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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by emma lee on September 8, 2001, at 23:30:32
Hi i'm emma. I'm an artist, and 19yrs old. I'm living in San Rafael, Cali. in a group living place(house). I've been through trials suchas leaving home for college, then the inevitable short term depression that comes hand in hand with leaving home/family/security, psychedelic drugs, cronic use of marijuana(senior year of highschool), psychopathic breakdown and hospitalization, then depression afterwards and suicidal thoughts while living with mother, weight gain(wrong meds), yadda yadda yadda. now all my docs and therapists believe I'm Bipolar, all of a sudden. I want to know the truth, but as we all know, the truth is in the eye of the beholder. I've read Don Miguel Ruiz's book: The Four Agreements, and understood it. Are lithium and prozac the right drugs for me? any input would be greatly appreciated. Be well(I think iam, might be the only one), emma
Posted by JohnL on September 9, 2001, at 6:52:59
In reply to They all think i am, but am I?bipolarthatis, posted by emma lee on September 8, 2001, at 23:30:32
Hi Emma,
I think it's worth noting, just out for curiosity sake, that a high percentage of artists and musicians happen to display bipolar features. That doesn't mean all artists are bipolar, but the odds are pretty good. Sometimes their best work comes during a hypomanic phase, or in a deep depressive phase, with the least impressive work coming while they are feeling ok.You asked if Lithium and Prozac is appropriate for you? Actually, I like the Prozac idea, but either Zyprexa or Lamictal would likely be far better choices as mood stabilizers than Lithium. Though it takes many years for doctors to come around to new innovations, those doctors who really know what they are doing are now using Zyprexa or Lamictal instead of Lithium.
John> Hi i'm emma. I'm an artist, and 19yrs old. I'm living in San Rafael, Cali. in a group living place(house). I've been through trials suchas leaving home for college, then the inevitable short term depression that comes hand in hand with leaving home/family/security, psychedelic drugs, cronic use of marijuana(senior year of highschool), psychopathic breakdown and hospitalization, then depression afterwards and suicidal thoughts while living with mother, weight gain(wrong meds), yadda yadda yadda. now all my docs and therapists believe I'm Bipolar, all of a sudden. I want to know the truth, but as we all know, the truth is in the eye of the beholder. I've read Don Miguel Ruiz's book: The Four Agreements, and understood it. Are lithium and prozac the right drugs for me? any input would be greatly appreciated. Be well(I think iam, might be the only one), emma
Posted by SalArmy4me on September 9, 2001, at 8:26:18
In reply to They all think i am, but am I?bipolarthatis, posted by emma lee on September 8, 2001, at 23:30:32
Bauer, Michael PhD, MD. Adverse Events and Tolerability of the Combination of Fluoxetine/Lithium Compared With Fluoxetine. Journal of Clinical Psychopharmacology. Apr 1996:
"Furthermore, there have been reports that administrating fluoxetine to patients who are already on lithium therapy can increase the level of lithium in serum. [15] It is not known why this might happen, and controlled studies for its systematic investigation are missing at present. [3] In a noncontrolled study, Breuel and colleagues [16] did not find pharmacokinetic interactions between lithium and fluoxetine after single and repeated fluoxetine administration in 10 healthy young volunteers. A naturalistic study with 50 outpatients showed a small and statistically not significant increase (mean increase, 0.02 mmol/liter) in lithium levels during the fluoxetine phase treatment. [11] Another potentially serious but rare side effect-the "serotonin syndrome"-occurs most commonly in patients who are given serotonergic agents in combination with a monoamine oxidase inhibitor. The most frequent clinical features of the "serotonin syndrome" are changes in mental status, restlessness, myoclonus, hyperthermia, hypertension, diaphoresis, shivering, and tremor. [17] Because lithium enhances the serotonergic transmission, [18] one would expect that serotonergic symptoms may also appear in the course of fluoxetine-lithium combination. There have been single case reports of significant negative interactions between fluoxetine and lithium, including the development of mania, [19] delirium, [20] absence seizures, [21] and "serotonin syndrome." [22]
This study was designed to evaluate adverse events for the combination of fluoxetine/lithium in comparison to fluoxetine alone in larger samples. The study revealed more adverse events in the fluoxetine/lithium group as compared with the fluoxetine group. However, this difference was statistically not significant. The combination of fluoxetine/lithium is accompanied by a slightly increased risk of adverse events (risk ratio, 1.4) such as those of the nervous system (especially nervousness and vertigo) and the metabolic/nutritional system. It must be emphasized that more patients (30.9%) in the fluoxetine/lithium group received an additional antidepressant drug (mostly TCAs) as compared with 14.9% in the fluoxetine group. The higher incidence of such adverse events as vertigo in the combination group may have something to do with the increased use of TCAs in that group. As we have already pointed out, the addition of fluoxetine to a preexisting TCA regimen can result in an acute increase in TCA levels in plasma, as well as excessive fluoxetine levels.
Because "serotonin syndrome" is a rare adverse drug reaction, the failure to observe it in 110 patients cannot be regarded as conclusive. However, we found a 1.5-fold increase in "serotonergic" adverse events in the combination group (20%) as compared with the fluoxetine group (13.6%). This is paralleled by a somewhat increased rate of early treatment termination because of adverse adverse events in the combination (10.0%) as compared with the fluoxetine group (6.4%). Because about one-third of the fluoxetine/lithium patients were also taking concurrent TCAs, it seems likely that the treating physician would probably discontinue the newer agent (fluoxetine) rather than the TCA when side effects occurred. This would result in an artificially high "dropout" rate for fluoxetine-giving the false impression of increased frequency of side effects in the fluoxetine/lithium group. Extrapyramidal side effects were not observed in both groups. In this study, we did not systematically assess lithium levels in serum, which is a limiting factor for the interpretation of data. However, there was no case of lithium toxicity as a reason for stopping the treatment.
Fava, M. Lithium and Tricyclic Augmentation of Fluoxetine Treatment for Resistant Major Depression: A Double-Blind, Controlled Study. Year Book of Psychiatry & Applied Mental Health. 1996(10):462-463, Annual 1996.
"We conclude from this study that, in general, the combination of fluoxetine and lithium is well tolerated. However, although not statistically significant, a combination of the two drugs reacting via a serotonergic mechanism may have a slightly higher incidence of adverse events than a single drug administration. Therefore, patients on the combination of fluoxetine/lithium in particular should be informed about the possibility of such typical adverse events by their physicians in order to improve their coping with and tolerance toward these symptoms; this will thus enhance treatment compliance."The therapeutic management of the refractory depressed patient is one of the most hotly debated topics in clinical management of affective illness. This study is particularly germane and helpful on the issue. They compared 3 widely used clinical strategies to augment antidepressant efficacy: increase the dose of fluoxetine, add lithium to fluoxetine, and add an antidepressant from another class, in this case desipramine, to fluoxetine. Although the subject sample was relatively small and therefore the results must be considered somewhat preliminary, it is interesting to note that increasing the dose of fluoxetine from 20 mg/day to the 40-60-mg range was the superior course of action. Adding desipramine to fluoxetine at 20 mg/day was the least advantageous approach. The addition of low-dose lithium to fluoxetine was the second most useful approach. Thus, if a patient fails to respond to higher-dose fluoxetine treatment, the next phase of treatment might be the addition of lithium to the fluoxetine regimen.-A. Breier, M.D."
Posted by zarathustra on September 9, 2001, at 8:34:15
In reply to They all think i am, but am I?bipolarthatis, posted by emma lee on September 8, 2001, at 23:30:32
Emma: thank you for your response to my post. It was quite comforting to know that there is somone else who feels the way I do. What is this book you speak of "the four agreements". It sounds like you are smart or "gifted" as they say; I believe there is a strong link whith what you suffer.
sincerely
andrew
Posted by Gundy on September 9, 2001, at 10:19:58
In reply to They all think i am, but am I?bipolarthatis, posted by emma lee on September 8, 2001, at 23:30:32
emma,
I was diagnosed bipolar in my junior year of high school, and put on zoloft and depakote, but as it turns out I only really needed an antidepressant because the "manic" phase was actually anxiety.
If you are an artist, your moods are not significantly interfering with your life, and of course you don't get suicidal, I would stay away from the drugs. These drugs may be "approved" by the FDA, but no one knows what their true long term effects are. Many antidepressants are even known to be carcinogenic.
If all it takes to control your moods is the occasional use of marijuana, you're better off with that. Pot is as safe or safer than most "approved" psychotropics.
I originally used pot to control my mood condition probably much like you did, and after using zoloft, paxil, effexor, remeron, wellbutrin, celexa, serzone, dexedrine, and paxil, I wish I had never taken a prescription psychodrug. They have left me with too many bad psychological effects, and permanent physical effects to have any respect for them.These doctors are not magicians and they do not have a crystal ball. They are human and fallable like the rest of us. You know more about your mind and body than they do.
Posted by Mitch on September 9, 2001, at 12:16:22
In reply to They all think i am, but am I?bipolarthatis, posted by emma lee on September 8, 2001, at 23:30:32
> Hi i'm emma. I'm an artist, and 19yrs old. I'm living in San Rafael, Cali. in a group living place(house). I've been through trials suchas leaving home for college, then the inevitable short term depression that comes hand in hand with leaving home/family/security, psychedelic drugs, cronic use of marijuana(senior year of highschool), psychopathic breakdown and hospitalization, then depression afterwards and suicidal thoughts while living with mother, weight gain(wrong meds), yadda yadda yadda. now all my docs and therapists believe I'm Bipolar, all of a sudden. I want to know the truth, but as we all know, the truth is in the eye of the beholder. I've read Don Miguel Ruiz's book: The Four Agreements, and understood it. Are lithium and prozac the right drugs for me? any input would be greatly appreciated. Be well(I think iam, might be the only one), emma
Hi, Emma
I was on that combo for about seven years and it worked pretty well (made it through college on it-so that says a lot!). I was only taking 300-450/day lithium and just a tiny dose of Prozac though (averaged about 2.5-5mg/day). The lithium can be a bit dulling (esp. at higher doses), but the Prozac seemed to actually help my attention and creativity.
Mitch
Posted by emma lee on September 9, 2001, at 17:31:52
In reply to Re: They all think i am, but am I?bipolarthatis, posted by JohnL on September 9, 2001, at 6:52:59
Thanks for your input, it's great to have found this site with all of you to talk to. who know what i'm going through. I've talked to a select few who actually Know what i'm talking about. I was on Zyprexa, that's what they first put me on(after a short period of Respiradol, not even sure how to spell that one.) But the zyprexa caused weight gain and slowed me down so they put me on Lithium. I've never heard of Lamictal. Will Marijuana mess me up even more, or help me?? Now that i have my life back i enjoy it and it doesn't magnify my problems. I've stopped smoking for now, because everone says how dangerous it could be. I stopped taking my medication for about twoand1/2 weeks during my "suicidal" state, and nothing happened. What does that mean?
It's so ironic/tragic that VanGogh's and Dali's work were best when they were so "strung out". I've read many books 'bout Vincent, and remember reading about how he felt as though no one was "there" for him especially his loved ones. No, i have no intents on taking my life or cutting off any body parts, but if my loved ones are "there" for me any more than they are already I think i might have to leave and be a Hermit for a while. Is this an ungrateful little bitch thing to say?? it's just that they all Think they know what's wrong/best for me when not one of them will listen to ME. My father, whom I was extremely close to, died three years ago and I'm stuck with my mother who isn't much older than me. Age and maturity wise. What is the most potent antipsychotic drug? Why are doctors and nurses so sterile? ~emma~
Posted by emma lee on September 9, 2001, at 17:34:26
In reply to Re: They all think i am, but am I?bipolarthatis » emma lee, posted by SalArmy4me on September 9, 2001, at 8:26:18
i understand most of this, but what is fluoxetine?
Posted by emma lee on September 9, 2001, at 17:58:21
In reply to Re: They all think i am, but am I?bipolarthatis, posted by zarathustra on September 9, 2001, at 8:34:15
'The Four Agreements' is a Toltec Wisdom self help kind of book by Don Miguel Ruiz. It's short, i read it in one sitting it was so righton/interesting. It talks about how society is based on materialistics and bullshit. Also, one of the Agreements is to not take anything personally. NOTHING. How what people call you reflects how they feel about themselves. It talks about "mom" and "dad" and how domesticated we all are. I was in tears when i finished it, call me what you will, but it was a self help book that i Actually Read. andi've tried to read others..The road less traveled, etc etc.
So, I've never been considered gifted by any means, barely graduated high school. but i've always had potential, and I think just the wrong teachers. aside from my parents and their friends. I think, being a highly creative person, that with true street smarts and knowledge of People and their Ways comes another package: people disliking you for speaking the Truth, enemies who pretend to be friends, and some kind of Disorder quoteunquote.
But hell, like they say, What're yagonna do?
Oh, and Andrew, you spoke of living on a mountain or wilderness with none of society fucking with you? are you serious?b/c....If...~emma~
Posted by SalArmy4me on September 9, 2001, at 18:41:12
In reply to Re: SalArmy, posted by emma lee on September 9, 2001, at 17:34:26
Prozac
> i understand most of this, but what is fluoxetine?
Posted by Gundy on September 9, 2001, at 19:23:21
In reply to Re: the four agreements, posted by emma lee on September 9, 2001, at 17:58:21
emma,
I found that no drug has ever artistically inspired me more than the antidepressant Remeron, and I mean that relative to both prescription drugs and other drugs more commonly used for inspiration. It slowed me down in terms of logical thought, but somehow it enabled me to create art unlike I had ever done or have ever done since.
As an artist, you may want to investigate it. One thing though, NEVER smoke marijuana while taking remeron. It is even more important not to smoke pot while on remeron than other antidepressants. It can and has caused permanent physical problems. You should also be aware of the weight gain associated with it. As far as I was concerned, the inspiration was worth the pounds....but not the other side effects related to pot.
What kind of art do you do anyway?
Posted by emma lee on September 10, 2001, at 1:36:50
In reply to side effect: artistic inspiration, posted by Gundy on September 9, 2001, at 19:23:21
Yes, i have decided that I should just give weed smoking a break, especially when there is so much at stake. I will look into Remeron. I am in love with prismacolor pencils on my black european paper. I do most everything, actually. I'm good with ceramics and printmaking, and love everything art related. graphics, i'm notsogood at writing, sculpture, i haven't yet found what i want to stick with though, my niche. they call me the searcher...
Posted by Jane D on September 10, 2001, at 16:11:49
In reply to They all think i am, but am I?bipolarthatis, posted by emma lee on September 8, 2001, at 23:30:32
Hi Emma,
There is nothing in your original post that indicates whether you are bipolar or not. (If I've missed something in another post I apologize.) Just what bipolar means is in the process of being redefined but at least for now it requires either manic (Bipolar I) or hypomanic (Bipolar II) symptoms. For some fairly accessible descriptions you might start at:http://www.psycom.net/depression.central.html
and
http:/www.psycheducation.org
and for bipolar AND all other medical conditions
http://www.nlm.nih.gov/medlineplus/This will help you decide whether you agree with the bipolar diagnosis or not and will give you a good overview of treatment options.
One poster suggested that if your moods are not interfering with your life now you should avoid medications. This may not be a good idea. One theme that you will see repeated over and over again in the above sites is that if you don't treat bipolar it will get progressively worse and hard to treat. There seems to be good support for that. You'll have to decide this one for yourself but remember - for every Vincent Van Gogh there are many artists who did brilliant work AND managed to die of old age with all their body parts still attached.
Finally, if the Prozac and Lithium combination is working for you my opinion is that you should stick with it. Jumping from one drug combo to another is a miserable experience and completely disrupts your life.
Jane
PS
I loved and relate to the following from your other post: "...but if my loved ones are "there" for me any more than they are already I think i might have to leave and be a Hermit for a while. "PPS
Risperadone - generic, Risperdal - brand name. They must have really worked at it to make this one so impossible to keep straight. I don't want to get obsessive about spelling but it does matter for looking up the various drugs.
Posted by emma lee on September 11, 2001, at 1:02:32
In reply to Re: They all think i am, but am I?bipolar that is » emma lee, posted by Jane D on September 10, 2001, at 16:11:49
Thank You Jane, i appreciate you. I'm going to those sites right now....~emma~
Posted by briana on September 13, 2001, at 8:12:28
In reply to Re: They all think i am, but am I?bipolarthatis, posted by JohnL on September 9, 2001, at 6:52:59
I have to disagree that all of the doctors who "really know what they are doing" are using Lamictal or Zyprexa vs. Lithium. I live in an area with some of the best docs in the country, and the consensus is still that lithium is the tried and true mood stabilizer of choice of BPD. I'm BP I AND I have epilepsy, and I take lithium and topomax and neurontin. I have three consulting p-docs and it was deemed that the evidence of lamictal as a mood stabilizer was still too tenuous to consider it as effective as lithium. I've been on Zyprexa, and the consensus there seems to be that it is quite effective at higher doses, but again, the evidence is more tenuous because the drugs are new. Many people have few or no side effects from lithium and it saves their lives. I am a very high functioning BP patient. I'm also an artist -- a writer, though -- in her 20s, and lithium put an end to 10 years of tumultous, suicidal depression. It hasn't dulled creativity, it has caused minimal weight gain (turns out the neurontin I was on caused most of the weight gain I experienced, as did the Zyprexa). I know that some people have a horrible experience with lithium and Depakote, but they both remain the "gold standard" as of now for treating bipolar 1 patients. I think that any doctor worth his or her salt would not discourage a patient from at least trying these mood stabilizers with extremely high success rates.
> Hi Emma,
> I think it's worth noting, just out for curiosity sake, that a high percentage of artists and musicians happen to display bipolar features. That doesn't mean all artists are bipolar, but the odds are pretty good. Sometimes their best work comes during a hypomanic phase, or in a deep depressive phase, with the least impressive work coming while they are feeling ok.
>
> You asked if Lithium and Prozac is appropriate for you? Actually, I like the Prozac idea, but either Zyprexa or Lamictal would likely be far better choices as mood stabilizers than Lithium. Though it takes many years for doctors to come around to new innovations, those doctors who really know what they are doing are now using Zyprexa or Lamictal instead of Lithium.
> John
>
> > Hi i'm emma. I'm an artist, and 19yrs old. I'm living in San Rafael, Cali. in a group living place(house). I've been through trials suchas leaving home for college, then the inevitable short term depression that comes hand in hand with leaving home/family/security, psychedelic drugs, cronic use of marijuana(senior year of highschool), psychopathic breakdown and hospitalization, then depression afterwards and suicidal thoughts while living with mother, weight gain(wrong meds), yadda yadda yadda. now all my docs and therapists believe I'm Bipolar, all of a sudden. I want to know the truth, but as we all know, the truth is in the eye of the beholder. I've read Don Miguel Ruiz's book: The Four Agreements, and understood it. Are lithium and prozac the right drugs for me? any input would be greatly appreciated. Be well(I think iam, might be the only one), emma
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