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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by robxblue on April 15, 2011, at 12:48:18
I began rapid cycling like crazy after taking Lexapro off and on for about two years... I am 28, and prior to that never really had significant depression, just anxiety.
Over this past year, I've been tried on most of the main mood stabilizers, most either don't help and some I can't tolerate.
I'm getting desperate for some relief, so I am curious if any of you know of other ideas I haven't tried? Thanks for any suggestions/guidance. This illness SUCKS! I used to be so happy and feel like my brain is permanently ruined...
Current Meds:
Lithium 300mg (helps depression some at lower doses, but doesn't touch sleeping/tears and other manic symptoms.)
Lyrica 300mg (great for bringing me back to normal, but can't take it too long because I develop tolerance.
Lunesta (wonderful for soothing agitation and making it possible to fall asleep.Past Meds: Mood Stabilizers:
Abilify: Felt great for 1 week, then fizzled out and "stabilized" me in a low depression, but not suicidal. Felt restless and uncomfortable.
Seroquel: Even though I slept great, it put me in a constant dysphoric mania and my moods would swing faster throughout the day.
Lamictal: Mania even on 25 mg, though great lift out of depression.
Trileptal: Helped enormously the first 10 days - stopped tears, improved sleep, felt almost normal. Then had a strange "throat closing, chest tightening" attacks on it; this happened both times I tried it.
Topamax: Felt very stimulating and had a lot of anxiety/nervousness, though it probably stopped cycling but was so uncomfortable.Antidepressants:
Lexapro: Started my illness, even though I did fine on it for the first year or so
Pamelor/Nortrptiline: Felt really good the first few weeks on it, but doctor took me off for fear of increasing cycling. Cried like crazy when I stopped it.
Mirapex: Works great in the beginning, then fizzles out and leaves me anxious dyshoric, decreased need for sleep.
Wellbutrin: Makes my anxiety 10x worse, irritable and agitated.
Other antidepressants tried that all either quite working or cause sleep problems: effexor,zoloft,prozac, remeron,The main problem now is I'm having tearfulness (my doc says a manic symptom, even though I feel down/sad), and sleep that cycles (some nights I wake up at 4 a.m. and cant go back to sleep.
We are going to try mexiletine experimentally since it's a sodium channel blocker and trileptal seemed to be helping me the most. I'm scared that Depakote will just make me so depressed, and I want a mood somewhere in the middle. I also haven't tried nimodipine or the thyroid approaches.
Thanks for any insight/hope/guidance you can provide!
Rob
Posted by linkadge on April 15, 2011, at 15:52:31
In reply to 1st Year of Rapid Cycling - Need Ideas Please..., posted by robxblue on April 15, 2011, at 12:48:18
Hi,
I am sort of in a similar situation, as I have antiderpessant induced issues too. I would say I experience rapid cycling, but at the moment is is more of a cylothymia or bp II rather than bp I.
Anyhow, I find that drugs that enhance my concentration, i.e. coffee, ritalin or even nortriptyline tend to decrease the mood shifts. Its probably because I may have comorbid ADHD.
I didn't find depakote all that bad. I would highly recomend omega-3 if you are not already taking it (it has probably kept me at BP II rather than I)
Unless nortriptyline actually made you cycle, I wouldn't stop it for fear of cycling. Perhaps a nortriptyline (or desipramine) + tegretol or trileptal.
The throat closing may have been anxiety / panic symptoms, were you coming off an antidepressant at the time?
Linkadge
Posted by robxblue on April 15, 2011, at 17:51:52
In reply to Re: 1st Year of Rapid Cycling - Need Ideas Please..., posted by linkadge on April 15, 2011, at 15:52:31
Thanks - I appreciate that.
Interestingly enough, cyclothymia is my "official" diagnosis right now. It seems like my moods are constantly shifting, but I have to say all of my coming on and off meds this year hasn't helped. I think or hope - my cycles will begin to decrease once I get on and stay on a med regimen.
Yea, my doc thought the throat closing might be a panic attack but I've never really had them before, and always went away once I stopped trileptal. I wonder if there's any reason I might not get this effect from tegretol?
Also, glad to hear your experience on Depakote wasn't that bad... I just envision it bringing on this intense depression that scares me, since I think my baseline mood is a little depressed.
Posted by linkadge on April 15, 2011, at 18:34:38
In reply to Re: 1st Year of Rapid Cycling - Need Ideas Please... » linkadge, posted by robxblue on April 15, 2011, at 17:51:52
I really didn't mind depakote in small doses say less than 500mg. It can stablize mood more rapidly than lithium (IMHO).
You might also try nicotine. I find nicotine acts as a really potent mood stabilizer (much more tollerabe than anticonvulsants).
Linkadge
Posted by Phillipa on April 15, 2011, at 21:50:57
In reply to Re: 1st Year of Rapid Cycling - Need Ideas Please..., posted by linkadge on April 15, 2011, at 18:34:38
Might also try Deplin as a poster here is finally stable with addition of that and some other supplements , mood stablizer, and nardil. Phillipa
Posted by mellow on April 17, 2011, at 2:08:14
In reply to 1st Year of Rapid Cycling - Need Ideas Please..., posted by robxblue on April 15, 2011, at 12:48:18
Sounds like where I was in 2006, but you actually admit you have a problem. I would step back and let your doc do the work. Some of them see hundreds of patients a week. They know what they are doing. I would also try and committ to your med trials longer. I will generally give things a go for about a month before I decide if I want to stay where I'm at or try something else.
Side effects do pass after a couple of weeks, but you can never find stability if you don't pick a path and stay with it. Cycling is no joke. The dsm doesn't really do it justice because the cycles don't always last for a diagnosable duration, but you can still be excited about starting a new degree and easily tearing up at the same time. That's very much a sign of mixed mania. Kind of a hyper emotional state. I tend to get looney as hell at first sign of spring. I did it like clock work this march. Just remember this too shall pass.
This most valuable thing my doctor and I have found is what will work in a pinch. We found a stabilizer that keeps me in check and an antipsychotic that can reel me back in quickly. Once you figure out what works this condition isn't so daunting, but that takes time and patience! I haven't tried new meds in two years. It's just been a variation of doses of the same cocktail.
Best of luck and don't forget about exercise and diet. That stuff is just as important.
mellow
Posted by robxblue on April 17, 2011, at 16:09:43
In reply to Re: 1st Year of Rapid Cycling - Need Ideas Please..., posted by mellow on April 17, 2011, at 2:08:14
Thanks - valuable insight. It just gets scary when you've tried so many different things, but at least there are many more...
I'll keep hanging in there,
Rob
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