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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phidippus on February 11, 2010, at 13:51:27
I am in the dumps. I just switched from Geodon to Zyprexa and added Prozac. I am bipolar and want to know if Prozac will help me out of this depression. Are SSRIs efficacious in treating Bipolar depression?
Here's my cocktail: Keppra 2000 mg, Lithium 1200 mg, Memantine 10 mg, Prozac 20 mg, Zyprexa 10 mg.
IF any of you have suggestions I'd appreciate it.
Posted by JayBTV2 on February 11, 2010, at 17:21:39
In reply to What do I do about my mood?, posted by Phidippus on February 11, 2010, at 13:51:27
> I am in the dumps. I just switched from Geodon to Zyprexa and added Prozac. I am bipolar and want to know if Prozac will help me out of this depression. Are SSRIs efficacious in treating Bipolar depression?
>
> Here's my cocktail: Keppra 2000 mg, Lithium 1200 mg, Memantine 10 mg, Prozac 20 mg, Zyprexa 10 mg.
>
> IF any of you have suggestions I'd appreciate it.Have you tried Lamictal? That's worked well for depression for me and I'm Bipolar 1. I wasn't particularly motivated though so after 2 years (and a few recent hospitalizations) I'm trying Parnate (MAOi) w/ Lamictal and Lithium since I've tried most everything else.
BTW I saw your post below this regarding opiates for OCD. While to me that's _very_ off label if you do start taking opiates you'll probably find a quick lift from depression.
But there's addiction/withdrawl issues there so I don't think that's the best course of action....
Good luck!
Posted by bleauberry on February 11, 2010, at 18:28:07
In reply to What do I do about my mood?, posted by Phidippus on February 11, 2010, at 13:51:27
I'm very sorry you are in the dumps. Been there so many times I lost count. Hang on, it does get better.
Keep in mind, switching from any med to another, even when the old med was not helping at all, will often unbalance things and cause bad feelings. The brain is basically in a state of confusion not knowing what to do for a few days to a couple weeks.
Prozac and zyprexa combo is a good one and I am surprised it is not employed more often. It is well researched for your needs, including bipolor and treatment resistant depression.
SSRIs can sometimes be used as monotherapy for bipolar depression, with destabilization avoided by starting at very low doses and increasing very slowly. Zyprexa onboard helps a ton.
Since we are all so different, and I don't know your symptoms or history at all, my following comments are in generalized terms. These are macro-views based on clusters of observations, but not focusing on individual differences.
First, Lithium might be way too high. That kind of dose is likely to be very dulling and depressing. It would be a reasonable dose as monotherapy to control mania. But with depression, that's a different story. I would think a dose in the 300mg to 600mg range would feel better.
Keppra I do not know enough to comment on. I would just take a moment to reassess why you are taking it and ask yourself what it is doing. If it isn't doing you a lot of good, you kind of have to question why stay with it. Be suspicious of anything that is not providing significant benefits.
Memantine, my guess is it is probably hurting more than helping. It is anecdotally good for preventing stimulant tolerance, and is used for treating senile senior citizens. I don't see any use for it in most people. The ones that have tried it here got either neutral or negative reactions from it. Comments from it making people feel worse rather than better were fairly common. The couple good ones were taking it with stimulants. Again, you have to ask yourself, is this med doing a lot of good? If not, you have to wonder if it is instead contributing to making you feel worse than you would be without it. Gotta be suspicious.
Prozac 20mg is a good common dose. It can go much higher, but give it 3 months before doing that. Generally when prozac starts to change how you feel is within the 2 to 3 week range. Most people feel some stimulation from it almost immediately, but the lithium and memantine are likely blunting that completely.
Zyprexa 10mg I think is too high. I would have been more comfortable at 5mg.
I was on Prozac 20mg and Zyprexa 5mg for almost 8 years and it worked pretty well. It was probably about 3 weeks before it was doing something I could feel, and about 2 to 3 months where I realized I had come a long way and was doing pretty good.
You are in the middle of a transition, and that is always hard. During this time, you should be able to see how well the other meds are helping or not. I mean, to feel down in the dumps doesn't speak very well of lithium or memantine doing much good for you. If they were providing antidepressant oomph, they should have buffered the blow. But they didn't. Kind of makes me wonder.
Give the prozac and zyprexa some time. Scrutenize the other meds with a sense of suspicion to determine whether they are keepers or not, and to determine if doses need to be adjusted downward.
> I am in the dumps. I just switched from Geodon to Zyprexa and added Prozac. I am bipolar and want to know if Prozac will help me out of this depression. Are SSRIs efficacious in treating Bipolar depression?
>
> Here's my cocktail: Keppra 2000 mg, Lithium 1200 mg, Memantine 10 mg, Prozac 20 mg, Zyprexa 10 mg.
>
> IF any of you have suggestions I'd appreciate it.
Posted by Zyprexa on February 11, 2010, at 19:02:17
In reply to What do I do about my mood?, posted by Phidippus on February 11, 2010, at 13:51:27
Are you taking generic prozac? I think there was a very big difference from the brand. I think I tried both and had bad results with generic. I decided to quit the prozac and years later took celexa with realy good results. Now I'm on generic zoloft with slightly better results. I've been taking zyprexa all this time. Zyprexa has been the best med I ever took.
Posted by Phillipa on February 11, 2010, at 19:25:52
In reply to Re: What do I do about my mood?, posted by Zyprexa on February 11, 2010, at 19:02:17
Since lithium is your mood stabalizer will you be having regular blood checks of levels? So assuming your're in a depressive state right now? Phillipa
Posted by g_g_g_unit on February 13, 2010, at 3:53:16
In reply to What do I do about my mood?, posted by Phidippus on February 11, 2010, at 13:51:27
> Here's my cocktail: Keppra 2000 mg, Lithium 1200 mg, Memantine 10 mg, Prozac 20 mg, Zyprexa 10 mg.
>sorry, i don't have any advice per se (i've just started Prozac myself, and am having mixed results, but it's only been two weeks), but was curious about the addition of Memantine to your regime . .
is that in order to prevent tolerance to the opiates you were planning on using? or does it have any independent benefits? i ask because once i stabilize on prozac (hopefully) my pdoc was planning on adding in a lowish dose (10mg or so .. 20mg felt too high) in order to potentially offset some SRI sfx (brain fog, etc.)
Posted by morganator on February 14, 2010, at 3:01:09
In reply to Re: What do I do about my mood?, posted by Zyprexa on February 11, 2010, at 19:02:17
Sorry this is off topic..Zyprexa, I would consider to switch to brand Zoloft if you can afford to. I found it to be much more effective and my stomach was upset much of the time on generic.
Posted by Phillipa on February 14, 2010, at 18:41:35
In reply to Re: What do I do about my mood?, posted by morganator on February 14, 2010, at 3:01:09
What is it with all these generics. Now I'm wondering if the reason luvox worked first was that it still came in brand name now generic. Phillipa
Posted by Phidippus on February 15, 2010, at 16:26:58
In reply to Re: What do I do about my mood?, posted by bleauberry on February 11, 2010, at 18:28:07
I am starting to feel much better on the Zyprexa than I did on the Geodon.
> Prozac and zyprexa combo is a good one and I am surprised it is not employed more often. It is well researched for your needs, including bipolor and treatment resistant depression.
I'm treating ADHD/OCD/BIPOLAR II
> SSRIs can sometimes be used as monotherapy for bipolar depression, with destabilization avoided by starting at very low doses and increasing very slowly. Zyprexa onboard helps a ton.
The Prozac is onboard to treat OCD primarily.
> First, Lithium might be way too high.
I found that at lower doses my mood was way too labile.
> Keppra I do not know enough to comment on. I would just take a moment to reassess why you are taking it and ask yourself what it is doing.Keppra I take for chronic daily headaches which it treats very well. It also helps with anxiety.
> Memantine, my guess is it is probably hurting more than helping.
I take the Memantine as augmentation for treating OCD. It seems to reduce some of the intrusive thoughts.
P
Posted by Phidippus on February 15, 2010, at 16:30:09
In reply to Re: What do I do about my mood? » Phidippus, posted by g_g_g_unit on February 13, 2010, at 3:53:16
>but was curious about the addition of Memantine to your regime . .
Memantine is onboard to help treat my OCD.
> is that in order to prevent tolerance to the opiates you were planning on using?
I did not know Memantine was used to prevent tolerance to opiates.
>or does it have any independent benefits?
It used to treat mood and in my case OCD.
P
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