Psycho-Babble Medication Thread 87755

Shown: posts 1 to 6 of 6. This is the beginning of the thread.

 

WHAT TO DO ABOUT BIPOLAR II ????

Posted by Geezer on December 23, 2001, at 13:45:06

DX: Bipolar II,Atypical Depression and Dysphoric Hypomania.

TCAs not acceptable due to adverse side affects.
SSRI's not acceptable due to ASTHENIA.
Wellbutrin did nothing, Remeron too sedating, Serzone too sedating, Effexor-will not try due to adverse side affects and Horrable withdrawal. Provigil is nothing more than the rebound depression portion of Dex. Can't take Stims. due to previous abuse. Can not find a pdoc with the intestinal fortitude to try selegiline or Parnate.
Current Meds:
Dakakote 750mg.
Klonopin 1mg
Ambien 10mg
Zoloft 25mg
(I know these are low doses but increases only add to the Asthenia)
Any suggestions?

 

Re: WHAT TO DO ABOUT BIPOLAR II ???? » Geezer

Posted by Cindylou on December 23, 2001, at 20:06:31

In reply to WHAT TO DO ABOUT BIPOLAR II ????, posted by Geezer on December 23, 2001, at 13:45:06

How do you feel on your current combo? Still depressed, tired, or anxious or all three?

Maybe adding Lamictal could help augment the Depakote?

I feel for you. I feel like I've been through the ringer trying all these meds, and I need low doses also. But keep trying! We'll find the right cocktail one of these days.

cindy

> DX: Bipolar II,Atypical Depression and Dysphoric Hypomania.
>
> TCAs not acceptable due to adverse side affects.
> SSRI's not acceptable due to ASTHENIA.
> Wellbutrin did nothing, Remeron too sedating, Serzone too sedating, Effexor-will not try due to adverse side affects and Horrable withdrawal. Provigil is nothing more than the rebound depression portion of Dex. Can't take Stims. due to previous abuse. Can not find a pdoc with the intestinal fortitude to try selegiline or Parnate.
> Current Meds:
> Dakakote 750mg.
> Klonopin 1mg
> Ambien 10mg
> Zoloft 25mg
> (I know these are low doses but increases only add to the Asthenia)
> Any suggestions?

 

Re: WHAT TO DO ABOUT BIPOLAR II Cindy Lou

Posted by Geezer on December 23, 2001, at 20:58:50

In reply to Re: WHAT TO DO ABOUT BIPOLAR II ???? » Geezer, posted by Cindylou on December 23, 2001, at 20:06:31

> How do you feel on your current combo? Still depressed, tired, or anxious or all three?
>
> Maybe adding Lamictal could help augment the Depakote?
>
> I feel for you. I feel like I've been through the ringer trying all these meds, and I need low doses also. But keep trying! We'll find the right cocktail one of these days.
>
> cindy

Hi Cindy,
Thanks for the reply-you have helped me out in the past. Actually feel terrible on the current combo. When they start messing around with SSRIs and TCAs the resulting Asthenia makes the atypical depressive symptoms worse. I don't have much trouble with the hypomania, aside from some anxiety and mild anger. I have been DXed by the best at the Stanley Foundation here at the Univ. of Cincinnati (after 30 years of treatment for major depression with AD monotherapy); the problem is I can't find anyone to prescribe Lamictal or Selegiline and hesitate to treat myself with those meds. The pdocs in research have the answers but they don't treat patients, the pdocs providing the treatment are too conservative to give the proper treatment.
Happy Holidays
>
> > DX: Bipolar II,Atypical Depression and Dysphoric Hypomania.
> >
> > TCAs not acceptable due to adverse side affects.
> > SSRI's not acceptable due to ASTHENIA.
> > Wellbutrin did nothing, Remeron too sedating, Serzone too sedating, Effexor-will not try due to adverse side affects and Horrable withdrawal. Provigil is nothing more than the rebound depression portion of Dex. Can't take Stims. due to previous abuse. Can not find a pdoc with the intestinal fortitude to try selegiline or Parnate.
> > Current Meds:
> > Dakakote 750mg.
> > Klonopin 1mg
> > Ambien 10mg
> > Zoloft 25mg
> > (I know these are low doses but increases only add to the Asthenia)
> > Any suggestions?

 

Re: WHAT TO DO ABOUT BIPOLAR II ???? » Geezer

Posted by jay on December 24, 2001, at 7:21:38

In reply to WHAT TO DO ABOUT BIPOLAR II ????, posted by Geezer on December 23, 2001, at 13:45:06

> DX: Bipolar II,Atypical Depression and Dysphoric Hypomania.
>
> TCAs not acceptable due to adverse side affects.
> SSRI's not acceptable due to ASTHENIA.
> Wellbutrin did nothing, Remeron too sedating, Serzone too sedating, Effexor-will not try due to adverse side affects and Horrable withdrawal. Provigil is nothing more than the rebound depression portion of Dex. Can't take Stims. due to previous abuse. Can not find a pdoc with the intestinal fortitude to try selegiline or Parnate.
> Current Meds:
> Dakakote 750mg.
> Klonopin 1mg
> Ambien 10mg
> Zoloft 25mg
> (I know these are low doses but increases only add to the Asthenia)
> Any suggestions?


Hi:

Just a couple of guesses...but it has been suggestedfor BP2 folks to try adding a couple of mood stabalizers together. That way you may be able to lower the Depakote dose. You could try adding Lamactil or Lithium, or or any of the mood stabalizers.

I found Depakote to be helpful only if I was taking a good stimulating a.d. combo, which included both Wellbutrin and Effexor at good, theraputic doses. Otherwise, the Depakote made me depressed as hell. It is the synergistic effect that helps, and though you may have had side-effects from each one individually, you may find the combinations balance each other out. I am a bit skeptical about just using one a.d., especially just an SSRI.

You could also look at adding an atypical antipsychotic. Zyprexa seems the popular choice, but it is best for you to try and find the one you like the best.

Some of the data now seem to indicate it is the combo of meds with various effects on different chemicals that make them work. Since we are all so unique, it is going to take some deep experimenting. Once you get a "bang on" combo, though, you will likely find a major world of difference. Go for it, and you may be very, very suprised! Let us know how you make out.

P.S. Just to note, the two things I think you should really look at are 1)adding a stimulating a.d. to your current combo 2)adding another mood stabalizer.

Jay

 

Re: WHAT TO DO ABOUT BIPOLAR II ???? jay

Posted by Geezer on December 24, 2001, at 10:36:05

In reply to Re: WHAT TO DO ABOUT BIPOLAR II ???? » Geezer, posted by jay on December 24, 2001, at 7:21:38

> > DX: Bipolar II,Atypical Depression and Dysphoric Hypomania.
> >
> > TCAs not acceptable due to adverse side affects.
> > SSRI's not acceptable due to ASTHENIA.
> > Wellbutrin did nothing, Remeron too sedating, Serzone too sedating, Effexor-will not try due to adverse side affects and Horrable withdrawal. Provigil is nothing more than the rebound depression portion of Dex. Can't take Stims. due to previous abuse. Can not find a pdoc with the intestinal fortitude to try selegiline or Parnate.
> > Current Meds:
> > Dakakote 750mg.
> > Klonopin 1mg
> > Ambien 10mg
> > Zoloft 25mg
> > (I know these are low doses but increases only add to the Asthenia)
> > Any suggestions?
>
>
> Hi:
>
> Just a couple of guesses...but it has been suggestedfor BP2 folks to try adding a couple of mood stabalizers together. That way you may be able to lower the Depakote dose. You could try adding Lamactil or Lithium, or or any of the mood stabalizers.
>
> I found Depakote to be helpful only if I was taking a good stimulating a.d. combo, which included both Wellbutrin and Effexor at good, theraputic doses. Otherwise, the Depakote made me depressed as hell. It is the synergistic effect that helps, and though you may have had side-effects from each one individually, you may find the combinations balance each other out. I am a bit skeptical about just using one a.d., especially just an SSRI.
>
> You could also look at adding an atypical antipsychotic. Zyprexa seems the popular choice, but it is best for you to try and find the one you like the best.
>
> Some of the data now seem to indicate it is the combo of meds with various effects on different chemicals that make them work. Since we are all so unique, it is going to take some deep experimenting. Once you get a "bang on" combo, though, you will likely find a major world of difference. Go for it, and you may be very, very suprised! Let us know how you make out.
>
> P.S. Just to note, the two things I think you should really look at are 1)adding a stimulating a.d. to your current combo 2)adding another mood stabalizer.
>
> Jay

Hi Jay,
Thanks for the good advice; you have done your homework.

I agree completely about the 2 mood stabalizers, Lithium causes Huge GI distress, I have been trying to get Lamactil but local pdocs get too "week in the knees" about the RASH. What are your thoughts on Triliptal(sp.-the new form of "stupid-max"), I may be able to try Zonisamide under investigation at the Stanley Foundation, University of Cincinnati.

Also agree on stimulating ADs. Wellbutrin at 300mg did nothing but cause constipation for three months but it might be a good idea with Effexor. Effexor has always scared me due to withdrawal, if I can convince myself I could get off Effexor (when it pooped out) by doing a cross over to Prozac I would certainly give it a try.

Zyprexa has been a big help to a lot of people but I just could not put up with the huge weight gain. Geodon was a disaster for me - triggered a hypomanic mixed state with panic, almost called the life squad, but resolved with Klonopin.

Your suggestions are a big help and I will act upon them-Thank you!
Happy Holiday

 

Re: WHAT TO DO ABOUT BIPOLAR II ???? » Geezer

Posted by Mitch on December 26, 2001, at 18:52:41

In reply to WHAT TO DO ABOUT BIPOLAR II ????, posted by Geezer on December 23, 2001, at 13:45:06

> DX: Bipolar II,Atypical Depression and Dysphoric Hypomania.
>
> TCAs not acceptable due to adverse side affects.
> SSRI's not acceptable due to ASTHENIA.
> Wellbutrin did nothing, Remeron too sedating, Serzone too sedating, Effexor-will not try due to adverse side affects and Horrable withdrawal. Provigil is nothing more than the rebound depression portion of Dex. Can't take Stims. due to previous abuse. Can not find a pdoc with the intestinal fortitude to try selegiline or Parnate.
> Current Meds:
> Dakakote 750mg.
> Klonopin 1mg
> Ambien 10mg
> Zoloft 25mg
> (I know these are low doses but increases only add to the Asthenia)
> Any suggestions?

Hi,

I would suggest adding some T4 (maybe just 50mcg), and maybe dropping the Depakote down to 500mg/day, and the Zoloft down to 12.5mg/day. I haven't tried it, but I would like to. Maybe it would help the cycling, and the reduced Dep and Zoloft would help tiredness and asthenia (with the T4 "perking" you up a little).

Mitch


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