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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SheilaC on January 15, 2011, at 19:19:17
Ok - I feel like I just need to start from scratch. Ever feel that way?
I am irritable first thing in the morning (especially when I have taken Seroquel or Geodon at night for sleep).
If I pop some Adderall, it lifts my mood (probably makes me high? - but does it help with my depression?)
Lithium makes me pee all day and night and makes my eye twitch (weird side effect).
Main issues are irritability, lack of motivation and slight, lingering depression.
Should I really be looking at mood stabilizers and anti-psychotics? Am I just on too low a dose of Geodon to balance out the Adderall mood instability? Geodon and Adderall can't be good for my heart.
I just don't know anymore.
Posted by Phillipa on January 16, 2011, at 0:07:29
In reply to Review my symptoms..., posted by SheilaC on January 15, 2011, at 19:19:17
Sheila what about providgil instead of an add med? Caffeine?. I know I feel worse in am as the sleep med night time. What's your diagnosis again? You say slight depression maybe just mood stabalizer instead of antidepressant? So hard to guess without face to face contact. Phillipa
Posted by merpmerp on January 16, 2011, at 10:19:25
In reply to Review my symptoms..., posted by SheilaC on January 15, 2011, at 19:19:17
Just throwing a couple questions out there - have you tried Wellbutrin? I ask because you say that Adderall acts as a mood brightener for you.
Why are you on the Seroquel or Geodon? If it's just for sleep, there's gotta be a better way to get some sleep...
My experience has only been with antidepressants and benzos so I don't know much about the meds you've mentioned...
Posted by SheilaC on January 16, 2011, at 17:03:38
In reply to Re: Review my symptoms... » SheilaC, posted by Phillipa on January 16, 2011, at 0:07:29
My diagnosis is BPII. I do tend to cycle fairly rapidly (feel like I'm on a roller coaster).
I used to take Seroquel for sleep. Now I take Geodon as my mood stabilizer. No weight gain from it and it seems to work pretty good at keeping me stable. I've tried going up to a higher dose like 80mg, but it still doesn't really help with depression.
My doc has mentioned to me several times Wellbutrin and I've been afraid of trying it again. I took it several years ago and it made me manic (but I wasn't on any sort of mood stabilizer).
Maybe Wellbutrin would be less de-stabilizing than Adderall?
She may suggest it again this week and I may have to give it a try now that I am stable on Geodon.
Is Wellbutrin milder than Adderall?
Posted by Ron Hill on January 17, 2011, at 13:28:58
In reply to Re: Review my symptoms..., posted by SheilaC on January 16, 2011, at 17:03:38
SheilaC,
We have talked in the past. May I throw out a couple of ideas? I'm certainly not an expert. I'm just a BPII pt who found wellness five months ago from my ultra rapid cycling and, as a result, my depressive phase does not occur any more.
My wellness is due to my addition of Valdoxan. Please review my med combo provided at the bottom of this post. Please note that I added a very small amount of Adderal XR because Valdoxan can make me a little sleepy during the day. However, I do not take the p-stim everyday and I may discontinue it soon because I do not think that I need it anymore.
> I am irritable first thing in the morning (especially when I have taken Seroquel or Geodon at night for sleep).
> Main issues are irritability, lack of motivation and slight, lingering depression.
Historical, when I experienced irritability it was always an indication of a serotoninergic problem. Irritability meant I was a quart low on serotonin. <[:-)}}
> Should I really be looking at mood stabilizers and anti-psychotics?
Personally, I have never taken an antipsychotic medication for fear of the possible long-term adverse health consequences. I use AED's for my mood stabilization. But, that's just me. Some pts need AP's.
> My diagnosis is BPII. I do tend to cycle fairly rapidly (feel like I'm on a roller coaster).
Refresh my memory, SheilaC; did you try Valdoxan?
If not, you might want to read the following link for Valdoxan and provide your p-doc with the link. Click on the Doctor button:
http://www.valdoxan.co.uk/landing.aspx?redirect=/Default.aspx
> I used to take Seroquel for sleep. Now I take Geodon as my mood stabilizer. No weight gain from it and it seems to work pretty good at keeping me stable. I've tried going up to a higher dose like 80mg, but it still doesn't really help with depression.
Have you ever considered trying Parnate as your antidepressant? Parnate does not work for me, but Nardil works very well. If Parnate does not work for you, then Nardil might. Nardil has weight gain tendencies and sexual side effects for some pts. Pts starting Nardil need to implement a proper diet and exercise program right from the start to avoid weight gain.
> My doc has mentioned to me several times Wellbutrin and I've been afraid of trying it again. I took it several years ago and it made me manic (but I wasn't on any sort of mood stabilizer).My concern with the addition of only Wellburtin is that it may worsen your irritability. It will most likely give you more motivation due to the norepinphrine. But, the lack of serotonin may make you more irritable.
One of the good things about Parnate or Nardil is that serotonin, norepinephrine, and dopamine levels are all raised.
> Maybe Wellbutrin would be less de-stabilizing than Adderall?
Yes. You are correct.
Some ideas:
Add 200 mg/day of Lamictal. Ramp slowly to avoid rash.
Discontinue Geodon and replace with an AED such as Trileptal.
Add 7.5 mg/day of Deplin taken with 5000 mcg/day of sublingual methyl B-12, and 25 mg/day of sublingual P-5-P:
http://www.deplin.com/
http://www.iherb.com/Jarrow-Formulas-Methyl-B-12-5000-mcg-60-Lozenges/117?at=0
http://www.iherb.com/Source-Naturals-Coenzymated-B-6-25-mg-120-Sublingual-Tablets/1038?at=0Lastly, you might consider taking the vitamins and supplements listed below. Some of them are a little expensive, but most are not. If I don't take my vitamins and supplements for more than two days in a row, I experience some depression and extreme sleepy-tiredness. But, within a couple hours after re-starting, I become fully well again. It's interesting how profound the improvement is by taking the vitamins and supplements.
Just some thoughts.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal (oxcarbazepine)
200 mg/day Lamictal (lamotrigine)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
12.5 mg at betime Valdoxan (agomelatine)
3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
2.5 mg/day Adderal XR45 ml/day of Carlsons Bottled Fish Oil
200 mg/day phosphatidylserene
One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
2000 IU/day Vitamin D-3
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
200 mcg/day GTF Chromium
600 mcg/day Chromium Picolinate
200 mg/day Co-Q10
1000 mg/day Cinnamon
480 mg/day Milk Thistle
2 g Vitamin C
Whats next to add?:
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid
Posted by Phillipa on January 17, 2011, at 21:27:31
In reply to Re: Review my symptoms... » SheilaC, posted by Ron Hill on January 17, 2011, at 13:28:58
Ron again congrats. I find it interesting about the vitamins rather strange. I found something strange also ibuphrophen makes me feel better? So I have inflammation? Not hyjaking but apologies in advance to Sheila. Phillipa
Posted by Ron Hill on January 18, 2011, at 3:41:36
In reply to Re: Review my symptoms... » Ron Hill, posted by Phillipa on January 17, 2011, at 21:27:31
Jan,
> Ron again congrats.
Thank you. I wish remission for all.
> I found something strange also ibuphrophen makes me feel better? So I have inflammation?
That's quite possible. Recent research is showing a connection between inflammation and p-disorders. Try N-acetylcysteine (NAC)?
http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-35/issue-6/pdf/pg100057.pdf
Sorry for the intrusion on your thread, SheilaC.
-- Ron
Posted by SheilaC on January 18, 2011, at 13:05:19
In reply to Re: Review my symptoms... » SheilaC, posted by Ron Hill on January 17, 2011, at 13:28:58
> SheilaC,
>
> We have talked in the past. May I throw out a couple of ideas? I'm certainly not an expert. I'm just a BPII pt who found wellness five months ago from my ultra rapid cycling and, as a result, my depressive phase does not occur any more.
>
> My wellness is due to my addition of Valdoxan. Please review my med combo provided at the bottom of this post. Please note that I added a very small amount of Adderal XR because Valdoxan can make me a little sleepy during the day. However, I do not take the p-stim everyday and I may discontinue it soon because I do not think that I need it anymore.
>
> > I am irritable first thing in the morning (especially when I have taken Seroquel or Geodon at night for sleep).
>
> > Main issues are irritability, lack of motivation and slight, lingering depression.
>
> Historical, when I experienced irritability it was always an indication of a serotoninergic problem. Irritability meant I was a quart low on serotonin. <[:-)}}
>
> > Should I really be looking at mood stabilizers and anti-psychotics?
>
> Personally, I have never taken an antipsychotic medication for fear of the possible long-term adverse health consequences. I use AED's for my mood stabilization. But, that's just me. Some pts need AP's.
>
> > My diagnosis is BPII. I do tend to cycle fairly rapidly (feel like I'm on a roller coaster).
>
> Refresh my memory, SheilaC; did you try Valdoxan?
>
> If not, you might want to read the following link for Valdoxan and provide your p-doc with the link. Click on the Doctor button:
>
> http://www.valdoxan.co.uk/landing.aspx?redirect=/Default.aspx
>
> > I used to take Seroquel for sleep. Now I take Geodon as my mood stabilizer. No weight gain from it and it seems to work pretty good at keeping me stable. I've tried going up to a higher dose like 80mg, but it still doesn't really help with depression.
>
> Have you ever considered trying Parnate as your antidepressant? Parnate does not work for me, but Nardil works very well. If Parnate does not work for you, then Nardil might. Nardil has weight gain tendencies and sexual side effects for some pts. Pts starting Nardil need to implement a proper diet and exercise program right from the start to avoid weight gain.
>
> > My doc has mentioned to me several times Wellbutrin and I've been afraid of trying it again. I took it several years ago and it made me manic (but I wasn't on any sort of mood stabilizer).
>
> My concern with the addition of only Wellburtin is that it may worsen your irritability. It will most likely give you more motivation due to the norepinphrine. But, the lack of serotonin may make you more irritable.
>
> One of the good things about Parnate or Nardil is that serotonin, norepinephrine, and dopamine levels are all raised.
>
> > Maybe Wellbutrin would be less de-stabilizing than Adderall?
>
> Yes. You are correct.
>
> Some ideas:
>
> Add 200 mg/day of Lamictal. Ramp slowly to avoid rash.
>
> Discontinue Geodon and replace with an AED such as Trileptal.
>
> Add 7.5 mg/day of Deplin taken with 5000 mcg/day of sublingual methyl B-12, and 25 mg/day of sublingual P-5-P:
>
> http://www.deplin.com/
> http://www.iherb.com/Jarrow-Formulas-Methyl-B-12-5000-mcg-60-Lozenges/117?at=0
> http://www.iherb.com/Source-Naturals-Coenzymated-B-6-25-mg-120-Sublingual-Tablets/1038?at=0
>
> Lastly, you might consider taking the vitamins and supplements listed below. Some of them are a little expensive, but most are not. If I don't take my vitamins and supplements for more than two days in a row, I experience some depression and extreme sleepy-tiredness. But, within a couple hours after re-starting, I become fully well again. It's interesting how profound the improvement is by taking the vitamins and supplements.
>
> Just some thoughts.
>
> -- Ron
>
> dx: Bipolar II and mild OCPD
>
> 600 mg/day Trileptal (oxcarbazepine)
> 200 mg/day Lamictal (lamotrigine)
> 500 mg/day Keppra (levetiracetam)
> 90 mg/day Nardil (phenelzine)
> 12.5 mg at betime Valdoxan (agomelatine)
> 3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
> 2.5 mg/day Adderal XR
>
> 45 ml/day of Carlsons Bottled Fish Oil
> 200 mg/day phosphatidylserene
> One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
> 2000 IU/day Vitamin D-3
> 850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
> 200 mcg/day GTF Chromium
> 600 mcg/day Chromium Picolinate
> 200 mg/day Co-Q10
> 1000 mg/day Cinnamon
> 480 mg/day Milk Thistle
> 2 g Vitamin C
>
>
> Whats next to add?:
> NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid
>
>
>Ron - I don't believe Valdoxan is available in the United States. I do worry about the long term side effects of Geodon. I have take Trileptal and Tegretol in the past and my only complaint was that they messed with my female hormones and gave me night sweats. But I do believe they would be a "safer" mood stabilizer without the weight gain.
Interesting you mentioned the tiny dose of Adderall. The past few days I have tried 2.5mg of Adderall IR and it has given me some pep. But, if I don't use that energy from the Adderall to work out I get irritable.
I also find that on days when I don't take Adderall I am irritable and must take Klonopin to take the edge off.
I have avoided Parnate in the past (it has been mentioned by a past doctor) due to the food and drink interactions. I rarely have a glass of red wine, but when I do, I want to. And I do eat chocolate and some cheese. So, I have been too worried about trying Parnate.
Also - I have tried Lamictal several times and every time, no matter how low the dose, my mouth breaks out in blisters (ouch). So, not sure that is an option.I have become manic in the past from Wellbutrin and I worry about taking it again. At least I know that Adderall IR will be out of my system within 6 - 8 hours (it actually lasts that long for me).
BUT - I also know that Adderall causes more irritability with me.
Feel like I am stuck.
I have switched over to all natural food grade vitamins, fish oil and Vit. D. I think they help.
Thanks for the input. I will discuss tomorrow with my doc.
Posted by MissThang on January 21, 2011, at 8:40:31
In reply to Review my symptoms..., posted by SheilaC on January 15, 2011, at 19:19:17
Sheila,
It's my understanding that adderall is far more de-stabilzing than wellbutrin and in me, led to irritability. Wellbutrin was great for me for quite some time, but pooped out a couple of years ago. I recently took a break from it to try parnate (parnate was a horrible experience for me) and have been slowly reintroducing wellbutrin again and it seems to be working again. I've tried most of the stims (except dexedrine) and I find wellbutrin makes me happier than a pure stimulent does and seems quite stabilizing, especially in the xl version.
Of course, I'm unipolar and not prone to manic states, but I would still say that wellbutrin would be a safer, better bet than adderall.
This is the end of the thread.
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