Posted by Penny on October 3, 2003, at 12:45:19
In reply to Li action, etc. » Penny, posted by DSCH on October 3, 2003, at 11:06:48
> LITHIUM
>
> This is what SLS reports on Li on his chart:
>
> http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
>
> 5-HT autoreceptor antagonist (serotonin)
> GLU decreased (glutamate)
> PI turnover decreased (phosphoinositide)
> PKC decreased (protein kinase-C)
> GSK-3b decreased (glycogen synthase kinase)
> MAP kinase increase (mitogen-activated protein)
> Bcl-2 increase (B-cell lymphoma protein-2)
> BDNF increase (brain derived neurotrophic factor)
> NFG increase (nerve growth factor)
>
> Don't expect me to explain any of that right now. I haven't gotten beyond the monoamines yet. :-)
>
> DIAGNOSIS
>
> Are you hypersomniac, insomniac, or bounce between those? You might want to see what the formal definitions of 'dysthymia' and 'cyclothymia' are to see if they fit well or not.I do cycle, but very rapidly, usually multiple times in a day and not with a definitive time schedule. My 'official' dx is Mood Disorders NOS. My former therapist dxed me with dysthymia and major depressive disorder recurrent. But even in my worst depressions (when I'm seriously suicidal), I'm still 'functioning' - i.e. I can still make myself go to work, walk the dogs, etc. I've never been affected by depression such that I can't get out of bed, though it's been hard at times. Still, even when I'm functioning, like I said, I will remain seriously suicidal, and I can appear fine (and feel *okay*) one minute and then my mood will crash at the drop of a hat - doesn't always have to be triggered - and I'll go from *okay* to *I think I'll kill myself.*
But I do go through periods of insomnia and periods of hypersomnia, and have taken multiple meds (Provigil, trazodone, ambien, sonata, Adderall) to try to keep me awake when I'm supposed to be awake and asleep when I'm supposed to be asleep. Sleep has been a long standing problem - even went for a sleep study where they determined that I don't have sleep apnea (a concern) and I don't have restless limbs, but that I experience a good deal of alpha-delta sleep, which they described as me waking, not completely, frequently throughout the night for no real reason. The sleep doc's suggestion was "Try to get your medications regulated." Yeah, right.
> TRICYCLICS
>
> Desipramine and nortriptyline are generally the best tolerated of the TCs according to D. Perrine (less beta blocking, less anti-histamine, less anti-acetylcholine). I believe both are more weighted towards norepinepherine rather than serotonin (seeing as you've already gone through many SSRIs this might be a point in their favor).Yes, that's what I'm thinking. Wellbutrin hasn't been too bad for me, and Effexor was more effective for a longer time period than any of the SSRIs, I suspect due to the effect on norepinephrine. Lamictal has been my mood stabilizer for about a year now, and was working pretty well until a couple of months ago, when I crashed. At that time I was on a Lamictal-Zoloft-Geodon-Wellbutrin combo. But it just stopped working - we fiddled with my dosages just a bit, when working on the lethargy in the daytime, insomnia at night thing, and it must have completely thrown me off. I ended up in the hospital for a week, where they increased my Wellbutrin and Zoloft a bit, to no avail. Most recently my doc tried me on Topamax, but it made me feel quite drugged, even at a lose dose, so we stopped it. He'd mentioned Lithium to me before, but then we tried the Lamictal, and so on.
Anyway, thanks for this! Fortunately, my pdoc is very well versed in polypharmacy and up-to-date on the latest research (he's a neuropsychiatrist and molecular geneticist). Doesn't tolerate major side effects with me and hasn't given up yet. I'm trying to hold out hope, and also trying to educate myself more on other possible meds.
P
poster:Penny
thread:264904
URL: http://www.dr-bob.org/babble/20030928/msgs/265232.html