![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by JahL on March 3, 2001, at 10:31:22
The background: I have unremitting life-long depression characterized by DYSPHORIA, IRRITABILITY, ANXIETY & suicidality. 20+ meds has had little impact. Extensive interpersonal, group & cognitive-behavioural therapy (in both public & private settings) achieved nothing & was not a little insulting towards my intelligence. Systemized common sense. I taught myself everything therapy has to offer (me) by age 11.
Anyway I am not confident in my current dx (dysthymia+double depr.) & am pondering a possible BIPOLAR II DX. During my years of mistreatment I have noticed the following:
1/ First ever AD (Paxil) brought about the fabled miracle cure overnight. Over the next month my mood swung wildly (RAPID CYCLING?) btwn agitated depression & (never b4 experienced) euthymia. When this petered out, the introduction of Prozac brought about another short period of euthymia.
2/ The above remissions/relapses were induced by a circadian 'switch' (would wake up cured or relapsed-no inbtwn).
3/ Sub-therapeutic doses of Paxil & Celexa brought about hypomania (8 days of).
4/ All these events were precipitated by a REDUCTION in dose (v strong correlation).
5/ Every mood stabilzer (Zyprexa, Risperdal, VPA, Lamotrigine) save Lithium (indicated for classic BP I) has quickly eliminated suicidal ideation.
Also to be considered:
1/ *V* strong family history of this disorder.
2/ Have been diagnosed Social Phobic + ADD (high Bipolar co-morbidity)
3/ No mood reactivity.
4/ Have never related to depression per se, or to those suffering. No problems with self-esteem, tearfulness etc. Cannot understand illogical depressive thought constructs. My symptoms are akin to schiz. neg. symptoms; dysphoria.
I am not so much depressed as wholly dysfunctional.
5/ I have a volatile temper.
6/ Have always been considered intellectually 'gifted'
7/ THE CLINCHER: started on Lamotrigine 25 mgs 10 days ago & already my derealisation has improved, my intellectual powers are returning & well I feel a little *hypomanic* (last night posted as much as I have in my whole PB 'career'!) This is a v low dose to be feeling such effects!
Well, do I have a case for possible BP II dx, or have I already answered my own question?
Or is this stretching the BP spectrum too far?
(Sorry 4 length of ths; wanted to get my facts straight)All replies gratefully received (& may be used in my next pdoc meet)
ta,
Jah.
Posted by missinglynx on March 3, 2001, at 11:55:31
In reply to A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JahL on March 3, 2001, at 10:31:22
> The background: I have unremitting life-long depression characterized by DYSPHORIA, IRRITABILITY, ANXIETY & suicidality. 20+ meds has had little impact. Extensive interpersonal, group & cognitive-behavioural therapy (in both public & private settings) achieved nothing & was not a little insulting towards my intelligence. Systemized common sense. I taught myself everything therapy has to offer (me) by age 11.
>
> Anyway I am not confident in my current dx (dysthymia+double depr.) & am pondering a possible BIPOLAR II DX. During my years of mistreatment I have noticed the following:
>
> 1/ First ever AD (Paxil) brought about the fabled miracle cure overnight. Over the next month my mood swung wildly (RAPID CYCLING?) btwn agitated depression & (never b4 experienced) euthymia. When this petered out, the introduction of Prozac brought about another short period of euthymia.
>
> 2/ The above remissions/relapses were induced by a circadian 'switch' (would wake up cured or relapsed-no inbtwn).
>
> 3/ Sub-therapeutic doses of Paxil & Celexa brought about hypomania (8 days of).
>
> 4/ All these events were precipitated by a REDUCTION in dose (v strong correlation).
>
> 5/ Every mood stabilzer (Zyprexa, Risperdal, VPA, Lamotrigine) save Lithium (indicated for classic BP I) has quickly eliminated suicidal ideation.
>
> Also to be considered:
>
> 1/ *V* strong family history of this disorder.
>
> 2/ Have been diagnosed Social Phobic + ADD (high Bipolar co-morbidity)
>
> 3/ No mood reactivity.
>
> 4/ Have never related to depression per se, or to those suffering. No problems with self-esteem, tearfulness etc. Cannot understand illogical depressive thought constructs. My symptoms are akin to schiz. neg. symptoms; dysphoria.
>
> I am not so much depressed as wholly dysfunctional.
>
> 5/ I have a volatile temper.
>
> 6/ Have always been considered intellectually 'gifted'
>
> 7/ THE CLINCHER: started on Lamotrigine 25 mgs 10 days ago & already my derealisation has improved, my intellectual powers are returning & well I feel a little *hypomanic* (last night posted as much as I have in my whole PB 'career'!) This is a v low dose to be feeling such effects!
>
> Well, do I have a case for possible BP II dx, or have I already answered my own question?
> Or is this stretching the BP spectrum too far?
> (Sorry 4 length of ths; wanted to get my facts straight)
>
> All replies gratefully received (& may be used in my next pdoc meet)
> ta,
> Jah.
Hey hows it going Jah...yea you do seem like a brain,, hey Ive enjoyed your postings lately. Why do you consider this a bad "sign". The following advice is not advice,since you seem more evolved on Treatment then me. And your British LOL and I dont argue with the British (rule # 87 in my handbook) In my case I get aggatated when Im depressed, akin to angry internal dialogue. I think why does this person dress so stupidly, why are they so "cute" acting, why do they have alot of money.... etc. Anyhow I asked my Psychiatrist about Lithium for this type of mood reaction He said "do you know the side effects of Lithium. Alot of people have alot worse reactions to them then the SSRIs " NOt wanting to create "bad Blood" I sort of dropped it. Anyhow He was semiopen to trying Tranxene and I can say its GOOD... No nightmare side effects...People here take Klonipin with their SSRIs this is sort of the same principle > By the way what are you taking right now.? Didnt you say you couldnt get any creative therapy cuz the MDs in London are not allowed or unwilling to try innovative treatments? How do you like the Lamotrigine... Is it a keeper? anyhow I hope you solve this real quick,,, I know how stressful it is ! Take care
Posted by JahL on March 3, 2001, at 13:21:15
In reply to Re: A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by missinglynx on March 3, 2001, at 11:55:31
> > Hey hows it going Jah...yea you do seem like a brain,, hey Ive enjoyed your postings lately.Aw, shucks. (hi there)
> > Why do you consider this a bad "sign".
Not a 'bad' sign-there just seems a body of opinion that suggests a positive correlation btwn intense creativity/power of thought & Bipolar.
> >The following advice is not advice,since you seem more evolved on Treatment then me. And you're British LOL and I dont argue with the British (rule # 87 in my handbook)
Wise move! Pressures of shitty health-care system make us liable to flip @ any time.
> >In my case I get aggatated when Im depressed, akin to angry internal dialogue. I think why does this person dress so stupidly, why are they so "cute" acting, why do they have alot of money.... etc.
That's *exactly* it; I could talk myself into killing someone, & sorry to say, have been fairly close to doing so on one occasion (tho' wholly justified) Isn't it amazing how intolerant of people you (me) can feel, for trivial things like, as you say (!), the way others dress, talk or act.
> > Anyhow I asked my Psychiatrist about Lithium for this type of mood reaction He said "do you know the side effects of Lithium. Alot of people have alot worse reactions to them then the SSRIs " NOt wanting to create "bad Blood" I sort of dropped it.
For me Lithium had the worst effects of any drug; I could barely walk/talk. However as I said before, Lithium is generally indicated for classical manic-depression & not for the marked agitation/anxiety of BP II.
> > Anyhow He was semiopen to trying Tranxene
Whossat?
> >and I can say its GOOD... No nightmare side effects...People here take Klonipin with their SSRIs this is sort of the same principle
Good on ya! BTW I kinda like Klonopin (*another* anti-convulsant)-mildly relaxing.
> > By the way what are you taking right now.?
Just the Lamactil (25mg).
> >Didnt you say you couldnt get any creative therapy cuz the MDs in London are not allowed or unwilling to try innovative treatments?
Both. The NHS are terrified of litigation (it just can't finance US-style pay-outs) & because care is not consumer-driven, a culture of complacency is engendered amongst our pdocs Though yr health-care system is far from perfect (& I'm thinking of the unhealthy level of power hlth co.s wield), it's leagues ahead of our own, which suffers from chronic underinvestment.
> >How do you like the Lamotrigine... Is it a keeper?
I don't want to speak too soon but you know,I think it might be. It just feels so 'right', so early on. And on so low a dose. *No* side-effects as yet :^)))))
> >anyhow I hope you solve this real quick,,, I know how stressful it is ! Take care
Thanks. Aren't you a musclehead? Now my motivation's returning I can't wait to get back on the weights. Missing that endorphin high...
Jah.
Posted by Sulpicia on March 3, 2001, at 22:37:03
In reply to A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JahL on March 3, 2001, at 10:31:22
>Quite curriculum vitae there. I'm no *expert* with BP II but my daughter has it
and I've managed to keep her alive long enough to be treated and stabilize -- perhaps
this counts for something? Like you, she has ADD, and strong positive family history, me with
ADD and depression.
The hallmark of BP, either I or II IMHO is mania or hypomania set off by ADs. I'm a bit
concerned that lamictal has had such a dramatic effect on you. Mania is BIG
problem for people with bipolar and I would call the pdoc and report it.
Most of what you report is consistent with BP but the depression is a bit odd. I fully
realize that psychological states are wholly subjective, and twice so when the pdoc puts
a label on them, but in my personal experience, whatever the manifestation[s] of depression,
whether hypersomnia or insomnia or eating or whatever, it is distressing to experience.
I'm afraid I don't really have anything insightful to add here.
I hope the lamictal works out for you. It's saved my daughter's life by lifting her depression.
S.
Posted by kate9999 on March 4, 2001, at 3:54:03
In reply to A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JahL on March 3, 2001, at 10:31:22
Does the diagnosis really matter? The more relevant question is - can you benefit from a mood stabilizer? It sounds like it's very worth a shot. A strong family history of bipolar disorder alone would suggest that.
> The background: I have unremitting life-long depression characterized by DYSPHORIA, IRRITABILITY, ANXIETY & suicidality. 20+ meds has had little impact. Extensive interpersonal, group & cognitive-behavioural therapy (in both public & private settings) achieved nothing & was not a little insulting towards my intelligence. Systemized common sense. I taught myself everything therapy has to offer (me) by age 11.
> Anyway I am not confident in my current dx (dysthymia+double depr.) & am pondering a possible BIPOLAR II DX. During my years of mistreatment I have noticed the following:
>
> 1/ First ever AD (Paxil) brought about the fabled miracle cure overnight. Over the next month my mood swung wildly (RAPID CYCLING?) btwn agitated depression & (never b4 experienced) euthymia. When this petered out, the introduction of Prozac brought about another short period of euthymia.
>
> 2/ The above remissions/relapses were induced by a circadian 'switch' (would wake up cured or relapsed-no inbtwn).
>
> 3/ Sub-therapeutic doses of Paxil & Celexa brought about hypomania (8 days of).
>
> 4/ All these events were precipitated by a REDUCTION in dose (v strong correlation).
>
> 5/ Every mood stabilzer (Zyprexa, Risperdal, VPA, Lamotrigine) save Lithium (indicated for classic BP I) has quickly eliminated suicidal ideation.
>
> Also to be considered:
>
> 1/ *V* strong family history of this disorder.
>
> 2/ Have been diagnosed Social Phobic + ADD (high Bipolar co-morbidity)
>
> 3/ No mood reactivity.
>
> 4/ Have never related to depression per se, or to those suffering. No problems with self-esteem, tearfulness etc. Cannot understand illogical depressive thought constructs. My symptoms are akin to schiz. neg. symptoms; dysphoria.
>
> I am not so much depressed as wholly dysfunctional.
>
> 5/ I have a volatile temper.
>
> 6/ Have always been considered intellectually 'gifted'
>
> 7/ THE CLINCHER: started on Lamotrigine 25 mgs 10 days ago & already my derealisation has improved, my intellectual powers are returning & well I feel a little *hypomanic* (last night posted as much as I have in my whole PB 'career'!) This is a v low dose to be feeling such effects!
>
> Well, do I have a case for possible BP II dx, or have I already answered my own question?
> Or is this stretching the BP spectrum too far?
> (Sorry 4 length of ths; wanted to get my facts straight)
>
> All replies gratefully received (& may be used in my next pdoc meet)
> ta,
> Jah.
Posted by JohnL on March 4, 2001, at 4:14:08
In reply to A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JahL on March 3, 2001, at 10:31:22
Hi,
I'm glad the Lamictal looks promising so far. You have my best wishes that it will continue! Fingers crossed. Like you, I've experienced many drug trials. I know how that goes.Anyway, I just wanted to put in my two cents. In my experience, the actual diagnosis is important when the patient first seeks treatment, because it helps to narrow down drug choices. However, after three or so drugs have not yielded satisfactory results, I think any diagnosis can be thrown out the window. The more drugs that are tried and failed, the more useless a diagnosis becomes.
There are at least ten general categories of different types of chemical imbalances. Any one of them can cause symptoms identical to another. It becomes more important, in my mind, to sample drugs from totally different classes to increase the odds of hitting the right chemical imbalance. Sooner or later the patient always discovers by accident a drug they really like. Actually, if it is done in an organized manner, it is no accident. In short, I find the actual diagnosis very limited when it comes to drug choice. The best method is to actually try different drugs just for short times.
As an example, one doctor kept records of which medications gave excellent long lasting results for treating anxiety. Everything worked, though it varied from patient to patient. Some patients did very well on SSRIs. With other it was benzos. Others found antipsychotics worked best. Some found Tegretol or Depakote best. Some found beta blockers best. Some experienced robust results in just one day on Lithium. Lithium has no clinical justification for a diagnosis of anxiety. But it worked completely anyway. The diagnosis in all these cases was useless. Sampling different drugs was the only way to discover the ones that really worked, especially when the sampling included drugs that had no clinical justification for the diagnosis.
All too often I think we get caught up in a diagnosis and focus on too few drugs because of it.
John
Posted by JahL on March 4, 2001, at 10:34:54
In reply to Re: A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by kate9999 on March 4, 2001, at 3:54:03
> >Does the diagnosis really matter? The more relevant question is - can you benefit from a mood stabilizer? It sounds like it's very worth a shot. A strong family history of bipolar disorder alone would suggest that.
I'm not interested in a dx for its own sake; personally I couldn't give a toss what my condition is called so long as it ceases to affect me. I am not seeking advice for the purposes of treatment; that is well in hand.
My interest in receiving a correct dx is for the purpose of explaining to any prospective university board or employer, my relative inactivity over the past 9 years. A dx of Dysthymia (ie *mild* depression) does not explain why I've never held down a job, or why I dropped out of college/university 5yrs out of 7 (!). A dx of Bipolar, an altogether more serious disorder, & more likely to explain the levels of dysfunction I suffer from, does.
A dx of Bipolar also vindicates my feeling that I have been comprehensively mistreated; you don't continue to feed someone ADs 4 3 yrs if their first AD induces clear rapid cycling/hypomania, and you certainly don't *insist* on irrelevant psychotherapy which winds up costing the patient $10,000 (!?!).
If I can prove my case, my GP will be obliged to set out the details of the misdiagnosis & subsequent mistreatment (which has sent me spiralling into a suicidal/incapacitating depression), *all* of which was against my better judgement @ the time (& I stated so). This would put my (excuse 4 a) CV in a better light....
Jah.
Posted by JahL on March 4, 2001, at 10:59:38
In reply to Re: A BIPOLAR (II) EXPERT *PLEASE* (longish) » JahL, posted by Sulpicia on March 3, 2001, at 22:37:03
> >Quite curriculum vitae there.
Yeah, I'm coming across a bit a serious, aren't I :) , but I *am* seriously p*ssed off that ludicrously inept UK pdocs are allowed to continue praticing.
> >I'm no *expert* with BP II but my daughter has it and I've managed to keep her alive long enough to be treated and stabilize -- perhaps this counts for something? Like you, she has ADD, and strong positive family history, me with ADD and depression.
> > The hallmark of BP, either I or II IMHO is mania or hypomania set off by ADs.That kinda answers my original Q, doesn't it?
> >I'm a bit concerned that lamictal has had such a dramatic effect on you. Mania is BIG problem for people with bipolar and I would call the pdoc and report it.
Not *hypomanic 2day (damn!) but yeah, it's something to watch. I don't think I'm susceptible to full-blown mania; but I'll be careful to raise the dose v. slowly (12.5mg increments).
> > Most of what you report is consistent with BP but the depression is a bit odd.
Hmm. Everyrthing I've read describes BP II depression as dysphoric in nature, characterised by agitation/anxiety/irritability (ie ME), not all all like classical depression. Never been 'sad'.
> >I fully realize that psychological states are wholly subjective, and twice so when the pdoc puts a label on them, but in my personal experience, whatever the manifestation[s] of depression, whether hypersomnia or insomnia or eating or whatever, it is distressing to experience. I'm afraid I don't really have anything insightful to add here. I hope the lamictal works out for you. It's saved my daughter's life by lifting her depression.
> S.I remember following that crisis; sounded like a tough job. I take it the rash behaved itself this time?
Ta,
Jah.
Posted by JahL on March 4, 2001, at 11:22:07
In reply to Re: A BIPOLAR (II) EXPERT *PLEASE* (longish), posted by JohnL on March 4, 2001, at 4:14:08
> > Hi,
> > I'm glad the Lamictal looks promising so far. You have my best wishes that it will continue! Fingers crossed. Like you, I've experienced many drug trials. I know how that goes.Hi John.
Thankya!> > Anyway, I just wanted to put in my two cents. In my experience, the actual diagnosis is important when the patient first seeks treatment, because it helps to narrow down drug choices. However, after three or so drugs have not yielded satisfactory results, I think any diagnosis can be thrown out the window. The more drugs that are tried and failed, the more useless a diagnosis becomes.
> > There are at least ten general categories of different types of chemical imbalances. Any one of them can cause symptoms identical to another. It becomes more important, in my mind, to sample drugs from totally different classes to increase the odds of hitting the right chemical imbalance. Sooner or later the patient always discovers by accident a drug they really like. Actually, if it is done in an organized manner, it is no accident. In short, I find the actual diagnosis very limited when it comes to drug choice. The best method is to actually try different drugs just for short times.My most robust reactions were to anti-psychotics (ie DA) & funnily enough (or not, as the pdoc below would claim) Lamactil is posited to act on dopamine.
> As an example, one doctor kept records of which medications gave excellent long lasting results for treating anxiety. Everything worked, though it varied from patient to patient. Some patients did very well on SSRIs. With other it was benzos. Others found antipsychotics worked best. Some found Tegretol or Depakote best. Some found beta blockers best. Some experienced robust results in just one day on Lithium. Lithium has no clinical justification for a diagnosis of anxiety. But it worked completely anyway. The diagnosis in all these cases was useless. Sampling different drugs was the only way to discover the ones that really worked, especially when the sampling included drugs that had no clinical justification for the diagnosis.
I agree. The dx shld help lead to prospective meds of all kinds, rather than cornering the patient within a single class of meds. I think I know the pdoc you are referring to personally. Like you I think he's an excellent psychopharmacologist, with a good 'feel' for meds & their properties. His methodology is not nearly so rigid as some people seem to believe.
> > All too often I think we get caught up in a diagnosis and focus on too few drugs because of it.
> JohnAs I said in another post, I'm only interested in a dx in as far as it could help explain to others why I've sat on my a*se for 9 yrs.
Ta,
Jah.
Posted by JahL on March 4, 2001, at 13:10:00
In reply to Re: A BIPOLAR (II) EXPERT *PLEASE* (longish) » Sulpicia, posted by JahL on March 4, 2001, at 10:59:38
> > >I'm a bit concerned that lamictal has had such a dramatic effect on you. Mania is BIG problem for people with bipolar and I would call the pdoc and report it.
> Not *hypomanic 2day (damn!) but yeah, it's something to watch. I don't think I'm susceptible to full-blown mania; but I'll be careful to raise the dose v. slowly (12.5mg increments).Spoke too soon. Split the dose today as the hypomania seemed to be related to the dosing. Took 2nd half of pill & BOOM, I'm up again. Kinda like comin' up on E. I'm not complaining ;O).
Think I'll e-mail my pdoc tho'...
J
Posted by Cece on March 4, 2001, at 16:44:07
In reply to Spoke too soon..., posted by JahL on March 4, 2001, at 13:10:00
Hello-
I'm BP II (although that was dx long time ago, and I think it's not quite so reducable), have tried many meds over years- some helped and pooped out, others kept helping and with dosage finessing have stayed in my mix (long list), others never worked or had intolerable SE- common story!
I started Lamictal last year, on a very slow dosing- see my previous post on "Lamictal dosing" if you're interested, and got immediate benefit for my low energy brain fog depression, which continued as I very slowly increased, although less dramatically than at start. But, I am also taking other meds that help balance the potentially over-activating effects of Lamictal- I think what is probably helping the most in that regard is Neurontin. I have also continued to take Depakote since beginning tx 8 yrs ago- now at a low dose 250mg/day, which is calming for me (too much sedation at higher dose), so may also be helping to balance (Depakote doubles the effect of Lamictal so has to be carefully combined). In addition, I take a tiny (now down to .0625mg/day) of clonazepam- another possible factor.
So I'm wondering why you are only on the one med? Is layering meds not done in UK? I just can't imagine, for myself, given my experience to date, that one med by itself is ever going to keep me anywhere close to center.
Good luck,
Cece
Posted by JahL on March 4, 2001, at 17:25:46
In reply to Re: Spoke too soon... » JahL, posted by Cece on March 4, 2001, at 16:44:07
> > I'm BP II (although that was dx long time ago, and I think it's not quite so reducable), have tried many meds over years- some helped and pooped out, others kept helping and with dosage finessing have stayed in my mix (long list), others never worked or had intolerable SE- common story!> >I started Lamictal last year, on a very slow dosing- see my previous post on "Lamictal dosing" if you're interested, and got immediate benefit for my low energy brain fog depression
*Exactly* my experience; dramatically improved ability to write etc.
> >, which continued as I very slowly increased, although less dramatically than at start. But, I am also taking other meds that help balance the potentially over-activating effects of Lamictal- I think what is probably helping the most in that regard is Neurontin. I have also continued to take Depakote since beginning tx 8 yrs ago- now at a low dose 250mg/day, which is calming for me (too much sedation at higher dose), so may also be helping to balance (Depakote doubles the effect of Lamictal so has to be carefully combined). In addition, I take a tiny (now down to .0625mg/day) of clonazepam- another possible factor.
Thanks Cece, this makes a lot of sense. The Lamactil is a little over-activating. Funnily enough, I just e-mailed my pdoc suggesting that we add Neurontin @ some point to 'anchor' the Lamactil. I don't mind the idea of Depakote either; I've just done a 2 month trial & it was mildly helpful. I take Clonazepam 4 sleep.
> > So I'm wondering why you are only on the one med? Is layering meds not done in UK? I just can't imagine, for myself, given my experience to date, that one med by itself is ever going to keep me anywhere close to center.See 'UKpdocs' posts above. Monotherapy=onlytherapy in UK.
I have done the sensible thing & got myself a US pdoc. He likes to add meds one by one in order to ascertain what's doing what.
I think you're right; I can see myself 'overshooting' with Lamactil alone.Ta,
Jah.
Posted by Noa on March 5, 2001, at 8:18:59
In reply to Spoke too soon..., posted by JahL on March 4, 2001, at 13:10:00
> >Kinda like comin' up on E. I'm not complaining ;O).
One thing to think about: It is my impression, from reading anecdotes here, that a history of using street drugs, especially something like Ecstacy, can have an effect on mood and on response to medications, something to discuss with the pdoc.
Posted by phillybob on March 8, 2001, at 20:37:11
In reply to Re: Spoke too soon... » Cece, posted by JahL on March 4, 2001, at 17:25:46
I have read your info Cece and thanks for it ... and, Jah, I am also sharing your trial (in a way)!
Upon recently ending a successful and yet sadly unsuccessful [check out my topamax experiences' last post: http://www.dr-bob.org/babble/20010302/msgs/55563.html] trial with a different neuromodular drug, topiramate, I have, after a week plus off, started Lamictal too at 12.5 mgs/day as monotherapy for my BPII rapid cycling dysthymic-type condition (all of the details, again, are in my posts in the topamax thread).
So far, for the past 4 days, I've already felt some mild improvement (somewhat consistent in depression-lifting but not in energy level). Only side-effect so far was a (provoked) laughing fit which I could not seem to shake. It was definitely a giddiness which I am not inclined to have so I will attribute it to the med.
I'll keep watching (as is my pdoc) for signs of (hypo)mania. Intention is to keep at 12.5 mgs/day for another week and a half to see what happens. (as I'm hugely sensitive to meds, in general, I am not expecting to need too much but we'll see, huh?). If I become too semi-permanently giddy, I'll think of adding topamax (anew) or neurontin.
Keep posting, Jah! I feel a kinship in a lot of ways.
Posted by JahL on March 9, 2001, at 9:29:17
In reply to current Lamictal trials in action, posted by phillybob on March 8, 2001, at 20:37:11
> > I have read your info Cece and thanks for it ... and, Jah, I am also sharing your trial (in a way)!
> > Upon recently ending a successful and yet sadly unsuccessful [check out my topamax experiences' last post: http://www.dr-bob.org/babble/20010302/msgs/55563.html] trial with a different neuromodular drug, topiramate, I have, after a week plus off, started Lamictal too at 12.5 mgs/day as monotherapy for my BPII rapid cycling dysthymic-type condition (all of the details, again, are in my posts in the topamax thread).Howdy, fellow Lamactil inductee!
I remember following yr Topiramate trial & thinking @ the time that Lamactil would be a better choice considering the chronic depression angle (as with myself). Apathy prevented me from posting my thoughts (not so amotivated on Lamactil)!> > So far, for the past 4 days, I've already felt some mild improvement (somewhat consistent in depression-lifting but not in energy level). Only side-effect so far was a (provoked) laughing fit which I could not seem to shake. It was definitely a giddiness which I am not inclined to have so I will attribute it to the med.
Benefits made themselves apparent soon after titration to 25mgs. Most dramatic has been the improvement in cognitive functioning & the near-elimination of social phobia (to the point where I have stopped taking Sulpiride-my S.phobia. med of the last yr). I think the true AD properties kick in @ higher doses (usually 100-200mg), although I have a feeling you & I might get away with less! Like you, my 'energy levels' haven't improved yet.
> > I'll keep watching (as is my pdoc) for signs of (hypo)mania. Intention is to keep at 12.5 mgs/day for another week and a half to see what happens. (as I'm hugely sensitive to meds, in general, I am not expecting to need too much but we'll see, huh?). If I become too semi-permanently giddy, I'll think of adding topamax (anew) or neurontin.
I too am taking it slow. 12.5mg increase/week. Unless you're desperately depressed this is probably a prudent measure; IMO (fwiw) Lamactil is potentially too good a drug to miss out on through impatience.
> > Keep posting, Jah! I feel a kinship in a lot of ways.
DITTO!
Jah.
Posted by phillybob on March 19, 2001, at 18:42:25
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on March 9, 2001, at 9:29:17
So, Jah, how does it go?
I've been up to 25 mg/day for almost a week and the verdict is still out. It sure beats nothing, though! Starting to get a few things done again. Since I am very sensitive, I am still going to take it very slow. I am thinking I may not even get up to 50 mg/day. I do think, in hindsight, with so many of my other medications trials, that the amounts taken (usually the recommended, sometimes more) were too much for me. We shall see. P.S. It's still monotherapy on my end.
Posted by JahL on March 21, 2001, at 16:48:45
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on March 19, 2001, at 18:42:25
> > So, Jah, how does it go?
(hi Bob)
Frustrating. No great advance upon the improvements (in cognition, co-ordination & s. phobia) I reported previously, though it's unrealistic (going by what I've read) to expect my current dose (67.5mg) to deliver the kind of results that doses of btwn 100 & 200+mg seem to.The tortuously slow dose ramping is starting to wind me up; I'm considering jumping 12.5mg every 5 days instead of 7. The worry is of course that I'll invoke the rash & have to start all over again!
Only side-effect I've noticed is slight GI discomfort.
Whatever happens tho', I'm already impressed enough w/Lamictal to keep it on board.
Keep us posted & stick with it!
Jah.
~
> > I've been up to 25 mg/day for almost a week and the verdict is still out. It sure beats nothing, though! Starting to get a few things done again. Since I am very sensitive, I am still going to take it very slow. I am thinking I may not even get up to 50 mg/day. I do think, in hindsight, with so many of my other medications trials, that the amounts taken (usually the recommended, sometimes more) were too much for me. We shall see.> > P.S. It's still monotherapy on my end.
(Me also.)
Posted by phillybob on March 21, 2001, at 19:57:04
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on March 21, 2001, at 16:48:45
Hey, Jah, hang in there, Friday's coming (a 70's expression, I believe). Friday'll be euthymia, for our purposes.
As far as titration, last week my pdoc explained how it would probably be okay to increase a bit faster because once past the beginning period, increases in dosage become a smaller percentage of the whole that one is taking.
In other words, in the beginning, a jump from 12.5 mg to 25 mg is a 100% increase. 25 mg to 50 mg is likewise a 100% increase. But, 50 mg to 75 mg then becomes just a 50% increase and 75 mg to 100 mg becomes a smaller 33% increase, etc., etc.
I also read somewhere that the first month is most important so that the body can acclimate to the drug. Once getting through that first month of adjustment, the likelihood of developing the rash is quite small. So, I've read, at least.
Nonetheless, I met with the pdoc tonight, and I'm gonna sally forward with a 12.5 mg/day increase some time this weekend for a total of 37.5 mg/day. I am going to split the dosage, for now. 25 mg then 12.5 mg later.
The pdoc has also more or less given the thumbs up to increase that to a total of 50 mg/day a bit quicker than we had been going, and then hang out there for a bit.
Yep, it's frustrating, this patience thang. I find that the not complete positive effects that I have kind of wear off by the afternoon. Perhaps, the higher doses will make it last for the day and perchance make me all better. Patience.
Posted by Bob on March 21, 2001, at 21:50:29
In reply to Re: current Lamictal trials in action, posted by phillybob on March 21, 2001, at 19:57:04
> Hey, Jah, hang in there, Friday's coming (a 70's expression, I believe). Friday'll be euthymia, for our purposes.
>
> As far as titration, last week my pdoc explained how it would probably be okay to increase a bit faster because once past the beginning period, increases in dosage become a smaller percentage of the whole that one is taking.
>
> In other words, in the beginning, a jump from 12.5 mg to 25 mg is a 100% increase. 25 mg to 50 mg is likewise a 100% increase. But, 50 mg to 75 mg then becomes just a 50% increase and 75 mg to 100 mg becomes a smaller 33% increase, etc., etc.
>
> I also read somewhere that the first month is most important so that the body can acclimate to the drug. Once getting through that first month of adjustment, the likelihood of developing the rash is quite small. So, I've read, at least.
>
> Nonetheless, I met with the pdoc tonight, and I'm gonna sally forward with a 12.5 mg/day increase some time this weekend for a total of 37.5 mg/day. I am going to split the dosage, for now. 25 mg then 12.5 mg later.
>
> The pdoc has also more or less given the thumbs up to increase that to a total of 50 mg/day a bit quicker than we had been going, and then hang out there for a bit.
>
> Yep, it's frustrating, this patience thang. I find that the not complete positive effects that I have kind of wear off by the afternoon. Perhaps, the higher doses will make it last for the day and perchance make me all better. Patience.***********
Hey phillybob! It's Bob from the Topomax thread.
I was just hoping that if this Lamictal thread has a long and prosperous life like like the Topo one, that comparisons will begin to be drawn between the two as relative therapeutic effects.
Just a thought. It doesn't sound like any of you guys on this thread for Lamictal are ready for that yet though, as you guys still seem to be trying to reach adequate doses.
Bob
Posted by JahL on March 22, 2001, at 13:36:08
In reply to Re: current Lamictal trials in action, posted by phillybob on March 21, 2001, at 19:57:04
> > As far as titration, last week my pdoc explained how it would probably be okay to increase a bit faster because once past the beginning period, increases in dosage become a smaller percentage of the whole that one is taking.
> > In other words, in the beginning, a jump from 12.5 mg to 25 mg is a 100% increase. 25 mg to 50 mg is likewise a 100% increase. But, 50 mg to 75 mg then becomes just a 50% increase and 75 mg to 100 mg becomes a smaller 33% increase, etc., etc.Thanks Bob, that makes a lot of sense.
> > I also read somewhere that the first month is most important so that the body can acclimate to the drug. Once getting through that first month of adjustment, the likelihood of developing the rash is quite small. So, I've read, at least.
Yeah, the general consensus seems to be that the first couple of months are the most critical.
I'll probally hit 75mg, & stay there for a week before making the jump to the magic figure of 100mg.
> > Nonetheless, I met with the pdoc tonight, and I'm gonna sally forward with a 12.5 mg/day increase some time this weekend for a total of 37.5 mg/day. I am going to split the dosage, for now. 25 mg then 12.5 mg later.
> > The pdoc has also more or less given the thumbs up to increase that to a total of 50 mg/day a bit quicker than we had been going, and then hang out there for a bit.
> > Yep, it's frustrating, this patience thang. I find that the not complete positive effects that I have kind of wear off by the afternoon. Perhaps, the higher doses will make it last for the day and perchance make me all better. Patience.I too am finding the response a little erratic (& am p*ssed off the hypomania's stopped!), but like youself, am expecting a more consistent, robust response @ more 'therapeutic' levels (I think the definitive Lamotrigine study 4 rapid-cyclers showed around *3 times* the reponse @ 200mg, compared with a 50mg dose).
I think Lamotrigine is split @ higher doses, so this may help with the afternoon 'dip'.
J.
Posted by Lexie on March 24, 2001, at 19:27:15
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on March 22, 2001, at 13:36:08
Well, you have all heard me brag on my pdoc, he has had me taking Topamax 400 mgs. almost one year now with Lamictal 500 mgs. Never any side effects to mention. I was doing so well I took it on myself to stop the lamictal, didn't think I needed it. Guess I was wrong. When I went back to see the doc he decided he would rather I try Gideon with the topamax. I did, it nearly killed me, nasua, fatigue etc.., When I called him he didn't want to give up on the Gideon. He wanted me to continue! What is up with this? I want my Lamictal? He even said eventually he wants to take me off the Topamax. So what's the scoop? Did Dr. Wonderful find out something not so wonderful about these drugs he is not telling me? Have any of you heard what is supposta be so wonderful about Gideon? Those 500 mgs. of Lamictal are looking pretty good right about now, I am not going anywhere near that Gideon "Poison"!!!!!! Lexie
Posted by JahL on March 24, 2001, at 19:50:59
In reply to It's Lexie the Lamictal/Topamax Poster Child, posted by Lexie on March 24, 2001, at 19:27:15
> >Well, you have all heard me brag on my pdoc, he has had me taking Topamax 400 mgs. almost one year now with Lamictal 500 mgs. Never any side effects to mention. I was doing so well I took it on myself to stop the lamictal, didn't think I needed it. Guess I was wrong. When I went back to see the doc he decided he would rather I try Gideon [do you mean Geodon?] with the topamax. I did, it nearly killed me, nasua, fatigue etc.., When I called him he didn't want to give up on the Gideon. He wanted me to continue! What is up with this? I want my Lamictal?
Sounds like you need it!
> > He even said eventually he wants to take me off the Topamax. So what's the scoop? Did Dr. Wonderful find out something not so wonderful about these drugs he is not telling me? Have any of you heard what is supposta be so wonderful about Gideon?
Zyprexa w/o the weight gain?
> >Those 500 mgs. of Lamictal are looking pretty good right about now, I am not going anywhere near that Gideon "Poison"!!!!!! Lexie
The only really worrying thing I've read about Lamotrigine is its melanin-binding properties, which mean it could theoretically accumulate in the eyes longterm, possibly causing damage (!) However this aspect was reviewed during trials & nothing significant showed up (over a yr I think).
Having read some of yr previous posts, I too wonder why yr pdoc won't put you back on Lamictal. If it ain't broke, why fix it?
J.
Posted by phillybob on April 3, 2001, at 22:43:55
In reply to Re: It's Lexie the Lamictal/Topamax Poster Child » Lexie, posted by JahL on March 24, 2001, at 19:50:59
Okay, Jah, what gives?
I'm not doin' so hot here (no side effects but no improvement). Slowly I titrate. I'm at 50 mg but seem to be so down and out that I'm not even excited 'bout the next jump up ... which I should be doin' to 75 mg tomorrow or the next day or the next (I have to look at a calendar). Okay, now I'm gonna cut and paste from a recent more clear-headed post of mine cause I'm feelin' lazy (but first, I'm gonna hypothesize in this here parenthetical that I'm getting a cold which is why I am so cranky and unproductive ... at least, that hypothesis makes me feel a little better) ...
I've added 5 mg/2X daily of Adderall after some thinkin' about my past experiences and recently talkin' with the younger bro about his experiences. I definitely have always had ADD problems but never got past a Ritalin trial, for some reason. I remember reading John L's concise analysis and discussion of "line of fire" approaches, including benign and fast-acting stimulants ( http://www.dr-bob.org/babble/20000209/msgs/20873.html ). Anyway, the pdoc and I discussed Adderall and Dexadrine and felt, based upon my bro's success, Adderall would be worth a trial right now.
Nonetheless, based upon my brief (almost 2 months) but "total" "cure" for my symptoms (atypical-type AD-treatment-resistent depression ... an oxymoron?) with Topamax, I think this class of "neuromodulatory" drugs would have good long-term efficacy for me. [From the Topamax Experiences thread ( http://www.dr-bob.org/babble/20001231/msgs/50878.html ), I discontinued Topamax due to a bad side effect of receding gums; however, I would certainly re-visit it at a lower dose in the future as an adjunct for a partial or in lieu of a failed Lamictal response.
Okay, I'm done with re-cycling posts for now. So tell us, Jah, what have you been up to lamictally-speaking?
Posted by katrina on April 5, 2001, at 9:14:55
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on April 3, 2001, at 22:43:55
I am in my second week on lamictal and up to 50 mgs. I find it helps stabilize my mood; I seem more even keel.
Posted by JahL on April 5, 2001, at 12:18:31
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on April 3, 2001, at 22:43:55
> > Okay, Jah, what gives?
> > I'm not doin' so hot here (no side effects but no improvement). Slowly I titrate. I'm at 50 mg but seem to be so down and out that I'm not even excited 'bout the next jump up ... which I should be doin' to 75 mg tomorrow or the next day or the next (I have to look at a calendar). Okay, now I'm gonna cut and paste from a recent more clear-headed post of mine cause I'm feelin' lazy (but first, I'm gonna hypothesize in this here parenthetical that I'm getting a cold which is why I am so cranky and unproductive ... at least, that hypothesis makes me feel a little better) ...> >So tell us, Jah, what have you been up to lamictally-speaking?
'Bout the same as you Bob. Tho' it's keeping my head above water, I feel only marginally better than when unmedicated (but @ least I'm not obsessively suicidal). Delayed delivery of most recent refill means I've been loitering @ 75mg for a couple of weeks; today I'm up to 100! Unfortunately most of the start-up benefits have dissipated, tho' according to Scott's TRD post above, this would seem to be par for the course.
On a more positive note, the fact that we share a lack of response is probably down to our low dosing. I'm yet to read of a sub-150mg robust response.
I think it's time to accelerate (my) upwards titration (with yr previous reasoning as to why this is OK in mind), tho' I'm pleased to have taken it so slowly thus far. To begin with, 75mg promoted noticable 'itching' of the skin (kinda like sunburn), which seems to have faded w/o progressing into anything more worrying.
Like you I have ADD-like probs (in fact have US dx, but I'm not so sure; I think they're just a symptom peculiar to my form of depression) & have tried all the available stims to absolutely no effect.
I sense a note of frustration in yr post; believe me, you're not alone. I'm kinda used to waiting 2 or 3 weeks 4 a result, not 3 months (& then there's no guarantee)! I think some of my frustration has crept into a couple of my posts recently, so I'm consciously avoiding anything remotely controversial on this board for now;-)
Anyway, chin up (focus on 150-200mg?) & I'll keep ya posted.
Jah.
BTW did you know Lamictal depletes folate concentrations? Supplementation is rec'd.
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