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best mood stabilizer for rapid cycling and mixed


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Fucking Lamictal isn't doing shit to stop the current month long bout of rapid cycling and now for the last week, mixed states.  Early spring is usually the worst period for me and this year it seems to be hitting even earlier.  Prior to the last month, things weren't great but they weren't horrible either.  I went from 200mg to 250mg two weeks ago and things are still getting worse.  Now, I'm ready to try just about anything to make this stop.  From what I have read, Lithium doesn't work so well for these problems.  Topamax can work really well, but it can also not work at all depending on whether the problems are in the temporal lobe area or not.  I read a couple of articles that said Depakote was the best med for dysphoric mania or mixed states, but the side effects suck.  Maybe I need an AP to deal with this instead of a MS.  I'm at the end of my leash.  Any thoughts on the subject would be welcome.

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Guest FrannyNZooey

Fucking Lamictal isn't doing shit to stop the current month long bout of rapid cycling and now for the last week, mixed states.  Early spring is usually the worst period for me and this year it seems to be hitting even earlier.  Prior to the last month, things weren't great but they weren't horrible either.  I went from 200mg to 250mg two weeks ago and things are still getting worse.  Now, I'm ready to try just about anything to make this stop.  From what I have read, Lithium doesn't work so well for these problems.  Topamax can work really well, but it can also not work at all depending on whether the problems are in the temporal lobe area or not.  I read a couple of articles that said Depakote was the best med for dysphoric mania or mixed states, but the side effects suck.  Maybe I need an AP to deal with this instead of a MS.  I'm at the end of my leash.  Any thoughts on the subject would be welcome.

<{POST_SNAPBACK}>

When frist dx they tried depakote for me, i was dx Bipolar 1 rapid cycling and mixed episodes.

Truly the depakote did nothing I mean nothing, then all side effect, first awful stomach pain,even with taking with meals.

We went to Lithobid with the more time release and coating so much better than eskalith, eskalith just burst right out and awful ache in belly and caused toxic, so plenty of reason to have written up needed lithobid medically, no generic.

Back then first given with Zoloft to get over flatness seem to work back then, this was 1999, when tried again after move back home to Pa stopped, for year then restared, Zoloft seem to cause agitation, mania, so tried lexapro.

That along with the sure fire weight gain and all marital other self esteem issues, I gave them up, then went back on just Lexapro alone at 10 mg not so much weight gain, and my 1 mg of klonopin at bedtime.

I know I need Lithobid again, I was thinking well actually at pdoc going to bring up staying on lexa pro beginning lithobid at 600 as before then to 900 as before, but adding Topomax at bedtime to stop weight gain blues and blahs as read does help and also hellish litho migraines, they really sucked, and then weaning klonopin since topomax should help with night time agitatation sleeping also.

So my plan and hopefully agree with go on lithobid again as so wanted by all professionals, stay on lexapro for helping with daytime slugginess, Go on Topomax to help with migraines, depression, sleep, weight gain from lithobid, so i am more willing to stick with lithobid, and taper off, of Klonopin.

I still want to keep not pharmacy in my body, but functioning one, and one i feel can stick by, no good taking meds that make you have horrid migraines blow up feel like shit, you know you will not stick with them, why need to get help be honest with what need.Honesty is my new policy all around.

Aly

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Hi there,

I'm sorry you're struggling. I actually have a post on this board (it's an active topic/thread) about how Lamictal actually CAUSED mixed states and rapid cycling in me. I had to be taken off the drug after 8 months. Perhaps the Lamictal is actually making things worse for you. Just a thought...

Take care,

Jill

Edit: The thread is called "Am I the only one this has happened to?

Lamictal triggering rapid cycling/mixed"

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Hi there,

I'm sorry you're struggling. I actually have a post on this board (it's an active topic/thread) about how Lamictal actually CAUSED mixed states and rapid cycling in me. I had to be taken off the drug after 8 months. Perhaps the Lamictal is actually making things worse for you. Just a thought...

Take care,

Jill

Edit: The thread is called "Am I the only one this has happened to?

Lamictal triggering rapid cycling/mixed"

<{POST_SNAPBACK}>

Yeah, I actually replied.  I still don't know for sure, but it wouldn't suprise me if the Lamictal has been contributing to the recent problems.  Once I get to a stable level on the Lithium and Seroquel, I am going to push for going off Lamictal.  It may make it's way to my evil meds list.

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Heya synthetic,

Yah, not a rare s/e of Lamictal.

Supposed to be more of a bring-the-down-up than a bring-the-up-down drug.

For mixed I'm looking at AAPs, and I like Seroquel too, but haven't used it myself yet.

Lamictal looks like a crappy drug for you.  That sucks.  Keep looking.

Don't give up.  Something will help.

--ncc--

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I am hoping to add Topomax to my cocktail.  I hear lithium is not terribly effective on rapid cycling and I have pale, sensitive skin and develop rashes frequently so lamictal would just make me a paranoid freak running to the ER every 2 days for a rash check.  Anything that makes you fat is absolutely out of the question because I am fat enough and would rather be crazy than get fatter.

The cocktail would then be:

Effexor 150 (or maybe 112.5 if I decide to drop it a level)

Topomax (whatever the starting dosage is)

Seroquel 50 mg (I don't want to give up my beauty sleep!)

Does this sound like a good plan to combat rapid cycling, mixed states and a constant hypomanic state?  Is there anyone on this combination of meds?

Dee

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Just to add- my pdoc said carbamazepine (Tegretol) was the drug of choice for rapid cycling BP. I'm not sure whether she meant that was the view of psychiatry in general or whether it was more of her own view, but she's definately pushed hard to keep me on it. Not that I'm complaining as it does seem to be working along with everything else I take.

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Tegretol requires regular blood work I just read.  Am I right in thining topomax doesn't?  I'm not crazy about the interactin with benzos listed with tegretol,  I like to know I can pop a valium when necessary.

Man, all the mood stabolizers suck!!!!

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Synthetic, I think that Lithium is a great med, and maybe the Seroquel will work out. For me it didn't, but then again, Lamictal seems to be fine. I'm going to ask my pdoc about a combo of Li and Lam again to beat the current mixed state/anxious/dysphoric mode.

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i fought with my doc for topamax. he finally caved and it has been my wonder drug for rapid cycling... i.shit.thee.not.

<{POST_SNAPBACK}>

Me and devilla are happy to hear this. Does it give you the side effect of constipation (which I need)? Anyone else? Did it make you stupid?

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It is so crazy that having been gone from the boards for a while, the very first thread I come across is about the EXACT problem I am having right now!

I have been taking 200mg Lamictal, along with 450 Wellbutrin and 20-40 Lexapro, and I am backsliding in a major way. Adding another 50mg of Lamictal was not a good thing...don't remember why now...oh, I was mixed state-y. The doc gave me some Lithium to add, but I am just not thinking that is what I need. I am up-down girl daily, and I did read that Lithium isn't so hot for that. I broke out in hives on Depakote, and literally could not stop eating with Zyprexa.

I went ahead and started taking the Lithium today, but I have a message into the doc. I am not looking forward to figuring out what I can tolerate on the med buffet again. But everyone says it's better than the alternative. Okay.

Topomax sounds interesting. I usually suggest to my doc what I want to try, but I am about out of bright ideas at this point!

Maybe it's just that misery loves company, but it is always helpful to know I am not the only one in the world with such wacky problems!

Sam

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  • 2 weeks later...
Guest Guestifarian

Depakote worked for me.  Quite well.  But the side effects did suck and in the end it wasn't worth it.  Still, Depakote would be a way better drug to try than Topamax or Tegretol or APs, simply because it is statisticaly more likely to work.  My pdoc is a BP specialist in a BP hospital and rarely uses any of the drugs discussed herein.  GP tried zyprexa but otherwise agrees.  Both will let me try what i want, but give me little encouragement for Topamax, Tegretol or APs.  Before you go off label with APs i think you are crazy not to try all of the big three MSs (depakote, lith, lamictal).  You sound like you are basing your decision on anecdotal evidence.  The facts point to depakote first and foremost.  Show me a sudy that says any of the drugs you've talked about work better than depakote and i'll change my mind.  But i think you will look for a very long time.

Doctors all have their favourites.  If you want a doctor to back up your opinion, shop around til you find one.  Or ask here until enough people confirm what you want to hear.  Anecdotal evidence and selection bias are very popular here.  Obviously i think i'm right and obviously i disagree with you entirely.  Good luck.

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Depakote worked for me.  Quite well.  But the side effects did suck and in the end it wasn't worth it.  Still, Depakote would be a way better drug to try than Topamax or Tegretol or APs, simply because it is statisticaly more likely to work.  My pdoc is a BP specialist in a BP hospital and rarely uses any of the drugs discussed herein.  GP tried zyprexa but otherwise agrees.  Both will let me try what i want, but give me little encouragement for Topamax, Tegretol or APs.  Before you go off label with APs i think you are crazy not to try all of the big three MSs (depakote, lith, lamictal).  You sound like you are basing your decision on anecdotal evidence.  The facts point to depakote first and foremost.  Show me a sudy that says any of the drugs you've talked about work better than depakote and i'll change my mind.  But i think you will look for a very long time.

Doctors all have their favourites.  If you want a doctor to back up your opinion, shop around til you find one.  Or ask here until enough people confirm what you want to hear.  Anecdotal evidence and selection bias are very popular here.  Obviously i think i'm right and obviously i disagree with you entirely.  Good luck.

<{POST_SNAPBACK}>

Thanks for your input.  Lemon and I are in the research phase while we are waiting to see pdocs, to be prescribed our first mood stabolizors.  We are freaked out a little by the side effects and yes we are crazy OF COURSE.

We're not doctor shopping.  We are just waiting for our appointments and hope to walk in with some of our own input to add, but ultimately will have to have faith in what our pdocs decide. 

Dee

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Seroquel and Topamax were my magic bullets. I've been on them both since I was diagnosed and have had good results.  Yes, topamax has the side effects, and yes, I experienced them (it's in a thread somewhere around here), but it was WAY worth it not to feel the way I did.  The side effects eventually dwindled.

I was put on lamictal about a year ago for increasingly nasty depressive episodes and it worked wonders once I hit the "sweet spot".  I didn't have any problems with it inducing mixed states or rapid cycling.

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Li and Lamictal together put a solid end to all mood swings, but Li made me the stupidest thing ever in the world, worse than a little kid learning the ABCs.

Zyprexa made me fat, so I became a dieter, and lost 30lbs in 2 months. mainly from not eating. Now I'm 5'4 and less than 120lbs.

I think I'll ask about going back to a lower dose of Li. I really liked it.

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I completely understand the frustration with Lamictal.  Honestly, I was stable for 14 years on Lithium and Lithium only (900-1200 mg a day). I was taken off of Lithium a year and a half ago due to kidney concerns and have not been the same since.  I have been titrated up to 250 of Lamictal.  Sometimes I'm OK, other times not at all.  I also have problems with dry eyes (severe) and have had quite a few episodes of instability/irritability/depression (is that a "mixed episode"?) at work and with my family. For a short while, I'll think I'm fine and then will have 2-3 weeks of feeling awful. Wellbutrin was added and I got even more irritable.  I worked full time successfully and also raised a family on lithium.  Now I feel like I am on the verge of losing my job, have made enemies at work, and am having marital problems.  My new doc says no to going back to lithium.  It is frustrating.  Maybe it is time to try Depakote? It is hard to know when to be patient and wait.  IF you say anything, they just jack up the dosages and/or add another medication.

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i fought with my doc for topamax. he finally caved and it has been my wonder drug for rapid cycling... i.shit.thee.not.

<{POST_SNAPBACK}>

Hi Tallulah,

Why did you have to fight for it?  There is good evidence it works for rapid cycling, it doesn't require frequent blook work like lithium, I don't really get why there seems to be a hesistation in prescribing it.  So it might make you stupid, you have to watch for kidney stones.  It doesn't seem as bad as other mood stabolizers from a side effect profile.  What am I missing?

Dee

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From what I understand, Lamictal is not meant to treat acute mania and/or mixed states. Seroquel and Zyprexa are great for that, and Lithium has worked wonders for many, but sucked for me. Zyprexa and Seroquel will knock your ass out cold (or should) and at least get you back to some level of stability fairly quickly. Lamictal is more for regulating in the long-term, or so my pdoc says.

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Lithium monotherapy used to work for me but I was bad about taking it - didn't "believe in drugs" and at some point I realised I didn't believe in 20 years of disability and trouble either.  Now a combo of lithium and risperdal is GREAT if I can just keep doing it . 

Ater a lifetime of being on a roller coaster and in trouble it's kind of frightening to be relatively stable.

Does anyone know what I mean by this?  It's just plain weird!  I'm afraid my new friends are going to be disappointed if I go back to having episodes.

The only drawback with risperdal is that it causes me to wake up too early and messes up my sleep.  It's good to know that it helps though because lithium becomes a little harder on the kidneys as you get older and that worries me because I can't take the anti-convulsants.

Does anyone know if risperdal can be used as monotherapy in Bipolar (classic bipolar)with mixed states as well???

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Anelize did Lamictal do anything for you up to 100mg? I'm curious because it didn't do a thing for me at 100 and then I gave up on it.

<{POST_SNAPBACK}>

Pffft.  Not a thing.  My first sweet spot was 200.  About 9 months in I had a fairly long episode and bumped up to 300 for almost a year.  My next episode bumped me up to 400.  I've been on 400 for almost a year now, and doing fine.

So, to use a phrase from recovery folks--

Don't give up until the miracle happens ;)

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Thanks for your input.  Lemon and I are in the research phase while we are waiting to see pdocs, to be prescribed our first mood stabolizors.  We are freaked out a little by the side effects and yes we are crazy OF COURSE.

We're not doctor shopping.  We are just waiting for our appointments and hope to walk in with some of our own input to add, but ultimately will have to have faith in what our pdocs decide. 

Dee

<{POST_SNAPBACK}>

Hey Dee, I got in to my pdoc today unexpectedly. Man am I depressed now. He was talking about how difficult I am because I'm so sensitive to side effects and can't often take a good dose of many drugs. He's so (not) encouraging.

Anyway the doc decided on Lithium. I'm pretty scared. I'm sure I'll end up with diarhea or unable to remember my name or get the shakes and look like I have Parkinson's (no offense to anybody who has it). And then if it works the cost of the stupid blood test. Or if it doesn't, yet another one to add to the list of failures.

All that research and he just went with the first line drug. Which is really what he should do. But we still have to research don't we.

I'll shut up now, I'm pretty mixed.

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Thanks for your input.  Lemon and I are in the research phase while we are waiting to see pdocs, to be prescribed our first mood stabolizors.  We are freaked out a little by the side effects and yes we are crazy OF COURSE.

We're not doctor shopping.  We are just waiting for our appointments and hope to walk in with some of our own input to add, but ultimately will have to have faith in what our pdocs decide. 

Dee

<{POST_SNAPBACK}>

Hey Dee, I got in to my pdoc today unexpectedly. Man am I depressed now. He was talking about how difficult I am because I'm so sensitive to side effects and can't often take a good dose of many drugs. He's so (not) encouraging.

Anyway the doc decided on Lithium. I'm pretty scared. I'm sure I'll end up with diarhea or unable to remember my name or get the shakes and look like I have Parkinson's (no offense to anybody who has it). And then if it works the cost of the stupid blood test. Or if it doesn't, yet another one to add to the list of failures.

All that research and he just went with the first line drug. Which is really what he should do. But we still have to research don't we.

I'll shut up now, I'm pretty mixed.

<{POST_SNAPBACK}>

Shit.  I think I will probably end up in the same boat myself.  I got an "emergency" appointment for Apr 21st.  So I will be heading to the ER and throwing myself at their mercy, probably tomorrow if I can bring myself to do it.  I have a feeling I will be leaving on fucking lithium too. 

I hope the lithium surprises you and helps.  We can be lithium buddies.

What a fucking life.

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Shit.  I think I will probably end up in the same boat myself.  I got an "emergency" appointment for Apr 21st.  So I will be heading to the ER and throwing myself at their mercy, probably tomorrow if I can bring myself to do it.  I have a feeling I will be leaving on fucking lithium too. 

<{POST_SNAPBACK}>

Are you serious about the ER? What's going on? Maybe you'll get Zyprexa, have you ever tried that? Sorry for all the questions, just concerned.

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I'm cycling too fast.  I can't wait a month.  I want to get this sorted out before I do end up in the psych ward for an extented stay.  The ER seems to be my only option.  No I haven't tried zyprexa.  I'd rather get more seroquel if I had to go that route.  I already take a low dose and it agrees with me.

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My thoughts on Z and S (I know you didn't ask for them). Z will calm you down fast. It felt really good to me at first but then after it built up in my body it made me extremely tired and depressed.  But I can see why hospitals use it for people out of control. And it would probably be great for those who can handle it and need help on the high end. Seroquel is less of a downer but still on that end as you know.

In any case let us know how it goes.

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You know, after listening to the audio file of the psychiatric conference of 2004  (I couldn't find 2005) as a first approach, I am more open to lithium, less open to anticonvulsants, and will blatently refuse depakote, based on PCOS risk which runs in my family.

I wonder though, what do the girls like me do when they have dibilitating cramps and can't take a handful of advil?  Tylenol is shit.  Can one be prescribed opiate-based pain killers on lithium?  Percacet maybe?  I also throw out my back from time to time and it's ice and advil, ice and advil.

Are cramps worse or better on lithium girls?  Not enough focus is given on this serious problem some of us have.  And no I cannot take the pill because I smoke.

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  • 4 weeks later...
Guest FrannyNZooey

I just saw I posted here so long ago , plesae go to side effects of Topomax post. I have been posting there.

Way back when posted here, doctor was not ready to go ahead with Topomax yet for me. Wanted me on the Lithobid mainly, after the depakote made me so sick.

Well Lithobid was a failure.

Topomax has been the drug to work for me for keeping me level, stopping the rapid cycling Hell.

I am sleeping better, when I allow myself, I am under lot of pressure now, but just feeling need to be here, while I can with husband.

No feelings of desperation or madness.

But I may from need to calm down look into sleep aide.

Please check out the Topomax sites, it has really helped so many of us.

I will keep udating my journey with it on that thread.

Aly

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