Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by qbsbrown on March 4, 2005, at 23:07:05
I have bp II with panic disorder/gad, but am unable to take any ssri's. They throw me for a complete loop, and hypomanias. Is there any other options besides the benzos?
advice is much appreciated
Posted by lunesta on March 4, 2005, at 23:15:27
In reply to BP II and anxiety??????, posted by qbsbrown on March 4, 2005, at 23:07:05
Try Lyrica, and Neurontin high dose. These will solve 75% of your problems most likely. Enjoy.
Posted by olysi79 on March 4, 2005, at 23:44:28
In reply to Re: BP II and anxiety??????, posted by lunesta on March 4, 2005, at 23:15:27
Hi there, a few suggestions... start a mood stabilizer first like trileptal, lamictal, or Depakote (just a few examples). Also use a benzo (as needed, but cautiously) to control panic symtpoms. Then perhaps consider adding in a tiny dose of an ssri to start.. too much = hypomanias and/or anxiety. For example, consider a 1/4 to a 1/2 tab of the smallest dose, take it for a few weeks, then titrate slowly. Another option is an AP. I love 'em, but akathisia is a problem for me that I cannot tolerate.
> Try Lyrica, and Neurontin high dose. These will solve 75% of your problems most likely. Enjoy.
Posted by shoebox on March 5, 2005, at 9:00:00
In reply to Re: BP II and anxiety??????, posted by olysi79 on March 4, 2005, at 23:44:28
Olysi has given you some excellent advice. It sure sounds like you need a mood stabilizer. If you can find one that fits, you may be able to titrate off of a benzo very, *very* gradually. That's what I was able to do. It took a long time, but now I don't take any benzos and I don't suffer from insomnia anymore (a miracle!), I sleep like a baby, wake up refreshed, and I haven't felt manic in years. Now if I can just find an AD that doesn't make me chomp holes into my tongue in my sleep...
> Hi there, a few suggestions... start a mood stabilizer first like trileptal, lamictal, or Depakote (just a few examples). Also use a benzo (as needed, but cautiously) to control panic symtpoms. Then perhaps consider adding in a tiny dose of an ssri to start.. too much = hypomanias and/or anxiety. For example, consider a 1/4 to a 1/2 tab of the smallest dose, take it for a few weeks, then titrate slowly. Another option is an AP. I love 'em, but akathisia is a problem for me that I cannot tolerate.
Posted by Ritch on March 5, 2005, at 10:02:32
In reply to BP II and anxiety??????, posted by qbsbrown on March 4, 2005, at 23:07:05
> I have bp II with panic disorder/gad, but am unable to take any ssri's. They throw me for a complete loop, and hypomanias. Is there any other options besides the benzos?
>
> advice is much appreciatedWow, deja vu! I just posted to Dinah above about my inability to take them for panic without getting irritable! You have the same exact (nearly) problem that I do. Supposedly, just taking more Depakote (i.e.) might settle anxiety and block the panic, but I've tried that and it doesn't seem to work well. I have tried Neurontin in combo with Depakote and it *did* work really well, but the Neurontin seems to induce mild hypomania.. but at least I wasn't real irritable. Don't know. You've put finger on a very big problem. I've tried bio-feedback, some CBT, etc., and I still have to take a little SSRI to keep panic away. I'd like to hear some other strategies too.
Posted by Phillipa on March 5, 2005, at 16:26:05
In reply to Re: BP II and anxiety?????? » qbsbrown, posted by Ritch on March 5, 2005, at 10:02:32
How come you don't want to take any benzosa? Just curious. Fondly,Phillipa
Posted by shoebox on March 5, 2005, at 17:29:42
In reply to Re: BP II and anxiety??????, posted by Phillipa on March 5, 2005, at 16:26:05
> How come you don't want to take any benzosa? Just curious. Fondly,Phillipa
For me it's about addiction and depression--a little-known fact is that benzos can *cause* depression while they are treating anxiety. It's too easy to build up a tolerance to benzos and find yourself taking fistfuls just to stay even. And then the withdrawal--AY CARAMBA.
Posted by Ritch on March 5, 2005, at 22:17:20
In reply to Re: BP II and anxiety??????, posted by Phillipa on March 5, 2005, at 16:26:05
> How come you don't want to take any benzosa? Just curious. Fondly,Phillipa
They intensify depression, and bipolar depression is the symptom cluster that I have that is the hardest to treat.
Posted by Ritch on March 5, 2005, at 22:18:06
In reply to Re: BP II and anxiety?????? » Phillipa, posted by shoebox on March 5, 2005, at 17:29:42
> > How come you don't want to take any benzosa? Just curious. Fondly,Phillipa
>
> For me it's about addiction and depression--a little-known fact is that benzos can *cause* depression while they are treating anxiety. It's too easy to build up a tolerance to benzos and find yourself taking fistfuls just to stay even. And then the withdrawal--AY CARAMBA.
>AY CARAMBA exactly.
Posted by qbsbrown on March 5, 2005, at 22:57:08
In reply to Re: BP II and anxiety?????? » shoebox, posted by Ritch on March 5, 2005, at 22:18:06
thanks guys. I actually am starting lamictal, and have taken it before. It does great for the bp and the depression, but could never touch my panic attacks. They always want to add a ssri, which i can not tolerate. I do take 1-1.5 of klonopin, but would prefer something else.
Posted by Spriggy on March 6, 2005, at 19:08:53
In reply to Re: BP II and anxiety??????, posted by qbsbrown on March 5, 2005, at 22:57:08
Well qbrown,
We could be twins it sounds like.They *think* I *might* have BP 2. It was more of a suggestion than a diagnosis.
I think it's because 2+2=4 and my father is bp and I had a bad reaction to SSRI's.
SSRI's make me have serious cycling/mood swings. I don't know if manic is the word since I don't feel GOOD.. but I feel SUPER edgy, anxious, irritated, like I want to kill myself.
Not the good mania that sends you shopping and not sleeping.
Anyway, right now, they tried me on Depakote ( I do not like it though) and I am taking .25 Klonopin twice a day. I've actually been skipping the morning dose lately and only taking it at night and have been doing okay.
I figure if I stay on a really low dose like that, it shouldn't be too hard to come off of.
This week I will be requesting Lamictal from my doctor. The Depakote made me feel weird, gave me heartburn and had me up all night.
No thanks- not to mention I don't want to get fat and lose my hair-- I could maybe take one or other but I wouldn't look good bald AND fat.
So, Lamictal may be what helps me too since it helps you.
Right now, I seem to be okay with anxiety- no full blown panic attacks but I do still notice that horrible knot in the pit of my stomach throughotu the day.
I can leave the house though and function almost at a "normal" me level.
The depression is not as bad as it was but it seems to just be "lingering" there.. Like, if I thought about it long enough, I could fall right into the dark pit.
I try to stay occupied (okay, maybe it's called denial)..
But I realize Klonopin alone won't help with the mood instability or depression and yet, I can't have most standard AD's without wigging out totally.
So Lamictal seems to be my next option. Let's just hope my doctor will agree with me.
Posted by Maxime on March 6, 2005, at 22:45:02
In reply to Re: BP II and anxiety??????, posted by shoebox on March 5, 2005, at 9:00:00
Actually sometimes it is hard for pdocs to diagnose anxiety versus bipolar type 2 (see link below). However, many of the meds people have suggested will help the symptoms you describe. I don't know if Seroquel was mentioned, but it is good for anxiety and hypomania.
Maxime
------------
From:http://www.psycheducation.org/depression/frameset.html
Anxious depression could be "bipolar"?!Warning: leaving DSM-IV territory
The remainder of this "diagnosis" discussion cannot be found in the DSM. I will repeatedly reference mood disorder experts, but many of these views are controversial. You must evaluate for yourself the validity of what follows.
Unfortunately, "hypomania" is quite a mis-naming. There are many patients whose "hypomanic" phases are an extreme and very negative experience. As noted above by Dr. Jamison, mania can be negative as often as it is positive. The "racing thoughts" can have a very negative focus, especially self-criticism. The high energy can be experienced as a severe agitation, to the point where people feel they must pace the floor for hours at a time. Sleep problems can show up as insomnia: an inability to sleep, rather than decreased need. (If you or a friend or doctor is skeptical about anxiety as a "bipolar" symptom, try that link for more details and references.)
In my experience most of these people come to treatment with a combination of agitation, anxiety and self-criticism — and they can’t sleep well. Is this "anxiety?" Is this some mood variation? How could you tell the difference? Is there a difference? What is really going on chemically? Unfortunately, this is still almost completely unknown. See the appendix "What’s the latest on why?", which I will try to keep updated frequently, for the latest research about the cause of this illness.
Again, my opinion: you can’t easily distinguish "anxious depression" from bipolar II in a mixed state. I doubt that there is a distinction to be made, ultimately (when we know, hopefully someday relatively soon, what the chemical basis for anxiety with depression really is). For example there is nearly complete overlap between Generalized Anxiety Disorder and Bipolar II.
For now, the only way to tell is by how treatment turns out. Depression that is not bipolar can get better and stay better: with time, or counseling, or formal psychotherapy, or antidepressants. If you get better — great! If you don’t, you may need this new understanding of mood disorders in order to consider mood stabilizers medications, discussed in detail below, as an option.
Meanwhile, at least one experienced mood researcher warns that anxiety in someone who is depressed is associated with a high suicide risk.Fawcett(b) So although there is diagnostic confusion, there are tremendous stakes involved. Approaching this situation with an open mind seems wise, given this risk.
This is the end of the thread.
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