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Dr. Bob is Robert Hsiung, MD,
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Posted by ben on July 6, 2001, at 14:22:39
Sounds it like bipolar II ?
I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
What do you think ?Many thanks for your ideas and suggestions
ben
Posted by Mitch on July 7, 2001, at 10:39:24
In reply to Re: Sounds it like bipolar II ?, posted by ben on July 7, 2001, at 7:17:38
Ben,
Yeah it sure does-I am bipolar as well. So your symptoms are predominantly depression and you are currently depressed now, right?
I would avoid anti-psychotics until you have had a chance with some other mood stabilizers. Lamictal sounds like a good idea to me, given that you are touchy with nausea and sedation. Gabitril might be something that could help at low doses, too (it is a little "buzzy" and activating).
Mitch> > Sounds it like bipolar II ?
> > I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
> > I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
> > Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
> > My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
> > What do you think ?
> >
> > Many thanks for your ideas and suggestions
> >
> > ben
Posted by ben on July 7, 2001, at 11:45:10
In reply to Re: Sounds it like bipolar II ? » ben, posted by Mitch on July 7, 2001, at 10:39:24
Mitch
What are you taking for bipolar II ? I am depressed since 18 months without any remission..up and down, but the ups arent
hypomanic they are euthymic. Is this really bipolar II ? My doc doesnt talk about diagnosis
he talks about symptoms.ben
> Ben,
>
> Yeah it sure does-I am bipolar as well. So your symptoms are predominantly depression and you are currently depressed now, right?
>
> I would avoid anti-psychotics until you have had a chance with some other mood stabilizers. Lamictal sounds like a good idea to me, given that you are touchy with nausea and sedation. Gabitril might be something that could help at low doses, too (it is a little "buzzy" and activating).
>
>
> Mitch
>
> > > Sounds it like bipolar II ?
> > > I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
> > > I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
> > > Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
> > > My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
> > > What do you think ?
> > >
> > > Many thanks for your ideas and suggestions
> > >
> > > ben
Posted by Mitch on July 7, 2001, at 12:51:20
In reply to Re: Sounds it like bipolar II ?, posted by ben on July 7, 2001, at 11:45:10
Ben,
I take Neurontin 400mg/day, Klonopin 1.0mg/day,
Zoloft 12.5mg/day, nortriptyline 10mg/day. For
BP-II and social anxiety/panic. The nortrip is
there to settle down my guts from the Zoloft-and it helps my ADHD symptoms. It doesn't appear
from what you write below that you are taking a "standard" mood stabilizer. Neurontin, Gabitril, Trileptal, and Lithium are the only ones that had an AD effect on me.
> Mitch
>
> What are you taking for bipolar II ? I am depressed since 18 months without any remission..up and down, but the ups arent
> hypomanic they are euthymic. Is this really bipolar II ? My doc doesnt talk about diagnosis
> he talks about symptoms.
>
> ben
>
> > Ben,
> >
> > Yeah it sure does-I am bipolar as well. So your symptoms are predominantly depression and you are currently depressed now, right?
> >
> > I would avoid anti-psychotics until you have had a chance with some other mood stabilizers. Lamictal sounds like a good idea to me, given that you are touchy with nausea and sedation. Gabitril might be something that could help at low doses, too (it is a little "buzzy" and activating).
> >
> >
> > Mitch
> >
> > > > Sounds it like bipolar II ?
> > > > I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
> > > > I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
> > > > Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
> > > > My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
> > > > What do you think ?
> > > >
> > > > Many thanks for your ideas and suggestions
> > > >
> > > > ben
Posted by ben on July 7, 2001, at 13:20:50
In reply to Re: Sounds it like bipolar II ? » ben, posted by Mitch on July 7, 2001, at 12:51:20
Mitch
I had a short trial with Klonopin but I experienced sedation of only 0.5 mg and unsteady walk. The Zoloft made me very agitated and nauseous all the time. I didnt read many reports about Trileptal and Gabitril as a mood stabilizer. Are these newer ones than Lamictal and Neurontin ? Did you take Lamictal ? It should theoretically have the most AD effect of the mood stabilizers (not for all as you said).
ben> Ben,
>
> I take Neurontin 400mg/day, Klonopin 1.0mg/day,
> Zoloft 12.5mg/day, nortriptyline 10mg/day. For
> BP-II and social anxiety/panic. The nortrip is
> there to settle down my guts from the Zoloft-and it helps my ADHD symptoms. It doesn't appear
> from what you write below that you are taking a "standard" mood stabilizer. Neurontin, Gabitril, Trileptal, and Lithium are the only ones that had an AD effect on me.
>
>
> > Mitch
> >
> > What are you taking for bipolar II ? I am depressed since 18 months without any remission..up and down, but the ups arent
> > hypomanic they are euthymic. Is this really bipolar II ? My doc doesnt talk about diagnosis
> > he talks about symptoms.
> >
> > ben
> >
> > > Ben,
> > >
> > > Yeah it sure does-I am bipolar as well. So your symptoms are predominantly depression and you are currently depressed now, right?
> > >
> > > I would avoid anti-psychotics until you have had a chance with some other mood stabilizers. Lamictal sounds like a good idea to me, given that you are touchy with nausea and sedation. Gabitril might be something that could help at low doses, too (it is a little "buzzy" and activating).
> > >
> > >
> > > Mitch
> > >
> > > > > Sounds it like bipolar II ?
> > > > > I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
> > > > > I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
> > > > > Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
> > > > > My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
> > > > > What do you think ?
> > > > >
> > > > > Many thanks for your ideas and suggestions
> > > > >
> > > > > ben
Posted by Mitch on July 7, 2001, at 15:44:11
In reply to Re: Sounds it like bipolar II ?, posted by ben on July 7, 2001, at 13:20:50
Ben,
Trileptal is a newer "cleaner" version of Tegretol (carbamazepine) which has been used as an anti-manic agent for a long time. Gabitril is also quite new. I haven't tried Lamictal-my pdoc is afraid of possible rash and I have sensitive skin so I am in no dire rush to try it. From what you write it sounds like you are more likely to be a treatment-intolerant person than treatment-resistant. If you haven't tried Neurontin I would recommend a low dose of that say 100mg 2x-3x a day to start and see how you react to it-it has the lowest side effect profile of the whole bunch and seems to work well for mixed depression/anxiety.
> Mitch
>
> I had a short trial with Klonopin but I experienced sedation of only 0.5 mg and unsteady walk. The Zoloft made me very agitated and nauseous all the time. I didnt read many reports about Trileptal and Gabitril as a mood stabilizer. Are these newer ones than Lamictal and Neurontin ? Did you take Lamictal ? It should theoretically have the most AD effect of the mood stabilizers (not for all as you said).
> ben
>
> > Ben,
> >
> > I take Neurontin 400mg/day, Klonopin 1.0mg/day,
> > Zoloft 12.5mg/day, nortriptyline 10mg/day. For
> > BP-II and social anxiety/panic. The nortrip is
> > there to settle down my guts from the Zoloft-and it helps my ADHD symptoms. It doesn't appear
> > from what you write below that you are taking a "standard" mood stabilizer. Neurontin, Gabitril, Trileptal, and Lithium are the only ones that had an AD effect on me.
> >
> >
> > > Mitch
> > >
> > > What are you taking for bipolar II ? I am depressed since 18 months without any remission..up and down, but the ups arent
> > > hypomanic they are euthymic. Is this really bipolar II ? My doc doesnt talk about diagnosis
> > > he talks about symptoms.
> > >
> > > ben
> > >
> > > > Ben,
> > > >
> > > > Yeah it sure does-I am bipolar as well. So your symptoms are predominantly depression and you are currently depressed now, right?
> > > >
> > > > I would avoid anti-psychotics until you have had a chance with some other mood stabilizers. Lamictal sounds like a good idea to me, given that you are touchy with nausea and sedation. Gabitril might be something that could help at low doses, too (it is a little "buzzy" and activating).
> > > >
> > > >
> > > > Mitch
> > > >
> > > > > > Sounds it like bipolar II ?
> > > > > > I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
> > > > > > I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
> > > > > > Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
> > > > > > My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
> > > > > > What do you think ?
> > > > > >
> > > > > > Many thanks for your ideas and suggestions
> > > > > >
> > > > > > ben
Posted by Zo on July 7, 2001, at 16:18:08
In reply to Any bipolar type II ?, posted by ben on July 6, 2001, at 14:22:39
Just me, but Lamactil was amazingly hard to tolerate. . .Neurontin so "mild" compared to other mood stabilizers/ anticonvulsants. . .might be next thing to try? Or you might be great on Lamactil!
Good luck,
Zo
Posted by geekUK on July 7, 2001, at 19:38:02
In reply to Re: Any bipolar type II ?, posted by Zo on July 7, 2001, at 16:18:08
this may have already been said, (skipping- tired)
but i have so far found depakote v.low on side effects (sleep+erm'gastronomic'). compared to effexor and even prozac this is easy> Just me, but Lamactil was amazingly hard to tolerate. . .Neurontin so "mild" compared to other mood stabilizers/ anticonvulsants. . .might be next thing to try? Or you might be great on Lamactil!
>
> Good luck,
> Zo
Posted by ben on July 8, 2001, at 10:24:35
In reply to Re: Any bipolar type II ?, posted by geekUK on July 7, 2001, at 19:38:02
Isnt Depakote very sedating and usualy you will have troubles with weight gain ?
> this may have already been said, (skipping- tired)
> but i have so far found depakote v.low on side effects (sleep+erm'gastronomic'). compared to effexor and even prozac this is easy
>
> > Just me, but Lamactil was amazingly hard to tolerate. . .Neurontin so "mild" compared to other mood stabilizers/ anticonvulsants. . .might be next thing to try? Or you might be great on Lamactil!
> >
> > Good luck,
> > Zo
Posted by geekUK on July 8, 2001, at 19:32:14
In reply to Re: Any bipolar type II ? Depakote, posted by ben on July 8, 2001, at 10:24:35
> Isnt Depakote very sedating and usualy you will have troubles with weight gain ?
sedating not a problem, weight not (yet), Ithink I am only about 140-50 pounds/ 10 stone and six ft tall. so I am verry woried about weight, could I put on tha t much could I -anyone?
Posted by Cece on July 9, 2001, at 1:31:38
In reply to Any bipolar type II ?, posted by ben on July 6, 2001, at 14:22:39
Hi Ben-
Your symptoms sound similar to mine, and I am diagnosed BP II. I've been working for 8 years (please don't let this discourage you- some of the meds that are helping me now weren't even available 8 years ago) to work out a med combo that works for me.
I won't go into the whole 8 year med saga- too long- uless requested, but will respond to some of the questions/comments that you and others have raised in this thread about different meds.
The first med I was on was Klonopin (before beginning working with a really knowledgeable pdoc) at a TINY dose: .125 mg/ day, and I still continue at this dose- any more makes me very draggy, sloggy- but when I recently tried going off it to see if I still needed it, I missed it and put it back in- it subtly helps my mood stability and anxiety. Docs are skeptical that this 'sub-clinical' dose is anything more than a placebo, but I know otherwise.
So, my first real pdoc put me on Depakote- building up to 1000mg/day. It was like magic- I felt like an electrical charge had been lifted from the surface of my skin. I also felt less depressed- but after a while I realized that I was still pretty depressed and that I felt like my brain was too slowed down. So, I tapered down, added other meds (tried MANY- some worked for awhile and then pooped out). But I have always kept a small amount of Depakote in my mix- for awhile as low as 125mg/day, now at 250mg/day. When I have tried going off it entirely, within 3 days I feel like I can't stand being in my own skin. And it seems to minimize my tendency to hypomania- a mixed bag, since although my hypomania was never euphoric, it did give me bouts of increased productivity which allowed me to 'catch up' from the nonproductivity of depression.
I have been on Neurontin for about 3 years, at different dosages, and again a feeling of magic. It is calming for me- subtly, but very significantly. It is a gentle, friendly med.
But still low grade depressed, and not sufficiently stable, I tried Topomax- lost weight (great!), but no significant mood stabilization and unacceptical cognitive dysfunction.
So now Lamictal- beginning at a very, very low dose with very, very gradual increases- 12.5mg/day, increasing by the same about every week (my pdoc had seen "the rash" and become conservative, I am on Depakote which potentiates Lamictal, and I have sensitive skin). I am now at 225mg/day and still increasing. I am feeling more stable and less depressed. When I do an increase, I sometimes feel low energy and 'fluish' the third day, but it's not a big deal and passes quickly- never any sign of 'the rash'. I think that this is a very good med for me, and will continue to build up my dosage. My (new) pdoc sez that many of his patients don't feel that it really 'kicks in' for them until around 300mg/day, and he has some on as much as 600 or more.
My 'cocktail' includes some other meds at low dosages (and as I said, I have tried many others along the way). One that someone mentioned in this thread is Nortriptyline, which I have been on for several years now- for a long time at 40mg/day. I have fibromyalgia as well as BP (similar, but different to CFIDS) and it has helped that problem a lot by helping my sleep. It also gives me some antidepressant effects (at higher dose I got unacceptable dry mouth and weight gain).
My hope is that as I increase the Lamictal, assuming that it continues to work better and better for me, that I can begin to drop out some of my other meds. It is a lot of work to run my own little home pharmacy and I would love to be able to simplify my regime. But for now, I know that each med has its own special helping effect, and I try to not resent the hand that I have been dealt.
I hope that some of this is helpful, and I wish you all the best!
Cece
> Sounds it like bipolar II ?
> I wonder if I am bipolar II because I never had mania, but before my depression begun (18 months ago) I had probably a hypomanic phase (increased activity, sex drive, angry and more talking). I am not sure about that. Since my dperession begun I never had a full remission and I always showed a response to several AD but pooped out very quickly. Increasing the dose showed the the sam thing.
> I had a trial with Lithium to 100 mg (yes 100 mg !) Celexa but gave it up after 2 weeks of awful nausea and loss of appetite (serotonergic overstimulation ?). Since then I tried Flupentixol (0.5-1.5 mg) and Zyprexa (1.25 mg) as mood stabiliser. The Flupentixol worked about two weeks and pooped out and the same procedure with increasing the dose. I couldnt stick to Zyprexa because it hit me like a rock (sedation, dizziness and headache during the day).
> Perhaps I should try Risperidone, Carbamazepine, Valproic acid or Lamotrigine ?
> My doc sees the Lamictal for the next step, because I am very sensitive to side effects and I have some ruminating thoughts.
> What do you think ?
>
> Many thanks for your ideas and suggestions
>
> ben
Posted by Janelle on July 14, 2001, at 23:33:54
In reply to Any bipolar type II ?, posted by ben on July 6, 2001, at 14:22:39
Cece & Ben: Between the two of you, wow, you both sound like me with my symptoms and meds!
I have been on Klonopin (0.5 to 1.5, depending on circumstances) for many years, and whenever my pdoc switches my other meds, she says to remain on the Klonopin, and she's been right all the way with that! She told me that the newer anti-psychotics (e.g. Zyprexa) and mood stabilizers (eg. Depakote, Lamictal) calm your "mind," whereas Klonopin (and presumably other benzos) calm your body and nervous system as a whole. Interesting...
From what you two have written, it sounds like these new mood stabilizers are quite effective for BipolarII/Hypomania, so I hope and pray they'll work for me with mine.
-Janelle
This is the end of the thread.
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