Question:

I am going through the same thing with my pills, weight gain bothers me so much that im willing to risk my stability for it.  Although Im on a different med than your husband im having the same problem.  I switched to a similar drug without the weight gain side effects,  The weight gain problem is gone but Im not functioning well at all. Kisha

Response:

Hi Francine, i’ve been on lithium and effexor for 6 months now and i’ve gained 40 + lbs. i keep telling my dr. that i want to get on something else cause i have grown out of all my clothes ad i eel more depressed than ever. she put me on topamaxx which has the opposite effect as far as hunger goes. i didn’t do well on it but that is not to say that others wouldn’t do better. it is relatively new and it might be worth  try.

Unfortunately, many people complain of weight gain while taking psychoactive drugs. I have included a post I had authored on this topic. I hope it is helpful. Please email me anytime. Peace, Lynda Prudent Eating Plan for Improved Well-Being By Lynda F. Cunningham, MSN, MA, A&GNP-C, CNS, RNC Adult and Geriatric Nurse Practitioner Clinical Nurse Specialist Exercise Physiologist Eliminate or cut down on refined carbohydrates (sugar, candy, cakes, cookies). Eat complex carbohydrates found in vegetables, beans and grains,and fruits…55% of diet calories should include complex carbohydrates which are high in fiber. Protein intake: Limit protein to less than 15% of your total calories ( 50 grams for females -60 grams for males daily). Limit the intake of red meat. Remove skin from poultry before cooking. Avoid frying. Substitute: baking, broiling, boiling, or microwaving. Too much protein can: Overwork the kidneys (nitrogenous wastes). Interfere with the absorption of certain minerals such as calcium and may cause the excretion of certain mineral in the urine. Saturated fats (fried foods, lard, butter, etc.) bacon, snacks like potato chips…pretzels are fine as are peanuts but be careful of the amount you eat because they can be fattening) Saturated fats contribute to obesity, atherosclerosis, angina, some types of cancer (colon), diabetes from an overworked pancreas, and fatigue. Eat polyunsaturated and monosaturated fats…limit intake to 30% or less of total calories. These are found in plants and fish. Omega-3 fatty acids may help lower blood cholesterol levels and prevent heart attacks. They are now being used to treat Bipolar Illness. Linoleic acid (a polyunsaturated fatty acid) is an essential fatty acid that must be gotten from foods. It is found in vegetable oils, raw nuts, seeds, legumes, and in unsaturatedvegetable oils, such a borage oil, grape seed oil, primrose oil, sesame oil, and soybean oil.. It is important for growth and development as well as the production of hormone like substances  (prostaglandins) that act as chemical messengers and regulators of various body processes. Omega 3 fatty acids (alpha-linoleic and eicosapentaenoic(EPA) are found in freshwater fish, fish oil, canola oil, walnut oil, and flaxseed oil. Consume these oils in pure liquid form or supplement form. Do NOT subject them to heat, either in processing or cooking as heat destroys essential fatty acids. If oils are hydrogenated (processed to make an oil more solid as in margarine) the linoleic acid is converted into trans-fatty acids which are not beneficial to the body. Eat 6 small meals daily instead of 3 large ones. This will keep your blood glucose steady instead of the peaks and valleys that can occur with eating only 3 times a day Limit caffeine intake including coffee, non herbal teas, sodas. CONSULT with your physician before taking any: Vitamin Supplements Homeopathic Preparations Herbal Supplements Amino Acids Suggested supplements after checking with your Physician, Nurse Practitioner, or Physician Assistant: Take a mutivitamin and mineral supplement as well as a B complex vitamin (50-100 mg) daily Extra vitamin C…1000-5000 mg depending on your nicotine intake. If you smoke each cigarette destroys anywhere from 25-75 mg of vitamin C Flaxseed oil…10 grams daily (it has to be refrigerated) do not use the capsules Calcium 1200-1500 mg/day Magnesium 600-750 mg/day Selenium 50-100 mcg/day VitaminE 400-800 IU/day Zinc 50 mg/day Exercise daily for at least 30 minutes. Start low and go slow!!! Aerobic exercises include non stop activities such as: Walking briskly Treadmill Walking Cycling Jogging Stairmaster Elliptical Cross Trainer Swimming Laps Water Aerobics Water Jogging Aerobic Dancing Step Aerobics Low Impact Aerobics Box Aerobics Funk/Jam Aerobics For weight loss, exercise 5 days a week at 60-85% of maximum heart rate-MHR ( 220-your age=MHR, then multiply by 60% and 85% . That is your target heart rate range(THR). Exercise for a minmum of 30 minutes as fat catabolism begins at 20 minutes into exercise. Aim for 45 minutes. If you go above your target heart range you are working anerobically and thus are burning carbohydrates not fat. Any excess carbohydrates or protein will be converted to fat. *****Fat is burned in the mitochondria of the muscles. So the more muscle mass you have, the more efficient you are at burning fat.**** Therfore add weight training to your program at least 2 times a week, preferably 3 times a week. {Copyright 1999: All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means , electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner} References: Food and Nutrition edited by John Feltman (1993) Griffin’s 5 Minute Clinical Consult by Mark R. Dambro M.D., FAAFP (1997) Nutrition in Clinical Nursing by Idamarie LaQuatra, Ph.D., R.D. and Mary Jo Gerlach, R.N., M.S.N.Ed. (1990) Pathophysiology: The Biologic Basis for Disease in Adults and Children, by Kathryn L. McCance R.N., Ph.D and Sue E. Huether, R,N., Ph.D (1994) Prescription for Nutrition and Healing by James L. Balch, M.D. and Phyllis Balch, C.N.C.<Certified Nutrion Consultant (1997) Understanding Normal and Clinical Nutrition by Eleanor Noss Whitney, Ph.D, R.D., Corinne Balog Cataldo, M.M.Sc.,R.D, L.D., C.N.S.D.and Sharon Rady Rolfes, M.S., R.D (1991) The Washington Manual of Medical Therapeutics, Editors: Charles F. Carey, M.D., Keith F. Woeltje, M.D., Ph.D., Hans H.Lee, M.D., Robyn A. Schaiff, Pharm.D (1998)

Response:

i’ve been on lithium and effexor for 6 months now and i’ve gained 40 + lbs. i keep telling my dr. that i want to get on something else cause i have grown out of all my clothes ad i eel more depressed than ever. she put me on topamaxx which has the opposite effect as far as hunger goes. i didn’t do well on it but that is not to say that others wouldn’t do better. it is relatively new and it might be worth  try.

Response:

Hi marie, My husband  has more than rapid cycling BP.  He is on Lithium and Paxil but has gained 30 pounds in 2 months.  (this only bothers him) He also has a rash that was worse on Prozac. He is not taking his meds regularly due to these side effects and has 1-2 great mood days ands 1-2 depressed days then 1-2 manic days. any ideas?

Prozac and Paxil can cause a rash and itchiness. Weight gain is common on Lithium for some people. It sounds like he does have RC…perhaps a discussion with his pdoc ,of other med options, such as Lamictal, may be helpful. I have included info on Lamictal for you all to read. Peace, Lynda This is an example of the info that can be quickly and easily accessed from Dr. Goldberg’s site. LAMICTAL: B.W. Inc.Lamotrigine Antiepileptic Pharmacology: Lamotrigine is a drug of the phenyltriazine class chemically unrelated to existing antiepileptic drugs (AEDs). Lamotrigine is thought to act at voltage-sensitive sodium channels to stabilize neuronal membranes and inhibit the release of excitatory amino acid neurotransmitters (e.g. glutamate, aspartate) that are thought to play a role in the generation and spread of epileptic seizures. Clinical Trials: In placebo-controlled clinical studies, lamotrigine has been shown to be effective in reducing seizure frequency and the number of days with seizures when added to existing antiepileptic drug therapy in adult patients with partial seizures, with or without generalized tonic-clonic seizures, that are not satisfactorily controlled. Pharmacokinetics: Adults: Lamotrigine is rapidly and completely absorbed following oral administration, reaching peak  plasma concentrations 1.4 to 4.8 hours (Tmax) post-dosing. When administered with food, the rate of absorption is slightly  reduced, but the extent remains unchanged. Following single lamotrigine doses of 50 to 400 mg, peak plasma concentration  (Cmax=0.6-4.6ug/mL) and the area under the plasma concentration-versus-time curve(AUC=29.9-211 hug/mL) increase linearly with dose. The time-to-peak concentration, eliminatio half-life (t1/2) and volume of distribution (Vd/F) are independent of dose. The t1/2 averages 33 hours after single dose and Vd/F ranges from 0.9 to 1.4 L/kg. Following repeated dosing of healthy volunteers for 14 days, the t1/2 decreased by an average of 26% (mean steady state t1/2 of 26.4 hours) and plasma clearance increased by an average of 33%. In a single-dose study where healthy volunteers were administered both oral and i.v. doses of lamotrigine, the absolute bioavailability of oral lamotrigine was 98%. Lamotrigine is approximately 55% bound to human plasma proteins. This binding is unaffected by therapeutic concentrations  of phenytoin, phenobarbital or valproic acid. Lamotrigine does not displace other antiepileptic drugs (carbamazepine, phenytoin, phenobarbital) from protein binding sites. Lamotrigine is metabolized predominantly in the liver by glucuronic acid conjugation. The major metabolite is an inactive  2-N-glucuronide conjugate that can be hydrolyzed by b-glucuronidase. Approximately 70% of an oral lamotrigine dose is recovered in urine as this metabolite. Geriatrics: The pharmacokinetics of lamotrigine in 12 healthy elderly volunteers (65 years) who each received a single oral  dose of lamotrigine (150 mg) were not different from those in healthy young volunteers. (However, see Precautions, Geriatrics  and Dosage.) Renal Impairment: The pharmacokinetics of a single oral dose of lamotrigine (100 mg) were evaluated in 12 individuals with chronic renal failure (with mean creatinine clearance of 13 mL/min) who were not receiving other antiepileptic drugs. In  this study, the elimination half-life of unchanged lamotrigine was prolonged (by an average of 63%) relative to individuals with normal renal function (see Precautions, Renal Failure and Dosage.) Hemodialysis: In 6 hemodialysis patients, the elimination half-life of unchanged lamotrigine was doubled off dialysis, and reduced by 50% on dialysis, relative to individuals with normal renal function. Hepatic Impairment: The pharmacokinetics of lamotrigine in patients with impaired liver function has not been evaluated. Gilbert’s Syndrome: Gilbert’s syndrome (idiopathic unconjugated hyperbilirubinemia) does not appear to affect the  pharmacokinetic profile of lamotrigine. Concomitant Antiepileptic Drugs: In patients with epilepsy, concomitant administration of lamotrigine with enzyme-inducing AEDs (phenytoin, carbamazepine, primidone or phenobarbital) decreases the mean lamotrigine t1/2 to 13 hours. Concomitant administration of lamotrigine with valproic acid significantly increases t1/2 and decreases the clearance of lamotrigine, whereas concomitant administration of lamotrigine with valproic acid plus enzyme-inducing AEDs can prolong t1/2 up to approximately 27 hours. Acetaminophen was shown to slightly decrease the t1/2 and increase the clearance of lamotrigine. The key lamotrigine parameters for adult patients and healthy volunteers are summarized in Table I.  Indications: As adjunctive therapy for the management of patients with epilepsy who are not satisfactorily controlled by conventional therapy. There is limited information on the use of lamotrigine in monotherapy at this time. Contraindications: Patients with known hypersensitivity to lamotrigine or to any components of the formulation.  Warnings: Serious dermatologic events have been reported infrequently in patients receiving lamotrigine. Such events were  more likely to occur during the first 6 weeks of therapy. More rapid initial titration dosing and use of concomitant valproic  acid were associated with a higher incidence of serious dermatologic events (see Precautions, Skin-Related Events, Table II  and Table III; see also Dosage). These events have included Stevens-Johnson syndrome, toxic epidermal necrolysis,  angioedema, and hypersensitivitysyndrome (which usually consisted of fever, rash, facial swelling and other systemic involvement, e.g. hematologic, hepatic and/or lymphatic). Hepatic injury, as part of a hypersensitivity syndrome, may have been the initiating event in one reported death. It is recommended that the physician closely monitor (including hepatic, renal and clotting parameters) patients who acutely develop any combination of unexplained rash, fever, flu-like symptoms or worsening of seizure control, especially within the first month of starting treatment. Patients who develop a rash should be promptly evaluated. Lamotrigine should be discontinued in all patients with a medically serious rash. Although many patients who developed a skin rash in clinical trials continued to receive lamotrigine without consequences, the initial presentation of a rash is not always indicative of its eventual seriousness. The potential medical benefits of continued therapy with lamotrigine must be weighed against the increased risk of serious rash in patients who have already developed a rash. Precautions: Drug Discontinuation: Abrupt discontinuation of any antiepileptic drug (AED) in a responsive patient with epilepsy may provoke rebound seizures. In general, withdrawal of an AED should be gradual to minimize this risk. Unless safety concerns require a more rapid withdrawal, the dose of lamotrigine should be tapered over a period of at least 2 weeks  (see Dosage). Occupational Hazards: Patients with uncontrolled epilepsy should not drive or handle potentially dangerous machinery. During clinical trials common adverse effects included dizziness, ataxia, drowsiness, diplopia and blurred vision. Patients  should be advised to refrain from activities requiring mental alertness or physical coordination until they are sure that  lamotrigine does not affect them adversely. Skin-Related Events: In controlled studies of adjunctive lamotrigine therapy, the incidence of rash (usually maculopapular  and/or erythematous) in patients receiving lamotrigine was 10% compared with 5% in placebo patients. The rash usually occurred within the first 6 weeks of therapy and resolved during continued administration of lamotrigine. Lamotrigine was  discontinued because of rash in 1.1% of patients in controlled studies and 3.8% of all patients in all studies. The rate of  rash-relatedwithdrawal in clinical studies was higher with more rapid initial titration dosing, and in patients receiving concomitant valproic acid (VPA), particularly in the absence of enzyme-inducing AEDs (see Table II and Table III; see also  Warnings and Dosage). Increased incidence of rash-related withdrawal was seen when initial doses were higher and titration more rapid than recommended under Dosage. Drug Interactions: Antiepileptic Drugs (AEDs): Lamotrigine does not affect the plasma concentrations of concomitantly administered enzyme-inducing AEDs. Antiepileptic drugs that induce hepatic drug-metabolizing enzymes (phenytoin, carbamazepine, phenobarbital, primidone) increase the plasma clearance and reduce the elimination half-life of lamotrigine  (see Pharmacology). Valproic acid reduces the plasma clearance and prolongs the elimination half-life of lamotrigine (see Pharmacology). When lamotrigine was administered to 18 healthy volunteers already receiving valproic acid, a modest decrease (25% on average) in the trough steady-state valproic acid plasma concentrations was observed over a 3-week period, followed by stabilization. However, the addition of lamotrigine did not affect the plasma concentration of valproic acid in patients receiving enzyme-inducing AEDs in combination with valproic acid (see Precautions, Skin-Related Events). Oral Contraceptives: In a study of 12 female volunteers, lamotrigine did not affect plasma concentrations of ethinyl estradiol  and levonorgestrel following administration of the oral contraceptive pill. However, as with … read more »

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 have any women on this list had any side effects relating to their menstrual cycles with any of the mood stabilizers?  

Response:

Hi,  have any women on this list had any side effects relating to their menstrual cycles with any of the mood stabilizers?  

Try: Relationship between BP and hormones: http://www.onhealth.com/ch1/columnist/item,46699.asp Peace, Lynda

Response:

My husband  has more than rapid cycling BP.  He is on Lithium and Paxil but has gained 30 pounds in 2 months.  (this only bothers him) He also has a rash that was worse on Prozac. He is not taking his meds regularly due to these side effects and has 1-2 great mood days ands 1-2 depressed days then 1-2 manic days. any ideas?

– Hide quoted text — Show quoted text – All medications have side effects. Some are harmless while others can cause havoc with one’s liver, kidneys or thyroid gland as well as affect blood sugar. Since medications are a necessary fact of life for people with BP illness, it is up to us and our pdocs to determine which ones are deleterious and which can be managed so the effects are minimized…

Response:

All medications have side effects. Some are harmless while others can cause havoc with one’s liver, kidneys or thyroid gland as well as affect blood sugar. Since medications are a necessary fact of life for people with BP illness, it is up to us and our pdocs to determine which ones are deleterious and which can be managed so the effects are minimized. Your pharmacist is a resource with whom to consult when you are unsure about interactions with other medications, including nonprescription drugs, herbs, vitamins, mineral, and homeopathic remedies. It is also important to let your medical doctor know all the medications you are taking…especially if you are being treated for other comorbid conditions (i.e. hypertension, diabetes). Some drugs should be taken on an empty stomach, while others require food. Many drugs should be taken at set intervals throughout the day (Neurontin every 6 hours) to insure adequate blood levels. Monitoring of drug blood levels for Lithium, Depakote and Tegertol are essential in insuring that a therapeutic level is achieved and maintained. Baseline blood tests done before initiation of treatment include: 1. CBC (complete blood count) 2. Thyroid tests (specifically a TSH level) as well as T3 and T4 3. Renal tests 4. Hormone panel for females 5. Electrolyte, blood lipids (fasting), and glucose (fasting) tests Blood pressure, heart rate, and a baseline EKG are also necessary components of a physical exam before treatment is started. Monitoring of blood levels, renal function and thyroid should be done every 6 months while on Lithium. Depakote and Tegretol levels should be monitored every 6 months. When a dose is changed ,then the level needs to be checked the first week and then in 3 months to insure that a therapeutic level is achieved. The newer medications used as Mood Stabilizers (MS) are Neurontin, Topomax, and Lamictal. At present, no therapeutic levels for BP illness have been established. It appears that polytherapy (combination drug therapy) is more successful in treating refractory or resistant BP illness as well as rapid cycling conditions. Peace, Lynda

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Question:

Thyroid function. Definitely thyroid function. Thyroid problems can induce depression-like symptoms, so you want your doctor to rule them out. The cyclical nature of your depressive episodes also suggests that you might suffer from seasonal affective disorder (known, appropriately enough, as SAD). It’s associated with the amount of sunlight to which you are exposed during the turn of the seasons. In the Northern Hemisphere a lot of us get it when the winter comes and the days become so short and dark. It can also be triggered, for some people, by exposure to too much sun during the long summer days. But at the moment medical science doesn’t seem to have any tests that allow a doctor to prescribe *the* drug for you. Unfortunately it is, in the words of one psychiatrist, "a crap shoot" whether you will hit the medication that works in your body. Good luck, and keep posting here. It may not be medication, but the support that is shared in asd has a distinct therapeutic effect. — Tara Ballance Montreal, Canada – Hide quoted text — Show quoted text – Just wondering… I’m sure their are others in the same boat as me..: on and off depression lasting 4 or more months at a time …sometimes meds work…sometimes they don’t. I can’t really see the point in going to docs anymore…what can they do? My mum wants me to have some tests done, which leads me back to the subject. Are there anypeople out their who had medical/blood tests done? Or ECGs…or anything else, to help decide what meds to take? Thanks Benno

Response:

That’s funny, my mom asked me the same question. "Aren’t there some tests they can take?" As far as I know, the answer is no, there are no test to find out which med will work. It’s pretty much hit or miss, with the drug that works telling the doc what your problem is rather than the other way around. There are test to see if the depression is caused by physical problems such as with the thyroid, and there are also tests to make sure the meds you’re taking, such as lithium or the MAOIs are at correct blood levels. Other than that, there are no tests that I know of. There was a news story I saw a few days ago about some tests (Q&A I think) that help determine what type of psychotherapy will help, or if meds will work better.

– Hide quoted text — Show quoted text – Just wondering… I’m sure their are others in the same boat as me..: on and off depression lasting 4 or more months at a time …sometimes meds work…sometimes they don’t. I can’t really see the point in going to docs anymore…what can they do? My mum wants me to have some tests done, which leads me back to the subject. Are there anypeople out their who had medical/blood tests done? Or ECGs…or anything else, to help decide what meds to take? Thanks Benno

Response:

Just wondering… I’m sure their are others in the same boat as me..: on and off depression lasting 4 or more months at a time …sometimes meds work…sometimes they don’t. I can’t really see the point in going to docs anymore…what can they do? My mum wants me to have some tests done, which leads me back to the subject. Are there anypeople out their who had medical/blood tests done? Or ECGs…or anything else, to help decide what meds to take? Thanks Benno

Response:

Question:

<Posted and Mailed to James Hey folks:

<Snip Happens! Ok..here is my new med combo.. -Effexor XR 75mg 1x a day

I think you will find better AD coverage by taking 37.5 mg twice per day. -Epival/Depakote (in U.S.)  125 mg 3x a day

That is a low (likely starting) dosage. You will probably need to increase that slowly to get your serum level in the accepted "therapeutic" range. Of course whatever stops your mood swings is therapeutic for you. -Trazodone 50mg at bedtime. -Bromazepam (which is like Ativan) 3x a day.

Are you sleeping well now? It is essential that you do! Are you feeling refreshed when you awaken? Try setting yourself a fixed schedule for bedtime. My question is about the Epival. Now, he stated my mood swings are not "heavy", but enough to cause havoc. In particular, disrupting my sleep patterns. This may be why when they first tried Elavil on me (at 100mg at bedtime), I couldn’t sleep, and just felt paranoid, grumpy, and hung-over all day long. Did anybody on here find an improvement (not too much/not too little) sleep when they started taking Depakote/Epival?? I know it is not as *new* as Neurontin, but still seems to beat out Lithium as far as side effects and mood improvement goes (for some anyways). Besides, I understand I am on a fairly small starting dose.

The most common adverse side effects of valproate are weight gain, hair loss, and potential liver damage. For weight gain you could take Topamax as a secondary mood stabilizer. For hair loss you could take zinc and selenium supplements. To determine if your liver function is being adversely affected, you need to have periodic blood tests. I also believe in checking your thyroid function (TSH, T3, T4) just to make sure — although it is lithium that is more likely to adversely affect your thyroid. started on a.d’s almost 6 years ago!!

If you have a BP II disorder and you present only depressive symptoms to your pdoc and never mention any hypomanic events, you are likely to be treated for clinical depression and given only ADs. I am willing to bet that many BP IIs went improperly diagnosed for many years. I certainly was — until Prozac sent me hypomanic. Ditto for Effexor. Almost every a.d. caused me to have a VERY hypersensitive reaction…even in VERY small doses!! I ESPECIALLY remember my Wellbutrin experience….to me..giving anybody with BP Wellbutrin is like handing them a loaded gun!!

Each person is different. Wellbutrin is quite well tolerated by many people with BP. Each of our brains is very individualistic in its response to ALL psychoaffective meds. A person with a BP condition MUST have an effective mood stabilizer before taking ANY antidepressant. My parents said it was like I had "PMS 24 hours a day!" The other a.d’s reacted this way too…to a minor less extent..but it was like I SNAPPED at everybody and everything! Yes, some of them made me tired and lethargic…but JUST as miserable..grumpy…and jumpy as ever!!

Some people are plain med sensitive. That is an unfortunate fact of life! Anyways..that’s my rant!!:-) If anybody could provide any experience, relations, or advice…I would greatly appreciate it!! Thanks very much…

Start low and go slow! Actually that is the same advice I give to EVERYONE — because the first time you try a new med, you have absolutely NO idea how you will respond. Nor does your pdoc! Peace:-) James

Best wishes for success from, James

Response:

Hi again James, Well…my new pdoc has tried a new angle on my meds, and even though this may not seem "new" to many of you, my old pdoc was just a conservative tight-a##!! snipped… Ok..here is my new med combo.. -Effexor XR 75mg 1x a day Epival/Depakote(in U.S.)  125 mg 3x a day -Trazedone 50mg at bedtime. Bromazepam (which is like Ativan) 3x a day. My question is about the Epival. Now, he stated my mood swings are not "heavy", but enough to cause havoc snipped… Did anybody on here find an improvement (not too much/not too little) sleep when they started taking Depakote/Epavil??

Some pdocs do prescribe the bulk of the Depakote at bedtime. It didn’t affet me either way though. I know it is not as *new* as Neurontin, but still seems to beat out Lithium as far as side effects and mood improvement goes (for some anyways.) Besides, I understand I am on a fairly small starting dose.

Yes you are as the usual dose is 750 mg but your brain and body may vary You know..

snipped… I cannot take ADs as they trigger a dysphoric mania. Give this regimen a try. It may take 3 – 6 months but be persistent. Make sure baseline liver function tests, thyroid tests, and a complete blood count were done before he started you on these meds. If they weren’t then request thay be done ASAP. I am gald you hired a new pdoc too! Peace, Reach beyond your grasp!

Response:

Did anybody on here find an improvement (not too much/not too little) sleep when they started taking Depakote/Epavil??

I had an improvement in EVERYTHING when I started on Depakote. I did sleep a lot at first, but I suspect I was catching up (I hadn’t slept for close to 48 hours…. I was really out of it!). Things normalized in a few days. I know it is not as *new* as Neurontin, but still seems to beat out Lithium as far as side effects and mood improvement goes (for some anyways.) Besides, I understand I am on a fairly small starting dose.

They start out with it slowly and then adjust for effect by patient response. There’s also some tests that your doctor may send you to the lab for. (It’s a simple blood test… unless, like last time, they had to go to non-standard procedures to get the sample!) started on a.d’s almost 6 years ago!!

Well, sometimes it’s not a clear-cut diagnosis. I had roughly the same experience. (I had some other medical problems that counfounded the diagnosis.) — IMPORTANT: Remove the edible part of the E-mail address before replying.

Response:

Hey folks: Well…my new pdoc has tried a new angle on my meds, and even though this may not seem "new" to many of you, my old pdoc was just a conservative tight-a##!! Anyways….he put my in as "cyclothemic", maybe BP3, with mixed mood states…heavy anxiety and depression. I don’t even think my "old" pdoc thought there was anything wrong with me!! Thank GAWD I dropped him. Ok..here is my new med combo.. -Effexor XR 75mg 1x a day -Epival/Depakote(in U.S.)  125 mg 3x a day -Trazedone 50mg at bedtime. -Bromazepam (which is like Ativan) 3x a day. My question is about the Epival. Now, he stated my mood swings are not "heavy", but enough to cause havoc. In particular, disrupting my sleep patterns. This may be why when they first tried Elavil on me (at 100mg at bedtime), I couldn’t sleep, and just felt paranoid, grumpy, and hung-over all day long. Did anybody on here find an improvement (not too much/not too little) sleep when they started taking Depakote/Epavil?? I know it is not as *new* as Neurontin, but still seems to beat out Lithium as far as side effects and mood improvement goes (for some anyways.) Besides, I understand I am on a fairly small starting dose. started on a.d’s almost 6 years ago!! Almost every a.d. caused me to have a VERY hypersensative reaction…even in VERY small doses!! I ESPECIALLY remember my Wellbutrin experience….to me..giveing anybody with BP Wellbutrin is like handing them a loaded gun!! My parents said it was like I had "pms 24 hours a day!" The other a.d’s reacted this way too…to a minor less extent..but it was like I SNAPPED at everybody and everything! Yes, some of them made me tired and lethargic…but JUST as miserable..grumpy…and jumpy as ever!! Anyways..thats my rant!!:-) If anybody could provide any experience, relations, or advice…I would greatly appreciate it!! Thanks very much… Peace:-) James — "Get some honesty… "Don’t Let The BASTARDS Grind You Down..".Latin Proverb take the best of me And the rest let go… When you’re tired of the Rage, Step outside your cage And let the real fool show.." Tears for Fear’s "Goodnight Song" Remember "Life is A Highway"?? Visit Tom Cochrane’s Official Homepage Http://www.tomcochrane.ca

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Question:

My first panic attack was back in July as I was driving to Vermont from Connecticut to pick up my son from  camp. I had an awful sensation wash over me, hands began to sweat, face flushed, shaking and pounding heart. I thought I was having a heart attack. My vision seemed to be affected, but its hard to describe. I went immediately (thanks to the Massachusetts State Police)  to the nearest emergency room where they checked my blood pressure, heart, and made me eat a sandwich and drink something. I sat there under supervision for about two hours and calmed down during that time. My husband and daughter came and took me home. Since that time, I’ve felt lousy from lightheaded-ness to shaky and severely depressed – crying nearly all the time. I have terrible thoughts of dying and feel as though I’m becoming a hypocondriac. I made an appointment with my regular doctor and he performed a physical (EKG, blood work and mammogram being the high points) and said I was fine. They found a "complicated" cyst in one breast and told me not to worry. Now I am convinced I have cancer…irrational though it may be, but after smoking for 30 years I feel not too far off base with the possibility. My doctor would not send me for a chest x-ray, even though I asked. I’ve since made an appointment with a therapist for help with the depression and my gynecologist to see if it could be hormone based. I tried St. John’s Wort, vitamins  (multi and B complex) but, they seemed to make me more nauseous than anything. I find myself unable to enjoy anything anymore, not the weather, not accomplishing those things I’ve been working on for the past few years, nothing. Does anyone think the panic attack was an indicator of something really wrong or is it just a trigger to the rest of these bad feelings?  I’d really like some help with this. Thank you for any input. Cheri

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My first panic attack was back in July as I was driving to Vermont from Connecticut to pick up my son from  camp. I had an awful sensation wash over

<rest snipped for space Dear Cheri, You should take comfort in the fact that all your docs tests turned up negative.  In this day and age, if there was something seriously wrong with you physically, chances are (hopefully) that it would be detected.  But your feelings are very common for PA sufferers.  This wonderful affliction had me convinced that I had throat cancer, a brain tumor, and bone cancer based on a sore throat, headache, or muscle ache.  As it turned out, nothing was wrong. Panic can cause many "secondary" problems such as depression and various phobias.  The best thing I can suggest is get help and get it fast.  You did not mention whether your doc had prescribed any meds or if you were using any therapy.  If not, you probably ought to look into it.  For me, once I got a handle on my PA, my depressive thoughts tremendously lessened. I’m sorry you are having such a tough time but there is help and a light at the end of the tunnel.  As you will notice from the other posts, meds and therapy have helped restore many lives, some almost back to mormal. Good luck and keep in touch. Dave I’m not an ambulance chaser.  I’m usually there before the ambulance.

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– Hide quoted text — Show quoted text – My first panic attack was back in July as I was driving to Vermont from Connecticut to pick up my son from  camp. I had an awful sensation wash over me, hands began to sweat, face flushed, shaking and pounding heart. I thought I was having a heart attack. My vision seemed to be affected, but its hard to describe. I went immediately (thanks to the Massachusetts State Police)  to the nearest emergency room where they checked my blood pressure, heart, and made me eat a sandwich and drink something. I sat there under supervision for about two hours and calmed down during that time. My husband and daughter came and took me home. Since that time, I’ve felt lousy from lightheaded-ness to shaky and severely depressed – crying nearly all the time. I have terrible thoughts of dying and feel as though I’m becoming a hypocondriac. I made an appointment with my regular doctor and he performed a physical (EKG, blood work and mammogram being the high points) and said I was fine. They found a "complicated" cyst in one breast and told me not to worry. Now I am convinced I have cancer…irrational though it may be, but after smoking for 30 years I feel not too far off base with the possibility. My doctor would not send me for a chest x-ray, even though I asked. I’ve since made an appointment with a therapist for help with the depression and my gynecologist to see if it could be hormone based. I tried St. John’s Wort, vitamins  (multi and B complex) but, they seemed to make me more nauseous than anything. I find myself unable to enjoy anything anymore, not the weather, not accomplishing those things I’ve been working on for the past few years, nothing. Does anyone think the panic attack was an indicator of something really wrong or is it just a trigger to the rest of these bad feelings?  I’d really like some help with this. Thank you for any input. Cheri

Cheri — You describe most of the symptoms of anxiety/panic, so at least you’re normal in that respect — in other words, you’re not alone and what you’re feeling is not unique.  We’ve all had moments when we thought we might die from anxiety.  But when the medical doctor tells you you’re fine, you should try to believe him/her.  They have no reason to hide the truth from you.  I think it’s good news that they wouldn’t do a chest x-ray — it means it’s not indicated, your chest sounds fine.  I, too, have cystic breasts, full of lumps — it runs in the family.  All my mammograms are normal, though, and I don’t worry about the lumps.  It seems you’ve had a bad scare from that experience, and you’re now convincing yourself there’s something physically wrong with you, also a common reaction.  Hopefully, you’re going to see a psychiatrist, because they can prescribe as well as other emotional disorders.  The idea is they balance out the imbalance in brain chemistry — specifically the neurotransmitters.  I hope you will find out about these meds and don’t be afraid to try your negative thoughts with positive ones.  I found that writing affirmations was a tremendous help to me.  And I have a book to recommend — "The Anxiety and Phobia Workbook", from New Harbinger Publications in Oakland, CA  1-800-748-6273.  It is absolutely loaded with very helpful information. Please keep posting to the group and let us know how you’re doing. Linda

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Cheri, you didn’t say how old you are, but I will ask anyway.  There are SO Many etiologies for anxiety and panic attacks–mine seem to be connected to peri-menopause.  Many will poo-poo this, but I got good validation today from my family doc that it is all too common.  I was switched today from the antidepressant Paxil to Zoloft, and use Xanax to ward off those rotten panic attacks. The doom thoughts and magnified fears that come over you in the midst of a panic attack are a familiar to ALL of us here, and also to many of us who frequent the NG <alt.support.menopause There IS help, so take heart that you are not alone and be asking some questions of your docs about medications to keep the attacks away. May the world be gentle with you today. sue

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I had a few panic attacks much like yours while driving my car on the freeway here in Dallas.  I had been pretty stressed out from conflicts at work (have been trying to get my employer to conform to OSHA laws, but without much luck), and dismissed the attacks as being perhaps rational fear stemming from the way the big old Chevys and Fords weave through traffic.  I pretty much have to take the freeway, so I said ‘The heck with it,’ and drove anyway.   After a few months it subsided, and now I can cross bridges and etc. without any problems at all.  Weird . . . I read somewhere that these things can just come and go, depending on how much other stress you have to deal with. You might get some benefit from taking some St. Johns Wort along with some Kava Kava. Best of luck, –dsg My first panic attack was back in July as I was driving to Vermont from Connecticut to pick up my son from  camp. I had an awful sensation wash over me, hands began to sweat, face flushed, shaking and pounding heart. I thought I was having a heart attack. My vision seemed to be affected, but its hard to describe. I went immediately (thanks to the Massachusetts State Police)  to the nearest emergency room where they checked my blood pressure, heart, and made me eat a sandwich and drink something. I sat there under supervision for about two hours and calmed down during that time. My husband and daughter came and took me home. Since that time, I’ve felt lousy from lightheaded-ness to shaky and severely depressed – crying nearly all the

             <  s n i p   – Hide quoted text — Show quoted text -Does anyone think the panic attack was an indicator of something really wrong or is it just a trigger to the rest of these bad feelings?  I’d really like some help with this. Thank you for any input. Cheri

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Hi, Cheri If I was to write a story about the ‘typical’ onset of PAs, then it would read much the same as yours. My first panic attack was back in July as I was driving to Vermont from Connecticut to pick up my son from  camp. snipped Since that time, I’ve felt lousy from lightheaded-ness to shaky and severely depressed – crying nearly all the time. I have terrible thoughts of dying and feel as though I’m becoming a hypocondriac.

I know this won’t help, but this is very typical, especially the thoughts of dying. Anxiety is all about fear and if you think about it the only real fear is of dying. The lightheadedness and shakes are probably due to BP changes and depression is the first cousin of anxiety. snipped My doctor would not send me for a chest x-ray, even though I asked.

Your doc. has done most of the usual tests, liver function and thyroid tests would be about the only other tests that may be needed. A chest x-ray isn’t likely to show anything that would account for your symptoms. I’ve since made an appointment with a therapist for help with the depression and my gynecologist to see if it could be hormone based.

Both good moves IMO. Hormones also act as neurotransmitters and are probably more important than most people realise. I tried St. John’s Wort, vitamins  (multi and B complex) but, they seemed to make me more nauseous than anything.

IMO, while these may assist in treating anxiety they are not going to offer a ‘cure’ for most with PA. The important thing is to get treatment asap. A combination of medication and CBT type therapy seems to offer the best solution at the moment. I find myself unable to enjoy anything anymore, not the weather, not accomplishing those things I’ve been working on for the past few years, nothing.

Again, depression, in most, is closely related to anxiety. Thats why the anti-depressents are used in treating both. Does anyone think the panic attack was an indicator of something really wrong or is it just a trigger to the rest of these bad feelings?  I’d really like some help with this. Thank you for any input. Cheri

Very few physical illness have anxiety as a significant symptom. I can only think of one and if you had it you would know by now. PA most commonly begins just as you have described-suddenly and without warning. Why is a matter of debate, but again for most there is no readily definable trigger or reason. Genetics seems to play a big part, so probably does temperament, possibly diet, possibly…. well think of a possibility and someone, somewhere will have run a study ‘proving’ its *THE* cause. But, the reality is that no-one knows, IMO its probably a combination and culmination of all the factors you can think of and a whole lot of others that you cannot. You have started on a long and difficulty journey. It’s a trip that none of us wants to be on we have all been kidnapped, but it aint all potholes either. My best advise is use this NG. Knowing your enemy is half the battle and some here are veterans with a capital V. Whatever problems you come up against, someone here will have been there before, so just ask. All the best Ian    Ian<<atdragoncon<dotnet

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Check out   efn.org/~raypeat  for info on his newsletter and sample articles. Unfortunately, my webtv can’t give me access to the sample articles.  If someone could email them to me, especially the one on the benefits of coconut oil,  in a simpler format  I’d be in your debt and you would surely have that kindness returned to you three times over.     Padraic (aka: Devildog) ~And=A0no more turn aside and brood Upon love’s bitter mystery~  

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Check out   efn.org/~raypeat  for info on his newsletter and sample articles. Unfortunately, my webtv can’t give me access to the sample articles.  If someone could email them to me, especially the one on the benefits of coconut oil,  in a simpler format  I’d be in your debt and you would surely have that kindness returned to you three times over.

Coconut Oil         I have already discussed the many toxic effects of the unsaturated oils, and I have frequently mentioned that coconut oil doesn’t have those toxic effects, though it does contain a small amount of the unsaturated oils.  Many people have asked me to write something on coconut oil.  I thought I might write a small book on it, but I realize that there are no suitable channels for distributing such a book–if the seed-oil industry can eliminate major corporate food products that have used coconut oil for a hundred years, they certainly have the power to prevent dealers from selling a book that would affect their market more seriously.  For the present, I will just outline some of the virtues of coconut oil.         The unsaturated oils in some cooked foods become rancid in just a few hours, even at refrigerator temperatures, and are responsible for the stale taste of left-over foods.  (Eating slightly stale food isn’t particularly harmful, since the same oils, even when eaten absolutely fresh, will oxidize at a much higher rate once they are in the body, where they are heated and thoroughly mixed with an abundance of oxygen.)  Coconut oil that has been kept at room temperature for a year has been tested for rancidity, and showed no evidence of it.  Since we would expect the small percentage of unsaturated oils naturally contained in coconut oil to become rancid, it seems that the other (saturated) oils have an antioxidative effect: I suspect that the dilution keeps the unstable unsaturated fat molecules spatially separated from each other, so they can’t interact in the destructive chain reactions that occur in other oils.  To interrupt chain-reactions of oxidation is one of the functions of antioxidants, and it is possible that a sufficient quantity of coconut oil in the body has this function.  It is well established that dietary coconut oil reduces our need for vitamin E, but I think its antioxidant role is more general than that, and that it has both direct and indirect antioxidant activities.         Coconut oil is unusually rich in short and medium chain fatty acids.  Shorter chain length allows fatty acids to be metabolized without use of the carnitine transport system.  Mildronate, which I discussed in an article on adaptogens, protects cells against stress partly by opposing the action of carnitine, and comparative studies showed that added carnitine had the opposite effect, promoting the oxidation of unsaturated fats during stress, and increasing oxidative damage to cells.  I suspect that a degree of saturation of the oxidative apparatus by short-chain fatty acids has a similar effect–that is, that these very soluble and mobile short-chain saturated fats have priority for oxidation, because they don’t require carnitine transport into the mitochondrion, and that this will tend to inhibit oxidation of the unstable, peroxidizable unsaturated fatty acids.         When Albert Schweitzer operated his clinic in tropical Africa, he said it was many years before he saw any cases of cancer, and he believed that the appearance of cancer was caused by the change to the European type of diet.  In the l920s, German researchers showed that mice on a fat-free diet were practically free of cancer.  Since then, many studies have demonstrated a very close association between consumption of unsaturated oils and the incidence of cancer.         Heart damage is easily produced in animals by feeding them linoleic acid; this "essential" fatty acid turned out to be the heart toxin in rape-seed oil.  The addition of saturated fat to the experimental heart-toxic oil-rich diet protects against the damage to heart cells. Immunosuppression was observed in patients who were being "nourished" by intravenous emulsions of "essential fatty acids,"  and as a result coconut oil is used as the basis for intravenous fat feeding, except in organ-transplant patients.  For those patients, emulsions of unsaturated oils are used specifically for their immunosuppressive effects.         General aging, and especially aging of the brain, is increasingly seen as being closely associated with lipid peroxidation. Several years ago I met an old couple, who were only a few years apart in age, but the wife looked many years younger than her doddering old husband. She was from the Philippines, and she remarked that she always had to cook two meals at the same time, because her husband couldn’t adapt to her traditional food.  Three times every day, she still prepared her food in coconut oil.  Her apparent youth increased my interest in the effects of coconut oil.         In the l960s, Hartroft and Porta gave an elegant argument for decreasing the ratio of unsaturated oil to saturated oil in the diet (and thus in the tissues).  They showed that the "age pigment" is produced in proportion to the ratio of oxidants to antioxidants, multiplied by the ratio of unsaturated oils to saturated oils.  More recently, a variety of studies have demonstrated that ultraviolet light induces peroxidation in unsaturated fats, but not saturated fats, and that this occurs in the skin as well as in vitro.  Rabbit experiments, and studies of humans, showed that the amount of unsaturated oil in the diet strongly affects the rate at which aged, wrinkled skin develops.  The unsaturated fat in the skin is a major target for the aging and carcinogenic effects of ultraviolet light, though not necessarily the only one.         In the l940s, farmers attempted to use cheap coconut oil for fattening their animals, but they found that it made them lean, active and hungry.  For a few years, an antithyroid drug was found to make the livestock get fat while eating less food, but then it was found to be a strong carcinogen, and it also probably produced hypothyroidism in the people who ate the meat.  By the late l940s, it was found that the same antithyroid effect, causing animals to get fat without eating much food, could be achieved by using soy beans and corn as feed.         Later, an animal experiment fed diets that were low or high in total fat, and in different groups the fat was provided by pure coconut oil, or a pure unsaturated oil, or by various mixtures of the two oils.  At the end of their lives, the animals’ obesity increased directly in proportion to the ratio of unsaturated oil to coconut oil in their diet, and was not related to the total amount of fat they had consumed.  That is, animals which ate just a little pure unsaturated oil were fat, and animals which ate a lot of coconut oil were lean.         In the l930s, animals on a diet lacking the unsaturated fatty acids were found to be "hypermetabolic."  Eating a "normal" diet, these animals were malnourished, and their skin condition was said to be caused by a "deficiency of essential fatty acids."  But other researchers who were studying vitamin B6 recognized the condition as a deficiency of that vitamin.  They were able to cause the condition by feeding a fat-free diet, and to cure the condition by feeding a single B vitamin.  The hypermetabolic animals simply needed a better diet than the "normal," fat-fed, cancer-prone animals did.         G. W. Crile and his wife found that the metabolic rate of people in Yucatan, where coconut is a staple food, averaged 25% higher than that of people in the United States.  In a hot climate, the adaptive tendency is to have a lower metabolic rate, so it is clear that some factor is more than offsetting this expected effect of high environmental temperatures.  The people there are lean, and recently it has been observed that the women there have none of the symptoms we commonly associate with the menopause.         By l950, then, it was established that unsaturated fats suppress the metabolic rate, apparently creating hypothyroidism.  Over the next few decades, the exact mechanisms of that metabolic damage were studied. Unsaturated fats damage the mitochondria, partly by suppressing the repiratory enzyme, and partly by causing generalized oxidative damage.  The more unsaturated the oils are, the more specifically they suppress tissue response to thyroid hormone, and transport of the hormone on the thyroid transport protein.         Plants evolved a variety of toxins designed to protect themselves from "predators," such as grazing animals.  Seeds contain a variety of toxins, that seem to be specific for mammalian enzymes, and the seed oils themselves function to block proteolytic digestive enzymes in the stomach. The thyroid hormone is formed in the gland by the action of a proteolytic enzyme, and the unsaturated oils also inhibit that enzyme.  Similar proteolytic enzymes involved in clot removal and phagocytosis appear to be similarly inhibited by these oils.         Just as metabolism is "activated" by consumption of coconut oil, which prevents the inhibiting effect of unsaturated oils, other inhibited processes, such as clot removal and phagocytosis, will probably tend to be restored by continuing use of coconut oil.         Brain tissue is very rich in complex forms of fats.  The experiment (around 1978) in which pregnant mice were given diets containing either coconut oil or unsaturated oil showed that brain development was superior in the young mice whose mothers ate coconut oil.  Because coconut oil supports thyroid function, and thyroid governs brain development, including myelination, the result might simply reflect the difference between normal and hypothyroid individuals.  However, in 1980, experimenters demonstrated that young rats fed milk containing soy oil incorporated the oil … read more »

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Has anyone heard of this research.  Supposedly revs up the thyroid as well. Yes I have. I know of two practitioners who vehemently recommend that people ingest coconut oil regularly. I do not know what to make of it, but the two sound very convincing. They are both serious scientists, which of course does not necessarily make them correct. But neither are they off the wall nutcases either.

Any area on the web to reach them or research by them? Thanks _BOB —

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Has anyone heard of this research.  Supposedly revs up the thyroid as well. _BOB —

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Has anyone heard of this research.  Supposedly revs up the thyroid as well.

Yes I have. I know of two practitioners who vehemently recommend that people ingest coconut oil regularly. I do not know what to make of it, but the two sound very convincing. They are both serious scientists, which of course does not necessarily make them correct. But neither are they off the wall nutcases either.

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Has anyone heard of this research.  Supposedly revs up the thyroid as well. Yes I have. I know of two practitioners who vehemently recommend that people ingest coconut oil regularly. I do not know what to make of it, but the two sound very convincing. They are both serious scientists, which of course does not necessarily make them correct. But neither are they off the wall nutcases either. Any area on the web to reach them or research by them?

Dr. Ray Peat is one, and I believe he has a web sight, but I do not know how to access it. He seems to focus on womens health, hormones, thyroid and diet. A search may help (Ray or Raymond Peat) The other is Lita Lee, from Oregon I believe, and I have not seen anything of hers on the internet. They are both very interesting people.  She is  a student of Dr. Peats ideas, and practices as an enzyme therapist. She has a PHD in chemistry, I believe. I can tell you that a medical doctor I showed some of the materials to did not dismiss their scientific reasoning, but was not sure what to make of it all . An alternative Dr. I showed it to was not in complete agreement with their conclusions, but neither did he dismiss their scientific reasoning. Thirdly, a medical doctor who practices with a strong leaning towards alternative ideas was mildly impressed by it all, and his adjunctive staff was quite taken aback by these unusual theories. He chose to stay away since his primary focus is elsewhere. The bottom line is that the human body is quite a complicated device. Nobody really knows as much about it and its intricacies as we would like to believe. (my opinion). If you would like to know how to reach either one I have their mailing addresses, but I will not put it over the WEB. E mail me.

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