional us as an augmentor of antidepressants. A combination of the two (Lamictal + lithium) has been shown to increase the time before relapse of both manic and depressive phases of bipolar disorder. Maybe I can dig up some of the material I came across that describes this observation.
> Currently, I take 300 mg/day of Lithobid (under normal circumstances).I might end up trying that myself. Do you find that 300mg flattens your affect or leaves you more passive and apathetic? Higher dosages of lithium leave me feeling worse.
But, if I start to feel hypomanic (I can recognize it right away), I bump up my Lithobid to 450 or 600 mg/day to reel-in the symptoms. Hypomania is the most treatable aspect of my BP II. The atypical depression and dysphoric mood states are more problematic when it comes to treatment.
I found that Depakote or Zyprexa did a good job of curbing the few manic-dysphoric reactions I have experienced. Zyprexa is interesting. It seems that it possesses mood-stabilization properties in addition to its acute anti-manic effects.
> However, thanks in large part to the information I learn from people on this site, I continue to make progress in these problem areas as well.
You are certainly persistent enough! I'm glad that it has payed-off for you.
> Zone dietWhat is the Zone diet?
> I’ve not been posting lately because I’m tied up with projects on my desk and projects around the house.
This is a good thing.
> The end is not yet in sight, so I'll continue to be tied up for a while. Thanks for staying in touch, Scott, and let me know if I can help you in any way.
Much thanks.
Sincerely,
Scott* What is the meaning of life?
* Life is its own meaning.
poster:SLS
thread:287370
URL: http://www.dr-bob.org/babble/20031208/msgs/287986.html