![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by jdawg on October 5, 2004, at 17:15:59
Hello,
I am new to this group and wanted to share my story. I'd be interested to hear if anyone has had similar experiences and may have advice on treatment and ways to deal with it all.
I've been suffering from a mood disorder for about 5 years now; I'm not sure exactly what it is just that it's an affective disorder. I was initially diagnosed with major depression with a psychotic episode and was treated w. anti-psychotics (risperdal or olanzapine) and anti-depressants (Celexa, venlafaxine, or Wellbutrin). Approximately 3 years after the initial episode, I had a relapse that was characterized (similarly to the first episode) by decreased sleep, irritability, paranoia, and anger. That was also followed by a depression, which slowly improved over the past 1.5 years.
Now, I find myself rapidly cycling from hypomania (characterized by decreased sleep, increased goal-directed behavior, increased productivity at work, increased sexuality) to deep depression (with lack of motivation, fatigue, headaches, thoughts of death, worthlessness and guilt). My cycles are about 7-10 days of feeling good/hypomanic followed by 3-5 days of depression.
Has anyone had similar experiences? If so, were you successful in dampening the cycles? I'm currently taking risperdal, Lamictal, Effexor XR, Wellbutrin, and Cytomel. I try not to get too high by occasionally taking lorazepam or drinking a glass of wine to fall asleep.
I'd appreciate any advice or thoughts on this.
Thank you.
Posted by Mike634 on October 5, 2004, at 19:02:55
In reply to rapid cycling, posted by jdawg on October 5, 2004, at 17:15:59
It sounds like your are in a state of rapid cycling - some type of bipolar at least. Have you discussed using mood-stabilizers like depakote or lithium with your doctor? The lamictol and risperdol may not be enough, or the effexor and wellbutrin may be agravating it. Just my thoughts--- I hope you can get things settled down, it sounds like things are pretty unstable at the moment.
Posted by D minor on October 5, 2004, at 23:14:43
In reply to rapid cycling, posted by jdawg on October 5, 2004, at 17:15:59
Jdawg,
I think I''m in the same boat. I was diagnosed with major depression with psychotic features about a year and a half ago. "For the migrains" I was put on Topamax. I tried Risperdal but due to side effects ended up on Abilify. I was also put on Remeron. Six months later Seroquel and Wellbutrin were added.I about 2 month ago I came off the Topamax because I felt like it dampened my emotions. My new pdoc thinks I'm bipolar. I didn't belive him until 2 weeks ago. I think I started rapid cycling. My cycle so far has been exactly 1 week. So for the past two wednesdays I'm been hypomanic. Feels like I'm really sped up and euphoric and think I'm sexy. Then the next day I'm normal, followed by two or three days of mild depression.
I see my pdoc on Thursday. He thought the Seroquel would act as a mood stabilizer, but obviously it hasn't. He said if that didn't work we would try Depakote. So I'll let you know what happens.
Oh, I talk about this a little in my above post "Tortured!" if you want to know a little more. The response I got from Happy Girl was really good.
Goodluck!
dm
Posted by HappyGirl on October 5, 2004, at 23:56:32
In reply to rapid cycling, posted by jdawg on October 5, 2004, at 17:15:59
HiL:
You certainly experiencing, so to speak, Bp II with rapid cycler as reading the content of your post along seeing your med. combo.To answer to your question below;
>>> I'm currently taking risperdal, Lamictal, Effexor XR, Wellbutrin, and Cytomel. I try not to get too high by occasionally taking lorazepam or drinking a glass of wine to fall asleep. <<<
--- One 'MAJOR'problem, in my opinion, ... I could notice on your med. combo., ... there are three different form of anti-depressants that might cause you to NOT get your 'rapid cycler' under control. Because, in most of cases, anti-depressants, particularly any of SSRIs induce 'rapid cycler,' because 'rapid cycler' is one of 'manic/hypomanic' symptoms. Lamictal itself is effective on the depressive side of your Bp II. Other two seems NOT need, at least until your 'rapid cycler' getting a bit 'calming down.' In my case, in the beginning of tx, I had absolutely NONE of anti-depressants until the manic side of my Bp II was semi-controlled, although the depressive side of my Bp II was NEVER mild form, ... rather 'severe.' However, my pdoc. was SO cautious NOT get me into 'mania/hypomania' due to my tendency of getting into 'rapid cycler.' At the beginning, I never appreciated my pdoc.'s overly-concern on this, however I now truly appreciate his 'great' professionalism. I've been fairly stabilized my 'rapid cycler' by taking four different med. combo. cosisting of Zyprexa 5 mg., Lithium 900 mg., Wellbutrin SR/generic 300 mg. and Trazodone 150 mg. The Trazodone and Zyprexa before the bed made me 'sleepy' even during the day, however it went away with time. It's a TERRIFIC combo. in all aspects of my Bp.
Then, in my suggestion, ... try to eliminate one or two of A.D.s, as seeing your 'unstability' of 'rapid cycler' which is said to be 'one of hardest/toughest' for most of pdocs. to challenge. For this reason, I needed to go through four different pdocs. and FINALLY found a right pdoc. who is the current pdoc. However, the patience along with spending countless days and months on searching for the right pdoc. was well worth.
H.G.
Posted by Ritch on October 6, 2004, at 9:58:58
In reply to Re: rapid cycling, posted by HappyGirl on October 5, 2004, at 23:56:32
> Then, in my suggestion, ... try to eliminate one or two of A.D.s, as seeing your 'unstability' of 'rapid cycler' which is said to be 'one of hardest/toughest' for most of pdocs. to challenge. For this reason, I needed to go through four different pdocs. and FINALLY found a right pdoc. who is the current pdoc. However, the patience along with spending countless days and months on searching for the right pdoc. was well worth.
> H.G.
>
>
>I agree with that, too. Look into *causes* as much as something to dampen it. The most potent anti-cycling med that I've ever taken was Trileptal (better than Depakote even). I couldn't tolerate the side effects of it though (I can tolerate the Depakote though). A lot of people can tolerate Trileptal better.. you might ask yourpdoc about it..
Posted by Organicgrll on October 6, 2004, at 17:40:36
In reply to rapid cycling, posted by jdawg on October 5, 2004, at 17:15:59
It sounds like you are taking too many meds. I know the Effexor XR sent me into a full blown mania episode. I am only now coming to terms with the fact that I manifest all symptoms of BP II disorder. Right now, I am trying to get off Effexor XR so I can then possibly deal with the bipolar.
Maybe you can discuss with your doc about removing some of these meds - from what I have researched some of them could definitely be aggravating your rapid cycles.
My doc gave me Trazodone for sleep because I could not stay asleep for more than 3 or 4 hours. I would wake up with my mind racing and could not stop. It definitely helped me stay asleep and did not leave me groggy in the morning. I would take 1/2 tablet (50mg tablet - easy to cut with a pill cutter)about an hour before bedtime.
Best of luck to you! I hope you can get to a stable place with your meds and moods.
Posted by jdawg on October 6, 2004, at 21:34:11
In reply to Re: rapid cycling, posted by Organicgrll on October 6, 2004, at 17:40:36
Hi,
Thank you for all of your replies. I have a few comments:
1) re. Depakote -- I've tried it and did not tolerate it. It made me feel like a zomby -- sleepy and unable to concentrate.
2) I'd *love* to go off some of my meds but am afraid of getting really depressed. I weaned off Effexor at one point and only took Wellbutrin. That did not work since I got really depressed.
3) My "high" periods are getting better as I'm able to sleep more and don't feel as wound up. But depressive periods are still debilitating -- I just shut down for 2-3 days unable to function well at work or at home.
For now it's not crucial to me to find out what the cause is -- it could be that I'm cycling due to my meds or because of my underlying disease. It doesn't matter which one it is (just knowing that I have a mood disorder is enough for me), I just want to be functional all or most of the time.
So I'm not sure how to proceed now. Should I go up on the Lamictal dose (I'm currently on 200 mg/day)? Should I increase my anti-depressant dose (Effexor XR 150 mg/ day & Wellbutrin XL 300 mg/d)? or do something else?
I'd appreciate any input you may have on this.
Posted by olysi79 on October 6, 2004, at 22:12:02
In reply to Re: rapid cycling, posted by D minor on October 5, 2004, at 23:14:43
Sounds like me to a "t"... my hypomanias haven't been much at all lately but earlier they were pretty out there as I started Luvox... My cycles run that way too... doesn't feel so good to be on that rollercoaster.
> Jdawg,
> I think I''m in the same boat. I was diagnosed with major depression with psychotic features about a year and a half ago. "For the migrains" I was put on Topamax. I tried Risperdal but due to side effects ended up on Abilify. I was also put on Remeron. Six months later Seroquel and Wellbutrin were added.
>
> I about 2 month ago I came off the Topamax because I felt like it dampened my emotions. My new pdoc thinks I'm bipolar. I didn't belive him until 2 weeks ago. I think I started rapid cycling. My cycle so far has been exactly 1 week. So for the past two wednesdays I'm been hypomanic. Feels like I'm really sped up and euphoric and think I'm sexy. Then the next day I'm normal, followed by two or three days of mild depression.
>
> I see my pdoc on Thursday. He thought the Seroquel would act as a mood stabilizer, but obviously it hasn't. He said if that didn't work we would try Depakote. So I'll let you know what happens.
>
> Oh, I talk about this a little in my above post "Tortured!" if you want to know a little more. The response I got from Happy Girl was really good.
>
> Goodluck!
> dm
>
>
Posted by Ritch on October 6, 2004, at 23:45:30
In reply to Re: rapid cycling, posted by jdawg on October 6, 2004, at 21:34:11
> Hi,
>
> Thank you for all of your replies. I have a few comments:
>
> 1) re. Depakote -- I've tried it and did not tolerate it. It made me feel like a zomby -- sleepy and unable to concentrate.
>
> 2) I'd *love* to go off some of my meds but am afraid of getting really depressed. I weaned off Effexor at one point and only took Wellbutrin. That did not work since I got really depressed.
>
> 3) My "high" periods are getting better as I'm able to sleep more and don't feel as wound up. But depressive periods are still debilitating -- I just shut down for 2-3 days unable to function well at work or at home.
>
> For now it's not crucial to me to find out what the cause is -- it could be that I'm cycling due to my meds or because of my underlying disease. It doesn't matter which one it is (just knowing that I have a mood disorder is enough for me), I just want to be functional all or most of the time.
>
> So I'm not sure how to proceed now. Should I go up on the Lamictal dose (I'm currently on 200 mg/day)? Should I increase my anti-depressant dose (Effexor XR 150 mg/ day & Wellbutrin XL 300 mg/d)? or do something else?
>
> I'd appreciate any input you may have on this.I would first consider swapping out (or cross-tapering) the Risperdal for Lithium to get some prophylactic antipsychotic effects. I'm assuming you're taking risperidone to *prevent* psychotic features of your hypomanias/depressions, rather than treating *active* positive psychotic symptoms. While lithium is generally regarded as not very effective for rapid cycling, I have heard reports that atypical AP's like Risperdal can aggravate or fail to help cyclicity. But you might be taking the Risperdal to offset some mild psychosis-*inducing* properties of Wellbutrin and also possibly Effexor (at higher doses)-- if that is the case maybe you can just reduce both Effexor and Wellbutrin and see if you can get *off* Risperdal (forget the lithium)??
Posted by HappyGirl on October 7, 2004, at 0:10:35
In reply to Re: rapid cycling, posted by jdawg on October 6, 2004, at 21:34:11
Hi:
>>> Should I go up on the Lamictal dose (I'm currently on 200 mg/day)? Should I increase my anti-depressant dose (Effexor XR 150 mg/ day & Wellbutrin XL 300 mg/d)? or do something else? <<<--- It's NEVER easy to answer to the question above, because a depressive side of your Bp sounds like more 'severe' form.
In my case, at the time of dxed with Bp, it seemed NOT 'severe' form, however strangely it got worse as the time went by, even on the Depakote which was one of the best meds. for Bp back six years ago. Then, it's very hard to say whether you should increase A.D., because if you do, the manic side of your Bp may progress.
In Bp, whether Bp I or Bp II, it's said to be one of 'serious form' of M.I. For this reason, most of Bpers need to spend months, even years to find the right med. combo. Furthermore, in my case, after dxed with Bp, most of my productive activities were shut-down. Then, I truly understand your frustration along with sadness attached with this illness, ... but as time went by, I got my life back again thanks to the right med. combo. rxed by the right pdoc. However, I would say this trughfully, it's not 100% but about 85% of my normalcy. Then, in my personal view on this, it takes time to get better. Because, first, it's VERY hard to find the right med. combo. Second, even you're on right route, it takes quite awhile med. combo. to start working on your system because you need to deal with side-effect or adverse effects from taking those 'potent' psycho.-meds.I wonder whether you're able to take 'leave' from the work in order to give more attention to your Bp, due to the nature of this illness.
H.G.
Posted by HappyGirl on October 7, 2004, at 0:15:19
In reply to Re: rapid cycling, posted by jdawg on October 6, 2004, at 21:34:11
:
>>> Should I go up on the Lamictal dose (I'm currently on 200 mg/day)? Should I increase my anti-depressant dose (Effexor XR 150 mg/ day & Wellbutrin XL 300 mg/d)? or do something else? <<<--- It's NEVER easy to answer to the question above, because a depressive side of your Bp sounds like more 'severe' form.
In my case, at the time of dxed with Bp, it seemed NOT 'severe' form, however strangely it got worse as the time went by, even on the Depakote which was one of the best meds. for Bp back six years ago. Then, it's very hard to say whether you should increase A.D., because if you do, the manic side of your Bp may progress.
In Bp, whether Bp I or Bp II, it's said to be one of 'serious form' of M.I. For this reason, most of Bpers need to spend months, even years to find the right med. combo. Furthermore, in my case, after dxed with Bp, most of my productive activities were shut-down. Then, I truly understand your frustration along with sadness attached with this illness, ... but as time went by, I got my life back again thanks to the right med. combo. rxed by the right pdoc. However, I would say this trughfully, it's not 100% but about 85% of my normalcy. Then, in my personal view on this, it takes time to get better. Because, first, it's VERY hard to find the right med. combo. Second, even you're on right route, it takes quite awhile med. combo. to start working on your system because you need to deal with side-effect or adverse effects from taking those 'potent' psycho.-meds.I wonder whether you're able to take 'leave' from the work in order to give more attention to your Bp, due to the nature of this illness.
H.G.
Posted by jdawg on October 7, 2004, at 12:53:21
In reply to Re: rapid cycling » jdawg, posted by Ritch on October 6, 2004, at 23:45:30
I'm taking Risperdal for depression. According to my pdoctor it improves the efficacy of the anti-depressants. It's probably because Risperdal is a "dirty" drug, (unlike typical anti-psychotics) affecting serotonergic and noradrenergic systems in addition to dopamine.
In any case, has anyone had experience in combining Risperdal w. anti-depressants for this purpose?
> I would first consider swapping out (or cross-tapering) the Risperdal for Lithium to get some prophylactic antipsychotic effects. I'm assuming you're taking risperidone to *prevent* psychotic features of your hypomanias/depressions, rather than treating *active* positive psychotic symptoms. While lithium is generally regarded as not very effective for rapid cycling, I have heard reports that atypical AP's like Risperdal can aggravate or fail to help cyclicity. But you might be taking the Risperdal to offset some mild psychosis-*inducing* properties of Wellbutrin and also possibly Effexor (at higher doses)-- if that is the case maybe you can just reduce both Effexor and Wellbutrin and see if you can get *off* Risperdal (forget the lithium)??
Posted by D minor on October 7, 2004, at 14:29:25
In reply to Re: rapid cycling » Ritch, posted by jdawg on October 7, 2004, at 12:53:21
Hey,
I said I'd keep y'all informed of the results of my pdoc visit today. I showed him my mood chart and told him about my ups and downs.Well, he's been saying for a while that he thinks I'm bipolar, but he actually wrote it down as my diagnosis for the first time today. He can't say what type of bipolar.
And he's been thinking about putting me on Depakote. Well, I just took my first pill a few minutes ago. we'll see if this stops my cycling. How have people's experiences with Depakote been?
dm
Posted by HappyGirl on October 7, 2004, at 16:26:08
In reply to This Just In !, posted by D minor on October 7, 2004, at 14:29:25
Hi D. minor:
>>>> How have people's experiences with Depakote been? <<<--- I took the Depakote, from 750 mg. to 1250 mg. right after dxed with Bipolar. I, too didn't know what type of Bp I was sufferring. However, one thing I knew was NOT a simple and easy M.I. I got.
As to the Depakote, ... frankly, it's hard to remember every details, however at the beginning of Depakote tx, I felt my moods started to lift, ... simply 'felt good' even the next day on it. For that 'quick' effectiveness, I even called the Depakote, a 'Wonder' drug. Also, my vivid memory over this med.,... it made me sleepy throughout the day. However, some saying, never sleepy, ... rather 'get hungry' which I didn't have, but maybe a bit increased my appetite. I didn't gain any pounds, but again some got a weight problem. Besides this, I remeber about lab-visit/test to get my blood test done, ... maybe, 'liver' function test before the Depakote. It was a good mood-stabilizer for the first year or so, but I needed more strong med., such as Zyprexa to alleviate my symptoms as time went by.
In my suggestion, ... take the Depakote as your pdoc.'s instruction, because he/she knows VERY well your dx along with symptoms.
H.G.
Posted by jdawg on October 7, 2004, at 16:28:14
In reply to This Just In !, posted by D minor on October 7, 2004, at 14:29:25
Terrible for me. I was almost completely asleep for the first 2-3 days, then got a bit better but not well enough to function. After 2 weeks I just stopped taking it (I don't think you should stop so abruptly).
Good luck with it.
Posted by jdawg on October 7, 2004, at 16:31:40
In reply to Re: This Just In !//D minor, posted by HappyGirl on October 7, 2004, at 16:26:08
You definitely need to monitor Depakote levels in the blood as well as liver enzymes. Your dose may need to be adjusted to reach therapeutic blood concentration, which will hopefully be safe for your liver.
Posted by Ritch on October 8, 2004, at 9:32:53
In reply to This Just In !, posted by D minor on October 7, 2004, at 14:29:25
> Hey,
> I said I'd keep y'all informed of the results of my pdoc visit today. I showed him my mood chart and told him about my ups and downs.
>
> Well, he's been saying for a while that he thinks I'm bipolar, but he actually wrote it down as my diagnosis for the first time today. He can't say what type of bipolar.
>
> And he's been thinking about putting me on Depakote. Well, I just took my first pill a few minutes ago. we'll see if this stops my cycling. How have people's experiences with Depakote been?
>
> dmIt's the main mood stabilizer I am on (about 5 years) except for lithium (18 years or so). It definitely makes a great set of brakes-no doubt about it. It reduces anxiety too, but not as well as clonazepam. It helps sleep, but not as good as Trileptal or Lithium did. The main troubles with it are weight gain and hair loss. I never had hair loss, but I did get some significant weight gain at "higher" doses (500mg-day - I'm med sensitive to everything, now taking 375mg day). The only other troubles I get with it are muscle "twitchiness" and cognitive dulling. The twitchiness tends to fade if I increase the dose temporarily (over a few days to a few weeks). I also got similar twitchiness from Lithium. The cognitive stuff fades after a few days - couple of weeks (for me anyhow). Suggestion: Don't get stuck taking a ton of it if you don't need to. It does diddly-squat for my seasonal bipolar depressions (except to ease the "mixed" or "agitated" part of any of that). Generally, it is the most tolerable antimanic that I've tried. I view tolerability in terms of what happens when you start something or increase something and how you adapt. If things generally worsen with time rather than ease (side effects) with time I don't consider it a tolerable med. Good luck with it.
This is the end of the 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.