Posted by Ritch on February 24, 2003, at 22:25:26
In reply to Lamictal and Pre-emptive Strikes , posted by colin wallace on February 24, 2003, at 13:40:48
>
> Hi guys,
>
> I need some innovative ideas here. I have my (BP11 type) depression pretty much under control right now, with Lamictal at 225mg.My experience with Lamictal has surpassed my most optimistic expectations, but it’s been a bit of a cat ‘n mouse affair all along- excellent results within three months or so and a complete normalizing of mood and temperament. Then, very suddenly the cracks start to appear, and the AD effect just ‘cuts-out’.When this happens, I immediately start to relapse into a dysphoric hypomania(angry, bitter, helter-skelter runaway depressive thoughts- reckless actions etc.).
> What cures this very quickly is raising the Lamictal dose by 25mg or so, although this too tends to wane over time. I had hoped(prayed) that I would reach an optimum dose where the mood stabilization and depression would be taken care of- at least for some considerable period of time. This may yet happen. However, my track record and the experiences of others suggest that at some point (possibly sooner than I’d anticipated)my underlying illness will finally outpace any viable Lamictal dosage.I say this because I am now forced to rely on an uniformed, overcautious GP. who just won’t raise my dose high enough or quickly enough .I’m only supposed to be taking 150mg as it is.
> If I start to slide again, I’d like to be prepared. I intend to pre-empt this by choosing a suitable mood stabilizer to fortify the Lamictal(I only ever experience dysphoric hypomania-never euphoric, sadly).At that point, I’ll also need to aggressively tackle my depression, with a serious AD, where all else has failed.
> My current thoughts are along the lines of Topomax or Carbemazapine for stabilization, with a last attempt at Prozac, before trying. Selegiline or another MAOI as a last resort.A lithium or Valproate re-trial are possibilities although I hated both without an AD first time around).
> If my Lamictal does finally poopout(God forbid), I know I’ll very quickly become badly unstable and depressed, and I want to be prepared should it happen.
> Any ideas would be appreciated here, so I can bounce them around with a psych.(assuming I can find/afford one).
>
> Col. The eternal pessimist.
>
>Colin, I would go with the Tegretol add since you haven't tried that one yet. Teg is sometimes used successfully for treatment-resistant bipolar depression. I tried Trileptal recently and I felt a definite antidepressant effect from it, but I have a weak stomach and the stuff nauseated me badly. Just a tip-don't take much of it-it seems like if you take very much you dull out-just a little seemed to help with the "black-anergia" I can get from Depakote. Kind of similar to Wellbutrin, but much milder without any hostility or grouchiness. Oh, another idea here-what about some thyroid supplementation? I have yet to try it-pdoc is scared of it-I think it would be perfect for me (rapid cycling).
poster:Ritch
thread:203376
URL: http://www.dr-bob.org/babble/20030224/msgs/203571.html