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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 phidippus on May 7, 2014, at 22:37:16
Diagnosis: Bipolar/ADHD/OCD
Rx:
Lithium 1200 mg (mood stabilizer)
Brintellix 10 mg (to treat OCD)
Geodon 160 mg (to treat bipolar and OCD)
Vyvanse 70 mg (treats ADHD and OCD)
Keppra 3000 mg (mood stabilization)All I have is some minor depression. If anyone has any ideas for treating it I'm all ears.
Eric
Posted by g_g_g_unit on May 8, 2014, at 1:15:05
In reply to New Regimin - still have some depression, posted by phidippus on May 7, 2014, at 22:37:16
hey Eric, how effective has Brintellix been in controlling your OCD? is it subjectively preferable to an SSRI (in terms of apathy, etc.)?
Posted by klein on May 8, 2014, at 6:54:47
In reply to New Regimin - still have some depression, posted by phidippus on May 7, 2014, at 22:37:16
> Diagnosis: Bipolar/ADHD/OCD
>
> Rx:
>
> Lithium 1200 mg (mood stabilizer)
> Brintellix 10 mg (to treat OCD)
> Geodon 160 mg (to treat bipolar and OCD)
> Vyvanse 70 mg (treats ADHD and OCD)
> Keppra 3000 mg (mood stabilization)
>
> All I have is some minor depression. If anyone has any ideas for treating it I'm all ears.
>
> EricHi Eric,
How about lowering your Geodon dose? According to Stahl high doses such as 160mg can be effective for very rapid cycling, but to get antidepressant effect a lower dose is recommended (20mg-40mg BID). The NE reuptake inhibition takes a while to kick though.
Small dose of Wellbutrin SR?
How is the Keppra working for you? Maybe you could augment it with stabilizers with a higher AD profile such as gabapentin or Lamictal or even LYrica.
How about increasing the dose of Brintellix?
Tricky diagnosis..
Posted by Phillipa on May 8, 2014, at 8:00:12
In reply to Re: New Regimin - still have some depression » phidippus, posted by klein on May 8, 2014, at 6:54:47
I guess a bit of luvox would raise or change the doses of the other meds? Phillipa
Posted by phidippus on May 8, 2014, at 20:34:54
In reply to Re: New Regimin - still have some depression, posted by g_g_g_unit on May 8, 2014, at 1:15:05
Way better than the typical SSRI. Much stronger effect on anxiety.
Eric
Posted by phidippus on May 8, 2014, at 20:40:19
In reply to Re: New Regimin - still have some depression » phidippus, posted by klein on May 8, 2014, at 6:54:47
>According to Stahl high doses such as 160mg can be effective for very rapid cycling
I am an extremely rapid cycler.
> Small dose of Wellbutrin SR?
May be a possibiility.
>such as gabapentin or Lamictal or even LYrica.
Gbapentin gives me a rash, Lamictal makes me psycho and Lyrica made me too stupid.
> How about increasing the dose of Brintellix?
Mania kicks in.
Eric
Posted by Christ_empowered on May 8, 2014, at 23:19:30
In reply to Re: New Regimin - still have some depression » klein, posted by phidippus on May 8, 2014, at 20:40:19
buspar?
Posted by g_g_g_unit on May 9, 2014, at 2:32:08
In reply to Re: New Regimin - still have some depression » g_g_g_unit, posted by phidippus on May 8, 2014, at 20:34:54
That's really cool. I just wish they'd release it here. I e-mailed Lundbeck and it hasn't even been approved.
Posted by LouisianaSportsman on May 11, 2014, at 21:23:36
In reply to Re: New Regimin - still have some depression » phidippus, posted by klein on May 8, 2014, at 6:54:47
> > Diagnosis: Bipolar/ADHD/OCD
> >
> > Rx:
> >
> > Lithium 1200 mg (mood stabilizer)
> > Brintellix 10 mg (to treat OCD)
> > Geodon 160 mg (to treat bipolar and OCD)
> > Vyvanse 70 mg (treats ADHD and OCD)
> > Keppra 3000 mg (mood stabilization)
> >
> > All I have is some minor depression. If anyone has any ideas for treating it I'm all ears.
> >
> > Eric
>
> Hi Eric,
>
> How about lowering your Geodon dose? According to Stahl high doses such as 160mg can be effective for very rapid cycling, but to get antidepressant effect a lower dose is recommended (20mg-40mg BID). The NE reuptake inhibition takes a while to kick though.
>
> Small dose of Wellbutrin SR?
>
> How is the Keppra working for you? Maybe you could augment it with stabilizers with a higher AD profile such as gabapentin or Lamictal or even LYrica.
>
> How about increasing the dose of Brintellix?
>
> Tricky diagnosis..Hey, look, some of my forum favorites in two quotes!
Yeah, klein, I think I brought up switching Latuda to Geodon in the past over to what Stahl considers to be a subtherapeutic, primarily 5-HT2C active, NE inhibiting lower dosage ziprasidone. It's on my list of ideas along with Eric's Keppra (gabapentin and bupropion were my last two medications I have went *off* of, actually)
Eric, I'll save you my best best advice for last.
I see your five meds and will raise you six (went off Lamictal XR recently in favor of seizure target dosage (where you actually lose the weight I've now learned too) Topamax XR.
I was just on Lamictal for so long prescribed by my older PDOC, and I just stayed on it because I wasn't any other mood stabilizing drugs. I never saw what it did for me, and now I am on other mood stabilizing drugs, I have decided to cease it. I don't notice anything negative about discontinuation. Have since brought back Nuvigil.
I would be on a lot more medicine, but I just don't want to be on so many now. I was once on a max of eight! I also don't want anything addictive (says the guy with a new meth prescription) I ran out very slightly, yet still early on Xanax XR so I switched to Klonopin 0.5mg. BID which I feel would be the minimal effective benzodiazepine and dosage for me that I can stick with. I feel comfortable with these six and hopefully sticking with this:
Brintellix 20mg. (treats depression)
Desoxyn 30mg. (treats ADHD)
Klonopin 1mg. (treats anxiety)
Latuda 80mg. (treats bipolar)
Nuvigil 250mg. (treats ADHD)
Topamax XR 400mg. (treats bipolar)There is still bipolar depression and anxiety manifesting itself covered with sluggish ADHD symptoms, however, even with the classic effective dosage mood stabilizer on top of an approved bipolar depression medication on top of antidepressant for BP and associated depression, top-notch stimulants for ADHD and a benzodiazepine. Ugh! I need ideas too, Eric. I'm more than happy to steal the good ones.
Lower doses of buspirone may be anxiolytic and tolerable? It can also generate more dopamine in lower dosages which might be relevant if you tried it unsuccessfully in the past and perhaps tried to dose too high while higher doses tend to negate it or antagonize them (notably D3 receptors, I believe). I've been wanting to know what a dopamine boosting maximum dosage would be? Going off this paragraph from this study:
" Buspirone at 1.25, 2.5, 5 mg/kg, ip neither induced catalepsy nor antagonised apomorphine stereotypy but did potentiate dexamphetamine stereotypy and antagonised cataleptic effect of haloperidol and small doses of apomorphine. Buspirone at 10, 20, 40 mg/kg, ip induced catalepsy and antagonised apomorphine and dexamphetamine stereotypies. Our results indicate that buspirone at 1.25, 2.5, 5 mg/kg blocks only presynaptic nigrostriatal D2 DA autoreceptors while at 10, 20, 40 mg/kg, it blocks postsynaptic striatal D2 and D1 DA receptors. Furthermore, buspirone at 1.25, 2.5, 5 mg/kg by selectively blocking presynaptic nigrostriatal D2 DA autoreceptors, increases synthesis of DA and makes more DA available for release by dexamphetamine and during haloperidol-induced compensatory 'feedback' increase of nigrostriatal DAergic neuronal activity and thus potentiates dexamphetamine stereotypy and antagonizes haloperidol catalepsy."
Indian J Physiol Pharmacol. 2007 Oct-Dec;51(4):375-86.
Effects of buspirone on dopamine dependent behaviours in ratsI believe the authors were seeing if they could use Buspar to treat catalepsy based on the results with DA in rats.
Also, I've seen that you've been on 70mg. of Vyvanse for a long time and maybe more dexamphetamine could help? I find methamphetamine to more of an antidepressant and a methamphetamine booster is something you and your doctor should discuss. Maybe halving your Geodon dosage (you have the lithium on board for the mood stabilization quality of the 160mg. effective dosage with the lithium) to 80mg. along with two 5 (7.5)mg.'s Desoxyns (Dexedrine) [remember 70mg. Vyvanse is made by Shire to be analogous to dexamphetamine which by strength = to 30mg. Adderall XR] later on in the day could make a tremendous impact with some low dose (15mg. PM, 7.5mg. AM? would be would I'd try) Buspar for a anxiolytic DA whirlwind? Always see if you can tolerate Brintellix 20mg.
Sum-Up of Various Ideas:
> > Lithium 1200 mg (mood stabilizer)
> > Brintellix *20 mg (to treat OCD)
> > Geodon *80 mg (to treat bipolar and OCD)
> > Vyvanse 70 mg (treats ADHD and OCD)
> > Keppra 3000 mg (mood stabilization)
> > *Buspar 22.5 mg
> > *Dexedrine 15 mg
> > *Nuvigil 150 mg.Just wanted to offer something. You could just switch to the Dexedrine Spansules if you're trying to be on a higher dosage/efficient. Also, have you tried Focalin? Many times depression can manifest itself because the ADHD isn't being effectively treated.
Therefore, my top-notch advice would be armodafinil for off-label depression and perhaps to help with any ADHD symptoms you might still have?
Posted by LouisianaSportsman on May 11, 2014, at 23:26:04
In reply to New Regimin - still have some depression, posted by phidippus on May 7, 2014, at 22:37:16
Eric, if I wanted to take Gabitril for my symptoms, what would be the target dosage for them? x mg BID? TID?
Posted by phidippus on May 12, 2014, at 16:33:55
In reply to Eric - Gabitril Target Dose?, posted by LouisianaSportsman on May 11, 2014, at 23:26:04
For anxiety, the target dose is 12 to 24 mg once every 12 hours. You can go much higher-up to 56 mg, but side effects make it intolerable.
Eric
Posted by LouisianaSportsman on May 12, 2014, at 20:49:09
In reply to Re: Eric - Gabitril Target Dose? » LouisianaSportsman, posted by phidippus on May 12, 2014, at 16:33:55
> For anxiety, the target dose is 12 to 24 mg once every 12 hours. You can go much higher-up to 56 mg, but side effects make it intolerable.
>
> EricMy PDOC told me that I might would fancy taking a 4mg. tablet with my first Desoxyn dose, second Desoxyn dose, and later in the afternoon with my Latuda at supper time for a total of 12mg.
You're saying not to divide up like that? Instead of doing that ^^^, just take the 12mg. tab? At night? Sounds like she was trying to make it something it's not. QD or BID? AM or PM? what size tabs? She was a fan of a #45 4mg. initiation prescription.
Posted by phidippus on May 13, 2014, at 13:54:29
In reply to Re: Eric - Gabitril Target Dose?, posted by LouisianaSportsman on May 12, 2014, at 20:49:09
I guess you could do 4 mg 3 times a day. I don't think it'll be as effective as 12 mg twice a day.
Its available as 2 mg, 4 mg, 12 mg, and 16 mg tablets.
Eric
Posted by Mogger on May 14, 2014, at 23:59:28
In reply to New Regimin - still have some depression, posted by phidippus on May 7, 2014, at 22:37:16
Eric I might have asked you before but have you tried 18 grams of inositol for at least 8 weeks? Took that long to kick in for me. Powerful supplement.
This is the end of the thread.
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