Health QuestionsCategory: TreatmentsAC for mixed states?
cache-monkey asked 3 years ago

[I posted something similar in the Tegretol forum…]
 
I’m pretty sure that I’m BPII with mixed states/dysphoria predominant and periodic depression. Possibly also ultra rapid-cycling, although that’s hard to seperate out from a mixed state for me.  
 
Current meds:
1) low-dose Lithium (60-120 mg/day) – any higher and I get more anxious (and my kidneys don’t like it); lower and I get a full-blown mixed-state.  
2) Klonopin (0.675 mg/day) – decent for dysphoria, but leaves me feeling a little blue  
This combo is definitely way better than nothing, but there are still a lot of ups and downs.
 
My pdoc has started me on Neurontin, but I’m very wary. I think a brief trial of it last week after sending my Lithium too low completely exacerbated the manic dysphoria. And Neurontin, from what I understand has a crappy rep as a mood stabilizer.
 
So, any thoughts on another MS? Ideally, something good for mixed states? I’ve been looking at Tegretol and Keppra (or maybe re-trialing low-dose Depakote at a super low-dose, see below). Thoughts?
 
Also, is Tegretol likely to be very similar to Trileptal? I had a bad reaction to the latter (again, see below).
 
Trials of mood stabilizers:
1) Depakote – increased depression, fractured sleep and cognitive blunting throughout a 6 week trial. But started at 250 mg/day, jumped to 500 mg after 4 days and got up to 1000 mg-1250 after a couple weeks. This might have been too much for me too fast This might have been too much for me since I’m incredible med-sensitive, so maybe this merits retrialing at pediatric doses.
2) The atypical antipsychotics – akathisia from Zyprexa and Geodon; severe dry mouth and some agitation from Seroquel. I think I’m leaving these alone for a while.
3) Trileptal – agitation and pretty bad cognitive dysfunction during 10 day trial at 75 mg BID
4) Lamictal – increased agitation, muscle aches, sexual dysfunction at 25 mg, panic attack at 50 mg. Conservative titration. Granted, this was an incredibly stressful period of my life, but retrialing this would be pretty far down on my list
 
Thanks for any input you might have!
 
Best,
cache-monkey

7 Answers
Kassiane answered 3 years ago

Re: AC for mixed states?
Tegretol, Topamax (sometimes) and Depakote are the best for dealing with mixed states for most people.  
 
As far as tegretol goes…I was mostly fine on it till I went toxic, then my body threw a fit…and on Trileptal Im a mess-illiterate, falling over, etc.
 
Topamax can work as an add on, but it can make some people rediculously aphasic.
 
Depakote has the most research behind it….
 
Keppra works for ME but I’m a freak.  
 
There’s always the antipsychotics, at low doses they make decent add ons.
 
Kassiane

cache-monkey answered 3 years ago

Re: AC for mixed states?
Thanks Kassiane. I’m a little scared of the Topomax. I’m willing to gain weight and be naseous, etc. But, I’m an academic and my mind’s my prime asset… I guess pretty much everything can mess with cognition. I’m still holding out hope that I get stabilization without cognitive blunting.  
 
I guess that’s why I’m interested in Keppra. I know it only has minimal evidence supporting it as a MS, but I guess I’m fishing for anectdotal evidence. When you say it works for you, is that for the epillepsy, the Bipolar, other stuff, or all of the above?  
 
I noticed in your Bio on the mainsite that you live in Illinois. I’m assuming downstate, since otherwise you would have said Chicagoland. Anyway, I grew up downstate too, so I thought I’d give a shout-out.
 
Best,
cache-monkey

Kassiane answered 3 years ago

Re: AC for mixed states?
Quote from cache-monkey on 24. Mar 2006 at 01:34:

Thanks Kassiane. I’m a little scared of the Topomax. I’m willing to gain weight and be naseous, etc. But, I’m an academic and my mind’s my prime asset… I guess pretty much everything can mess with cognition. I’m still holding out hope that I get stabilization without cognitive blunting.

 
I’ve been pretty lucky in that regard. The only things that made me stupid were Zonegran and Trileptal.  
 
Quote:

I guess that’s why I’m interested in Keppra. I know it only has minimal evidence supporting it as a MS, but I guess I’m fishing for anectdotal evidence. When you say it works for you, is that for the epillepsy, the Bipolar, other stuff, or all of the above?

 
It works for everything! Really good stuff. It neutralizes mixed, depressed, manic, AND reduces my seizure frequency significantly.
 
Quote:

I noticed in your Bio on the mainsite that you live in Illinois. I’m assuming downstate, since otherwise you would have said Chicagoland. Anyway, I grew up in Champaign, so I thought I’d give a shout-out.

 
Yay for the Land O Corn. Heee. I got out of there because, well, I’m horridly allergic to corn. I grew up in Peoria, and used to compete with a couple gyms out of Champaign (gymnastics=the best way to meet every skinny kid in any given state).
 
Good luck finding the right med.
 
Kassiane

cache-monkey answered 3 years ago

Re: AC for mixed states?
Thanks much, again!
 
~cache-monkey

Haunted_leaves answered 3 years ago

Re: AC for mixed states?
I’ve had alot of luck with Topamax (400mg) and Seroquel (300mg) working together.  They do wonders for me.  I also take Klonopin for anxiety and sleeping issues.
 
I didn’t have any trouble with getting the stupids for the Topamax…  I guess this was just the righ combination for me.  It must have targeted just the right spot in my brain.  I felt like the illness was causing so many problems that the medication actually brought my world into sharper focus rather than bungling things up for me.
 
Hope this helps…  Smiley

cache-monkey asked 3 years ago

[I posted something similar in the Tegretol forum…]
 
I’m pretty sure that I’m BPII with mixed states/dysphoria predominant and periodic depression. Possibly also ultra rapid-cycling, although that’s hard to seperate out from a mixed state for me.  
 
Current meds:
1) low-dose Lithium (60-120 mg/day) – any higher and I get more anxious (and my kidneys don’t like it); lower and I get a full-blown mixed-state.  
2) Klonopin (0.675 mg/day) – decent for dysphoria, but leaves me feeling a little blue  
This combo is definitely way better than nothing, but there are still a lot of ups and downs.
 
My pdoc has started me on Neurontin, but I’m very wary. I think a brief trial of it last week after sending my Lithium too low completely exacerbated the manic dysphoria. And Neurontin, from what I understand has a crappy rep as a mood stabilizer.
 
So, any thoughts on another MS? Ideally, something good for mixed states? I’ve been looking at Tegretol and Keppra (or maybe re-trialing low-dose Depakote at a super low-dose, see below). Thoughts?
 
Also, is Tegretol likely to be very similar to Trileptal? I had a bad reaction to the latter (again, see below).
 
Trials of mood stabilizers:
1) Depakote – increased depression, fractured sleep and cognitive blunting throughout a 6 week trial. But started at 250 mg/day, jumped to 500 mg after 4 days and got up to 1000 mg-1250 after a couple weeks. This might have been too much for me too fast This might have been too much for me since I’m incredible med-sensitive, so maybe this merits retrialing at pediatric doses.
2) The atypical antipsychotics – akathisia from Zyprexa and Geodon; severe dry mouth and some agitation from Seroquel. I think I’m leaving these alone for a while.
3) Trileptal – agitation and pretty bad cognitive dysfunction during 10 day trial at 75 mg BID
4) Lamictal – increased agitation, muscle aches, sexual dysfunction at 25 mg, panic attack at 50 mg. Conservative titration. Granted, this was an incredibly stressful period of my life, but retrialing this would be pretty far down on my list
 
Thanks for any input you might have!
 
Best,
cache-monkey

7 Answers
Kassiane answered 3 years ago

Re: AC for mixed states?
Tegretol, Topamax (sometimes) and Depakote are the best for dealing with mixed states for most people.  
 
As far as tegretol goes…I was mostly fine on it till I went toxic, then my body threw a fit…and on Trileptal Im a mess-illiterate, falling over, etc.
 
Topamax can work as an add on, but it can make some people rediculously aphasic.
 
Depakote has the most research behind it….
 
Keppra works for ME but I’m a freak.  
 
There’s always the antipsychotics, at low doses they make decent add ons.
 
Kassiane

cache-monkey answered 3 years ago

Re: AC for mixed states?
Thanks Kassiane. I’m a little scared of the Topomax. I’m willing to gain weight and be naseous, etc. But, I’m an academic and my mind’s my prime asset… I guess pretty much everything can mess with cognition. I’m still holding out hope that I get stabilization without cognitive blunting.  
 
I guess that’s why I’m interested in Keppra. I know it only has minimal evidence supporting it as a MS, but I guess I’m fishing for anectdotal evidence. When you say it works for you, is that for the epillepsy, the Bipolar, other stuff, or all of the above?  
 
I noticed in your Bio on the mainsite that you live in Illinois. I’m assuming downstate, since otherwise you would have said Chicagoland. Anyway, I grew up downstate too, so I thought I’d give a shout-out.
 
Best,
cache-monkey

Kassiane answered 3 years ago

Re: AC for mixed states?
Quote from cache-monkey on 24. Mar 2006 at 01:34:

Thanks Kassiane. I’m a little scared of the Topomax. I’m willing to gain weight and be naseous, etc. But, I’m an academic and my mind’s my prime asset… I guess pretty much everything can mess with cognition. I’m still holding out hope that I get stabilization without cognitive blunting.

 
I’ve been pretty lucky in that regard. The only things that made me stupid were Zonegran and Trileptal.  
 
Quote:

I guess that’s why I’m interested in Keppra. I know it only has minimal evidence supporting it as a MS, but I guess I’m fishing for anectdotal evidence. When you say it works for you, is that for the epillepsy, the Bipolar, other stuff, or all of the above?

 
It works for everything! Really good stuff. It neutralizes mixed, depressed, manic, AND reduces my seizure frequency significantly.
 
Quote:

I noticed in your Bio on the mainsite that you live in Illinois. I’m assuming downstate, since otherwise you would have said Chicagoland. Anyway, I grew up in Champaign, so I thought I’d give a shout-out.

 
Yay for the Land O Corn. Heee. I got out of there because, well, I’m horridly allergic to corn. I grew up in Peoria, and used to compete with a couple gyms out of Champaign (gymnastics=the best way to meet every skinny kid in any given state).
 
Good luck finding the right med.
 
Kassiane

cache-monkey answered 3 years ago

Re: AC for mixed states?
Thanks much, again!
 
~cache-monkey

Haunted_leaves answered 3 years ago

Re: AC for mixed states?
I’ve had alot of luck with Topamax (400mg) and Seroquel (300mg) working together.  They do wonders for me.  I also take Klonopin for anxiety and sleeping issues.
 
I didn’t have any trouble with getting the stupids for the Topamax…  I guess this was just the righ combination for me.  It must have targeted just the right spot in my brain.  I felt like the illness was causing so many problems that the medication actually brought my world into sharper focus rather than bungling things up for me.
 
Hope this helps…  Smiley