![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 83 to 107 of 948. Go back in thread:
Posted by polarbear206 on April 16, 2002, at 10:40:35
In reply to Re: Cyclothymia mood stabilizers, posted by Mondeo on April 16, 2002, at 8:55:25
> Hey,practically there are some more modern approaches to the issue bothering you and I am referring to Lamictal which seems to be a better med.than Depakote,dueto its specific AD quality,missing from the other known Mood Stabilizers ; I suggest you to discuss it with your doc.,moreover that he has indeed a correct opinion about extra AD's administration(trying to avoid hypomania,rapid cycling etc.)
> good luck
> Mondeo
>
> > Hey, I have recently been diagnosed as having bipolar II, though I kinda disagree and think I just have cyclothymia. My psychiatrist put me on 750 mg of depakote and said that it was real small dosage, I just started taking it and was curious about other people's experience with it.My psychiatrist wont put me on an anti-depressant for now cuz shes scared of me going manic. Personally, I think that when I'm manic I'm not that manic and I do great things, even if i don't manage to do them for real long periods of time...but that's because I start going down again. Is there anyway to keep highs without having lows? I think this forum is a great idea and don't know if anyone still reads this. I know this post is a little long winded...so I hope you all forgive me. Thanx.;)Mondeo,
The upswing of this illness can just be periods of energy and getting alot accomplished. You don't have to present a textbook case of hypomania to be diagnosed as bipolar 2. In my case, my bipolar is depression dominated and my highs are just increased energy and a hyperthymic personality comes out. Many people don't realize that there is a very broad spectrum to bipolar dosorders. The various levels of bipolar illness other than true manic depression were thought to be rare and even, according to the current edition of DSM. However, research over the past two decades and in recent years, indicates it is considerably higher and perhaps may account for half of all clinical depressions. I find this very interesting!
Laura.
Posted by BarbaraCat on April 17, 2002, at 0:02:26
In reply to Re: Mild Bipolar - mood stabilisers » BarbaraCat, posted by polarbear206 on April 16, 2002, at 9:19:44
Laura,
Sounds like we have alot in common with our symptoms. Thanks for your answer. I think I'm going to ask my pdoc about trying lamactil next time. He added Topamax to the lithium to help with the weight gain but it's created some of the inner tension and restlessness that I'm wanting to be rid of. If lamactil doesn't cause weight gain, then I've heard enough good things about it, aside from the pesky rash thing, that it sounds worth giving a try. Best of luck to you. - Barbara
Posted by Psydoc on April 18, 2002, at 5:02:39
In reply to Re: Mild Bipolar - mood stabilisers » polarbear206, posted by BarbaraCat on April 17, 2002, at 0:02:26
Lamictal is turning out to be an excellent treatrment for people with Cyclothymia or Bipolar-II. While the rash is potentially a serious problem, I have treated over 300 patients with Lamictal, and while a few have developed a rash, over half of those who did, were able to continue on Lamictal after an adjustment in the dose and the speed with which the dose was being increased.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> Laura,
> Sounds like we have alot in common with our symptoms. Thanks for your answer. I think I'm going to ask my pdoc about trying lamactil next time. He added Topamax to the lithium to help with the weight gain but it's created some of the inner tension and restlessness that I'm wanting to be rid of. If lamactil doesn't cause weight gain, then I've heard enough good things about it, aside from the pesky rash thing, that it sounds worth giving a try. Best of luck to you. - Barbara
Posted by polarbear206 on April 18, 2002, at 15:10:02
In reply to Re: Mild Bipolar - mood stabilisers » BarbaraCat, posted by Psydoc on April 18, 2002, at 5:02:39
> Lamictal is turning out to be an excellent treatrment for people with Cyclothymia or Bipolar-II. While the rash is potentially a serious problem, I have treated over 300 patients with Lamictal, and while a few have developed a rash, over half of those who did, were able to continue on Lamictal after an adjustment in the dose and the speed with which the dose was being increased.
>
> Best regards . . .
>
> Ivan Goldberg
> psydoc@psycom.net
> %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
>
> > Laura,
> > Sounds like we have alot in common with our symptoms. Thanks for your answer. I think I'm going to ask my pdoc about trying lamactil next time. He added Topamax to the lithium to help with the weight gain but it's created some of the inner tension and restlessness that I'm wanting to be rid of. If lamactil doesn't cause weight gain, then I've heard enough good things about it, aside from the pesky rash thing, that it sounds worth giving a try. Best of luck to you. - Barbara
Dr. Goldberg,
I want to thank you for your wisdom, knowledge and compassion. Your dedication to your profession is outstanding. We are all greatful for your time and advice. " Depression Central" is an excellent informative site. For people like you, I have been able to endure my illness with courage and dignity!!Laura
Posted by Cecilia on April 21, 2002, at 0:23:45
In reply to Re: Mild Bipolar - mood stabilisers Dr. Goldberg, posted by polarbear206 on April 18, 2002, at 15:10:02
Of the patients you have treated with Lamictal, how many have had unipolar depression and what percent of these improved? I started Lamictal on Jan. 1, have been increasing the dose very slowly-upto 150 mg now (plus trazodone, celexa and clonazepam) no benefit yet-just wondering how many unipolars really do get any benefit from it. Thanks. Cecilia
Posted by Psydoc on April 21, 2002, at 7:54:16
In reply to Question for Dr. Goldberg, posted by Cecilia on April 21, 2002, at 0:23:45
I have treated about a dozen people with "treatment-resistant" unipolar major depression with Lamictal. Despite their being individuals who had not done well with multiple previous treatments, about half showed meaningful improvement with Lamictal. Doses of about 400 mg/day continued for 6 to 8 weeks were typical.
There is little in print about the use of Lamictal to treat patients with unipolar depression. A letter by T.M. Maltese on the topic can be found in the November 1999 issue of the American Journal of Psychiatry.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> Of the patients you have treated with Lamictal, how many have had unipolar depression and what percent of these improved? I started Lamictal on Jan. 1, have been increasing the dose very slowly-upto 150 mg now (plus trazodone, celexa and clonazepam) no benefit yet-just wondering how many unipolars really do get any benefit from it. Thanks. Cecilia
Posted by Phil on April 21, 2002, at 8:47:37
In reply to Re: Question for Dr. Goldberg » Cecilia, posted by Psydoc on April 21, 2002, at 7:54:16
Posted by allisonf on April 21, 2002, at 22:50:12
In reply to Re: Dr. Goldberg-1 week at Babble?????Dr. Bob? (nm), posted by Phil on April 21, 2002, at 8:47:37
Hi! I'm new to this thread (and relatively new to PB). I saw that you were all talking about Lamictal and I had to put in my 2c!
I was diagnosed with cyclothymia last fall and have been taking 200mgs of Lamictal since the end of January. It has helped tremendously so far, esp with the depressed side, and no side effects to speak of. I just started 25mg Seroquel to catch the hypomania before it starts this spring, but I think to treat bipolar depression (and maybe even unipolar?), Lamictal is a great choice.
Thanks for your input, Dr. Goldberg.
Also, Geoff, the generic name for Lamictal is lamotrigine. Maybe you can find it under that? Good luck!
Allison
Posted by Psydoc on April 22, 2002, at 4:37:03
In reply to Cyclothymia and Lamictal, posted by allisonf on April 21, 2002, at 22:50:12
For those looking for information on Lamictal (lamotrigine) there is an FAQ at http://www.psycom.net/depression.central.lamotrigine.html. Included in the FAQ are links to abstracts of mamy publications on the psychiatric uses of Lamictal.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
> Hi! I'm new to this thread (and relatively new to PB). I saw that you were all talking about Lamictal and I had to put in my 2c!
>
> I was diagnosed with cyclothymia last fall and have been taking 200mgs of Lamictal since the end of January. It has helped tremendously so far, esp with the depressed side, and no side effects to speak of. I just started 25mg Seroquel to catch the hypomania before it starts this spring, but I think to treat bipolar depression (and maybe even unipolar?), Lamictal is a great choice.
>
> Thanks for your input, Dr. Goldberg.
>
> Also, Geoff, the generic name for Lamictal is lamotrigine. Maybe you can find it under that? Good luck!
> Allison
Posted by Cecilia on April 23, 2002, at 1:35:07
In reply to Re: Question for Dr. Goldberg » Cecilia, posted by Psydoc on April 21, 2002, at 7:54:16
> I have treated about a dozen people with "treatment-resistant" unipolar major depression with Lamictal. Despite their being individuals who had not done well with multiple previous treatments, about half showed meaningful improvement with Lamictal. Doses of about 400 mg/day continued for 6 to 8 weeks were typical.
>
> There is little in print about the use of Lamictal to treat patients with unipolar depression. A letter by T.M. Maltese on the topic can be found in the November 1999 issue of the American Journal of Psychiatry.
>
> Best regards . . .
>
> Ivan Goldberg
> psydoc@psycom.net
> %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
>
> > Of the patients you have treated with Lamictal, how many have had unipolar depression and what percent of these improved? I started Lamictal on Jan. 1, have been increasing the dose very slowly-upto 150 mg now (plus trazodone, celexa and clonazepam) no benefit yet-just wondering how many unipolars really do get any benefit from it. Thanks. Cecilia400 mg a day?! I`m not sure I`ll make it that far. At 150 mg. I`m starting to have scary little memory blips where I forget what I was going to say for a second or two. Cecilia
Posted by Psydoc on April 23, 2002, at 4:42:03
In reply to Re: Question for Dr. Goldberg, posted by Cecilia on April 23, 2002, at 1:35:07
Hi . . .
No matter what dose is the maximum, if the medication is being tolerated, it is important to remain on it for 6-8 weeks as the antidepressant effects of Lamictal often take that long to develop.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> > I have treated about a dozen people with "treatment-resistant" unipolar major depression with Lamictal. Despite their being individuals who had not done well with multiple previous treatments, about half showed meaningful improvement with Lamictal. Doses of about 400 mg/day continued for 6 to 8 weeks were typical.
> >
> > There is little in print about the use of Lamictal to treat patients with unipolar depression. A letter by T.M. Maltese on the topic can be found in the November 1999 issue of the American Journal of Psychiatry.
> >
> > Best regards . . .
> >
> > Ivan Goldberg
> > psydoc@psycom.net
> > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
> 400 mg a day?! I`m not sure I`ll make it that far. At 150 mg. I`m starting to have scary little memory blips where I forget what I was going to say for a second or two. Cecilia
Posted by Cecilia on April 24, 2002, at 1:14:27
In reply to Re: Question for Dr. Goldberg » Cecilia, posted by Psydoc on April 23, 2002, at 4:42:03
Posted by Listohep on May 21, 2002, at 18:12:22
In reply to Cyclothymia & mood stabilizers, posted by andrewb on August 7, 1999, at 10:33:51
Greetings all! Have a question for you, but first some history... After five years of therapy and 10 years of self medicating with AD's (originally Zoloft and now Celexa)for SAD, I think we have come upon a diagnosis of cyclothymia.
Usually this time of year I am in my seasonal upswing and don't take any AD, but this year, I have symptoms outside of my normal cycle. My AD medication seems to be inducing what seems to be manic periods of irrational irritability, but if I stay off I am cycling into a low period of sleeping all the time and low functioning. This is wreaking havoc on my job since I have a heavy workload I have to balance and obviously my personal life as well.
Here is the catch-I am afraid of adding a new med to my current cocktail because I take Propulsid (approved in pharm study since they pulled it of market) because its the only med that treats my low esophageal pressure(I feel like a walking pharmacy some days and find all meds annoying although necessary.) This means life threatening results if I take tricyclics or don't watch what I am taking very carefully.
My question(s) are this-of the mood regulators-are any of them trycyclic? or does anyone have any insight why the Celexa isn't regulating like it normally does? Thanks-
Posted by JonW on May 22, 2002, at 0:59:15
In reply to Re: Cyclothymia mood stabilizers, posted by Listohep on May 21, 2002, at 18:12:22
Hi Listohep,
When you say mood "regulator" do you mean anti-depressant or mood stabilizer. I assume you mean mood stabilizer. Bipolar NOS is often confused with SAD. You've eluded to this by suggesting cyclothymia. Bipolar disorder is a progressive disorder and you may be more sensitive to destablizing agents (i.e. anti-depressants) than you were before. This may explain the "manic periods of irrational irritability" and rapid cycling on Celexa. If you are currently seeing a psychiatrist, you should ask them to recommend someone who specializes in bipolar disorder and go to them for a consultation. If you are not seeing a psydoc, you might try calling a major research university to see if they see people with bipolar disorder (or at least for a consultation) or refer you to someone who does. I don't want to scare you, after all, maybe you and Celexa just don't get along but if you do have a bipolar disorder the sooner you are treated the better. This is a link to an archive of questions an answers sent to a reputable bipolar doc -- you might want to check this out and see if you identify with any of the posts:
http://www.bipolarworld.net/Phelps/topicarchive.htm
(if it doesn't work, go to www.bipolarworld.net and navigate from there)
http://www.psycheducation.org
(another good link)I'm not familiar with Propulsid but none of the mood stabilizers are TCAs as far as I know -- actually, TCAs are very destabilizing. If they took this drug off the market aren't you going to have to stop taking it eventually? Or is it still on the market in other countries? In any case, you should be under the care of an expert doc and you might want to ask about trying Lamictal (lamotrigine). It's a mood stabilizer with marked anti-depressant qualities, and if you have a soft bipolar disorder you will benefit greatly from a mood stabilizer. You doctor might add the Lamictal and then slowly pull away the Celexa or you may need the Celexa and be able to tolerate it with the Lamictal on board. Lamictal inhibits the reuptake of serotonin (though not as potently as the SSRIs) and this may explain how it exerts its anti-depressant effect.
Good luck,
Jon> Greetings all! Have a question for you, but first some history... After five years of therapy and 10 years of self medicating with AD's (originally Zoloft and now Celexa)for SAD, I think we have come upon a diagnosis of cyclothymia.
>
> Usually this time of year I am in my seasonal upswing and don't take any AD, but this year, I have symptoms outside of my normal cycle. My AD medication seems to be inducing what seems to be manic periods of irrational irritability, but if I stay off I am cycling into a low period of sleeping all the time and low functioning. This is wreaking havoc on my job since I have a heavy workload I have to balance and obviously my personal life as well.
>
> Here is the catch-I am afraid of adding a new med to my current cocktail because I take Propulsid (approved in pharm study since they pulled it of market) because its the only med that treats my low esophageal pressure(I feel like a walking pharmacy some days and find all meds annoying although necessary.) This means life threatening results if I take tricyclics or don't watch what I am taking very carefully.
>
> My question(s) are this-of the mood regulators-are any of them trycyclic? or does anyone have any insight why the Celexa isn't regulating like it normally does? Thanks-
Posted by polarbear206 on May 22, 2002, at 8:57:00
In reply to Re: Cyclothymia mood stabilizers » Listohep, posted by JonW on May 22, 2002, at 0:59:15
> Hi Listohep,
>
> When you say mood "regulator" do you mean anti-depressant or mood stabilizer. I assume you mean mood stabilizer. Bipolar NOS is often confused with SAD. You've eluded to this by suggesting cyclothymia. Bipolar disorder is a progressive disorder and you may be more sensitive to destablizing agents (i.e. anti-depressants) than you were before. This may explain the "manic periods of irrational irritability" and rapid cycling on Celexa. If you are currently seeing a psychiatrist, you should ask them to recommend someone who specializes in bipolar disorder and go to them for a consultation. If you are not seeing a psydoc, you might try calling a major research university to see if they see people with bipolar disorder (or at least for a consultation) or refer you to someone who does. I don't want to scare you, after all, maybe you and Celexa just don't get along but if you do have a bipolar disorder the sooner you are treated the better. This is a link to an archive of questions an answers sent to a reputable bipolar doc -- you might want to check this out and see if you identify with any of the posts:
>
> http://www.bipolarworld.net/Phelps/topicarchive.htm
> (if it doesn't work, go to www.bipolarworld.net and navigate from there)
> http://www.psycheducation.org
> (another good link)
>
> I'm not familiar with Propulsid but none of the mood stabilizers are TCAs as far as I know -- actually, TCAs are very destabilizing. If they took this drug off the market aren't you going to have to stop taking it eventually? Or is it still on the market in other countries? In any case, you should be under the care of an expert doc and you might want to ask about trying Lamictal (lamotrigine). It's a mood stabilizer with marked anti-depressant qualities, and if you have a soft bipolar disorder you will benefit greatly from a mood stabilizer. You doctor might add the Lamictal and then slowly pull away the Celexa or you may need the Celexa and be able to tolerate it with the Lamictal on board. Lamictal inhibits the reuptake of serotonin (though not as potently as the SSRIs) and this may explain how it exerts its anti-depressant effect.
>
> Good luck,
> Jon
>
> > Greetings all! Have a question for you, but first some history... After five years of therapy and 10 years of self medicating with AD's (originally Zoloft and now Celexa)for SAD, I think we have come upon a diagnosis of cyclothymia.
> >
> > Usually this time of year I am in my seasonal upswing and don't take any AD, but this year, I have symptoms outside of my normal cycle. My AD medication seems to be inducing what seems to be manic periods of irrational irritability, but if I stay off I am cycling into a low period of sleeping all the time and low functioning. This is wreaking havoc on my job since I have a heavy workload I have to balance and obviously my personal life as well.
> >
> > Here is the catch-I am afraid of adding a new med to my current cocktail because I take Propulsid (approved in pharm study since they pulled it of market) because its the only med that treats my low esophageal pressure(I feel like a walking pharmacy some days and find all meds annoying although necessary.) This means life threatening results if I take tricyclics or don't watch what I am taking very carefully.
> >
> > My question(s) are this-of the mood regulators-are any of them trycyclic? or does anyone have any insight why the Celexa isn't regulating like it normally does? Thanks-
Listohep,I have the exact same problems as you do. The Celexa used alone with "soft bipolar" will exacerbate your mood cycling. You need to concentrate on introducing a mood stabilizer first. If an antidepressant is needed, it should be the at lowest effective dose. SSRI's used alone caused me to cycle with low grade hypomania (good energy) and made my atypical depression (oversleeping, eating, confusion and concentration) worse!!! What works for me is a tricyclic antidepressant in combo with Lamictal. Some low grade bipolars can get away with using tricyclics. From my experience with many antidepressants, I prefer the older drugs over the newer ones. I feel more like myself on imipramine.
Sexual side effects are minimal compared to the SSRI'S. I totally agree with John about finding a good pdoc. Good Luck.Laura.
Posted by Listohep on May 22, 2002, at 9:19:36
In reply to Re: Cyclothymia mood stabilizers » Listohep, posted by JonW on May 22, 2002, at 0:59:15
JonW-
Thank you for your insight. I will take a look at the links you provided. It's a great start. (Better to have some research done and understand all this stuff myself before I follow up with the doctor in next few days.)SRI's have always worked well for me so I will speak with the doc re the Lamictal.Next question. It was strange doing all this reading and seeing myself emerge off the page-especially since so much of who I see myself as as a person is part of the creativity in the highs and the insight in the lows. I am scared of losing that part of myself on a stabilizer. Should I expect that?
PS
Re the question about Propulsid-its a very safe drug if taken properly. Unfortunately, I have tried everything else on the market and nothing else works for me. I have managed to get special approval from the pharm co.and have an amazing doc and we monitor constantly. New drugs evolve daily so I am hopeful that one of these days I will find a replacement before I have to stop taking it.
Posted by BarbaraCat on May 22, 2002, at 12:56:08
In reply to Re: Cyclothymia mood stabilizers, posted by Listohep on May 21, 2002, at 18:12:22
Hi,
I second Jon's suggestions. I was recently rediagnosed from unipolar severe depression with mixed states to Bipolar II in January. Actually, it was me who presented my Bipolar theory to my pdoc after following up through research what I learned from the folks on this board. He agreed completely. The main thing that alerted me was the fact that the depression/anxiety would always break through any SSRI's, and an increase always initiated anxiety and/or panic attacks. Or else the AD would just make me feel more depressed from the get-go. Since starting Lithium, the world has been a much better place and the AD I'm taking also works better.You ask about creativity and concerns that a mood stabiliser will inhibit it. I'm a musician and dancer (by avocation rather than as a career). My own experience is that I feel about 10 times more creative now that I have the clarity and motivation to follow through. I used to have swirling frenzied ideas and a desperate longing to create but be too mentally disorganized to follow through, and then I'd beat myself up for it. Since feeling so much better, I'm now in the process of getting a dance class together and have started studying music again and am in a chorale ensemble -- impossible tasks when I was cycling up and down all the time. I can now hold one thought at a time and this helps immensely with the discipline required to pefect an art. Hypomania just wore me out and left too many loose ends.
Posted by JonW on May 22, 2002, at 19:55:34
In reply to Re: Cyclothymia mood stabilizers, posted by Listohep on May 22, 2002, at 9:19:36
> Next question. It was strange doing all this reading and seeing myself emerge off the page-especially since so much of who I see myself as as a >person is part of the creativity in the highs and the insight in the lows. I am scared of losing that part of myself on a stabilizer. Should I expect that?
One of the questions on the page that my last post linked to is very similar to your question. A guy named Mark asked the question, "I Like Being Manic". Here's the link:
http://www.bipolarworld.net/Phelps/ph_2000/ph118.htm
It turns out Mark takes Prozac + Wellbutrin + Ephedrine + Caffeine. I bet this combo would make anyone manic! :) Nonetheless, Dr. Phelps' answer addresses your question. He replies to Mark, "The point is, if somebody comes along and tells you 'oh, stop that stuff and get on the right stuff', meaning mood stabilizers, you'll probably say 'yeah, thanks a lot' and be gone. So I'd start by trying to show you that mood stabilizers may take you in a general direction that you like, particularly in that they may improve your level of function."
I've given most anti-epileptic drugs (depakote, etc.), lithium, and several atypical anti-psychotics (zyprexa, etc.) a good test drive. In my opinion, Topamax (affectionately refered to as "Dopamax" and "Stupimax" :)) is probably the most likely to disrupt your cognitive abilities which I imagine would affect creativity but everyone's different, of course. I understand your question to be what effect mood stabilizers might have in general on the exciting, genuine, emotional up and down world you're used to. In other words, what's it like to be on a mood stabilizer?
But first... "Some of the most famous artists furnished the world with a masterpiece borne of madness... and such superlative human expression remains an intangible legacy of unbearable existence." <-- That's mine, so it might not make sense ;) So, were many of the great musicians, poets, and writers great because of mental illness and drug abuse? Maybe, maybe not. But it's certainly possible to be very creative *and* and have a stable mood. It's not hard to understand how the symptoms of a hypomanic or mixed state would aid and inspire the creative process. It's even easier to understand how they destroy lives. Using LSD is somewhat analogous to this, and I believe most would wisely choose to avoid it. One psydoc once told me that great acomplishment seems to run in bipolar families, so bipolar disorder is not only very treatable but maybe even a good thing to be associated with! It's my guess that you would describe your mood instability as fitting bipolar NOS (not otherwise specified), but maybe even bipolar II now that you've done some research. If you want, there's a test you can take to rule in bipolar disorder:
http://www.ndmda.org/screening.asp
Regardless of the results, you may benefit from treatment with mood stabilizers. It may be more significant if you identify with bipolar symptoms and have some type of cycling going on -- be it energy, irritability, sleep, whatever. You should also consider that there are other disorders often misdiagnosed as bipolar disorder like atypical depression, adhd, GAD, depression + anxiety, borderline personality disorder (although, depakote may be effective). I know for sure atypical depression and adhd are correlated with bipolar disorder, but I would assume the other disorders are as well as having any one disorder seems to increase your odds of having another in most cases. Anyhow, this means you could have any one of these disorders alone (and not necessarily bipolar disorder because a lot of the symptoms overlap) or in combination. Having both bipolar and adhd seems to be fairly common, and also bipolar and atypical depression.
However, given that there is an average lapse of 8 years from onset of bipolar disorder symptoms to treatment and an average of 3 to 4 doctors are seen before people with bipolar disorder are correctly diagnosed, and the fact that the drugs used to treat the other disorders (anti-depressants, stimulants) can induce mania and cause cycling, it would seem that a mood stabilizer is a the logical next choice for you but you should definitely be working closely with your psydoc on this one. Anecdotally (is that a word?), it's been my impression that many people with your symptoms seem to end up on a mood stabilizer + anti-depressant combo but maybe you'll get lucky with Lamictal. It's a great drug. Being on a mood stabilizer can really help with the agitation you are talking about. Right now I take depakote + neurontin, and if I miss a dose of dep. the first thing I notice is I find myself very agitated and I get myself in screaming matches with people and have no idea how I got there. I still cycle on the dep. but I don't experience as many mixed episodes and my cycles aren't as severe. I suffer from life long bipolar, atypical depression, social anxiety, and possibly adhd so it's been complicated. Next we're going to try adding Nardil and see if I can tolerate it without cycling because someone on Nardil is easier to stabilize (with thyroid) than someone on an SSRI, according to my psydoc.
Man, I'm long winded today... anyway, back to your original question. There are so many mood stabilizers out there and so many different possible combinations that it is very likely you will find relief, and without any major side-effects. Anti-depressants (the SSRIs in particular) can kill your zest for life and your desire and motivation to be involved -- however, relative to the symptoms of depression maybe they're not so bad and not every one experiences side-effects and you can combat them. In my opinion mood stabilizing drugs are like placebo compared to anti-depressants. The only problem side-effects with mood-stabilizers that I've experienced are weight gain, sedation (which goes away) and depakote, for example, makes me more stable but it also seem to be kind of depressing. There are so many alternatives, though, that are far less likely to have this effect, Lamictal probably being the best. In a way being stable can rob you of the "highs" but gives you much more in return. If part of your cycles are desireable experiences then treating bipolar disorder could be described as analogous to sobering up. You may lose the euphoric highs, but you also lose the agitation, the irritability, the *depression*, and you may not realize how damn good "normal" life can be once you've been treated! Treatment doesn't have to rob you of any of the emotion or inspiration of "normal" life which has plenty of "highs" of its own! Of course, I say all of this as a depressed person on disability, so what do I know about how life can be??? :) I know one thing for sure, it can't be this bad or we'd all be extinct! ;) I think Dr. Phelps has a good idea about dabbing in the mood stabilizers to see if things go in the right direction and take it from there. Anyone with a serious chronic mental illness is selling themselves short by not working with an expert psydoc. And if things don't improve within say 6 months, go to the top and work with a "best of the best" psydoc if you can afford it. A lot of docs have very liberal prescription pads, but make sure they're working on your behalf and know when to send you to someone who knows more than them. -- It can save years!
Good luck,
Jonp.s. It sounds like you're working with a good doc, but here are a couple of links that could be useful in the future. The first is a referral database to locate a local psydoc who specializes in treating bipolar illness. The second is Ivan Goldberg's list of the best doctors in the nation:
http://www.mghmadi.org/referraldatabase.html
http://www.psycom.net/depression.central.psychiatrists.html
Posted by PamelaLynn on May 22, 2002, at 21:48:01
In reply to Re: Cyclothymia mood stabilizers, posted by Listohep on May 21, 2002, at 18:12:22
Talk to your doctor(s) about trying Lamictal (Lamotrigine). Or check with the great 'World Wide Web' and research it.
I am a rapid cycler with Borderline Personality Disorder. I was recently put on this med. and it seems to be helping me. Good Luck
P.L.
> Greetings all! Have a question for you, but first some history... After five years of therapy and 10 years of self medicating with AD's (originally Zoloft and now Celexa)for SAD, I think we have come upon a diagnosis of cyclothymia.
>
> Usually this time of year I am in my seasonal upswing and don't take any AD, but this year, I have symptoms outside of my normal cycle. My AD medication seems to be inducing what seems to be manic periods of irrational irritability, but if I stay off I am cycling into a low period of sleeping all the time and low functioning. This is wreaking havoc on my job since I have a heavy workload I have to balance and obviously my personal life as well.
>
> Here is the catch-I am afraid of adding a new med to my current cocktail because I take Propulsid (approved in pharm study since they pulled it of market) because its the only med that treats my low esophageal pressure(I feel like a walking pharmacy some days and find all meds annoying although necessary.) This means life threatening results if I take tricyclics or don't watch what I am taking very carefully.
>
> My question(s) are this-of the mood regulators-are any of them trycyclic? or does anyone have any insight why the Celexa isn't regulating like it normally does? Thanks-
Posted by Listohep on May 23, 2002, at 13:28:35
In reply to Re: Cyclothymia mood stabilizers » Listohep, posted by PamelaLynn on May 22, 2002, at 21:48:01
Thank you guys so much for the input. Hearing from real people helps a great deal.
Listohep
Posted by Zo on May 24, 2002, at 16:56:10
In reply to Re: Cyclothymia mood stabilizers, posted by Listohep on May 22, 2002, at 9:19:36
Oh, my. I'm a writer and painter who has been hung up with undiagnosed Bipolar II--and ADD, and TLE, which all three are related, or perhaps faces of the same thing, related to Kindling. . .which is so much a part of creativity, the separation of diagnoses becomes pointless; what is important is to become stabilized at just the right point.And I am here to tell you, after many many lost years, that the adjustment to being "mood stabilized" evoked only a very brief sense of loss, with me, in that this wonderful peace began. . .and out of it, more mature work than I was ever capable of doing. As well as follow-through! It took very little practice to reaccess the writing state, and in six months, I must admit, I never think of the highs anymore. Never miss them--so much so that perhaps one becomes in a way addicted to them, dependent upon that feeling of being high. People told me it wasn't necessary, to creativity, to happiness. I didn't really believe it, but was so depressed and exhausted by Bipolar II, I took the Lamictal anyway.
Only when profound suffering is over, can one begin to unravel the myths, even begin to use the experience in one's art, oneself, in a rewarding way--which is the best reward of all.
Zo
Posted by PamelaLynn on May 25, 2002, at 12:11:38
In reply to Re: Cyclothymia mood stabilizers » Listohep, posted by Zo on May 24, 2002, at 16:56:10
Well now, one couldn't TELL you were a writer could one?? LOL I think I 'got' all of what you were trying to express here.....Just one question, so you are saying it is a 'good' thing that you are taking the Lamictal?
P.L.
> Oh, my. I'm a writer and painter who has been hung up with undiagnosed Bipolar II--and ADD, and TLE, which all three are related, or perhaps faces of the same thing, related to Kindling. . .which is so much a part of creativity, the separation of diagnoses becomes pointless; what is important is to become stabilized at just the right point.
>
> And I am here to tell you, after many many lost years, that the adjustment to being "mood stabilized" evoked only a very brief sense of loss, with me, in that this wonderful peace began. . .and out of it, more mature work than I was ever capable of doing. As well as follow-through! It took very little practice to reaccess the writing state, and in six months, I must admit, I never think of the highs anymore. Never miss them--so much so that perhaps one becomes in a way addicted to them, dependent upon that feeling of being high. People told me it wasn't necessary, to creativity, to happiness. I didn't really believe it, but was so depressed and exhausted by Bipolar II, I took the Lamictal anyway.
>
> Only when profound suffering is over, can one begin to unravel the myths, even begin to use the experience in one's art, oneself, in a rewarding way--which is the best reward of all.
>
> Zo
Posted by BarbaraCat on May 25, 2002, at 19:44:51
In reply to Re: Cyclothymia mood stabilizers » Zo, posted by PamelaLynn on May 25, 2002, at 12:11:38
Kate Refield Jamison, who is Bipolar herself, has written a great book about this called Touched by Fire. It chronicles many of earlier poets and composers and makes a convincing case that most of the great minds in the art world have been bipolar. The artistic temperment and talent is a blessing and gift that does not go away. It may become rerouted for a while and the wild ecstacy may become tamed, but that wild passion is wired into our soul. I believe there are meds that can cause us to become drooling zombies, but that's not what we're alluding to here with the stabilizers.
What Zo metioned about a more mature expression is so true. I am abundantly blessed in many artistic areas - music, art, dance, cooking, you name it. I pick things up easily and do them well and visions swirl and dance in my mind. But it's been the heartbreak of my life that I've been too depressed and mentally disorganized to successfully sustain anything. I'd start a class, lessons, a paying job and have to bail out midway because IT would hit.
Just a few months ago I was on the toilet reading Oprah crying my eyes out in despair 'How do these women do these things?'. I was so utterly depressed, scattered and defeated. That was before adding lithium to my brew. For the first time in so very long I'm on the right med combo and am starting to tentatively spread my wings. I have to get over the fact that I'm now 51 and despair that it's 'too late'. Too late for who and what? I'm getting a belly dance class together and already it's almost full. I definitely have not run out of creative ideas! It's gonna one hot class!!
Posted by Zo on May 26, 2002, at 3:28:39
In reply to Re: Cyclothymia mood stabilizers » Zo, posted by PamelaLynn on May 25, 2002, at 12:11:38
Are you saying my post was. . .. writerish?Wandering? ENORMOUSLY ADD? Huh? Is that what you're saying?
I'm glad you appreciated it. It is sooo much work for me to write a concise, straightforward post.
YES it's a good thing I'm taking Lamictal! It's only proven gooder and gooder, as the months have gone on. ..
;o) Zo
Posted by Iago Camboa on May 28, 2002, at 14:00:58
In reply to mood stabilizers creativity, posted by BarbaraCat on May 25, 2002, at 19:44:51
Hi Barb,
I don't know much about 'Bipolarity II' but I must confess I strongly admire your courage & your creativeness and envy your writing talents. Also, I think I understand what is meant by the title you refer ('Touched by Fire', that's a tremendously expressive phrase...).
And didn't you know that 'life' begins at 50? Take care my friend.Iago
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