![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 594 to 618 of 948. Go back in thread:
Posted by katia on September 11, 2003, at 13:49:10
In reply to Re: Official Side-effects, posted by fluffy on September 11, 2003, at 11:42:13
Katy and the rest,
What dose did you start at on Lamictal? I'm starting at 5mg tomorrow. Hopefully that won't cause distruptions in my sleep. I'm feeling better, but a little foggy headed sometimes on the Dep. and I always crash in the late afternoon. I've taken to just laying down for an hour and it's helped. But then my energy is up and running again. I agree with the Mediterranean way of living - siesta and late dinners! Glad to hear you're better. What sort of class do you teach?Patricia,
It's been my experience that ADs make me worse. Like Katy said, try the WB and if it doesn't work, "bag it".
I too can give up some of the addictions when I'm feeling centered and well.
Katia
Posted by fluffy on September 11, 2003, at 15:15:05
In reply to Re: Official Side-effects, posted by katia on September 11, 2003, at 13:49:10
Hey Katia--
I didn't know they made Lamictal tabs in 5mg. I started at 25mg. Some people start SUPER SLOW (at 12.5 mg going up in 25mg incriments) until they reach the "therapeutic" dose. These days, most clinicians agree that 200mg is the target dose. Everyone is different, though.
I teach art appreciation. Seems like it would be easy--but it takes a TON of research!
take care,
Katy
Posted by fluffy on September 11, 2003, at 17:49:04
In reply to Re: Official Side-effects » SUMMER2002, posted by femlite on September 11, 2003, at 7:34:42
Posted by BarbaraCat on September 11, 2003, at 18:53:01
In reply to Where's B-cat? (nm), posted by fluffy on September 11, 2003, at 17:49:04
Thanks for asking. Been a little preoccupied lately. I don't know why. I spin wheels alot and don't get much done when I'm neither depressed nor manic yet not quite alright either. The house is slowly cluttering up again, a sure sign that I'm losing my focus. Husband just got a double hernia operation so that should keep me busy being nurse for awhile.
Glad everyone is relatively OK. I empathise with you Katia about how thick headed pdocs can be. You just wish they'd take into account your whole being instead of as a lab experiment. I guess the insurance companies have hobbled alot of well intentioned doctors. Katia, do you qualify for any kind of state aid? Working 2 days a week, you can't be making much over the Federal poverty limit. You might be able to go on SSI or get some kind of state aid or insurance, or at least food stamps. It's worth looking in to. It's so damn hard to heal when the stress of financial worries are looming over you. I know you've said how most of these symptoms came on after starting Dep, but honey, they sure sound physical to me.
Why isn't someone paying more attention to you? All this stuff with your pdoc, the poems, paying, etc. aren't biggies in themselves, but taken together with the way you're feeling, you're not being listened to. You don't have a significant other to give you feedback or help out with anything when you're at the end of your rope. You need to get more, much more, from your care providers. You're paying this pdoc? He's falling down on the job, I'm afraid, and you can damn well tell him I said so. I've been to many and it's the dear souls who really care who notice 'hmmm, maybe this person needs a little more than I'm providing'. Money is always the issue. If you have questions about your dx and how he arrived at his speculations, you should ask. Have you had any mood assessment tests done? Has he ever mentioned the dreaded 'B' dx? No, not BP but BPD? No one wants to look at borderline disorder, but it's real, it's a fact and it's treated differently than BP.
You deserve to be talked to plainly and clearly about what's ailing you. You seem to be a strong-willed, very smart and creative person, but pardon me, a bit of a wimp when it comes to biting this guy on his nuts and not letting go until he jumps to your care. GRRRRR!! Now I'm getting mad, so hang on.
I don't know, Katia, maybe you write here when you're feeling really awful and the rest of the time you're maintaining OK. But if all the time you're riding the rollercoaster, it's just not good for you. It's causing way too much stress. The bottom line of this rant is this: you should (yes, I'm using the should word) you should tell your pdoc that you need much more help and much more quickly and that you need his help to get it. You need to go to some kind of Human Services office and find out about whatever kind of aid they can give you, medication assistance, medical, whatever. Keep on pushing for this. Call United Way, tell them what you're going through and ask them if they can suggest anything.
I'm pissed and you bloody well should be too. I'm also projecting because I've felt like I was totally losing it at times and felt like nobody responded as quickly as I needed, but I have insurance and have the luxury of knowing I can always check myself in somewhere. You don't and so I hope you can make it your mission to find out where you can get some assistance to get the help you deserve.
Maybe you're pretending nice for your pdoc? Maybe you don't let him know how this mad cycling is making you feel horrible because he won't like you? STOP IT!! This is not a personality contest! You're paying him to get better! If you need to talk to him about life issues that you feel are very relevant to your issues today then INSIST he listen to you, and if he doesn't, ask him WHY NOT??? These guys are not Gods, even though they get paid like they were. Jump up and down and tell him YOU FEEL LIKE SHIT AND YOU AIN'T GONNA TAKE IT NO MORE!!!!! Love, B-Cat
Posted by katia on September 11, 2003, at 19:21:05
In reply to I is here, posted by BarbaraCat on September 11, 2003, at 18:53:01
Hi Barb,
Thanks for rooting for me.
But it does sound like you've got the exaggerated take on what I really feel and am experiencing. He actually is doing his job and he does call me back when I call him with concerns or questions.2. Will you be my caregiver???? will you make all those calls and followup calls and follow, follow-up calls for me trying to get help?
I've actually been down that route somewhat and it's so frustrating, which is why I finally chose to go into debt to see this private doc and to live stress(ish) free for awhile. All the stress that goes into getting what little aid there is out there is almost not worth it. I wouldn't even know where to begin. I am being covered with dental and medical (the medical part is a joke however), but have recently qualified to receive low to no cost meds. But that was after way too many phone calls following up with doctors, case workers, pharmacies, etc. etc. I finally just ordered from Canada. If it were easy to 1. find the aid, I would 2. wouldn't take so much out of me to just get poor quality care and service (i.e. last year with all my rounds with psychiatrists at two clinics and rounds with ADs - no thanks).
It's sometimes more difficult than it is worth it. If you know where I could begin to start, let me know (in regards to financial aid). It's also a bit degrading, they normally treat you like shit (in regards to the medical care part I've encountered)
The health care in this country is not good. And what little aid there is is poor quality and you have to wait for eons. You have to make nothing in order to qualify for anything, (like $500) per month. In California that's a joke. So even tho' I make more than $500 a month, and still live going further into debt each month, I don't think I can qualify. The system doesn't work with you to help yourself basically.So I've acutally been fine the past two days. quite good actually and sleeping fine. Thanks for your concern Barbara, but I think you have a slightly off perception of how dire my mood state is.
BTW, I know what you mean about not being productive in limbo land.
Katia
Posted by Dr. Bob on September 11, 2003, at 19:58:02
In reply to I is here, posted by BarbaraCat on September 11, 2003, at 18:53:01
> Jump up and down and tell him YOU FEEL LIKE SH*T AND YOU AIN'T GONNA TAKE IT NO MORE!!!!!
It's great to support fluffy, but please don't use language that could offend others, thanks.
Bob
Posted by BarbaraCat on September 11, 2003, at 21:52:39
In reply to Re: please be civil » BarbaraCat, posted by Dr. Bob on September 11, 2003, at 19:58:02
Thanks, Dr. B. Actually, that was Katia, but I appreciate the sentiment. Offensiveness doesn't help anyone but, but, but, sometimes this whole system gets me really feeling bad and oooohhgg, mad!!!
> > Jump up and down and tell him YOU FEEL LIKE SH*T AND YOU AIN'T GONNA TAKE IT NO MORE!!!!!
>
> It's great to support fluffy, but please don't use language that could offend others, thanks.
>
> Bob
Posted by katia on September 11, 2003, at 22:26:54
In reply to I is here, posted by BarbaraCat on September 11, 2003, at 18:53:01
hey Barb,
I had to run off earlier and didn't get to write everything that I wanted to.
One, I DO appreciate your concern really. And it feels like your last post was not totally about me, as you said some projection going on. AND it seems that you are in a rotten mood tonight?, so please don't take this the wrong way.
I feel absolutely exhausted with how I solely have pulled myself up after where I was a year ago - in a suicidal depression, no insurance, no home, no job, pregnant. I've had to move three times in the midst of all this alone. I feel like I've made great strides with my persistance in this whole med thing and have a lot of courage and endurance/strength to keep going. I've done soooo much work on myself this year, including with medications. It has not been easy in the least to have this persistance esp. when you're feeling so down. I feel I researched different pdocs in the area, everyone was either not taking any new patients or booked two months in advance (including my current one), so i don't have too much choice in finding someone new at the moment especially when he's not doing such a bad job. I feel I do ask all the questions I need to and get responses. So in regards to you last post, "wimp" would not be a term I'd use to describe myself. I just needed to say that that word made me almost react and I realize that you are in a fiery mood and it's not totally about me and that you had my best interest in mind. I still needed to voice that.
Hope you're not feeling too badly in general. And I too get worked up about it all, but have come to a calmness about it all or it will eat me alive.
warmly,
Katia
Posted by BarbaraCat on September 12, 2003, at 13:39:39
In reply to Re: I is here » BarbaraCat, posted by katia on September 11, 2003, at 22:26:54
Hi Katia,
I'm not sure where to post this. It doesn't fit neatly into any of the Babble boards, but here I am and here this is. You are right about all that the other day not being entirely about you, although it was conveyed totally out of care for you. What I was getting from your posts, especially when you were feeling really down and in need, was that you weren't being heard and weren't getting the help that you needed and that you were in alot of pain. I've come to like you very much and care about you and it infuriates me to think that a friend who is in need, who deserves it, is not getting it because 1) they don't insist upon it due to the sense of powerlessness our pain subjects us to; 2) those who could give help don't because they're either overwhelmed due to a mental health HMO system that's a travesty, or; 3) these caregivers are inept and shouldn't be in that business, or; 4) we can't afford the care. It's true that I was concerned about what was happening to you and causing needless suffering for you because of others' neglect. BUT I've also gotten in touch with so much in these past few days and you're right and so am I - most of it is projection. Most of ALL our crap is projection one way or the other.I drank almost every night since the first 'fall' a few nights ago, thinking I could control it, moderate it. I beat myself up, of course, but could not prevent myself from buying those bottles. I finally had a long talk with myself, or rather, that part of myself that is driving this, and SO MUCH emerged, just from the act of being willing to endure the previously unendurable pain and just listen to it. Not to go into the dregs of my life's history, but it's important to do so to explain yours and my interraction, but also because I'm lately finding it important to share some of my story.
I grew up in a very abusive home situation due to my father's extreme and unpredictable bipolar rages. My mother tried to protect, but she was helpless and paralyzed and could only offer furtive comfort when she felt safe to do so. The Catholic school I went to had a few truly sick-o nuns who were terribly abusive as well. In short, I had no one to turn to, no one to listen to my story, no help or protection, and no trust that there was any escape because, of course, I deserved it. How else could a little kid make sense of all this insanity? I was constantly told from the time I was 4-5 years old that I was 'the bad seed', rotten, a no-goodnik, and although I rebelled quite spectacularly, the belief of being a 'bad girl', not deserving help or care, no one listening to me (except those I paid a nice sum to) and being in danger with no place to turn has never left me. The idea of unburdening all of this to my friends or lovers has been unthinkable. Some of it, yes, but not all the deep scary stuff. Most have their own pain and no one can truly know another's and certainly don't want theirs stirred up. I know enough about human nature to know that there's a limit and eventually they would freak and scram. Instead, my shadow stuff has been faced down and suppressed, but is still alive, a unversal dilemma that is not unique to me. Those disowned pieces have been converging lately and I found myself unbearably hurting without even realizing it. There was a layer of coping that was a product of the meds and my own tough resolve and resourcefulness, but it was just a layer.
Your plight that I perceived with you being 'in danger' and not getting help, not being listened to, and neglected because of the perceived inability to pay really hit home and activated all sorts of things, especially in light of the fact that I've been sorting so many things out since my Mom's death in December. Many dreams almost every night to make sense of, memories good and bad, going through old pictures, unpacking boxes she'd put away that I haven't seen since childhood, so many memories that aren't clear, are hazy, like being on the tip of my tongue. There's some abuse issues in there that haven't surfaced yet, but they're on their way.
Alot has been activated with this reconciling the loss of my home, my mom, my childhood things, and memories of how I handled the pain when I was old enough to take control - through drugs and 'feeling better'. I was in alot of pain and needed help and that was the ONLY way available to me and one I could take into my own hands.
The same goes for drinking. After being sober for years, I'm now falling, falling and feel compelled to do so. Why, I've been asking myself, am I hurting so much that I have this need to numb myself and even destroy myself? I finally hunkered down and just sat with the awful feelings that were lurking and that I've been afraid of getting too close to, like they'd subsume me and not let go. The rage, the fear of the little girl, the shame, self-loathing, rebelliousness, the 'bad girl', the dark demonic stuff that needs to be snuffed out. We've all been having some very interesting conversations. It's time these disowned parts of me, although not pretty, were listened to, were helped and protected and not projected. I really don't want to go to a therapist at this stage. The whole messy money/time/business end of it has to be reconciled for me to trust it, and the way I'm going about this seems right. I'm more than up to it, but when I need help to figure it out, I'll get it. Lord knows, with 20 years of therapy under my belt, I think I know the drill by now.
So, dear Katia, you got the brunt of the outrage that I've been surpressing over the neglect of a hurting young girl and woman who desperately needed help, but no one listened. I admire you for sticking to your guns and committing yourself to your wellness and take your word for it that you're not in danger. If you were, I trust that you'll handle it. You're not a helpless 8 year old. You're not me. But, whew, this has been quite a journey, and thanks for lending a hand to hold (and jerk around) during it. - Barbara
Posted by katia on September 12, 2003, at 13:51:11
In reply to Re: Official Side-effects, posted by fluffy on September 11, 2003, at 15:15:05
HI Katy,
Have you or your clinic ever heard of Lithium Orotate? There are some posting on here about it, but nothing I coming from research or "doctors" (not that that ultimately matters). Just wondering what you've heard about it - it could be something for both of us actually.
I asked my pdoc about it and he had never used it or I dont think he's even heard of it. So I don't really want to be his guinea pig. I'd like to hear from other people's doctors.
thanks./
Katia
Posted by katia on September 12, 2003, at 14:59:01
In reply to Thanks, friend » katia, posted by BarbaraCat on September 12, 2003, at 13:39:39
Hi Barbara,
Thanks for your long post! If we get re-directed somewhere, let's just follow it.>>What I was getting from your posts, especially when you were feeling really down and in need, was that you weren't being heard and weren't getting the help that you needed and that you were in alot of pain.
You got it right, but maybe not to the extent in your previous post. (I'll write more of this below)
>>I've come to like you very much and care about you
Likewise!
>>Most of ALL our crap is projection one way or the other.
I agree and it's not easy to sort out what's what sometimes. You actually pushed one of my buttons that didn't have to do with you in your last post. I feel very very stuck right now and I'm trying to have patience knowing this is a slow process. I feel like i have tried my hardest to get the best help and it's dawning on me that maybe I'm not getting the best help. My hands feel tied, I'm frustrated and exhausted.
I'm going thru' a lot too in regards to days when the medication actually seems to work, that's scary too because I'm left looking at the rubble from the fallout with no real life - no career, no boyfriend, no REAL social life. Those are actually scarier days for me now! I've been reading "Bipolar Survival Guide". it doesn't mention anything about this period of finally getting well. It asks to check what traits we think are our "personality" and what traits we feel are manic/depressive, I don't know WHO I am. I feel like I'm ten years old again and have to redevelop into a totally new person. A person I might have been if I hadn't endured all these mood swings for so many years. I look back and all I remember was either a tornado in my head or agonizing molasses.
I feel stuck because I want to make a move (step out into life) b/c I've had two good days, but then I fall down again and realize I'm not ready. So this is an agonzing process that I'm enduring more or less alone. (apart from a couple of good friends - who as you say, still can't get the extent of the suffering and pain of my experience).
All that crap with the pdoc - crush, poem, etc. doesn't and DOES have to do with him. I'm trying to work that one out in therapy (my therapist is a woman - thank god). I think I was slightly disappointed with him and with the amount he charges (is not equivalent to the service) so to distract myself from feeling like I am yet again in a frustrating and financially draining situation, I think subconsciously I made up this crush. and it worked. But you actually woke me up yesterday with that post to feelings I was already feeling; like disappointment with him. And it really feels like I should just stay with him because how much of that disappointment is based on my own idealization of him? So I'm trying to work out what's what. ANY Pdoc can only do so much.
My take is that he doesn't have time to get caught up in the discussions about transference or anything other than medications and symptoms. and that makes me feel unseen and unheard - I think part of it is my issues and not necessarily a reflection about his services. (I had to wait two months to get into to see him - hes' overworked I think). and I pay out of pocket, he's not part of an HMO.But on top of already what's mine, I think are valid concerns I have are, I suggest treatment plans. I mentioned that Lithium has been studied to anti-aging effects on the brain. he hadn't heard of that. he hadn't heard of Li. Orotate, but yet was willing to try me as a guniea pig. that didn't feel good to hear yesterday.
So Barb, you stirred up my stuff too! but that's ok, I needed to wake up to what I was really feeling. But even that changes per minute! I don't know what is real or what is my ever changing perception.
> I drank almost every night since the first 'fall' a few nights ago, thinking I could control it, moderate it. I beat myself up, of course, but could not prevent myself from buying those bottles.Do you mean, you've drunk every night since Labor day w-end when we both had a big night?
If so, don't beat yourself up!!!! The last thing your poor body and soul needs is guilt on top of that. And I'm sure you know all about guilt! I grew up Catholic too!>>I'm lately finding it important to share some of my story.
I'm glad you did share some of it. I'm open to hearing more of it. and I too, can relate to that feeling of having no where to go for safety. I think that's what my "crush" was about. It made it safe. I didn't have to feel frustation and so forth with him. I too have experienced that frantic panic of no where to run.
It ain't easy being human!
Keep writing Barb!
Hugs,
Katia
Posted by fluffy on September 13, 2003, at 11:29:30
In reply to Thanks, friend » katia, posted by BarbaraCat on September 12, 2003, at 13:39:39
Hi Barb-cat--
You sound like you're not doing so great. (duhhh!). And that concerns me, as someone in your (online) support group. And I DO consider this a support group!! You've been a great help to me here. I don't think I would have found the patience to stick with Lithium had you not given me so much support and information. And guess what--I'm feeling so much better.
Now about the pain you're feeling. I can certainly relate to that. I, too had an abusive father (physically, emotionally). And I, too feel that it was due to bipolar rages now. It took me some time to forgive him and now I actually empathize with him. Something I thought not possible. But I have to wonder, Barb-cat--Is this something that you dwell on when you are depressed/mixed? I don't want to make light of the pain you are feeling. But for me, there are triggers--some of which I can't discern when I'm feeling them. But later when I'm feeling well, I can see that there is a subject that always comes up when I'm heading for an episode, or already in the midst of one.
Also--the alchohol use. You know what the deal is with that. You're self medicating.
Why don't you call your doctor and tell him what's going down? I don't want you to take offense to any of this or feel that I'm patronizing you. I just care about your well being. And I can sense you are in a downward spiral. Maybe feeling fully depressed or mixed. Please get help, Barb-cat.
Your friend,
Katy
Posted by katia on September 13, 2003, at 12:04:25
In reply to Re: Thanks, friend, posted by fluffy on September 13, 2003, at 11:29:30
Hi,
I'm actually not doing so well either. God, I hate being this fragile and sensitive and RAGEFUL too.
I had something hurtful happen to me last night, and I still haven't stopped crying from it! I feel scared of myself and what Ifeel. and I'm so tired of feeling this way. two days up two days down. I think I might start the Lam. today. And what's the point of continuing to call the pdoc? What can he do? Can he take away the pain? can he get me thru' this? What else can he do? Why am I suppose to be here? It doesn't make sense. This is toooo hard. I can barely hang on. What's this about? Why is this so hard? I want to go away somewhere and be a new person!
chaos and agony/suffering!!!
Katia
Posted by BarbaraCat on September 13, 2003, at 14:46:24
In reply to Lithium Orotate » fluffy, posted by katia on September 12, 2003, at 13:51:11
First of all, thanks Katia and Katy. I'll write more on all the recent stuff later. I'm doing much better, got in touch with alot of old pain. Not that that makes things magically better, but it helps with the self disgust part (I really OUGHT to be over this. I really SHOULD get my act together, blah blah).
But anyway, on to the Lithium Orotate question. I tried it last year and before going into the why of why it didn't work, my humble opinion is that it don't work!
I too saw many of the very intriguing ads, and hoping to minimize the side effects of lithium (primarily thyroid related), I wanted to believe that much less was needed due to the more efficient orotic acid transporter.
I ordered a couple bottles for $30 a pop thinking to give it a try. In the meantime, my pharmacy mail order for lithium got lost, needed authorization and I ended out of lithium for almost 2 weeks. I started to get definitely hypomanic. At first, it was just more energy, more of a sense of urgency, plans whizzing through my head. I decided to totally re-landscape our yard and went out and bought literally palletts of plants, all kinds of gardening tools and clothing, books, landscaping software. Having a great old time spending lots of money we didn't have and making plans and then getting home and not having one whit of interest in the un-fun part, like unloading the plants, watering them, digging the holes, until they withered.
My husband pointed out to me that I was seeming a trifle scattered and I thought, slapping my forehead, Ah yes! No lithium! That very day, my shipment of Lithium Orotate arrived that I had recently ordered and I was convinced in true BP fasion that this was surely a sign from God. So I took it faithfully and got worse and worse. Even once my prescription arrived I held off, thinking that I had to give Li Orotate a fair chance. I even doubled it and kept getting worse. By 2 weeks later, I was in full blown mixed states depression, sobbing every time I passed by those pathetic plants. So I went back to good old Lithium carbonate and within 1 week I was back to 'normal'.
There's alot to argue here, like maybe I should've started taking it when I was stable first instead of already heading into a mania, or maybe I should've given it some more time, or maybe it really was the Li Orotate kicking in around the same time I restarted my old prescription. But I really don't think so. I think it just doesn't work the way they say it does, especially for people with BP illness. Perhaps it's good for the neuro protective qualities for people without BP, but not for us.
There have been some recent posts on this topic about two months ago. Try doing a search on it. Some babblers well versed in the biochemistry of it gave it a thumbs down. Thanks to you for caring about me. We live very interesting lives. - Barbara
> Have you or your clinic ever heard of Lithium Orotate? There are some posting on here about it, but nothing I coming from research or "doctors" (not that that ultimately matters). Just wondering what you've heard about it - it could be something for both of us actually.
> I asked my pdoc about it and he had never used it or I dont think he's even heard of it. So I don't really want to be his guinea pig. I'd like to hear from other people's doctors.
> thanks./
> Katia
Posted by fluffy on September 13, 2003, at 15:05:33
In reply to Re: Lithium Orotate, posted by BarbaraCat on September 13, 2003, at 14:46:24
Hi Barbara--
You seem better today. I was worried about you. I have been, well, kinda all over the place. I had a very wierd first two weeks on Li. It did NOT have the calming effect I was expecting. In fact, I became very hypomanic and mentally confused. It seems to have calmed down. The past couple of days, I've felt I have the personality of a rock. Today is better. But what the hell??!! The most troublesome side effect I'm having that seems to be lasting is bruxism (or teeth clenching). It happens almost all day, every day--my jaw hurts really bad! Supposedly, this is related to seratonin blockage? Or something seratonin related. Does Li have much to do with Seratonin? Do you know anything about this? My doc did NOT seem pleased by the Li results!! And I can't say for certain I'm pleased yet either. My memory is better, though. My sleep has not improved yet.
If you or anyone else knows about the bruxism part, i'd like to know.
Thanks,
Katy
Posted by Dr. Bob on September 13, 2003, at 15:59:56
In reply to Re: Lithium Orotate, posted by BarbaraCat on September 13, 2003, at 14:46:24
> But anyway, on to the Lithium Orotate question...
I'd like to redirect that aspect of this thread to the new Psycho-Babble Alternative board. Here's a link:
http://www.dr-bob.org/babble/alter/20030903/msgs/259704.html
Bob
Posted by BarbaraCat on September 13, 2003, at 16:25:12
In reply to Let me run this question by you, Barb-cat, posted by fluffy on September 13, 2003, at 15:05:33
Lithium has a weak serotonergic affect, but I don't know the details. Hypomania can be an early side effect which quickly calms down. I don't remember if I got hypomania or not when I first started. As far as the bruxism, I had it really badly when I was on SSRI's. The higher dose I took, the worse it got. I was also twitchy, like a neuron would fire and a muscle would jerk. I've heard that higher doses of serotonin can cause this, but why that would be with Lithium, if it is the Li, is puzzling.
My gut feeling on this is that it's the Lamictal and not Lithium that's causing bruxism. Don't forget that Lithium is going to potentiate the effects of Lam and bruxism and other akathasia type symptoms are pretty typical when ramping up with Lam. How much are you taking of each? Have you noticed any other side effects like tremors, diarrea, nausea, blurred vision? These are the sx you'd expect with Li, but not the tension or grinding. - BCat
> Hi Barbara--
>
> You seem better today. I was worried about you. I have been, well, kinda all over the place. I had a very wierd first two weeks on Li. It did NOT have the calming effect I was expecting. In fact, I became very hypomanic and mentally confused. It seems to have calmed down. The past couple of days, I've felt I have the personality of a rock. Today is better. But what the hell??!! The most troublesome side effect I'm having that seems to be lasting is bruxism (or teeth clenching). It happens almost all day, every day--my jaw hurts really bad! Supposedly, this is related to seratonin blockage? Or something seratonin related. Does Li have much to do with Seratonin? Do you know anything about this? My doc did NOT seem pleased by the Li results!! And I can't say for certain I'm pleased yet either. My memory is better, though. My sleep has not improved yet.
>
> If you or anyone else knows about the bruxism part, i'd like to know.
>
> Thanks,
> Katy
Posted by fluffy on September 13, 2003, at 18:12:01
In reply to Re: Let me run this question by you, Barb-cat » fluffy, posted by BarbaraCat on September 13, 2003, at 16:25:12
Hey Barb-cat--
Thanks so much for fielding my question! I'm on 200mg of Lamictal, and it has always been a good dose for me. I never had ANY of the clenched teeth stuff with Lamictal alone (or even when my dose was a bit too high @250mg). The only drugs that ever gave me this problem were Zoloft and Lexapro. Maybe it's possible that I'm ultra sensitive to Lithium? I'm only on 600mg of Li. The severe side effects I had last week were ones similar to toxicity. So who knows? My doc doesn't seem to think that this reaction is from Lithium potentiating Lamictal. And I'm pretty sure he knows his stuff. (he has the pedigree, anyway) But I think he's puzzled, too.
I may give something else a try if this keeps up. Otherwise, I think I will have to refuse to titrate up on the Li. I can't stand another 2-3 weeks of alzheimer's-like confusion!
Thanks again for your thoughts.
Take care Miss Barb-cat!Katy
> Lithium has a weak serotonergic affect, but I don't know the details. Hypomania can be an early side effect which quickly calms down. I don't remember if I got hypomania or not when I first started. As far as the bruxism, I had it really badly when I was on SSRI's. The higher dose I took, the worse it got. I was also twitchy, like a neuron would fire and a muscle would jerk. I've heard that higher doses of serotonin can cause this, but why that would be with Lithium, if it is the Li, is puzzling.
>
> My gut feeling on this is that it's the Lamictal and not Lithium that's causing bruxism. Don't forget that Lithium is going to potentiate the effects of Lam and bruxism and other akathasia type symptoms are pretty typical when ramping up with Lam. How much are you taking of each? Have you noticed any other side effects like tremors, diarrea, nausea, blurred vision? These are the sx you'd expect with Li, but not the tension or grinding. - BCat
>
> > Hi Barbara--
> >
> > You seem better today. I was worried about you. I have been, well, kinda all over the place. I had a very wierd first two weeks on Li. It did NOT have the calming effect I was expecting. In fact, I became very hypomanic and mentally confused. It seems to have calmed down. The past couple of days, I've felt I have the personality of a rock. Today is better. But what the hell??!! The most troublesome side effect I'm having that seems to be lasting is bruxism (or teeth clenching). It happens almost all day, every day--my jaw hurts really bad! Supposedly, this is related to seratonin blockage? Or something seratonin related. Does Li have much to do with Seratonin? Do you know anything about this? My doc did NOT seem pleased by the Li results!! And I can't say for certain I'm pleased yet either. My memory is better, though. My sleep has not improved yet.
> >
> > If you or anyone else knows about the bruxism part, i'd like to know.
> >
> > Thanks,
> > Katy
>
>
Posted by fluffy on September 13, 2003, at 18:24:17
In reply to Re: Let me run this question by you, Barb-cat » fluffy, posted by BarbaraCat on September 13, 2003, at 16:25:12
Hi again Barb-cat--
I was just wondering...What exactly does serotonergic mean? I know it has something to do with seratonin. Does it mean that it INCREASES seratonin or DECREASES seratonin. Or--does it inhibit like an SSRI? I have no clue.
And to answer your other question--I had mostly confusion and stupor as a side effect on Lithium in the first 2 weeks. It's not so bad now. But the bruxism has been constant since the first week.
Maybe it is the Lamictal? I really don't know. I'll let you know any updates in this when I talk to my doc on tuesday.
warm wishes,
Katy
Posted by katia on September 13, 2003, at 19:48:01
In reply to Re: Let me run this question by you, Barb-cat » fluffy, posted by BarbaraCat on September 13, 2003, at 16:25:12
Hiya,
I feel like I'm being ignored, am I?I was reading your Monkey's posting Barb (btw, did you make that up?) I didn't really read the whole thing - maybe my ADD mind!? I've been thinking about that I might have ADD rather or also. And/or BPD as you said. So you tried Ritalin? No good? At least you found out.
If you did make it up - WOW! what an imagination you have there. And how wonderfully you are able to get that across in such a creative articulate way!
I started my Lamictal 5g today. You know I had two good days and then crashed again last night. It was circumstantial. But the circumstance didn't warrant me tearing out in the middle of a ceremony in tears in a HUGE crowdful of people b/c I was hurt by a friend(s). I cried the night and the morning away. And thought, "hey, I may be caught again in my mood swing. Would ANYONE have reacted like that?"
Just to let you know, I self-medicated! That'll be the code word from now on. I went straight for the beach, got another friend and bottle of dopamine and watched the sunset. Ahhhh. much better.Want to hear the most transporting music ever ever???? (ok ok alternatives board for music therapy). Arvo Part "Alina". Lovely jubley. Simple, yet conveys the deep mystical lovely beauty of life.
It helped me get thru' the night and the morning, I tell ya what!
I highly recommend it!let me know how you are. I'm a sensitive type! I think you may be upset with me.
Katia
Posted by BarbaraCat on September 13, 2003, at 20:01:39
In reply to serotonergic?, posted by fluffy on September 13, 2003, at 18:24:17
I'm not sure of the exact details (who is?), but lithium is suspected (no one knows for sure on any of this stuff) of having a weak affinity for serotonin, which means that it may have properties whereby it looks like serotonin to the serontonin receptors, but it's probably more due to the fact that Lithium works on inhibitory neurons, and the serotonin system is inhibitory.
Our Lam/Li is something we both share, so let me see if I can remember my neurophysiology and we'll try to sleuth this thing out. Lithium acts differently than the SSRI's, TCA's or any of the other meds we associate with neurotransmitter activity. The way neurons communicate is both chemically and electrically. SSRI's, TCA's, MAOI's affect amines, or the classic neurotransmitters we hear about, i.e., serotonin, norepinephrine, dopamine. These chemically stimulate receptors on the dendrites, or receiving ends of another neuron. When the receptors are stimulated, they literally wiggle and send an impulse to the neuron's cell nucleus which, once it decides what to do with this info, sends an electrical signal down to the end, or terminus of the axon, the long arm of the neuron. The information in this electrical transmission has that synaptic gap to cross and the only way to do this is by releasing chemicals (neurotransmitters) that ferry the appropriate neurotransmitter across to the next neuron's receptors and on and on.
Lithium works on the electrical system rather than the chemical, as far as anyone can tell, so it can't be described in the same terms as how the amines work at the synaptic cleft. Lithium is a metallic element and regulates the positive/negative charged ion gates on the surface of the axon. It's not too particular which neuron it acts on, so it can affect the electrical potentials of the serotonin system, and don't quote me on this but I believe also norepinephrine, dopamine, gaba, acetylcholine, and many more groups of neuro chemicals. That's why it's given as an augmentor to turn up the volume on many meds, not just for BP, but mainly SSRI's are the ones that lithium is usually prescribed for as an augmentor when they start to poop. That serotonin affinity again.
Because it acts on inhibitory neurons, you're going to get some lethargy and dullness which is a good thing if you're manic, but not good if you're feeling dopey. That's where Lamictal comes in. Why and how I do not know, but for whatever reason, it seems to balance Li's dopey effects. Like the majority of the 'mood stabilizers' Lam acts on the electrical system, but differently than Li, probably on the excitatory neurons (because it really is stimulating, I don't care what the drug pamphlets say), and both together appear to be greater than the sum. Lam probably also has chemical properties as well, but who knows, it's all so iffy.
So, the reasoning is that when you're taking Lam and Li together, you don't need as much as if you're taking them separately. I've read this in many resources and it's true for me. I'm taking 600mg of Li and that is quite adequate. My pdoc keeps wanting me to bump it up because my blood levels are therapeutically low, but if I go higher I feel horrible, get tremors, nausea, and feel blunted emotionally. Perhaps you can disuade your doc from increasing your Li levels until things sort out, and because you may not need more.
I've been doing some more research and bruxism is definitely a sx with Lam, so it could be that the lithium is making Lam behave as if it's much stronger and you're getting a fairly typical reaction of agitation from too high a dose of Lam. I've tried to increase Lam from my 125mg, especially when I was having a real hard time. I can't do it and get uncomfortable very quickly. Luckly, Lam is a fast acting drug as far as sx's go and any discomfort subsided after a few days.
Before throwing out the Lithium baby with the bathwater, when you see your pdoc you might want to discuss lowering the Lam a little and not increasing the Li for a while. You really don't need to be in that therapeutic window unless you're primarily manic and really need to come down. You're not going to lose any therapeutic ground if you go slow and you can always go back up again. With my recent downward skids, I'm probably not the Li/Lam poster child, but my setbacks are short lived and for the most part, I'm happy with my puny dosages. Plus, I'll take the occasional subtherapeutic risks of lower Li to maintain more emotional spark.
One more question. What other meds are you taking? Guess that should have been the first question before going into Neurophysiology 101. - Barbara
> I was just wondering...What exactly does serotonergic mean? I know it has something to do with seratonin. Does it mean that it INCREASES seratonin or DECREASES seratonin. Or--does it inhibit like an SSRI? I have no clue.
>
> And to answer your other question--I had mostly confusion and stupor as a side effect on Lithium in the first 2 weeks. It's not so bad now. But the bruxism has been constant since the first week.
>
> Maybe it is the Lamictal? I really don't know. I'll let you know any updates in this when I talk to my doc on tuesday.
>
> warm wishes,
> Katy
Posted by BarbaraCat on September 14, 2003, at 3:35:11
In reply to Transporting Arvo Part » BarbaraCat, posted by katia on September 13, 2003, at 19:48:01
Katia, Katia,
Ignoring you? Upset with you? Silly wench! Of course not - you is my Sis, my ally and who else would know what the heck a glass of D is? I came to the conclusion that I'm not going to be a succesful abstainer and so have made a compromise. I will allow myself to enjoy, enjoy being the operative word and not glut myself on, a nice drink or two on the weekend. Not wine, unless I'm with other people sitting around a dinner table where I'm in the public eye so I can only have a glass or two and not the whole bottle. There's something about wine that is very dangerous for me. The other stuff I can take or leave, but it makes social occasions definitely more festive and relaxed. So there I am with that one and it feels fine.Glad you had a therapeutic beach adventure with the help of the D-ster. I will definitely check out Arvo Part. I've made a note to myself. What kind of music is it?
Hope you're feeling on more stable ground. It's so hard to know what's real when the chemistry is so sensitive. When I'm feeling bad I just KNOW that no one really likes me, that I have no true friends, my family connections are gone, I'm married to a dolt, I'll end up a sick failure out on the streets covered with pustules, I'm ugly and sloppy and no matter how often I bathe I still stink and am humiliated that other people are surely thinking 'ick, she stinks'. All this becomes very real and tormenting. I see the evidence everywhere. I walk into rooms and just KNOW that they've been talking and laughing about me because I FEEL it so strongly. It hurts terribly how mean and petty and uncaring everyone is just when I really need some TLC, but I can't blame them because they're right, I really am a substandard sneaky little failure.
But that's just my sickness talking. When I've come down or up to a normal place, my thoughts clear and I'm aware of the many resources I really do have. Things are no longer so fragmented and I can pull together the pieces and see the whole picture better. I can even see the higher picture and how it might all fit into the whole. I also have better energy when I'm not sick so figuring these things out isn't so exhausting and things seems so much easier to deal with.
Of course, I'd prefer if people thought well of me, but most of the time I don't let their opinions affect me at all (except maybe for the smelly part. I'm pretty compulsive about showering). I figure that if they don't like or approve of me, well, there are a few billion other folks they can hang out with instead. When I'm feeling bad, it's hard to be in my own skin, but when I'm feeling OK, I rather like my own company quite alot. If I start ruminating about the sick old bag lady stuff which EVERYONE seems to run, then I figure that I'm resourceful enough to prevent it or see my way out of it. I take care to spend time with people I really like and since it's no longer of interest to me to win popularity contests, I'm satisfied with the quality and not quantity of my friends. My family can be weird, but so is everybody's. My husband is my best buddy even though he can be a world class ass. In short, the same situations look soooo different depending on where I'm at in my mental health. What's becoming clear is that everyone is preoccupied with their own stuff and has too little time energy or interest to spend it on putting me down or taking care of me for very long. There were so many years of hell, but I have to admit that there are more good times now than bad and I'm beginning to trust in them more and believe that it's my time finally to come to peace with my self and my life. The skids are less frequent and less intense and I'm over them more quickly. Trust is a big issue with me and probably with most of us. That's why we're depressed. We don't trust we'll ever be better and that's scary.
You're on a rollercoaster right now with all the adjustments your body and brain are going through. These meds are powerful. It's very frustrating and frightening not to know if you're on the right track with them and if you can really trust anyone to know what you need. It may take longer than you'd like, maybe not, but eventually you'll settle in with a good fit. I know you won't give up until you do.
I think that most of the anguish we put ourselves through is about worrying about what might happen, fantasizing the worst and not even noticing that the present moment is usually OK, even though it might feel rocky and uncomfortable. But the discomfort is usually caused by worry about the what ifs. Have you read "The Power of Now" by Eckhard Tolle? It's probably been the most helpful and powerful book/philosophy for me throughout this whole thing. It's alerted me to my morbid worry obsession which has completely kept me from living and enjoying my life as it is right now, no matter what.
For me, it's the fear that the discomfort will always be there, that it will get better for a while then I'll be back in the pits again and I won't be able to stand it. I project terrible circumstances where I just give up because it's too much and life becomes a living hell. That's just the illness talking, saying that I won't be able to take the pain and craziness, I'll shatter and I'll be abandoned. But it's not real and it becomes easier to recognize that scared voice that's become a habit. That's easy to say from the vantage point of feeling better, but even in the worst of times I've always been able to handle it or found some help. My survival instinct is intact enough to know that I can trust myself to help myself or get help. Sometimes life is hell and other times it's an adventure where I feel like, shoot, I'm up for the ride - bring it on! Most of the times it's just usual stuff, sometimes a little boring even, but not always the pain and suffering like it appears when I'm sick. One thing that "The Power of Now" changed for me is that I now truly know that whatever arises in the future, I'll deal with it, so not to waste time worrying about it and miss out on the here and now.
Your cycles will even out. It may feel terrible at times and you wonder if you can stand it another minute. But you always do, as evidenced by the fact that here you are, bruises and all. Remember your Witness at times like that. Maybe you're not on the right meds, but you'll perservere until you are because you're dedicated to this search with everything you've got. nYou sure helped me get in touch with some old deep issues that I wasn't aware of, so your pain isn't there only to senselessly torment you. It's also serving the greater good and you just have to trust the process. If we all just trusted the process and our own inner wisdom things would go much more smoothly on this long strange trip we're on - but then we wouldn't be mood disordered, we'd be great sages who have reached inner serenity.
And yes, I made up the Typing Monkey thing. There was a pile of washed clothes to be folded and put away, but telling the tale of how monkeys came to type seemed so much more important than mundane laundry. Love ya, Barbara
Posted by katia on September 14, 2003, at 4:31:41
In reply to Re: Transporting Arvo Part » katia, posted by BarbaraCat on September 14, 2003, at 3:35:11
Barb,
I just have to exhale because you responded to me. I'll read your post tomorrow in more detail. What I can respond to right now...>What kind of music is it?
The best you can imagine. B/c when you imagine the thoughts coming to you -- they are simply within a backdrop of this beautiful man's music. *tear drop*.Tolles's stuff. Amazingly enough, when I was in a suicidal depression last year, unable to sleep, sitting up in bed holding my head, crawling sobbing and drooling on the floor to the bathroom to stare at me in the mirror, bags and wrinkles and I'M SO SAD!!!; I'd put his tape on. At 4 am I'd listen to him and again at 8 before I walked and walked for miles in the forest. breathing and trying to "be here now". It did help. really. There's just such a story behind that w/ me. and I partook in too many glasses of d. I feel sick!
thanks for responding Barb. I needed that.
I'll respond tomorrow. and there's nothing you should be doing with your energy BUT JUST writing.
I might just cut you off and force you to channel your writing energies into something else. Not that I don't love to hear from you!!!!
Love,
KAtia
Posted by Dr. Bob on September 14, 2003, at 8:45:59
In reply to Re: please be civil » Dr. Bob, posted by BarbaraCat on September 11, 2003, at 21:52:39
Posted by fluffy on September 14, 2003, at 12:39:02
In reply to Re: serotonergic? » fluffy, posted by BarbaraCat on September 13, 2003, at 20:01:39
Wow Barb-cat!
You've done your homework! I knew I could count on you to know some of this stuff. The only other med I'm taking right now besides Li 600mg and Lam200mg is 15mg of Temazepam at night to sleep. It helps with the bruxism and my terrible sleep. I want to NOT be taking anything for sleep right now, but it is still sketchy. I don't want to raise my Li dose right now b/c I'm fearful of the stupor I experienced. I also felt a bit blunted emotionally after a couple of weeks. I don't want to have the personality of a rock. I'm feeling functional but dysphoric at this point. I still need sleep. I wonder if a pinch of zyprexa or seroquel would help my sleep and mood stability? Lots of questions for the doc!!
All in all, I feel loads better than I did a year ago. I read my diary from then to check if I had teeth clenching...OH MY GOD!! I was such a wreck!! Pages and pages of how I was really normal and just having problems with my past. It never occurred to me that I had a chemical imbalance. I remember crying and crying and feeling suicidal then. Worlds away from where i am now. I have the LUXURY of complaining about side effects!
I'm feeling close to normal today, and I just hope that I can get a normal night's sleep w/o the benzo.
Thanks so much for the info Barb-cat. I need to bookmark that post!
I hope you (and all) are well,
Katy
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