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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by sheilac on May 15, 2012, at 11:45:52
My doc wants me to take 300mg of Trileptal a day (which keeps me anger free, but depressed, very depressed). She also wants me to take 150mg - 300mg of Lithium a day to help with depression.
She also has me on Klonopin as needed and just yesterday she gave me Wellbutrin XL 150mg. In the past Wellbutrin has made me manic.
So far no mania, just a stomach that won't stop flip flopping. ANXIETY. I've already taken Klonopin.
I've been on Trileptal for a while and just recently my husband has suspected that IT is what is making me sooooo depressed.
I hate heart palps with Geodon, plus my mother has atrial fib, which Geodon can cause, but I am thinking of going back to that.
I just seemed happier and more energetic on Geodon. Not stable until I reached a higher dose.
Today, I split my morning 150mg Trileptal in half and only took 75mg. Feel better, not as weighed down. But the stomach anxiety that Wellbutrin is giving me is not good. I hate it.
Posted by SLS on May 15, 2012, at 14:22:27
In reply to Wellbutrin yuk - old meds..., posted by sheilac on May 15, 2012, at 11:45:52
> My doc wants me to take 300mg of Trileptal a day (which keeps me anger free, but depressed, very depressed).
Some people find anticonvulsant "mood stabilizers" depressing. This seems to be a particular problem with Depakote. I guess it can happen with Trileptal, too.
It may be that Trileptal is not making you depressed so much as it is bringing you down from a manic state. Depression usually follows mania, and the initial drop can be quite precipitous. It is possible that with time, the depression will lift, despite continuing with Trileptal treatment. That would be ideal. However, if depression continues to be a problem, there are several alternatives, including revisiting Wellbutrin, now that you have a mood stabilizer on board. Other choices would include Lamictal and Abilfy. Since I began taking Abilify, I have not experienced a manic reaction to antidepressants. For me, Abilify has antidepressant properties.
I like the idea of taking 150 - 300 mg of lithium on a regular basis for its antidepressant, neuroprotective, and neurotrophic (nerve growth) properties. I plan on continuing with lithium 300 mg indefinitely. Lithium might have some protective properties to prevent Alzheimers Dementia, a disease known to occur more often in people with chronic or recurrent depression. At such a low dosage, though, lithium will not usually act to treat mania.
- Scott
Posted by Sheilac on May 15, 2012, at 15:39:09
In reply to Re: Wellbutrin yuk - old meds... » sheilac, posted by SLS on May 15, 2012, at 14:22:27
So you think I should stay with Trileptal and keep trying the Wellbutrin?
Today on 75mg of Trileptal and 150mg of Wellbutrin xl was a nightmare! I have never been so anxious in my life. I ended up taking 2 mg of Klonopin and 300 mg of lithium and that helped somewhat.
I'm just not sure I can take the Wellbutrin again. I'm wondering if the depression will lift if I cut down on my Trileptal dose.
At first the Trileptal was great, but now it just depresses me.
Posted by SLS on May 15, 2012, at 16:09:00
In reply to Scott - Re: Wellbutrin yuk - old meds..., posted by Sheilac on May 15, 2012, at 15:39:09
> So you think I should stay with Trileptal and keep trying the Wellbutrin?
Not if the Wellbutrin is treating you badly. I thought you had not restarted the Wellbutrin yet. My mistake.
> Today on 75mg of Trileptal
Why are you taking only 75 mg? Is that what your doctor prescribed for you? It seems rather low. I thought 600 mg was at the low range for treating bipolar disorder.
If you want to avoid using an antidepressant, the combination of Lamictal and Abilify will not only help with the depression, but prevent the mania as well.
How do you know when you are manic? How does mania differ from the anxiety you experienced with Wellbutrin? Did you ever experience mania without being on an antidepressant?
Perhaps you can provide some more information regarding your case history in order for people to offer input. What did your illness look like before being treated? How old were you when you experienced your first mood episode (depression or mania)? Which antidepressants help? Which antidepressants hurt? Which antidepressants trigger mania?
- Scott
Posted by sheilac on May 15, 2012, at 17:59:14
In reply to Re: Scott - Re: Wellbutrin yuk - old meds..., posted by SLS on May 15, 2012, at 16:09:00
From the time I was a child I can remember what I now know is anxiety and panic attacks. I have had them all my life. Then following the anxiety would come depression and sometimes rage with it.
My life has been a viscous circle of anger/rage/ depression and anxiety.
The doc wants me on 300mg of Trileptal a day, plus 150 - 300mg of Lithium for the help of depression. At first when I was experiencing anxiety and rage episodes Trileptal worked great. Sometimes I would even go up to 450 or 600mg.
Now having been on just 300mg of Trileptal a day for the past few months I have fallen into a depression. I thought if I cut back on the Trileptal that would take away some of the medication induced depression. I have experienced depression with Lithium and Depakote as well when they were used as my mood stabilizers. I guess mood stabilizers just make me depressed. At first they are great to put out the fire, then after a few months the depression sets in.
My doc suggestion Wellbutrin, even though that has made me manic in the past. I think what I experienced today wasn't mania, but extreme anxiety from the Wellbutrin. Maybe I wouldn't have experienced that if I was on my full dose of Trileptal and Lithium? I don't know. I just know that the Trileptal seemed to be the cause of the depression, thus, my thinking was to cut the Trileptal in half to 75mg 2x a day. This DID NOT work with the Wellbutrin.
So, I am stuck with feeling flat and depressed on the Trileptal and throwing some Wellbutrin into the mix, which probably induced severe anxiety.
I was only on Wellbutrin XL 150 for one day and it was the worst day ever.
Do I go back to my high dose of Trileptal and get depressed and then thrown in some Wellbutrin to get me moving? Seems like a case of taking one drug to counteract the effects of another drug.
I thought Trileptal would HELP my depression. It only helped my rage and anger and kept me flat and with no emotion. I tried Lexapro but that made me tired and flat as well.
I'm kind of afraid of taking Wellbutrin anymore unless I am on a higher dose of Trileptal. And then I wonder if I will experience depression.
Or do I drop the Wellbutrin and cut back on the Trileptal until my mood says I need more? And use the Trileptal accordingly?
I wish I has some mania right now. The depression (maybe just low mood - which is what a mood stabilizer is supposed to do) is awful. I can't get much lower.
What do you think? Lower my Trileptal without the Wellbutrin and go from there for a week or so. OR Go up on my Trileptal and add in Wellbutrin for motivation and depression?
At this point, even though the Geodon caused heart palpatations, I miss the Geodon as my mood stabilizer. But that was a weird drug.
Posted by Phillipa on May 15, 2012, at 20:43:44
In reply to Re: Scott - Re: Wellbutrin yuk - old meds..., posted by sheilac on May 15, 2012, at 17:59:14
If geodon was a wierd drug for you why do you wish to switch to it? I kind of think from reading that the abilify might work? Phillipa
Posted by SLS on May 15, 2012, at 21:02:31
In reply to Re: Scott - Re: Wellbutrin yuk - old meds... » sheilac, posted by Phillipa on May 15, 2012, at 20:43:44
> If geodon was a wierd drug for you why do you wish to switch to it? I kind of think from reading that the abilify might work? Phillipa
Also, one might consider Latuda (lurasidone), which is a cousin of Geodon (ziprasidone). I don't remember any mention of cardiac conduction side effects in the literature I encountered. Unlike Geodon, Latuda does not inhibit the reuptake of serotonin and norepinephrine. I'm guessing that Latuda might be a more predictable drug than Geodon.
- Scott
Posted by bleauberry on May 16, 2012, at 5:17:20
In reply to Wellbutrin yuk - old meds..., posted by sheilac on May 15, 2012, at 11:45:52
Hey that sounds great.....take a pscyhiatrict patient and put them on a med that makes them a lot more depressed and keep them on that med. Yeah right. Ok. Not me.
I don't know why doctors are unaware or avoiding of the approaches that have the best potential outcomes. I do not see a good approach here, except for the very low dose lithium which I think is a good idea as long as it doesn't make anything else worse.
Anyway, whenever I run into a med that I think is making me worse, I will challenge it. That is, I will carefully get off it temporarily to see what happens, and then get back on it carefully to see what happens. Usually my suspicions are confirmed that way so there is no doubt. But honestly, your instincts are good enough. If you didn't get that depressed until after you started a med, then it's obviously the med.
Posted by SLS on May 16, 2012, at 6:03:52
In reply to Re: Wellbutrin yuk - old meds..., posted by bleauberry on May 16, 2012, at 5:17:20
> Hey that sounds great.....take a pscyhiatrict patient and put them on a med that makes them a lot more depressed and keep them on that med. Yeah right. Ok. Not me.
How long would you allow SC's current depression to continue following the discontination of Trileptal before reinstating it so as to prevent mania? It has already demonstrated efficacy. Mania isn't always that easy to treat.Sometimes, the only way to manage an acute manic episode with a mood stabilizer is to cause a subsequent mood shift towards depression. This oscillation is the natural course of the illness, and is often temporary. Perhaps a drug like Abilify can avoid this sequalae. It would be interesting to study this. It may not be the Trileptal that is perpetuating the depression, but the switch into depression that the drug originally facilitated by resolving the mania. However, SC reported feeling great for awhile immediately upon starting Trileptal. How would one interpret this? The depression appeared later.
I guess the quickest way to determine the role that Trileptal plays in SC's depression is to discontinue it, although it can be argued that her already reducing the dosage to 75 mg is tantamount to doing this. If the depression continues post discontinuation, then it might be a good idea to restart Trileptal at 300 - 600 mg/day and begin to treat the depression more aggressively with drugs such as Lamictal and Abilify. If this tactic doesn't work, then it might be time to add an antidepressant.
It is critical to prevent the mania from reemerging. If it recurs, then the whole process, including a switch into depression, must begin again. If it turns out that Trileptal is not tolerated, some other strategy must be employed to prevent the mania.
- Scott
Posted by sheilac on May 16, 2012, at 7:57:17
In reply to Re: Wellbutrin yuk - old meds... » bleauberry, posted by SLS on May 16, 2012, at 6:03:52
Today I am still suffering from the severe anxiety brought on by the Wellbutrin 150 XL! I have taken 150mg Lithium, 150mg Trileptal and 1mg Klonopin upon waking. I am still a nervous mess. I can't wait until this drug is out of my body!
I wonder if staying on the Trileptal at 300mg a day, (which robs me of my creativity, memory and personality - but keeps the mania away) and adding in 2mg of Abilify would help, instead of a traditional antidepressant.
Why do all the mood stabilizers make me so darned depressed in the end? I hate that. At first they work for the mania, but then they plummet me into the depths of such severe depression.
Posted by sheilac on May 16, 2012, at 10:58:42
In reply to Scott - Re: Wellbutrin yuk - old meds..., posted by sheilac on May 16, 2012, at 7:57:17
Since the 150mg Wellbutrin did JOLT me out of depression, but left me jittery beyond belief, I am wondering if I went down to 75mg. Even if that was too much, at least I could cut that in half.
BUT - my here's my question... Is 75mg or even half that better or worse for depression than 5mg Adderall XR? I had some mood issues after a week on Adderall.
Would Wellbutrin be less likely to give me mood disturbances (make my mood unstable) than Adderall or are they basically the same?
Posted by SLS on May 16, 2012, at 13:13:40
In reply to ??? 1/2 Wellbutrin OR Adderall?, posted by sheilac on May 16, 2012, at 10:58:42
Hi SheilaC.
> Since the 150mg Wellbutrin did JOLT me out of depression, but left me jittery beyond belief, I am wondering if I went down to 75mg. Even if that was too much, at least I could cut that in half.
How are you feeling at this moment?
> BUT - my here's my question... Is 75mg or even half that better or worse for depression than 5mg Adderall XR? I had some mood issues after a week on Adderall.
Your system may need some extra dopamine (DA), but not norepinephrine (NE). That is just speculation on my part, though. We don't have reliable biological tests to determine which drugs will help and which will hurt.
> Would Wellbutrin be less likely to give me mood disturbances (make my mood unstable) than Adderall or are they basically the same?
They are different enough such that I couldn't guess which would be a better drug for you.
Have you tried Effexor or Paxil?
What other antidepressants have you tried? Which among them helped you most?
At this point, I think you should work closely with your doctor to develop a plan of attack. It seems like your treatment is in disarray. The first issue to be addressed is what to do with the Trileptal. I'm not sure that dosages below 600 mg will be fully effective as a mood-stabilizer. I would ask about Lamictal and Abilify as adjunctive medications.
- Scott
Posted by Sheilac on May 16, 2012, at 14:34:31
In reply to Re: ??? 1/2 Wellbutrin OR Adderall? » sheilac, posted by SLS on May 16, 2012, at 13:13:40
I am just now starting to feel calmer. I have had to take a lot of Klonopin and my Trileptal 300 and Lithium 300 to help calm the severe anxiety that 150mg oh Wellbutrin brought on. One pill made me anxious for 2 days!
Trileptal and lithium seem to keep me flat and lead to the depression. I thought maybe a small dose of Wellbutrin would help. Maybe I should be looking at Abilify to treat the depression. Not sure.
Posted by Sheilac on May 16, 2012, at 14:50:51
In reply to Re: ??? 1/2 Wellbutrin OR Adderall?, posted by Sheilac on May 16, 2012, at 14:34:31
Is Trileptal and lithium along with klonopine supposed to be enough to take care of both mania AND depression?
Posted by SLS on May 16, 2012, at 20:53:25
In reply to Question, posted by Sheilac on May 16, 2012, at 14:50:51
> Is Trileptal and lithium along with klonopine supposed to be enough to take care of both mania AND depression?
All three drugs possess antimanic properties. Lithium is the best known to have antidepressant properties as well. That's not to say that Trileptal won't help depression. There is just less data supporting its use in bipolar depression.
What is your current dosage of lithium?
I am under the impression that lithium has more potential to act as an antidepressant for bipolar I disorder than for bipolar II disorder.
Perhaps you can discuss with your doctor adding Lamictal first and Abilify or Saphris second. These drugs have antidepressant potential, but are less liable to produce mania when compared to standard antidepressants. Zyprexa would probably work, too, but the weight gain and metabolic effects can limit its usage.
I still think that the Trileptal did what it was supposed to do - resolve the mania. The depression that came afterward is likely to be an artifact of a mood swing and not the result of Trileptal exerting a depressive effect. I think your feeling well transiently was your falling through a "zone" of euthymia on your way to depression. Obviously, I don't know every person who has ever taken Trileptal, but it seems that it is less likely than Depakote to produce a depression in the long-term.
For rapid cyclers, a combination of Lamictal and lithium can act as a prophylactic against relapse into both depression and mania.
I think it is desirable for you to educate yourself as much as possible, but allow the doctor to do his work. Think of your doctor and you as being a team. Your primary responsibility is to report as much as you can about your case history and present symptoms. Your secondary responsibility is to ask questions. You can then offer theories and treatment alternatives. Ultimately, it also becomes your responsibility to evaluate the effectiveness of your doctor in treating you and seek others if necessary.
- Scott
Posted by Sheilac on May 17, 2012, at 6:23:43
In reply to Re: Question » Sheilac, posted by SLS on May 16, 2012, at 20:53:25
For now I guess I am going to stay on 300mg of Trileptal and 300mg of Lithium and try a low dose of Wellbutrin (maybe half of a plain old 75mg pill) for depression and motivation.
I can't depend on Adderall, I experience too much mood instability ultimately.
I can use Klonopin as needed for daily anxiety as it occurs, especially if the Wellbutrin causes some anxiety.
This may turn out to be a good combo. I've never been truly stable enough to tolerate an antidepressant.
So, maybe as you said Scott, the Trileptal is doing what it is supposed to do and I've finally reached the point where I am able to add low dose Wellbutin and not go manic.
If that doesn't work in the long run, I may have to switch to a one pill wonder like Abilify.
I like the fact that Trileptal hasn't caused weight gain and it stabilized me at first pretty quick on a higher dose. My doc threw in low dose Lithium to help with depression (which at first it did) and because I was unable to tolerate a higher dose of Lithium.
I have to low dose meds and do combos. I will give this 2 weeks before I see doc again. Hopefully in that time I won't become depressed or manic.
Posted by sheilac on May 17, 2012, at 8:09:28
In reply to Scott - Re: Question, posted by Sheilac on May 17, 2012, at 6:23:43
It has been an hour and a half since I took the following:
150mg Trileptal
150mg Lithium
37.5 mg Wellbutrin
1mg KlonopinThe Wellbutrin just makes me feel hot and nervous. I'm not sure I will be able to stick it out. In the past Wellbutrin hasn't worked for me, so, I'm not so sure it will work for me this time.
Not sure what to do. Trileptal makes me depressed.
Do I just ask my doc to take me off everything (except the Klonopin) and try a low dose of Abilify?
Posted by bleauberry on May 18, 2012, at 8:52:45
In reply to Re: Wellbutrin yuk - old meds... » bleauberry, posted by SLS on May 16, 2012, at 6:03:52
You ask some tough questions Scott that no one on the planet has any answer to. I'm just saying, I do not buy the premise that someone must descend into deep depression induced by a new med in order to come out well on the other side. I just don't buy that. Does it happen? Sure. Not reliably. Some of those people we can visit at the gravesite. Suicide is always a real risk in the back of my mind, so when I see someone's depression significantly worsened, I get all kinds of red flags and alarms going off.
Personally I have had a few situations where a med or herb felt great at the start, quickly turned into very bad, and stayed very bad as long as I was on it. Why or how, no clue. My best guess is it must have something to do with feedback mechanisms or receptor sensitivities, either of them adjusting too far in an undesired direction. But in 0% of my cases did it ever turn around to better. So I admittedly have a little bias on the topic. It's just that as I think back on pbabble, I'm having a hard time recalling anyone that felt deeply worse at the start but then got a robust response when they toughed it out. I just haven't seen that, not enough to remember anyway.
I like the idea of abilify in this situation.
> > Hey that sounds great.....take a pscyhiatrict patient and put them on a med that makes them a lot more depressed and keep them on that med. Yeah right. Ok. Not me.
>
>
> How long would you allow SC's current depression to continue following the discontination of Trileptal before reinstating it so as to prevent mania? It has already demonstrated efficacy. Mania isn't always that easy to treat.
>
> Sometimes, the only way to manage an acute manic episode with a mood stabilizer is to cause a subsequent mood shift towards depression. This oscillation is the natural course of the illness, and is often temporary. Perhaps a drug like Abilify can avoid this sequalae. It would be interesting to study this. It may not be the Trileptal that is perpetuating the depression, but the switch into depression that the drug originally facilitated by resolving the mania. However, SC reported feeling great for awhile immediately upon starting Trileptal. How would one interpret this? The depression appeared later.
>
> I guess the quickest way to determine the role that Trileptal plays in SC's depression is to discontinue it, although it can be argued that her already reducing the dosage to 75 mg is tantamount to doing this. If the depression continues post discontinuation, then it might be a good idea to restart Trileptal at 300 - 600 mg/day and begin to treat the depression more aggressively with drugs such as Lamictal and Abilify. If this tactic doesn't work, then it might be time to add an antidepressant.
>
> It is critical to prevent the mania from reemerging. If it recurs, then the whole process, including a switch into depression, must begin again. If it turns out that Trileptal is not tolerated, some other strategy must be employed to prevent the mania.
>
>
> - Scott
>
>
>
Posted by SLS on May 18, 2012, at 10:19:55
In reply to Re: Wellbutrin yuk - old meds... » SLS, posted by bleauberry on May 18, 2012, at 8:52:45
> You ask some tough questions Scott that no one on the planet has any answer to.
Don't underestimate neuroscience and experienced clinical psychiatrists. They see far more than you and I, and the sophistication of their expertise would probably blow us both away.
> I'm just saying, I do not buy the premise that someone must descend into deep depression induced by a new med in order to come out well on the other side.
> I just don't buy that. Does it happen? Sure. Not reliably.
Yes. Reliably.
Sorry, but I must disagree with you here. I have seen enough people in real life (50 or more individuals in a patrial hospitalization setting) experience the almost inevitable switch into depression following mania, whether it be due to the natural course of the illness or from a biological intervention. It can be a paroxysmal event. I believe it occurs more often that depression follows mania than mania follows depression.
euthymia > mania > depression > euthymia
> Some of those people we can visit at the gravesite. Suicide is always a real risk in the back of my mind, so when I see someone's depression significantly worsened, I get all kinds of red flags and alarms going off.
I suppose I don't?
Bipolar disorder is what it is.
Anyway, I had indicated that SC should work with her doctor to decide what to do with the Trileptal and lithium. I would guess that depression preceded the application of these two drugs, as Wellbutrin was administered for a reason. If not for depression, then what? I asked SC a few questions, but received no answers.
I just don't know.
- Scott
Posted by sheilac on May 18, 2012, at 13:49:41
In reply to Re: Wellbutrin yuk - old meds... » bleauberry, posted by SLS on May 18, 2012, at 10:19:55
I'm sorry if I didn't answer all your previous questions. But here are how things stand.
Yes, the depression was there before anything else.
The Lithium and Trileptal took care of the mania and and I guess I was left with depression.
My pdoc threw Wellbutrin into the mix and even at just 37.5mg Wellbutrin made me feel severely anxious. It was awful.
My pdoc doesn't have a lot of time to see patients anymore (1 or 2 days a week) because she is retiring.
Today went to see an old pdoc (and he chewed me out for stopping seeing him - I never really liked him, he was the one that kept me manic on 40mg of Geodon for a month and didn't see a problem with it, he felt I was the problem for not sticking with the Geodon).
Anyway, old pdoc said my thinking that Trileptal and Lithium are what is causing the depression is wrong. These meds are keeping me stable, it's just that the depression hasn't been taken care of. When I went to see him I was convinced that Trileptal was making me depressed.
Maybe he's right. Maybe I am stable, just depressed. So he suggested adding Abilify to the Trileptal and Lithium, hoping that the Abilify would help with the depression.
Any thoughts on that?
Sometimes I wonder if I shouldn't just cut the Wellbutrin into quarters and try again. Or just throw Adderall at the depression (which only works at first).
What do you think? I need energy, motivation and to get out of this awful depression.
My sister says dump everything except Klonopin and use Tramadol!
Posted by Christ_empowered on May 18, 2012, at 14:01:14
In reply to Scott - What doc said..., posted by sheilac on May 18, 2012, at 13:49:41
hey, that stuff is very effective for some people. I think its somewhat similar to effexor, plus it has the whole opioid thing going for it. I liked it...it even calmed down my depressive psychosis a bit.
Have you tried Vyvanse? Its dexedrine that's been modified. It occurred to me that you might just need something that won't cause as much jitteriness as Adderall. Vyvanse is all the rage right now, so if your doc was willing to try Adderall, Vyvanse shouldn't be a huge problem.
Posted by sheilac on May 18, 2012, at 14:30:57
In reply to tramadol...., posted by Christ_empowered on May 18, 2012, at 14:01:14
I tried Vyvanse first and it made me manic. That is why she tried the Adderall 5mg XR.
I wish there was another stimulant with less of a let down.
Concerta didn't work either.
This is the end of the thread.
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