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Dr. Bob is Robert Hsiung, MD,
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Posted by Maxime on January 9, 2005, at 19:29:16
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 9, 2005, at 18:04:11
Hi
Have you tried an MAOI as your antidepressant? Parnate would be a good one for you since it is stimulating. It is least like to bring on hypomania.As for a mood stabiliser. Try taking niacin which is really good for irritability. There are some anti-arhythmia heart meds as well that work well as stabilisers and some for Parkisons as well.
Here is a link to different meds for bipolar meds many of which you might not have thought of trying.
http://home.comcast.net/~pmbrig/BP_pharm.html
I hope you find relief soon.
Maxime
Posted by Maxime on January 9, 2005, at 19:32:46
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
Actually your symptoms when I read them SOUND like depression alone. I am assuming there is a reason why you were dx'd bp2? What was it?
Maxime
> Hi, this site has been very informative, so first I need to say thanks.
>
> Now for the problem...I have tried almost everything with only limited temporary help (or such severe side effects, I had to stop). This list includes: Prozac (regular and weekly), Paxil (regular and CR), Zoloft, Serzone, Trazadone, Wellbutrin (regular And XR), Effexor (Regular and XR), Trycyclics (can't remember which ones, sorry), Depakote, Trileptal, Lithium, Lamictal, Topamax, Zyprexa, Abilify,Valium, Klonopin, Xanax, Ritalin, Dexedrine, Adderall, atenolol, Risperdal, Provigil, Ambien, Buspar, and probably some I can't remember right now.
>
> My symptoms include IRRITABILITY, lethargy, lack of motivation, moodiness, insomnia and the need to sleep all the time (sounds weird but I am sure someone can relate)and did I mention irritability?
>
> So my question is: Any advice on where to go next? The SSRI's gave temporary with little relief (note: I did not ever get full relief) and the rest had such severe side effects, I can't tolerate them. But I need some help.
>
> Any advice is greatly appreciated. Thanks, Michelle
Posted by Michelle123 on January 10, 2005, at 17:37:22
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle, posted by Maxime on January 9, 2005, at 19:29:16
> Hi
> Have you tried an MAOI as your antidepressant?
No but My doctor has recommended Parnate, just been scared cause I live on coffee, chocolate and pizza....
>
> As for a mood stabiliser. Try taking niacin which is really good for irritability. There are some anti-arhythmia heart meds as well that work well as stabilisers and some for Parkisons as well.
>
I will definitely look into that- thank you and will go to the web site as well
>
>
> Again thanks to all!
Michelle
>
Posted by CareBear04 on January 10, 2005, at 22:09:53
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
hi michelle,
i just read your post and haven't read any of the followups. i just wanted to say that i'm with you right now and understand how frustrating it is. i've been diagnosed as BPII, too, and i've been through all the meds. right now, my primary mood stabilizer is lamictal, 200mg, and i don't think it's a high enough dose, or else lamictal is just worthless. lithium has always worked really well for me, but in the past few months, i got really toxic over and over and my body keeps rejecting even small doses. i feel like i need to be back on it, though, because my mood is slipping fast right now, and i don't know of anything else that will help. i was in the hospital for my insurance-alloted 10 days in november. it was my third psych hospialization in two years, and all it did for me was affirm that no psych unit in the world can help me b/c i'm too strong-willed to be submissive and docile like they want you to be in the hospital, and i ask too many questions and have read too many books and stuff. i'm on a horrible mess of meds right now; i can't even remember them all-- lamictal, zoloft, prozac, haldol, percocet, ambien, klonopin, xanax, zofran, phenergan, adderall, and i'm sure i'm forgetting others. i'm restricted from taking courses until i get off the heavy-duty narcotics, and i have all these other restrictions on my life to the point that i feel tied up and stuck for both psych and physical reasons. like you, i need something that works. i'll try to catch up on the replies, and i hope people have been able to help you, but i just wanted to let you know that i'm frustrated, too, and you're not the only one. take care.
Posted by Lyrical13 on January 11, 2005, at 14:33:20
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle, posted by Michelle123 on January 10, 2005, at 17:37:22
> > Hi
> > Have you tried an MAOI as your antidepressant?
> No but My doctor has recommended Parnate, just been scared cause I live on coffee, chocolate and pizza....
>The caffeine in the coffee and chocolate are probably not helping your sleep issues. Chocolate has an even higher level of caffeine than coffee does. Personally I avoid caffeine because it exacerbates several of my health problems. Mainly in terms of blood sugar and anxiety. Caffeine is a stimulant...so if you have anxiety or sleep issues, it's going to cause problems with body chemistry even hours after you consume it. On the occasions that I do have something with caffeine I definitely notice it...much more jittery and anxious. also in terms of hypoglycemia, the adrenal gland is involved in regulating blood sugar...for hypoglycemics, our bodies produce too MUCH insulin or when the body is triggered to release insulin to metabolize sugar in the blood, we keep dumping more insulin which then results in low blood sugar. I'm probably getting too complicated here, but that prompted another thought..... you might also be hypoglycemic....it mimics the symptoms of several different conditions including sleep issues (not sleeping or sleeping too much) depression, anxiety and many other things. and I have talked to a couple of people who are both bipolar and hypoglycemic. I'm not a doctor though. This is something you'll have to check out for yourself. I do notice though that when my blood sugar has been messed up, I don't sleep as well. Something to think about.....
Good luck
Lyrical
Posted by Michelle123 on January 11, 2005, at 18:58:41
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need H » Michelle123, posted by CareBear04 on January 10, 2005, at 22:09:53
> hi michelle,
> i just wanted to say that i'm with you right now and understand how frustrating it is. and you're not the only one.Sorry to hear that you are feeling this way too. I will say that going off of everything has been somewhat helpful lately. I am now taking only the fish oil. I am a little anxious (I guess ~ jittery and irritable) but am able to work. So either the cycle is winding down, or I am better off without some of the side effects. However, I do think that going off the SSRI's was tougher than anything I ever did. But it may be worth it not to feel so tired, hungry and flat.
Now to try and find something to calm my nerves without sedating me. (Hey that may be my next topic.)
Take care
Michelle
Posted by CareBear04 on January 12, 2005, at 1:55:31
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle, posted by Maxime on January 9, 2005, at 19:29:16
maxime, can parnate be used in combination with other psych meds, or are there too many interactions? i've heard it can be really effective, so i asked a dr about it recently, and he said that it was meant to be used sort of as monotherapy and it was a measure of last resort. i'm on a lot of benzos, pain meds, adderall, SSRIs, and others. i know the SSRIs would have to go, but do you know what else? thanks!
Posted by Maxime on January 12, 2005, at 21:36:42
In reply to Re: Bipolar ll: Tried it all! Nothing -Michelle » Maxime, posted by CareBear04 on January 12, 2005, at 1:55:31
Hi
Yes, the SSRI would have to go. But I take Adderal, klonopin and trileptal with Parnate.I also take thorazine when I need it. You can even take a small amount of a trycyclic although it is SUPPOSE to be contraindicated.
So you can it with other psych meds.
Maxime
> maxime, can parnate be used in combination with other psych meds, or are there too many interactions? i've heard it can be really effective, so i asked a dr about it recently, and he said that it was meant to be used sort of as monotherapy and it was a measure of last resort. i'm on a lot of benzos, pain meds, adderall, SSRIs, and others. i know the SSRIs would have to go, but do you know what else? thanks!
Posted by zero on January 13, 2005, at 0:08:52
In reply to Bipolar ll: Tried it all! Nothing works-Need HELP, posted by Michelle123 on January 8, 2005, at 12:30:41
Since you seem to be stressing the IRRITABILITY part, it brings to mind the place where bipolar meets borderline (are lots of theories on this).
For this, there's a combination of Prozac (start 1st, take daily for 1 week), then add Tegretol (mood stabilizer).
I can't tolerate Prozac, but Tegretol helps me big time with IRRITABILITY, plus your list indicates you haven't tried Tegretol yet (don't mistake it for Trileptal, it's chemical cousin - very different effects). Tegretol is great for anxiety also.
Hope this helps.
z.
(Bipolar II w. Irritability, Anxiety)
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Posted by Ritch on January 13, 2005, at 10:23:49
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need H » Michelle123, posted by zero on January 13, 2005, at 0:08:52
> Since you seem to be stressing the IRRITABILITY part, it brings to mind the place where bipolar meets borderline (are lots of theories on this).
>
> For this, there's a combination of Prozac (start 1st, take daily for 1 week), then add Tegretol (mood stabilizer).
>
> I can't tolerate Prozac, but Tegretol helps me big time with IRRITABILITY, plus your list indicates you haven't tried Tegretol yet (don't mistake it for Trileptal, it's chemical cousin - very different effects). Tegretol is great for anxiety also.
>
> Hope this helps.
>
> z.
> (Bipolar II w. Irritability, Anxiety)Hi, sorry to switch gears somewhat, but you brought up a very interesting topic about the difference between Trileptal and Tegretol. I've only tried Tegretol once (a long long time ago) during a bad depression (as a switch from Lithium) and it didn't seem to help the depression ... but I only tried switching for a couple of weeks and then went back to lithium. Anyhow, I've been on Trileptal for a few weeks in the last few years and found I couldn't tolerate it due to bad nausea. So you have been on Teg and Trileptal at separate times and found the Tegretol to be different? Can you elaborate somewhat on what the differences were? Just curious, because I got a REALLY good anticyclic response from Trileptal (better than anything else in fact), and it worked on irritability just as good as Depakote. Just wondering if maybe I would actually tolerate Tegretol a lot better than Trileptal and it would work just as well....
Posted by ed_uk on January 13, 2005, at 10:44:35
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » zero, posted by Ritch on January 13, 2005, at 10:23:49
Hi!
Just wanted to add that Trileptal is very rarely prescribed in the UK but Tegretol is used all the time.
Ed.
Posted by Ritch on January 13, 2005, at 12:49:19
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » Ritch, posted by ed_uk on January 13, 2005, at 10:44:35
> Hi!
>
> Just wanted to add that Trileptal is very rarely prescribed in the UK but Tegretol is used all the time.
>
> Ed.
Hi, my pdoc doesn't want to use Tegretol because of all the potential drug interactions (liver-enzyme induction). Trileptal is *supposed* to be the *same* as Tegretol without the drug interaction risks. This is great for people with epilepsy who are on multiple AED's whose serum levels are altered profoundly by using Tegretol (carbamazepine) in the mix. What I am wanting to find out about is .... what's the difference in the effects of taking either drug (given an "equivalent" dosage)?? And even more specifically, for me personally, is ... has anybody *tolerated* Tegretol and then switched to Trileptal (at an equiv. dosage), and then found that they *couldn't tolerate* the Trileptal?? I just wonder if the "Trileptal is the same as Tegretol except it is safer and cleaner" is true for BIPOLAR, or whether that is somewhat mythological. Bottom line, could I nearly 100% expect the same nausea from Tegretol if I went on it that I experienced with Trileptal?
Posted by CareBear04 on January 13, 2005, at 14:07:22
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need H » Michelle123, posted by zero on January 13, 2005, at 0:08:52
hey zero,
i too am a little confused about the difference between tegretol and trileptal and why trileptal shouldn't be better since isn't the same base drug, just newer and cleaner? is it an isolated active isomer or something, the same as teg without as many side effects?
someone else mentioned that teg/trileptal was useless for depression. that's what i've heard, too, though i've never tried either. i was on depakote briefly and didn't like it, so the drs say teg/trileptal is basically the same effect. i have much blacker depressions-- they are the bigger problem than manias-- so i've used lithium succesfully and recently, lamictal. i think the lamictal is pretty weak, personally. it may be doing something for the depression, but i've had handfuls of hypomanic episodes in the past two or so months, whereas lithium kept me grounded at both ends. interested in hearing about experiences like these.
Posted by ed_uk on January 13, 2005, at 15:23:39
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » ed_uk, posted by Ritch on January 13, 2005, at 12:49:19
Hello Ritch,
>Trileptal is *supposed* to be the *same* as Tegretol without the drug interaction risks.
Trileptal and its active metabolite do inhibit the cytochrome P450 isoenzyme CYP2C19. Trileptal and its metabolite also have the capacity to induce CYP3A4 and CYP3A5. Trileptal induces hepatic enzymes to a lesser extent than Tegretol.
Are you on any drugs which might interact with Tegretol or Trileptal?
>what's the difference in the effects of taking either drug (given an "equivalent" dosage)??
I would expect them to be somewhat similar- although the efficacy of Tegretol in bipolar disorder is better established. A pubmed study said 'The mechanism of action of Trileptal involves mainly blockade of sodium currents but differs from Tegretol by modulating different types of calcium channels.'
>I just wonder if the "Trileptal is the same as Tegretol except it is safer and cleaner" is true for BIPOLAR, or whether that is somewhat mythological.
Some similarities and differences between Tegretol and Trileptal.......
1. Trileptal seems to cause hyponatremia more frequently than Tegretol. Symptoms include lethargy, restlessness and confusion. With Trileptal, hyponatremia is usually mild but 'hyponatraemia occurred in 23% of 350 patients whose serum-sodium concentrations were monitored.' In the rare cases where severe hyponatremia occurs, seizures and coma may result.
2. Hypersensitivity (allergic-type) reactions such as skin rashes occur less frequently with oxcarbazepine (Trileptal) than with carbamazepine(Tegretol). However, cross-sensitivity does occur and about 25 to 30% of patients hypersensitive to carbamazepine may experience such reactions with oxcarbazepine.
3. Trileptal appears to cause leucopenia less frequently than Tegretol. Thrombocytopenia has been reported rarely with Trileptal, as is the case with Tegretol. The risk of serious blood disorders is said to be lower with Trileptal.
4. Hepatitis has been reported rarely with Trileptal, as is the case with Tegretol.
5. Apparantly 'switching from Tegretol to Trileptal normalized Tegretol-associated thyroid and sexual hormone abnormalities and pathological lipid values in small patient samples.'
'Trileptal has been reported to be a preferable antiepileptic drug, when compared to Tegretol with respect to its effects on lipid metabolism, especially cholesterol, high-density lipoproteins, and low-density lipoproteins.'
6. In one study 'More adverse events were self-reported with Tegretol (63%) than the other treatments (Trileptal 12%,, placebo 5%). Tegretol induced the greatest motor slowing (p = 0.002), followed by Trileptal (p = 0.01).'
7. 'The pharmacokinetic profile of Trileptal is less complicated than that of Tegretol, with less metabolism by the cytochrome P450 system, no production of an epoxide metabolite, and lower plasma protein binding.'
8. Cases of Systemic Lupus Erythematosus (SLE / 'Lupus') have been reported with both drugs.
9. A study in 1989 found that 'Trileptal caused significantly fewer (P = 0.04) severe side effects than Tegretol; global evaluation of tolerability demonstrated a trend towards the better tolerability of Trileptal.'
Sorry, can't be sure about the nausea. You'll have to try it!!!Regards,
Ed.
Posted by Maxime on January 13, 2005, at 22:20:13
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » ed_uk, posted by Ritch on January 13, 2005, at 12:49:19
The ONLY difference, which makes ALL the difference is that Trileptal has the same chemical make up as Tegretol EXCEPT it has an oxygen atom attached to it.
With Trileptal you don't have worry about drug interactions or getting blood levels. I couldn't tolerate Tegretol but Trileptal has been a dream. It's the only mood stabiliser I can take. It has been around for a long time in France apparantly.
Maxime
> > Hi!
> >
> > Just wanted to add that Trileptal is very rarely prescribed in the UK but Tegretol is used all the time.
> >
> > Ed.
>
>
> Hi, my pdoc doesn't want to use Tegretol because of all the potential drug interactions (liver-enzyme induction). Trileptal is *supposed* to be the *same* as Tegretol without the drug interaction risks. This is great for people with epilepsy who are on multiple AED's whose serum levels are altered profoundly by using Tegretol (carbamazepine) in the mix. What I am wanting to find out about is .... what's the difference in the effects of taking either drug (given an "equivalent" dosage)?? And even more specifically, for me personally, is ... has anybody *tolerated* Tegretol and then switched to Trileptal (at an equiv. dosage), and then found that they *couldn't tolerate* the Trileptal?? I just wonder if the "Trileptal is the same as Tegretol except it is safer and cleaner" is true for BIPOLAR, or whether that is somewhat mythological. Bottom line, could I nearly 100% expect the same nausea from Tegretol if I went on it that I experienced with Trileptal?
Posted by CareBear04 on January 13, 2005, at 22:28:24
In reply to Re: Bipolar ll: Trileptal vs. Tegretol, posted by Maxime on January 13, 2005, at 22:20:13
maxime, does trileptal help you when you're in depressed states, or is it better for reigning in mania? or is it good enough to keep these extremes from happening? that would be nice. thanks!
Posted by CareBear04 on January 13, 2005, at 22:29:57
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » Maxime, posted by CareBear04 on January 13, 2005, at 22:28:24
oh also, have you tried depakote? can you compare it to trileptal (e.g., is it as sedating, cause weight gain, stuff like that)? thanks!
Posted by Ritch on January 14, 2005, at 9:28:37
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » Ritch, posted by ed_uk on January 13, 2005, at 15:23:39
> Sorry, can't be sure about the nausea. You'll have to try it!!!
>
> Regards,
> Ed.
>
>THANKS! That was a great set of info. What a drag I couldn't tolerate Trileptal. I can take 150mg and get a pronounced antimanic effect within a couple of hours (i.e. in the midst of a hostile mixed set of symptoms), but if I continue to take more than 150mg/day (i.e. 225-300+), I develop a slowly worsening nauseous state. The only thing that looked somewhat "hopeful" was the increased hyponatremia risk with Trileptal vs. Teg. But the tendency to reduce serum sodium probably has nothing to do with mechanisms that are creating the nausea... Thanks.
Posted by CareBear04 on January 14, 2005, at 16:40:45
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » ed_uk, posted by Ritch on January 14, 2005, at 9:28:37
ritch, would an antiemetic to go along with the trileptal help? it seems like if trileptal worked so well for you, there have to be other ways to stay on it instead of dropping it just because of nausea. i don't know if all drs, especially pdocs approve, but for med-induced nausea, i've tried reglan, phenergan, and zofran for the past two months. reglan was ineffective, but it was good for GI motility. phenergan is available as generic, and it's defeinitely better than reglan. i think it's more for motion sickness type nauseas, but i'm not sure. it has helped me significantly, though. zofran is maybe the best, but it costs more than an arm and a leg. i used mail order to pay a lower copay, and they put major restrictions on how much you can take. my doctor wrote for 3x a day, and the pharmacy would only fill one a day-- they gave me 36 pills, and i can't refill till sometime in february or even march. ridiculous! but even for just 36 pills, the cost was about $570. i thought atypical antipsychotics or stomach proton pump inhibitors were expensive, but nothing compared to $15+ for a single pill!
still, antiemetics have helped me a lot. they've helped me keep down unpleasant medications and have helped with motion sickness, which is a recent phenomenon. i've found that they work best when i take them regularly, whether or not i feel nauseated. when i miss a dose, i sometimes have breakthrough vomiting and horrible hangover type feelings without the fun of alcohol.
one concern is that most antiemetics work by hitting the neurotransmitters, too. i think many are dopamine antagonists, which can cause extrapyramidal effects just like antipsychotics. zofran is a serotenergic drug. and used together, there's a risk of CV effects like prolonged QT interval and stuff. i don't know much about this stuff, except to be careful.
still, you might find that if trileptal is effective for you with the exception of nausea, antiemetics might be an option worth trying. le me know what you think.
Posted by SLS on January 15, 2005, at 8:31:50
In reply to Re: Bipolar ll: Tried it all! Nothing works-Need H, posted by Maxime on January 9, 2005, at 19:32:46
> Actually your symptoms when I read them SOUND like depression alone.
This was my initial reaction as well.
- Scott
Posted by Ritch on January 15, 2005, at 14:11:46
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » Ritch, posted by CareBear04 on January 14, 2005, at 16:40:45
Thanks for your concern and advice. When I was taking Trileptal and I was trying to increase the dose I was taking meclizine with some success. I just don't want to take another med to counter the nausea. Depakote works nearly as well and I can tolerate it a lot better. Dep. just doesn't work on depression worth a hoot and Trileptal seemed to help with that better plus I slept better on it.
Posted by Maxime on January 15, 2005, at 22:23:06
In reply to Re: Bipolar ll: Trileptal vs. Tegretol » Maxime, posted by CareBear04 on January 13, 2005, at 22:28:24
Hi - it keeps the extremes from happening. Sometimes I still go hypomanic or have a mixed state, but it's rare and I haven't had a manic episode since I started taking it. It does nothing for depression.
Maxime
> maxime, does trileptal help you when you're in depressed states, or is it better for reigning in mania? or is it good enough to keep these extremes from happening? that would be nice. thanks!
Posted by Maxime on January 15, 2005, at 22:26:16
In reply to Re: Bipolar ll: Trileptal vs. Tegretol, posted by CareBear04 on January 13, 2005, at 22:29:57
> oh also, have you tried depakote? can you compare it to trileptal (e.g., is it as sedating, cause weight gain, stuff like that)? thanks!
Yes I was depakote but it was too sedating. So sedating I didn't notice the weight gain.
At first Trileptal made me dizzy and nauseous but it went away after two weeks. I lost the weight I gained on Depakote. It's almost weight neutral. It has the least amount of side effects of any meds I have been on.
Maxime
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