Tricyclic Antidepressants

Does anyone drink heavily only when MANIC?

Question:

Can it really be true that other countries are more stringent about approving meds than the US? How can that be? Codeine preparations seem to be sold OTC in all the world but the US. Most new drugs in the US have already been used in europe for years. Drugs are routinely yanked off the market here for slight problems that could be avoided by proper prescribing and dosing. And then there is the demonization of any drug that has any "recreational appeal". Look what happened to GHB, simply because some few people abused it. And then there is the economic blackmail campaign that the US has waged upon the rest of the world to force compliance with puritanical drug prohibitions dreamed up in america. Comments, anyone? Keith

Response:

– Hide quoted text — Show quoted text -> sites. Sure its dangerous, and sure it can be abused, but then so can > any of the sleeping tablet formulations. Tamazepam used to be a popular > one here, and even some tricyclic antidepressants have been used for > recreational purposes, and they’re lethal if you take enough of them… > Hugh Davies-Webb >True enough.  I was just reacting from an emotional standpoint because of >my own irresponsible, self-destructive behaviour.  I’m sure I could get >high off the Klonopin my pdoc prescribes if I was still into that sort of >thing.  Instead I’m fastidious about using my prescription drugs as >prescribed and continually ask my pdoc if I should be weaning myself off >it.  I got a little freaked out when my pdoc said I could take up to 3 >trazodone and I ended up almost passed out on the bathroom floor like my >GHB episode.  I’m sure GHB has many uses.  I justified using it around the >clock because of it’s reported anti-depressant effects, the quantities I >was taking turned me into a severe rapid-cycler, from laughing my head off >in love with the world to crying and suicidal in minutes. >I’m on here now because I can’t sleep even after hours of meditation and 1 >Klonopin.   >Aurora(posting from dad’s account)

Well this is where GHB would help… <g> I’m also a narcolepsy sufferer, and GHB is one of the great hopes for sufferers, if it ever gets pat the hypocritical/ corrupt/ puritanical FDA. If taken in correct dosages, and of pharmaceutical grade etc, etc, it can give us the next best thing to a decent night’s sleep, as well as sorting out cataplexy and sleep paralysis. You might try old-fashioned tricyclics/tetracyclics in small doses to help with your sleep though… Hugh. Hugh Davies-Webb

Response:

> sites. Sure its dangerous, and sure it can be abused, but then so can > any of the sleeping tablet formulations. Tamazepam used to be a popular > one here, and even some tricyclic antidepressants have been used for > recreational purposes, and they’re lethal if you take enough of them… > Hugh Davies-Webb

True enough.  I was just reacting from an emotional standpoint because of my own irresponsible, self-destructive behaviour.  I’m sure I could get high off the Klonopin my pdoc prescribes if I was still into that sort of thing.  Instead I’m fastidious about using my prescription drugs as prescribed and continually ask my pdoc if I should be weaning myself off it.  I got a little freaked out when my pdoc said I could take up to 3 trazodone and I ended up almost passed out on the bathroom floor like my GHB episode.  I’m sure GHB has many uses.  I justified using it around the clock because of it’s reported anti-depressant effects, the quantities I was taking turned me into a severe rapid-cycler, from laughing my head off in love with the world to crying and suicidal in minutes. I’m on here now because I can’t sleep even after hours of meditation and 1 Klonopin.   Aurora(posting from dad’s account)

Response:

writes – Hide quoted text — Show quoted text -> >Codeine preparations seem to be sold OTC in all the world > >but the US. Most new drugs in the US have already been used > >in europe for years. Drugs are routinely yanked off the > >market here for slight problems that could be avoided by > >proper prescribing and dosing. And then there is the > >demonization of any drug that has any "recreational appeal". > >Look what happened to GHB, simply because some few people > >abused it. > A lot of what goes on between the FDA and FBI seems very strange… > There is a lot of evidence to suggest that GHB is of great theraputic > benefit to people with narcolepsy (like myself), however, GHB is an > orphan medicine with no big pharmaceutical company doing funny > handshakes with the FDA to get it approval… From what I’ve read on the > NGs the FDA seems to be a rather corrupt organisation. After all, >[snip] >GHB is a dangerous substance.  I almost died from OD’ing on it, >unintentionally, although earlier that evening I considered that the >quantity I had on hand would be a convenient suicide method, probably >painless too.  The problem with it is the low margin between what gets >you high, what makes you pass out, what puts you in a coma, what kills >you.  Many young people have died from this stuff (ie. River Pheonix)  I >know that what happened to me is my fault and others are also >responsible for their actions, but if it does have a medical use it >should be controlled by prescription.  I got mine by mailing away for a >kit to make it by adding KOH to an acid that was almost GHB, so they >could get away with selling it.   >Aurora

The GHB I’m talking about is pharmaceutical grade stuff, prescibed under the supervision of a consultant physician, not the stuff that people make from kits. If you want to know about GHB and its benefits to narcoleptics I suggest you go to any of of the many excellent narcolepsy sites. Sure its dangerous, and sure it can be abused, but then so can any of the sleeping tablet formulations. Tamazepam used to be a popular one here, and even some tricyclic antidepressants have been used for recreational purposes, and they’re lethal if you take enough of them… Hugh Davies-Webb

Response:

So? We’re still good guys. Regards, John – Hide quoted text — Show quoted text -> Because of people using GHB carelessly I don’t even get the > chance to try to use this quite promising stuff responsibly. > I have done enough research to learn that it is not possible > to OD on GHB alone; if you take too much you sleep until it > is done with you. Only fools who mixed GHB and alcohol > despite the very prominent warnings on the internet not to > ever died. BTW, GHB was sold over the counter in this > country for many years without any problems. > GHB’s mode of action is apparently quite similiar to > Neurontin! > — > Keith Hardwick > web page is up at > http://home.att.net/~keithncarol/web_page.htm > Lots of good info for newcomers to > alt.support.depression.manic >  and soc.support.depression.manic! >Well, forgive me for doing stupid things, but I guess that is part of >BP, believing that the warnings don’t apply to me and that if a little >is good a lot is better.  But even without alcohol taking enough of it >will make you unstable(more so than I was anyway). >And there is some question as to whether a drug that is easy and >enjoyable to use irresponsibly is a good choice for BP’s since according >to Jamison’s book ‘Touched with Fire’ almost half have drug/alcohol >problems. >Aurora

Response:

- Hide quoted text — Show quoted text – > Because of people using GHB carelessly I don’t even get the > chance to try to use this quite promising stuff responsibly. > I have done enough research to learn that it is not possible > to OD on GHB alone; if you take too much you sleep until it > is done with you. Only fools who mixed GHB and alcohol > despite the very prominent warnings on the internet not to > ever died. BTW, GHB was sold over the counter in this > country for many years without any problems. > GHB’s mode of action is apparently quite similiar to > Neurontin! > — > Keith Hardwick > web page is up at > http://home.att.net/~keithncarol/web_page.htm > Lots of good info for newcomers to > alt.support.depression.manic >  and soc.support.depression.manic!

Well, forgive me for doing stupid things, but I guess that is part of BP, believing that the warnings don’t apply to me and that if a little is good a lot is better.  But even without alcohol taking enough of it will make you unstable(more so than I was anyway). And there is some question as to whether a drug that is easy and enjoyable to use irresponsibly is a good choice for BP’s since according to Jamison’s book ‘Touched with Fire’ almost half have drug/alcohol problems.   Aurora

Response:

- Hide quoted text — Show quoted text – > gamma hydroxy butyrate, something like that > It is useful as a sleep aid, anti-depressant, helps hard > core addicts deal with their cravings, etc.. It is a mild > relaxant and is not really a drug to get high on, although > that is why it is now banned. > — > Keith Hardwick > web page is up at > http://home.att.net/~keithncarol/web_page.htm > Lots of good info for newcomers to > alt.support.depression.manic >  and soc.support.depression.manic!

BUT it will get you high and a lot of teens and Gen-X’ers are doing it. I was taking it in liquid solution so I don’t know what the dosage is compared to those who use it as an antidepressant or whatever.  I do know that after using large amounts continuously for a day and a half I couldn’t stop crying and was really suicidal but then refused to let my fiance take my supply away from me.  That night I OD’d and he had to pick me up off the bathroom floor of a club.  Of course I was not doing all that well before I discovered this stuff either.  It is a lot like alcohol, and probably like other downers  at first makes it easy to socialize feel connected with others, carefree and laugh a lot but then just as easy to switch into crying or rage. The problem with using it to help addicts/alcoholics with cravings is the fact that addicts think if some is good, more is better and the results can be deadly with this stuff.  Maybe it would be useful for this purpose in a hospital setting where dosage is controlled.   I could probably get interesting effects if I took large amounts of some of my prescribed meds but I have no interest in trying.  3 trazodone’s took me straight to the worshipping the porcelain goddess stage (and that was pdoc’s recommendation) Aurora

Response:

gamma hydroxy butyrate, something like that It is useful as a sleep aid, anti-depressant, helps hard core addicts deal with their cravings, etc.. It is a mild relaxant and is not really a drug to get high on, although that is why it is now banned. — Keith Hardwick web page is up at   http://home.att.net/~keithncarol/web_page.htm Lots of good info for newcomers to alt.support.depression.manic  and soc.support.depression.manic!

Response:

What is GHB?

Response:

Because of people using GHB carelessly I don’t even get the chance to try to use this quite promising stuff responsibly. I have done enough research to learn that it is not possible to OD on GHB alone; if you take too much you sleep until it is done with you. Only fools who mixed GHB and alcohol despite the very prominent warnings on the internet not to ever died. BTW, GHB was sold over the counter in this country for many years without any problems. GHB’s mode of action is apparently quite similiar to Neurontin! — Keith Hardwick web page is up at   http://home.att.net/~keithncarol/web_page.htm Lots of good info for newcomers to alt.support.depression.manic  and soc.support.depression.manic!

Response:

> >Codeine preparations seem to be sold OTC in all the world >but the US. Most new drugs in the US have already been used >in europe for years. Drugs are routinely yanked off the >market here for slight problems that could be avoided by >proper prescribing and dosing. And then there is the >demonization of any drug that has any "recreational appeal". >Look what happened to GHB, simply because some few people >abused it. > A lot of what goes on between the FDA and FBI seems very strange… > There is a lot of evidence to suggest that GHB is of great theraputic > benefit to people with narcolepsy (like myself), however, GHB is an > orphan medicine with no big pharmaceutical company doing funny > handshakes with the FDA to get it approval… From what I’ve read on the > NGs the FDA seems to be a rather corrupt organisation. After all,

[snip] GHB is a dangerous substance.  I almost died from OD’ing on it, unintentionally, although earlier that evening I considered that the quantity I had on hand would be a convenient suicide method, probably painless too.  The problem with it is the low margin between what gets you high, what makes you pass out, what puts you in a coma, what kills you.  Many young people have died from this stuff (ie. River Pheonix)  I know that what happened to me is my fault and others are also responsible for their actions, but if it does have a medical use it should be controlled by prescription.  I got mine by mailing away for a kit to make it by adding KOH to an acid that was almost GHB, so they could get away with selling it.   Aurora

Response:

America in gereral has a problem of having a near schiz. type of society: puritanical on the outside and hendoistic on the inside….makes for strange behavior in all sorts of sectors on American culture. Personally, I’ve always learned from other cultures and societies and after living in Germany for 3 years….have become very European in thinking. Puritanical thinking is all well and good for those who can live up to it’s mores and demands…but I for one have never been able to. As for medications, you’re right…..America is the slowest to approve and/or allow drugs to be  used, even  if studies in other countries have been done and the benifits seen.  The FDA needs to get off it’s duff and stop the big pharmacutical companies from bulling the little guys and also greasing palms and such.  The FDA also needs to start looking a benifits and stop pulling drugs off the market because of abuse.  The FDA needs to fine the pharacutical companies for lack of educating doctors on these drugs (instead of just giving them a ton of samples and telling the docs that its the newest wonder drug) and also fining the doctors for not following the guidlines of prescribing the meds. And lastly….as for geriatric care….America is probably worse in that area too…as I know a good portion of countries have families take care of the elderly.  And only those with no family are placed into a nursing home to be cared for.  Sorry….I don’t care if my parents are both incontenent of bowel and bladder, agressive to the point that things have to be locked up, etc…ect….they will stay at home and they will not go into a nursing home. — Jacque Miller ICQ # 10876877 AIM; PowWow; and Ichat – Jymata noli illigitimi carborundum "don’t let the bastards grind you down" – Hide quoted text — Show quoted text – >I read Keith’s posting with some interest. Firstly, I’d point out that >I’ve always felt that the psychiatric care I’ve received  excellent. UK >doctors use lithium because there are more long term  to prove its >effectiveness. In short it is a very ‘known about’ drug. And I would say >that using cognitive therapy to manage bp is a rather forward way of >thinking… >Doctors in the UK are not under pressure to prescibe the cheapest drugs >- I have narcolepsy as well, and my general practitioner has no problems >prescribing modafnil (Provigil) which can be as expensive as Viagra, >depending on dose, and SSRI’s are very popular over here and they aren’t >exactly cheap. >The NHS does have a problem with geriatric care however… (Our whole >country has a problem with this) >best wishes, >Hugh >Hugh Davies-Webb

Response:

I read Keith’s posting with some interest. Firstly, I’d point out that I’ve always felt that the psychiatric care I’ve received  excellent. UK doctors use lithium because there are more long term  to prove its effectiveness. In short it is a very ‘known about’ drug. And I would say that using cognitive therapy to manage bp is a rather forward way of thinking… Doctors in the UK are not under pressure to prescibe the cheapest drugs – I have narcolepsy as well, and my general practitioner has no problems prescribing modafnil (Provigil) which can be as expensive as Viagra, depending on dose, and SSRI’s are very popular over here and they aren’t exactly cheap. The NHS does have a problem with geriatric care however… (Our whole country has a problem with this) best wishes, Hugh   Hugh Davies-Webb

Response:

– Hide quoted text — Show quoted text ->Can it really be true that other countries are more >stringent about approving meds than the US? How can that be? >Codeine preparations seem to be sold OTC in all the world >but the US. Most new drugs in the US have already been used >in europe for years. Drugs are routinely yanked off the >market here for slight problems that could be avoided by >proper prescribing and dosing. And then there is the >demonization of any drug that has any "recreational appeal". >Look what happened to GHB, simply because some few people >abused it. >And then there is the economic blackmail campaign that the >US has waged upon the rest of the world to force compliance >with puritanical drug prohibitions dreamed up in america. >Comments, anyone? >Keith

A lot of what goes on between the FDA and FBI seems very strange… There is a lot of evidence to suggest that GHB is of great theraputic benefit to people with narcolepsy (like myself), however, GHB is an orphan medicine with no big pharmaceutical company doing funny handshakes with the FDA to get it approval… From what I’ve read on the NGs the FDA seems to be a rather corrupt organisation. After all, puritanism is what America was founded on and must linger in the national psyche… Prohibition, McCarthyism etc… Hugh Hugh Davies-Webb

Response:

Gary- Please email me your phone number. KI – Hide quoted text — Show quoted text -> We have a > psychologist visit at least once each week always someone on call if > an emergency arises. > Tony, I’d give my left testicle to have a psycholgist visit me in my home > once a week. That, above anything else, in my opinion would, would cut my > "down" time at least in half, make the day to day drudgery of being on > medical leave while trying desperately to find meds that work (seeing my > PDoc only once a month, maybe twice if I push to get any cancellations), > improve my rather reclusive social situation and hasten my return to the > working world. > I asked my PDoc about seeing a Therp, but he seemed to feel I needed > "specific goals" before he would make the recommendation. But actually > having someone see me in my home…someone who cared, who is qualified and > experienced in BP, someone I could look forward each week to seeing so I’d > clean up a bit, put on some coffee, God, someone I could really talk to > while I’m actually living this hell rather than ‘preparing’ for the > artificial environment of an office where I’d feel compelled to give the > "correct" answers… > Oh well. I sure do envy you and Nolene in this matter. > Sorry for rambling, but your post really touched a tender nerve in me. I > guess I should push for a Therp when I see the PDoc on Wednesday. > Thanks For Listening, > GaryO

Response:

Lots of snips Although this is not regarding Lithium as such I think it is still on thread. Keith feel free to correct me if not.  This time around when Nolene developed major symptoms of mental unwellness we went along the usual diagnosis merry-go-round and it stopped after several hospital visits for various reasons with our local Psychiatric Services Team. First admittance to the local (60 mile away) Psych ward ended with the doctor saying "you shouldn’t be here." He’d made his mind up that nothing was really wrong, probably a personality disorder but that could be treated at home with support from me.  I’ve since heard several people refer to this person as an arrogant prick who doesn’t want to listen, only to tell you what is wrong with you. Our experience didn’t differ from this view point.  Fortunately the doctor assigned to the team was not the same person. He got us both in and asked us to fill him in with what was going on. He listened. He asked if this or that occurred. He told us what he thought. He asked how we thought it should be treated.  He seemed to care.   This gave us a great deal of confidence in him and allowed Nolene to have a degree of control over her treatment. Diagnosis was Borderline Personality Disorder. Unfortunately this doctor changed jobs within the organisation so we then came to our present doctor. He also sat us down after going through all the notes and said tell me about your depressions. He listened to Nolene and he also listened to me. Not a common thing for Doctors to ask or listen to me.  He then said tell me about these periods of activity.  Something we had always just accepted as a better then depressed time.  At least Nolene could do something She had he energy and the stamina. Sure she didn’t sleep and couldn’t sit still but we didn’t see that as a problem.  The ideas were great. Not always practical but always ambitious and the furniture. Always the furniture.  Move it here. No, that’s not right move it back.  Let’s try this. The only place the couch didn’t go was on the roof.  But still this wasn’t a problem. Nolene didn’t want to hurt herself like when she was depressed. The doctor then said I think it is Bi-polar disorder and went on to explain 15 major depressions and 10 manic episodes in 5 years wasn’t what normal people went through.  We knew that. It was just good to hear someone with qualifications say it too. He then suggested Epilim (Sodium Valporate) as a mood stabiliser. Something Nolene had never had before. She had been on lithicarb in the past and had been on Aropax (paroxine – Paxil) Prozac, and most of the other common anti-depressants without any on going benefits. He went on to explain Lithium as a mood stabiliser was an Australian discovery and tradition was that it was used but he had no problems with Epilim or Tergatol either.  He explained the side-effects etc but felt Epilim was best in Nolene’s case due to the problems she might have with her liver due to a previous addiction to paracetamol and codeine. (purchasable across the counter. Nasty stuff and she still fights the urge now. Was up to 50 tablets of 10mg codeine 500mg Para per day.  The sister in the Emergency department wouldn’t believe her that she was taking them because it was a fatal dose. But that’s a whole other story for another time.) Total cost for this treatment.  Zero except for the medication. We have no private insurance either medical or hospital. We have a psychologist visit at least once each week always someone on call if an emergency arises. Still no cost.  Sure we pay for it in taxes but we don’t have the situation where we can’t see anyone due to the cost. My guess is that we in Australia drag a little behind the states in cutting edge technology but the totally different health care system seems from where I’m sitting to be worth the sacrifice.  We also have a far more stringent acceptance standard for drugs then America. Whether for good or bad I’m not sure. (Although they seem to have fast tracked viagra here. Perhaps the politicians wanted it?) Our social welfare system is also vastly different. I’m horrified to read what you poor people in USA are made to go through if you cannot work.  I work in the agency here that pays disability, unemployment, age pension and family payments and cannot imagine the stress your system puts on the sick (ill) people of america.  I feel that I’ve rambled on her quite enough for the moment but will post further details of the welfare system later on a new posting.   ynoT still here and reading everything I post carefully.

Response:

A few comments: It appears that lithium can be stopped and restarted without running any risk of losing its effectiveness…provided that it is restarted prior to the next affective episode. It is now recognized that lithium is less useful in people who have had the most manias or depressions than in people who have had few. I doubt that the average manic-depressive in Britain is substantially different than in America, and I know very few people with bipolar who could safely predict their cycles well enough to go on and off their meds safely. I wouldn’t risk my life that way! Verapamil is the only drug with any antimanic/mood stabilizing properties that has a side effect profile suitable for pregnant women. It is to our discredit that we do not have a national health care plan, however I suggest that in Britain doctors are under tremendous pressure to use only the very cheapest drug for bipolar, which happens to be lithium. It is very easy to justify such a policy since there is such a wealth of info on lithium and not on any other antimanic. What is conveniently ignored is the overwhelming evidence that only about 40% of bipolars receive adequate relief from symptoms while taking lithium, and 20% are not helped at all! Shall we fine tune the lithium levels of all these people? That is a delusion. Lithium comes in few different sizes and formulations. You have sub-therapeutic, therapeutic, and toxic blood levels; no room for fine tuning. Lithium was hardly developed for bipolar; neither were the anticonvulsants. Should we turn our back on them? Perhaps we should return to the days when manic-depressives were Dx’ed schizophrenic and confined for life? Maybe the UK does a better job with drug approvals than the US but I rather doubt it. It seems to me as if UK health care, at least in the area of mental health, is very backward. But don’t copy us; try to be more like Canada! Keith

Response:

Dear James, Thanks for replying to my post. I was discussing this very subject with my psychiatrist last time I saw him. I’m a narcoleptic as well as a rapid-cycling bp, and some of the medications involved with the treatment of narcolepsy (which are also used in the treatment of depression) react rather badly with lithium, and I was inquiring about an alternative… One of the wonders of UK psychiatry is not having to pay for it. Also, psychiatrists are are far less likely to be sued in the UK than their colleagues in the States, so they do not shy away from lithium therapy. Love it or hate it, lithium is very effective in most cases (on this side of the Atlantic); however, it does require constant supervision in the form of blood tests, especially if your psychiatrist is tweaking levels. This is fine in the UK, where such care is free, but elsewhere its a pain in the arse, because it costs you (or the dreaded insurance company) lots of money. Things like carbamazepine have an advantage, as they do not require the supervision that lithium does. Over here, anti-psychotic drugs are used sometimes to bring a manic bp back down to earth again (with a bump!), but only in emergencies, as lithium can sometimes take a few days to work properly. You describe some of the drugs in your list as ’second generation mood stabilisers’. I would say this is slightly inaccurate or misleading. Most of these drugs were developed for something else, and okay, if they work, all well and good, but there isn’t a great deal of research or trials to back that up – if there were, psychiatrists would use them over here. After all, many of the drugs on your list are not expensive. Remember UK and EEC drugs trials are much stricter than the US, and certainly in the UK – are much less likely to be swayed by drug company hype and marketing. Lets have a look at the list: >1. Lithium carbonate — Lithobid, Eskalith CR >2. Carbamazepine     — Tegretol, Epital

Antiepileptic – not a good idea to take with lithium (neurotoxicity) or other antiepileptic drugs (can become more toxic without any increase in effectiveness) or MAOI antidepressants >3. Divalproex sodium — Depakote, Depakene, Epival — valproate

Antiepileptic – Not a good idea to take with antidepressants or other antiepileptics. >                    Second Generation Mood Stabilizers >1. Gabapentin        – Neurontin (may enhance cognitive abilities)

Antiepileptic – a newer medication- don’t know much about this one (I’ll find out though) >2. Lamotrigine       — Lamictal (possibly more effective than Neurontin)

Not a good idea to take with other antepileptics >3. Topiramate        – Topamax (may cause weight loss)

Don’t know anything about this… >4. Verapamil         — Isoptin (caution indicated with heart problems)

Calcium channel blocker used in hypertension and angina (wasn’t Viagra originally developed for this purpose!?). Neurotoxicity with Lithium, potentially dangerous with antiepileptics. You should see the list of other drug interactions….! >5. Tiagabine         — Gabatril

Know bugger all about this >Combining two (or more) mood stabilizers may be more effective than when >each is taken alone. One med may "potentiate" the effectiveness of >another — so that the whole effect becomes greater than the sum of its >individual contributors. Lithium carbonate may prove helpful as a >secondary adjunct to one of the newer mood stabilizers which have >demonstrated antidepressive properties. Consequently I suggest that >Neurontin-Lithium, Lamictal-Lithium, and Topamax-Lithium combinations be >considered. It is also possible that subtherapeutic dosages of lithium >carbonate may be taken so as to minimize its adverse side effects.

I’d check the interactions first! I have an old copy of the British National Formulary knocking about and that through up the above interactions. It is worth remembering that its not a terribly good idea to mix a lot of antiepileptics. Also, lithium interacts with many drugs. Apart from some of the above, lithium also interacts rather nastily with SSRI’s. Verapamil is a seriously nasty drug… Not all the drugs in America make it past our drugs trials (Viagra is having a real beasting at the moment). I guess that we all want to be taking medication that works, and as you say, we’re all different, but having read up on some of the above medications, I’ll stick with lithium. Incidently, I’ve been ’stopping and starting’ with lithium for 18 months – no problems yet. My psychiatrist is rather pleased with the results. But he does keep an eye on me…. Love and hugs, Hugh Hugh Davies-Webb

Response:

<Posted and Mailed to Hugh> >It is possible to have holidays from lithium and get back on it when you >need to take it again.

How long have you been utilizing this "on-again off-again" approach? This is apparently a fairly new British approach to mood stabilization. In previous posts I have expressed strong reservations about this philosophy — particularly if a person has a cyclical mood disorder more severe than cyclothymia. Has your pdoc ever discussed the well-known phenomenon of developing "tolerance" to psychoaffective meds? When you need to go back on a mood stabilizer, you may well find that it not nearly as effective as previously. Consequently you may need to take ever-increasing dosages in order to achieve the same effect. I suspect that the effectiveness of any mood stabilizer would eventually wear off using such an approach. >I have been treated with cognitive therapy with respect to knowing when >to get back on the lithium. This is a rather new-fangled technique, and >I find it very effective, and means that I can spend a lot of time off >lithium.

Hugh, I certainly hope that this procedure continues to works for you! To me — it sounds like a recipe for disaster just waiting to happen! >My psychiatrist allows me to be ’self-prescribing’, although he >keeps a close eye on me.

I have no problem with an informed patient increasing or decreasing their psychoaffective meds — as long as they know what they are doing. Stopping them totally periodically is not a viable option as far as I am personally concerned. Perhaps those who have also attempted this could give us the benefit of their experiences (both pro and con)? TIA! >With respect to coming off lithium permanently, I’m afraid that there >isn’t anything that is nearly as effective.

That entirely depends upon the person. In the US we are currently using 8 mood stabilizers that I am aware of. Lithium carbonate does work quite well for many of us with non-rapid cycling BP disorders. However for rapid, ultra-rapid, and refractory cases other mood stabilizers may well be required in order to achieve reasonable mood stability. The latest therapy in the US (and I believe in Canada as well) is to use a primary second generation mood stabilizer (such as Neurontin or Lamictal) together with a secondary first generation stabilizer (such as lithium carbonate). The latter may possibly be used in subtherapeutic dosages. For additional information — please see the following FAQ on this subject. >You might try lowering your >lithium level. Lithium has differing effects depending on where you are >in the therapeutic band. Some people, myself included, find that a >reasonably low level, say 0.4 – 0.5 mmol/ml works for them, and that you >get more effect and less side effects.

That is very true for some people. However others require much higher levels of lithium for adequate stabilization. >Some people in the UK take Tegretol (carbamazepine) if they have a real >problem with lithium. I believe it is not supposed to be anything like >as good as lithium, and there is not much in the way of tests to support >it’s effectiveness at treating BP, just drug company hype.

Hugh, I must strongly disagree! Therapy with the newer second generation mood stabilizers (or combinations) as well as other first generation mood stabilizers has saved many a life for those who prove resistant to lithium therapy. >Best wishes, >Hugh

FAQ: "Mood Stabilizers Being Used in the Treatment of BP Disorder" By James D. Milton Please see below for 8 psychoaffective meds that are currently being used as mood stabilizers in the United States. I currently post FAQs about some of the newer ones on a bimonthly basis. I have not attempted to list adverse side effects because they vary considerably from person to person. You will just have to keep on experimenting until you find the ones that are effective for each person with side effects that can be tolerated. You can find out a lot about the treatment of bipolar disorder by visiting this Web site: http://www.psycom.net/depression.central.drugs.html There also are many links to other informative sites. Knowledge, Patience, Persistence, and Consistency IMO are keys to success over our common illness. I wish you well! Best regards from, James                 Information Regarding BP Mood Stabilizers                     First Generation Mood Stabilizers 1. Lithium carbonate — Lithobid, Eskalith CR 2. Carbamazepine     — Tegretol, Epital 3. Divalproex sodium — Depakote, Depakene, Epival — valproate                     Second Generation Mood Stabilizers 1. Gabapentin        – Neurontin (may enhance cognitive abilities) 2. Lamotrigine       — Lamictal (possibly more effective than Neurontin) 3. Topiramate        – Topamax (may cause weight loss) 4. Verapamil         — Isoptin (caution indicated with heart problems) 5. Tiagabine         — Gabatril Combining two (or more) mood stabilizers may be more effective than when each is taken alone. One med may "potentiate" the effectiveness of another — so that the whole effect becomes greater than the sum of its individual contributors. Lithium carbonate may prove helpful as a secondary adjunct to one of the newer mood stabilizers which have demonstrated antidepressive properties. Consequently I suggest that Neurontin-Lithium, Lamictal-Lithium, and Topamax-Lithium combinations be considered. It is also possible that subtherapeutic dosages of lithium carbonate may be taken so as to minimize its adverse side effects. It is important to realize that each of us has very individualistic reactions to ALL psychoaffective meds. YBMV (Your Brain May Vary) — and likely will. What is a blessing for one person may prove to be a curse for another and ineffective for a third. We are moving targets that are VERY difficult to hit. With some people their brain neurochemistry appears to change from time to time — thus necessitating further changes in the dosage and composition of their psychoaffective medications. Also there are many antidepressant, antianxiety, antimania, antiseizure, and antipsychotic meds that may prove to be very useful adjuncts to mood stabilizers in the treatment of a BP condition. Where available I highly recommend the time-release formulation of any psychoaffective med. If such is currently unavailable or is too expensive, smaller dosages taken more frequently (4 times daily in equal amounts) may well enhance mood stabilization and potentially lessen any adverse side effects. Any and all med or dosage changes should be first thoroughly discussed with your psychiatrist or psychopharmacologist. Some people apparently seem to think I come across like a medical professional. I would once again like to emphatically state that I am NOT! I am just a person that has had a bipolar (manic-depressive) condition for many years. However I do attempt to keep up with meds and dosage regimens that might prove potentially beneficial in the treatment of BP. Also I have personally experienced the importance of taking lesser dosages more frequently. This IMO is unfortunately greatly under appreciated by many health care professionals! FYI my professional background includes degrees in Engineering Sciences, Nuclear Engineering, and Nuclear Science and Engineering.

Response:

It is possible to have holidays from lithium and get back on it when you need to take it again. I have been treated with cognitive therapy with respect to knowing when to get back on the lithium. This is a rather new-fangled technique, and I find it very effective,  and means that I can spend a lot of time off lithium. My psychiatrist allows me to be ’self-prescribing’, although he keeps a close eye on me. With respect to coming off lithium permanently, I’m afraid that there isn’t anything that is nearly as effective. You might try lowering your lithium level. Lithium has differing effects depending on where you are in the theraputic band. Some people, myself included, find that a reasonably low level, say 0.4 – 0.5 mmol/ml works for them, and that you get more effect and less side effects. Some people in the UK take Tegretol (carbamazepine) if they have a real problem with lithium. I believe it is not supposed to be anything like as good as lithium, and there is not much in the way of tests to support its effectiveness at treating bp, just drug company hype. Best wishes, Hugh. Hugh Davies-Webb

Response:

I started drinking heavily 2 years ago….immediately stopped drinking when I was diagnosed with BP II and was placed on Lithium and Zoloft.  However, I have become terribly apathetic and numb taking these meds and decided last week just to come off the Lithium for good.  The 5 days to follow were BAD ones and included manic behavior and drinking again…..(way too much).  However I did feel more energetic and focused when not drinking.  I have heard about Wellbutrin and wonder if it would work better with Lithium….I need to feel something again…to care about something…to start a project and finish….Lately Im just slush taking up space…..Any suggestions?

Response:

Filed under: Tricyclic Antidepress