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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Chinaboy on July 8, 2015, at 1:06:23
There is a difficult question that has been bothering me for years. Which is whenever I take a mood stablizer, I would be fumed with major rage.It caused "turbulence of mood", which can be explained as I'm all the more unstable, such as confusion and agitation, than on any other types of meds.
But how come? Aren't mood stablizers supposed to bring stability to your mind?
In terms of severity, lithium ranks No.1，then it is followed by tegretol， Sodium Valproate， and Lamictal. And antipsychotics only lead to a zombie-like state of mind.
I speculate that it has something to do with noradrenaline？All the mood stablizers work to curb mania/hypomania by lowering noradrenaline, the action of which could possibly stablize mood? And my noradrenaline is likely to be already very low?
I do need an agent that could stablize my mood cuz there is clearly mood instability in me. Can any of you guys offer an explaination or solution to my question?
Any input would be greatly appreciated.
PS: for those of you who wish to be a penpal of mine, feel free to drop me a line at wangguanzhuang167@163.com
Posted by SLS on July 8, 2015, at 5:38:58
In reply to Rage and agitation caused by mood stabllizers., posted by Chinaboy on July 8, 2015, at 1:06:23
> There is a difficult question that has been bothering me for years. Which is whenever I take a mood stablizer, I would be fumed with major rage.It caused "turbulence of mood", which can be explained as I'm all the more unstable, such as confusion and agitation, than on any other types of meds.
What illness are you treating?
If you are bipolar, in what phase of the illness are you? Do you experience a mixed state even without medication?
- Scott
Posted by Chinaboy on July 8, 2015, at 21:23:54
In reply to Re: Rage and agitation caused by mood stabllizers. » Chinaboy, posted by SLS on July 8, 2015, at 5:38:58
THank you for your timely reply.
I once had a pdoc to whom I could tell my unexpected reaction to mood stablizers. But he just dismissed it with a reply that this was all coincidence which was not indicatIve of any treatment error on his part
All the antidepressants, regardless of their class, are seemingly effective for me. But that efficacy never lasts and there is just a short distance towards remission, which I can never overcome.
I do have mood instablity. I would be down when there is work to do or classes to attend, but I'm apparently OK when there is no work or classes. Many pdocs in my province interpret this as suggesting my mood being bipolar. But my interpretation is that this is a spontaneous mood shift in sync with external stumili instead of any bipolar thing.
Having read my account, what do you think? Any opinion would be greatly welcomed.
Posted by rjlockhart37 on July 8, 2015, at 23:44:11
In reply to Re: Rage and agitation caused by mood stabllizers. » Chinaboy, posted by SLS on July 8, 2015, at 5:38:58
I've had similar feelings on lamictal, it makes, it like forces me to be in a stable, one mood all the time and won't let me get euphoric and feel elevated mood, and it tends to make me get angry about it.....not at anything, just by the way it makes me feel......i'm not really thinking i need to take lamictal anymore....
Posted by Chinaboy on July 9, 2015, at 2:37:29
In reply to Re: Rage and agitation caused by mood stabllizers., posted by rjlockhart37 on July 8, 2015, at 23:44:11
Dear SLS:
I'm sorry to know that Lamictal gets your mood overly leveled so that you couldn't feel the happiness.
My story is different from yours. All the mood stablizers never got me stable, on the contrary, they made my mood more unstable and I was fumed with rage and confusion, as if I was in a drunken state.
I tried to work out some thoeries to explain the above, such as the lowered NE theory, but always failed to come up one. Though knowing this might be a difficult question, I'm still longing to hear one.
Could any of you guys, who are much more versed in psychiatry, offer any explanation? Any input would be greatly appreciated.
Posted by SLS on July 9, 2015, at 7:23:07
In reply to Re: Rage and agitation caused by mood stabllizers. » Chinaboy, posted by SLS on July 8, 2015, at 5:38:58
Have you tried Klonopin (clonazepam)? What was your reaction to it? What about the other benzodiazepines (BZD)
I really can't account for your reaction to mood stabilizers. There is a phenomenon known as disinhibition. It occurs sometimes in people who take BZDs. In a minority of people, instead of producing calmness, these drugs produce agitation and rage. This is what is known as a paradoxical drug reaction. BZDs act on GABA receptors and turn them on (opens the lock). Perhaps you are having s paradoxical disinhibition reaction to anticonvulsants, whose actions are to increase GABA activity. Your guess that an increase in noradrenaline (NE) activity would make you feel better is an interesting one. If you feel that strongly about it, you can explore trying desipramine. Desipramine is a very effective tricyclic antidepressant that works on NE only.
Have you tried Abilify (aripiprazole)? What about Saphris (asenapine)? Abilify can increase dopamine (DA) activity without producing the receptor desensitization that DA agonists can produce. For some people, Saphris can produce an antidepressant effect without cognitive blunting. My doctor really likes Latuda (lurasidone) better than Abilify for depression, but I have yet to see someone do well with it. However, my doctor sees lots of patients, so I would not discount his opinions.
The lithium thing is interesting. Like many of the anticonvulsants, it can be anti-manic and perhaps anti-dopaminergic. It is interesting that Lamictal is the least effective anti-manic agent, and it is also the least deleterious to you. I wonder if you might need something that is pro-dopaminergic. I would look at Abilify, Wellbutrin, and MAOIs if depression is still an issue. If an anxiety disorder is present, Nardil would be the better choice. However, I would look to Abilify first so as to avoid the food and medication restrictions that are necessary when taking an MAOI. Note, however, that Abilify can produce mild akathisia at first, but it usually dissipates. Some people experience a more severe reaction, though, that requires discontinuation.
I'm sure you will find an answer. It just might take more trial-and-error. In the meantime, you can try taking N-acetylcysteine (NAC). It has the potential to act as a mood stabilizer, but it can take several months for it to take effect. Omega-3 fatty acids in the form of fish oil (60% EPA; 40% DHA) is another substance that might be helpful. Inositol is a supplement that can help stabilize neuronal membranes and has been shown to be helpful in bipolar disorder for both mania and depression.
After saying all of that, I am still confused by your situation and cannot make any recommendations at this point.
- Scott
Posted by Horse on July 9, 2015, at 16:14:41
In reply to Me being polar? » SLS, posted by Chinaboy on July 8, 2015, at 21:23:54
>
>
>
> I do have mood instablity. I would be down when there is work to do or classes to attend, but I'm apparently OK when there is no work or classes. Many pdocs in my province interpret this as suggesting my mood being bipolar. But my interpretation is that this is a spontaneous mood shift in sync with external stumili instead of any bipolar thing.ADHD?
Posted by SLS on July 9, 2015, at 18:32:10
In reply to Re: Me being polar?, posted by Horse on July 9, 2015, at 16:14:41
> > I do have mood instablity. I would be down when there is work to do or classes to attend, but I'm apparently OK when there is no work or classes. Many pdocs in my province interpret this as suggesting my mood being bipolar. But my interpretation is that this is a spontaneous mood shift in sync with external stumili instead of any bipolar thing.
> ADHD?That's a great suggestion.
- Scott
Posted by Chinaboy on July 9, 2015, at 21:29:54
In reply to Re: Me being polar? » Horse, posted by SLS on July 9, 2015, at 18:32:10
Many thanks to the above kind, considerate, and helpful folks who contributed new idea to my diagnosis.
This morning I went to another pdoc's office and got a diagnosis of bipolar mixed state, with an explanation that the mood-stablizer-induced anger and agitation are from the extremely unpredictable disease itself. The prescription he offered went as follows: 500mg of lithium carbonate ,very low dose of magnesium valprote, 400 mg of Lamictal, 15mg of Abilify.
What do you guys think?
Posted by Slugbrain on July 10, 2015, at 10:13:19
In reply to Re: Me being polar?, posted by Horse on July 9, 2015, at 16:14:41
Inattentive or unproductive or more moody in school not out.... Ding ding!! Sounds like one of the ADHD versions. Something related to being forced to concentrate when brain doesn't want to or can't. Years of that effect can build to a depressive reaction you may not even be aware you are having (so how would y be able to articulate to a doctor?
When I'm super inattentive I get extremely bored, and that makes me feel depressed. (Or maybe it's just a depression helped by ADD meds.) I constantly feel I'm underachieving and have a history of being that way. That thought sequence for me leads to anxiety and/or depression.
But your rage - that really sounds like ADHD, and for ADHD (hyperactive or combined) mistakenly treated as a depression or mood instability, antidepressants can make some things worse, or introduce new problems.
I probably should stay away from anything sounding diagnostic. It's just that I have read about people in what sounds like your situation again and again (usually in ADD research texts). Also was my experience to an extent.
A PDoc once had me try lamictal and other "-als". Felt like a total zombie. Lost months of productivity. Became more depressed because he didn't believe /agree with ADD idea, suggested "in my head". He next tried Ritalin. Almost same, dulling effect. Methylphenidate family does not work for me. Amphetamines work extremely well. Tiny amounts work fine (for me).
See drcharlesparker.com. He is a bit self promotional but if you can tolerate it, he's got excellent guidance for exactly your situation. Some ADHD people misdiagnosed and incorrectly treated as bipolar or similar find their mood hugely improved when off antidepressants and on ADHD meds.
Posted by Slugbrain on July 10, 2015, at 10:21:40
In reply to Re: Me being polar? ADHD - swconded, posted by Slugbrain on July 10, 2015, at 10:13:19
That was meant to say seconded - I second horse's thought re: ADHD. (And you shouldn't look a gift horse in the mouth...yuck yuck)
Also wanted to add that ADHD is almost always comorbid with (occurs at same time as...) anxiety and/or depression. Can be a very complicated Dx. Easy to miss.
Try this
https://www.psychologytoday.com/blog/bipolar-you/201402/misdiagnosis-bipolar-disorder
Posted by linkadge on July 10, 2015, at 17:58:47
In reply to Re: Me being polar? ADHD - seconded, posted by Slugbrain on July 10, 2015, at 10:21:40
Yes. I have noticed this too. I find that many mood stabilizers work better for euphoric mania. With mixed states and depression, sometimes mood stabilizers seem to "lock in" a irritable mood.
I find that mood stabilizers will do this more frequently, if I am on an antidepressant, stimulant, coffee, or other supplements.
Linkadge
Posted by SLS on July 10, 2015, at 21:42:02
In reply to Re: Me being polar? ADHD - seconded, posted by linkadge on July 10, 2015, at 17:58:47
> Yes. I have noticed this too. I find that many mood stabilizers work better for euphoric mania. With mixed states and depression, sometimes mood stabilizers seem to "lock in" a irritable mood.
>
> I find that mood stabilizers will do this more frequently, if I am on an antidepressant, stimulant, coffee, or other supplements.
>
> LinkadgeI've seen Topamax 200 mg/day help with mixed-states and dissipate irritability. Everyone is different, though.
- Scott
Posted by Chinaboy on July 13, 2015, at 7:42:39
In reply to Re: Me being polar? ADHD - seconded, posted by SLS on July 10, 2015, at 21:42:02
Many thankS to you guys for your support and posting so many informations and educational opinionS.
I tried to talk to the pdoc about ADHD thing.He dismissed it with words "how can you so much, and that you are being pathetic,"
THey won't listen. Can any of you help point out the way to treat ADHD>?
Posted by SLS on July 13, 2015, at 8:18:12
In reply to Re: the way to treat ADHD, posted by Chinaboy on July 13, 2015, at 7:42:39
> Many thankS to you guys for your support and posting so many informations and educational opinionS.
>
> I tried to talk to the pdoc about ADHD thing.He dismissed it with words "how can you so much, and that you are being pathetic,"
>
> THey won't listen. Can any of you help point out the way to treat ADHD>?
For now, I would spend some more time confirming your diagnosis rather than treating something you don't have with powerful drugs.Do some web surfing. You can start with Google.
- Scott
Posted by Chris O on July 15, 2015, at 16:12:32
In reply to Re: the way to treat ADHD, posted by Chinaboy on July 13, 2015, at 7:42:39
How insensitive of your "doctor" to suggest that you are "pathetic." You are most definitely not "pathetic" for trying to get help for your suffering.
I also struggle greatly (overwhelming anxiety, rage) when forced to do scheduled tasks (work, study, etc.). I have been diagnosed with GAD, but recently got a prescription for Adderall just to see if the amphetamine class would do anything for me. Alas, Adderall just made me more anxious and unfocused. But you should definitely give the amphetamine class a try if you haven not done so yet.
Chris
Posted by Christ_empowered on July 15, 2015, at 17:24:32
In reply to Re: the way to treat ADHD » Chinaboy, posted by Chris O on July 15, 2015, at 16:12:32
yeah...your shrink sounds like an *ssh*l* from Hell. A lot of them are, unfortunately.
Posted by Slugbrain on July 17, 2015, at 18:59:05
In reply to Re: the way to treat ADHD » Chinaboy, posted by SLS on July 13, 2015, at 8:18:12
ChBoy: Boy, do I understand your frustration! It took me years to find someone who'd respect my thoughts and really listen. So much wasted time.
SLS - i respectfully disagree that ChBoy and his doctors can know exactly what he doesn't have - or does have. It's just not an exact science, this mental health/mood management business (wry smile)...
And again, there is certainly enough well-documented overlap in symptoms to at least consider ADHD in the differential. Not doing so might be even more detrimental to ChBoy's health, in the case that ADHD is the culprit; and ignoring the option *might* also preclude a much easier fix than the current multi-med cocktail (understanding of course that anger management still involves some behavioral modification).
ChBoy, IMHO I don't think you'd need a heavy hitter like Adderall to determine what will work best for you. In addition, if - as would be my guess - there is some ADH/D -h (hyperactive predominantly) or -c (combined) in the mix, you might well be better off with a methylphenidate (Ritalin etc.) than amphetamine (Adderall, Dexedrine, Vyvanse). See Adele Diamond work on this subject. If they try Adderall and mood control gets worse, as it might if you are a really -h type, they may not know to instead try a methylphenidate -- and just jump to mood disorder dx and meds.
For starters, compile as much anecdotal detail as possible as related to time of day, activity at onset of and type of symptoms. I'd think the in-school vs out of school difference in your mood (and inability to control anger) would be worth very careful observation and journaling. A truly informed psychiatrist would want to know about how your symptoms differ in each scenario and s/he would probably greatly appreciate your detailed notes. Note-taking works really well for me, anyway (thank goodness my OCD comes in handy once in a while!).
In treating ADH\D, once you've found the med that fits your needs, it can really help with anger management. Even though I'm an inattentive ADD-er, not typically prone to anger issues, I still notice that when the ADD meds are working all my social interactions go so, so much better. I am calmer and much less impulsive in my reactions to things I'm not happy about.
Last thought: if out of pdoc options, see if a child/adolescent pdoc would give you a consult. They'd know about how childhood ADH/D symptoms continue into adulthood, while "adult" psychiatrists, unless very recent grads, won't be current with ADH/D diagnosis and treatment, might think it's only in childhood, etc.
Posted by Zyprexa on July 17, 2015, at 19:55:01
In reply to Re: Me being polar?, posted by Chinaboy on July 9, 2015, at 21:29:54
I was going to suggest lamictal and abilify. So I agree with your doctor. Let me know how those go. I don't think its ADHD. My doc tried to put me on something for that, but it never helped. I'm schizoaffective. So I have half your dx. Lamictal and abilify never worked for me, but I think they might for you.
Posted by Chinaboy on July 18, 2015, at 5:34:04
In reply to Re: the way to treat ADHD, posted by Slugbrain on July 17, 2015, at 18:59:05
Many thanks to the above informative and educational posts written by the kind-hearted guys of psycho-babblers.
Visited another pdoc and he wrote a prescription of 2.5mg of zyprexa without being specific about the diagnosis and how it works.
I want to know What 2.5mg of zyprexa does to DA &NE as well as ADHD or bipolar mixed state?
Any input would be greatly appreciated!THank you in advance!
Posted by SLS on July 18, 2015, at 8:01:33
In reply to Re: the way to treat ADHD, posted by Slugbrain on July 17, 2015, at 18:59:05
> SLS - i respectfully disagree that ChBoy and his doctors can know exactly what he doesn't have - or does have. It's just not an exact science, this mental health/mood management business (wry smile)...
I don't disagree with you. Things are changing, though.
Diagnosing ADD or ADHD can be a real pain in the butt, but it is not impossible, even in the presence of comorbid conditions with overlapping symptomatology. However, it often takes a specialist in ADD/ADHD to get it right.
Bad doctors can do more harm than no doctors at all.
I tend to be biased towards having a favorable view of the state of psychiatry because I have been around researchers and specialists from the beginning of my odyssey.
Which of the diagnostic tests do you feel come closest to being accurate for ADD/ADHD? Which tests were worthless?
- Scott
- Scott
Posted by Zyprexa on July 19, 2015, at 5:26:18
In reply to Re: What does 2.5mg of zyprexa do to DA +NE? » Slugbrain, posted by Chinaboy on July 18, 2015, at 5:34:04
Zyprexa is a dopamine antagonist. I don't think it does anything to NE. Zyprexa is my favorite drug. Its good for mood disorders too. 2.5mg is the lowest dose, but still effective. its also an antipsychotic. its sedating and calms rapid thoughts.
Posted by Christ_empowered on July 19, 2015, at 18:44:48
In reply to Re: What does 2.5mg of zyprexa do to DA +NE?, posted by Zyprexa on July 19, 2015, at 5:26:18
the symbyax combo (prozac+zyprexa) works because low doses of zyprexa can somehow increase concentrations of dopamine and ne in some important brain areas, or something like that.
I mean, its a tranquilizer, but low dose tranquilizers can sometimes have weirdly stimulating effects and/or augment other drugs in unexpected ways.
Posted by Sheilac on July 28, 2015, at 13:33:49
In reply to Re: What does 2.5mg of zyprexa do to DA +NE?, posted by Christ_empowered on July 19, 2015, at 18:44:48
I've had the exact same reactions to traditional mood stabilizers. Depakote actually makes me manic, as does Lamictal.
I definitely have ADD and use Adderall XR, but am also using Geodon (antipsychotic) as a mood stabilizer.
The best feeling I ever had was on low dose zyprexa. I was happy, calm, in a good mood. But my doc at the time wouldn't let me stay on it due to possible weight gain. Sometimes I think I should give it a try again. It would be nice to feel that way.
Good luck. I often have the opposite reactions to meds, especially all the mood stabilizers.
This is the end of the thread.
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