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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by bjohnson on April 17, 2000, at 20:02:56
I am bipolar-I took Prozac and Tegretal for the past four years.My only ill effects were loss of sex urge, some twitching, yawning and afternoon sleepiness. My family has urged me off the meds. Money, dependancy,fear of liver problems from the Tegretal, and not understanding by my spouse are the reasons I agreed to quit taking my meds on Jan.1,2000. Now the signs of depression are closing in, my sex drive never returned and I am afraid that the really bad times are beginning again. My next dr. appt is not until May 5. I am afraid. Has anyone any advice about alternative medications? Maybe cheaper,less controversial meds that my family wont be so afraid of? Also has anyone else ever gone off these meds cold-turkey and what was the result for them? Thank you.
Posted by JohnL on April 18, 2000, at 3:13:22
In reply to bipolar and medication options, posted by bjohnson on April 17, 2000, at 20:02:56
> I am bipolar-I took Prozac and Tegretal for the past four years.My only ill effects were loss of sex urge, some twitching, yawning and afternoon sleepiness. My family has urged me off the meds. Money, dependancy,fear of liver problems from the Tegretal, and not understanding by my spouse are the reasons I agreed to quit taking my meds on Jan.1,2000. Now the signs of depression are closing in, my sex drive never returned and I am afraid that the really bad times are beginning again. My next dr. appt is not until May 5. I am afraid. Has anyone any advice about alternative medications? Maybe cheaper,less controversial meds that my family wont be so afraid of? Also has anyone else ever gone off these meds cold-turkey and what was the result for them? Thank you.
BJohnson,
You bring up some very good points. The one that disturbs me greatly is the lack of understanding and support from family members. That is all too common and only worsens your condition. I can relate, because my family is the same way. Even my wife's best efforts to understand are futile at best. Long ago I learned this is my own private battle, and I have to leave family members out of it. I can never talk about depression or my medications with them. It has to remain private and confidential to avoid family pressure/misunderstanding. I've learned that everyone has their own private battles of some sort, and that we can't talk about everything with anyone. Some things just sadly have to remain private. In a perfect world I would love for my wife and parents to make the efforts to read about, ponder, and understand depression. But it aint gonna happen. In your shoes, the best first step I would take is to frame your bipolar condition in a personal private way and keep it as private and silent as possible. No amount of debating or convincing them will likely may any difference. If anything, it will probably create more tension and more resistance.Going off Prozac cold turkey is not a problem. Its very long halflife allows it to titrate down on its own. It will still be half in your system nine days after stopping it abruptly. With Tegretal I think a systematic reduction of dosage would be advised. Stopping any anticonvulsant abruptly is not a good idea.
Alternative meds...have you tried St Johnswort? It only costs about $10, and it does indeed truly work for many people. It has the reputation of being effective only in mild depression, but I think that is because the standard U.S.A. doses are actually very low. Studies have shown that one pill (300mg) is roughly the same as 10mg of a trycyclic antidepressant. Since therapeutic ranges of TCAs begin at about 75mg, obviously 3 pills a day of SJW (roughly 30mg of a TCA) is too low. Some of the scientific studies on SJW used doses of 1800 to 2700mg a day (that's 6 to 9 pills, instead of the usual 3). Those studies had the most impressive results. While it is generally agreed that SJW has many therapeutic actions--all of which are like many small streams making a mighty river--the primary actions seem to be: Reuptake inhibition of serotonin, norepinephrine, and dopamine, in roughly equal percentages; some MAO inhibition (though it has been suggested this is found in the whole herb, not the extract). Some brands, such as Solgar, have both the extract and the whole herb combined in one capsule.
The SJW formula used in scientific studies is called LI160. It can be purchased over the counter in health food stores, drug stores, department stores, and some supermarkets, under the brand names Movana or Kira. The main difference from other SJW brands is that these have a minimum guaranteed 3% content of hyperforin in addition to the usual .3%hypericin. Hyperforin has recently been suspected as being the primary player in SJW. While all brands claim to have .3%hypericin, other brands have either inconsistent, low, or unknown levels of hyperforin. Though I don't know the hyperforin content of Solgar brand SJW, I like it because it also has the raw herb mixed in. It might be suggested to take 3 pills a day of Movana or Kira along with 3 pills a day of Solgar. Nine pills a day maximum.
Other alternatives would include SAMe (very pricey!), 5HTP, and sometimes ginkgo biloba or ginseng. I've heard of some people doing very well with a combo of all these...SJW, ginkgo, and a brand of ginseng that has a mixture of four different kinds of ginseng. The best I ever felt in my life was when I was taking SJW 1200mg a day + 5HTP200mg a day. Sadly the 5HTP causes some sort of strange burning urine side effect with me and I had to stop. It must have been very rare, because my phsycians have never heard of it or could explain it. A rare mystery.
These alternative suggestions would cover the depressive symptoms. As for mood stabilization, they might also work. Or they might throw you into a manic state if you are susceptible to that. If a mood stabilizer is absolutely needed, my top choice is Lamictal. It has hardly any side effects, it can actually be pro-sexual (as can SJW), and it can be taken with SJW. I say that from personal experience. I took Lamictal + SJW for probably half a year before deciding it really wasn't treating my anhedonia. But the combo did indeed provide solid stability, social comfort, and considerable improvement. The only depressive symptom I had leftover was anhedonia. Lamictal + SJW cured all other symptoms. So hopefully somewhere in this post you might find some helpful ideas. But to start, you might want to begin contemplating keeping your condition and treatments private and personal. Unless family can understand and be supportive, it is best to leave them out of this one. But you have to be personally responsible to do whatever it takes to get well and stay well, regardless of whether anyone else is involved or not.
What if you had diabetes? High blood pressure? Would they be complaining and urging you to stop medication then? Of course not. You would die. What they fail to understand is that depression is not any different. It's a biological condition with consequences. Stop your medication and you die...either quickly by suicide, or slowly by deterioration and withdrawal from life. You know it. I know it. But as long as they fail to see it, leave them out of it. Just concentrate on getting yourself well, and begin the adjustment process of viewing it as a private battle. Everything in your personal life and family life will be much smoother if this debatable topic can be sidestepped. JohnL
Posted by AndrewB on April 18, 2000, at 7:24:10
In reply to Re: bipolar and medication options, posted by JohnL on April 18, 2000, at 3:13:22
John,
How does St Johnswort compare to a classic MOAI like parnate or nardil as far as effect and side effects. You've tried one of those haven't you?
Posted by Cam W. on April 18, 2000, at 7:37:02
In reply to Re: JohnL: St Johnswort, posted by AndrewB on April 18, 2000, at 7:24:10
John - I have read recently (actually last summer) that the supposed MAOI activity of St.John's wort was actually artifact in the testing (an impurity of the whole plant as you said, I believe). The MOAI activity is probably not a feature of the hyperforin or hypericin. I don't think they have quite figured out it works, but then again, do we really know how any antidepressant really works? - Cam W.
Posted by William on April 18, 2000, at 23:23:53
In reply to bipolar and medication options, posted by bjohnson on April 17, 2000, at 20:02:56
> I am bipolar-I took Prozac and Tegretal for the past four years.My only ill effects were loss of sex urge, some twitching, yawning and afternoon sleepiness. My family has urged me off the meds. Money, dependancy,fear of liver problems from the Tegretal, and not understanding by my spouse are the reasons I agreed to quit taking my meds on Jan.1,2000. Now the signs of depression are closing in, my sex drive never returned and I am afraid that the really bad times are beginning again. My next dr. appt is not until May 5. I am afraid. Has anyone any advice about alternative medications? Maybe cheaper,less controversial meds that my family wont be so afraid of? Also has anyone else ever gone off these meds cold-turkey and what was the result for them? Thank you.
Hi:I have some URGENT thoughts I would like to pass on. Of course, none of this is "medical" advice or whatever. But, from being Bipolar, to dealing with family...even sex drive....I have a bit of experience in each.
As mentioned...I don't think you should STOP the Tegretol right away. Talk to your doctor, and ask if there is an alternative a bit less risky. Second..your "family" Now...are we talking your "spouse", "children", or in-law's?
There are some EXCELLENT books out there available to family members of us suffering with a mental illness. I can't recall the titles off hand...but I will search around the net for some. To you, AND, to the above posters...we can't sit silently..living in fear and pain?? Is that what life is all about?? No. Being "silent" is just contributing to the "stigma" of Mental Illness.
Also, if you can ask your doctor about support groups in your area, that would be excellent. You will get a chance to meet fellow bipolar and depressives, and share your issue in an open forum.
I would honestly say..CALL your doc...talk to them...get back on your meds regarding what they say. The sexual component CAN be treated..but you have to get the family REALIZING that this IS a BONIFIDE illness like Cancer, Aids, etc.
Also..just a note on the St. John's Wort...in the North American Medical Community...it's efficiacy holds VERY little ground. We need serious medicine for a serious problem. (not demeaning what you said.)
Best wishes..and please respond back with questions..and let us know how you make out...
Sincerely, William:-)
Posted by JohnL on April 19, 2000, at 3:43:18
In reply to Re: Please Read bipolar and medication options, posted by William on April 18, 2000, at 23:23:53
> > I am bipolar-I took Prozac and Tegretal for the past four years.My only ill effects were loss of sex urge, some twitching, yawning and afternoon sleepiness. My family has urged me off the meds. Money, dependancy,fear of liver problems from the Tegretal, and not understanding by my spouse are the reasons I agreed to quit taking my meds on Jan.1,2000. Now the signs of depression are closing in, my sex drive never returned and I am afraid that the really bad times are beginning again. My next dr. appt is not until May 5. I am afraid. Has anyone any advice about alternative medications? Maybe cheaper,less controversial meds that my family wont be so afraid of? Also has anyone else ever gone off these meds cold-turkey and what was the result for them? Thank you.
>
>
> Hi:
>
> I have some URGENT thoughts I would like to pass on. Of course, none of this is "medical" advice or whatever. But, from being Bipolar, to dealing with family...even sex drive....I have a bit of experience in each.
>
> As mentioned...I don't think you should STOP the Tegretol right away. Talk to your doctor, and ask if there is an alternative a bit less risky. Second..your "family" Now...are we talking your "spouse", "children", or in-law's?
>
> There are some EXCELLENT books out there available to family members of us suffering with a mental illness. I can't recall the titles off hand...but I will search around the net for some. To you, AND, to the above posters...we can't sit silently..living in fear and pain?? Is that what life is all about?? No. Being "silent" is just contributing to the "stigma" of Mental Illness.Getting someone to read a book isn't that easy, especially if they are defiant or non-believing to begin with. If they could just get started reading, that could indeed help a whole lot. Much easier said than done though. Try it. Even if they do read something that is agreeable and interesting to us, it will probably be disagreeable and uninteresting to them. Depression is painful for those around us that have to witness it day in and day out. It's a natural human tendency to steer away from pain rather than face it head on. I believe supportive family members are a minority. Most don't understand, don't want to understand, and will actually purposefully or subconciously sidestep the issue.
>
> Also, if you can ask your doctor about support groups in your area, that would be excellent. You will get a chance to meet fellow bipolar and depressives, and share your issue in an open forum.Remaining silent and private at home can be very constructive for the home atmosphere and relationships. We all have problems, but when they become a topic of discussion day after day, they wear people down and cause friction. The appropriate place to talk--when family members are resistant--is with a professional counselor or a group forum or both. These people are open, understanding, and very helpful. Family members--even the best-intentioned ones--are pitifully underprepared to help much, especially in an ongoing daily basis. I wish it weren't so, but that's just reality. Not in every case, but most.
>
> I would honestly say..CALL your doc...talk to them...get back on your meds regarding what they say. The sexual component CAN be treated..but you have to get the family REALIZING that this IS a BONIFIDE illness like Cancer, Aids, etc.
>
> Also..just a note on the St. John's Wort...in the North American Medical Community...it's efficiacy holds VERY little ground. We need serious medicine for a serious problem. (not demeaning what you said.)True, North America is embarrassingly lagging in SJW research. But in Europe where a bonifide organization for herbal medicines has existed for decades--similar to our FDA--SJW has been proven effective for decades and in hundreds of controlled studies. Many of the studies were flawed by USA standards, but some of them were perfect. Whether SJW has scientific support or not depends on which part of the world we look for it. Where it hasn't been heavily researched (USA), efficacy support is lacking. In places where it has been well-researched (Europe) it is prescribed more often than any other prescription antidepressant. I'm pretty sure it's not a continent-wide placebo effect. To see all the controlled scientific studies on SJW and its proven efficacy, go to www.hypericum.com. All the studies, complete with graphs and statistics, are there for review.
>
> Best wishes..and please respond back with questions..and let us know how you make out...
> Sincerely, William:-)
This is the end of the thread.
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