Posted by Ron Hill on June 12, 2003, at 19:17:21
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 10:58:14
Hi Ms. Katy Fluffy,
> I'm a clear-cut case of Bipolar II. I have been titrating up on Lamictal for 11 weeks now, doing better than before, but my effect still "slips" if I don't titrate up within a couple of weeks. I still notice a fair amount of cycling--13 days "normal"--2 days hypomania--2-3 days of depression. There has been an overall reduction in my irritability, anger, anxiety & sleep problems, but only if I titrate up.
This sounds very similar to Colin Wallace's experience with Lamictal. Flag Colin down and get his input. He also found it necessary to continually bump up the dose to retain its effectiveness.
I have a couple questions:
Is this the first moodstabilizer prescribed for you?
How long ago did you get the BP II dx?
You mentioned your unfavorable reaction to an antidepressant without a moodstabilizer. What other meds have you tried and what were the overall results (Reader's Digest version is fine)?
How many years have you been taking psychotropic medications?
Why did your pdoc select Lamictal instead of lithium or Depakote?
> My question is this: Is it realistic to expect full relief of symptoms & cycling on medication?
Define "full relief". My short answer is yes (pretty much). You can certainly get closer than you are now with your cycling. However, it is a trial-and-error process to find a med combo that works best for you.
> Is this the *best* it's going to get?
No, it gets better. However, some medication trials may make your condition worse. Do your homework and, thereby, identify those medications with the highest probability of success for your individual case. See homework assignment at the end of my post.
> I wonder if I should jack with this monotherapy thing and take the risk of feeling worse.
You mean increase your Lamictal dose, correct? What dosage are you currently taking? Any rash so far? What is your pdoc’s advice regarding dosage increases? As you know, small incremental increases are advised to avoid getting a rash.
> If I augement, would a pinch of Lithium do the trick?Perhaps. Or maybe Depakote monotherapy, or maybe slow release lithium monotherapy. Or maybe Trileptal has a role to play in your med cocktail. Given the fact that hypomania is a significant component of you BP II, I would have thought that your pdoc would have tried a first-line moodstabilizer such as lithium or Depakote before prescribing Lamictal.
Ritch makes a good point when he said that Depakote might be a good moodstabilizer to try since it typically works well to control rapid cycling. But as he also pointed out, adding Depakote to Lamictal is tricky because Depakote elevates the blood levels of Lamictal. Depakote monotherapy might be something to try, but your pdoc would likely require a wash-out period (discontinue Lamictal a week or two prior to starting Depakote).
> I know there are *many* meds to try. I just don't want to slip again.
>
> I tend to get REALLY hypomanic late in the summer, and then REALLY depressed in the fall and winter. At other times, I'm just cyclothymic. What would be your next step?My bias is toward using either slow-release lithium monotherapy or Depakote monotherapy to get the hypomania under control. (I personally like a low-to-moderate dosage of Lithobid because it works so well for me, but YMMV) Then, if your depression and/or irritability are not adequately treated by the moodstabilizer monotherapy, then medication and/or nutritional supplements could be carefully added on as needed. On the other hand, however, Colin is currently obtaining good results using Lamictal and a pinch of Prozac.
Here is your homework assignment. Please read the treatment (i.e.; medication) sections of the following document and scan the other relevant portions of the paper.
http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
Please answer the questions above and stay in touch. Best Wishes.
-- Ron
poster:Ron Hill
thread:99976
URL: http://www.dr-bob.org/babble/20030609/msgs/233527.html