[CamW]

Darkeyes -....and I bet they are (like limpid pools) ;^)
I just noticed something about Topamax that was reported on CNN/Health. It regards glaucoma potentially as a side effect of Topamax. There have been only 22 reported cases in adults (out of the thousands and thousands of people taking it), but I thought you might like to know. Just watch for abnormally sore and dry eyes. Here is the link:

http://www.cnn.com/2001/HEALTH/condi....ap/index.html

I'm sorry to hear about the trouble with your husband. Us men can be such shits, sometimes.

- Cam

[darkeyes]

Thanks!
I personally feel Ritalin would be the best for me, considering what my other brother has experienced who the doctors first treated with bipolar meds. but then his present doctor diagnosed him as ADD, that was also added to my diagnose besides mild bipolar, mild personality disorder, sometimes I get synical and wonder do "they" really know what "they" are talking about? Meanwhile we are given meds. that do nasty things to us because a doctor(s) is afraid to try something that really does agree with you. I had no problems with sleep and negative moods when I would go to weight centers and get phenterimine or phen/fen combo, I lost weight, had a great sleep/wake cycle and more alert without "speeding" and I did go to sleep at normal hours, but because the abuse of ritalin I guess doctors are reluctant to prescribe it to patients, especially any with bipolar tendencies. My other brother who has been on lithium for over 25 yrs, was given ritalin years ago while in a major depression and it was good for a short while then threw him into a major manic episode. I do not feel that would happen to me due to being mildly bipolar and do not have the same triggers that put me here in the first place, but cant convince the doctors, maybe they are so fearfull of malpractice issues today, cause that does exist so intensly today. Sorry to keep gabbing. Take care and stay well.
"darkeyes"

[CamW]

DE - Docs usually don't really know what is going on with a person. The diagnoses are so concrete and subjective, while our disorders have no solid edges. The way to get a best diagnosis is to write a list of troublesome symptoms; try a med &/or a certain type of therapy; rewrite the list; add a med &/or therapy or try different ones; rewrite the list...ad nauseum.

I am not a big fan of stimulants outside of those who really can get a descent diagnosis showing a lack of dopamine (ie. ADD, ADHD, etc) via symptomatology. Stimulants, for the most part, are short-term gain resulting in long-term pain. They are okay until your mood deflates again at a specific dose. Something happens to your natural dopamine supply &/or certain subtypes of dopamine receptors. The "reward" (ie. increased dopamine flow in the nucleus accumbens and other brain structures) you get in the beginning will last a year, maybe more, but eventually it seems that those who do not have a real dopamine transmission problem, will get one. This is not always the case, but I have seen it in many cases.

That being said, who's to say that you don't have a dopamine neurotransmission problem. We just don't have any really reliably test to tell if you've got a dopamine receptor or neurotransmission problem.

Anergic depression responds to antidepressants and stimulants, but you can't even keep these people on stimulants long-term, without increasing the dose. Like they said in the Haight in the 60s, "speed kills". Give the

Topamax a chance; then if it doesn't do anything in a month or two, what have you lost, but 2% of your lifetime (hey, at our age 2 months is nothing <smirk>). When you show the doc that you've tried his/her way, they seem to be more receptive to try your way next time.

Hang in there, I cheering for ya. - Cam

[darkeyes]

Yeah you are right, I really have nothing to lose (except more hair and patience, ha!ha!) but at least not my mind this time thanks to therapy (had an excellent "cool dude" for a therapist where I lived before and a patient psychiatrist too!) I'm starting to get use to the new replacements where I live now, but I miss the old ones like one misses old friends (unfortunately due to ethics and all that stuff I am "not suppose to") but I do!
CamW, I really want to get off this damn depakote, the hair loss, the weight gain and the evening "zombie" with the sluggish morning start sucks! Though the doctors says I am not overweight, I am 5' 4" and up to 130lbs, true I am muscular but I still feel fat! I guess I will continue the doctors "med.show", and take the "wait and see approach", what's another couple or more months, right? It is just that before Oct.1999 (husband's secret(s) exposed) I never had a need for this crap plus the "label" I now carry plus all the other little bags I carry that I won't even go into, it is not anyone's problem to know about. Whatever, I still try to set my brain on things or places I'd rather be at before I fall asleep at night so I can "go there" for a little refuge for now and sometimes that works and I awake to a great day!! Or I read some poetry or even write some, connect with the outdoors and creatures, what a great escape!! I better stop before I become too obnoxious with my "stuff". Again take care, and stay well.
"darkeyes"

[curlyq]

I'm curious, is meridia considered a stimulant and does it have the same effects as you described to darkeyes? I mean causing a dopamine problem for a year after withdrawal?

<font color=orange>Do unto others as you would have them do unto you.</font color=orange>

[CamW]

Hi CurlyQ - Meridia™ (sibutramine?) is a different kind of stimulant. While one of it's major metabolites does block dopamine reuptake, the parent molecule is far more potent at blocking the reuptake of serotonin and norepinephrine. This actually blows me away, because this would indicate that it's actions basically make it Effexor™ (venlafaxine).

To tell you the truth, I am not a big fan of "diet pills" and go for exercise and diet changes (ie. lifestyle modification) as the way to take "some" weight off, and more importantly, keep it off. I also point out to people to look at the shape of their parents...genetics screws you every time. ( Therefore, I have not really looked into the mechanism of action of Meridia, except for a cursory look at the drug company information that has come across my desk.

Since Meridia (like Effexor) blocks both serotonin and norepinephrine reuptake, you would expect it to be marketed as an antidepressant. Since Effexor causes weight gain in many people, you would expect Meridia to "cause" weight gain, instead of weight loss. Hmmmm...

I have being saying for a long time that the real antidepressant activity of SSRI-like drugs (or any antidepressants for that matter) have little to do with their effect at serotonin (or norepinephrine or dopamine) sites. The binding to, and blocking of, the reuptake sites seem to be what all these molecules have in common....except Wellbutrin™ (bupropion). It is the "excepts" that kill theories.

So, to get back on track, you asked if Meridia affected your dopamine system. Probably not. But, I am not really sure I understand how Meridia works. By drug company accounts, Meridia "should not" disrupt the dopamine system. I tend to believe a drug company when they say this in their product monographes. A product monograph, which tells about a drug, it's actions, side effects, contraindications, doasges, etc., is pretty much a lawyer's document; written by lawyers for lawyers. The drug company, with this document, tend to fully cover their butts. The only "fudge factor" I see them using is the weaker blocking of dopamine reuptake by one of Meridia's metabolites; but I don't see this as a major action, and may only contribute to some side effects.

Sorry that I cannot help anymore than this, but I hope that this clears up some of your concerns. - Cam

"Sometimes you can see the light in the strangest of places, if you look at it right". "Scarlet Begonias" - Robert Hunter

[curlyq]

Thanks for your reply on it CamW. I'm glad it doesn't do what the other ones you described before do. That's scary. I lost some weight on it anyhow-22 pounds. I know regulating the diet and exercising is best but for some reason I couldn't do that at one time and had to lose weight for serious health reasons and fast. My cholesterol and triglycerides were sky high 338-660. I do need to get back into exercising and soon. I noticed it helped with the depression I suffer from but it also made me edgy and irritable at first and caffeine can make it worse. I do notice a similarity to the effects of effexor except it hasn't made my body temp. go up and down like effexor did. I went off the Meridia and back on and off and that probably wasn't wise but I was so irritable and at times it seemed not to work. I know a lot of it is sticking with my diet journaling and calorie counting and I'm doing that again. I wish I were more diet conscious than pizza conscious! I am back on it (meridia) and also back on risperdal for ptsd/depression. This combination doesn't seem to bother me as much as zyprexa/meridia. Some warn against these combinations, I'm aware. The zyprexa had me eating everything in sight, seriously. I even ate in the middle of the night. Found crackers all over the place. Yes, my genetics is a part of it. I just want to be healthier. I'm not aiming for skinny at this point. I was near there years ago but also was taking overdoses of diet pills way back then. I don't do that now. Thanks again.

<font color=orange>Do unto others as you would have them do unto you.</font color=orange>

[darkeyes]

Dear Curlyq,
I tried Meridia when it first came out it did nothing for me except constipate me really bad! In fact that slowed down weight loss because it seemed to make me become sluggish.
I know everyone disagrees about stimulants and yes they can become addicting but they seem to be the "only" med. that ever helped me in so many areas besides helping appetite control, I was alert, energetic, and happy. . . while taking them I was able to keep up with the rest of my world, because I have always been labeled as slow poke. Another interesting thing I had a normal wake sleep cycle probably because I was on a dosage and timing that did not interfer with sleep ability, it really sucks that my doctors can't understand how my quality of life was better with that kind of med. compared to what they have prescribed to me! After all their prescriptions can cause dangerous and even long term damaging side-effects. They'll give developing children ritalin (stimulant) but not me and yet my system responds the same way which brings me to the conclusion that though I've been diagnosed as mild bipolar I am very much "ADD"!!
But then what do I know? It is only "me" that mentally and physically feels the difference. Also Meridia did not have any stimulant quality at all, it is a waste of time and money(very expensive!) Take care and stay well.
"darkeyes"

[curlyq]

I had good results with Meridia and I think I would not had I been in your shoes. If I had taken amphetamines before Meridia would seem like candy and expensive candy. I lost weight with it. I guess our systems are different. I noticed that it helps me feel fuller after eating than when I don't take it. It doesn't work for everyone. I took amphetamines years ago to the point where I o.d. ed on them and could not take them now if I wanted to. Plus I do not have a condition that would warrant it. Amphetamines kept my weight down 30 years ago but I got burned out on them badly. I used to like the stimulant quality but developed some awful side effects that are typical of schizophrenia-so I am scared of them now. I never had schiz. though. I noticed a slight stimulant quality to Meridia but then it's not a typical stimulant. Once I took 2 by mistake and then I noticed a lot more energy. What is a waste of money for you was not for me. Glad something works well for your condition. Take care.

<font color=orange>Do unto others as you would have them do unto you.</font color=orange>

[adaml]

I have been on Topamax for ove a year know and I lost the over the 17lb avg. wieght fromt eh clinical trials. I do like it i was on the depakote before I i did gain 40 lbs in 6 weeks that is why I went on Topamax. Someone had mentioned something about Ritalin and Weelbutrin and stuff for ADD\ADHD, weel I was on them both at the same time pluys Paxil, and well it wsn't a great combo. But I think Topamax was a wonder drug for me it turned me right around, very quickly too

[darkeyes]

Adaml,
Thanks for an upbeat opinion, my psych. says it may cause confusion and drowsiness, but what the hell has this depakote done for the past months or actually almost a year!
I am almost at the point to go natural, I am feeling good and my major life issues are now all settled and I am settled with myself. I have gained 16lbs. while "watching my weight" could you imagine what would have happened if I let myself go?? Depakote gave me or gives me "night munchies" I actually do "sleep eating"!!!! It is really weird, I actually woke up finding myself at the kitchen counter eating lime tortia chips like a shark on a food frenzy, I do not like this plus the hair loss, did your hair start to thin?? Do you think I may do better with Topamax? Thanks for your response(s).
"darkeyes"

[adaml]

darkeyes,
No problem I really don't like seeing people upset and I try to help as best I can.
You are right Topamax can cause a number of side effects, AS CAN ANY DRUG, but as patients and as physicians they must weigh the pro versus the cons. Most mild side effects go way after 3 months so. But I do like ti I have heard anything bad from it, however it is a sulphinamide so be careful. I hate all the time for the most part when I was on depakote I was hospitalized so all i could really do to help my slef was eat, i couldn't get any exercise so the punds came rolling in. My hair did thin but nto a whole lot I was only on the drug for 5 months. According to my psych. he is really good, another benefit of topamax is that it has a antidepressant LIKE effect to it so it can help bring people wout of depressions where the other drugs in the sma e category (Lamicital Gabapentin) do not. so that is also a plus for the drug, it is hard to say if it would help, but i really don't think it could hurt the worst that could happen is that you could be one of the 50% who lose some weight, no harm in that is there. A site that I like to find out more info is <A target="_blank" HREF=http://www.docguide.com>http://www.docguide.com</A> so it is worth investigatingit is your health.
Good luck and if you have any questions feel free to ask.
Adam

[darkeyes]

Again,
Adaml thanks! I spoke to my psychiatrist, he said I can start cutting back on the depakote but if I see any problems to contact him right of way. My therapist says exactly what I've been saying, I may have been misdiagnosed as bipolar because I told my first psychiatrist and psychologist that my one brother is bipolar and has been on lithium since the early 70's where as my other brother was diagnosed years ago as bipolar and never had a positive response to the meds for bipolar plus over the years a lot of hard times due to this till about 2 years ago another doctor diagnosed him as being ADD and treated him with ritalin and it was a miracle, he got his GED and started college and did great. I too was a poor student in school and managed to graduate HS, always having complaints from teachers that I did not pay attention, never followed directions and always clowning around. After marriage and being a mom, I did college part time had A's and B's only C's in algebra and precalc, but was also on diet pills, better concentration, better sleep and wake cycle, better outlook and better libido, my husband said he thinks I was doing my best in every way while on CNS meds. Does not take a rocket scientist to see what type of meds. I should really be on. So far all this crap I've been given does not make me feel that good and focussed, I can't even complete reading stuff I enjoy plus need to read and do. I hope at my next visit to my doctor he will hear me out and in the near future re-evaluate me and see what I really need. Meanwhile all I can do is WAIT and perhaps gain more WEIGHT
Thanks fore responding to my questions and giving me some comfort.
"darkeyes"

[curlyq]

Cam,
Is Topomax ever prescribed for Major Depression accompanied by PTSD? I asked my former MD about prescribing it for me because I heard that most don't gain weight on it or even lose it. He would not prescribe it because he said it is not for my problems. Nothing has worked for me and I've tried many things. What often happens is that my PTSD is worsened by the antidepressant and other strange things happen. Obsessions get ridiculouly worse to the point of curling up on the couch in a blanket praying. Strange case, huh? Any information on drugs for these problems would help, too. I've tried all the SSRIs and Triclyclics and some others too like wellbutrin and more-even risperdal and zyprexa. I'm getting to the point of looking into shock treatments but with my luck I'd forget the past 10 years and who I am! Just kidding-those things scare me too much. I look forward to your informed reply.

<font color=orange>Do unto others as you would have them do unto you.</font color=orange>

[CamW]

CQ - I have not heard of Topamax™ (topiramate) being successfully used for anything, except as an augmenting agent for mood stabilizers in the treatment of bipolar disorder. It seems to help drugs like lithium, valproate (Depakene™), divalproex (Epival™ - CDN; Depakote™ - U.S.) carbamazepine (Tegretol™), and, in a few instances, lamotrigine (Lamictal™) work better.

This is, of course, aside from it's use as an augmenting agent (sometimes by itself) in epilepsy; and some cases as a weight loss agent (especially for Zyprexa™ - olanzapine - induced weight gain - but I find it is not as effective as the it's press states, in most instances). I have heard that it's clinical trials in the treatment of obesity have not been as successful as hoped. Still, about 20% of people who use it for Zyprexa-induced weight gain will lose some weight; but usually not all the weight they did gain from the Zyprexa. It is still much easier to keep the weight off when taking Zyprexa (through diligent diet control and exercise), than it is to try to get rid of the weight, once it has been gained. Weight gain with Zyprexa seems to palteau at about 8 monts. But I digress from our original topic.

I do believe that your doc is correct in saying that Topamax probably is not the right drug to use for unipolar depression, nor PTSD. I may be wrong in this, but I have not even seen any case reports where it has been tried in these conditions.

Perhaps some cognitive-behavioral therapy or some graded desensitiztion techniques may help you to deal with the PTSD and be able to help you live with your condition. I am definitely not an expert in these fields, and DocJohn may be able to add some insight.

Have you tried Effexor XR™ (venlafaxine) for the depression. It seems to be the "flavor-of-the-month" in depression therapy, and works in cases where other antidepressants don't. It has worked in my depression, where nothing else seemed to.

Augmentation of antidepressants with lithium does work in many cases of treatment-resistant unipolar depression. Therre is much literature to back this up. Sometimes the lithium side effects can be intolerable, though.

As a side note, sometimes PTSD and panic disorder are made worse in the initial 2 to 4 weeks of antidepressant therapy. I call these "start-up" side effects. If you can get through this initial month of "hell", the PTSD &/or panic symptoms do, in most cases, drop off sharply. The hard part is getting to this stage. The benzodiazepines like clonazepam (Rivotril™ - CDN; Klonopin™ - U.S.), or alprazolam (Xanax™) can sometimes ease the transition from start-up side effects to therapeutic effect. Usually the Xanax or Klonopin can be stopped once the antidepressant kicks in. Aside from Effexor XR, Paxil™ (paroxetine), with it's sedating antimuscarinic effects seem to be very effective in panic-like disorders (like PTSD). I always say that antidepressants should, if at all possible, be given a fair trial of at least 8 weeks; in depression with an obsessive component, trials should be at least 12, or better yet, 16 weeks; again, if possible. Remember, the worsening of panic-like and PTSD will probably increase for the first 2 to 4 weeks, but, in the long run, this can be a small price to pay.

Still, I do believe that psychotherapy is a must, along with meds, in most, if not all psychiatric disorders. Again, DocJohn can tell you which specific modality would probably be best in your situation.

Also, don't rule ECT out. It is the treatment of choice for depression in the old-old (>75 years) and in pregnant women. The memory loss is transient, and usually only affects memory around the time the procedure is done. ECT today is not of the "One Flew Over the Cuckoo's Nest" or "Snake Pit" variety. Hollywood has really ruined a great treatment by stigmatizing it.

Another new treament for depression involves seizure-inducing transmagnetic stimulation (sTMS). Where regular TMS is probably not going to live up to it's hype as an antidepressant treatment, sTMS may hold promise. I would let the researchers work the bugs out first. In principle sTMS should be able to focus directly on brain structures where scientists believe depression seems to be located (eg. probably the hypothalamus &/or pituitary), without affecting adjacent brain structures. The magnetic impulses of sTMS are not impeded by the skull, as ECT electrical currents are (the skull partially blocks and spreads out much of the electrical signal, thus affecting adjacent brain structures). The major problem with sTMS is getting enough magnetism to induce a seizure. This require the magnets to heat up far too much and burns the skin on the scalp. Once they overcome this problem, and run several successful clinical trials, this procedure may become a very viable treament for depression and bipolar disorder. Until then, let others be the guinea pigs (including rats and guinea pigs).

Sorry for the rambling. If there is anything that you would like me to clarify, I will be happy to try. Perhaps ask DocJohn for his opinions on this as well.

- Cam

[curlyq]

Cam, OK, I see what you mean about the use of Topamax in general.

I could not stop eating 24/7 on the Zyprexa. The doctor told me it does something to a part of the brain that tells you you are full or something like that. In other words it was telling me I'm hungry all the time. I could not tolerate that. With Topomax maybe, though. I know what you're saying about digency with the diet but I have never taken anything that had me eating like that. It took me over, honestly. I never thought anything like that could happen to me but it did bigtime.


I wonder if anyone will try Topamax for PTSD.

Cam, I've studied counseling many techniques myself while in college and cognitive behavioral helps for some problems but from my studies it is not advised as a sole treatement for extremely traumatic incidents and I believe that firmly. I also tried CBT and desensitization early on with disastrous results and that confirmed it for me. My illness with desensitization technique became much worse and I was in a constant state of terror and panic and grief. It took me a very long time to come down from it. Never again.

Yes I tried Effexor and the xr version, too, and long term for around a year. Honestly, with effexor and the ssris I never stopped having the panic and was on all of them for at least 6 mos. and some a few years. It was a nightmare on Elm Street. Effexor was one that wasn't the worst but still it gave me many effects of inducing ptsd worse-like being in a nightmare and with nightmares. The longer I was on Effexor the worse things got. I also had the effects of beign hot and then cold on and off throughout the years on it.

I'm a person who just does not tolerate these drugs well and I guess that's just how it is. My sensitivities are off the scale.

I do believe in therapy, though, not the CBT or behavioral type strictly. I use CBT in my life for some things and find it useful. But for the PTSD I prefer something more eclectic and with CBT as only a small component. For me, I really like humanistic therapy (Rogerian). For traumatic issues I believe that being empowered again and finding a good therapeutic relationship are the most important issues.

About the Lithium augmentation, that's very interesting and I will consider that, too.

Cam, I'm one of those who never got rid of the obsessions with the ssris, like I mentioned before. ( I have been diagnosed with severe chronic ptsd and acute ptsd at the same time. Plus I have other diagnosis ) I always had them as long as I was on the drug and for very long trials of at least 6 mos. and for years, too. I was given ativan but cannot be taking that for years on end. The ativan gave me memory problems and made me lethargic all the time, too.

I've gone through years of psychotherapy and got somewhat better in specific areas but am believing to think that this is as good as it gets with the PTSD. Parts of the PTSD and depression seem to be very resistent to everything and believe me I have tried very hard to get rid of it. I was told that I am an excellent client, too. I can accept that I may not get any better but still I have an appointment with a new psychiatrist coming up. I also am looking into the type of therapy that I feel I need and considering my prior experiences, needs and readings.

Cam, I'm sorry but I have dependents to look after and I could not risk the side effects of ECT and really was joking.

Cam, thanks for telling me about all of these options. No, I don't want to be a guinea pig with the sTMS and feel sorry for the real guinea pigs on that one.

Cam, thanks for all the input-I appreciate every bit of it. After thinking it over I might consider the topamax and zyprexa together but not sure on that one. I know diet and exercise are important but while eating all the time on Z , I had no time for exercise. It activated my eating obsession bigtime.

I may just read some self help books too on the subjects that are my issues. I'm a big believer in them. It's been hard for me to find a good long term therapist (I had one but he retired) but I am still looking. I haven't given up. I haven't given up on medicine totally but I may be a person who just cannot tolerate them. My liver is abnormal, too, so that may have a lot to do with it.

Thanks for your thoughtful suggestions. I'm going to mull it all over. I definitely am getting into therapy (mostly for support and empowerment) and plan on going back on my diet and exercise. I actually exercised one day this week! I have a powertrek I put to use and then I did exercises I've learned over the years right on the living room floor. It didn't cost me a thing and in the comfort of home. I'm going to get to it again today.

Thanks again, Cam, I enjoyed your "ramblings!"! CQ



<font color=orange>Do unto others as you would have them do unto you.</font color=orange>

[neverlnds]

Darkeyes, I hate topamax, depkote, risperdal, celexa et al. I have bipolar disorder, PTSD, anxiety attacks, and was getting fat from the lithium zoloft combo I was on now in addition I take dexampetimines. I am really not sure that they are the best thing for me mentally but emotionally weight gain was the last thing I needed. All the heavier drugs did was take away all my emotions and good looks lol. Hope this could help you. If not just go cop some ritalin from the kiddies down the road. Just kidding really.

[bptoo]

All

Just wanted to toss my $1.98 in on the Topamax. I was given it by my Psych for two reasons, the Neurontin was giving me extreme fatigue as a mood stabilizer and I was gaining severe weight on the Zypreza. It's been an excellent answer to both. I experienced some pretty heavy duty cognitive dulling with the Top early on, to the point where I thought about giving it up. My profession requires me to be reasonably "on the ball". But it worked so well on my mood and helped with weight loss (about 30 pounds so far), I decided to stick it out. With the weight, I should add that I also started watching my diet a lot more closely and started getting more exercise, so I'm sure it wasn't the Top on it's own. But it did help. I'm glad I stuck it out. The cognitive dulling is gone (shut up Cam) and my thinking is cleared up and has returned to normal (now THERE'S a scary thought...). Topamax is like most meds, it's not for everyone, but it's worked really well for me. I'd be glad to answer any questions anyone has about it.

I hope everyone is well!

bptoo

[darkeyes]

I wish I could, all joking aside! In the past I found phenteramine (diet pills) to be the best for me, I had normal sleep - wake cycles, more energy(have none now!), better cognitive functioning (focused better and completed things I started, grades in college were A's & B's) these are factors that make me believe I am more ADD than bipolar but the docs are afraid to see fearing that a CNS might trigger a manic episode, but I tell them I never really did in the past that was typical, serious or violent. Like I do not think it is "mental" to go out shopping at the mall and staying within your means, people that do more than that aren't being called bipolar! Oh, I better stop rambling, I'm sure you get the picture! Good to hear from you
"darkeyes"