![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Mr. Scott on February 4, 2002, at 21:32:13
Hello fellow babblers-
I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
1)chemical sensitivities
2)sub affective bipolar disorder
3)poor response, non response, or worsening response to ADSSo I'm taking a new approach to this whole mess.
Lithium CR 450mg
Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
Xanax or Klonopin or Tranxene(whichever whenever)
Wellbutrin SR (start low)
Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)Anyone have any comments or suggestions?
Scott
Posted by OldSchool on February 4, 2002, at 21:51:33
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:13
> Hello fellow babblers-
> I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive.This DEFINITELY sounds like bipolar disorder. I am unipolar depressed and have never gotten a response from antidepressants as you describe. Antidepressants make me happier, more relaxed, less angry, more focused, calmer, etc. It sounds like they do the opposite to you and that is a classic bipolar sign...antidepressants making your more irritable, angry, agitated, etc.
However the good news from your description is that it sounds like ADs dont make you fully manic. Some people become fully manic on antidepressants.
>I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
>
> He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
>
> 1)chemical sensitivities
> 2)sub affective bipolar disorder
> 3)poor response, non response, or worsening response to ADS
>
> So I'm taking a new approach to this whole mess.
>
> Lithium CR 450mg
> Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> Xanax or Klonopin or Tranxene(whichever whenever)
> Wellbutrin SR (start low)
> Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
>Probably is about right. Your description of your reactions to antidepressants alone sounds like bipolar to me. A mood stabiliser is probably in order for you. I hope you do OK.
take care,
Old School
> Anyone have any comments or suggestions?
> Scott
Posted by JohnX2 on February 4, 2002, at 23:03:52
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:13
Hi Scott,
That looks like a good strategy.
I'm not sure if you would want to start
into too many meds at once. But I like
the selection of meds.Personally I don't care much for mixing
Effexor with Wellbutrin and agree with
your strategy of dumping Effexor. I might
reconsider holding out on starting Wellbutrin
until you are at a healthy dose of Lamictal
and/or Lithium. You might find out that you
do just fine on Lithium and/or Lamictal alone.I would pick Klonopin over Xanax. I've never
heard of Tranxene? I might try Neurontin instead
of these as it is non habit forming. Again, you
may not require these meds if the Lamictal/Lithium/Wellbutrin
address the irritability issues. You just need
to wait and see I suppose. Another option is
Topamax. Topamax increases Gaba conductance
in a manner similar to Klonopin. When I added
it to Lamictal I only had benzo like side effects.
This was a unique experience as most people seem
to get cognitive side effects, but not me. So perhaps
I'm thinking that Lamictal interactions are keeping
the Topamax from causing cognitive downsides. I would
seriously consider a Topamax trial add on to Lamictal.Anyways, I suspect you'll hit paydirt with
your new approach.
Regards,
John
> Hello fellow babblers-
> I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
>
> He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
>
> 1)chemical sensitivities
> 2)sub affective bipolar disorder
> 3)poor response, non response, or worsening response to ADS
>
> So I'm taking a new approach to this whole mess.
>
> Lithium CR 450mg
> Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> Xanax or Klonopin or Tranxene(whichever whenever)
> Wellbutrin SR (start low)
> Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
>
> Anyone have any comments or suggestions?
> Scott
Posted by Mr. Scott on February 4, 2002, at 23:32:45
In reply to Re: Update on my broken brain and its treatment » Mr. Scott, posted by JohnX2 on February 4, 2002, at 23:03:52
> Hi Scott,
>
> That looks like a good strategy.
>
> I'm not sure if you would want to start
> into too many meds at once. But I like
> the selection of meds.
>
> Personally I don't care much for mixing
> Effexor with Wellbutrin and agree with
> your strategy of dumping Effexor. I might
> reconsider holding out on starting Wellbutrin
> until you are at a healthy dose of Lamictal
> and/or Lithium. You might find out that you
> do just fine on Lithium and/or Lamictal alone.
>
> I would pick Klonopin over Xanax. I've never
> heard of Tranxene? I might try Neurontin instead
> of these as it is non habit forming. Again, you
> may not require these meds if the Lamictal/Lithium/Wellbutrin
> address the irritability issues. You just need
> to wait and see I suppose. Another option is
> Topamax. Topamax increases Gaba conductance
> in a manner similar to Klonopin. When I added
> it to Lamictal I only had benzo like side effects.
> This was a unique experience as most people seem
> to get cognitive side effects, but not me. So perhaps
> I'm thinking that Lamictal interactions are keeping
> the Topamax from causing cognitive downsides. I would
> seriously consider a Topamax trial add on to Lamictal.
>
> Anyways, I suspect you'll hit paydirt with
> your new approach.
>
>
> Regards,
> John
>
>
>
>
> > Hello fellow babblers-
> > I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
> >
> > He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
> >
> > 1)chemical sensitivities
> > 2)sub affective bipolar disorder
> > 3)poor response, non response, or worsening response to ADS
> >
> > So I'm taking a new approach to this whole mess.
> >
> > Lithium CR 450mg
> > Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> > Xanax or Klonopin or Tranxene(whichever whenever)
> > Wellbutrin SR (start low)
> > Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
> >
> > Anyone have any comments or suggestions?
> > ScottThanks John! I see your point about not starting too many at once and also trying to avoid the Klonopin if possible. Over the past decade I've had to taper off the benzos on three seperate occassions and generally went back on about a year later in each case, because the antidepressants I didn't hold the AD response or because they boosted my agitation. It's not fun, they are definately habit forming. Nonetheless, for those times you need them nothing works as well and as fast!
So then I think Lithium + Lamictal is the way to start and if needed I'll go Neurontin before klonopin.
I worry about depression coming on fast and strong as I ditch the Effexor so I'll stand by with Wellbutrin, but ultimately I think the more AD's I can avoid the better.
I think I'll be tinkering with this for awhile. My main goal is to wait it out until I can get the Lamictal dose up to good level and see if it works.
Thanks for the advice & encouragement.
Scott
Posted by Mr. Scott on February 4, 2002, at 23:38:58
In reply to Re: Update on my broken brain and its treatment, posted by OldSchool on February 4, 2002, at 21:51:33
> > Hello fellow babblers-
> > I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive.
>
> This DEFINITELY sounds like bipolar disorder. I am unipolar depressed and have never gotten a response from antidepressants as you describe. Antidepressants make me happier, more relaxed, less angry, more focused, calmer, etc. It sounds like they do the opposite to you and that is a classic bipolar sign...antidepressants making your more irritable, angry, agitated, etc.
>
> However the good news from your description is that it sounds like ADs dont make you fully manic. Some people become fully manic on antidepressants.
>
> >I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
> >
> > He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
> >
> > 1)chemical sensitivities
> > 2)sub affective bipolar disorder
> > 3)poor response, non response, or worsening response to ADS
> >
> > So I'm taking a new approach to this whole mess.
> >
> > Lithium CR 450mg
> > Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> > Xanax or Klonopin or Tranxene(whichever whenever)
> > Wellbutrin SR (start low)
> > Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
> >
>
> Probably is about right. Your description of your reactions to antidepressants alone sounds like bipolar to me. A mood stabiliser is probably in order for you. I hope you do OK.
>
> take care,
>
> Old School
> > Anyone have any comments or suggestions?
> > ScottThanks Old School for the well wishes!
Scott
Posted by medlib on February 5, 2002, at 0:09:37
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:13
Hi Scott--
Just a few comments on your combo:
--Effexor at low levels affects only seratonin, so it probably should be d/ced (discontinued) as soon as practicable (given your reaction to SSRIs). Many people have difficulty ditching that last (37.5) dose. If you do, ask your pdoc for a few lowest-dose Prozacs. P's extremely long half-life eases withdrawal effects of the shorter-acting E.
--Many pdocs don't prescribe Xanax (except for emergencies) because it's much shorter-acting than Tranxene or Klonopin. Short-acting rxs lead more quickly to tolerance (requiring increasing dose to achieve same effect). They're also more difficult to withdraw from.
--Some bipolars find that Wellbutrin triggers mania or hypomania. If your pdoc is anywhere near as difficult to contact as mine, it would be useful to have a "quick response" protocol in place before you begin the Wellbutrin. Check with your pdoc re specifics.
--Manufacturer recommends that initial dose of Lamictal be taken for 2 weeks before first increase.I hope that this combo works for you; it *sounds* good, anyway. I presume that you'll remember to add (and ramp up) only 1 rx at a time, so effects and side effects will be clear. If you're still depressed on this combo, there are neuroleptics (Geodon, Zyprexa) waiting in the wings (presuming you haven't tried them already).
Well wishes---medlib
> Lithium CR 450mg
> Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> Xanax or Klonopin or Tranxene(whichever whenever)
> Wellbutrin SR (start low)
> Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
Posted by Ritch on February 5, 2002, at 0:21:50
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:13
>
> He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
>
> 1)chemical sensitivities
> 2)sub affective bipolar disorder
> 3)poor response, non response, or worsening response to ADS
>
> So I'm taking a new approach to this whole mess.
>
> Lithium CR 450mg
> Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> Xanax or Klonopin or Tranxene(whichever whenever)
> Wellbutrin SR (start low)
> Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
>
> Anyone have any comments or suggestions?
> ScottSounds like a good plan==thumbs up!!
Asolutely, get rid of Effexor if you are BP if possible (I might be in jail now if I had continued that one).Mitch
Posted by TSA West on February 5, 2002, at 0:52:52
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:28
Dear Scott, you are not doomed, and here's why:
You can try all kinds of things that are not antidepressants, like:
Buspirone - as effective as an SSRI at 60-90 mg.
All the anticonvulsants - including Topiramate and tiagabine.
Pindolol - not just an augmenting agent.
Selegiline - 60 mg of selegiline (an MAOI-B) is the equivalent of 30 mg of phenelzine according to one of Dr. Bob's colleagues on the Tips.
Pramipexole, Bromocriptine, Ropinirole - dopamine agonists which have been tried in depression and bipolar disorder in the 1980s.
And much more, which I can tell you about. For everyone who insists they have tried them all, there is 5 viable options. That is the great part about psychopharmacology.
Keeping your best interests in mind,
TSA West-------------------------- :)
Posted by Anna Laura on February 5, 2002, at 6:13:59
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:13
> Hello fellow babblers-
> I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
>
> I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
>
> 1)chemical sensitivities
> 2)sub affective bipolar disorder
> 3)poor response, non response, or worsening response to ADS
>
> So I'm taking a new approach to this whole mess.
>
> Lithium CR 450mg
> Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> Xanax or Klonopin or Tranxene(whichever whenever)
> Wellbutrin SR (start low)
> Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
>
> Anyone have any comments or suggestions?
> ScottHi Scott
Unfortunately i don't have much suggestions to offer, just sharing my experience.
ADs have the same effect on me too: i'm wondering if i'm some kind of bipolar also.
Effexor starts working after months: i become aggressive and sometimes even furious on it, somehow overconfident.
It's not so unplesant though, since when i'm off ADs i get apathetic, insecure and i turn in to a punching bag, to all the frustratred people delight."He said it sounds like I have bipolar III, whatever the hell that really means ...."
Bipolar III means hyperthymic temperament: i was hyperthymic before i got depressed. Unfortunately AD don't seem to revert me to my previous, pleasant condition.
Wishing you good luck with the mood stabilizers!
Anna Laura
Hyperthymic Temperament:
These attributes are not episode-bound and constitute part of the habitual long-term functioning of the individual:
* Cheerful and exuberant
* Articulate and jocular
* Overoptimistic and carefree
* Overconfident, boastful, ang grandiose
* Extroverted and people seeking
* High energy level, full of plans and improvident activities
* Versatile with broad interests
* Overinvolved and meddlesome
* Uninhibited and stimulus seeking
* Habitual short sleep (less than 6 hours/night)
Posted by spike4848 on February 5, 2002, at 17:42:18
In reply to Re: Update on my broken brain and its treatment, posted by Anna Laura on February 5, 2002, at 6:13:59
>Bipolar III means hyperthymic temperament: i was hyperthymic before i got depressed.
I though bipolar III was a hypomanic response to antidepressents with no previous history of mania/hypomania off meds? And I still think pdocs are debating whether or not a hypomanic response to antidepressant is an indication the individual is bipolar ....
Spike
Posted by Mr. Scott on February 5, 2002, at 18:58:53
In reply to Re: Update on my broken brain and its treatment » Mr. Scott, posted by TSA West on February 5, 2002, at 0:52:52
> Dear Scott, you are not doomed, and here's why:
>
> You can try all kinds of things that are not antidepressants, like:
>
> Buspirone - as effective as an SSRI at 60-90 mg.
>
> All the anticonvulsants - including Topiramate and tiagabine.
>
> Pindolol - not just an augmenting agent.
>
> Selegiline - 60 mg of selegiline (an MAOI-B) is the equivalent of 30 mg of phenelzine according to one of Dr. Bob's colleagues on the Tips.
>
> Pramipexole, Bromocriptine, Ropinirole - dopamine agonists which have been tried in depression and bipolar disorder in the 1980s.
>
> And much more, which I can tell you about. For everyone who insists they have tried them all, there is 5 viable options. That is the great part about psychopharmacology.
>
> Keeping your best interests in mind,
> TSA West-------------------------- :)
Thanks TSA! Your optimism is contagious!
Scott
Posted by Mr. Scott on February 5, 2002, at 19:01:28
In reply to Re: Update on my broken brain and its treatment, posted by Anna Laura on February 5, 2002, at 6:13:59
> > Hello fellow babblers-
> > I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
> >
> > I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
> >
> > 1)chemical sensitivities
> > 2)sub affective bipolar disorder
> > 3)poor response, non response, or worsening response to ADS
> >
> > So I'm taking a new approach to this whole mess.
> >
> > Lithium CR 450mg
> > Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> > Xanax or Klonopin or Tranxene(whichever whenever)
> > Wellbutrin SR (start low)
> > Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
> >
> > Anyone have any comments or suggestions?
> > Scott
>
> Hi Scott
>
> Unfortunately i don't have much suggestions to offer, just sharing my experience.
> ADs have the same effect on me too: i'm wondering if i'm some kind of bipolar also.
> Effexor starts working after months: i become aggressive and sometimes even furious on it, somehow overconfident.
> It's not so unplesant though, since when i'm off ADs i get apathetic, insecure and i turn in to a punching bag, to all the frustratred people delight.
>
> "He said it sounds like I have bipolar III, whatever the hell that really means ...."
>
> Bipolar III means hyperthymic temperament: i was hyperthymic before i got depressed. Unfortunately AD don't seem to revert me to my previous, pleasant condition.
>
> Wishing you good luck with the mood stabilizers!
>
> Anna Laura
>
> Hyperthymic Temperament:
>
> These attributes are not episode-bound and constitute part of the habitual long-term functioning of the individual:
>
> * Cheerful and exuberant
> * Articulate and jocular
> * Overoptimistic and carefree
> * Overconfident, boastful, ang grandiose
> * Extroverted and people seeking
> * High energy level, full of plans and improvident activities
> * Versatile with broad interests
> * Overinvolved and meddlesome
> * Uninhibited and stimulus seeking
> * Habitual short sleep (less than 6 hours/night)AL-
This how I was as a kid! Until 16 then I went south and have been on AD's since age 17. 10 years!
Thanks for the info!
Scott
Posted by Mr. Scott on February 5, 2002, at 19:25:15
In reply to Re: Broken brain rxs » Mr. Scott, posted by medlib on February 5, 2002, at 0:09:37
> Hi Scott--
>
> Just a few comments on your combo:
>
> --Effexor at low levels affects only seratonin, so it probably should be d/ced (discontinued) as soon as practicable (given your reaction to SSRIs). Many people have difficulty ditching that last (37.5) dose. If you do, ask your pdoc for a few lowest-dose Prozacs. P's extremely long half-life eases withdrawal effects of the shorter-acting E.
> --Many pdocs don't prescribe Xanax (except for emergencies) because it's much shorter-acting than Tranxene or Klonopin. Short-acting rxs lead more quickly to tolerance (requiring increasing dose to achieve same effect). They're also more difficult to withdraw from.
> --Some bipolars find that Wellbutrin triggers mania or hypomania. If your pdoc is anywhere near as difficult to contact as mine, it would be useful to have a "quick response" protocol in place before you begin the Wellbutrin. Check with your pdoc re specifics.
> --Manufacturer recommends that initial dose of Lamictal be taken for 2 weeks before first increase.
>
> I hope that this combo works for you; it *sounds* good, anyway. I presume that you'll remember to add (and ramp up) only 1 rx at a time, so effects and side effects will be clear. If you're still depressed on this combo, there are neuroleptics (Geodon, Zyprexa) waiting in the wings (presuming you haven't tried them already).
>
> Well wishes---medlib
>
> > Lithium CR 450mg
> > Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> > Xanax or Klonopin or Tranxene(whichever whenever)
> > Wellbutrin SR (start low)
> > Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
Thanks Medlib for your suggestions and advice!Scott
Posted by Anna Laura on February 5, 2002, at 20:53:27
In reply to Bipolar III? » Anna Laura, posted by spike4848 on February 5, 2002, at 17:42:18
> >Bipolar III means hyperthymic temperament: i was hyperthymic before i got depressed.
>
> I though bipolar III was a hypomanic response to antidepressents with no previous history of mania/hypomania off meds? And I still think pdocs are debating whether or not a hypomanic response to antidepressant is an indication the individual is bipolar ....
>
> SpikeI think the bipolar subcategory you're talking about is bipolar V.
Dr. Ivan Depression Central's site identifies bipolar III with hyperthymic temperament:http://www.wpic.pitt.edu/stanley/2ndbipconf/ppt/W404_13/sld002.htm
Anyway, i guess this is a controversial matter some pdocs not relying on the so called soft bipolar spectrum for diagnose.
Posted by Mags on February 5, 2002, at 20:55:31
In reply to Update on my broken brain and its treatment, posted by Mr. Scott on February 4, 2002, at 21:32:13
>hi Scott,
Your history sounds very similar to mine and my doc is debating if I am BPII or III. I am currently on
Lamictal 50MG to be ramped to 200 MG.
150 MG Wellbutrin and will ramp to 300 mg in two weeks.
Ativan when needed. Will let you know how it goes. One thing to watch for is not to increase lamictal too fast(due to bad rash, doc will tell you about it.. I was OK until I increased from 50mg to 75 mg. Got terrible flu like syptoms (aches and pains, sore ears and throat) he thinks it is like an allergic reaction and if we back off and go slower it should be fine. When I tried Effexor I only got to 75 MG. At 100 mg I couldn't stand the headaches.
Good luck with your new regimen. I hope it works for you. pls let us all know.
Take Care
Mags> > Hello fellow babblers-
> > I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
> >
> > I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
> >
> > 1)chemical sensitivities
> > 2)sub affective bipolar disorder
> > 3)poor response, non response, or worsening response to ADS
> >
> > So I'm taking a new approach to this whole mess.
> >
> > Lithium CR 450mg
> > Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> > Xanax or Klonopin or Tranxene(whichever whenever)
> > Wellbutrin SR (start low)
> > Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
> >
> > Anyone have any comments or suggestions?
> > Scott
>
> Hello fellow babblers-
> I told my doc that antidepressants generally make we worse, by leaving me still depressed only activated and hence more angry, impulsive, irritable and more negative than ever. Like I become a ranting and raving depresssive instead of a quiet depressive. I also generally only get a few weeks or months at best out of any of them before I'm left with the above condition, and a bunch of side effects. Also the SSRI/Effexors of the world quickly pinch off my frontal lobes and make me dumb, numb and fatigued as hell. I also generally have a hard time tolerating pills.
>
> He said it sounds like I have bipolar III, whatever the hell that really means I don't know. In any event I think it's safe now to assume that I have some level of bipolarity that makes me unresponsive to SSRI's alone.
>
> 1)chemical sensitivities
> 2)sub affective bipolar disorder
> 3)poor response, non response, or worsening response to ADS
>
> So I'm taking a new approach to this whole mess.
>
> Lithium CR 450mg
> Lamictal 12.5mg (raise 12.5mg every 1-2 weeks)
> Xanax or Klonopin or Tranxene(whichever whenever)
> Wellbutrin SR (start low)
> Effexor XR 37.5mg (stop trying to tolerate 75mg and eventually ditch unless helpful)
>
> Anyone have any comments or suggestions?
> Scott
Posted by bob on February 5, 2002, at 22:53:18
In reply to Re: Update on my broken brain and its treatment » Mr. Scott, posted by TSA West on February 5, 2002, at 0:52:52
> Pindolol - not just an augmenting agent.
What symptoms would pindolol be good for in monotherapy?
Posted by Ritch on February 5, 2002, at 23:34:16
In reply to Bipolar III? » Anna Laura, posted by spike4848 on February 5, 2002, at 17:42:18
> >Bipolar III means hyperthymic temperament: i was hyperthymic before i got depressed.
>
> I though bipolar III was a hypomanic response to antidepressents with no previous history of mania/hypomania off meds? And I still think pdocs are debating whether or not a hypomanic response to antidepressant is an indication the individual is bipolar ....
>
> Spike
Hi Spike, et al,I think the APA is seriously considering the BP-III subcategory. It doesn't surprise me considering the ever increasing number of new and more potent antidepressants becoming available and the increased exposure of the general population to antidepressant medications. There are so many agents around that have the capability of triggering hypomania and mania-I personally think that it *might* be incorrect to assume that the meds are "uncovering" a "latent bipolar disorder". Perhaps if you give a normal person (no psycho-pathology) some of these new meds you will start seeing some manic and hypomanic responses as a side-effect....well that does complicate things now doesn't it??
Mitch
Posted by Mr. Scott on February 6, 2002, at 3:37:57
In reply to Re: Bipolar III? » spike4848, posted by Ritch on February 5, 2002, at 23:34:16
> > >Bipolar III means hyperthymic temperament: i was hyperthymic before i got depressed.
> >
> > I though bipolar III was a hypomanic response to antidepressents with no previous history of mania/hypomania off meds? And I still think pdocs are debating whether or not a hypomanic response to antidepressant is an indication the individual is bipolar ....
> >
> > Spike
>
>
> Hi Spike, et al,
>
> I think the APA is seriously considering the BP-III subcategory. It doesn't surprise me considering the ever increasing number of new and more potent antidepressants becoming available and the increased exposure of the general population to antidepressant medications. There are so many agents around that have the capability of triggering hypomania and mania-I personally think that it *might* be incorrect to assume that the meds are "uncovering" a "latent bipolar disorder". Perhaps if you give a normal person (no psycho-pathology) some of these new meds you will start seeing some manic and hypomanic responses as a side-effect....well that does complicate things now doesn't it??
>
> MitchMitch this is very true and a solid point. If you give people enough stimulants they will run an increasing risk of becoming psychotic. Does that mean they are uncovering schizophrenia? I don't think so.
Scott
Posted by Dinah on February 6, 2002, at 7:58:21
In reply to Re: Bipolar III? » spike4848, posted by Ritch on February 5, 2002, at 23:34:16
> Hi Spike, et al,
>
> I think the APA is seriously considering the BP-III subcategory. It doesn't surprise me considering the ever increasing number of new and more potent antidepressants becoming available and the increased exposure of the general population to antidepressant medications. There are so many agents around that have the capability of triggering hypomania and mania-I personally think that it *might* be incorrect to assume that the meds are "uncovering" a "latent bipolar disorder". Perhaps if you give a normal person (no psycho-pathology) some of these new meds you will start seeing some manic and hypomanic responses as a side-effect....well that does complicate things now doesn't it??
>
> MitchI think the problem is when AD induced hypomania and mood cycling doesn't go away after the AD is discontinued. I probably had some mood cycling before I started AD's but it was minor. I had my first clearly hypomanic episode on AD's and although I've been off them for over a year and only on Depakote and Klonopin, the mood cycles continue. Either the AD's uncovered an underlying bipolar tendency or they changed the wiring in my brain so that whatever I was before, now I'm permanently on the bipolar spectrum.
So is Bipolar III considered a hypomania while on medications (which sounds more like a side effect than a disorder), or a mood cycling problem caused by medications?
Posted by Ritch on February 6, 2002, at 10:15:44
In reply to Re: Bipolar III?, posted by Dinah on February 6, 2002, at 7:58:21
> > Hi Spike, et al,
> >
> > I think the APA is seriously considering the BP-III subcategory. It doesn't surprise me considering the ever increasing number of new and more potent antidepressants becoming available and the increased exposure of the general population to antidepressant medications. There are so many agents around that have the capability of triggering hypomania and mania-I personally think that it *might* be incorrect to assume that the meds are "uncovering" a "latent bipolar disorder". Perhaps if you give a normal person (no psycho-pathology) some of these new meds you will start seeing some manic and hypomanic responses as a side-effect....well that does complicate things now doesn't it??
> >
> > Mitch
>
> I think the problem is when AD induced hypomania and mood cycling doesn't go away after the AD is discontinued. I probably had some mood cycling before I started AD's but it was minor. I had my first clearly hypomanic episode on AD's and although I've been off them for over a year and only on Depakote and Klonopin, the mood cycles continue. Either the AD's uncovered an underlying bipolar tendency or they changed the wiring in my brain so that whatever I was before, now I'm permanently on the bipolar spectrum.
> So is Bipolar III considered a hypomania while on medications (which sounds more like a side effect than a disorder), or a mood cycling problem caused by medications?
Dinah,From what I understand, the current DSM excludes a diagnosis of BP-II if hypomania is caused by substance abuse, hyperthyroidism (i.e.), or other medications (antidepressants, i.e.). By creating a "BP-III" category that *does* include medication-induced hypomania, allows the dx of bipolar that otherwise technically wouldn't be allowed. This is (IMO) because many pdocs believe that *any* hypomanic presentation (regardless of cause) is symptomatic of an underlying bipolar disorder. I don't have a solid opinion on the matter-I truly wonder if that would be accurate or not. As for your last question about an acute hypomanic presentation (med-induced) versus a chronic cycling syndrome (while taking inducing meds), that's a tough one. If you are prescribed an antidepressant, then obviously you are suffering from depression (the most common use for AD's other than anxiety disorders, ADHD, etc.). Then you experience a hypomanic *episode* while on the antidepressant. Well, there is a *cycle* of sorts there. I suppose it would depend on whether it took on a predictable cyclic duration (10-day cycles, i.e.). If it was a "random" episode of hypomania while on the AD, then maybe a bipolar dx would not be appropriate.
Mitch
Posted by Blue Cheer 1 on February 6, 2002, at 21:17:45
In reply to Re: Update on my broken brain and its treatment » Mr. Scott, posted by TSA West on February 5, 2002, at 0:52:52
> Dear Scott, you are not doomed, and here's why:
>
> You can try all kinds of things that are not antidepressants, like:
>
> Buspirone - as effective as an SSRI at 60-90 mg.
>
> All the anticonvulsants - including Topiramate and tiagabine.
>
> Pindolol - not just an augmenting agent.
>
> Selegiline - 60 mg of selegiline (an MAOI-B) is the equivalent of 30 mg of phenelzine according to one of Dr. Bob's colleagues on the Tips.
>
> Pramipexole, Bromocriptine, Ropinirole - dopamine agonists which have been tried in depression and bipolar disorder in the 1980s.
>
> And much more, which I can tell you about. For everyone who insists they have tried them all, there is 5 viable options. That is the great part about psychopharmacology.
>
> Keeping your best interests in mind,
> TSA West-------------------------- :)
These are some good recommendations, but what I see missing is a systematic treatment plan that targets specific symptoms or sets of symptoms. Also, adding one drug at a time is basic psychopharmacology. Third, the lack of response and the side effects Mr. Scott experienced on ADs aren't, by themselves, diagnostic of a bipolar disorder. I really don't understand the rationale for starting all of those drugs together.
Blue
This is the end of the thread.
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