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Dr. Bob is Robert Hsiung, MD,
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Posted by Janelle on May 6, 2002, at 21:40:06
I have been diagnosed as BiPolar2, and in my case I have SEVERE depression but only mild mania episodes.
I'm trying to find a mood stabilizer that would be most effective for this particular set of symptoms. Failed miserably on Lamictal (induced intense anxiety) and Depakote (induced more and more depression).
Any ideas? I'd like to find a mood stabilizer that works more on the depression side of BiPolar2 than on the mania side, since I have much more of depression than mania - would Neurontin be a good next one for me to try?
Thanks to whoever can help out!
Posted by Uppendown on May 6, 2002, at 22:59:00
In reply to HELP! BiPolar2 with severe depr and mild mania:, posted by Janelle on May 6, 2002, at 21:40:06
Hi Janelle,
I'm sorry you're having such a rough time of it.... I've "watched" a lot of bipolars go through this same battle... trying to find meds that will fullfill that "promise" of relief...
I'm not so sure the is just one answer to this all... After a couple years, and hundreds of folks saying so many similar things... doing the research and review of so many clinical studies... I think it has to be a "combination" approach.
Let me run by a thought for ya... Maybe you already know this... But, most of us BPs went some period of time undiagnosed, thrashing through our lives, until we were given a "reason" for what we go through. Using my self as an example.. I first manifested my symptoms/episodes when I was 11-12.. I didn't get diagnosed until I was in my 40s... during the years inbetween, I developed relationships which I destroyed.. I created businesses that I later lost.. I made a fool out of myself... and much more. But through it all, I developed ways to "cope".. ways in which I rationalized why things turned out as they did. I developed alot of self hate, self doubt, etc... Blah, blah, blah.. You know where I'm going with all this..
So... it is no wonder that I get depressed... I have alot of "ingrained" belief structures that no pill is going to be able to resolve or "cure" for me. BUT. I am still bipolar... there are TWO things going on here ( at least ! LOL!) ... as I'm quite sure are going on with all BPs.. So, YES.. we can look to meds for help... but they can only do so much. We can't be disappointed when they fail to help with EVERTHING that is going on with us...
I think we need both... therapy to learn new ways to "cope"... ( and, boy, do we ever have things to cope with !! Does ANYONE seriously doubt that we face stigma in our daily interactions, for example ? Family? Co-workers? ).. and meds to help us tone down... when we need that..
Okay... so... what meds? Given that you've tried drugs like Lamictal and Depakote... and knowing that Lithium is also known to have depression "problems".. I can't see why you shouldn't ask your doc to try Neurontin... and.. to discuss a "variable dosage" script. It is known to have a sedating effect... which works pretty well if your mind is spinning out with hypomania or mania.. and it can be effective with depression... ( It worked very well for me, and I'm a BP1.. depression and true mania... LOL! Like.. I hallucinate lots! LOL! And,suicidal depressions.. ).. Prescribing less than 600 mgs a day is virtually useless.. I've talked to LOTS of BP Neurontin users... 900 mgs is "standard".. I think a base amount of 600 mgs works.. and then more as needed for "episodes"... JMHO..
Also.. Depakote and Neurontin together is a pretty good combo... you might try that... Depakote can impact your liver... whereas Neurontin passes through your kidneys pretty quickly...
Personally.. I would look into working with a good therapist... AND try Neurontin.. if it helps ya.. great.. if not.. then ya know, eh ?
Best Wishes,
Uppendown
Posted by polarbear206 on May 7, 2002, at 14:50:25
In reply to HELP! BiPolar2 with severe depr and mild mania:, posted by Janelle on May 6, 2002, at 21:40:06
> I have been diagnosed as BiPolar2, and in my case I have SEVERE depression but only mild mania episodes.
>
> I'm trying to find a mood stabilizer that would be most effective for this particular set of symptoms. Failed miserably on Lamictal (induced intense anxiety) and Depakote (induced more and more depression).
>
> Any ideas? I'd like to find a mood stabilizer that works more on the depression side of BiPolar2 than on the mania side, since I have much more of depression than mania - would Neurontin be a good next one for me to try?
>
> Thanks to whoever can help out!
Hi!What antidepressants are you on? What ones have you tried? I would still give the Lamictal another try. You could add on the neurontin to conteract the anxiety with the Lamictal. From what I've read about Neurontin, it's not very potent used alone as a mood stabilizer. I'm also bipolar. Soft cycling and also depression dominated. No mania, just increases in energy with my ups. You could also consider Lithium. I tried lithium in the past, but I felt strange on it. Depakote made me too sleepy. What are your depressions like? Atypical? Many bipolar's do good on MAOI's. I'm on a tricyclic. I have been on Lamictal for a month now and it's working great. Best mood stabilizer for me!!
Posted by Janelle on May 7, 2002, at 17:20:20
In reply to Re: HELP! BiPolar2 with severe depr and mild mania:, posted by polarbear206 on May 7, 2002, at 14:50:25
Hi there,
Thanks for responding. First to answer your question, the AD I'm currently on is EffexorXR (I was successful with the tricyclic Elavil before the SSRI's came out, then had success on Paxil for many years before poopout, have tried and not done well on Zoloft, Celexa).
Interesting suggestion regarding trying Lamictal along with Neurontin ... especially because from what I read about Neurontin it almost sounds too *mild* or something!
Your Bipolar2 sounds very similar to mine in that your cycling is depression dominated and you have EXACTLY what I do in terms of no mania, just increases in energy with the ups. Incredibly alike!
I may wind up on Lithium although its narrow range of toxicity and need for blood monitoring scare me and only feed into my anxiety problems!
I have a few questions for you, if you don't mind:
1) You asked me if my depressions are "atypical" - what is atypical depression? Once you tell me what that is, I will know if I have that or not!
2) But what do you mean by "soft cycling"??
3) Are you taking Neurontin along with the Lamictal?
Thanks!
Posted by wendy b. on May 7, 2002, at 17:41:01
In reply to HELP! BiPolar2 with severe depr and mild mania:, posted by Janelle on May 6, 2002, at 21:40:06
Hi Janelle,
Thank you for your message on the PBAdmin Board, I am happy that someone could take some time off to reflect (even if it wasn't chosen by you but chosen FOR you), and come up with some good reasons why the 2000 and 2001 boards might be ok... It WAS a courageous post, and I appreciated it. Everyone should lighten up and enjoy themselves, don't we have enough other stuff to worry about? JIMHO...
As for the other question you had on PBAdmin, I don't think you should refrain from posting messages to Dr B, if they're legitimate questions. Others are trying to protect him and his time, I'm sure, but we don't have to feel guilty about posting to him... after all, it is HIS board, he is the owner, we might need to know something from the horse's mouth, so to speak... I have e-mailed him off the Boards when I wasn't sure that a comment would be taken in the spirit I had intended, and he has been nice enough to answer. But it's not guaranteed there'll be a swift reply... simply because PBabble is only one of Bob's many tasks. So if you've read the FAQ and other info and still have a question, ask away, and the Admin Board IS indeed the place to ask Admin-type questions. The other thing to remember is: Don't be paranoid!! If he doesn't answer, it's not because you, Janelle, are someone he's trying to avoid. You can't take it personally. Either he'll get to you soon, or there's some (probably good) reason that he can't answer right away. I can pretty much guarantee you, he is not avoiding you or shunning you, or whatever.
Getting on to your bipolar question, I, too, have the same symptoms as yourself and the others who have been nice enough to answer. I have had a very good response to Neurontin. The shrink doesn't want me to move to the big guns (depakote or lithium) because of the liver issues. And she probably thinks I am too flakey to remember to go to have the blood levels drawn. Lamictal scares me because of the rash thing (I have incredibly sensitive skin), and people have had some good results from topamax on this board.
Neurontin is relatively easy on the body (though there are exceptions). I agree with Uppendown and Polarbear that a higher dose (above 600 mg) is necessary for the right kick. I would ask your practitioner to start you in the evening, with a relatively easy dose (200-300 mg at bedtime) for about a week, then your body has time to "recognize" it, but possible sedation or dizziness won't affect you as badly if you introduce it this way. Then start taking 300 mg a few times a day, later 600 mg a few times a day, til you find the right dose for you. Be patient with any side effects, because I believe they will go away after a while (did for me), and then the benefit is clearer...
I am now on 600 mg 5 or 6 times a day (so 3000 to 3600 mg per day). Shrink says this is NOT a particularly high level. The only problem I have is remembering to take it that often (about once every 3 1/2 to 4 hrs thru the day), since slight memory loss seems to be one of my "issues," perhaps from the meds, perhaps not... I believe that the company that manufactures it, Parke-Davis, should respond to consumer needs and make an extended- release version for people like me who have to take these horse-pills! Why not orange chewables?? I don't know what the doseage is for epileptics (it is actually an anti-seizure med), probably a lot lower than what somebody like me takes... they didn't bank on the anti-seizures being good for mood-stabilization, but it is...
Anyway, a long-winded reply, but I hope you will give neurontin a try, can't hurt, might well help! And any other questions you may have, we're here for you...
all the best,
Wendyps: almost forgot: also to combat the depressive side of the bipolar 2 thing, I am on Wellbutrin (350 mg/day), seems to work better than the SSRIs like Prozac or Zoloft or Paxil. Gives a little kick, too, so people who have apathy or anhedonia (inability to experience pleasure) can be helped immensely by it. The combination with neurontin has been great...
> I have been diagnosed as BiPolar2, and in my case I have SEVERE depression but only mild mania episodes.
>
> I'm trying to find a mood stabilizer that would be most effective for this particular set of symptoms. Failed miserably on Lamictal (induced intense anxiety) and Depakote (induced more and more depression).
>
> Any ideas? I'd like to find a mood stabilizer that works more on the depression side of BiPolar2 than on the mania side, since I have much more of depression than mania - would Neurontin be a good next one for me to try?
>
> Thanks to whoever can help out!
Posted by Janelle on May 7, 2002, at 18:16:08
In reply to Re: HELP! BiPolar2 with severe depr and mild mania » Janelle, posted by wendy b. on May 7, 2002, at 17:41:01
Hi WendyB:
Words can't express how much your message on here about PBAdmin mean to me. I feel so much better having had that time off and away from the boards to reflect (even as you said, if it wasn't chosen BY me but chosen FOR me). I still can't believe how suddenly I had that *revelation* and came up with those reasons (thanks for saying they were good!) why why the 2000 and 2001 boards might be ok! IMHO, I can now say that they sure ARE okay!
Thanks ever so much for saying that it WAS a courageous post (as often, I was nervous hitting the "confirm" button to post it!) and that was very kind of you to indicate that you appreciated it. ITA with you (and finally realized myself!) that everyone should lighten up and enjoy themselves, cuz we sure DO have enough other stuff to worry about!
As for the other question I had on PBAdmin, Thanks for your opinion that you don't think you should refrain from posting messages to Dr B, if they're legitimate questions. I see them as legit questions, but I fear that Dr. B does not see them this way, and I still worry that I've offended and bugged him (too much) so that he won't bother with my PBA posts.
You are so RIGHT that there are times when we might need to know something from the horse's mouth, so to speak but perhaps my questions which I thought I needed to get answers from him on, don't need that. I'm rather confused and a wee bit upset about the *legitimacy* of my questions!
Which FAQ should I read - you said "So if you've read the FAQ and other info" ??
I don't know WendyB, while I appreciate and understand what you're saying about if I still have a question, ask away, and the Admin Board IS indeed the place to ask Admin-type questions, I'm feeling gun-shy now (a better, perhaps more accurate way of putting it than paranoid).
There is something else I'd like to share with you about a concern I have with the whole question/response issue ... if you don't mind, could you give me your email address (only if you feel comfortable doing that) under here and I will contact you that way. I really need someone to talk to about it and you have a handle on what I've been feeling about possibly bugging Dr. B to the point where he might feel he has to avoid me. If you don't want to e-mail with me, that's fine, no problemo. Let me know here either way! :-)
As for my BIPOLAR question, thanks for sharing your positive response to Neurontin. Your shrink sounds wise not to move you to the "big guns" (depakote or lithium) because of the liver issues. Mine, unfortunately, throws meds at me and poo-poo's concerns about liver problems, etc,.
I can understand how Lamictal scares you because of the rash thing (especially since you have sensitive skin). I happen to also have VERY sensitive skin, so each time I was on Lamictal, my pdoc had me titrate up so slowly from a pediatric/micro dose (I'm talking 2mg/day!) up to 100mg/day over a long course of time and I had NO rash! :-) Low and slow seems to be the way to avoid the rash.
I had a feeling based on what I've read that Neurontin is relatively easy on the body because I get the impression it is *mild* (which could be why high doses are needed for it to work properly).
I am also VERY sensitive to new meds (I must be started at VERY low doses; have had terrible reactions to starting at even medium doses), so I also agree with what you said about asking my pdoc to start me in the evening, with a relatively easy dose (200-300 mg at bedtime) for about a week, so my body will have time to recognize and adjust to it.
I am very sensitive to possible sedation and dizziness, another reason to introduce Neurontin low and slow!
From what you (and others have written), Neurontin is a med one has to take several times/day (oh gosh, I'm bad at that - I like the once-a-day or extended release ones) - I also have memory problems and forget to take meds during the course of a day. Oh well ... I'll have to work on that if I go on Neurontin!
As for Wellbutrin, my pdoc is adamantly against me trying that one because I am such an anxious person, with agitated depression and Wellbutrin is activating and can cause agitation. Actually, I talked her into letting me try it once awhile ago and wow was I ever irritable on it. So, unfortunately, Wellbutrin is not a possibility for me.
Again, WendyB, thanks for EVERYTHING you wrote to me! :-)
-Janelle
Posted by Ritch on May 7, 2002, at 22:06:35
In reply to HELP! BiPolar2 with severe depr and mild mania:, posted by Janelle on May 6, 2002, at 21:40:06
> I have been diagnosed as BiPolar2, and in my case I have SEVERE depression but only mild mania episodes.
>
> I'm trying to find a mood stabilizer that would be most effective for this particular set of symptoms. Failed miserably on Lamictal (induced intense anxiety) and Depakote (induced more and more depression).
>
> Any ideas? I'd like to find a mood stabilizer that works more on the depression side of BiPolar2 than on the mania side, since I have much more of depression than mania - would Neurontin be a good next one for me to try?
>
> Thanks to whoever can help out!
Hello again,The first antimanic agent I was on was lithium for many years. I got switched to Depakote during a depression and the depression got worse.
I added-on Neurontin during a BP depression to the mix of Depakote+Klonopin+Celexa and felt so much better I stopped the other three (which was a mistake!). It is worth a try. It acts fairly quickly. Bottom line: during a depressive episode the "mood stabilizers" that have worked the best for me are Neurontin and Lithium. What about that combo?you never know...
Mitch
Posted by wendy b. on May 7, 2002, at 22:13:09
In reply to WendyB: wow, U're so kind, please read more here: » wendy b., posted by Janelle on May 7, 2002, at 18:16:08
Janelle,
You can e-mail me at :
kolepp at ivillage dot com
(can you read this? did you see on Admin, I think it was, that this is the better way to post your e-mail, cuz then it can't be looked up by search engines, can't remember who told us to do it this way, trouble, I think...)
For FAQ, see:
http://www.dr-bob.org/babble/faq.html
For Statistics (might give you a better idea what we're being guinea pigs for, sorry to all you guinea pigs out there), see:
http://www.dr-bob.org/babble/stats/
For research interests of Dr. Bob:http://www.dr-bob.org/babble/research.html
All these links can be found at the bottom of any of the PB board pages... The more informed you are the better the questions you can ask...
Please check the admin board thread, I'll go there (seems more appropriate than here) and try to answer your question, if I can...
But again, please do not feel that you have rubbed Dr B the wrong way, you have been so easy compared to many we've seen him have to dole out 'punishment' to!! He's just not that kind of person, a very compassionate, even-handed guy if there ever was one. So don't invent something to feel badly about, ok?
take care, e-mail if you want to...
Wendy
Posted by JohnX2 on May 8, 2002, at 1:50:34
In reply to HELP! BiPolar2 with severe depr and mild mania:, posted by Janelle on May 6, 2002, at 21:40:06
> I have been diagnosed as BiPolar2, and in my case I have SEVERE depression but only mild mania episodes.
>
> I'm trying to find a mood stabilizer that would be most effective for this particular set of symptoms. Failed miserably on Lamictal (induced intense anxiety) and Depakote (induced more and more depression).
>
> Any ideas? I'd like to find a mood stabilizer that works more on the depression side of BiPolar2 than on the mania side, since I have much more of depression than mania - would Neurontin be a good next one for me to try?
>
> Thanks to whoever can help out!Janelle,
As I mentioned before you switched to Depakote, the Neurontin
add on to Lamictal may reduce the Lamictal agitation.Also as Mitch has noted, AD's can be like "earthquakes" for
people with bipolar diagnosis. A lot of doctors like to add
the ADs in slowly with the mood stabilizer.Can I ask a question? Did the Depakote help with the
"racing, intrusive" thoughts?Neurontin is a good medicine to help with agitation and
anxiety. I believe for more people it has a bit of an
antidepressant property and less of an anti-manic property.
If your racing,intrusive thoughts are anxiety related then
Neurontin may help.Maybe the idea stated of a Depakote+Neurontin combo is not
bad to try. If the Depakote is helping with the mild hypomania,
maybe you could maintain or lower the Depakote dose and add
on the Neurontin.Another mood stabilizer option would be to try something like Trileptal.
Trileptal (derivative of Carbamazepam), I found has pretty
good AD effects and mood stabilization. The medicine is quick acting
like Depakote.Best Wishes,
John
Posted by Janelle on May 8, 2002, at 2:01:45
In reply to Re: HELP! BiPolar2 with severe depr and mild mania: » Janelle, posted by JohnX2 on May 8, 2002, at 1:50:34
John,
Thanks for the info/answers.
To respond to YOUR question - To a certain extent, yes, the Depakote helped with the "racing, intrusive" thoughts. However, NOT completely which other meds (Klonopin being one) have given me (total relief from such thoughts, they're *gone*!)
The answers I've gotten have been amazingly consistent in terms of recommending NEURONTIN! I am definitely going to mention it to my pdoc.
I need exactly what you said Neurontin has - a bit of an antidepressant property and less of an anti-manic property. My racing,intrusive thoughts are DEFINITELY anxiety related. I have very mild mania episodes, repeat very mild and not very often. I'm far more inclined to bad and frequent depression.
Thanks again for responding!
-Janelle
Posted by JohnX2 on May 8, 2002, at 2:31:18
In reply to JohnX2 - Re: Depakote, etc. » JohnX2, posted by Janelle on May 8, 2002, at 2:01:45
> John,
>
> Thanks for the info/answers.
>
> To respond to YOUR question - To a certain extent, yes, the Depakote helped with the "racing, intrusive" thoughts. However, NOT completely which other meds (Klonopin being one) have given me (total relief from such thoughts, they're *gone*!)
>
> The answers I've gotten have been amazingly consistent in terms of recommending NEURONTIN! I am definitely going to mention it to my pdoc.
>
> I need exactly what you said Neurontin has - a bit of an antidepressant property and less of an anti-manic property. My racing,intrusive thoughts are DEFINITELY anxiety related. I have very mild mania episodes, repeat very mild and not very often. I'm far more inclined to bad and frequent depression.
>
> Thanks again for responding!
> -JanelleJanelle,
As an additional thought -- do you take fish or flaxseed oil
supplements?Fish-oil (omega-3's) have been shown to be effective for many
stabilizing bipolar and reducing anxiety. Flax Seed oil has some
of the same therapeutic compounds. Note: a few people have reported
hypomanic responses. NEED A GOOD BRAND with vitamin C + E.John
Posted by Janelle on May 8, 2002, at 2:56:27
In reply to Re: JohnX2 - Re: Depakote, etc. » Janelle, posted by JohnX2 on May 8, 2002, at 2:31:18
Hi John,
I do take a supplement called "Total EFA" which has all the omega oils because I've heard that the omegas (3 and 6 I think) have been shown to be effective in stabilizing bipolar (didn't know about them also helping with reducing anxiety.)
However, I didn't know about needing a brand that has Vitamin C and E in it. Mine just has the omega oils.
Also, didn't notice on the jar till just recently that it has to be taken several times/day -- I had been taking only one/day! I've increased it now!
Thanks for the info!
-Janelle
Posted by CtrlAlt n Del on May 9, 2002, at 1:41:07
In reply to It is worth a try..., posted by Uppendown on May 6, 2002, at 22:59:00
! Like.. I hallucinate lots! LOL!
hi there **sparky** :)
Just curious ..what do you hallucinate?..you don't have to answer..
Like do you have problems driving or worry that you've left the gas on , that it may of been a hallucination that you turned it off..
Actually I don't know if I hallucinate -strong illusions I get continually and visions flashing often.
Are hallucinations almost tangible, is it like arrrrgg here comes the giant slinky or is it just semi opaque absract , colour, shape?
Sorry to butt in the thread...I'm interested.dreamer
This is the end of the thread.
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