Posted by Ron Hill on February 8, 2005, at 23:47:37
In reply to Re: Trileptal: Great sleep, no hypomania, posted by catmint on January 31, 2005, at 0:57:18
Amy,
Sorry to take so long to get back to you. I just returned home.
> It makes me smile whenever you post lately. You only have one or two more days, and you can't resist!I like it when you smile!
> I have been feeling better since I dropped from 200 to 100 mg. Lamictal. I see my pdoc tomorrow and will discuss three options with her (in order of my preference):
>
> 1)Decrease Lamictal to 75mg. Use melatonin at night.You know that melatonin can cause depression, right? The usual dosage of off-the-shelf melatonin is much too high. When I used to take melatonin, I took about 1 mg/night of the Source Natural's sublingual product. But even at this dose level, I could only take it ocassionally or else it would cause depression. Amy, if you decide to take melatonin, please talk to Larry Hoover. The topic best fits on the PB-ALT board, so you could flag him down over there.
> 3)Add Depakote, decrease Lamictal to 25-50 mg.(doesn't Depakote increase levels of Lamictal)?Yes, here is a link to the Lamictal prescribing information. The interaction of Depakote with Lamictal is detailed in the document. Also, the interaction of many of the other AED's with Lamictal are also discussed:
http://us.gsk.com/products/assets/us_lamictal.pdf
> 3)Add Trileptal (not sure about where to keep Lam.)According to the document linked above, Trileptal and Lamictal do not interfer with each other. If it were me, I'd probably keep the current 100 mg/day of Lamictal on board and add Trileptal. Further, I'd ramp up the Trileptal slowly at first to minimize any side effects. You'd have to play it by ear to determine how high to go. Typical Trileptal dosages for BP II patients are around 1800 mg/day. YMMV.
What did your pdoc say? Which option?
> Ron, I tried Tripetal a couple years ago. It didn't do much for me although I probably didn't give it enought time because it upset my stomach considerably.
Have you ever tried ginger to treat the nausa? I buy crystallized ginger in the bulk foods section of a local grocery store. The crystallized form tastes GREAT and just a small piece takes away the Trileptal induced nausa. YMMV. It costs about seven bucks a pound, but it works for me.
> Maybe I'll give it another go. I'm intrigued by it's ability to promote a good nights sleep. I can only remember one good nights sleep in the past 3 months.
I can't overstate how much Trileptal benefits my sleep. I go to sleep quickly (i.e.; within minutes), I sleep soundly, and I wake up feeling refreshed (unless I've cycled into a depressive phase, in which case, I don't want to get up).
The other thing that greatly helps my sleep is magnesium. Have you ever tried it? I take 600 mg (measured as elemental magnesium) at bedtime. There are many good chelates to choose from. I usually take magnesium malate, but that's just me. If you take too much magnesium, it will cause diarrhea. Magnesium and Trileptal are the key elements in my magic sleep potion.
> Depakote is A #1 for my irritablity which is one of my main symptoms. I not thrilled about weight gain or PCOS (polycystic ovarian syndrome), not to mention worsening depression and not able to get my *ss out of bed in the morning! Do you have trouble rising in the morning on Trileptal?
So long as I'm not depressed, I jump right out of bed. On Depakote, I gained weight, lost hair, became depressed, and it caused other problems that I don't remember right off.
> I gave Lithium a trial this summer and had the driest, bad taste in my mouth and constipation. I felt pretty slammed on it. I gave it 2 weeks. I was taking a low dose of Lithobid I believe. I was still irritable and wouldn't increase the dose.
>
> You asked what my symptoms are. I am primarily BPII now but when I was younger I had a couple full blown manic episodes. My doctor has also diagnosed me as dysphoric and I supposedly have a personality disorder NOS (whatever).
>
> The mixed state and manic sypmtoms that are marked with a * are what I have constantly and have only responded to Depakote. The depressive sypmtoms have responded to Lamictal, although only in the beginning of treatment and maybe half the time now.
>
> I was on Depakote before Lamictal three years ago and until now had never considered combining the two.
>
> Mixed state symptoms:
> *Agitation
> *Irritablity
> Pressured speech
> *Hypersensitivity
> *Racing thoughts
> *Insomnia
> Paranoia
> Rage (suppressed, because ya know I'm a sweet girl really).Yes, I know you are, Sweetie.
> Manic symptoms:
> *Increased awareness
> Active and obssessed
> Agitation
> *Heightened perception
> Delusions
> Auditory hallucinations (very rarely, once every 3 months).
> *Thought disorder
> Inappropriate behaviour
> Poor judgemnentAmy, have you every tried a low dose of an antipsychotic? If so, what were your results? I'm not necessarily advocating an AP, just curious if you've ever tried one.
> Depressive sypmtoms:
> *Anger
> *Despair
> Hopeless
> Suicidal ideation
> *Crying spells
> Severe agitation
> *Increased appetite
> *Insomnia
> Sleep all the time
> *Sad
> Substance abuseAt my current Trileptal dosage (see below) in conjunction with my other mood stabilizers, my anger and irritability have virtually disappeared. My wife is particularly happy about this and she hopes that it lasts.
As I mentioned previously, if I could only figure out a solution to my periodic bouts of atypical depression, I'd be good to go. Currently, I'm able to chase away the depression demons (when they show up once every week-and-a-half or so) with a very low one-day dose (5 or 10 mg) of Adderall XR. However, I have a hunch that this pstim approach will stop working at some point. So I'm thinking about Selegiline or Parnate, but time will tell.
> Thanks for your support Ron.
You bet! I really want you to get better and have a good life. Nobody benefits when you are "Grumpy Girl".
-- RonBP II and OCPD
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal (level limited by rash)
5 or 10 mg Adderall XR prn to pull out of an atypical depressive episode; use rarely and only for one day per episode (more frequently causes "pstim burnout" symptoms)
poster:Ron Hill
thread:449685
URL: http://www.dr-bob.org/babble/20050207/msgs/455252.html