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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by SheilaC on August 25, 2009, at 17:41:38
My regular MD doc mentioned that since I had trouble tolerating antidepressants (make me manic and hurt my bladder) that I should be looking at mood stabilizers.
Will taking a mood stabilizer help with depression?
On a daily basis I have trouble with depression and irritability - not mania. Mania for me comes from medications (SSRIs, etc.)
I'm afraid of Lithium - even small doses. What mood stabilizers could help with mood and depression?
Posted by Maxime on August 25, 2009, at 17:55:03
In reply to Mood Stabilizer for BPII?, posted by SheilaC on August 25, 2009, at 17:41:38
Lamictal would be my first choice.
Posted by SheilaC on August 25, 2009, at 18:07:59
In reply to Re: Mood Stabilizer for BPII? » SheilaC, posted by Maxime on August 25, 2009, at 17:55:03
> Lamictal would be my first choice.
My gums broke out in blisters - scary!
Posted by floatingbridge on August 25, 2009, at 18:17:46
In reply to Re: Mood Stabilizer for BPII?, posted by SheilaC on August 25, 2009, at 18:07:59
Hi Sheila,
Maybe you could list what you have tried that didn't work and maybe why? You'll find something yet!
fb
Posted by alchemy on August 25, 2009, at 21:43:39
In reply to Re: Mood Stabilizer for BPII?, posted by SheilaC on August 25, 2009, at 18:07:59
> > Lamictal would be my first choice.
>
> My gums broke out in blisters - scary!How quickly did you increase your dosage on Lamictal and how long were you on it? I got acne one time when I tried it so I ruled it out. But later I gave it another try & my acne eventually improved. I am still on it, for me it is not my miracle, but it is important to have in my cocktail.
Lamictal is probably the best choice for Bipolar II, but if you gave it a long enough trial & you still had the gum blister problem, I guess that it's not the one for you.
Posted by Phillipa on August 25, 2009, at 22:05:40
In reply to Re: Mood Stabilizer for BPII?, posted by alchemy on August 25, 2009, at 21:43:39
Also the lower the dose and longer the titration period less side effects. Some start at 12.5 and some 25mg. Phillipa
Posted by morganator on August 25, 2009, at 23:00:31
In reply to Mood Stabilizer for BPII?, posted by SheilaC on August 25, 2009, at 17:41:38
There is reason to be afraid of all mood stabilizers. Lithium just gets a bad wrap. It is safer than what has been portrayed.
Posted by morganator on August 25, 2009, at 23:07:51
In reply to Re: Mood Stabilizer for BPII?, posted by morganator on August 25, 2009, at 23:00:31
Lamictal is over hyped as a clean and safe medication. Yes, it can help many people and for some it is a "miracle" drug. Unfortunately, it is VERY powerful, as many mood stabilizers are, and it can have a number of adverse effects. I am biased of course, I did not have a great experience with lamictal. The good thing about Lamictal is that you don't have to worry about your kidneys or liver like you do with Depakote or Zyprexa.
Posted by morganator on August 26, 2009, at 0:55:30
In reply to Re: Mood Stabilizer for BPII?, posted by morganator on August 25, 2009, at 23:07:51
OOps, I said Zyprexa in my last post but I meant Lithium.
Posted by SheilaC on August 26, 2009, at 7:05:52
In reply to Re: Mood Stabilizer for BPII?, posted by morganator on August 26, 2009, at 0:55:30
> OOps, I said Zyprexa in my last post but I meant Lithium.
I started at a very tiny, tiny dose of Lamictil and after the very first dose my mouth started feeling weird again. This was the 3rd or 4th time I tried it. It made me feel like my teeth were going to fall out.
I wish I could take it.
Posted by SLS on August 26, 2009, at 7:12:51
In reply to Re: Mood Stabilizer for BPII?, posted by SheilaC on August 26, 2009, at 7:05:52
What are you looking for in a mood stabilizer? What do you need it to do?
BPII does not usually respond to lithium when used as an antimanic drug, either acutely or prophylactically. However, it can act as an antidepressant when used at low dosages (300-600mg) in combination with a standard antidepressant. The two mood stabilizers that have been reported to be effective for BPII are Depakote and Tegretol, although I would suggest using Trileptal in place of Tegretol. With the continued use of Depakote, some people report feeling somewhat more depressed, but there are also people who report it as being a potent antidepressant.
- Scott
Posted by SheilaC on August 26, 2009, at 7:42:48
In reply to Re: Mood Stabilizer for BPII? » SheilaC, posted by SLS on August 26, 2009, at 7:12:51
> What are you looking for in a mood stabilizer? What do you need it to do?
>
> BPII does not usually respond to lithium when used as an antimanic drug, either acutely or prophylactically. However, it can act as an antidepressant when used at low dosages (300-600mg) in combination with a standard antidepressant. The two mood stabilizers that have been reported to be effective for BPII are Depakote and Tegretol, although I would suggest using Trileptal in place of Tegretol. With the continued use of Depakote, some people report feeling somewhat more depressed, but there are also people who report it as being a potent antidepressant.
>
>
> - ScottI am looking for a mood stabilizer that will keep me from getting deep depression (not so much manic) and give me a little energy or at least keep me from sleeping all day.
I think I tried Trileptal before and the only side effect I had from it was that it messed with my periods. Maybe that is dose dependent though.
I do well on Seroquel for sleep, but if I had to take it during the day I think it would be hard to get through the day.
Posted by SLS on August 26, 2009, at 8:03:49
In reply to SLS - Re: Mood Stabilizer for BPII?, posted by SheilaC on August 26, 2009, at 7:42:48
> > What are you looking for in a mood stabilizer? What do you need it to do?
> >
> > BPII does not usually respond to lithium when used as an antimanic drug, either acutely or prophylactically. However, it can act as an antidepressant when used at low dosages (300-600mg) in combination with a standard antidepressant. The two mood stabilizers that have been reported to be effective for BPII are Depakote and Tegretol, although I would suggest using Trileptal in place of Tegretol. With the continued use of Depakote, some people report feeling somewhat more depressed, but there are also people who report it as being a potent antidepressant.
> >
> >
> > - Scott
>
> I am looking for a mood stabilizer that will keep me from getting deep depression (not so much manic) and give me a little energy or at least keep me from sleeping all day.
>
> I think I tried Trileptal before and the only side effect I had from it was that it messed with my periods. Maybe that is dose dependent though.
>
> I do well on Seroquel for sleep, but if I had to take it during the day I think it would be hard to get through the day.
The higher the dosage of Seroquel, the less sedating it is. Likewise, I believe that you need a higher dosage to glean an antidepressant effect from Seroquel. Maybe 200-300mg would be a good dosage to target. I did not respond at all to Seroquel. In fact, it made me irritable and somewhat dysphoric. I didn't give it more than a week, though. The thing about using one of the atypical antipsychotics is that you usually know within 2 weeks whether it is going to help with depression. For bipolar depression, Seroquel is the only one approved by the FDA thus far as monotherapy for bipolar depression.Wellbutrin and Parnate make for good antidepressants for bipolar depression, particularly when combined with Lamictal.
Now, why do you think that you need a mood stabilizer in the first place?
- Scott
Posted by SLS on August 26, 2009, at 8:20:42
In reply to Re: SLS - Re: Mood Stabilizer for BPII?, posted by SLS on August 26, 2009, at 8:03:49
> Now, why do you think that you need a mood stabilizer in the first place?
Never mind. I can see why from reading your previous posts. Also, I see that Lamictal is not an option.
Topamax 100mg might be an option. It works well for bipolar II mixed states. Also, lithium in low dosages acts as an antidepressant. I need to find out if its effects on the kidneys and thyroid are dose-dependant. One doctor I asked said that they were not dose-dependent. I am still dubious, though. If these effects are dose-dependent, then I don't think you would have much to fear from the low dosages used depression.
I like Abilify for bipolar depression.
- Scott
Posted by SheilaC on August 26, 2009, at 10:30:01
In reply to Re: SLS - Re: Mood Stabilizer for BPII?, posted by SLS on August 26, 2009, at 8:20:42
> > Now, why do you think that you need a mood stabilizer in the first place?
>
> Never mind. I can see why from reading your previous posts. Also, I see that Lamictal is not an option.
>
> Topamax 100mg might be an option. It works well for bipolar II mixed states. Also, lithium in low dosages acts as an antidepressant. I need to find out if its effects on the kidneys and thyroid are dose-dependant. One doctor I asked said that they were not dose-dependent. I am still dubious, though. If these effects are dose-dependent, then I don't think you would have much to fear from the low dosages used depression.
>
> I like Abilify for bipolar depression.
>
>
> - Scott
Scott, what about carbamazepine or the time released version of it, Equetro for a mood stabilizer? I loved Abilify, but hated the severe bloating.I took Trileptal years ago and they only issue I had with it was that it messed with my periods. Now I am in surgical menopause so I take estrogen.
I've never taken carbamazepine before.
Posted by SLS on August 26, 2009, at 12:31:09
In reply to SLS - Re: Mood Stabilizer for BPII?, posted by SheilaC on August 26, 2009, at 10:30:01
> > > Now, why do you think that you need a mood stabilizer in the first place?
> >
> > Never mind. I can see why from reading your previous posts. Also, I see that Lamictal is not an option.
> >
> > Topamax 100mg might be an option. It works well for bipolar II mixed states. Also, lithium in low dosages acts as an antidepressant. I need to find out if its effects on the kidneys and thyroid are dose-dependant. One doctor I asked said that they were not dose-dependent. I am still dubious, though. If these effects are dose-dependent, then I don't think you would have much to fear from the low dosages used depression.
> >
> > I like Abilify for bipolar depression.
> >
> >
> > - Scott
>
>
> Scott, what about carbamazepine or the time released version of it, Equetro for a mood stabilizer? I loved Abilify, but hated the severe bloating.
>
> I took Trileptal years ago and they only issue I had with it was that it messed with my periods. Now I am in surgical menopause so I take estrogen.
>
> I've never taken carbamazepine before.I just so happened to come upon an article that reported that Trileptal, but not Tegretol, affected sex hormones and caused irregular bleeding or spotting. The only thing with Tegretol is that it might reduce the effectiveness of birth control pills if you don't make a compensatory increase in dosage. What preparation are you using for HRT?
- Scott
Posted by SheilaC on August 26, 2009, at 13:23:23
In reply to Re: SLS - Re: Mood Stabilizer for BPII? » SheilaC, posted by SLS on August 26, 2009, at 12:31:09
> > > > Now, why do you think that you need a mood stabilizer in the first place?
> > >
> > > Never mind. I can see why from reading your previous posts. Also, I see that Lamictal is not an option.
> > >
> > > Topamax 100mg might be an option. It works well for bipolar II mixed states. Also, lithium in low dosages acts as an antidepressant. I need to find out if its effects on the kidneys and thyroid are dose-dependant. One doctor I asked said that they were not dose-dependent. I am still dubious, though. If these effects are dose-dependent, then I don't think you would have much to fear from the low dosages used depression.
> > >
> > > I like Abilify for bipolar depression.
> > >
> > >
> > > - Scott
> >
> >
> > Scott, what about carbamazepine or the time released version of it, Equetro for a mood stabilizer? I loved Abilify, but hated the severe bloating.
> >
> > I took Trileptal years ago and they only issue I had with it was that it messed with my periods. Now I am in surgical menopause so I take estrogen.
> >
> > I've never taken carbamazepine before.
>
> I just so happened to come upon an article that reported that Trileptal, but not Tegretol, affected sex hormones and caused irregular bleeding or spotting. The only thing with Tegretol is that it might reduce the effectiveness of birth control pills if you don't make a compensatory increase in dosage. What preparation are you using for HRT?
>
>
> - ScottI am using an HRT patch. My doc is the one that brought up Equetro - which I never heard of until I read the label and it said extended release carbamazepine.
So I'm guessing that maybe Tegretol won't have the same hormone interference that Tripleptal did. Since I've had a total hysterectomy, I can always up my estrogen if the Tegetol interferes.
I'm wondering what the usual doseage is for this drug?
My doc suggested starting the Equetro at night at 100mg and working up to 200mg over a month or so (since I am med sensitive). She (the nurse) said that in time if the Equetro makes me groggy the next day I could drop the Seroquel.
Posted by Ron Hill on August 26, 2009, at 13:47:21
In reply to Re: Mood Stabilizer for BPII?, posted by SheilaC on August 26, 2009, at 7:05:52
> I started at a very tiny, tiny dose of Lamictil and after the very first dose my mouth started feeling weird again. This was the 3rd or 4th time I tried it. It made me feel like my teeth were going to fall out.
>
> I wish I could take it.Hi SheilaC,
1) How many mg/day did you start at for Lamictal?
Like you, I hope you can find a way to take it. I get severe rashes from Lamictal unless I start at 12.5 mg/day and increase the dosage by 12.5 mg/day each week.
2) Why not see a p-doc instead of using a family doc?
3) What meds are you taking right now?
4) How do you know you are BP II?
5) Trileptal is better than Tegretol. Oxcarbazepine is a much cleaner med than carbamazepine.
For some patients, Trileptal helps reduce irritability which is often associated with a mixed state. As I'm sure you know, some pts have dysphoric hypomania as opposed to euphoric hypomania.
6) May I tell you what I think? Bear in mind that free advice is often worth about what you pay for it.
You have atypical depression. You will need an MAOI to treat the depression. My hunch is that Nardil might work better than Parnate or Emsam because Nardil has a larger serotonin effect than the other two. I believe you need the serotonin to treat your irritability.
HOWEVER, you ABSOLUTELY MUST be on a fully ramped-up dosage of moodstablizer(s) BEFORE you begin ANY antidepressant. I suspect that you will respond best by using more than one moodstabilizer.
Please write back and let's talk more.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by SheilaC on August 27, 2009, at 8:15:18
In reply to Re: Mood Stabilizer for BPII? » SheilaC, posted by Ron Hill on August 26, 2009, at 13:47:21
Scott,
I thought Tegretol is better for BPII than Trileptal (maybe its the same).
I'm understanding it right that Tegretol will interfere less with my hormone replacement threapy than Trileptal?
Thanks for any input you give!
Posted by Zyprexa on August 28, 2009, at 4:04:48
In reply to Re: Mood Stabilizer for BPII?, posted by alchemy on August 25, 2009, at 21:43:39
Seroquel works, why not stick to it. Add a dose in morning and afternoon and a larger one at bed.
Posted by SheilaC on August 28, 2009, at 8:35:17
In reply to Re: Mood Stabilizer for BPII?, posted by Zyprexa on August 28, 2009, at 4:04:48
> Seroquel works, why not stick to it. Add a dose in morning and afternoon and a larger one at bed.
If I go over 100mg of Seroquel I start to swell up and gain weight - not side effects I want to deal with. But, if in the long run that is my only choice, I guess I will have to get fat. For now, I want to stick with my 50mg of Seroquel and Klonopin at night for sleep and I will try the Tegretol 100mg for now. We'll see.
Posted by Zyprexa on August 28, 2009, at 21:03:01
In reply to Zyprexa- Re: Mood Stabilizer for BPII?, posted by SheilaC on August 28, 2009, at 8:35:17
I take perphenazine now it works pretty good, helps me sleep. No weight gain from it, and its generic. Might be worth a try?
This is the end of the thread.
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