Wednesday, October 17, 2007

Please Vote On Our Sidebar Poll

What's your favorite mood stabilizer? I set up the sidebar poll a couple of weeks ago, right on the heels of the What's Your Favorite SSRI? poll. The Shrink Rap poll was actually mentioned on The Wall Street Journal Health Blog. Yup, we've arrived in blogger nirvana, move over Fat Doctor!

These are funny questions, they're asked without context, kind of purposely so. What's your favorite? But we don't ask who you are, the doctor or the patient, or perhaps the relative of someone who never actually prescribed or swallowed the pill. And we don't ask your this the only mood stabilizer you've taken? Are you a family practice resident who has only written 4 prescriptions ever for mood stabilizers? Or are you an experienced Bipolar Expert who has written many many scripts and really knows your stuff?

Roy didn't like the poll to begin with. I went for the cheesy blogger poll, too lazy to import a bigger one from polldaddy, and it limits the number of choices. Roy wanted Klonopin added. He wanted Trileptal. He wanted Topamax. He scoffed. What can I say? And apparently either no one likes or uses Tegretol (carbamazapine) so that was a waste of a choice.

I had more to say about SSRI choices. I'll think of something to say about Mood Stabilizers. Just not tonight. For now, please vote. Thank you.


Anonymous said...

I take Lamictal. Never be on any other mood stablizer (other than klonopin-does that really count? Cause I would pick it!).

I have no idea if it works at all...let alone better than all of the others.

I am still moody!

I I have blimped a bit with the other drugs (I know Lamictal is weight neutral). Isn't Topamax the skinny one?

I want skinny.....

(Or at least not being obese)

Roy said...

I use Tegretol. It's on the Walmart $4 list.

Anonymous said...

I'm curious about who's voting for Zypreza and why? It's interesting because it was doing better than Lithium and almost keeping pace with Lamictal for the longest time. For a drug that can cause **MAJOR** weight gain, diabetes and raise triglycerides, can be extremely sedating, and may carry a risk for developing tardive dyskinesia (I know, hasn't been out long enough to know yet, but that's what's scary), I'm really surprised at it's popularity.

Is it being used for short-term acute treatment or long-term maintence treatment? At what point do you have to consider that you might be slowly killing your patient instead of helping them (diabetes, heart disease)? (Sorry, I hope that doesn't come off as harsh criticism. If I were in a serious emergency, I hope you'd be giving me something like Zyprexa to calm my tush the heck down.) Have any patients voted for it and why?

None of this has to be answered now. I'll wait until you announce your results, but I've been keeping track and thought it was interesting!


I personally use Lamictal as my primary mood stabilizer. It works well, and I definitely need the antidepressant effects. I've done Topamax for migraines, and while you do lose weight, it comes at a cost--IQ points. Right now I'm using Zonegran and notice what I believe are some mild mood stabilizing effects from that. It also makes me lose weight like crazy and helps my migraines (it's actual purpose). I've found that Verapamil is a nice add-on drug to my Lamictal too! Again, originally used for migraines but really helped my moods too.

NeoNurseChic said...

Would be interested to hear what you have to say on SSRIs. Would like to make it clear that I am NOT asking for advice, but tomorrow at my psychiatry appt, I plan to FINALLY ask about taking an antidepressant. The reason I haven't asked is twofold. First off, he is the one who got me off all the junk my neuro had put me on, in order to see what really lies beneath, to simplify my med list, and to get me on one thing that would be more effective, fewer side effects, etc instead of 5 different things that didn't work. Secondly, after all I have told him, he hasn't recommended an antidepressant...even when I have discussed some pretty dark stuff. That reason actually carries bigger weight than the first because wanting to ask about an antidepressant makes me feel like I am somehow questioning him, saying the therapy just isn't cutting it, or that I want to jump to meds instead of working through it in therapy. (I might note here that I've been in therapy with him 1-3 times a week for 3 years now!) Tonight after I finished work, I thought about how nothing stands now between me and the appt that I've been planning for in my mind for a week (but really thinking about this for months), and now I'm anxious and starting to feel sick to my stomach/heart racing, etc. *sigh*

I've taken prozac, cymbalta, pamelor, parnate, elavil in terms of antidepressants. Prozac was the only one that had an effect on my depression, but it made me not care about anything and ultimately was not a good thing for me because the apathy was really affecting my life in negative ways. Cymbalta made me more depressed and anxious. The latter 3 had no effect on mood for me. I know all the antiseizures I've been on are also mood stabilizers, but I never noted any effects on mood - except perhaps with lamictal, which on the whole was a good drug for me. (I voted for it, to make this poll relevant!)

From what I've read, good choices for me would include something like zoloft or perhaps wellbutrin. (I am going off of layperson reading plus information about myself that I know quite well - but this could be something entirely different than what my psychiatrist or psychiatrists in general might think. And I would go with whatever my psychiatrist prescribed, without question, as he has shown to always have my best interests at heart when it comes to meds and treatment. I'm someone with depression, anxiety, ADD, and some OCD-type symptoms that have actually been pretty horrific for me in the last few weeks. So I assume that a med that works well for depression and anxiety together would probably be good for me. I'd lean towards paxil, which my dad is on for panic disorder, but I don't want it. The withdrawal syndrome that happens rarely would not be a good addition to my plethora of current medical problems, and as my mom said just the other day, I tend to hit all the severe rare side effects of everything. As I said, that is all just speculation.

My stomach is kinda in knots right now over the idea of even bringing this up tomorrow. Like I said, it's been on my mind for months, but even moreso the last few weeks. I don't want to seem lazy or that I just want an easy way out instead of working through it all in therapy, and I don't know why I fear that this will be what he thinks. (He said nothing about laziness when I asked for an increase of my ritalin, even though I was afraid of it then, too!)

But then I was reading a lot of stuff online - seems that most of the people I know with chronic headaches are also on an antidepressant for the resulting depression from chronic pain. I started to think, "Why am I being so hard on myself and expecting so darn much? I have two of the most painful, difficult to treat headache types in existance every single day, and I'm thinking I'm lazy for wanting some help with my depression..." I came to a thought about something. A year and a half ago, my psychiatrist asked me if I felt my pain (physical) was being treated. I had burst into tears with the sudden realization that even though I had done absolutely everything my doctors had asked of me (in spite of the negative effects these things gave me), when the treatments weren't working, at the end of the day my pain was not being treated. This led to major treatment changes and decisions for me - difficult decisions that have worked out mostly for the better.

But I could also apply that to my depression/anxiety. Is my emotional pain being treated? I'm doing the psychotherapy and working very hard at it - but still have some pretty bad symptoms that take over my life, leave me exhausted, and dysfunctional many times, especially when I'm not at work. While it's great that I am very functional at work and put a lot into it, I should also have some degree of functionality in my personal life, and I don't have that right now. I spend lots of time in bed, although in the last week, I have pushed myself to take daily walks and to be more active to see if that would help my mood. So maybe it's time to look at another angle in treating depression/anxiety. Don't they always say the best combination is meds and therapy?

Sorry to ramble on, as usual! Wish me luck for tomorrow - I have to try to sleep tonight, even though I'm having some low level anxiety attack over all this! My appt is at 12, but I also have to work tomorrow evening for my last shift this week. I think I'll feel better once I just get it over with and bring it up with him!! He's never given me any reason at all to fear him or his judgements (must be transference! haha), but I've been avoiding the question and dreading discussing it, yet really wanting to address it. So here goes!

Take care,
Carrie :)

NeoNurseChic said...


Topamax (dopeymax!) is the "skinnhy one" as you say! I've heard a lot of people lose weight on it. I can't remember if I did or not, but I've always been fortunate to be thin most of the time! One of our NPs at work says her daughter has lost weight on the topamax. I took it for a few years for migraine, but it didn't help that (it does help it for many others, though!), and the brain fog was too much to handle! Not everyone gets the cognitive side effects of topamax (I'm referring to the concentration and memory difficulties), but I'd say that's one of the biggest drawbacks to the med! If the med helps with the main problem leading to the prescription, then people are often willing to put up with the side effects, even some of the bad ones!

I think you make a good point about still being moody and not knowing if it works! That's the weird part about a lot of psych meds in my opinion (at least in terms of the more common axis I - I'm talking no-psychosis diagnoses!). What exactly are the markers you're supposed to judge by? Reduction in suicidal thoughts for antidepressants? Reduced irritability? Lack of moodiness? I dunno.... I'd love to know what most people judge med success by for various conditions!

Take care,
Carrie :)

NeoNurseChic said...


Verapamil helped your moods? I'm up to 400mg spread out over 3 times a day dosing. I've gone all the way up to 960mg (this drug at high doses is a primary treatment for chronic and episodic cluster headache), but that dropped my blood pressure so low that I was barely perfusing my brain and was vomiting uncontrollably, plus felt like an elephant was sitting on my chest. I'm working up to 480mg a day now, but may go higher - we're doing very slow increases....120mg a month basically. Curious what effect you've found it has on mood!

I'd taken verap for a number of years, but came off it in February of 2006 when we washed me off preventatives for migraine/clusters, and I just started on it again in August of this year.

Take care!
Carrie :)

P.S. Have you tried zyprexa as an abortive for your migraines? It works well as an abortive for migraine and clusters for many of us. I have a bottle handy to use on the bad days.... Mostly it knocks me out so I don't feel the bad pain and finally get some sleep (especially when I can't get breaks from my clusters), but I have friends with CH who don't get sedated, even on doses higher than what I take! 2.5mg isn't as sedating for me, but doesn't seem to help. 5mg is the best dose of it for me, but I've taken 10mg in the past, too - just made me sleep a LOT. Anyway...just thought I'd ask!

Anonymous said...

If neurontin is up there then sugar pills should be too.

DrivingMissMolly said...

I hate lithium, but I take it. Does anyone know if it causes acne? I used to have beautiful skin. F the lithium.

I didn't know the big K (Klonopin) was considered a "mood stabilizer." I take that too.

Lithium keeps me from intensely wanting to kill myself ALL the time. I'm not sure if that's good or bad...

That's the operative word--"intensity." It's like, I think, "Oh, yeah, I don't want to live, but, there's no hurry." Compared to "Must. Die. Now."

I picked up my Xanax yesterday and the tech made a point of telling me the cost before insurance was $50 and some change. My co-pay was $10. Kind of eye-opening.


Anonymous said...

Yes, Lithium can cause acne.

Anonymous said...

Verapamil is slightly helpful as an adjunct for me too. My main vote is for a classic, valproate.

Lithium caused severe acne for me.

Anonymous said...

I hope you have a really great reason for purposely for gathering useless data. I hope you don't diagnose that way. Ms X hasn't slept in days. Does she need a presciption or does she have a newborn baby or is she a hopital resident or is it actually good that she hasn't slept in days because now she has trained her body to sleep at night instead?
Useless info can make it into The Wall Street Journal blog or print edition. Most information is useless. We really don't need more.

Aqua said...

I've tried all of these and none helped me for more than a week to a few weeks (placebo effect??)

I'm the lone voter for Carbamazepine (Tegretol). Not because it has helped my mood stabilization (not yet anyways...I'm still hopeful), but because I have had NO side effects. I'm not fatigued or hungry, or having huge cognitive problems, or getting up 5-6 times a night to I guess for me it's the best so far.

My experiences:

Lithium: At 1200 mg mood lifed for 5 weeks, got really sick for 4 weeks, levels in the high range, lowered dose and took for a year. Did not work again. I had no side effects except having to pee all night long...annoying, but had it helped I would have stayed on it.

Depakote (Valproate): at 1000 mg it helped anxiety and irritability, but not my depressed mood and I became so stupid on it. I became dissociative, my memory was disturbingly awful and concentration non-existent. Still had measurable cognitive problems at 750mgs and it did not help with any mood stabilization at lower dose.

Zyprexa (Olanzapine): could not even function at low doses I was so fatigued.

Other atypical antipsychotics: Same as above except Risperidone on which I had constant anxiety attacks.

Carbamazepine (Tegretol) No side effects, but not yet helping with mood.

Gabapentin (Neurontin) I may as well have been taking a sugar pill.

Lamotrigine: tried 3X. it seemed to work in the beginning and then would stop working. Second time was after ECT, so that may have been what lifted my mood. Third time did nothing.

Anonymous said...

Neonursechic--We've chatted before (hope you remember) about migraine/headache stuff, and you dropped your email. I really want to talk to you! I keep meaning to go back and get it, but been having a hard time finding the time the past few weeks. I'm a graduate student, so my time is limited plus I've been dealing with a flare up in the migraines, so my down time is generally spent sleeping. I've heard of Zyprexa being used as a preventative, but not as an abortive! I sometimes use Seroquel to knock me out for the bad onesI see my migraine specialist tomorrow to discuss meds again.

Verapamil does indeed help my moods. Quite a bit actually. I was up to 300-some mg at my highest, but my BP drops too low and I start to have dizzy spells. It's one of my favorite migraine prevnentatives ever because it worked GREAT, had virtually no side effects, and helped keep my moods stable. Coming off after poop-out was a real bummer.

Topamax marginally helped my migraines, but effected me so much cognitively that I had to *stop driving*. I always seem to get some cognitive side effects with anti-seizure meds, but Topamax was extreme. I know a lot of people who do just fine on it though. As far as stabilizing moods, though, I think it's probably equivalent to a sugar pill. The only reason I got happier on it was because I lost a little weight!

Anonymous said...

Shrinks, your polls are awesome!! I think they're fun and interesting:)

Anonymous said...

(Sorry for all the spelling mistakes, etc. There's a thunderstorm coming in and not enough Imitrex left for me to take. C'est la vie.)

Rach said...

Dearest Shrinks...

On the topic of mood stabilizers - would you ever give a manic-depressive an SSRI and a mood stabilizer, or is that just stupid? (i think I know the answer, but I want to know what you think...) throw in whatever conditions, ifs, ands or buts that you want...

Oh and when I say Mood Stabilizer, I mean Neurontin or Lamictal, not Lithium. If you need lithium, you're far gone.

NeoNurseChic said...


Yes I remember! Interesting about the verap working on mood and all! I think it gives me fatigue... Plus when I increase my doses, I get palpitations, which cause mild chest pain, but I've had tests and it's okay. Will have to get another EKG when I go above 480mg. Never had it positively effect my migraines, but get this for my clusters.... When I first started getting them, I got them every single night at 5pm, 7pm, 9pm, 11pm, 2am, and 4am. I was afraid to sleep. After we went up to like 720mg, my CH hits stopped coming on a regular schedule, and ever since they've been random. Still have some 4am stuff - if I don't wake up with an attack, then I still wake up with weird autonomic symptoms (droopy, watery eye, stuffy right side of my face...). So the verap did something!

At Jefferson they use zyprexa and thorazine as abortives. Whenever mine get bad and out of control (the migraine), they prescribe zyprexa again, but when my clusters got real bad in August, the NP said that thorazine worked better to abort the CH. I've also used geodon to abort (and got geodon injections in the hospital), but they made me so tired - one time I took it and was driving back to Penn State (this was actually one of the first times I ever took it, so I didn't know it was so sedating!) and I had to pull off the road 3 times to take a nap. I was driving with the windows down (it was cold), music blasting, and chugging caffeine plus staying on my cell phone with my mom just to keep myself awake. It was awful, but I had to get back to take a physics quiz!

That was the same semester I almost failed out of school thanks to topamax. We went up to 375mg and I was having huge memory/concentration issues with both my piano stuff and my science classes. We came down to 100mg at night and I started on concerta, but my brain has never been the same since.

My neuro wants me to look into getting an occipital nerve stimulator implant now. He will even help with the push to get it covered by insurance. My parents still want to discuss it because my mom pointed out that I have hit just about every single rare, negative side effect possible with most of the weird treatments I've tried, and she's afraid I'll be the one person who has a plethora of complications from the ONSI.

Today at my psychiatry appt, we discussed antidepressants and also other things for 50 minutes... Tomorrow we are continuing the discussion - his thought is to perhaps try wellbutrin. He asked me if I had a particular antidepressant in mind that I wanted to try, but I said I didn't - because even though I had vague thoughts, I was more interested in what he had to say. Interestingly enough, wellbutrin was one I had been thinkiing about. My biggest concern is that it may cause more anxiety for me - cymbalta did that and it was awful! Plus my dad heard voices on wellbutrin, and he only has panic disorder! I still think it sounds like a good choice for a lot of reasons (byebye ritalin maybe), but we'll be continuing the discussion tomorrow. I am relieved that we finally talked about it, and even though it was a difficult discussion with lots of tears, I feel better.

Good luck with the migraine specialist tomorrow!

Carrie :)

Anonymous said...

I voted for Lamictal because when I pack them into blister packs for nursing home patients they smell really nice (blackcurrant flavoured). Mmmmmmm.

Seems as good a reason as any :p

DrivingMissMolly said...


You said ..."If you need lithium, you're far gone."

Gone where? I hope somewhere good because I haven't gone there yet....

I take two 300mg tablets of lithium at bedtime. Doc has wanted to raise the dose but I refuse. About 13 years ago I took lithium but quit because I had severe sweating and leg cramps. My doc then told me that my levels were within normal limits so tough titty.

I guess taking it for suicidality as opposed to "mood stabilization" is different, or maybe making one less suicidal is a kind of mood stabilization? Or am I taking it for augmentation of my SSRI, paroxetine?


Aqua said...

I wasn't sure what you meant by the " If you need lithium, you're far gone" comment either.

I know for me it took years of trying to find ANY OTHER med, but Lithium. Partly because I felt I was misdiagnosed with bipolar in the hospital and because of my preconceived ideas of how it was going to make me feel and what it would mean about me if I took it.

I thought I would be flat and lose myself to the medication. I also thought I don't have bipolar disorder, why do I need Lithium?

To my surprise it didn't make me flat, or numb, or anything I expected. For the first time in 5 years I felt like me (until I got sick and it stopped working), but for 5 really needed weeks I felt myself again.

A good lesson to me: people's experiences on different medications can be vastly different from each other.

I think of myself as having treatment resistant depression with a cycling component, or a bipolarity to it. I never get high enough, for long enough to fit the description of hypomanic...but I get pretty close.

Probably most days I feel pretty hopeless about my odds of getting well again. I guess that could be seen as "far gone", but today I'm hoping I'm not too far gone to heal.

NeoNurseChic said...

I took Lithium, too - but for cluster headache, and I also did not get flat or lose my personality or anything. It seemed to help in combination with verapamil, but I had to come off because I started having a lot of vomiting, even though I was actually below therapeutic range with a level of 0.3 or something like that. Would do it again, though!

Lily - do you think it helps a lot with suicidality? That's one of my biggest problems, actually.

Today we ended up going with buspar to try to treat anxiety (and hopefully impact depression) instead of going for the wellbutrin. I will fill the prescription tomorrow, but I'm hoping this helps - I need something to!

Take care,
Carrie :)

Anonymous said...

rach-neurontin has absolutley no proven effects as a mood stabilizer and lamictal is better for depression but not for the manic side so much, so neither is much of a stabilizer for people who swing back and forth.
lithium plus ssri has been a good combo. i don't think you need to be far gone to take it. you take it because it works provided you can handle the side effects.there are plenty of people on lithium who you would never think of as "far gone". thats just the stigma at work

Sarebear said...

I'm not up on this discussion totally yet, but was skimming through.

I'm on Neurontin, and there's DEFINITELY a stabilizing effect.

The manufacturer may have got their hands slapped for promoting it for use in bipolar, as they hadn't gone through the FDA process for approval for that use, and studies showed, I THINK, that it wasn't helpful for the majority.

It still works for me, though. I'm not sure if another stabilizer would have more or less of an effect, as I don't have any experience with anything else for that, yet. I guess we'll see, as the sleepiness on this has been a problem for me. If that's the only major side effect, it could be alot worse.

Just because it works for me, though, doesn't mean I'm telling anyone to go ask their doctor for it. It's my opinion that shrinkoid #1 put me on it, as I had a rash reaction to the Lamictal he tried first, and a numer of the other go-to stabilizers can add weight, which I'm about at 40-42 BMI. Trying to work on THAT, starting gently and w/seeing family doc, may be what messed up my knee. Insurance provider list problems are interfering with me getting in to see what's up with it.

Ah, there I go justifying, which I don't have to do to anyone. stupid anxieties

Insurance sucks.

To end on a positive, if still OT note: I MIGHT be able to access weekly therapy again, reliably. A combination of unusual factors.

Anyway, Clink, I'm jealous. I had my first Lobster earlier this year, right when we got our tax return. I had a sampler, and after eating them all ugh Rock was tough. The last was the best, mmmm mmm mmm. Was too scared to try to figure out how to open it though, so I ate the shell, too.

Naaah. Should I pull the other leg? Hee. (The waitress did it for me with my permission.)

Sarebear said...

Er, the waitress cracked the lobster. She didn't pull my leg . . . . I just realized how that sounded.

Anonymous said...

Lamictal is a good mood stabilizer. I won't argue with whether it's as good as Lithium because Lithium will always be the gold-standard, but it's a good mood stabilizer. It's antidepressant qualities are great, particularly for a significant number of people with predominanetly depressive episodes, but it also keeps the ups in check as well. Repeated clinical trials certainly support this, as do the personal experiences of many patients. Of course, not every med will work for every patient the same, and some people will respond more favorably to one med over another.