![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Girlnterrupted78 on December 14, 2009, at 4:01:49
My doctor insists that I might be low bipolar and wants to give me Lithium. I keep telling him I'm not bipolar.
My own self-diagnosis is depression with social and generalized anxiety and obsessive compulsive.
I am currently on 80mgs Parnate, 15mgs Adderall and we're about to add either Nortriptyline or Lithium.
Does anyone know what reaction would Lithium have in someone who is not bipolar? What would it do to me? What about Nortriptyline?
Thanks for any info.
Posted by willyeee on December 14, 2009, at 4:35:15
In reply to Parnate + Lithium for a unipolar depressive, posted by Girlnterrupted78 on December 14, 2009, at 4:01:49
Few things id say about your post.
First why are you letting a doc control you,if you feel one way then you should be in charge.
Second on the flipside perhaps hes responing to parnate induced mani,with the impact on sleep and parnates method of action,induced mani or maniac bahvoir is common on parnate.
Third if you concerned,why not start on a more minor mood stablizer such as nuerontion or lamictal then the more toxic lithium where you have to monitor levels and such.
Last with the combo of adderall and parnate,personaly id be weary of adding additional drugs,im actualy surprised a doc would give both adderall and parnate,considering there strong effect on similiar chemicals.
good luck!
Posted by SLS on December 14, 2009, at 6:44:08
In reply to Parnate + Lithium for a unipolar depressive, posted by Girlnterrupted78 on December 14, 2009, at 4:01:49
> My doctor insists that I might be low bipolar and wants to give me Lithium. I keep telling him I'm not bipolar.
Lithium can work as an adjunct to Parnate to produce an antidepressant response in unipolar depressives. However, the range of dosages used for this indication is pretty low (300mg-600mg). As Willyeee has commented, I would not make high-dose lithium (900mg or higher) the next treatment choice. It is best to avoid the potential toxicity of this treatment if possible. In my estimation, adding nortriptyline to Parnate is a logical choice. If you go that route, don't forget that testing for blood levels of nortriptyline is often helpful to determine the ideal dosage of this drug. Most people do well at 75mg. However, rapid metabolizers can need upwards of 150mg. It may be that your doctor would feel it better to use lower doses of nortriptyline because of the presence of Parnate.
- Scott
Posted by Phillipa on December 14, 2009, at 7:36:00
In reply to Re: Parnate + Lithium for a unipolar depressive » Girlnterrupted78, posted by SLS on December 14, 2009, at 6:44:08
Do you like your pdoc? Is there another you might trust more? Good luck. Phillipa
Posted by Girlnterrupted78 on December 14, 2009, at 11:52:48
In reply to Re: Parnate + Lithium for a unipolar depressive » Girlnterrupted78, posted by SLS on December 14, 2009, at 6:44:08
"In my estimation, adding nortriptyline to Parnate is a logical choice."
Thanks Scott. Just curious about how did you estimate this? A lot of times I tell my doctor things I heard here (I suggested nortriptyline after hearing success stories from different people here) so I would just like to have the whole story for him.. the whys and hows of what I suggest.
So if you can give me more info, I'd appreciate it.
My doctor thinks that because I stay up all night, that I'm "hypomanic" and "dysphoric" at the same time, since I no longer feel the initial positive effects of the med..and he also thinks that because I change from one activity to the next, that it further confirms some degree of mania.
But I keep explaining that I'm obsessive compulsive--a big procrastinator with chronic anxiety and guilt. I cannot get things done because I'm anxious and guilty during the day, and during the night I feel less guilt and anxiety because the night is not a time to "accomplish" so that freedom allows me to actually accomplish more.. but I don't feel out of control or anything.. I'm just not under the pressure of the daytime accomplishments I usually set for myself.
So I see it as a pattern of chronic procrastination, where I'm behind in 30+ things and I don't know where to start, and I only work on them when I feel less guilty or pressured--at night. I also hate mornings, so I sleep in a lot, and at night I'm not tired.. it's a vicious cycle that seems will never end.
Thanks again and I'd really like to hear your reasoning for choosing nortriptyine over Lithium so I can speak to him with a little more info.
Posted by SLS on December 14, 2009, at 14:07:25
In reply to Re: Parnate + Lithium for a unipolar depressive » SLS, posted by Girlnterrupted78 on December 14, 2009, at 11:52:48
> "In my estimation, adding nortriptyline to Parnate is a logical choice."
>
> Thanks Scott. Just curious about how did you estimate this? A lot of times I tell my doctor things I heard here (I suggested nortriptyline after hearing success stories from different people here) so I would just like to have the whole story for him.. the whys and hows of what I suggest.
>
> So if you can give me more info, I'd appreciate it.
>
> My doctor thinks that because I stay up all night, that I'm "hypomanic" and "dysphoric" at the same time, since I no longer feel the initial positive effects of the med..and he also thinks that because I change from one activity to the next, that it further confirms some degree of mania.Well, perhaps you don't want to go with the nortriptyline so quickly after all. I think it is important to get a better idea as to whether or not bipolarity is involved. The prevailing sentiment has been that tricyclics is the group of antidepressants that is most likely to cause a switch into, or exacerbate, mania. These drugs can also precipitate rapid cycling.
After not sleeping for a few days, how is your energy level? Do you feel that you are drawn to starting too many projects at once and not be able to finish any one of them? How is your sex drive?
- Scott
Posted by willyeee on December 14, 2009, at 15:31:25
In reply to Re: Parnate + Lithium for a unipolar depressive » Girlnterrupted78, posted by SLS on December 14, 2009, at 14:07:25
Dont mean to cross post your thread,i responded to it and will offer any more advice or ideas if they pop up,HOWEVER SCOTT just wanted to ask how are you doing,i know you stopped and changed parnate so hoping that transition went well,anyway good luck to both.
Posted by SLS on December 14, 2009, at 15:42:59
In reply to Re: Parnate + Lithium/Scott, posted by willyeee on December 14, 2009, at 15:31:25
> Dont mean to cross post your thread,i responded to it and will offer any more advice or ideas if they pop up,HOWEVER SCOTT just wanted to ask how are you doing,i know you stopped and changed parnate so hoping that transition went well,anyway good luck to both.
Thank you so much for your concern. Today should be the last day of my Parnate taper. So far, the only withdrawal symptoms I have experienced are REM rebound dreaming and fatigue. We'll see how things change this week as MAO inhibition continues to decline. I have not experienced a significant increase in depression yet. Perhaps my initial positive response to Parnate declined gradually over the past year until the drug was no longer helping. I hope I don't end up with no better alternative than to switch back and forth between Parnate and Nardil.
- Scott
Posted by Phillipa on December 14, 2009, at 19:24:30
In reply to Re: Parnate + Lithium for a unipolar depressive » SLS, posted by Girlnterrupted78 on December 14, 2009, at 11:52:48
Just wanted you to know that your thinking on nights is exactly like mine and husbands. No pressure so lessens anxiety. And we sleep late today an exception doc's appointment for bones. I rationalize it as if I were working still as an RN at night. Love Phillipa
Posted by willyeee on December 14, 2009, at 20:15:34
In reply to Re: Parnate + Lithium/Scott » willyeee, posted by SLS on December 14, 2009, at 15:42:59
I feel the same way,i loathe parnate at times due to its sleep effect and its brutal bashing with insomnia.
I stay on it however,because one thing parnate did if it did anything was lock up that deep gut wrenching fear in my gut while being depressed,and standing where i due on terms of being anti-ssri i simply dont know of a sbustitute as a primary Anti depressant to switch to,lots of meds for augments,but nothing has shown to be as effective for me then parnate blah.
Emsam while in its pre arrival stage was gonna be my ticket out,i had high hopes for it and well asking every pharmcist ive seen if they ever even heard of it i lost hope in that.
Anyway hope its final before xams so you can start your new meds.
Posted by Girlnterrupted78 on December 15, 2009, at 6:20:47
In reply to Re: Parnate + Lithium for a unipolar depressive » Girlnterrupted78, posted by SLS on December 14, 2009, at 14:07:25
> Well, perhaps you don't want to go with the nortriptyline so quickly after all. I think it is important to get a better idea as to whether or not bipolarity is involved.
What makes you think I'm possibly bipolar? Was it my elaborate explanation as to why I'm NOT bipolar that made you come to that conclusion? Or did you just ignore it altogether and went on to advice pretending I never wrote anything? You could have at least acknowledged that I explained I was not bipolar, and even challenged/disagreed with it, but not even considering it seems rude, imo.
I find it strange that once I ask you to elaborate on something, you simply change your mind. Almost like you never really thought about what you wrote.
>The prevailing sentiment has been that tricyclics is the group of antidepressants that is most likely to cause a switch into, or exacerbate, mania. These drugs can also precipitate rapid cycling. I find it awfully disrespectful when people don't even acknowledge that you said something on the matter.
If that were the case, then taking Nortriptyline would tell me for sure whether I'm bipolar or not, and I could discontinue + start a mood stabilizer. But I'm already on Parnate + Adderall, and I'm not manic, so I doubt I'm bipolar.
I've never had a manic episode in my life, and staying up all night not knowing where to begin with all the things that I've procrastinated is more related to obsessive compulsive than mania.
The cycle begins in the mornings: I refuse to get up and instead sleep in as an escape mechanism to avoid the depression and anxiety I feel at the prospect of a morning full of responsibilities.. so I procrastinate and get up late.
When I finally get up, I feel so guilty about getting up so late, that I continue to procrastinate all the stuff I have to do.
The obvious result is that after sleeping during the morning, I will be up all night with a bunch of things I should do and not knowing where to begin. Now, if that is the definition of "bipolar" lol, then yes, I guess I'm bipolar.
> After not sleeping for a few days, how is your energy level? Do you feel that you are drawn to starting too many projects at once and not be able to finish any one of them? How is your sex drive?My energy level after not sleeping for 2 days has always been low. In fact, I never went on to stay up two nights in a row until I started Parnate + Adderall. And my energy level obviously increased with Parnate and Adderall, since they're both stimulants. But I guess, just like my doctor, your reasoning must be: You're up two nights in a row? Forget about Parnate + Adderall or their stimulant effects, or the well-known fact that they exacerbate insomnia, you ARE bipolar...
I still feel tired.. btw, I just have a little more energy to waste sitting in the computer instead of lying down motionless in my bed without energy to even get up.
I guess there will be lots of newly created bipolars every time somebody begins a treatment with highly stimulating drugs. I'm the new creation! A Parnate-Adderall induced bipolar!!
Posted by SLS on December 15, 2009, at 7:02:16
In reply to Re: Parnate + Lithium for a unipolar depressive » SLS, posted by Girlnterrupted78 on December 15, 2009, at 6:20:47
> > Well, perhaps you don't want to go with the nortriptyline so quickly after all. I think it is important to get a better idea as to whether or not bipolarity is involved.
> What makes you think I'm possibly bipolar?
>
> Was it my elaborate explanation as to why I'm NOT bipolar that made you come to that conclusion?Yes. "Possibly."
> Or did you just ignore it altogether and went on to advice pretending I never wrote anything?
I did no such pretending.
> I find it strange that once I ask you to elaborate on something, you simply change your mind. Almost like you never really thought about what you wrote.
I would be remiss if I weren't to suggest examining the possibility of bipolarity when recommending that someone take a tricyclic antidepressant.
> You could have at least acknowledged that I explained I was not bipolar, and even challenged/disagreed with it, but not even considering it seems rude, imo.
Rude or not, I thought it important to look at your description of lack of sleep more closely.
> >The prevailing sentiment has been that tricyclics is the group of antidepressants that is most likely to cause a switch into, or exacerbate, mania. These drugs can also precipitate rapid cycling. I find it awfully disrespectful when people don't even acknowledge that you said something on the matter.
> If that were the case, then taking Nortriptyline would tell me for sure whether I'm bipolar or not, and I could discontinue + start a mood stabilizer. But I'm already on Parnate + Adderall, and I'm not manic, so I doubt I'm bipolar.
Ok.
> I've never had a manic episode in my life
Many bipolars never recognize their manias, and are often triggered to become angry when anyone suggests that they are.
> and staying up all night not knowing where to begin with all the things that I've procrastinated is more related to obsessive compulsive than mania.
Ok.
I'll refrain from commenting any further about your illness. Although you might be very accurate in your appraisal of your condition, I believe I was very prudent in being cautious when making treatment suggestions, a behavior of mine that I should perhaps reevaluate.
I can only react to the information I am presented with. As someone discloses or updates more information about their condition, I feel obligated to update my thinking.
- Scott
Posted by willyeee on December 15, 2009, at 7:59:02
In reply to Re: Parnate + Lithium for a unipolar depressive » SLS, posted by Girlnterrupted78 on December 14, 2009, at 11:52:48
Wow rude,biggest misconception i have seen in a long time!
First in my opinion scott could have easly NOT assumed as he did no such thing,but include in his "advice" the mentioning of bipolar,i did too,why?
A. You mentioned that your doc believed this was a possability,so much he wants to add a strong mood stablizer.
B.Rather then put your foot down,you instead are posting about the drug instead,giving the impression that although you dont agree your willing to maybe go on with your docs treatment hence part of the orignal question.
C.In a case where a patient,myself rather is dead set aganist a docs view or treatment course,i leave,i am gone,again the fact that you dident seem to mention this,but instead ask about his idea of treatment shows your in confusion as to whether or not you are going to.
D.Scott,being nice as he was took the time out of his day to answer you,which he choose to do,and i personaly think he was being very careful in his advice speaking generaly never stating you were bi-polar but stating if you were in considering this with your doc by allowing the possable addition of lithium.So his answer to you was well rounded working with the info you gave him.
Last even if he did misunderstand something you felt you wrote clear,HOW RUDE of you to attack someone who holds a enromous track record of good advice and considered a asset here simply because they miosundertood your post,if he did perhaps you could have replied with an answer correcting him to what he read wrong and i truly doubt scott would have debated with you whether or not you were bi polar but instead answered the question.
If you take in to account how many people have been helped by scott,how many people value his advice,how he has posted here,how many conflicts he avoids,and on and on,i think perhaps you might come to a 360 and actualy appreciate he took the time out at all to even read and reply to you,and that calling him RUDE was prob furtherst from the truth.
Posted by Dr. Bob on December 25, 2009, at 0:34:20
In reply to Re: Parnate + Lithium /scott rude?, posted by willyeee on December 15, 2009, at 7:59:02
> did you just ignore [my explanation] altogether and went on to advice pretending I never wrote anything? ... not even considering it seems rude, imo.
>
> Girlnterrupted78> Wow rude,biggest misconception i have seen in a long time!
>
> willyeeePlease don't post anything that could lead others to feel accused or put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're bad people, and I'm sorry if this hurts you.
Scott, I'm also sorry if you felt hurt.
More information about posting policies and tips on alternative ways to express yourself, including a link to a nice post by Dinah on I-statements, are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Thanks,
Bob
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.