![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by sheilac on August 7, 2012, at 16:37:01
My Pdoc is retiring and today was my last appointment with her. It was interesting to see the Discharge Sheet she gave me. It said: Bipolar Mixed, mood fluctuations, partial response, Severity of Psychosocial Stressors - Severe, GAF rating - 45-50!
Yikes! I don't look so good. I told her I was having trouble going up on the Lithium due to the severe diarrhea, she said that could have effected my low blood level of Lithium.
She disagreed with my regular MD about using zoloft for anxiety. She felt it would make anxiety worse.
She is fine with using Adderall for motivation and depression.
I have been told in the past that I was BPII. Her take on me is that I am Mixed Bipolar. Which is probably true.
When I read about Mixed Bipolar it said Depakote and atypical antipsychotic drugs, are considered the first-line treatments.
It said antridepressants are a no no and Lithium didn't work as well with Mixed Bipolar.
I wonder since I can't seem to get my level of Lithium up if my new doc will suggest Depakote?
Does this mean that people that are mixed take both Depakote and an atypical? Or just an atypical?
Geodon was a weird drug, but at higher doses it helped. Couldn't take Adderall with it.
Abilify makes me fat. Seroquel makes me fat.
I DO NOT WANT TO GET FAT.
Geodon causes Atrial Fib, which my mother has, so I'm scared to go back to that med.
I can do a low dose of Depakote.
Who knows what the new doctor will suggest. Another doctor in the area I saw once (he was very mean) said Abilify - if it made me fat or not!
When I told her the Adderall helps but does cause some anxiety, she told me I would need to find another way to deal with my anxiety. I'm thinking, cut down the Adderall!
I think she is happy to be retiring and didn't really care too much at the end.
It just makes me wonder about the diagnosis and her choice of drugs?
Posted by Phillipa on August 7, 2012, at 19:01:21
In reply to Mixed Bipolar / Pdoc..., posted by sheilac on August 7, 2012, at 16:37:01
I still miss my old pdoc who retired last year. She got me. This guy is also old but doesn't talk. Do or did you meet your new doc? Phillipa
Posted by Sheilac on August 7, 2012, at 19:13:55
In reply to Re: Mixed Bipolar / Pdoc... » sheilac, posted by Phillipa on August 7, 2012, at 19:01:21
No, haven't met new doc yet. I find it interesting how different docs give you a different diagnosis.
Posted by phidippus on August 7, 2012, at 21:26:14
In reply to Mixed Bipolar / Pdoc..., posted by sheilac on August 7, 2012, at 16:37:01
what were her choice of drugs?
Lithium works fine for mixed bipolar-works well for mine. Depakote is not a bad choice though.
Eric
Posted by sheilac on August 8, 2012, at 17:05:19
In reply to Re: Mixed Bipolar / Pdoc... » sheilac, posted by phidippus on August 7, 2012, at 21:26:14
She started me on Geodon, which was a wacky drug. It made me manic until I got to 120mg. Then it messed with my heart rhythm, and my mother has Atrial Fib really bad and that is a side effect of Geodon, so she stopped that.
Trileptal - which depressed me (made me suicidal!)
Lamictal - which would be great, but I got blisters in my mouth.
Lithium, but I have been unable to get my blood level high enough, so far I've made it to .4. I keep having diarrhea and she thinks that could be washing away some of the lithium.
Plus, I hate the hair loss - soon I'll be bald! And the red, dry skin. It sucks.
I feel a little manic and obsessive now due to the Adderall and I'm only taking 5mg. But it has really helped with my depression and motivation.
Maybe I should try to go up to 600mg of Lithium again. When I tried it before, it made me irritable. Odd. Plus I worry about losing more hair and my skin flaking off at a higher dose. So far, the 450mg works fine, without the Adderall. Or maybe I have to stop the Adderall.
I'm afraid of becoming depressed or having a let down from stopping the Adderall. Plus, I wonder if I will have the motivation to do anything.
I know I am not stable right now, but I am not irritable and I am happy.
I'm very sensitive to meds and if I go too high on the mood stabilizers I get crushing depression. Can't take antidepressants, but low dose Adderall works great.
So, not sure what to do.
I'm afraid of all the side effects of these drugs too. Don't want to get fat and I don't want to damage my liver or kidneys. Both Depakote and Lithium have their issues.
Not sure what else I can try.
I'm trying to keep my med regime down to a minimum. I have Klonopin, Lithium and Adderall.
Maybe I should try Risperal or something else like it instead of the lithium? Then the Adderall would help protect against some weight gain. I don't know.
An old doc of mine years ago had me try Abilify and it made me a little manic and HUNGRY.
I just want a few simple pills.
Posted by phidippus on August 8, 2012, at 17:44:28
In reply to phidippus- Meds..., posted by sheilac on August 8, 2012, at 17:05:19
>I've made it to .4.
Just .2 below the effective range, which is .6 to 1.2
>I keep having diarrhea...Plus, I hate the hair >loss - soon I'll be bald! And the red, dry skin. >It sucks.
If you can't toletrate the side effects,try a different mood stabilizer.
>I feel a little manic and obsessive now due to >the Adderall and I'm only taking 5mg.
I doubt this very much. Stimulants do not cause mania unless in huge doses. Also, Dextroamphetamine(Adderall) is a proven treatment for OCD, so I'm sure your perceived maniaa and ocd aree purely psychological.
>When I tried it before, it made me irritable.
I doubt the Lithium was the cause of your irritability. Again look for psychological reasons.
>Or maybe I have to stop the Adderall.
Stopping 5 mg of Adderall is not going to change anything. You should try going up on the Adderall.
>if I go too high on the mood stabilizers I get >crushing depression.
This can happen with most mood stabilizers because they do nothing to treat depression. Lithium is different-it treats bipolar depression.
>I'm afraid of all the side effects of these >drugs too
There is no need to be. The chances of gettin
the worst side effects are very low.>Maybe I should try Risperal or something else >like it instead of the lithium?
No,no, no. Risperdal is an atypical antipsychotic and provides no mood stability.
You're running around in circles in your head. What you need to do is stop nit-picking over your every mood(you've got yourrsself under a microscope)and stop looking for signs of mania, ocd, whatever.
THEN, you need to commit to a medicine regime, which currently is Lithium, Adderall, Klonopin (I think you said so). The problem with your regime is your not at therapeutic levels. Your Lithium is a touch too low and your Adderall is at a tiny dose. Address the
Try Lithium at 600 mg again. I don't know what to say about the diarrhea-that usually passes.
Try a higher dose of Adderall. It may help you make sense of the mess in your head.
Eric
Eric
Posted by sheilac on August 8, 2012, at 19:34:18
In reply to Re: phidippus- Meds... » sheilac, posted by phidippus on August 8, 2012, at 17:44:28
I think you are right. I guess what I have been perceiving as mania as just been me being productive and not depressed, which is something that hasn't been in a very long time.
You're probably right about the Adderall. If I take a 2nd dose of 5mg XR, it doesn't make me hyper, it actually calms me down. So, for some reason the first dose of the day makes me hyper, but the 10mg doesn't.
My doc kept telling me to try to get to 600mg on the Lithium. I will try to do that and see what happens. I think with the Adderall on board I don't have to worry about getting depressed.
You're right about the atypical antipsycotics, they are not good mood stabilizers - Abiify and Geodon made me manic at times.
Maybe a higher dose of Lithium will stop the bathroom issues - or at least slow them down.
Will I ever stop losing my hair with the Lithium?
I hope so.
Thank you so much for your input! I really appreciate it.
I never would have thought I would be on Lithium - I have resisted for 15 years, and now everyone tells me how much better and healthier I seem (they don't know I'm on Lithium.
Guess it works.
Posted by bleauberry on August 9, 2012, at 8:01:50
In reply to Mixed Bipolar / Pdoc..., posted by sheilac on August 7, 2012, at 16:37:01
If weight gain in as issue, then that pretty much rules out all of the antipsychotics, and all of the mood stabilizers except maybe lamictal. I disagree with the opinions on zoloft or antidepressants. There is too much mystery involved for anyone to know if you would do well or do poorly on any certain med. There is too much overlap between one diagnosis name and another, and too much error in it because it is not factual but just opinion. That means there will also be overlap in which drugs are helpful or hurtful. For example, it seems to me one of the last things you would want to give to a patient with supposedly mixed bipolar is an amphetamine, but it is helpful to you. I like the zoloft idea except I really don't favor it as a stand alone antidepressant. But with Adderall on board it sort of fits the combo ideas I favor that include zoloft + tca. I think an little known option could do well with you, Savella.
Anyway, depakote is a weight gainer for most people, including me, I can't ever gain weight, but on mood stabilizers and antipsychotics I do. For a straight out mood stabilizer I would favor magnesium in the form of Mg glycinate over lithium, Mg malate or taurate as second choices.
Posted by phidippus on August 9, 2012, at 21:35:59
In reply to Eric -Meds..., posted by sheilac on August 8, 2012, at 19:34:18
If you have ADHD, then its to your advantage to take the right dose. Just for comparison, you take 5 mg of Adderal while my 10 year old son takes 10 mg of Adderal on top of Straterra. Do you have ADHD? Or do you hope the Adderal will help you with your mood?
As you raise your Lithium, more seratonin will be released...In fact, more than the Adderal is pushing. So, the Lithium will be helping with your depression the higher your dose gets. I take 1200 mg and hardly ever have problems with depression.
Abilify and Geodon, especially Geodon have antidepressants in them. Both have been known to cause mania.
I'm mistified why the bathroom issues persist. Hopefully they go away soon. If they don't stop, you may have to stop the Lithium or you might become dehydrated.
Hair loss could become a serious problem. If you start to bald, I would stop the Lithium.
IF you have to stop the Lithium, I would recommend you switch to Depakote.
Eric
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.