A Lot of Meds

[pdr7686]

I was diagnosed with Bi-Polar, Major Depression, Panic Attacks, and Paranoia several years ago. I am on alot of meds right now. I am on Depakote 500mg x 2 @bedtime, Gabapentin 100 mg x 2 capsules 3 times a day, Lunesta 3mg for sleep @ night, Clonazepam 0.5mg 3 x a day, Lexapro 20mg x 2 @ bedtime, and Budeprion 150mg every am. I went to my Psychiatrist yesterday and because I stay depressed she was going to take me off the Lexapro but did not. She did not take me off of it but did say if I come back next month as depressed she was going to take me off of it because she did not think it was helping. She did mention putting back on an anti-depressant in place of it. Therefore, I am confused on all this. Just wondering if anyone has a comment on all this. I have tried alot of meds. If anyone could help I would certainly appreciate it. God Bless.... Pam

[ILADVOCATE]

It would depend on what you have tried. You are on two mood stabilizers. Gabapentin and Depakoate. Have you tried Lamictal? I found that to be effective without any side effects of concern except for the 1 in 1,000 chance of a rare rash (Stephen's Johnson Syndrome) that can be monitored for. Neither appear to be treating the depressive aspect of the bipolar from what you say so you are two anti-depressents Lexapro and Budeprion. Its normal to give adjunct mood stabilizers or an adjunct anti-depressent but 4 medications for that is quite a lot and they still don't seem be helping as much as they could. Klonopin is safe for anxiety as long you don't build up a tolerance to it. I take it as well. Lunesta can be taken every day for sleep without being addictive. However, what is the reason for insomnia? Are the medications activating? Or was it the bipolar itself?
   I would make one strong suggestion though. Have your psychiatrist refer you to a mood disorders specialist. You could still see your psychiatrist but the specialist in knowing everything that is available as a mood stabilizer, including experimental medications that are approved but used off label would be better able to find something that could work without such extreme poly-pharmacy. For a good website on mood disorders look up "Depression Central" (covers bipolar as well) and this site has a complete list of all medications currently in use as mood stabilizers and is medically and clinically accurate and up to date
http://www.psycheducation.org/depression/meds/moodstabilizers.htm
  With the help of my psychopharmocologist I was able to find a mood stabilizer I could tolerate that was effective as well but it took a lot of trial and error but there were many that a clinician in standard practice might not have been familiar and some are very effective just not among the first to use or still experimental but approved for other uses and can be used off label. A good mood disorders specialist or psychopharmocologist would know more though.

[LeftCoastChick]

I have to agree with Advocate, have you tried Lamactil? Now it is slow going at first due to the possibility of the rash, but if you slowly titrate (up) the drug, it's fantastic. I was told it's now a first line drug - I've been on all the SSRI's minus Prozac, and none have worked and some including the SNRI's have caused serious hypomania, phobias and anxiety.  Lamactil I think works better then any AD, I"m a human guinea pig and very much impressed with it.

I'm on a few drugs, Lamactil 200mgs @ night(depression)t, Seroqual (for anxiety/mania) 50mgs morning, afternoon and 200mgs @ night, Lithium 300mgs @ dinner (mania/depression), Trazadone 200mgs @ night for insomnia and mid sleep anxiety, as well 1mg of Ativan as needed. I have to put my meds in little cases or I would forget which drug I took because I have so many! oy vey!

If you're pdoc doesn't seem to be well equipped, like the previous person said, a Mood Disorder Clinic is awesome for us BP folks and/or psychopharmacologists though I'm told they are very rare, your best bet is the Clinic.  

I even asked about ECT, but I was told this really was for BP1's who can't have their BP controlled at all by the drugs and therapy. It's much safer then it used to be. Cogntive therapy is really important to help you conquer this as well, because negative thought then goes to negative behaviour. You are your best advocate don't forget that!

[pdr7686]

I have tried Lamital and developed the rash you were referring to. Therefore, was taken off it. I have been tried on several AD with my mood stablizers. In the past, I have tried Budeprion and it did not seem to help. My Psychiatrist decided to try me on it again. I guess because nothing seems to be helping. Over the years I have tried to commit suicide 8 or 9 times.

[pdr7686]

I have tried Lamital and developed the rash you are referring to. Therefore, I was taken off it. Also, you mentioned you were on Lithium. I have tried that and had to be taken to the ER because I got so I could not walk and had no use of my legs. I was taken off it even though my Psychiatrist had been having my levels drawn. I have been tried on all the medications you are on plus alot more. I was at one time doing the ECT you were referring to and it did not help. I have a Therapist. I feel as though I am a helpless case.

[pdr7686]

I can figure out why my Psychiatrist would put me back on Budeprion when I plainly told her it had not helped me in the past. She was not my Psychiatrist at this time. Also, the last time I went to see her she talked about increasing my dosage and taking me off the Lexapro. I do not understand this.

[ILADVOCATE]

I thought that Stephen's Johnsons syndrome as an effect of Lamictal was a statistical rarity. That's unfortunate. As for ECT, it is done in a safer manner but can cause short term memory loss and in a certain percentage of people there is some long term memory loss. They are now studying a procedure trans cranial magnetic stimulation. Before recovery, I almost considered it but the procedure is still experimental and they haven't figured out exactly which area of the brain to target (at least at the time I almost signed up for the study in 2003) but it does not appear to have the impact on the brain in the negative manner that ECT does and when FDA approved might someday replace it.
  However, as I posted for anyone not responding to the standard mood stabilizers there are a large number of medications that are FDA approved but used off label. Psychiatrists will make a referral to a mood disorders specialist if warranted and they would know of these treatments if a person has been unable to tolerate existing medications.

[pdr7686]

I guess I ended up being the rare case with the rash. I have never heard of the trans cranial magnetic stimulation you were referring to. I tried looking up the sites you mentioned but the one about mood stabilizers would not come up for me. I am so bad my Psychiatrist is not going to allow me to go through Hep C treatments because of suicidial ideaizations. She is afraid it may send me "over the hill". Therefore, I consider myself a helpless case. Thanks. God Bless.

[ILADVOCATE]

Google "List of all mood stabilizers in developments". Its the 2nd result.
You can find "Transcranial Magnetic Stimulation" on Wikipedia. Its still a highly experimental procedure but its showing promising results and in the long run may prove to be safer than ECT but has to go through all the phases of testing first. Clinical studies for that are ongoing though. As for the experimental mood stabilizers listed since they all approved medications but used off label a mood disorders specialist would be legally allowed and perfectly willing to prescribe them now though I don't want to reccommend one over the other as each person reacts differently to different medications.

[pdr7686]

I have been reading and you can have a rash without it actually turning into Stephens Johnsons Syndrome. Well, I had a rash where my Psychiatrist told me after observing the rash to go off it and "Do Not Go Back On It For NO Reason." I read about the "Transcranial Magnetic Stimulation." "Do you not think I need the AD with Mood Stabilizers"

[ILADVOCATE]

No. There your psychiatrist was correct. The beginnings of the rash are mild but after it turns into Stephen's Johnson Syndrome (technically an allergic reaction to medication) it can turn deadly even if the medication is discontinued. If someone has bipolar a good mood stabilizer should control depression as well as mania. It does in me and I have schizoaffective. Some people need an adjunct anti-depressent depending if their depression is still not controlled but they can push a person into mania at times. There are new anti-depressents and medications used for that purpose as well and a mood disorders specialist would know about both mood stabilizers and anti-depressents.

[pdr7686]

Thank you for all your info. I have noticed you have help to get someone there disabilty on some site, I think. How did you do this? I applied for my disability and at that time was told it would be May 2009 before I could consider getting a hearing. Am I right?

[ILADVOCATE]

Yes it takes a year or more to recieve a hearing date. In the meantime, have good documentation from your psychiatrist about how your disability prevents you from working. I have given people information but do representation as a volunteer through a non profit in the area I live. However, your local independent living center could probably represent you or at least have a comprehensive list of free legal referrals. Here's a list of the ones in North Carolina:
http://www.ilru.org/html/publications/directory/northCarolina.html

[pdr7686]

Thank you for the info. I think my condition could qualify for disablity or SSI. Am I right or wrong? My Psychiatrist has written in her notes several times that I was not able to hold a job for any gainful employment or how ever that is said. I had a doctor at one time at a clinic I no longer go to say I was not able to hold down a job. My doctors have changed since then. I do not know how this Dr. feels. Now, I have the Hep C. Would that qualify for disability or not? I appreciate any answers you can give me. I have my medical records from several different sources and the ones I do not can obtain.

[ILADVOCATE]

The hep C alone because its untreatable would and certainly in combination with the bipolar which has proved hard to treat. "Unable to perform substantial gainful employment" is the terminology and you need full documentation for that. If you have any more questions pm me.

[MistressNomad]

Holy cow that's a lot of meds.

Have you considered maybe starting again? At this point, it's impossible to tell what's helping you and what's not. It's impossible to tell which meds you take for your symptoms, and which meds you take to get rid of side effects of other meds.

That's the problem with adding more drugs as patches over other drugs - no way to tell what's helping and what's not.

I understand it's frustrating - I'm bipolar, and I try to pretend that monitoring my moods doesn't take up 75% of my life, but it really does. All the same, I'm not surprised you dont feel right on all those meds.

Have you done all the things that should go with your meds? Have you changed your lifestyle (set a bedtime, healthy diet, monitored stress levels, routine, etc)? Is there any way you could be somewhere safe to come off your meds, and start over with them? It may be a simple case of your brain being overloaded.

[pdr7686]

I went to see what my results were for my Ultrasound (Hep C) and they had turned out okay. They want to see me back in 6 months. I was told my lab work was okay but my viral load was a little on the high side. How is the best way to prove what my Psychiatrist said that " I was unable to hold gainful employment?. It is documented in my records where I had several jobs and could not hold to any of them any length of time. Is there more that I need? My doctors yesterday on my Hep C want my Depression problems better before they do treatment. They told me I would have to be on Hep C medications for a year (do not know whether you are familiar with Hep C or not.) I am sorry I could not get back to you before now. I hope things are going well for you. God Bless! See 'ya

[pdr7686]

I usually go to bed around 10:00pm until 11:00pm. I have to eat pretty well right because I am a diabetic which has to take 1000mg Metformin and 4 insulin shots per day. I have tried to monitor my stress level as best I could. I am afraid to come off the meds because it could make me worse, I think. Thanks! God Bless!
Sorry I could not get back to you before now. Hope things are going well for you.

[ILADVOCATE]

If your psychiatrist said it that's proof enough. "Unable to engage in substantial gainful activity". But they must detail. Why? And how your depression affects you? As for the hep. c, I am familiar with that disability and as with all disabilities for Social Security its how it affects you not what it is but if it needs treatment that is last resort then yes that would count as well. Any disability that affects you in addition to the depression. And as for postponing the hep. c. treatment I would like to know their rationale. You will recover from depression. But worst case scenario and you didn't if they postponed that treatment for the hep c it could be life threatening. And then you could never recover physically at all. Depression is a psychiatric disability but it does not limit life span or affect a person physically and if you felt better physically it would help with your mental recovery as well. Please explain why their reasoning behind this decision.

[pdr7686]

Good Morning! I personally can not tell you anything but the fact that the medicines they would put me on have suicidial ideaizations and they are afraid my mental status is not stable enough. Also, I was told my lab work was not quite bad enough even though my viral level was a little high. It was 326,000 when it could go up into the millions. The way I understand it -- the US shows whether you have cancer,etc and the liver biopsy shows the fibrosis, cirosis(not spelled right) I asked about the biopsy but they did not seem to want to do that right now. My mom was with me and she was glad they thought everything sounded good but she does not know any more than I do about it. I was told I was type 1 and would have to be on treatment for a year and that this was the hardest to treat.
If and when my case goes to court will what my therapist has to say have anything to do with it? She does not think I could hold down a job either. Do I need a lawyer? I, at one time, had a Advocate and my case was denied. Running out of room. Thanks!

[LeftCoastChick]

When I hear that someone has tried every drug, I find that hard to believe (no offense) there are so many drugs out there, it's staggering. I was on Lithium when I was 16, but at such a high dose I had a seizure, so I was reluctant to take it again. I'm at 300mgs to augment my other mood stabilizer. Like others have said, you might have to start all over again, and hopefully you can find a pyschopharmacologist to guide you through. I was told to have patience and not expect and instant cure, and it sure hasn't been. I slept in today by accident and it's really messed with my day, I have to keep to a strict regime, or I get messed up. I wish you much luck. LCC

[pdr7686]

Thank you for your answer on my problem. My Psychiatrist has told me I have tried all the medicines but I do not believe it. I have tried several since I was diagnosed with BI-Polar, Major Depression, Panic Attacks, Paranoid, and hearing voices. I know there has to be an answer but I feel like I am a guiena pig and there is no hope for me.
Hope all is well for you.

[LeftCoastChick]

Hey there!
Ya know, pdocs are like any people, some just don't fit. I had to wait for 6 months for a pdoc after a serious suicide attempt in '98, (not sure why the hospital didn't hook me up), when I met Dr. P I immediately didn't like him. I didn't have a choice of going to another one because in Vancouver BC, there are very few here. I never felt like I could fully open up to him and I felt he was critical of me, though I did learn some valuable coping skills. He never wanted to try different drugs, except for a couple of temporary augments to me AD. He also didn't diagnose me correctly. So pdocs do make errors, if you don't feel you are getting the right help, maybe consider getting a new pdoc if that's possible.

Have you tried Seroqual, at higher doses it is an anti-psychotic, it will help with hearing voices, paranoia  AND the anxiety. It's a godsend to me.  I was also told that there are new studies out to show that at higher doses 600mgs+, it can help as an AD. Amazing what new info is coming out.  I've been naughty, because I feel flat alot, which I was told may be a fact of life, I've taken  less so I'm a little manic so I can get things done lol! I was told most drugs will flatten you out a bit ugh.

Do keep in touch, and remember there is hope.I was told that I have to work hard as well and not expect the drugs to do everything and I have to do my part.  You are your best advocate and I know that you can do it!  Have faith in yourself that you can conquer this! Keep in touch!

[ILADVOCATE]

Sometimes anti-psychotics can be of use as mood stabilizers and in bipolar with psychotic features it may be neccessary. I would not suggest someone with straight bipolar asking for an anti-psychotic because of the risk of all current antipsychotics (except for Clozaril which can cause blood dyscreias and like all atypical antipsychotics has the risk of diabetes, Zyprexa is the worst offender for that) causing tardive dyskinesia at the rate of to quote my psychopharmocologist "5% per person per year for typical antipsychotics and 2.5% per person per year for atypical antipsychotics". That is the current generation of antipsychotics however. But antipsychotics in development such as the glutamate antagonists will not cause diabetes or tardive dyskinesia. I am on glycine, an anti-psychotic in Phase II FDA study that has promoted a full recovery from schizoaffective disorder in me. My psychopharmocologist will be publishing the case study in a psychiatric journal which will also be online which I will make available at that time. Until then, you can look up the official study. Google "Dr. Javitt, glycine".

[pdr7686]

I have tried Seroquel. It did not help me at all. I feel like a helpless case. Thanks for answering me and my problem. God Bless

[pdr7686]

I am Bi-Polar with Psychotic features and I already have diabetes. I have tried Zyprexa. Thanks! God Bless

[ILADVOCATE]

Zyprexa is the most likely out of the atypicals to cause diabetes. Abilify is the least likely but its still a possibility. You are not a "hopeless case". Please don't think that way. I did before. It was 2007. I had advanced tardive dyskinesia and could not tolerate Clozaril but had to be on an antipsychotic and knew anything else would worsen it. My psychiatrist agreed to start me on Invega, then just released and I knew it was going to worsen the tardive dyskinesia. He warned me. But on the Clozaril I had suicidal ideations. I asked about medication studies. Then I found out that glycine was available. And that it was being studied. And then I recovered. If you are ruled out as a candidate for all current antipsychotics because of diabetes but you need an antipsychotic at that point perhaps your provider would consider glycine. Print out the official study for them as well as any post or journal entry I have that would help (they are in the public domain) and if they want more information or haven't heard of it pm me and I'll provide you with more specific information. Just don't change anything or try anything on your own. But your situation is not "hopeless". It has a solution. This is one worth considering if you need an antipsychotic but can't tolerate what's out there because of the risk of worsening the diabetes you have. Diabetes is not caused by this new class of antipsychotic from study results.