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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by sar on July 30, 2001, at 22:41:19
in the past months i've seen 2 pdocs who dx'd me as Bipolar II, "mixed state" almost immediately. The first pdoc was an emergency doc and i was drunk at the time, v. happy + talkative but there because i was terribly suicidal.
the second pdoc is kind of a big cheese in my big city. he's seen me both sober and drunk and dx'd "histrionic, borderline, Bioplar II mixed states." That seems like a hell of a lot of diagnoses to me.
Elizabeth said above that the BPII is kind of a fad in her opinion, and if there's any truth to that then i don't want to go on Depakote if i don't need it for my "impulsivity."
my family and one close friend do not believe that i am BPII, but these pdocs (who don't know me well) do.
Can anyone describe a "mixed episode" in great detail to me? pretty please...(and add what meds you're on)
thanks,
sar
Posted by MM on July 30, 2001, at 23:36:31
In reply to mixed episode?, posted by sar on July 30, 2001, at 22:41:19
hmm, well I'm newly dxd BPII and IF I am, I get mixed episodes. What I feel is anxiety, agitation (just like I wanna beat the hell out of anything), VERY negative, depression, pissed off etc. I guess I could describe it like being on acid (things seem weird, kinda freaky), speed (wanna go go go) and yet very depressed. Someone on another board desribed it as feeling like a jet sitting on a runway with the superpower engines on FULL blast waiting to take off, YET the brakes are on, and you can't go anywhere. It's like a gnawing, intense feeling of needing to run around the house a billion times, SCREAMING, raging, crying, and beating the hell out of anything that crosses your path. I'm also having panic attacks at this time (I feel like I'm going to die, I worry I'm completely insane, my chest is so tight I can't breathe etc.). It's sort of like every cell in your body is full of intense electric activity, but you have the flu so they're all kind of sick (have you ever smoked a cigarette REAL fast and gotten kind of nauseous, and light headed? It kind of feels like each cell is smoking too fast). hmm I don't think that makes sense. A mixed episode isn't pleasant.
Currently I'm on NO meds (but seeing a pdoc, getting on neurontin as soon as I see him), but I've tried SSRI's and SNRI's (which I don't think were too good).
anyway, hope this helps.
Posted by SalArmy4me on July 30, 2001, at 23:43:00
In reply to Re: mixed episode? » sar, posted by MM on July 30, 2001, at 23:36:31
Gabapentin for Mixed Episodes:
Botts, Sheila R.. Raskind, Jackie. Gabapentin and lamotrigine in bipolar disorder. American Journal of Health-System Pharmacy. 56(19):1939-1944, October 1, 1999:
"...McElroy et al. treated nine patients with bipolar disorder with adjunctive gabapentin therapy (1600-4800 mg/day orally) in an open-label study. All the patients were being treated as outpatients, were inadequately responsive to standard mood stabilizers (anti-depressants, antipsychotics, benzodiazepines, valproic acid), and were displaying persistent manic, hypomanic, or mixed symptoms. Eight of the nine patients had mixed symptoms, and six had rapid cycling. Seven patients demonstrated a moderate or marked reduction in manic symptoms one month after the addition of gabapentin therapy. One other patient had a moderate reduction after three months. Six patients maintained their antimanic response for one to seven months..."
Posted by MM on July 30, 2001, at 23:51:53
In reply to Re: Gabapentin » MM, posted by SalArmy4me on July 30, 2001, at 23:43:00
Thanks sal. I'm kind of excited to try neurontin, but now I'm reading about all these side effects I didn't think it had. Do you know anything about gabatril?
Posted by SalArmy4me on July 30, 2001, at 23:55:30
In reply to Re: Gabapentin » SalArmy4me, posted by MM on July 30, 2001, at 23:51:53
I've never used it, but I know gabatril has more side-effects than gabapentin. Try the Neurontin anyway. Neurontin could be good for you, and here's my explanation of why (based on what the Tips say, and my experiences of being on it for a long time):
*Its side effect profile is benign.
*It has no anticholinergic side-effects.
*It has no sexual side-effects.
*I have heard of it being used for many different disorders, and I used it for both agitation and unipolar depression.
*It has gained the respect of psychiatrists around the world in only a few years of availability.
*It is now available in 600 and 800 mg formulations, thus decreasing the number of pills you have to take.
*You will need no blood-levels taken.
*It has few drug-drug interactions, and can be taken with any antidepressant.200 of the 400mg capsules cost $286.39 (wholesale) in the United States.
Posted by MM on July 31, 2001, at 0:04:45
In reply to Re: Gabapentin » MM, posted by SalArmy4me on July 30, 2001, at 23:55:30
Thanks again. Someone on another board favors gabatril over gababentin because it makes them feel less spacey or stoned. I wouldn't mind that much I don't think (I'm extremely spacey anyway) but weight gain is a concern for me. They said gabatril was exactly like gababentin, except without side effects, so I guess I assumed it doesn't have weight gain. I value your opinion though and will take it to heart. Thanks.
Posted by Mitch on July 31, 2001, at 1:47:14
In reply to Re: Gabapentin » SalArmy4me, posted by MM on July 31, 2001, at 0:04:45
> Thanks again. Someone on another board favors gabatril over gababentin because it makes them feel less spacey or stoned. I wouldn't mind that much I don't think (I'm extremely spacey anyway) but weight gain is a concern for me. They said gabatril was exactly like gababentin, except without side effects, so I guess I assumed it doesn't have weight gain. I value your opinion though and will take it to heart. Thanks.
MM,
Been on both (not at the same time) gabapentin (Neurontin) and tiagabine (Gabitril) pushed to fairly high doses (1800mg/Neurontin/day), (24mg/Gabitril/day). I had cognitive problems with Neurontin only above 900mg/day, but had cognitive trouble with the Gabitril just about from the getgo-although I did notice a definite antidepressant effect with the Gabitril (but also noticed a definite AD effect with Neurontin). I was seeing a neuro when I was on them and he pushed for rapid dose escalation in both cases-so that may have contributed. The nice thing about Gabitril (as opposed to Neurontin) is that you *might* get away with once or twice daily dosing. Perhaps if the Gabitril was carefully and slowly increased (like Topamax needs to be) then some of the cognitive side-effects from the Gabitril could be avoided or at least lessened. In my opinion I think the Gabitril could be more effective for chronic pain syndromes than Neurontin (if tolerated otherwise). I experienced a definite "anesthesia" of sorts at the highest dose (just before discontinuing).
Mitch
Posted by Andy123 on July 31, 2001, at 1:57:54
In reply to mixed episode?, posted by sar on July 30, 2001, at 22:41:19
> Can anyone describe a "mixed episode" in great detail to me? pretty please...(and add what meds you're on)
> thanks,
> sarA "mixed episode" sounds alot like just "agitated depression." I think its strange that feeling and acting agitated while very depressed could change your overall diagnosis from unipolar to bipolar depression.
I've been agitated while depressed, and I don't think I'm bipolar. If I'm going to be called bipolar, I'd at least like to have had some mania to enjoy. :)
Posted by MM on July 31, 2001, at 2:00:25
In reply to Re: mixed episode?, posted by Andy123 on July 31, 2001, at 1:57:54
If I'm going to be called bipolar, I'd at least like to have had some mania to enjoy. :)
***D I T T O !!!!!***
Posted by MM on July 31, 2001, at 2:06:50
In reply to Re: Gabapentin/gabitril » MM, posted by Mitch on July 31, 2001, at 1:47:14
How many times do you have to take neurontin a day? Does anyone know if they're going to try to make a once or twice a day pill?
Posted by Zo on July 31, 2001, at 2:09:52
In reply to Re: Gabapentin/gabitril-Mitch, posted by MM on July 31, 2001, at 2:06:50
> How many times do you have to take neurontin a day? Does anyone know if they're going to try to make a once or twice a day pill?
I have always taken mine all at bed, and despite what you may have read. . .there's even newer reference to it being effective this way. And it certainly holds for 24 hrs for me. . it would be real obvious (temporal lobe seizures) if not!
So give it a try if you're interested.
Best,
Zo
Posted by Kingfish on July 31, 2001, at 9:35:56
In reply to Re: Gabapentin/gabitril » MM, posted by Mitch on July 31, 2001, at 1:47:14
> Just my input re: Neurontin, personal experience - it has been a kind, gentle drug - only side effect was some stomach upset at first, but very little effect on its own. A good adjunct mood stabilizer, though. I would say certainly worth a try. I think most people have very few side effects.
Posted by Mitch on July 31, 2001, at 9:57:49
In reply to Re: Gabapentin/gabitril-Mitch, posted by MM on July 31, 2001, at 2:06:50
> How many times do you have to take neurontin a day? Does anyone know if they're going to try to make a once or twice a day pill?
Three times (for me anyway), my kidneys work quite well and get rid of it real fast. I can feel it when it is wearing off. I tried just taking one dose at bedtime and I would wake up feeling ok, but toward late afternoon and evening I would experience some rebuond hypomania and gave up on taking it that way.
Posted by Wendy B. on August 1, 2001, at 4:40:10
In reply to Re: Neurontin Once A Day, posted by Zo on July 31, 2001, at 2:09:52
> > How many times do you have to take neurontin a day? Does anyone know if they're going to try to make a once or twice a day pill?
>
> I have always taken mine all at bed, and despite what you may have read. . .there's even newer reference to it being effective this way. And it certainly holds for 24 hrs for me. . it would be real obvious (temporal lobe seizures) if not!
>
> So give it a try if you're interested.
>
> Best,
> ZoHi Zo, Sar, and others,
I've been on neurontin for many months now, and have appreciated the effects it's had on me for mood-stabilization. Sar, I'd ask the p-doc for neurontin BEFORE trying the depakote, it's easier on the system I believe, and probably not so many side effects. The prescribing doc should have no trouble letting you go on a trial of neurontin first.
Last week, I ran out of the neurontin (drugstore gave me 300s rather than 600s), and I was out of town so couldn't do much about it till I got back home. Wow!... I couldn't believe how out of sorts I was until I got back to the normal dose (600 mg 4x a day, spaced evenly thru the day). If I needed evidence that the drug is working, that was it...
I would definitely suggest NOT to take it all in one dose, esp. at the higher doses. And by the way, 1800 is not a high dose - 4800 is about the top I've ever heard of or read about. The spacing of the dosage will give you the desired effect (mood stabilization) all thru the day. Taking it all at night is, IMHO, not effective, and against the medical advice of my p-doc.
I was taking 2 600s at night before bed, but it made me unable to dream, so I just take one now, but still no dreams... or very few.
Sar, re: the original mixed-state question, I believe I have that too, and I think it has to do with going back and forth, even within the span of a day, between being way up (happy, singing) and way down (ready to go in the garage and turn on the engine).
I do believe, just from reading your posts, that the diagnosis of BPII is right. (This is not medical advice, just observations of a cyber-friend). Impulsivity and hyper-sexuality are hallmark symptoms, and you've described scenes of both... also, the drinking and bingeing are co-morbid symptoms of BPII...
There's a lot to read on the Dr. Bob tips on BPII, check it out -Yours, Wendy
Posted by MM on August 1, 2001, at 4:48:54
In reply to Re: Neurontin Once A Day » Zo, posted by Wendy B. on August 1, 2001, at 4:40:10
> Sar, re: the original mixed-state question, I believe I have that too, and I think it has to do with going back and forth, even within the span of a day, between being way up (happy, singing) and way down (ready to go in the garage and turn on the engine).
Wendy, I think you may be mistaken. I'm pretty sure a mixed state is both feeling depression and yet having much energy. Like yin and yang at the same time. I think what you're reffering to is ultradian cycling (ultra-ultra rapid). Mixed is MIXED. It's not going up, then down, then up etc. It's like the ENERGY of a mania/hypomania with the depression of the down cycle. I could be wrong tho.
P.S. Sorry about my post on the mixed state. It was a little unintelligible.
Posted by Wendy B. on August 1, 2001, at 13:21:33
In reply to Re: Neurontin Once A Day » Wendy B., posted by MM on August 1, 2001, at 4:48:54
>
> > Sar, re: the original mixed-state question, I believe I have that too, and I think it has to do with going back and forth, even within the span of a day, between being way up (happy, singing) and way down (ready to go in the garage and turn on the engine).
>
>
> Wendy, I think you may be mistaken. I'm pretty sure a mixed state is both feeling depression and yet having much energy. Like yin and yang at the same time. I think what you're reffering to is ultradian cycling (ultra-ultra rapid). Mixed is MIXED. It's not going up, then down, then up etc. It's like the ENERGY of a mania/hypomania with the depression of the down cycle. I could be wrong tho.
> P.S. Sorry about my post on the mixed state. It was a little unintelligible.
********
MM (if you've posted your name before, I don't know it, sorry),God, I thought it was the other way. But I'm absolutely no expert, that's why I said to Sar that she should do some research on P-B Tips, etc. I think a quick check of the DSM-IV would help...
I always thought manic behavior was precisely NOT depressed, but happy and/or elated mood.
Don't want to be a spreader of mis-information, so I'll try to do some quick checking. Anyone else want to chime in?
Thanks,
Wendy
Posted by MM on August 1, 2001, at 13:34:45
In reply to Re: Neurontin Once A Day » MM, posted by Wendy B. on August 1, 2001, at 13:21:33
Wendy, you're right, MANIC behavior is usually happy, elated, etc. A MIXED state is the ENERGY of that, and the DEPRESSION of the down cycle. It's MIXED between the two. I don't think many people have happy mixed episodes. I guess it's possible, but then that seems like it would be mania or hypomania and not mixed. I can see why it all can be confusing. It just kinda clicked with me when I started reading about BP I guess.
Posted by MM on August 1, 2001, at 13:39:11
In reply to Re: Neurontin Once A Day » Wendy B., posted by MM on August 1, 2001, at 13:34:45
Did anything on this thread help you?
Posted by Jady on August 2, 2001, at 23:52:16
In reply to Re: Neurontin Once A Day » Wendy B., posted by MM on August 1, 2001, at 13:34:45
> I read somewhere, by Dr. Jamison (a well-known Psych who is bipolar) that there is a theory that Mania is just really exaggerated depression, or that it is really a continuum rather than "two poles" or opposite feelings.
In any event, this thread is really helpful because my last psych wanted me to take Neuronton, but I chickened out on adding another med. Now my new Psych wants me on Depakote. Perhaps the old doc was less inclined to label it "mania" but wanted to assist with the irritability and feeling like "I wanted to beat the hell out of everything".
Thanks everyone!
Posted by jtevers on November 15, 2003, at 15:12:24
In reply to Re: Gabapentin » SalArmy4me, posted by MM on July 31, 2001, at 0:04:45
i would like to know if previous or future posters have had weight gain with gabapentin?
i have gained much weight (initially 30 then 30 more lbs.) that seemed to be due to a dose escalation in gabapentin... but i am also taking an antipsychotic(seroquel) that may be to blame.
the weight gain is unresponsive to diet and exercise... any similarities in experience out there?i will try to switch from gabapentin to tiagabine and hoped someone with experience could tell me what to look forward to and if the weight gain may respond to a switch. the gabapentin seems entirely benign otherwise.
This is the end of the thread.
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