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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by CynthiaM. on July 11, 2000, at 11:11:16
It has been a while since I have posted. I have BPI and rapid-cycle very frequently. I am now taking cogentin due to tremors mostly in my hands, arms and wrists. I have a hard time keyboarding and writing and even holding things. I am dropping stuff at odd times. It is very frustrating . I am also having a hard time reading anything I have tohold(like a newspaper) because I am shaking. I have also felt some shaking in my legs but it has seemed to improve with the cogentin. I have also tried to take 50 mg Benadryl to help with the shaking but it doesn't seem to do much. I am taking Seroquel(300mg) at bedtime and also 1200mg Carbatrol(am)and Gabatril8mg (2x daily) Levoxyl(.175) daily Estrace (2mg 2x daily) 1500mg Carbatrol (pm) and 15 mg Remeron (at bedtime) . I can also take 90 mg Restoril for sleep If Iam particularly manic. Then I started the Cogentin Just 1 mg 2x a day. I am hoping it will help with the twitching. I am , right now, hypo-manic, but not severely ( well, my own opinion, maybe not my husband's). I am trying to regulate my sleep patterns a little more but have trouble relaxing when I feel like this! Too much stuff in my head! Any opinions would be appreciated!
Posted by SLS on July 11, 2000, at 16:48:46
In reply to Cogentin and TD, posted by CynthiaM. on July 11, 2000, at 11:11:16
Dear Cynthia,
> It has been a while since I have posted. I have BPI and rapid-cycle very frequently.
I guess I have more questions than answers. I am thinking about trying Gabitril for bipolar depression.
---------------------------------------
For me:
Does Gabitril work? How has it helped you?
Are there any side effects?
Was Gabitril prescribed specifically to address the rapid-cyclicity?
---------------------------------------
For you:
Why do you think that you have tardive dyskinesia (TD)? Has this been diagnosed by your doctor? What drugs are responsible for it?
Tardive dyskinesia usually begins as involuntary movements of muscles around the head, neck, face, and mouth. You haven't described any of this. Tremors and shakiness are not necessarily TD, but can still be the results of taking antipsychotics (neuroleptics) and sometimes Carbatrol. Like TD, these symptoms can improve as the result of taking Cogentin. I'm glad it's helping. Excessive thyroid hormone can sometimes produce hand tremors.
I am not a doctor, but I just wanted to make an observation and ask a few more questions. As you describe it, the drugs you are taking are not currently treating your mania adequately. Besides Carbatrol and Gabitril, what other mood stabilizers and combinations have you tried? Carbatrol is a good choice to treat rapid-cyclicity, but may not do the job without lithium. Neurontin and Lamictal have also been used to help control rapid cyclicity, usually in combination with lithium, Depakote or Carbatrol. Topomax may also be helpful. Someone here on Psycho-Babble who is a rapid-cycler has had success with it. It sometimes takes 6-12 months for a particular combination of mood stabilizers to control rapid-cyclicity.
Have you tried Zyprexa? Zyprexa is a relative of Seroquel that is known to be very effective to treat mania. It is probably more effective than Seroquel in most people. Zyprexa is currently the only antipsychotic to be approved for mania in the U.S. It is also one of the antipsychotics least apt to cause TD.
Is there any possibility that Remeron is making your mania worse? Is it needed as an antidepressant, or is it being used to induce sleep?
Has your mania or rapid-cycling become better or worse following the addition of:
1. Remeron
2. Estrace
3. Levoxyl
- Scott
Posted by CynthiaM. on July 11, 2000, at 18:52:45
In reply to Re: Cogentin and TD » CynthiaM., posted by SLS on July 11, 2000, at 16:48:46
Wow! Scott- thanks for the great reply. For you- Gabitril- I am not really noticing anything from it and I am taking as much as they (pdoc et al ) want me to right now. I may be wrong and it may be keeping me from going overboard but I don't want to test it by dropping it. For Me- I have taken solely or in combination: Neurontin(caused severe systemic edema) , Depakote ( was taking upwards of 3000mg daily and was showing no theraputic level in my labs) Lithium ( No real effect other than causing disturbances in my equilibrium)Zyprexa ( severe weight gain (45 lbs.) and no real stabilizing effect) Also Topomax with no real effect , even in high dosages , on my level of stability. ( although I did experience a decreased appetite and an inability to drink anything with carbonation In it)
I guess I am just concerned about the spechter of TD. Not really thinking I have it , but the involuntary movements are new to me. I have a high teg level (11.1) right now so I know that I cannot increase the teg (Carbatrol) to attempt to salvage some stability. I am interested in the idea of taking yet another drug to combat the effects of the first drug. I was actually taking the levoxyl and estrace prior to my actual dx with bp so I am not sure that they really would have any detrimental effect on the bipolar or specifically the rapid-cycling. The Remeron I am taking for sleep primarily although I was hositalized in March for a severe and pervasive depression (i guessit doesn't hurt to have it on board).So, I guess my real concern was , or is that most of what I have read regarding Cogentin links it to TD. It makes me a little panicky. I am not sure where I need to go from here. I guess I am more stable than I have been for a while ,. but not as stable as I would like to be and I know is possible. Very frustrating. I do feel like I am slamming into mania and I am not certain how to hit the brakes. Maybe if I just keep cleaning? Any thoughts?
Posted by SLS on July 12, 2000, at 0:22:48
In reply to Re: Cogentin and TD, posted by CynthiaM. on July 11, 2000, at 18:52:45
Cynthia (pretty name) -
Just a quickie before I go to bed.
> I do feel like I am slamming into mania and I am not certain how to hit the brakes. Maybe if I just keep cleaning? Any thoughts?
Yes. Come over and clean my house to see if that helps any.
I hope someone else jumps in here. Perhaps there is something going on for which a simple diagnosis of bipolar disorder doesn't explain. Is there any family history of bipolar disorder, ADD, or other similar malady? How old were you when you first became ill? Was your first episode mania or depression? When did you first begin rapid-cycling? How often do you cycle?
In which order do your episodes occur?
1. normal -> mania -> depression -> normal
2. normal -> depression -> mania -> normal
3. mania -> depression -> mania -> depression
4. otherI ask lots of questions, I know.
I am suspicious of both thyroid and estrogen. When did you begin taking them, and when did you start rapid-cycling?
If you are bipolar I, I think you should remain on lithium since it doesn't seem to hurt you any. It can make a good base around which to add other mood stabilizers or antimanic agents. Like I said, rapid-cyclicity can take 6 months or longer to improve from the time you establish the right combination at the right dosages. It does not resolve all at once. The cycles may change slowly. They will hopefully become spaced further apart, with the episodes being of shorter duration and decreasing severity. The folks at the NIH like Tegretol, but they almost always combine it with lithium, and often a third drug like Depakote, Lamictal, or Neurontin.
I hope I was clear in stating that Cogentin is used to treat the extrapyramidal symptoms (EPS) that appear early in treatment with neuroleptic antipsychotics. These symptoms are not tardive dyskinisia. The newer "atypical" neuroleptics (Zyprexa, Risperdal, Seroquel, and Clozapine) are not as likely to produce TD as the older ones.
Did your tremors begin immediately after starting Tegretol?
I wish I knew how to get us both well.
I'll keep the front door unlocked.
Good night.
- Scott
Posted by CynthiaM. on July 12, 2000, at 14:02:50
In reply to Re: Cogentin and TD, rapid-cyclicity » CynthiaM., posted by SLS on July 12, 2000, at 0:22:48
> Cynthia (pretty name) -
> Thanks Scott,
> Yes. Come over and clean my house to see if that helps any.
÷As soon as I get mine clean!÷
Is there any family history of bipolar disorder÷Yes ! My parents (although they won't admit it) and my eight year old son!÷ How old were you when you first became ill?÷ I have manifested symptoms all of my life but it got worse about 7 years ago.÷Was your first episode mania or depression?÷ Severe Depression, but it was after the loss of one of my children (during a pregnancy) I almost died!÷ When did you first begin rapid-cycling?÷ It was about 3 years ago.÷ How often do you cycle?÷It seems very constant, weeks to months.
>
> In which order do your episodes occur?÷ There really isn't such a thing as "normal " to me althoug h with the latest increase in Carbatrol I have has several glimpses of normality. I usually go from Hypo-mania to mania to Rage ( I have been told depression manifest as rage) I have had only 3 specific instances of true depression and they all landed me in the hospital.÷>
> I ask lots of questions, I know.
>÷This is how you get answers! ÷
> I am suspicious of both thyroid and estrogen.÷ Thyroid was 11 years ago and I was symptomatic, exhausted Irregular mentrual cycle etc. Estrogen, almost 2 years ago after atotal hysterectomy. ( isn't it horrible what women have to go through?)÷
>
> If you are bipolar I, I think you should remain on lithium since it doesn't seem to hurt you any.÷ One of the problems I had with litium was that I had no equilibrium, couldn't walk without holding onto walls .÷
The folks at the NIH like Tegretol, but they almost always combine it with lithium, and often a third drug like Depakote, Lamictal, or Neurontin.÷ I am also taking Gabitril that is supposed to augment the Teg.÷
>
> I hope I was clear in stating that Cogentin is used to treat the extrapyramidal symptoms (EPS) that appear early in treatment with neuroleptic antipsychotics. These symptoms are not tardive dyskinisia.÷ I am soooo relieved. I had not read up on the EPS. Thank you so much for putting my fears to rest.÷ The newer "atypical" neuroleptics (Zyprexa, Risperdal, Seroquel, and Clozapine) are not as likely to produce TD as the older ones. ÷This is a real relief since I would really hate to have to discontinue the Seroquel!÷
>
> Did your tremors begin immediately after starting Tegretol?÷ I has just been recently and I have been taking Teg for over a year. I do believe that my level is at the highest it has been in a long time (11.1) Maybe it is the contributing factor. The problem was that I was in a severe rage episode and my level had bottomed out to a 6.5 I am never that low. So maybe it was the dramatic increase in the teg level.÷
>
> I wish I knew how to get us both well.÷ Boy, me too!÷
>
> I'll keep the front door unlocked.÷ I will be there as soon as my house is clean (btw, I have nine kids, it may be a while :)÷
>
> Good night. ÷Night!÷
>
>
> - Scott
÷Cynthia÷
This is the end of the thread.
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