Posted by SLS on September 29, 2011, at 4:39:20
In reply to Effexor...is there hope, posted by mellow on September 28, 2011, at 21:31:53
> Anyhow pdoc started me on Effexor 37.5 today. Said it should take two week and I should be skeptical (assume I am manic) if it comes on too fast.
It is possible to to experience a subtle improvement during the first week, even in unipolar Major Depressive Disorder. You brain is not "clean". You have had psychotropic substances flowing through your veins for awhile now. It is difficult to be certain that these drugs have not produced changes that will allow the Effexor to work faster. On the other hand, two weeks will not be enough time to see a response if you have not reached a therapeutic dosage.
I would not be so afraid of hypomania. It is likely that it can be prevented with APs and/or AEDs. Lamotrigine is usally not a good anti-manic drug, but risperidone is. I like Topiramate 100mg for mixed-state bipolar II. You can always use Depakote as a mood-stabilizer.
How do you like risperidone? Any complaints?
> I have read that it is not approved for bipolar associated depression for this reason but I am on stabilizers so I may be ok.
I agree with you.
There are certain people for whom almost no drug will control mania. They are considered to be treatment resistent. Rarely, ECT can be used for such manic conditions. I think this sort of thing is more likely to occur with bipolar I than bipolar II.
> This really concerns me because I have heard Effexor is nearly impossible to taper. He warned of brain zaps. He does not plan to go above 37.5 however. He says lower doses are more serotogenic rather than effecting the norepinephrine
omponents of the brain.I disagree with your doctor. He might be thinking a little too much (theorizing) and treating too little (under-dosing). Go ahead and follow your doctor's recommendations. Perhaps you will get lucky. Perhaps your doctor has seen his treatment strategy work for his other patients. However, if you should get "stuck", I cannot see abandoning Effexor until you reach a dosage of 300mg.
> All in all this puts me on four drugs and I am worried about this just making me more unstable,
Don't count drugs. Count days in remission. Count side effects. What if a new set of drugs were designed so that each performed only one action? You might need four or more to complete a cocktail specific to your unique biology. There is no such thing as "too many" drugs to be defined using some unjustified philosophy. Do what works.
> Dx: Bipolar II Cyclothymic
Cyclothymic? How did that get in there? How would one separate out cyclothymia from bipolar disorder. Perhaps you are rapid-cycling or seasonal, but cyclothymic?
> Cocktail:
> Effexor 37.5 (probably too low)
> Risperidone 1.5 (possibly too low for the prevention of mania)
> Lamotrigine 150 (possibly too low - 200mg is the average)
> Topiramate 50 (probably too low to treat bipolar disorder - 100-200mg is average)
>
> Fish oil 2000 (nice in concept, but can precipitate mania or make depression worse)
> Mega B stress (good)
> High Energy Multi (probably good)
> D3 1000 (probably unnecessary)
>
> 6-8 cups of coffee daily (And no I can't quit!) (good)
>
> Thanks, mellowThese are my opions based upon medical literature, personal experience, communications with doctors, and the obervation of a great many patients in a partial hospitalization setting.
Good luck with whatever you choose to do. When you feel better - and you will - please post your experiences to arrive at an effective treatment.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:998197
URL: http://www.dr-bob.org/babble/20110925/msgs/998219.html