Her I go again, CamW . . .

Cam sorry to bombard you with my med. question(s) but till I see the doc 2//26/02, can you tell me if there is truth to some of the stuff I have read that says that sometimes if people on lithium switch to something else that in the future if they go back on lithium that the lithium may no longer be effective like previous? I have also heard that about some SSRI's, is this really true? You see after hearing bptoo's great outcome with the topamax and the weight issue I've been thinking of going back to my original interest in trying the topamax or even letting the doc try to let me wean off all this crap and live like I did way before the husband's affair which is responsible for me being put on meds. after my "freaking out" over that incident which I think any "normal" spouse would do, right? I just want to be my old "physical and mental" self again. Sorry to get carried away but I am tired of being on medications especially when I never was before and was fine. If you are not too busy drop a line, no not "line" ha!ha!. P.S. the online prescrip.med. sites that sell various meds online and do not ask for prescriptions are they "real"?? Probably not right? It would be too good to be true if people could get prescrip.diet pills without a doctor's script. some even show a questionairre for you to fill out and their "online" doc. then okays the purchase, is this possible? Sorry to chew your ear off, but thanks for listening.
"darkeyes"

Darkeyes be careful with the diet pills and be honest about what medications you are on if you see a Dr for them. My shrink and I were discussing it and he said that being on SRI's and diet pills like Meridia can cause stroke. He told me that I would look "real attractive" with drool coming down my chin. So careful please none of us look good drooling. Take Care Neverlands

Darkeyes - Now you know that I don't mind answering questions, especially for someone as nice as you .

I have a slightly different take on the refractoriness of lithium after stopping and restarting. The latest studies show that there is decrease in efficacy when one returns to lithium after stopping, in most cases. I'll try to explain why some people do not respond to lithium after stopping it.

I believe that one's response to lithium may be predicted by the onset of the bipolar disorder, the type of bipolar disorder one has, and the number of manic episodes one has experienced. A positive response to lithium can be correlated with an early onset (<25 years old), classic Type I bipolar disorder (full blown manic episodes, followed by depressive episodes), and fewer than 7 to 10 lifetime episodes.

I believe that many of the studies that reported refractoriness to lithium upon rechallenge may be explained in terms of the number of previous manic episodes the study participants had experienced. First, most of these studies used retrospective chart reviews of hospital records. The results of retrospective studies need to be understood within the limitations of such studies. Patterns that arise in such studies (eg. a number of patients did not respond to lithium upon rechallenge) can do so without there being clear causes and effects being evident (or controlled for).

A more likely explanation for the refractoriness to lithium upon rechallenge, which may not have been evident in all of the hospital records, is the exact number of previous manic episodes one has experienced. It is a well-studied fact that "kindling" more than likely occurs in bipolar disorder (and probably also occurs in unipolar depression); every manic episode kindles the next. This means that, with every episode experienced by an person with bipolar disorder, subsequent episodes will occur progressively closer together, be more severe, and last longer. In the days before mood stabilizing medication, some people would have episodes (both manic and depressive) lasting years, and causing total debilitation.

Mood stabilizing medication (lithium, valproate, carbamazepine, lamotrigine, topiramate, etc.) interferes with the kindling, and lengthens the time period between episodes. This decreases the total number of lifetime episodes one experiences, thus decreasing the potential for the eventual increased severity of the bipolar disorder.

Yeah, yeah, now I will answer the question .

People who have had more than 10 manic episodes do not seem to respond to lithium as well as those who have had fewer episodes. The studies that showed subsequent lithium refractoriness upon rechallenge were obviously done in acutely sick individuals (ie. they were hospitalized), who also had had bipolar disorder for a fairly long time. Hospital charts may not accurately reflect the number of episodes one has had. For instance, many people who are eventually diagnosed with bipolar disorder experience 2 or 3 (or more) manic or hypomanic episodes before they are formally diagnosed.

Not taken into account by most of these retrospective studies was the total number of episodes each participant had experienced, and more importantly, the number of episodes suffered between stopping the lithium and restarting it again. It is likely that many of the participants in these studies had become refractory to the lithium while taking it the previous time (or why did they quit taking it) and it is reasonable to assume that they had one or more episodes of mania before retrying the lithium, pushing them past that 7 to 10 lifetime episodes range. This could have resulted in them being more refractory to the effects of lithium in the current trial of the drug, than they had in the past.

Although I do not know the full story of your "freak-out" (eg. symptoms, extenuating circumstances, etc.), I would think that any amount of freaking-out is justifiable when finding out about spousal infidelity (but that is only in my opinion). As you know, cheating within a monogamous relationship is not something that I back, as a rule. I am surprized that your husband still has intact testicles.

Topamax™ (topiramate) is usually used only as an "add-on" (ie. adjunctive) mood stabilizer. It's use as a monotherapy is being debated. It is far more effective when used with lithium, valproate, or one of the so-called atypical antipsychotics. My suggestion would be to try adding it to the lithium, first. Ask your doc about this. You still have the potential of losing weight with the litium/Topamax combination.

Something that I am totally against is self-medication for psychiatric conditions (even by, or especially by, pharmacists and psychiatrists). There is no way that one can objectively assess (in a clinical manner) one's own change in mood &/or cognitive states. Self-medication can be, at least, very dangerous and, at most, crippling or deadly (even when you think you know what you are doing).

Yes, there are pharmacies in Europe and South America that will send you medication without a prescription. However, I have not heard of any that will send prescription diet pills (or other controlled drugs, or narcotics). Also, the FDA in your country (and Health Canada, in mine) have cracked down on this practice. They will (may) seize your medication at the border (especially meds like diet pills). I know that if you import medications into Canada, you better have a doctor's order (ie. prescription) for them, or Customs will not let you have them. They will also enter your name into a computer and anything that you import will be automatically flagged, resulting in every one of your packages being opened. Not that this would bother me; it is just that it slows down getting the order by a day or two.

I hope that this is of some help.
Lovingly yours - Cam


<font color=orange>"Sometimes you may be shown the light in the strangest of places, if you look at it right"
- Robert Hunter</font color=orange>

I mean "here" I go again, thnaks for getting back to me!! You know I am in such a quandry, right? I am at a point which I just told my husband, is that I really do not know what is right for me any longer, which really sucks if you know what I really mean. I HATE feeling like this, cause what I know what really would help me is not what a doctor will really help me with. So it is really hard to FEEL good when NO ONE will really help you with meds. if you know what I mean. But thanks anyway
"darkeyes"

I know what you mean, Darkeyes. It does come down to having an objective outlook on treatment. I believe that your doc is thinking that stimulants like diet pills will just give you a short term gain, but result in long term pain.

Sorry, but I believe that is what he is thinking. - Cam

<font color=orange>"Sometimes you may be shown the light in the strangest of places, if you look at it right"
- Robert Hunter</font color=orange>

Cam, Pardon me if I came across as being "*****y" yesterday, you are 100% right about what you said about the doc and the meds. I guess I was having one of those "***** on wheels" day, sorry. When I was a little girl and I'd get cranky my mom use to sometimes call me "a ***** on wheels". I always thought that was kind of funny, cause you know how kids are "literal" so I thought it was something with wheels. She's not your "storybook" mom. Cam thanks so much for all that you do for me and the others here.
"darkeyes"

Darkeyes - You didn't come across as *****y, at all. I doubt that you ever have typed in a "*****y" manner or style [lol]. I really think that your doc was trained in between 1975 and 1990. Not is only more likely from a statisical point of view, but I find this group of psychiatrists were being taught that you had to be suspicious of ulterior motives. They (and I) were taught "every means something". I worked with a lot of these guys, and they all have this undercurrent of suspiciousness. I think that you should collect as much information as to why you think you need a stimulant added to your med regime. (eg. need more energy, never feel like doing anything, etc.).

There is a newer drug called modafinil (Alertec™ - CDN; Provigil™ - U.S.). It is a CNS stimulant used for narcolepsy by increasing "sub-normal levels of alertness." The manufacturer does say that there is no evidence that the drug does not heighten normal levels of alertness. They also say it should not be used in "normal fatigue states" until more testing is done in that area. This drug is new and I have heard mixed reviews about it. When used in people with anergic (low energy) depression, it did help many subjects, but a lot of those patients said that the drug caused, "modafinil increased self-estimate of performance which is not commensurate with actual changes in performance", or basically, "modafinil caused over-confidence leading to an increase mistakes". I have also heard that it has a lower potential to cause addiction than dexedrine or ritialin. Your doc may be open to this suggestion.

Good luck - Cam

<font color=orange>"Sometimes you may be shown the light in the strangest of places, if you look at it right"
- Robert Hunter</font color=orange>

Cam, How's it going? You know when our 11:00 news showed this new drug I thought instantly about it with my complaints, they claimed they were still able to sleep at night but yet were more alert during the day hours, and I thought this may be my answer!! Well Tues. I see him and have collected on paper questions, I just hope that after the "15" minute interval that you get allotted I'll get some relief, who knows, I am totally disgusted with it all, I may even start to look for a new doctor that has not been furnished with the info my original doctor and therapist have furnished this guy with, I think when they hear you have a brother that is bipolar they start "typing" you with the same thing, kind of unfair in a way Oh well sorry that I am rambling again. Thanks again
"darkeyes"