![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 81 to 105 of 116. Go back in thread:
Posted by Sabino on June 30, 2005, at 19:33:04
In reply to Re: More newbie Lithium questions » Sabino, posted by yesac on June 27, 2005, at 14:11:16
>> And like I said before, I do feel like it never ends, which is depressing in itself. Like, I still feel as though I'm working at finding the right drugs--- <<
Man, I so completely agree with this. What a struggle. My initial tremendous response to Li is now not as tremendous. Sometimes, when I feel really wound up, and I take at least 150, it calms me right down, and is a godsend. Today makes two weeks that I've been trying it. There have been times these last couple of days that I've felt as nervous as a cat on a hot tin roof. But I've only been taking a small amount.
I guess I really need to try upping the dose to see if that'll be okay. Today I'm almost up to 600mgs. I chip away at the tabs throughout the day to try and even it out, even though they're supposed to be sustained release (damned fast metabolism strikes again.)
Plus, today was just my second day back at work after taking two months off, and truth be told, I don't feel all that much better now than I did two months ago. At least I can joke about it a little bit. Like saying 'what's the office pool up to on how long I'll stay'. See, I tried to go back a couple of weeks ago, and lasted five minutes before my anxiety attack had me heading for the door.
Anyway, I'm still trying to tweak this thing too.
Effexor XR 150mgs
Remeron 15mgs (for sleep)
Lithium (around 500mgs)That's my story and I'm stickin to it... til I find a better one.
Posted by crazyteresa on July 1, 2005, at 10:32:30
In reply to Re: Does anyone like lithium? » crazyteresa, posted by ed_uk on June 29, 2005, at 21:14:49
> Hi!
>
> Can you try 450mg/day. It can be so much better when the dose is right :-)
>
> ~EdI'll try it just for you! ;~}
crazy t
Posted by barbaracat on July 1, 2005, at 13:08:45
In reply to Re: Vive le Lithium! » barbaracat, posted by Maximus on June 30, 2005, at 13:57:13
Hi Maximus,
Most of the research I found was pretty much based on findings new to 1998 when this article was published, but I think this one explains it clearly. I can imagine that they'll find a genetic anomaly in bipolars that account for a faulty glutamate set-point. The questions is, if low glutamate levels supposedly account for the depression phase of bipolar and vice-versa, why isn't glutamate used more to tweak low and high moods? The amino acid L-glutamate is a supercharged excitatory amino acid, so why isn't anyone looking in this area?Newer research also points to glutamate not clearing from the cells because there aren't enough glial cells in bipolars to mop it up. Now, how one gets more glial cells is the questions, however, rumor has it that lithium actually makes more of the little buggers! Good old lithium. Not only makes you feel good - it's good for you!
Here's an article found in a number of websites:
NEW RESEARCH EXPLAINS LITHIUM'S DUAL ANTI-MANIC/ANTI-DEPRESSIVE EFFECT
MADISON, WI. -- July 6, 1998 -- Researchers at the University of Wisconsin Medical School have solved the puzzle of how one drug - lithium - can effectively stabilise both the wild euphoria and the crushing melancholy that are the hallmark of manic depression, or bipolar disorder.
As reported in the July 7 Proceedings of the National Academy of Sciences, the researchers found that in mice brains, lithium exerts a push/pull effect on the neurotransmitter glutamate, eventually causing it to level off in a stable zone where it can control both extremes.
“Glutamate is the primary excitatory neurotransmitter, carrying messages instantaneously from one nerve cell to another in 85 percent of the brain,” said UW Medical School professor of pharmacology Dr. Lowell Hokin, who directed the research. Other neurotransmitters include serotonin, dopamine, norepinephrine and acetylcholine.Under normal circumstances, an impulse from a nerve cell releases a flood of message-bearing glutamate aimed at a neighboring neuron across the synapse. A structure on the end of the releasing nerve cell, called a reuptake transporter, then shuts off the signal by reabsorbing the glutamate, pumping it back into the cell for reuse.
If the reuptake mechanism malfunctions, inappropriate concentrations of neurotransmitter remain in the synapse. Hokin postulates that abnormally low glutamate levels are involved in depression, while elevated levels are responsible for mania.
Nearly a half century ago, Australian psychiatrist John F. Cade discovered lithium’s mood-stabilizing effect. It has long been the drug of choice in treating bipolar disorder, which affects approximately 2.5 million Americans. Despite some side effects, lithium usually successfully dampens the mood swings that in the most severe cases end in suicide, the dire result for one in five untreated or unresponsive bipolar patients.
In an earlier study (reported in PNAS, Aug. 30, 1994), Hokin and his colleague showed that lithium causes glutamate to accumulate in synapses of mice and monkey brain slices, but exactly how it worked remained unclear until now.
In the current study, functioning slices of mice brain were examined following exposure to lithium, while control slices were not exposed to the drug. The researchers observed that lithium raised the glutamate level by slowing its reuptake. The higher the lithium dose, the greater the inhibition, they found.
To study the chronic effect of the lithium, the UW team administered it to live mice for two weeks. To their surprise, they saw that glutamate reuptake increased. This “up-regulation” resulted in less neurotransmitter in the synapse, which would produce an anti-manic effect.
“We were especially interested to find that the reuptake mechanism in the 18 lithium-treated mice was stabilised in a very narrow range, compared to the 18 controls,” he said.
Hokin speculates a compensatory mechanism in the reuptake system strives over time to reset raised glutamate levels down into a fixed range. When the levels are too low, as postulated in depression, lithium brings them up into the stable region.
The research findings support clinical observations, he noted. “It takes a few weeks before lithium begins to relieve depression and mania in bipolar patients,” he said. “It’s now apparent an adaptive reuptake mechanism that brings glutamate within a ‘normal’ range works over time to curb both the highs and lows.”
What’s more, he added, lithium doesn’t change the moods of people who aren’t bipolar, suggesting that their glutamate levels may be positioned consistently within the set zone, and therefore would not be affected by the drug.
Posted by barbaracat on July 1, 2005, at 13:26:43
In reply to Re: Vive le Lithium! Maximus/Barbaracat, posted by yesac on June 30, 2005, at 17:55:17
I've heard also that lithium responds better to bipolar I and I believe that's what I am. Other mood stabilizers that have worked for BP-II acquaintenances have done nothing for me.Most of my bipolar episodes have fallen in the milder II class, but I have had some absolute corker manias complete with hallucinations and hellish psychotic mixed states depressions which I understand is a BP-I phenomenon. All you need is one truly classic BP-I experience to know how different it is from BP-II. Unlike going from a 3-speed to a 10-speed bike, or dial-up to DSL, it's not just a matter of same thing but higher speed and intensity, but something different altogether. For me, I'd have to say the difference is greater intensity, but with definite psychosis, both enjoyable and horrific.
It feels distinctly electric to me. In fact, with many of the artists labeled 'bipolar', you can see this electric quality to their paintings, jaggy spiky outlines and such.
I read about glutamate, calcium and so on, but my gut feeling is that lithium, being an elemental metallic salt, is primarily electically conductive and that's where the business goes on. - Barbara
> >> I wonder the same thing. None of the other mood stabilizers, anticonvulsants do a thing for me, only lithium. I've been on the trail of how it works for some time and, as with most research when they don't know, theories keep changing. But I'm doubly intent on finding out now after this recent experiment because whatever it is that makes us so susceptible to what lithium does no doubt affects other bodily systems as well.
>
>
> Well, I don't know either, I have no idea how it works or why some people respond. But it seems to be basically the only thing that has worked for me so far, out of many many drugs. And, as I've mentioned, I'm not even diagnosed as bipolar, just sort of an agitated depression/ mixed state type thing. Supposedly, lithium works *best* for people who are "classically bipolar" (ie bipolar 1), and anticonvulsants work better for other forms of bipolar and non-classic features like rapid cycling or mixed states. Anyways, I don't know if that holds any truth.
>
> But there are some people who do not respond at all to lithium.
>
> I guess it's just like other drugs too. I mean, why did I not respond to so many other things? But some people do. Lots of people do. Why? And why does it seem that I do not respond to stimulants for attention problems, even though so many people do? In the end, no one knows these answers, at least not yet.
Posted by ravenstorm on July 1, 2005, at 16:25:20
In reply to How does lithium work, posted by barbaracat on July 1, 2005, at 13:26:43
Very cool article.
I would just caution anyone who is BP on running out and buying L-glutamine the amino acid. Julia Ross, who does amino therapy stuff out in California, has finally reallized that L-glutamine can bring about mania in some bipolars.
Posted by barbaracat on July 1, 2005, at 18:58:37
In reply to Re: How does lithium work, posted by ravenstorm on July 1, 2005, at 16:25:20
I'm not 100% on this but I think there's a difference between L-glutamine (inhibitory) and L-glutamate (excitatory). I should have gone back over my notes before saying anything, but I believe L-glutamine is a precursor to GABA. Or is it L-Glycine - or both?!! There's also the amino acid L-aspartate which is very excitatory and bad for bipolars. In fact, any mineral bonded with aspartic acid, i.e., magnesium aspartate, should be avoided.
There's some contention with the targeted amino acid precursor theory that Julia Ross and others espouse, i.e., tryptophan for serotonin, tyrosine for NE, phenylalanine for dopamine, etc., and that other aminos are precursors as well and have to be included in the proper ratios to avoid imabalances. Way too much to keep up with.
Anyhow, Ravenstorm, I'm glad I'm back on lithium and glad I didn't have to go bonkers to prove it to myself. - Barbara
>
> I would just caution anyone who is BP on running out and buying L-glutamine the amino acid. Julia Ross, who does amino therapy stuff out in California, has finally reallized that L-glutamine can bring about mania in some bipolars.
Posted by barbaracat on July 1, 2005, at 19:03:55
In reply to Re: More newbie Lithium questions, posted by Sabino on June 30, 2005, at 19:33:04
How long have you been on Remeron? I'm always interested in Remeron stories. I have my own tale to tell. There aren't too many of us. And BTW, you do know that low doses make you sleep but because of the lithium maybe you've got an extra sleepy punch going on that's lasting all day?
>
> Effexor XR 150mgs
> Remeron 15mgs (for sleep)
> Lithium (around 500mgs)
>
> That's my story and I'm stickin to it...**That wouldn't be from 'Off to see the Lizard' - would it? One of my faves.
Posted by Sabino on July 1, 2005, at 20:07:18
In reply to Re: More newbie Lithium questions » Sabino, posted by barbaracat on July 1, 2005, at 19:03:55
> How long have you been on Remeron? I'm always interested in Remeron stories. I have my own tale to tell. There aren't too many of us. And >>BTW, you do know that low doses make you sleep but because of the lithium maybe you've got an extra sleepy punch going on that's lasting all day? <<
Hiya. I started taking Remeron a day or two after I started Effexor, which gave me fairly bad insomnia. Actually, I've had insomnia for about 9 years now. Effexor just exacerbated it.
I had some left over Remeron from a couple of years ago, and I knew it would let me sleep.
When I took Rem 2 years ago, for around six months, at first I was really appreciative of the sleep. Plus, when not medicated, mine is an anxious depression, so I liked Remeron at first. After a while though, I became too detached; like I wasn't a part of things. I started feeling like I didn't have a personality anymore. I started at 15mgs, for a month and a half, then up to 30 for about a month, but 30 actually made me feel worse, like more sluggish. I tried 45mgs one day, and it just felt like way too much. I backed down to 15 for the last couple of months, and ultimately quit because I was still depressed.
Still, as far as side effects are concerned, it was the easiest to deal with of any AD I've tried, but like I've said before, its main side effect is sedation, and that was desirable at night.
Now I just use it to aid in sleep. Being 9 weeks into my Effexor experiment, and seeing as I've not achieved remission, I am seriously thinking of reducing that a good deal, to see what happens. I feel different than I did 9 weeks ago. I thought about killing myself more back then. The thought still crosses my mind daily. Seems like I've tried everything under the sun, and I feel just about at the end of my tether.
Gonna try upping the Lith to 600mgs over the long weekend. Any and all suggestions welcome.
I don't know what to make of Lithium yet.
I remember reading of your experiences when you took Rem all the way up to 90mgs. And then it seemed like Lithium and Rem were a really good combo for you. I don't recall why you dropped the Rem.
>> **That wouldn't be from 'Off to see the Lizard' - would it? One of my faves.<<
Hmmm. Never heard of that one.
Posted by barbaracat on July 2, 2005, at 15:25:27
In reply to Re: More newbie Lithium questions » barbaracat, posted by Sabino on July 1, 2005, at 20:07:18
*Rem worked very very for me on its own for about 2 months getting up to 45 mg. I was so pleased at the energy, optimism, motivation I felt. And then it suddenly pooped and no amount of increasing ever got it back. I first started adding lithium around that time and hoped it would augment things, but never did.
I never experienced being able to sleep better on Rem and had to take Ambien. But I did notice a daytime lethargy that I was told disappeared as the dosage got higher and the NE kicked in more. My depressions, as I've mentioned veer from either vegetative drag my butt around to shreiking banshee wailing. This was the former. I got up to 90 mg and once again, it kicked in, but much too activating, even with lithium. No matter how I played with the dose it was either/or, too little, too much and the worst part was the snarling slobbering incessant hunger. I gained 40 pounds and developed kill- for cravings for gooey carby stuff I never was interested in before.
Remeron, I'll say this much for it, was the easiest med to get off. I weaned from 90 to 0 in 3 weeks and didn't miss it. There followed a long spell of different trials combined with lithium, lamictal which worked OK but I got the rash, lithium alone which was OK as long as there were no stresses in my life. One med worked very well, nortriptyline and brought me out of a desperate place after my mother died. But the sxs were too much and so I powered through it with only lithium and St. John's Wort. That really was pretty good, but I hit a very bad stressful skid and it could not compete. Ended up in the hostpital in January and since then have been on the low dose Cymbalta, Lithium 600mg Ambien to sleep (changing to Lunesta) and various hormones, like thyroid. All in all I'm feeling better than ever.
My report is not unbiased since I had negative experiences with it, as well as with Serzone, another Rem like med. Have you considered replacing the Remeron with a non-hangover sleep med? Some of us are very sensitive to the histamine blockade some of these meds cause in the name of sleep. The few times lately I took Seroquel, Zyprexa or doxepin to help me sleep left me suicidally depressed the next day and they all have that histamine punch. I can only give you my jive on Remeron and Lithium and point blank, I didnt like it. It's such an easy med to get off and back on, perhaps it would be worth a try without
>
> >> **That wouldn't be from 'Off to see the Lizard' - would it? One of my faves.<<
>
> Hmmm. Never heard of that one.**Jimmy Buffet album, circa 1984 or so. I'm by no means a Parrot Head, but this one I like.
>
>
Posted by Maximus on July 3, 2005, at 17:04:25
In reply to Re: Vive le Lithium! » Maximus, posted by barbaracat on July 1, 2005, at 13:08:45
Many thanks to you Barbaracat. It is very exhaustive, indeed.
Max xxx
Posted by Maximus on July 3, 2005, at 17:13:15
In reply to How does lithium work, posted by barbaracat on July 1, 2005, at 13:26:43
>
> I've heard also that lithium responds better to bipolar I and I believe that's what I am. Other mood stabilizers that have worked for BP-II acquaintenances have done nothing for me.
Very interesting. I'm bp II and it works also very well for me. But i'm a *slow cycler*, mostly in the depressive side. This is the only thing i share with bp I folks because i have never had a manic episode, any.
Posted by Maximus on July 3, 2005, at 17:23:07
In reply to Re: More newbie Lithium questions » Sabino, posted by barbaracat on July 1, 2005, at 19:03:55
I would be the happiest man on earth if i was able to tolerate Remeron. No sexual side effects... But each time i took it i became a monster of rage, in spite being on Lithium. Weird.
Posted by yesac on July 5, 2005, at 10:07:48
In reply to Re: More newbie Lithium questions, posted by Sabino on June 30, 2005, at 19:33:04
Have you ever had your lithium level checked? It might help to know what it is.
Posted by yesac on July 5, 2005, at 10:20:28
In reply to Re: More newbie Lithium questions » barbaracat, posted by Sabino on July 1, 2005, at 20:07:18
> I thought about killing myself more back then. The thought still crosses my mind daily. Seems like I've tried everything under the sun, and I feel just about at the end of my tether.
Me too. That's exactly how I feel.
> Gonna try upping the Lith to 600mgs over the long weekend. Any and all suggestions welcome.
I think it's a good idea (even though the long weekend is over now so you've probably already done it).What happened with Effexor? I think that maybe you should try increasing your dose before giving up on it. Aren't you only taking 150?
As for me, I went down to 25mgs of Seroquel. I think that I still feel about the same as before, but less tired which is good. I've been feeling kind of badly for a couple weeks, but it doesn't seem like that's gotten worse since I reduced the Seroquel. I haven't slipped back to an agitated suicidal depressive wreck yet, so I guess that's good. I think that a lot of my gloom and depression lately is due to my life/problems. Also I've gotten pretty anxious and stressed lately, which might have something to do with reducing Seroquel, but also is because of certain things going on in my life.I was on vacation until yesterday, when I flew back to where I live. It was hard to leave my family and return to my life, and then when I got home my apartment was infested with fleas. Still is. So that sucks.
Posted by Sabino on July 5, 2005, at 19:11:16
In reply to Re: More newbie Lithium questions » Sabino, posted by barbaracat on July 2, 2005, at 15:25:27
Things have really fallen apart the last couple of days. Here's what happened...
When I was pushing the Li up to 600 mgs, I felt cognitive dulling. Didn't feel that the first couple of days on Li.
So I backed off Li a good deal. I had stopped Remeron a few days ago too. Barb, I've gone off it cold turkey before with no problems too.
Finally, I had cut down on the Effexor some too, since it didn't really whip my depression.
Anyway, I've been back to work since last week, and not really doing a whole lot. Last week, I had classes, so didn't really have to do much. Today, in a smaller sort of class, a much more intimate environment, my utter lack of concentration was a real problem, and I was starting to get that panicky I have to get out of here feeling... so I did. It was already late afternoon, so I could probably come up with some lame excuse. But lame excuses only go so far. (Please don't redirect; I'm soliciting opinions on meds here).
I really don't feel up to doing that job anymore. I don't know what to do. Don't know whether to take more time off. Don't know whether to drop my meds, since they didn't improve anything. My concentration actually is worse than when I first took time off of work two months ago.
I actually wrote a farewell note to my son last night.
Geez, I'm blowing huge chunks of insecurity out my blowhole.
Barb - For some reason I remembered something you wrote about Remeron that really tickled my funny bone. The context was talking about Remeron induced constipation and you said you 'felt like you swallowed a cement pie'.
That still cracks me up.
Anyway, my current med regimen is not cutting it. Don't you feel like 9 weeks of Effexor is enough time? I do.
Now if somebody could tell me that the cognitive dulling that I experience on Lithium would abate, well I'd consider giving that a try again. Honestly, Li felt so wonderful the first day I took it. Why couldn't that have kept up?
I'm real whiny today, but some days with these stupid mental issues, a guy just feels cursed. Whaaa!
Posted by Sabino on July 5, 2005, at 19:22:59
In reply to Re: More newbie Lithium questions, posted by yesac on July 5, 2005, at 10:20:28
Hi again. I was curious about what all your meds are. I know Lithium and Seroquel are in the mix. Do you take an AD too?
Oh, and I did take Effexor at 225 for at least three weeks. I'm completely confused about what to do.
Here's a funny thing about people that have the kinds of difficulties that we on this board do. Unless your really a ranting lunatic, other folks would never even realize you had issues.
I was visiting a dear friend who had a very manic episode and was hospitalized, and when I used to go visit, I'd meet some of the other folks in there too, and there was this one kid; just seemed like a nice young guy, and I couldn't imagine why he was in there, so I asked him. He was in there because he was depressed, and I wouldn't have even guessed that.
Often times I feel like my meds make me feel worse than my baseline state. I don't know. I probably shouldn't post when I'm feeling like this.
Posted by barbaracat on July 6, 2005, at 1:11:25
In reply to In a helluva way - Yesac » barbaracat, posted by Sabino on July 5, 2005, at 19:11:16
Geez, it sounds like things are really in the sh[*]thole - uh, I mean 'cement' hole for you. Sorry, but one must keep some sense of humor throughout this.
First of all, it sounds like you quit everything all at once. That in itself is going to put your brain through a wringer. When I'm going through a mind meltdown I simply cannot think. Stare at the same paragraph over and over, everything is slowed and feels broken. That's not to say that lithium isn't causing dulling, because it does for many people. But you did well on it at first and that's a very good sign. Usually the first couple days you know if it's going to work or not.
Could be that the combination of everything you were taking was working some good magic, but maybe not the best. I'll bet you need an antidepressant along with the lithium because it's clear you're going through a rough one. But perhaps something else. I can only go by my own experience. I hated Remeron after it pooped (it did, I did not), I hated Effexor. There weren't many I liked, however...
I love my current Cymbalta but only a small dose. I loved Zoloft. It worked the best when I was not yet taking lithium and nothing else worked. I recall you said you might give it a try. Why don't you and see if it doesn't do the trick. It's very smooth, not activating and although you may feel like you need something activating for a little cognitive zip, I'll bet once the depression gets lifted you'll find yourself thinking clearly and have alot more interest in everything.
Just today I realized 'Hey, I'm interested in things again. Everything holds a certain fascination that makes me want to keep at it.' How lovely because when I was so depressed nothing held any interest, everything was overwhelming and futile. I still have bad days but no big deal. I've found both a med combo that works - finally - and am in a good place in my life - finally. Once you start feeling better you'll probably be motivated to get more exercise, eat and sleep better and stuff. Very helpful, but almost impossible when you're brain is on duh control!
Keep trying. It won't take long. Your synapses are basically fried so no wonder you can't think. Who could? God put molecules on this earth for good reasons and there are just the right ones with your name on it - Mr. Yesac! Probably not a good idea to quit the lithium. Maybe 450mg is all you need to keep from skidding until you're more stable with an AD, but if you do need it and just quit - whoo boy, I've been there too many times and it ain't recommended. Also, don't ramp up too fast with whatever AD you go with. Lithium tends to augment them and if you are bipolar, go real slow for a while. The hardest thing is to have patience when you're so uncomfortable and feel like there's no hope anyway, but there is and you can do it. I used to think of Frodo carrying the Ring 'I will carry this thing though I do not know the way'. Now, if he had Zoloft he probably wouldn't have gotten so strange on that journey, but then there wouldn't have been the book or movie either. It's this kind of sh*t that makes you brave.
My thoughts and good wishes are on their way to you. - Barbara
Posted by yesac on July 6, 2005, at 10:49:27
In reply to In a helluva way - Yesac » barbaracat, posted by Sabino on July 5, 2005, at 19:11:16
> When I was pushing the Li up to 600 mgs, I felt cognitive dulling. Didn't feel that the first couple of days on Li.That's what happened to me when I tried going up to 900. I started to feel really spaced out and I didn't like it. So I went back down to 600.
> Finally, I had cut down on the Effexor some too, since it didn't really whip my depression.
I can understand going off. It seems like you've given it a good trial. I think I went up to 300mgs on Effexor, and I stayed on it for several months, but it never did anything. At some point, you just have to accept that you've given the drugs a good chance to work and they haven't. Often I wonder about if I should stay on things longer or go up to a higher dose and then maybe they'll work. It's hard to know, and it sucks to waste time and money on a drug that doesn't do anything.
> I really don't feel up to doing that job anymore. I don't know what to do. Don't know whether to take more time off. Don't know whether to drop my meds, since they didn't improve anything. My concentration actually is worse than when I first took time off of work two months ago.
What is your job, if you don't mind me asking? I think if they'll let you take more time off, why not? It seems like you could use it right now. I feel very similar to you because I am supposed to go back to school in the fall, and I've been trying to decide whether to take a semester off. I keep going back and forth on that. I don't know what to do.> I actually wrote a farewell note to my son last night.
I've written those notes to my family many times.
> Now if somebody could tell me that the cognitive dulling that I experience on Lithium would abate, well I'd consider giving that a try again. Honestly, Li felt so wonderful the first day I took it. Why couldn't that have kept up?
I don't think that the dulling abates unfortunately. I think that you just have to reduce your dose. But couldn't you go back to 450 or whatever you were on? It seems like it had some benefit, even if not the best. You don't have to go off it altogether.
I think that you should stay on the lith, forget about Effexor, I don't know about Remeron.... but like Barb said, maybe look into adding something new, an antidepressant. That's what I'm planning to do... see my other post.I definitely know what it's like to feel hopeless and desperate about meds and about life. I feel for you because it sounds like you're going through a rough time and have to make some decisions about stuff. IN fact, I feel like our situations are quite similar. Please don't give up yet.... Remember that just a few weeks ago you WERE feeling a little bit better, maybe not awesome, but better. You can get there again, and hopefully even better than that. We have to cling to these hopes and moments of sanity when we feel so down.
Posted by yesac on July 6, 2005, at 11:22:26
In reply to What's your current med regime? » yesac, posted by Sabino on July 5, 2005, at 19:22:59
> Hi again. I was curious about what all your meds are. I know Lithium and Seroquel are in the mix. Do you take an AD too?
Right now all I'm taking are Seroquel 25mgs and lithium 600mgs. I'm not happy with it though. As I mentioned I just went down on the Seroquel, but I still feel this tiredness. I don't know if I should go back up but try reducing the lithium, or try reducing the lithium and staying at 25 of Seroquel. I'm afraid to go off Seroquel altogether.I had been taking Cymbalta for about 5 or 6 months, but decided it wasn't helping anything and stopped in mid May.
So now I am looking for an antidepressant and/or something for attention. I haven't had much luck with stimulants or antidepressants. I've been thinking about Strattera and Zoloft. But every time I see my psychiatrist, I sort of don't feel quite ready to take on a new drug. I've just gone through so many med trials and I'm so sick of all of it that the idea of starting something new is not enticing, especially given that it probably won't work. And I don't want to deal with new side effects, especially because I'm about to start an internship.
But I'm pretty depressed and just overall don't feel too good, so I feel like I need something else.
> Here's a funny thing about people that have the kinds of difficulties that we on this board do. Unless your really a ranting lunatic, other folks would never even realize you had issues.
Well I think that's good, don't you? I don't want other people to realize, although I think sometimes it makes people less understanding (like my family for example-- don't realize the full depth of my desperation and despair), or it could allow people to make insensitive comments. Yeah, mostly my meltdowns are when I'm all alone by myself and the only ones who witness the height of my craziness are my kitties (and sometimes my psychiatrist).But the other thing is, I think there's something wrong with our culture in that it's so not okay to have *issues*. And it's especially not okay to talk about them. That's why we have to come to this board, don't you think? Sure it's good for information, but I think that a lot of what people like about it is the anonymity. It's easier to talk when no one knows you, and when you feel pretty sure that most people have similar issues. But I'm in a group therapy thing right now (which I hate and want to quit, by the way)... and there, even though presumably everyone else has issues, I don't like talking about my craziness, not face to face with people.
The other problem is that because issues are so hidden in our culture, I tend to delude myself into thinking that I'm the only one with problems, everyone I see seems to have a great life and they're so happy and I feel like the only miserable one alive.
> Often times I feel like my meds make me feel worse than my baseline state.
I definitely think they can. Not always, but sometimes. If the side effects outweigh the benefits then of course you feel worse.
Posted by barbaracat on July 6, 2005, at 23:23:54
In reply to Re: What's your current med regime? » Sabino, posted by yesac on July 6, 2005, at 11:22:26
Have you ever tried Wellbutrin? It doesn't work for me, too activating, but it's helped my husband very much. He is not bipolar. His depressions leave him fatigued, cognitively dulled and unmotivated - wanting to distract, hide, split the scene.
WB is also indicated for ADD symptoms. As I said, it didn't work for me but I've heard it works well for many who don't otherwise benefit from the typical SSRI type AD. Plus, sexual side effects are muy bueno.
Posted by yesac on July 7, 2005, at 10:42:36
In reply to Re: What's your current med regime? » yesac, posted by barbaracat on July 6, 2005, at 23:23:54
> Have you ever tried Wellbutrin?
>
> WB is also indicated for ADD symptoms. As I said, it didn't work for me but I've heard it works well for many who don't otherwise benefit from the typical SSRI type AD. Plus, sexual side effects are muy bueno.
WB was actually the very first AD that I tried. Didn't work. Then, several years later I tried it again because the shrink I was seeing wasn't sure if I had really given it a good trial (even though I had been on it previously for about 3 months, probably at 300mgs). The second time, it still didn't work after 4 months, 400mgs.So then, just last February, knowing that it is used for ADD and feeling like my ADD symptoms were extremely bothersome, I tried it yet again. I was only on it for a few days when I had a complete meltdown, worse than anything I've ever experienced. Still, I stayed on it for a couple more weeks, but continued having these bizarre meltdowns. Finally I went off it. I think that since I was also taking Cymbalta, the combo was just too much for me. The addition of WB to Cymbalta seemed to totally send me over the edge of sanity. Those few weeks were when I felt like I had truly lost my mind, more than any other time in my life.
So unfortunately, I don't know if I can take WB. I've still been considering it though--- I can't help but wonder if MAYBE it could work now combined with lithium and not being on Cymbalta. I used to think if something doesn't work, it doesn't work, but over the past months, I've realized (and experienced) that combinations of drugs can really work differently than the same drugs by themselves.
Posted by barbaracat on July 7, 2005, at 13:33:23
In reply to Wellbutrin » barbaracat, posted by yesac on July 7, 2005, at 10:42:36
Whoa! Cymbalta, Wellbutrin and no Lithium? I shudder to think. When I first started Cymbalta it was at 30mg and even though I was taking Lithium I swear I have never been so out in orbit, hallucinating, bizarre, truly terrible. I had also just come out of the hospital from major meltdown, was taken off lithium and put on depakote briefly, all my chemistry was bonkers so I wasn't sure at the time what was doing what. The fact that I'd just started back on lithium at that time also made it unclear. So I stuck with Cymbalta but started taking 3 pellets instead of the whole 30mg capsule, titrating slowly until I am now at 10mg after 5 months.
I tell you this, first of all to emphasize the crazy making nature Cymbalta has on some of us, and secondly that I believe LIthium will change the action of ADs. Cymbalta at 10mgs is the best AD I've ever had, but I believe, only because Lithium is augmenting it and allowing appropriate neural conductivity. I cannot imagine taking something like Cym without a mood stabilizer and I can't imagine going up more than 5 pellets a week.
Too many of us take too strong a dose of neuro-chemicals and when they poop or are ineffective, we ramp up even more. The problem may have more to do with gene transcription, second messenger systems and electrical potential in the neuron that the amount of chemicals floating around in the synapses, too much of which can cause problems of excess.
I've been watcing webcasts from the UCLA school of neurochemistry. These webcasts feature luminaries in the field of bipolar research. All are good, but the one by Dr. Manji explains the beauty and magic of what lithium does for bipolars. Here's the link if you want to explore:
http://www.bipolargrandrounds.com/archived.html
An important point is that if your condition is even vaguely bipolar, there are neural events occurring that no amount of antidepressants, stimulants, benzos, will work for long. From my own research, I realize that what Lithium and to a lesser extent, Depakote, provides actually CORRECT these neural anomolies and degeneration and allow the brain to function both chemically and electrically. In effect, Li is neuroprotective and neuroregenerative, grows new neurons, heals damaged ones, and compensates for quirky genes. And it seems to have these properties only for bipolars but not ALL bipolars. Dr. Manji also said bipolar disorder is hands down the most fascinating pathology ever to come along. How one disorder can present the vast array of disparate symptoms is staggering. So strange, but so much more understandable why, if we need what Lithium provides and don't take it, we have a very difficult time indeed.
I recently tried an experiment to wean off lithium. LIke all of us, I frequently wonder if I need this sh*t, if I can do it myself. Thank God I caught myself before my brain tangled too badly, because I could feel it disintegrating. Anyhow, for those of us for whom Lithium works, we are truly lucky. Watching that webcast may help you appreciate this fact and keep enough Li onboard to help augment and stabilize other meds you might be considering.
One more thing. I'm starting a trial month of Concerta because of my own cognitive issues. My pdoc said ADD is so common with bipolar that you might as well figure you've got it and see if treatment helps. I know you've been having concerns about cog dulling. It may be possible that Lithium is not causing the dulling but uncovering, bringing to the surface a coexisting condition. And if you've cold-turkeyed on Effexor, cognitive issues would certainly be in your stars for the next few weeks. - Barbara
> > Have you ever tried Wellbutrin?
> >
> > WB is also indicated for ADD symptoms. As I said, it didn't work for me but I've heard it works well for many who don't otherwise benefit from the typical SSRI type AD. Plus, sexual side effects are muy bueno.
>
>
> WB was actually the very first AD that I tried. Didn't work. Then, several years later I tried it again because the shrink I was seeing wasn't sure if I had really given it a good trial (even though I had been on it previously for about 3 months, probably at 300mgs). The second time, it still didn't work after 4 months, 400mgs.
>
> So then, just last February, knowing that it is used for ADD and feeling like my ADD symptoms were extremely bothersome, I tried it yet again. I was only on it for a few days when I had a complete meltdown, worse than anything I've ever experienced. Still, I stayed on it for a couple more weeks, but continued having these bizarre meltdowns. Finally I went off it. I think that since I was also taking Cymbalta, the combo was just too much for me. The addition of WB to Cymbalta seemed to totally send me over the edge of sanity. Those few weeks were when I felt like I had truly lost my mind, more than any other time in my life.
>
> So unfortunately, I don't know if I can take WB. I've still been considering it though--- I can't help but wonder if MAYBE it could work now combined with lithium and not being on Cymbalta. I used to think if something doesn't work, it doesn't work, but over the past months, I've realized (and experienced) that combinations of drugs can really work differently than the same drugs by themselves.
>
>
Posted by crazy teresa on July 9, 2005, at 1:43:07
In reply to Re: Does anyone like lithium? » crazyteresa, posted by ed_uk on June 29, 2005, at 21:14:49
> Hi!
>
> Can you try 450mg/day. It can be so much better when the dose is right :-)
>
> ~EdThanks so much Ed, this is much better.
t
Posted by ed_uk on July 9, 2005, at 7:16:41
In reply to Re: Does anyone like lithium? » ed_uk, posted by crazy teresa on July 9, 2005, at 1:43:07
Hi t,
Do you think it's helping? ........or is it simply a matter of it being less unpleasant than 900mg!?
~Ed
Posted by crazy teresa on July 10, 2005, at 12:59:12
In reply to Re: Does anyone like lithium? » crazy teresa, posted by ed_uk on July 9, 2005, at 7:16:41
> Hi t,
>
> Do you think it's helping? ........or is it simply a matter of it being less unpleasant than 900mg!?
>
> ~Ed
I don't know. I'm having a hard time sleeping most nights. I sleep on my stomach so my eyes are very puffy in the mornings. Shakes from effexor are more pronounced. Seems to have slowed me down.How will I know? I know how to tell if the antidepressants are working--you feel less depressed. Am I supposed to feel less bipolar???
Thanks pal.
t
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.