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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 32. Go back in thread:
Posted by AWorriedMom on June 14, 2003, at 21:52:54
In reply to Re: Which meds for mania and depression ? » AWorriedMom, posted by Barbara Cat on June 13, 2003, at 21:55:59
I am going to ask doc about the lamictal, possibly in combo with the lithium she takes.
I don't know about the ADD. As a child, she never had any type of attention problem. In fact, her personality was the opposite. Can this start during teen years? She does have lots of panics and anxieties, though. They manifest themselves through physical complaints like the time she couldn't feel her legs or walk; another time she was convinced she couldn't see. Has IBS. But as bad as all that it is it all pales compared to her mixed state bipolar. That is why I'm seeking info on meds that might help her be on a stable path.
It looks like you have found a medicine combination that works for you. That is great.I hope we will find one soon.
Thanks
> Topomax - ugh, ugh ugh!!!! I was on it for a month hoping to lose some of the Remeron pudge. This was before I was on lamictal. I felt antsy, irritable, erratic. I hated it. Plus I didn't lose a pound. I can't say for sure if lamictal is the magic bullet. I had tremendous response to it at a low dose for about 2 months and then it started pooping out. I had some extreme stressors even after it pooped so my pdoc added nortriptyline for the black hole I was falling into. This combo, lithium, lamictal, nortriptyline seems to be working for me. I also notice a very definitely response from high quality fish oil at about 13-14 grams a day. I can tell when I don't take it for awhile. I hope her diet is pristine (yeah, like a schoolage kid is going to have a pristine diet). She needs good nutrition, especially at her age.
>
> One other thing to consider is comorbid ADD along with her bipolar. I'm reading more and more about how these two states are looking like similar dysfunctions. In fact, fibromyalgia/bipolar/ADD are looking like similar dysfunctions. I'll be seeing my pdoc in 2 weeks and we're going to try a trial of a stimulant. I have a very disabling recurring case of fibro and we're hoping it relieves it, along with remnants of classic ADD symptoms.
>
> > Your description of mixed states sounds exactly like my kid. I am interested in what you said about lithium with the lamictal.
> >
> > One time, her pdoc tried a combo of lithium and topomax. At first she seemed better, then she became very erratic and uncharacteristic in her behaviors and interactions with peers, teachers, etc. Don't know if lithium level wasn't right or if topomax had the bad effect. Pdoc put her back on combo of lithium and depakote. That doesn't seem to be working either, but not as bad as topomax.
> >
> > Is lamictal related in any way to topomax?
> >
>
>
Posted by Barbara Cat on June 15, 2003, at 13:05:11
In reply to Re: Which meds for mania and depression ?, posted by AWorriedMom on June 14, 2003, at 21:52:54
Dear Mom,
I don't know enough about ADD, as it's only recently I've started the research, but here's what I know so far. ADD is usually noticed in childhood but can resolve on it's own as the child reaches adulthood. ADHD on the other hand, is primarily a later onset condition. I may have the ADD/ADHD labels switched around, but the point is that yes, an ADD type condition (there are 6 different subtypes postulated) can manifest later in life. But usually the symptoms were allways there, only very mildly. It doesn't sound like your daughter's problem is ADD, however, new research is saying that there usually is some overlap with the two conditions, however mild.It truly sounds like your daughter is having some psychosis during her mixed episodes. This is not uncommon, especially with panic disorder. Overwhelming Fear and terror is the hallmark of this condition. During the worst of my episodes a few years back (I was taking high doses of Zoloft at the time for 'depression' that was not resolving and no mood stabilizers) I was hallucinating terrible things, voices, visions of dread and doom (not so off the mark considering our current events).
It's interesting about your daughter's blindness and loss of leg function. That was a huge obsession for me, not that I had gone blind or crippled, but that I was sure going to. The thought of being blind, in a wheelchair and in desolation would trigger a panic attack. For instance, I'd be reaching for the pasta in Thriftway when this voice in my head would say "Heh, better enjoy this while you can. When you're blind and crippled, no more buying or cooking pasta." I can't tell you how many times I'd be sobbing uncontrollably in public, or collapsed in the aisles of supermarkets in a truly desperate state. I lived in uncontrollable desperation and despair, day in, day out, for 2 years. And that was only one (but a bad one) of many episodes throughout my life. What a ride.
Now that I'm stable I look back on these nightmarish times. All my psychoses took on the same general theme. There's a message in there, something that needs deep healing and is not just 'Oh yeah, ho hum, that's mixed states for ya'. I've been studying many spiritual teachings since then, practicing self-inquiry, and slowly learning to live in the now and not to fear. Of course, my meds had to get me to a stable place first where I could think clearly, but everything has a mixed blessing in it. Once your girl gets medically stabilized, I'll bet she will be so ahead of her time because of the amazing transformations such experiences put one through. The real trick is learning to trust the process, minute by minute, and finding peace in the face of fear. A good lesson we all could learn. -- BarbaraCat
Posted by McPac on June 16, 2003, at 23:22:16
In reply to Re: Which meds for mania and depression ? » AWorriedMom, posted by Barbara Cat on June 13, 2003, at 21:55:59
Are you taking Carlson's liquid fish oil by any chance?
What can you tell it doing for you---mostly mood stabilization?
Also, the CoQ10 and Alpha Lipoic Acid ---I know about these --- but what can you tell them doing for you?
Have you tried selenium by any chance?
Take care!
Posted by Barbara Cat on June 17, 2003, at 10:40:17
In reply to Barb, Re: Which meds for mania and depression ?, posted by McPac on June 16, 2003, at 23:22:16
Carlson's fish oil is very good. I take the lemon flavored which actually tastes pretty good. It's purified and a very good price (I order it from www.iherb.com which is more than half price of what you'd pay in stores). I also take Dr. Barry Sears Omega Rx which is supposedly the cadillac, but the price reflects it. I think the Carlson's is probably fine, at 1-2 tbl a day. Yes, mood stabilization is the best way to put it, better sleep also. It helps the permeability and flexibility of cell membranes and therefore cellular ionic transport and exchange, and aids in prevents cell atrophy and death. Plus I've noticed it doing good things for my hair and skin.
I have fibromyalgia on top of all my other woes and CoEnzyme Q helps with providing a good steady source of energy. It's a great antioxidant and assists in detoxifying cells, including neurons. It helps transport oxygen into tissues. Alpha Lipoic Acid is a very potent antioxidant and helps the conversion of other nutrients. I don't feel anything definite on it alone but believe that other vitamins are working better with it. Also it has a nice effect on skin tone and elasticity.
I take SAM-e as well, but not everyday. It can spin me into a hypomanic episode if I take too much, but do feel a positive lift when taking it. Selenium is a good one as well. It's very good for the thyroid, helps to convert amino acids into helpful neurotransmitters. More than 200mcg isn't good though. Also, folic acid is coming up more and more as effective against mood disorders. Sigh. So many nutrients, so little time (and money!). - BarbaraCat
> Are you taking Carlson's liquid fish oil by any chance?
> What can you tell it doing for you---mostly mood stabilization?
> Also, the CoQ10 and Alpha Lipoic Acid ---I know about these --- but what can you tell them doing for you?
> Have you tried selenium by any chance?
> Take care!
Posted by McPac on June 18, 2003, at 17:23:37
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 17, 2003, at 10:40:17
Barb,
have you ever tried Depakote or Tegretol for a mood stabilizer?
Have you ever tried a mood stabilizer other than lithium that you liked and that was effective?
Thanks!
Posted by Barbara Cat on June 18, 2003, at 18:15:20
In reply to Barb, Re: Which meds for mania and depression ?, posted by McPac on June 18, 2003, at 17:23:37
Never tried Depakote or Tegretol. Depakote sounds interesting but I fear adding an additional porkogenic med. The only other ones I've tried were gabapentin, mainly for fibro pain, which it didn't help. The first few days I had a very nice mellow response but it pooped out quickly. I've been taking it again because I've had a flare up of fibro symptoms recently, but it sure isn't helping.
The other is Topomax which I took briefly, mainly to counteract the weight I gained on Remeron. I absolutely hated the way it made me feel, very irritable and anxious.
I think you know I'm also taking lamictal. I really don't know if it's working or not. The initial wonderful sparkly effect wore off quickly so I don't notice anything in particular. I've never tried going off it, and hesitate in doing so. It's probably supporting things in the background.
I have an appt with pdoc next week and I'm going to discuss some interesting research I've come across linking bipolar with ADD and fibromyalgia with ADD and even linking all three. Supposedly, the same areas of the frontal lobes are 'lights out' on SPECT images. So, we're going to talk about ADD/ADHD therapy in addition to the lithium/lamictal/nortrip.
My disability hearing before a judge is this Monday, and I'm worried and having to dredge up all kinds of triggering memories. It's fascinating to watch myself become totally disorganized, obsessive compulsive, PTST'd. It's worth a pstim trial if it helps. How about you? You ever been on a pstim or other mood stabilisers?
> Barb,
> have you ever tried Depakote or Tegretol for a mood stabilizer?
> Have you ever tried a mood stabilizer other than lithium that you liked and that was effective?
> Thanks!
Posted by McPac on June 18, 2003, at 19:38:22
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 18, 2003, at 18:15:20
Barb, I justed posted this a little earlier...it tells my dilemma:
Posted by McPac on June 18, 2003, at 18:25:21In reply to Mcpacster- how are you bro?! (nm) » McPac, posted by ace on June 18, 2003, at 0:26:27
Major dilemma for me dudes.......
Zoloft WORKS for my ocd BUT I get terrible anger FROM ZOLOFT (ssri's in general, it seems).....(I don't know for sure if I'm bipolar...but the Zoloft DOES definitely cause me terrible anger/irritability problems...I take lithium to counter the Zoloft anger effect....I would LOVE to find an anti-dep. that worked well for BOTH depression AND OCD......now, Zoloft DOES work well for both my depression and OCD BUT I get that terrible anger/irritability problem....right now I'm probably going to increase the Zoloft (feeling 'down' and obsessive somewhat) and therefore I am FORCED to increase the lithium as well (to counter the Zoloft-induced anger/irrit)...if I could just find a good anti-dep. that also worked for ocd (the ssri's give me the bad reaction that I mentioned, I don't want an anti-psychotic, the old tca's were okay for depression but not much for ocd.....I have NO choice but to increase my Zoloft and then increase the lithium to counter the Zoloft side effects! It's a terrible 'catch-22'/can't win situation....Ace, I could try the Nardil....but I'm always out and about, eating out, eating at friend's houses, at work, get-togethers, etc., and when I took Nardil I was always afraid of eating something wrong...I wouldn't eat much...I never like to even tell anybody about my problems at all...if I were on Nardil I would constantly have to watch what I ate and everywhere I went I'd be having to explain to everybody why I couldn't eat 'this or that' when they offered me something....it would be easier if I were always home but I'm always eating with somebody, somewhere and having to worry over everything I put in my mouth would drive me nuts....but I do remember Nardil very fondly though, worked well for my depression and I think it worked well for my ocd too(wasn't on it too long though, can't remember the ocd part as well)......anyway, that's my dilemma......take care!!!!
Posted by McPac on June 18, 2003, at 19:42:53
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 18, 2003, at 18:15:20
"You ever been on a pstim or other mood stabilisers?"
Barb, I've never been on a pstim (I'd be afraid with my ocd)...don't really want to be sped up, I'd rather be mellowed out.....lithium (for 20 years, low-dose) has been my mood stabilizer so I really don't know too much about the other ones out there.
Posted by Barbara Cat on June 18, 2003, at 20:17:19
In reply to Barb, Re: Which meds for mania and depression ?, posted by McPac on June 18, 2003, at 19:38:22
You mention having fond memories about Nardil. I don't have the names of the meds at my fingertips, but I know there are reversible MAOIs out there. Think they're referred to as RIMAs. They allegedly have very similar effects, less side-effects including the food thing. There was one mentioned on this board a few times but not available in the States. I'll find my notes and get back to you.
Posted by McPac on June 18, 2003, at 20:27:40
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 18, 2003, at 20:17:19
"but I know there are reversible MAOIs out there. Think they're referred to as RIMAs. They allegedly have very similar effects, less side-effects including the food thing. There was one mentioned on this board a few times but not available in the States. I'll find my notes and get back to you".
>>>>THANKS Barb!!! I'd never heard about these reverse MAOI's...wonder if they would work for ocd? I'm going to try to find some info now about them too! Thanks!!
Posted by Ponder on June 18, 2003, at 22:51:36
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 18, 2003, at 18:15:20
Barbara, is this a hearing to establish eligibility for benefits?
Posted by Barbara Cat on June 18, 2003, at 22:58:37
In reply to Barb, Re: Which meds for mania and depression ?, posted by McPac on June 18, 2003, at 20:27:40
The med I was trying to remember is Moclobemide. It's not approved here, but you'll get alot of hits on where to get it, how to use it, etc if you do a search. Also try searching on *reversible inhibitor of monoamine Oxidase-A* to get a broader picture of what's in the pipeline.
> "but I know there are reversible MAOIs out there. Think they're referred to as RIMAs. They allegedly have very similar effects, less side-effects including the food thing. There was one mentioned on this board a few times but not available in the States. I'll find my notes and get back to you".
>
> >>>>THANKS Barb!!! I'd never heard about these reverse MAOI's...wonder if they would work for ocd? I'm going to try to find some info now about them too! Thanks!!
Posted by McPac on June 19, 2003, at 2:37:23
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 18, 2003, at 22:58:37
Thanks Barb...check out my post way below on Reboxetine.
Take care!
Posted by Barbara Cat on June 19, 2003, at 11:11:03
In reply to Monday hearing » Barbara Cat, posted by Ponder on June 18, 2003, at 22:51:36
> Barbara, is this a hearing to establish eligibility for benefits?
I applied for SSA disability benefits 1-1/2 years ago, primarily for fibromyalgia, with concomittant bipolar disorder. I was denied twice by the SSA examining board, which is the norm, got a lawyer (which I wish I'd done from the beginning) and am now on my second appeal, or the third hearing, which is before a SSA judge. A vocational rehab person will also be there as a consultant and based on my medical records, affadavits from friends and family, the judge will decide if I am disabled, which will enable me to receive Social Security disability benefits.
I'm concerned about it since this judge is infamous for being biased against fibromyalgia and to a lesser degree, mood disorders. He is very harsh on 'subjective disorders' and I am stuck with him. Luck of the draw. But I will appeal it all the way to Federal Superior Court because there's no way I can sustain any job on a full-time consistent basis with the severe fibro flares I get.
Posted by Barbara Cat on June 19, 2003, at 11:12:32
In reply to Barb, Re: Which meds for mania and depression ?, posted by McPac on June 19, 2003, at 2:37:23
Can you give me a link to your post? I can't find it. - Barbara
> Thanks Barb...check out my post way below on Reboxetine.
> Take care!
Posted by McPac on June 19, 2003, at 11:14:56
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 19, 2003, at 11:12:32
Barb (try this?)
Posted by judy1 on June 19, 2003, at 11:47:52
In reply to Re: Barb, Re: Which meds for mania and depression ? » McPac, posted by Barbara Cat on June 18, 2003, at 18:15:20
What happened? Were you denied social security? I was granted disability 3 months after applying (the first time). If I can help, please post on Psycho Social- take care, judy
Posted by judy1 on June 19, 2003, at 11:49:28
In reply to Re: Monday hearing » Ponder, posted by Barbara Cat on June 19, 2003, at 11:11:03
Posted by Barbara Cat on June 19, 2003, at 12:10:16
In reply to Disability Hearing » Barbara Cat, posted by judy1 on June 19, 2003, at 11:47:52
Judy,
I don't know how to move this link to Social so I'll reply here. I've never heard of anyone getting disability on first try so quickly!! It took them 8 months to just reply to me. Unless major physical bodily functioning is lost, disability almost NEVER approves first time, especially for mental disorders or anything 'subjective'. Wow, I'm impressed. Were you in extreme danger, hospitalized, whatever, at the time? Living in another country besides US? If you know how to move this to Social, I'd love to discuss it more with you (although the die seems cast at this point).
> What happened? Were you denied social security? I was granted disability 3 months after applying (the first time). If I can help, please post on Psycho Social- take care, judy
Posted by whiterabbit on June 19, 2003, at 18:39:19
In reply to Re: Which meds for mania and depression ?, posted by AWorriedMom on June 14, 2003, at 21:52:54
Mom-
I didn't get through the entire thread so forgive me if I repeat any advice from others.First let me say bless you for loving your daughter enough to do this for her. My own mother not only ignored the obvious signs of a serious mood disorder that I was showing from a young age (depression, isolating, insomnia, and self-injury all by the age of 13)she acted as if my behavior
was an intentional ploy to inconvenience her life
and she would constantly chide me to "snap out of it". She never tried to understand or help me, and later in life I didn't get help for myself,
maybe because I was still trying to snap out of it. Or maybe because she made me feel as if I didn't deserve help.My illness went untreated through my 20s and 30s as my symptoms got progressively worse. I did get very sick and caused a great deal of pain and destruction for myself and others. But now I'm recovering with the right medication and good therapy, and I wanted to share with you some of the things I learned along the way about psychiatric treatment. Because I made just about every mistake you can possibly make and delayed
my own recovery in the process...I almost didn't make it. Almost.The first and MOST important step is to find the right doctor. I STRONGLY urge you to consult a psychiatrist who specializes in treating children and adolescents. Through my own career in orthopedic medicine, I know there is an ENORMOUS difference between the skill and training of an orthopedic surgeon and a pediatric orthopedic surgeon. Children are not small adults and should not be medically treated as such; your daughter will get optimal care from a specialist in adolescent psychiatry.
Due to differences in brain chemistry, it's not uncommon for a person with bipolar disorder to have a paradoxical (reverse) reaction to some medications. These reactions need to be noted and all your daughter's medications should be closely monitered by her psychiatrist. NEVER stop or start taking psychiatric medications or attempt to adjust dosage without medical supervision - the consequences can be quite serious. These are
powerful drugs and they're capable of wreaking havoc in the mind with improper use. They also have the ability to improve your daughter's quality of life to a degree that, right now, you hardly dare to dream of. But first you need the right doctor, who will supply you with the other two things you need: the correct diagnosis, and the best treatment for that diagnosis.Learn as much as you can about your daughter's condition and treatment: knowledge is power. The more you learn, the less frightened, confused and helpless you'll feel. You'll be able to make informed observations of your daughter's behavior
and symptoms and discuss these important signs with her psychiatrist. These behavioral "clues" help the doctor make needed adjustments in medication. A terrific website for information on mood disorders is www.nami.org - NAMI also has chapters nationwide that offer group support to families dealing with mental illness. It would be helpful for your daughter to meet others who are going through the same ordeal - she will feel less
"different" and alone. It will help you too.Apart from a support group, I highly recommend therapy for both of you - separately. That way it will be easier for you and your daughter to be honest and open with the therapist. I avoided therapy for a long time because I had it confused with analysis, and I didn't want to talk about my crappy childhood. Now I have a therapist that I just love, and she's helping me deal with a painful divorce. A good therapist will teach you coping skills and give you invaluable information and advice. My therapist gives me hope and courage.
If you're not satisfied with your daughter's psychiatrist or therapist, don't hesitate to move right on to the next person on your list, or make a list if you don't have one. I went through three psychiatrists (four if you count the jerk who mistreated me at the hospital) before I found a guy that was really on the ball. If you're not comfortable and confident about your daughter's treatment - if her psychiatrist doesn't seem to be listening or interested enough, doesn't explain things well, is often unavailable or doesn't return calls, is arrogant or unpleasant...whatever the reason is, I can assure you that there's another doctor out there who WILL provide you with much better care.
Don't lose hope. The trial-and-error phase of medication is difficult and seems impossibly long-
but the better the doctor, the less trial-and-error you'll need. In the end, when your daughter is stabalized and doing well, you'll have saved her from a lifetime of suffering...the most loving gift a mother could give.Prayers for you and your daughter-
Gracie
Posted by AWorriedMom on June 20, 2003, at 9:17:09
In reply to Re: Which meds for mania and depression ? » AWorriedMom, posted by whiterabbit on June 19, 2003, at 18:39:19
> Mom-
> I didn't get through the entire thread so forgive me if I repeat any advice from others.
> The first and MOST important step is to find the right doctor.Absolutely!
We are looking hard for new pdoc. At last weeks appointment with these concerns (lithium, depakote low levels- lack of stability along with depression)it was "No changes now, see you in 2-3 months" This pdoc is supposedly certified for child and adolescent treatment - sigh.
Anyway am running into insurance run around. We may have to go out of pocket.About 4 yrs ago she was relatively stable on tegretol. Had depression symptoms that I missed (all those tummy aches, lots of missed school, irritability, etc.)but the horrible mania, delusional thoughts were not there. Then,pdoc took her off the tegretol and put her on topomax. I thought she was getting better, then full blown mania and hospitalization. Doc put her back on tegretol, but this time even at high levels, it didn't work and from there we have lived a nightmare of medication merry-go-round and still no real stability. This doc seems content so long as she's well enough to stay out of the hospital. I can't settle for that and neither can my daughter.
> Learn as much as you can about your daughter's condition and treatment: knowledge is power.
A terrific website for information on mood disorders is www.nami.org - NAMI also has chapters nationwide that offer group support to families dealing with mental illness. It would be helpful for your daughter to meet others who are going through the same ordeal - she will feel less
"different" and alone. It will help you too.Found local NAMI group and organization for parents of BP kids. Thanks.
> Apart from a support group, I highly recommend therapy for both of you - separately.
This past year through a special ed program in our school district that works through a pdoc's office, she found a therapist that we both like for her. I can see that it would help me also, thanks for that advice.
> Don't lose hope. The trial-and-error phase of medication is difficult and seems impossibly long-
> but the better the doctor, the less trial-and-error you'll need. In the end, when your daughter is stabalized and doing well, you'll have saved her from a lifetime of suffering...the most loving gift a mother could give.
>
> Prayers for you and your daughter-
> GracieThank you for your prayers. We will need them to get her to another pdoc. Our mental health insurance company owns the one and only pschiatric practice that they allow to be in their network of providers. It is all totally separate from the medical side of our insurance with the school board. (I'm a teacher)
Thanks,
Mom
Posted by whiterabbit on June 20, 2003, at 12:09:31
In reply to Re: Which meds for mania and depression ? » whiterabbit, posted by AWorriedMom on June 20, 2003, at 9:17:09
You tell your daughter's psychiatrist that she's not improving or getting worse, and the psychiatrist says, "See you in 2 or 3 months?"
Excuse me but, that's horse****. I don't think that's good medical care at ALL.If you're reduced to paying out-of-pocket for competent medical treatment you should apply for social security benefits if you haven't already.
Your daughter has a documented psychiatric history and bipolar disorder is a qualifying disability. If you want more information let me know.Good luck to you dear, wish you had been my mom.
-Gracie
Posted by judy1 on June 20, 2003, at 13:31:00
In reply to Re: Disability Hearing » judy1, posted by Barbara Cat on June 19, 2003, at 12:10:16
I'll write a post on psycho-social to you since I totally forgot how to move a post. take care, judy
Posted by McPac on June 20, 2003, at 23:17:25
In reply to For heaven's sake..., posted by whiterabbit on June 20, 2003, at 12:09:31
"You tell your daughter's psychiatrist that she's not improving or getting worse, and the psychiatrist says, "See you in 2 or 3 months?"
Excuse me but, that's horse****. I don't think that's good medical care at ALL".>>>>>>>>That is terrible. And typical as well. A shame.
Posted by Dr. Bob on June 23, 2003, at 3:48:06
In reply to Re: Disability Hearing » Barbara Cat, posted by judy1 on June 20, 2003, at 13:31:00
> I'll write a post on psycho-social to you
Here's a link:
http://www.dr-bob.org/babble/social/20030617/msgs/235487.html
> since I totally forgot how to move a post.
If you mean how to redirect a follow-up (to a different board), see:
http://www.dr-bob.org/babble/faq.html#redirect
Bob
This is the end of the thread.
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