![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 35. Go back in thread:
Posted by Mitch on July 25, 2001, at 0:12:16
In reply to Now I am a dopamine junkie. » Mitch, posted by Chloe on July 24, 2001, at 19:12:03
Chloe,
I also had a definitely positive response to conventional and atypical AP's (at low-doses) in the past and recently. After listening to your experiences and comparing them with my similar ones I conclude this should be a rule of thumb for ANY pdoc:
IF THE PATIENT IS NOT HAVING PSYCHOTIC SYMPTOMS AND ESPECIALLY IF THEY ARE BIPOLAR, you SHOULDN'T BE PRESCRIBING ANY ANTIPSYCHOTICS!!! We are especially susceptible to their damaging effects upon dopamine function. Hey, it took me MONTHS to get over the dystonia caused by super-low-dose Risperdal over the course of just three weeks!!! And, I don't think I am back at "square one" like I was before I tried the med. I think Mellaril (thioridazine)and Thorazine (chlorpromazine) is no worse(at lower doses used for BP folks) compared to some of the newer stuff that is touted to be so "free from extrapyramidal symptoms". I was so fascinated with the *newer* AP's that "boosted serotonin to prevent EPS" that were developed and of course I wanted to try them (so I suggested them). I wished I would have kept my mouth shut (in hindsight).
It has already been proven that most people that present at the ER with florid manic symptoms can be controlled in most cases just as well with lorazepam or clonazepam or DEXEDRINE as they can by an antipsychotic. Well isn't it interesting that older meds just don't make any money nowadays?
Another thing is SSRI meds. We know that the extra serotonin decreases dopamine function and EVERY SSRI has "extrapyramidal syndrome" as a possible side-effect. I have also had similar problems with Celexa that you have described (and even worse dystonia with Paxil!).
"Start-up EPS" is not something like headache or nausea that goes away with continued treatment-it gets worse or it gets MASKED by the drug that is causing it.
I have no second thoughts recommending dx'ing of the Geodon. In my mind it is akin to damage control. I can tell from your posts that you have had no psychotic symptoms and you have not reported any.
Take care,
Mitch
Posted by Chloe on July 25, 2001, at 8:54:59
In reply to Re: Now I am a dopamine touchy » Chloe, posted by Mitch on July 25, 2001, at 0:12:16
I get your point. And you are right I am not hearing voices or hallucinating. But I do have very distorted thinking and perceptions that make it difficult to manage in this world.
I don't really feel comfortable being specific about my toubles out here on the www, however, surfice it to say, I have been hospitalized several times, and continue to seek ways to stay sane dispite my "psychotic features."
I know I am going to have big troubles when I stop this stuff. I am so much calmer and able to understand and communicate better. That is one of the hardest things for me. I get into situations where I don't understand the meaning of discussion. I tend to be a bit paranoid and self deprecating and obsessive about things. I will replay a conversation or event over and over in my head, putting a negative twist on everything. I am chronically anehedonic, until Geodon.
So, I really don't know what to do and my pdoc seems at sea as well. She knows me well, and knows the AP's work wonders for me. But at what cost?..I am on two mood stabilizers (Trileptal, neurontin), an AD(Celexa) and a benzo(Valium), which allow me to survive. But with little hope or lust for life. I cannot hold a paying job.
That my story. I wonder how the next chapter is going to go...
Any ideas for a med for anehedonia and distorted thinking that doesn't cause EPS? :)
Chloe
Posted by Mitch on July 25, 2001, at 14:41:21
In reply to Re: Now I am a dopamine junkie » Mitch, posted by Chloe on July 25, 2001, at 8:54:59
Chloe,
There are only a couple of things I could suggest, that I can think of right now. One is lithium which is *supposed* to be more helpful for BP with psychotic features than AC's. You have probably been there done that, though. As far as all of the atypicals-Seroquel has the lowest EPS incidence (and it didn't bother me near as much as Risperdal). Another possibility may be a need to "juggle" your existing med combination without the Geodon. Maybe something is dosed too high or low, maybe one of your existing meds is actually creating more problems than it is solving. Some anticonvulsants (in some people) pushed to too high a dose level can *cause* psychosis and depression, by the way. Perhaps?? the *combination* of the Celexa and the Geodon is causing the EPS? I am taking a tiny dose of Zoloft right now (switched from Celexa) partly because the "tongue thing" happened to me with the Celexa. Hmmm. You said you were sweating excessively... Celexa makes me sweat like a pig-more so than the other SSRI's. You might be able to ditch the Celexa and the EPS might fade...maybe (a long shot). Hey, run all this by your pdoc and see what she thinks ok? I am going to be back in town Sunday.
good luck
Mitch> I get your point. And you are right I am not hearing voices or hallucinating. But I do have very distorted thinking and perceptions that make it difficult to manage in this world.
>
> I don't really feel comfortable being specific about my toubles out here on the www, however, surfice it to say, I have been hospitalized several times, and continue to seek ways to stay sane dispite my "psychotic features."
>
> I know I am going to have big troubles when I stop this stuff. I am so much calmer and able to understand and communicate better. That is one of the hardest things for me. I get into situations where I don't understand the meaning of discussion. I tend to be a bit paranoid and self deprecating and obsessive about things. I will replay a conversation or event over and over in my head, putting a negative twist on everything. I am chronically anehedonic, until Geodon.
>
> So, I really don't know what to do and my pdoc seems at sea as well. She knows me well, and knows the AP's work wonders for me. But at what cost?..I am on two mood stabilizers (Trileptal, neurontin), an AD(Celexa) and a benzo(Valium), which allow me to survive. But with little hope or lust for life. I cannot hold a paying job.
>
> That my story. I wonder how the next chapter is going to go...
> Any ideas for a med for anehedonia and distorted thinking that doesn't cause EPS? :)
> Chloe
Posted by chloe on July 26, 2001, at 20:30:31
In reply to Re: Now I am a dopamine junkie, posted by Mitch on July 25, 2001, at 14:41:21
I realize you are away at the moment....
But, thanks for the informative answer. I have used Li in the past and felt nothing for years on end. I think that is how I got through college.I also have to report, that dropping out the Celexa today has made a dramatic difference with the clenching and tension in my mouth. I did not realize I was so wired and wound up being on both Celexa and Geodon. I blamed all the symptoms soley on Geodon.
I just hope my queitness and ability to "sit still" doesn't turn into meloncholy! Hey at the moment anything is better than the clenching.
I do still have some tongue wag, but I only stopped my 1.5 mgs of Celexa this am...
Take care.
C
Posted by Mitch on July 28, 2001, at 19:36:52
In reply to Now I am a dopamine junkie » Mitch, posted by chloe on July 26, 2001, at 20:30:31
> I realize you are away at the moment....
> But, thanks for the informative answer. I have used Li in the past and felt nothing for years on end. I think that is how I got through college.
>
> I also have to report, that dropping out the Celexa today has made a dramatic difference with the clenching and tension in my mouth. I did not realize I was so wired and wound up being on both Celexa and Geodon. I blamed all the symptoms soley on Geodon.
> I just hope my queitness and ability to "sit still" doesn't turn into meloncholy! Hey at the moment anything is better than the clenching.
> I do still have some tongue wag, but I only stopped my 1.5 mgs of Celexa this am...
> Take care.
> C
Chloe,That is very interesting. While I have been gone I stopped my Zoloft and my "jaw clenching" has tapered off (not to mention improved sleep). Hmm. I am going to stay off it for a while and see what happens.
Mitch
Posted by chloe on July 29, 2001, at 16:43:42
In reply to Re: Now I am a dopamine junkie » chloe, posted by Mitch on July 28, 2001, at 19:36:52
Well, my pdoc has been AWOL for 4 days, so I finally paged her. She said to stop the Geo. Dah!
But I am in total despair. Geodon worked so well for me. I have never felt better or been more productive. I wanted the EPS to go away to badly...You were right that it was not a "start up" symptom, Mitch
The next few days are going to be hell withdrawaling from this stuff...
Pdoc did mention the possibility of trying topomax. Have you ever heard of that for distorted thinking, ruminating, short fused type feelings?
I am very upset that another very effective med
has to go in the crapper due to side effects :(
Chloe
Posted by Mitch on July 29, 2001, at 17:11:32
In reply to No more Geodon... » Mitch, posted by chloe on July 29, 2001, at 16:43:42
> Well, my pdoc has been AWOL for 4 days, so I finally paged her. She said to stop the Geo. Dah!
>
> But I am in total despair. Geodon worked so well for me. I have never felt better or been more productive. I wanted the EPS to go away to badly...You were right that it was not a "start up" symptom, Mitch
>
> The next few days are going to be hell withdrawaling from this stuff...
>
> Pdoc did mention the possibility of trying topomax. Have you ever heard of that for distorted thinking, ruminating, short fused type feelings?
>
> I am very upset that another very effective med
> has to go in the crapper due to side effects :(
> ChloeChloe,
Don't *automatically* assume you are going to have a hell of a withdrawal from the Geodon-you will self-fulfill it if you aren't careful! From what I understand you were not on much of a dose.
So, now you are just on Trileptal for a mood stabilizer right? Does she want to swap the Trileptal for the Topamax or just add it?? Does the Trileptal seem to be doing you any good?
I would suggest a trial of Topamax. It seems to be good for PTSD and OCD-like symptoms from what I have heard here and my own personal experience with it. I would start it at 12.5mg sprinkle caps once at bedtime and GO SLOW on the way up. I mean REAL SLOW. You are hypersensitive to meds like I am. I would stay at just 12.5mg for TWO weeks before increasing it to 25mg at bedtime and then hold it there for TWO more and titrate it in tiny 12.5mg dose increments and HEY, if you find it is working GREAT at 50mg at bedtime, say eight weeks from now, WELL JUST STAY THERE.
I screwed up and increased it rapidly up to 50mg (with a truckload of Neurontin and Klonopin on top of it) and my mind got all fogged up and I got the itchies too, so it wound up getting trashed for me. (not a rash just pruritis) If you are careful and patient (and maybe with less or no Trileptal later on) this might be the one for you. I found it had a very pronounced anxiolytic and antimanic effect. I guess to summarize it seemed to be a great "anti-agitative", good for mixed stuff.
take care,
Mitch
Posted by chloe on July 29, 2001, at 17:31:51
In reply to Re: No more Geodon...topamax? » chloe, posted by Mitch on July 29, 2001, at 17:11:32
Thanks Mitch
You are right about the withdrawal stuff. I have to be a positive thinker!I also am taking some nuerontin (400mgs) with the miniscle dose of Trileptal (375 mgs). I just posted something about it farther down this list in "Trilepal Experiences."
My pdoc also thinks going back to Li maybe a good idea. God, I just can't put up with the tremors and nausea and inability to feel anything good. It's the blah drug for me.
She also mentioned adding maybe 125 mgs of Depakote to my mood stabilizer hodge podge. I am not sure about that one either. I don't like being on so many at subtherapuetic doses... Have you heard of such a treatment stradegy?Ah, I am not really thinking straight. And can't decide what to do about anything right now. But I do think Top. sounds interesting. I need to research and hear more about it. My only concern is the weight loss that tends to come with that med. I am already thin and don't want to have any less of an appetite...
Top. sounds a little like Lamictal, in that you have to titrate slowly...But I hope Top. isn't as activating! I was too racy on Lamictal.I am sorry that Topomax didn't work out for you. But is a retry in the future ruled out?
Thanks for your timely post
Chloe
Posted by Mitch on July 29, 2001, at 23:05:30
In reply to Re: No more Geodon...topamax? » Mitch, posted by chloe on July 29, 2001, at 17:31:51
> Thanks Mitch
> You are right about the withdrawal stuff. I have to be a positive thinker!
>
> I also am taking some nuerontin (400mgs) with the miniscle dose of Trileptal (375 mgs). I just posted something about it farther down this list in "Trilepal Experiences."
>
> My pdoc also thinks going back to Li maybe a good idea. God, I just can't put up with the tremors and nausea and inability to feel anything good. It's the blah drug for me.
> She also mentioned adding maybe 125 mgs of Depakote to my mood stabilizer hodge podge. I am not sure about that one either. I don't like being on so many at subtherapuetic doses... Have you heard of such a treatment stradegy?
>
> Ah, I am not really thinking straight. And can't decide what to do about anything right now. But I do think Top. sounds interesting. I need to research and hear more about it. My only concern is the weight loss that tends to come with that med. I am already thin and don't want to have any less of an appetite...
> Top. sounds a little like Lamictal, in that you have to titrate slowly...But I hope Top. isn't as activating! I was too racy on Lamictal.
>
> I am sorry that Topomax didn't work out for you. But is a retry in the future ruled out?
>
> Thanks for your timely post
> Chloe
Chloe,Well, that is a lot of info! You can check off Lamictal obviously, and you had some negative reactions to Lithium (why revisit something that you had some neg reactions to if you have the time to check out other possibilities?) You know, given that you are on low-doses of everything that you are taking currently and you don't have a stressful demanding job to throw monkey-wrenches in the mix I would suggest you discuss further withdrawals of current meds with your pdoc (Trileptal first) and see how you are feeling...you know take it as it goes...one step at a time.
POSSIBLY: Get to a point where all meds are withdrawn except the one that currently works the *best* for you, say Neurontin, and optimize that ONE med.
When you are ONLY on the Neurontin, push THAT dose UP a *little* at a time and plumb your limits with that ONE med. When you have figured out what the max dose you can take of it that helps you, THEN,
*ADD* some Topamax (the lowest dose is actually 15mg sprinkle-not 12.5mg) at bedtime. You see, you don't want to blow off something that is helpful-if you think that it is causing a side effect when SOMETHING ELSE is really causing it-that is the problem with *modern* polypharmacy-not liver/kidney/CYPxxx interaction problems, but being able to DETERMINE what is REALLY causing problems. The bottom line is that you don't want to "throw out the baby with the bathwater" due to polypharmacy and the confusion that results from it.
I just say this because I am also in a current state of low-dose polypharmacy where it is unclear what is helping/hindering progress.
I wouldn't worry about excessive weight loss with low-dose Topamax. I found Topamax NOT to be activating at all-quite anxiolytic almost neuroleptic-like (well here might be a Geodon replacement??). I would also try Topamax before Depakote.Mitch
Posted by chloe on July 30, 2001, at 10:27:49
In reply to Re: No more Geodon...topamax? » chloe, posted by Mitch on July 29, 2001, at 23:05:30
Hi Mitch
What you say about polytherapy makes sense. However, I don't have one med that I think is really "good" or effective except perhaps valium...And that is not a long term solution.I am not sure what neurontin dose except make me mildly sleepy (doesn't help with anger!). I still had hypomania when I added activiting drugs while being on neurontin and trileptal. Neurontin alone doesn't seem powerful enough. Trilepatal alone is too activating. And more than 1.5 Celexa and I am so racy I become suicidal.
So, I said all that to say I am in a terrible state of confusion, and though I don't have a *paying* job, I have many responsibilities and boyfriend who has a lot of difficultly with my med changes. When ever I got down on anything, at the moment Geodon, I get the worst anger streak and uncontrollable temper. And my dear friend, Anhedonia has also returned with a vengence!
So, if Topomax does have the neuroleptic type feel, it may be worth a try...I don't mind the brain cloud, some folks report. In fact it's a relief to me not to remember every single detail of my day. That's pretty pathetic!
During your short trial of Topo, do you recall it having any effect on your negative feelings (I am not sure if this is an issue for you...so you might not know!)?Thanks so much for you quick replies and thoughtful answers. I have so appreciated your support through this crappy time. Geodon was a BIG mistake. People on this board are much more informed than most pdocs!
Chloe
Posted by Mitch on July 30, 2001, at 12:35:49
In reply to Re: No more Geodon...topamax? » Mitch, posted by chloe on July 30, 2001, at 10:27:49
> Hi Mitch
> What you say about polytherapy makes sense. However, I don't have one med that I think is really "good" or effective except perhaps valium...And that is not a long term solution.Chloe, have you tried Klonopin??
>
> I am not sure what neurontin dose except make me mildly sleepy (doesn't help with anger!). I still had hypomania when I added activiting drugs while being on neurontin and trileptal. Neurontin alone doesn't seem powerful enough. Trilepatal alone is too activating. And more than 1.5 Celexa and I am so racy I become suicidal.I agree that Neurontin doesn't "do it" on it's own. I am taking it with Klonopin and a little Depakote right now. However, I must admit that I had the *best* *positive* response to it than ANY of the others-but then from what I understand people with comorbid ADHD with onset of bipolar while teenagers are supposed to be unique "responders" for Neurontin.
>
> So, I said all that to say I am in a terrible state of confusion, and though I don't have a *paying* job, I have many responsibilities and boyfriend who has a lot of difficultly with my med changes. When ever I got down on anything, at the moment Geodon, I get the worst anger streak and uncontrollable temper. And my dear friend, Anhedonia has also returned with a vengence!No bad vibes intended about being employed or not. It is just when you are undergoing experimentation it can really wreak havoc with either
a) doing the job-ability to focus and
b) temper tantrums can easily end in termination!! (getting hypomanic/dysphoric on an AD for example or failure for a "new" mood stabilizer to well, do it's job)
>
> So, if Topomax does have the neuroleptic type feel, it may be worth a try...I don't mind the brain cloud, some folks report. In fact it's a relief to me not to remember every single detail of my day. That's pretty pathetic!That may have something to do with its ability to help with PTSD. You should get less ruminations and mental churning about daily events which don't help any.
> During your short trial of Topo, do you recall it having any effect on your negative feelings (I am not sure if this is an issue for you...so you might not know!)?
Generally, I just felt a sense of "quiet" with it. No distinct AD activity. But, much less agitation, it really puts a lid on racing thoughts! It might work well with the Neurontin for you.
> Thanks so much for you quick replies and thoughtful answers. I have so appreciated your support through this crappy time. Geodon was a BIG mistake. People on this board are much more informed than most pdocs!
> ChloeNo problem, well we are the guinea pigs aren't we?
Mitch
Posted by chloe on July 30, 2001, at 20:26:48
In reply to Re: No more Geodon...topamax? » chloe, posted by Mitch on July 30, 2001, at 12:35:49
> Chloe, have you tried Klonopin??Yes, about 10 years ago. I found I couldn't function! I didn't stick with it very long, because I think I was totally knocked out from it.
People on this board seem to really have success with it. But I find no reason to switch from something that is working and has worked for years. I do hate the stigma associated with valium, however!I emailed my pdoc about the topamax and when I got home after a long day, she wrote back that she called it in! She said it has AD and antimanic qualities. And is sedating. Sounds too good to be true.
However, I am afraid to try it so soon. I still have Geodon swimming around in me. And I want to get my Celexa back up to 1.5 mgs or so again. I just have a lot equilibrating to do before I add another agent...
I am hoping my mood stays as good as it is now. But I think I am just so relieved to be stopping the AP, that it has made me slightly elated! That mouth stuff was (IS, of course I still have it...and will for a while I am sure) scary and was making me obsess about everything I did with my tongue and lips. Ugh. I also started having a little galactorrea. Can you believe it? At the smallest dose possible too. When the drug works, I get the horrible side effects. NOT FAIR.
I am glad you are having some success with just neurontin/dep/klon. It's a constant balancing act. How are things without the Zoloft?
Thanks for the info on Top.
Chloe, the guinea pig :)
Posted by Mitch on July 31, 2001, at 0:18:29
In reply to Re: No more Geodon...topamax. » Mitch, posted by chloe on July 30, 2001, at 20:29:35
> > Chloe, have you tried Klonopin??
>
> Yes, about 10 years ago. I found I couldn't function! I didn't stick with it very long, because I think I was totally knocked out from it.Well, everything is relative..but could there have possibly been an interaction with or another med that caused it, or too much Klonopin?? I was also on diazepam for many years, but for some reason I got hostile and depressed on diazepam, and that is something I didn't experience with either Klonopin or Xanax..just thought I would let you know that..
> People on this board seem to really have success with it. But I find no reason to switch from something that is working and has worked for years. I do hate the stigma associated with valium, however!
Chloe, please forget STIGMAS about supposedly addictive meds-that is the LAST thing you need to be concerned about.
> I emailed my pdoc about the topamax and when I got home after a long day, she wrote back that she called it in! She said it has AD and antimanic qualities. And is sedating. Sounds too good to be true.
>
> However, I am afraid to try it so soon. I still have Geodon swimming around in me. And I want to get my Celexa back up to 1.5 mgs or so again. I just have a lot equilibrating to do before I add another agent...JUST BE CAREFUL to start the Topamax slowly and take your time with it-you don't want to blow it. I hope she didn't start you out too high..
I suppose taking a fragment of Celexa isn't going to be too harmful-just watch it, OK?>
> I am hoping my mood stays as good as it is now. But I think I am just so relieved to be stopping the AP, that it has made me slightly elated! That mouth stuff was (IS, of course I still have it...and will for a while I am sure) scary and was making me obsess about everything I did with my tongue and lips. Ugh. I also started having a little galactorrea. Can you believe it? At the smallest dose possible too. When the drug works, I get the horrible side effects. NOT FAIR.Don't forget that sometimes it is quite tough to figure out what is truly causing a *problem*! The Celexa could for real be aggravating any lingering EPS that you have.
> I am glad you are having some success with just neurontin/dep/klon. It's a constant balancing act. How are things without the Zoloft?
I feel more *pain* for some reason and I feel like I am procrastinating more than usual. That is probably a withdrawal effect. I sleep better however. I thought I would have a worsening of my social anxiety-but that hasn't happened! Of course I am taking a tiny dose of nortriptyline for my ADHD. But, I have also dropped my clonazepam dosage to .5-.75mg/day successfully..
>
> Thanks for the info on Top.
> Chloe, the guinea pig :)be careful,
Mitch
Posted by chloe on July 31, 2001, at 12:30:59
In reply to Re: No more Geodon...topamax. » chloe, posted by Mitch on July 31, 2001, at 0:18:29
I feel so "off" and agitated from the withdrawal of Geodon. I also have chills and sweats. So, I don't want to rush into a new med. Esp. one that can have some agitating or AD effects. I think I need to balance out my Trileptal/Celexa/Neurontin before I add anything. And would prefer to be off or lower on Trileptal before starting another AC.
Perhaps adding Top. would help with my agitation and feelings of insecurity and fear. But I am not sure what "normal" for me is right now. So adding another med, I think will only confuse me more.
At least I have it as an option...
I am sorry for increased *pain*, but it's nice that you have no increase of social anxiety so far. Sometimes I think the SSRI's make one more tense and anxious, not less. Better sleep is also a plus!!! The tad of nortrip. maybe a good med for you right now.
Thanks Mitch
Chloe
Posted by Mitch on August 1, 2001, at 0:05:47
In reply to Re: I think I'll wait on the Topamax » Mitch, posted by chloe on July 31, 2001, at 12:30:59
> I feel so "off" and agitated from the withdrawal of Geodon. I also have chills and sweats. So, I don't want to rush into a new med. Esp. one that can have some agitating or AD effects. I think I need to balance out my Trileptal/Celexa/Neurontin before I add anything. And would prefer to be off or lower on Trileptal before starting another AC.
>
> Perhaps adding Top. would help with my agitation and feelings of insecurity and fear. But I am not sure what "normal" for me is right now. So adding another med, I think will only confuse me more.
>
> At least I have it as an option...
>
> I am sorry for increased *pain*, but it's nice that you have no increase of social anxiety so far. Sometimes I think the SSRI's make one more tense and anxious, not less. Better sleep is also a plus!!! The tad of nortrip. maybe a good med for you right now.
>
> Thanks Mitch
> ChloeChloe,
That is probably good reasoning-with regard to Trileptal and waiting to start the Topamax. It is something I am doing right now with SSRI's. You just have to put up with some crap and get through it so you have some clearer idea of what is helping or hindering. You definitely don't want Topamax to get prematurely stopped (if it can really help you) because of some *other* med's withdrawal, etc.
The *pain* problems I have are currently being addressed by rapidly increasing my exercising schedule (boost those endorphins!).
Mitch
Posted by chloe on August 1, 2001, at 18:14:16
In reply to Re: I think I'll wait on the Topamax » chloe, posted by Mitch on August 1, 2001, at 0:05:47
How does one know if a med is going to work or not? I did some research on Topamax and it can have some pretty nasty side effects, ie, mouth sores, numbness of hands, feet, face, kidney stones, rash. They actually seem worse than Trileptal, at the moment. At least I am used to Trileptal. But I can't go above a very low dose that does allow some major instability. But also horrible dry skin/ hair and a sun intolerance.
How is one to decide which is the better evil? Or if it's worth a switch? My pdoc doesn't seem to think I should choose one or the other. That I have difficultly with side effects with ALL meds, and that sub therapeutic dose of several seems to work ok for me. I am not sure I am in agreement. Perhaps I haven't found the right med, or maybe there isn't one...AC's don't generally completely hit the nail on the head for me.
I don't even think I would ponder a change. Except that I constantly need to refine my "regime" since I can't use an AP to dowse my bipolar 2 or 3 (still not sure), some borderline issues and transient inability to think clearly (psychotic features).
That Geodon worked so well, I am so disappointed it didn't pan out due to side effects. Not only did it quite my thoughts, it worked great on anhedonia/depression. I am back to my old negative self, blah. But 3 day post discontinuation, I still have mouth problems, and trouble swallowing. I really hope this goes away in time...
I guess I wish I could see the future to know if it's worth the turmoil of a change to topamax...Anyone have a crystal ball?
Sorry this is so long and incoherent...Don't know if I should even post this.
ChloeMitch, keep up your exercising!
Posted by amuse on August 1, 2001, at 21:43:50
In reply to Topamax or Trileptal?, Mitch, anyone?, posted by chloe on August 1, 2001, at 18:14:16
> topomax interest me but I know little about it. At the clinic where I work one of the nurse practioners prescribed it to two client of mine with many years of major depression ( along with many other meds) and they made remarkable improvement. I guess it could have been a coincidence but I dont think so.
Posted by Mitch on August 2, 2001, at 0:25:27
In reply to Re: Topamax or Trileptal?, Mitch, anyone?, posted by amuse on August 1, 2001, at 21:43:50
> > topomax interest me but I know little about it. At the clinic where I work one of the nurse practioners prescribed it to two client of mine with many years of major depression ( along with many other meds) and they made remarkable improvement. I guess it could have been a coincidence but I dont think so.
amuse,
Topamax is something I wouldn't be looking at if you have only unipolar depression. There are safer meds for that. All the chat you will find here about Topamax usually relates to bipolar disorder for the most part. Of course if those patients "were on many other meds", then they may have been bipolar patients. Are you curious because of your own personal problems, or just about Topamax being an antidepressant agent in itself?
Mitch
Posted by amuse on August 5, 2001, at 20:58:32
In reply to Re: Topamax or Trileptal?, Mitch, anyone? » amuse, posted by Mitch on August 2, 2001, at 0:25:27
> > > topomax interest me but I know little about it. At the clinic where I work one of the nurse practioners prescribed it to two client of mine with many years of major depression ( along with many other meds) and they made remarkable improvement. I guess it could have been a coincidence but I dont think so.
>
> amuse,
>
> Topamax is something I wouldn't be looking at if you have only unipolar depression. There are safer meds for that. All the chat you will find here about Topamax usually relates to bipolar disorder for the most part. Of course if those patients "were on many other meds", then they may have been bipolar patients. Are you curious because of your own personal problems, or just about Topamax being an antidepressant agent in itself?
>
> MitchDear Mitch, I am interested in Topomax a drug I dont know much about. The reaction of these two clients of mine, very sick and probably bi-polar and PTSD, was so dramatic, still it could have been a coincidence, I asked my pdoc about it and he was incredibly discouraging reeling off all the nasty side effects. I also have been on low-dose polypharm for almost eight years. Paxil 5mg, imiprimine 50, wellbutrin 300, and lithium 600 keeps me feeling good and normal most of the time. Never had complete remission of depression until I started on lithium about four years ago. I am always looking for meds with out the nasty side effects the two that bother me the most, sexual dysfunction and weight gain. Dont think I will get a chance to try topomax. The doses the nurses used were also I understand sub theraputic, for nightmares from PTSD. I would go on an MAO inhibitor except pdoc says they have the same side effects. I think I probably have a bi-polar two diagnosis but was mostly depressed. Now I feel great most of the time.
Posted by Mitch on August 6, 2001, at 8:15:11
In reply to Re: Topamax or Trileptal?, Mitch, anyone?, posted by amuse on August 5, 2001, at 20:58:32
> Dear Mitch, I am interested in Topomax a drug I dont know much about. The reaction of these two clients of mine, very sick and probably bi-polar and PTSD, was so dramatic, still it could have been a coincidence, I asked my pdoc about it and he was incredibly discouraging reeling off all the nasty side effects. I also have been on low-dose polypharm for almost eight years. Paxil 5mg, imiprimine 50, wellbutrin 300, and lithium 600 keeps me feeling good and normal most of the time. Never had complete remission of depression until I started on lithium about four years ago. I am always looking for meds with out the nasty side effects the two that bother me the most, sexual dysfunction and weight gain. Dont think I will get a chance to try topomax. The doses the nurses used were also I understand sub theraputic, for nightmares from PTSD. I would go on an MAO inhibitor except pdoc says they have the same side effects. I think I probably have a bi-polar two diagnosis but was mostly depressed. Now I feel great most of the time.
I suspect the reason your pdoc is hesitant to try it is because of the number of meds that you are already taking. He might be afraid of neurotoxicity by adding it (especially with the lithium). He also may not be inclined to use meds "off label". Topamax isn't approved by the FDA for bipolar, yet. Obviously the lithium has helped you a great deal-you said "complete remission". He probably thinks that you are fairly stable and doesn't want to make a lot of waves by adding any new meds, that's all (I counted 3 AD's). If you still feel insistant about trying topamax approach him with the idea of a substitution with one of your other meds-say Paxil for instance. If you do start topamax (esp. given your other meds in the mix), you need to start off as low as you can and be patient increasing-it can really fog up your head if you jack the dose up too quickly or start off with too much of it.
Mitch
Posted by Bellalaya on November 14, 2001, at 6:30:48
In reply to Help! GEODON, hypomania?, posted by Chloe on July 21, 2001, at 17:11:05
My 24 year old son takes 180 mg of Geodon/day & was recently increased to 200 (100 BID)! Does anyone have experience with this dosage? He takes this for "negative symptoms". (He also has dyskenia which he developed on rispertal and now on geodon.)
He has recently experienced hypomania as described here. How does one determine if it is 1. the Geodon, 2. actually a bipolar response (we are still unsure of the diagnosis even after hospitalization, 3. Exhilaration in finally feeling good after 11 months of trying different meds.
Thanks, Bella> I started Geodon 1 week ago, 20 mgs at bedtime for obsessive thoughts. After 2 days on Geodon, I got so racy, couldn't sleep my usual amount, and I was talking a blue streak. I did not shut up until yesterday, when my mood finally crashed. I felt very depressed and shaky after a day of feeling very pressure, elated and excited.
>
> So, I took the Geodon earlier than usual and began to feel a bit better in the evening. My pdoc said to discontinue the Celexa, because Geodon has some seratonin in it. I stopped that today, and I was much more relaxed and less pressured.
>
> Has anyone else had this hypomanic type response to Geodon? Did the agitation where off? And does anyone else feel shaky and nervous before the next dose? What is the half life of this stuff? If I increase the dose I am afraid that I might get hypomanic again, or even seratonin syndrome (I am so sensitive to anything with seratonin, it's ridiculous!). I was really confused the for a day or two, dizzy, nauseated. I feel ok now, but if the med begins to runout, I start feeling "funny" and shaky again.
>
> Can anyone help me figure out what is going on? Just now, a whole week, the med seems to be kicking for the obsessive thinking. I have never known an antipsychotic that needs to "build up" before it works. Mellaril used to work in 15 minutes for me, years ago.
>
> Any info so appreciated
> Chloe
Posted by Chocoholic on November 25, 2001, at 1:00:49
In reply to Re: Help! GEODON, hypomania?, posted by Bellalaya on November 14, 2001, at 6:30:48
>I got extreme restlessness, which can feel like hypomania. It lessened when I lowered the dose and now I feel much better!
Chocholic
My 24 year old son takes 180 mg of Geodon/day & was recently increased to 200 (100 BID)! Does anyone have experience with this dosage? He takes this for "negative symptoms". (He also has dyskenia which he developed on rispertal and now on geodon.)
>
> He has recently experienced hypomania as described here. How does one determine if it is 1. the Geodon, 2. actually a bipolar response (we are still unsure of the diagnosis even after hospitalization, 3. Exhilaration in finally feeling good after 11 months of trying different meds.
> Thanks, Bella
>
> > I started Geodon 1 week ago, 20 mgs at bedtime for obsessive thoughts. After 2 days on Geodon, I got so racy, couldn't sleep my usual amount, and I was talking a blue streak. I did not shut up until yesterday, when my mood finally crashed. I felt very depressed and shaky after a day of feeling very pressure, elated and excited.
> >
> > So, I took the Geodon earlier than usual and began to feel a bit better in the evening. My pdoc said to discontinue the Celexa, because Geodon has some seratonin in it. I stopped that today, and I was much more relaxed and less pressured.
> >
> > Has anyone else had this hypomanic type response to Geodon? Did the agitation where off? And does anyone else feel shaky and nervous before the next dose? What is the half life of this stuff? If I increase the dose I am afraid that I might get hypomanic again, or even seratonin syndrome (I am so sensitive to anything with seratonin, it's ridiculous!). I was really confused the for a day or two, dizzy, nauseated. I feel ok now, but if the med begins to runout, I start feeling "funny" and shaky again.
> >
> > Can anyone help me figure out what is going on? Just now, a whole week, the med seems to be kicking for the obsessive thinking. I have never known an antipsychotic that needs to "build up" before it works. Mellaril used to work in 15 minutes for me, years ago.
> >
> > Any info so appreciated
> > Chloe
Posted by PattyG on November 30, 2001, at 18:54:11
In reply to Re: Help! GEODON, hypomania?, posted by Chocoholic on November 25, 2001, at 1:00:49
//Okay - I give..........what's the other name for Geodon?! I know I know it, but I must be having a senior moment.
Thanks,
PG
Posted by Chocoholic on November 30, 2001, at 20:28:25
In reply to Re: Help! GEODON, hypomania?, posted by PattyG on November 30, 2001, at 18:54:11
>Ziprasidone is the generic name!
Chocoholic
//Okay - I give..........what's the other name for Geodon?! I know I know it, but I must be having a senior moment.
> Thanks,
> PG
Posted by PattyG on December 1, 2001, at 8:13:46
In reply to Re: Help! GEODON, hypomania?, posted by Chocoholic on November 30, 2001, at 20:28:25
> >Ziprasidone is the generic name!
>
> Chocoholic//////Oh my gosh.......I was just talking about that drug with someone the other day!!! Talk about a "senior moment!" Thanks for the info:)
PG
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.