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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Maya on September 16, 2001, at 16:27:47
Hi, I am just about 25 and I was just dx with Bi-polar. I was prescribed neurontin, klono and celexa. I know I am risking some hypomanic backlash from the celexa, but I hope not. My question really concerns the nuerontin and klono.
Neurontin is a MS, right? How long does it take to work? And do you think I should slowly build up the mg dosage? I am pretty desparate right now because I just strted my training to be an art therapist...and I need to get my shit together. Right now I take 100mg at night of Neurontin, but I could go up to 300.
Also, is Klonopin more effective if you take it regularily, like evryday to avoid serious anxiety? Right now, I am using it just on my scariest days,,, but it is only .5 mg, and it isn't totally working...also I am nervous about taking more; the side-efects and the addiction.
Thank for any advice to come,
Maya
Posted by Mitch on September 16, 2001, at 18:16:31
In reply to Questions: neurontin, klono ,celexa and BiPol NOS, posted by Maya on September 16, 2001, at 16:27:47
> Neurontin is a MS, right? How long does it take to work? And do you think I should slowly build up the mg dosage? I am pretty desparate right now because I just strted my training to be an art therapist...and I need to get my shit together. Right now I take 100mg at night of Neurontin, but I could go up to 300.
>Hi, I have been on all of your meds. I guess Bipolar NOS is the same as "atypical bipolar" which is a fairly recent diagnosis of mine. Neurontin is pretty tolerable-I take 100mg 3x daily with Klonopin .25-.5mg/day.
> Also, is Klonopin more effective if you take it regularily, like evryday to avoid serious anxiety? Right now, I am using it just on my scariest days,,, but it is only .5 mg, and it isn't totally working...also I am nervous about taking more; the side-efects and the addiction.
>
> Thank for any advice to come,
> MayaI find the Klonopin works best if you take a low "base" dose every day (say .25mg) and then push it up when you need it more. As far as addiction goes I think it is overblown-I have never taken it in an attempt to get high on it. In fact, I have never experienced any euphoria or "drunk" feelings on it like Valium can provoke (I never abused Valium either though). Probably with some more time on the Celexa and Neurontin (maybe at a little higher dose) you will probably find yourself needing the Klonopin less.
Posted by Cam W. on September 17, 2001, at 6:55:07
In reply to Re: Questions: neurontin, klono ,celexa and BiPol NOS » Maya, posted by Mitch on September 16, 2001, at 18:16:31
Maya - They are not sure of the mechanism of action of Neurontin™ (gabapentin). It is similar in structure to the inhibitory neurotransmitter GABA, but is not an agonist at the GABA-receptor complex (ie. it does not bind to the receptor where GABA does). Stated simply, it probably works by slowing hyperactive neurons containing serotonin, norepinephrine, dopamine, etc. It sorta attenuates, or cuts off, the manic high (ie. stops the high from getting too high).
The dosage of Neurontin must be raised slowly to allow the neurons to adjust to it, and to minimize the profound sedation the drug can cause. The therapeutic dose is highly individualized; anywhere from 100mg/day to 4800mg/day, with most people taking between 300mg/day and 900mg/day.
As for the Klonopin™ (clonazepam), Mitch is right. A low daily maintenance dose is usually the way to go (eg. 0.25mg/day, or a little more, if needed - best to discuss the right dose for you with your doc), and increase the dose for breakthrough anxiety. Also, like Mitch said, most people with bipolar disorder do not abuse Klonopin. The addiction potential is low if you are not using it to try to get high or to escape. The tolerance usually only happens to the psychomotor (impaired movement) effects of the drug, and not the anti-anxiety effects.
Good luck with the art therapy. - Cam
Posted by dove on September 17, 2001, at 16:11:00
In reply to Re: Questions: neurontin, klono ,celexa and BiPol NOS » Mitch, posted by Cam W. on September 17, 2001, at 6:55:07
I take anywhere from 1,200 mgs of Neurontin to 2,400 mgs, depending on if I'm feeling stable or emotionally wobbly. I space out my dosage to about every 3-4 hours for maximum benefits. One facet of Neurontin that needs to be addressed is it's short half-life, and the maximum mgs per dosage that your body can process. I have heard others state that taking their full daily dosage before bed seems to do a fine job. However, that is definitely not the case for me. I have to spread-out it out and keep the max dosage amount below 600 mgs for good results. Everyone seems to have their own personal method that works though :o)
I also take klonopin, 3 mgs per day (1 mg x3), but I started at 0.5 mg x3 per day. It seems to work better when taken regularly. However, when I was taking the 0.5 mg and I had to go into a very "negative" situation I was allowed to move the dosage up to 1 mg or 1.5 mgs. And it did help a lot in those situations. Also, I find klonopin a bit of a depressant, so be aware of increasing depressive symptoms as you begin to use klonopin regularly.
I also take the anti-depressants Serzone, Prozac, Amitriptyline, which have not seemed to induce any manic symptoms in at least 3 years. In addition, I take Adderall for "ADHD". My p-doc's are still working on a definitive dx for me. So far, ADHD (since childhood), Major Depression, SAD, GAD, Bipolar I (now they believe it's not BP I but a sort of atypical?), Atypical Depression, Panic Disorder, Social Phobia, and on it goes.
Anyway, take it slow, and if you find good results early on, move forward with less trepidation. Godd luck and keep us updated if you like.
dove
Posted by Maya on September 17, 2001, at 18:19:15
In reply to Re: Questions: neurontin, klono ,celexa and BiPol NOS, posted by dove on September 17, 2001, at 16:11:00
Thank you for the info all.
This is a shitty time for me, and I need to at least have hope that meds will work...and I am very glad to hear that it is not totally useless to START taking the neurontin at night, and at such a low dosage.
Thanks again,
Maya
I'll keep reading and writing to psycho-babble
Posted by Mitch on September 18, 2001, at 0:02:29
In reply to Re: Questions: neurontin, klono ,celexa and BiPol NOS » Mitch, posted by Cam W. on September 17, 2001, at 6:55:07
> Maya - They are not sure of the mechanism of action of Neurontin™ (gabapentin). It is similar in structure to the inhibitory neurotransmitter GABA, but is not an agonist at the GABA-receptor complex (ie. it does not bind to the receptor where GABA does). Stated simply, it probably works by slowing hyperactive neurons containing serotonin, norepinephrine, dopamine, etc. It sorta attenuates, or cuts off, the manic high (ie. stops the high from getting too high).
>
Hi Cam,I read here a week or two ago about the discovery of gabapentin's most likely mechanism of action: voltage dependent calcium channels. Evidently they have discovered a specific selective binding site in the hippocampus (I believe)that directly affects calcium (influx?) into neural cells in these specific sites. It is supposed to be a very selctive calcium channel activity unlike calcium channel blockers (CCB's) that have a "shotgun" like effect. It took me a bit by surprise. Could someone re-enlighten us to that link??
Mitch
Posted by Cam W. on September 18, 2001, at 6:50:24
In reply to Re: Questions: neurontin, klono ,celexa and BiPol NOS » Cam W., posted by Mitch on September 18, 2001, at 0:02:29
Mitch - That makes sense. Calcium ion influx into a neuron would hyperpolarize the nerve cell and make it less likely to fire, thus stabilizing the cell. The GABA receptor complex is a calcium ion channel, but it does not appear that Neurontin opens this one. Neurontin must open a different calcium ion channel. This theory has been kicking around for while; they must have found the channel. - Cam
Posted by fluffykitty on September 19, 2001, at 11:48:16
In reply to Questions: neurontin, klono ,celexa and BiPol NOS, posted by Maya on September 16, 2001, at 16:27:47
> Neurontin is a MS, right? How long does it
Check out the Neurontin FAQ here:
http://web.tampabay.rr.com/lymecfs/
Im up to 1800 a day. Started at 300. Had good effect right away!
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