![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 133. Go back in thread:
Posted by JahL on March 9, 2001, at 19:59:34
In reply to Re: treatment resistant depression, posted by sweetmarie on March 9, 2001, at 17:32:20
> I would like to really thank all that have replied to my post. It certainly seems that I am NOT the freak I thought I was. I am encouraged by what I have heard re. Lamotragine (although I have developed quite a noticeable rash on my arms, which is stated as a possible side effect of this medication, so I`m assuming that the Lamotragine is the cause; I`m not sure what to do about this - any ideas? has anyone else experienced this?). Anyway, I`ll have to wait and see ...Like phillybob says, the rash is cause for concern. The Lamotrigine PDF says to discontinue Lamot. immediately upon appearance of a rash. CamW, Sunnely et al can better explain, but there are potenially serious implications here, not least of which is the the potentially fatal Stevens-Johnson (sp?) Syndrome. The PDF warns that rashes *could* result in permanent skin blemishes.
Don't freak out, but keep an eye on the rash & speak to someone knowlegable about Lamotrigine specifically ASAP. Plenty of people have continued to take Lamot. only for the rash 2 disappear w/o trace, but you *must* get it checked out (IMO).
Good Luck,
J.
Posted by steve on March 9, 2001, at 21:52:50
In reply to Re: treatment resistant depression » steve, posted by JahL on March 9, 2001, at 16:56:55
The sad thing is that there are credible epidemiological estimates putting the number of deaths due to ssri activation at roughly 50,000. Atypicals rarely if ever kill themselves, but melancholics do, particularly when overstimulated.
As for finding competent doctors, in my experience that has been pretty hard. If you want a good critique of the dangers and untold side-effects of psychotropics, www.skepticalpsych.com or Breggin's "Your med might be your problem" are great places to start reading. I don't agree with their absolute hostility to bio psychiatry, which isn't factual, but reading about all the shenanigans, ignorance and outright lies made by paid for researchers certainly was an eye-opener.
S.
> Steve. On this one I am COMPLETELY in agreement with you (makes a change, huh?). I fit yr description of 'melancholic depressive' and found that the SSRIs, Nardil etc did indeed worsen my depression (pdocs insisted that ADs *couldn't* exacerbate depression-how ignorant can you get? Can you see why I've practically given up on them?), specifically by making me more agitated.
>
> As your pdoc predicts, Lamotrigine has been by far the best drug so far & it's still early days.
>
> Jah.
>
Posted by sweetmarie on March 10, 2001, at 6:22:05
In reply to Re: treatment resistant depression » sweetmarie, posted by phillybob on March 9, 2001, at 19:53:59
> Okay, sweetmarie, I did not want to alarm you but I thought you were in a hospital setting. Please read the following quote from Dr. Ivan Goldberg's depression central ( http://www.psycom.net/depression.central.lamotrigine.html ):
>
> "14. Which side-effects are severe enough to force people to discontinue lamotrigine?
>
> The side-effect of lamotrigine that most often causes the drug to be discontinued is a rash. Rashes can be mild, similar to a slight sunburn, or can be quite severe resembling a severe case of poison-ivy. The more severe the rash the less likely it is that the individual will be able to continue the medication. ALL rashes should be reported to the physicians prescribing the lamotrigine.
>
> A rash is more likely to develop when the initial doses of lamotrigine are high or when lamotrigine is too rapidly started when someone is taking valproate.
>
> It is important that people taking lamotrigine who develop a rash immediately contact their physician as there have been a few deaths in people who have developed lamotrigine-induced rashes."
>
> I think the name of the deadly rash problem is Steven-Johnson's Syndrome. It does not seem that your prescribing doc is aware of this? How much of an increase in dosage has he/she prescribed for you?
>
> Again, best wishes.The rash is similar to a `dry skin rash`, of the kind I have always had on my upper arms, except now it`s got worse and is more noticeable. It`s interesting that you make the Vaproate connection, as I am also taking this. However, I am coming off this - slowly decreasing the dosage until I come off altogether. Possibly this will help. I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there).
sweetmarie
Posted by phillybob on March 10, 2001, at 10:37:37
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 6:22:05
< I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there). >
If you are NOT going into the hospital today or tomorrow, please inform a professional of your rash as it can lead to most unfortunate consequences (even death).
Also, to help us (those, like myself, beginning lamictal therapy) understand what factors may have contributed to causing the rash:
(1) How much of lamotrigine are you taking and what was the rate of increase in dosage?
and, (2) How much valproate have you been taking along with the lamotrigine?
Thanks for your input, sweetmarie, and I hope your rash ends up being nothing bad after all.
Posted by sweetmarie on March 10, 2001, at 13:13:55
In reply to Re: treatment resistant depression , posted by phillybob on March 10, 2001, at 10:37:37
> < I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there). >
>
> If you are NOT going into the hospital today or tomorrow, please inform a professional of your rash as it can lead to most unfortunate consequences (even death).
>
> Also, to help us (those, like myself, beginning lamictal therapy) understand what factors may have contributed to causing the rash:
>
> (1) How much of lamotrigine are you taking and what was the rate of increase in dosage?
>
> and, (2) How much valproate have you been taking along with the lamotrigine?
>
> Thanks for your input, sweetmarie, and I hope your rash ends up being nothing bad after all.Phillybob, over the past year I have been taking 25 mg of Lamotragine plus 1000 mg of Valproate. My psychiatrist - on instruction from the specialist I saw (and will subsequently be `under` during my hospital stay) put the dosage up from this (25 mg) to 100 mg, with the aim of increasing it to 250 mg. I was taking the 100 mg for a week and went up to 200 mg 2 days ago. I will then increase to 250 mg in another week. Having written it down, it seems like quite a `steep` increase. I`m not sure whether this is a good or a bad thing - I guess it must be O.K. otherwise my psychiatrist wouldn`t have done it. I`m not due to go into hospital for about another 5 weeks, but as I said before, my psychiatrist didn`t seem to think that the rash was anything to worry about. Neither did the dermatologist - mind you, I was in and out of that appointment within about 5 minutes, so I don`t know whether she made the connection (although I did tell her which medications I was taking). The rash itself is basically little spots, kind of like normal spots only smaller. They mostly have `heads` on them (sorry for being a bit graphic here). Having said all of this, my psychiatrist had only put one other patient on Lamotragine (a woman who had `discovered` it on the Net). Prior to this, she hadn`t heard of the drug. I`m not actually sure of what to do about all this; I feel like I have exhausted all my options (psychiatrist, GP, and dermatologist). What I may do, is post a question to one of the on-line psychiatric `experts`, and see what they say.
I guess that this isn`t very helpful (though at least I was able to give you dosages). I can`t remember whether I mentioned this, but as I am increasing the Lamotragine, I am phasing out the Valproate altogether. This may make a difference - I don`t know.
Anna (I feel strange calling myself `sweetmarie` - it`s the first time I have used an alternative to my real name. I got it from my favourite song - Absolutely Sweet Marie by Bob Dylan. This is of course irrelevant.
Posted by phillybob on March 10, 2001, at 16:19:40
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 13:13:55
< I was taking the 100 mg for a week and went up to 200 mg 2 days ago. I will then increase to 250 mg in another week. Having written it down, it seems like quite a `steep` increase.... Having said all of this, my psychiatrist had only put one other patient on Lamotragine (a woman who had `discovered` it on the Net). Prior to this, she hadn`t heard of the drug. >
Anna, I am not a doctor, but the risks of your dose increase are not worth it, right now. You must speak with a professional who has familiarity with lamotragine. That seems to be from what I've read to be a HUGE increase and that is not good even if you were taking NO valproate whatsoever.
I myself would speak with a professional. Perhaps, someone with familiarily of rashes and this drug might suggest dropping back to 100 mg and probably even lower until the rash goes away ... all the while monitoring it closely? Even then, increases, I don't think, are recommended at only up to 25 mg per two weeks (and maybe as little as one week).
I am taking 12.5mg/day to start and will then go by 12.5mg/day increases (Jah is doing the same).
[Bob Dylan rules]
Posted by sweetmarie on March 10, 2001, at 17:40:48
In reply to Re: treatment resistant depression » sweetmarie, posted by phillybob on March 10, 2001, at 16:19:40
> < I was taking the 100 mg for a week and went up to 200 mg 2 days ago. I will then increase to 250 mg in another week. Having written it down, it seems like quite a `steep` increase.... Having said all of this, my psychiatrist had only put one other patient on Lamotragine (a woman who had `discovered` it on the Net). Prior to this, she hadn`t heard of the drug. >
>
> Anna, I am not a doctor, but the risks of your dose increase are not worth it, right now. You must speak with a professional who has familiarity with lamotragine. That seems to be from what I've read to be a HUGE increase and that is not good even if you were taking NO valproate whatsoever.
>
> I myself would speak with a professional. Perhaps, someone with familiarily of rashes and this drug might suggest dropping back to 100 mg and probably even lower until the rash goes away ... all the while monitoring it closely? Even then, increases, I don't think, are recommended at only up to 25 mg per two weeks (and maybe as little as one week).
>
> I am taking 12.5mg/day to start and will then go by 12.5mg/day increases (Jah is doing the same).
>
> [Bob Dylan rules]It`s always good to find another Bob Dylan fan.
I guess that I assumd that my psychiatrist increased the dosage the way she did because that`s what what this specialist recommended. I don`t know how I could get a proffessional opinion without speaking to the bloke himself, which I would be reluctant to do. The rash has been around since I very first started on the Lamotragine at 25 mg. It hasn`t become any worse since the dosage was increased (a week and a half ago). I`m really not sure of what to do about the increase, i.e. who to ask - except, as I said this professor/specialist whose advice my own psychiatrist is taking (if you see what I mean). It`s a difficult one. I suppose I could try to get advice from another source, e.g. another psychiatrist, but I don`t think that Lamotragine is all that widely used. I might actually ask my sister (who is a trained psychiatric nurse, and see what she says. She may be able to make enquiries at her hospital.
Anna.
Posted by phillybob on March 10, 2001, at 19:33:04
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 17:40:48
Anna, sounds like a plan. Also, click on this link to another thread I posted in today for some good lamictal links in addition to the Dr. Ivan Goldberg one I posted earlier in this very thread (click on the one by the doctor as he has familiarity with lamictal):
http://www.dr-bob.org/babble/20010310/msgs/56133.html
Your sister should be able to find out what's up, though. The information is out there. It does sound better that the rash has not gotten worse since you started ... but, again, with the increase in dosage now, you should really have it monitored by someone (somehow!?) who knows what they are looking at it.
[I'm a big Wilco fan, particularly Jeff Tweedy, the lead singer, who's recently done some great solo shows ... I liken him to a future Bob Dylan ... he even sings a song about Bob Dylan's beard. :) ]
Posted by sweetmarie on March 11, 2001, at 6:18:34
In reply to Re: treatment resistant depression » sweetmarie, posted by phillybob on March 10, 2001, at 19:33:04
> Anna, sounds like a plan. Also, click on this link to another thread I posted in today for some good lamictal links in addition to the Dr. Ivan Goldberg one I posted earlier in this very thread (click on the one by the doctor as he has familiarity with lamictal):
>
> http://www.dr-bob.org/babble/20010310/msgs/56133.html
>
> Your sister should be able to find out what's up, though. The information is out there. It does sound better that the rash has not gotten worse since you started ... but, again, with the increase in dosage now, you should really have it monitored by someone (somehow!?) who knows what they are looking at it.
>
> [I'm a big Wilco fan, particularly Jeff Tweedy, the lead singer, who's recently done some great solo shows ... I liken him to a future Bob Dylan ... he even sings a song about Bob Dylan's beard. :) ]phillybob - I checked out the thing you sent. Jah seems only to be on a small dosage of Lamotragine, and doesn`t say whether this will be increased. I wonder if it will (Jah, if you are reading this, could you let me know - cheers). I`m actually quite concerned about this huge increase; the only reason I can think of, is that they are concerned that I be kept on a high level of something whilst I undergo the transition. I am really quite ill already (immobilised by the severity of the depression much of the time) The last time I came off meds altogether, I was very nearly catatonic. This may be a factor, I don`t know. Anyway, I`ll still check it out.
Never heard of `Wilco` (presumably an American band - we don`t get to hear much U.S. stuff over here). As for Bob Dylan`s beard, I always thought it was a poor excuse of a beard! (mind you I was only about 2 when he first grew it, so I didn`t have an opinion one way or the other. I prefer him without, although perhaps he should grow one now; I reckon he looks a lot like an old lady (mind you, I think he`s 60 this year).
Anna.
Posted by JahL on March 11, 2001, at 9:58:20
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 11, 2001, at 6:18:34
> > phillybob - I checked out the thing you sent. Jah seems only to be on a small dosage of Lamotragine, and doesn`t say whether this will be increased. I wonder if it will (Jah, if you are reading this, could you let me know - cheers). I`m actually quite concerned about this huge increase; the only reason I can think of, is that they are concerned that I be kept on a high level of something whilst I undergo the transition. I am really quite ill already (immobilised by the severity of the depression much of the time) The last time I came off meds altogether, I was very nearly catatonic. This may be a factor, I don`t know. Anyway, I`ll still check it out.Hi Anna.
Valproate more than doubles Lamotrigine blood levels. The increase you described previously was effectively a jump from 50mg-400mg/day in just over a week! Phillybob & I wld take *8 months* to reach 400mg on our current dosing schedule! IMO (FWIW) Lamotrigine has been recklessly prescribed to you.
Phillybob is spot on when he says you must get this checked out, & dropping the dose back to say 100mg is probably good advice too.
To answer your Q, I'm now on 37.5mg/day & intend titrating upwards (weekly) in 12.5mg increments to btwn 100 & 200 mg, based on response/side-effects. If yr depression is severe, the proposed (4 you) dose of 250mg sounds reasonable.
This slowly-slowly approach shld enable me to pin-point the optimal point of benefits against side-effects, whilst reducing drastically my chances of developing the rash.
Jah.
Posted by sweetmarie on March 11, 2001, at 11:35:32
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 11, 2001, at 9:58:20
>
> > > phillybob - I checked out the thing you sent. Jah seems only to be on a small dosage of Lamotragine, and doesn`t say whether this will be increased. I wonder if it will (Jah, if you are reading this, could you let me know - cheers). I`m actually quite concerned about this huge increase; the only reason I can think of, is that they are concerned that I be kept on a high level of something whilst I undergo the transition. I am really quite ill already (immobilised by the severity of the depression much of the time) The last time I came off meds altogether, I was very nearly catatonic. This may be a factor, I don`t know. Anyway, I`ll still check it out.
>
> Hi Anna.
>
> Valproate more than doubles Lamotrigine blood levels. The increase you described previously was effectively a jump from 50mg-400mg/day in just over a week! Phillybob & I wld take *8 months* to reach 400mg on our current dosing schedule! IMO (FWIW) Lamotrigine has been recklessly prescribed to you.
>
> Phillybob is spot on when he says you must get this checked out, & dropping the dose back to say 100mg is probably good advice too.
>
> To answer your Q, I'm now on 37.5mg/day & intend titrating upwards (weekly) in 12.5mg increments to btwn 100 & 200 mg, based on response/side-effects. If yr depression is severe, the proposed (4 you) dose of 250mg sounds reasonable.>
> This slowly-slowly approach shld enable me to pin-point the optimal point of benefits against side-effects, whilst reducing drastically my chances of developing the rash.
>
> Jah.Now I`m really worried. I suppose that I`m reluctant to speak to my psychiatrist about this, as I don`t want hoer to think that I`m questioning her judgement. I guess that the other thing I could do is to take it into my own hands, and drop back to 100 mg myself. As I am seeing her in 4 weeks, this should be easy to do. In other words, I could go back to 100 mg for the next couple of weeks, and then up to 200 mg. I don`t want to take it further than that myself. The other thing is that I am juggling this increase with decreasing the Valproate. So, I`m coming off the Valproate at a rate of 200 mg per 5/6 days (I was on 1000 mg). It`s really bloody complicated I can tell you. I don`t like this set-up at all; I thought that the whole reason for my going into hospital was that this could all be managed there. Frankly, I feel too ill to be doing it myself. Still, that`s the way it is - and I`m perfectly capable of ringing my psychiatrist and asking her to spell it out more clearly for me. Or at least double check the report sent to her by the professor, and see what he actually says. I`m really confused.
Anna.
Posted by JahL on March 11, 2001, at 13:51:24
In reply to Re: treatment resistant depression » JahL, posted by sweetmarie on March 11, 2001, at 11:35:32
> > Now I`m really worried. I suppose that I`m reluctant to speak to my psychiatrist about this, as I don`t want hoer to think that I`m questioning her judgement.I know UK pdocs don't take kindly to patients questioning their judgement but what if you printed out a few of these posts & presented them to yr pdoc, expressing yr concern? The other thing to do is visit the GlaxoWellcome site & download the Lamotrigine PDF. This gives clear dosing guidelines (which you can print out), which do not concur with those of yr pdoc. Yr pdoc cannot argue with the manufacturer's recommendations.
If you're concurrently on VPA, Lamotrigine shld be increased by 12.5mg/week. Mine & phillybob's regimes are conservative bearing in mind neither of us takes VPA.
> >I guess that the other thing I could do is to take it into my own hands, and drop back to 100 mg myself. As I am seeing her in 4 weeks, this should be easy to do. In other words, I could go back to 100 mg for the next couple of weeks, and then up to 200 mg. I don`t want to take it further than that myself. The other thing is that I am juggling this increase with decreasing the Valproate. So, I`m coming off the Valproate at a rate of 200 mg per 5/6 days (I was on 1000 mg). It`s really bloody complicated I can tell you. I don`t like this set-up at all; I thought that the whole reason for my going into hospital was that this could all be managed there. Frankly, I feel too ill to be doing it myself. Still, that`s the way it is - and I`m perfectly capable of ringing my psychiatrist and asking her to spell it out more clearly for me. Or at least double check the report sent to her by the professor, and see what he actually says. I`m really confused.
>
> Anna.I don't feel comfortable actually recommending you independently change yr dose, however the rash is more of a concern. I can't see what damage reducing the dose wld do (except possibly inducing epileptics fits in those susceptible), whereas exacerbating the rash, which higher doses are more likely to do, wld be dangerous.
This is a toughie, Anna. Perhaps yr Lamotrigine trial is best left until you are under the close supervision of the hospital prof. As you say, you shld'nt be expected to deal with this yourself.
J.
Posted by sweetmarie on March 11, 2001, at 15:05:20
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 11, 2001, at 13:51:24
>
> > > Now I`m really worried. I suppose that I`m reluctant to speak to my psychiatrist about this, as I don`t want hoer to think that I`m questioning her judgement.
>
> I know UK pdocs don't take kindly to patients questioning their judgement but what if you printed out a few of these posts & presented them to yr pdoc, expressing yr concern? The other thing to do is visit the GlaxoWellcome site & download the Lamotrigine PDF. This gives clear dosing guidelines (which you can print out), which do not concur with those of yr pdoc. Yr pdoc cannot argue with the manufacturer's recommendations.
>
> If you're concurrently on VPA, Lamotrigine shld be increased by 12.5mg/week. Mine & phillybob's regimes are conservative bearing in mind neither of us takes VPA.
>
> > >I guess that the other thing I could do is to take it into my own hands, and drop back to 100 mg myself. As I am seeing her in 4 weeks, this should be easy to do. In other words, I could go back to 100 mg for the next couple of weeks, and then up to 200 mg. I don`t want to take it further than that myself. The other thing is that I am juggling this increase with decreasing the Valproate. So, I`m coming off the Valproate at a rate of 200 mg per 5/6 days (I was on 1000 mg). It`s really bloody complicated I can tell you. I don`t like this set-up at all; I thought that the whole reason for my going into hospital was that this could all be managed there. Frankly, I feel too ill to be doing it myself. Still, that`s the way it is - and I`m perfectly capable of ringing my psychiatrist and asking her to spell it out more clearly for me. Or at least double check the report sent to her by the professor, and see what he actually says. I`m really confused.
> >
> > Anna.
>
> I don't feel comfortable actually recommending you independently change yr dose, however the rash is more of a concern. I can't see what damage reducing the dose wld do (except possibly inducing epileptics fits in those susceptible), whereas exacerbating the rash, which higher doses are more likely to do, wld be dangerous.
>
> This is a toughie, Anna. Perhaps yr Lamotrigine trial is best left until you are under the close supervision of the hospital prof. As you say, you shld'nt be expected to deal with this yourself.
>
> J.I was kind of thinking along those lines myself. After I posted that last post, I spoke to my sister (a psych nurse), who basically said that I should do whatever feels O.K. for me within the framework given to me by my consultant and the professor. She suggested that I say on 100 mg for another week, and instead of going right up to 200 mg, go up to 150 mg for a couple of weeks. Then 200 mg. By that point, I should be going to go into hospital (I was given a waiting time of 5/6 weeks on Monday, which is now 4/5 weeks, which should tie in with this arrangement. As for the Valproate; I`m not entirely sure. My consultant has told me to decrease from 1000 mg to nothing in weekly 200 mg intervals. In the light of the new arrangement I`ve made with the Lamotragine, I think I`ll slow this down (maybe 200 mg decrease over a week and a half instead of a week). There is something here called `the medication helpline`, who deal exclusively with psychiatric medication questions. I`m going to give them a ring. If Im still confused, I am going to have to `bite the bullet`, and get in touch with my psychiatrist. After all, that`s what she`s there for (and gets very well paid for it, I`m quite sure).
I`ll let you know how I get on.
Anna.
Posted by JahL on March 11, 2001, at 15:42:48
In reply to Re: treatment resistant depression » JahL, posted by sweetmarie on March 11, 2001, at 15:05:20
>
> > I spoke to my sister (a psych nurse), who basically said that I should do whatever feels O.K. for me within the framework given to me by my consultant and the professor. She suggested that I say on 100 mg for another week, and instead of going right up to 200 mg, go up to 150 mg for a couple of weeks.How about staying on 100mg til you see the prof? 50mg (to 150mg) is still quite a big leap, which is in effect doubled whilst you remain on VPA.
> > Then 200 mg. By that point, I should be going to go into hospital (I was given a waiting time of 5/6 weeks on Monday, which is now 4/5 weeks, which should tie in with this arrangement. As for the Valproate; I`m not entirely sure. My consultant has told me to decrease from 1000 mg to nothing in weekly 200 mg intervals. In the light of the new arrangement I`ve made with the Lamotragine, I think I`ll slow this down (maybe 200 mg decrease over a week and a half instead of a week).
Unless Valproate is significantly helping you, it makes sense to decrease it *more quickly* since the sooner it is out of your system, the sooner Lamotrigine blood levels will drop to within safer limits.
Good luck,
J.
Posted by sweetmarie on March 11, 2001, at 16:36:26
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 11, 2001, at 15:42:48
> >
> > > I spoke to my sister (a psych nurse), who basically said that I should do whatever feels O.K. for me within the framework given to me by my consultant and the professor. She suggested that I say on 100 mg for another week, and instead of going right up to 200 mg, go up to 150 mg for a couple of weeks.
>
> How about staying on 100mg til you see the prof? 50mg (to 150mg) is still quite a big leap, which is in effect doubled whilst you remain on VPA.
>
> > > Then 200 mg. By that point, I should be going to go into hospital (I was given a waiting time of 5/6 weeks on Monday, which is now 4/5 weeks, which should tie in with this arrangement. As for the Valproate; I`m not entirely sure. My consultant has told me to decrease from 1000 mg to nothing in weekly 200 mg intervals. In the light of the new arrangement I`ve made with the Lamotragine, I think I`ll slow this down (maybe 200 mg decrease over a week and a half instead of a week).
>
> Unless Valproate is significantly helping you, it makes sense to decrease it *more quickly* since the sooner it is out of your system, the sooner Lamotrigine blood levels will drop to within safer limits.
>
> Good luck,
> J.Valproate is doing absolutely sod-all (and never did), so I will. I was playing it cautious; my consultant advised me to come down by 100 mg every 5 - 7 days. I decided on the 7, which I have now changed to a week and a half. I reckon I`ll stick to her original suggestion.
As to the Lamotragine, I think I`ll do what you suggest. The main thing I guess is to make a plan and stick to it. I`m not going to `fiddle` with it any more.
By the way, was it you that told me that a combination of Valproate and Lamotragine can cause a rash? If it wasn`t you, then someone said it at some point. I hope that this is true because it might mean that the rash coud clear up once I`m off the Valroate. It`s not a serious rash, and caused no physical discomfort, but it`s noticeable and I`m self-concious about it. If it gets worse, I will be ringing my consultant right away. The other thing that I thought of is that they (the team at Newcastle hospital where I will be going), may be able to get a dermatologist to look at it.
Thanks for your help,
Anna.
Posted by sarai on March 12, 2001, at 14:51:36
In reply to Re: treatment resistant depression » JahL, posted by sweetmarie on March 11, 2001, at 16:36:26
Hi,
I work in a research clinic in NYC and we are doing a clinical trial for treatment resistant depression. If you live within travel (weekly) distance of lower Manhattan and would like more information, please call Sarai...
Posted by sweetmarie on March 12, 2001, at 16:43:16
In reply to Re: treatment resistant depression , posted by sarai on March 12, 2001, at 14:51:36
> Hi,
>
> I work in a research clinic in NYC and we are doing a clinical trial for treatment resistant depression. If you live within travel (weekly) distance of lower Manhattan and would like more information, please call Sarai...Sarai - sounds perfect for me. Unfortunately, I live at the other side of the Atlantic. I wish they did that kind of thing here (they don`t).
Anna.
Posted by Dr. Bob on March 12, 2001, at 18:17:10
In reply to Re: treatment resistant depression , posted by sarai on March 12, 2001, at 14:51:36
> I work in a research clinic in NYC and we are doing a clinical trial for treatment resistant depression. If you live within travel (weekly) distance of lower Manhattan and would like more information, please call Sarai at...
It's great to spread the word about studies, but please if you do so include who the principal investigator is, which institution, if any, it's being conducted at, and whether it's been approved by an Institutional Review Board or other human subjects committee. Posts without this information will be removed. Thanks,
Bob
PS: Follow-ups, if any, regarding this should be redirected to Psycho-Babble Administration.
Posted by steve on March 12, 2001, at 18:29:07
In reply to Re: treatment resistant depression , posted by sarai on March 12, 2001, at 14:51:36
> Hi,
>
> I work in a research clinic in NYC and we are doing a clinical trial for treatment resistant depression. If you live within travel (weekly) distance of lower Manhattan and would like more information, please call Sarai...How much money do you stand to make per guinea pig you find?
Are estimates of a $200 bounty accurate?
Do you think you have an ethical obligation to disclose how much money is involved so as to create truely informed consent, or do you advocate the mushroom treatment (feed them manure and keep them in the dark) for your charges?
TIA
Posted by SLS on March 13, 2001, at 17:19:59
In reply to treatment resistant depression, posted by sweetmarie on March 7, 2001, at 14:29:45
> I suffer from (severe chronic `double`) depression, which has proved VERY difficult to treat (I`ve had Tricyclics, SSRIs, an MAOI (Nardil), ECT, Maclobomide, Reboxetine, L-Tryptophan, Venlafaxine, and different permutations. I am currently on Nardil, Trimipramine, Lamotragine and Epilim to no effect).
> I`ve been referred to a specialist in `difficult to treat depression`, who plans to put me onto Venlafaxine, Mirtazapine and increase the dose of Lamotragine.
I hope this helps:Your new doctor has chosen a treatment that demonstrates his expertise. You found a good one.
I have a question for you. What side effects does trimipramine cause? My main concern is that it is too sedating. What do you think?
Good luck with your new doctor. It may still take some time, but it sounds like you have a good chance with this person. Patience is required. It is a requirement that I have lots of trouble with, but I know my chances of getting well are much greater if I exercise it. I too am treatment resistant. I'm still looking.
- Scott
Posted by sweetmarie on March 13, 2001, at 19:31:14
In reply to Re: treatment resistant depression » sweetmarie, posted by SLS on March 13, 2001, at 17:19:59
> > I suffer from (severe chronic `double`) depression, which has proved VERY difficult to treat (I`ve had Tricyclics, SSRIs, an MAOI (Nardil), ECT, Maclobomide, Reboxetine, L-Tryptophan, Venlafaxine, and different permutations. I am currently on Nardil, Trimipramine, Lamotragine and Epilim to no effect).
>
> > I`ve been referred to a specialist in `difficult to treat depression`, who plans to put me onto Venlafaxine, Mirtazapine and increase the dose of Lamotragine.
>
>
> I hope this helps:
>
> Your new doctor has chosen a treatment that demonstrates his expertise. You found a good one.
>
> I have a question for you. What side effects does trimipramine cause? My main concern is that it is too sedating. What do you think?
>
> Good luck with your new doctor. It may still take some time, but it sounds like you have a good chance with this person. Patience is required. It is a requirement that I have lots of trouble with, but I know my chances of getting well are much greater if I exercise it. I too am treatment resistant. I'm still looking.
>
>
> - ScottScott,
Thanks for the encouragement.
Trimipramine has had no side effects on me (as far as i know). It`s difficult to tell, though, as I am taking 4 different medications. I don`t feel `sedated` in any way, or at least not by Trimipramine. I am lethargic, but I think that`s to do with depression in general. In other words, my lethargy has not increased since I started taking Trimipramine. The side effects of the drug are basically the same as those of other Tricyclics (none of which spring to mind except the usual dry mouth, constipation, dizziness, possible weight gain etc.) Are you thinking of taking Trimipramine? I don`t know how effective it is on it`s own (for `resistant` people); As I said, it`s one of four medications I am taking (Lamotragine, Valproate, Trimipramine and Phenelzine). I will be coming off the Trimipramine in order to try out this new combination.
Sorry to not to have been of much use.
Good luck to you too - it`s a long haul and as you say, patience is not easy when you`re suffering.
Anna.
Posted by SLS on March 13, 2001, at 21:21:21
In reply to Re: treatment resistant depression » SLS, posted by sweetmarie on March 13, 2001, at 19:31:14
Dear Anna,
Thank you for replying to my question.
> Trimipramine has had no side effects on me (as far as i know). It`s difficult to tell, though, as I am taking 4 different medications. I don`t feel `sedated` in any way, or at least not by Trimipramine. I am lethargic, but I think that`s to do with depression in general. In other words, my lethargy has not increased since I started taking Trimipramine. The side effects of the drug are basically the same as those of other Tricyclics (none of which spring to mind except the usual dry mouth, constipation, dizziness, possible weight gain etc.)
> Are you thinking of taking Trimipramine?
Yes.
> I don`t know how effective it is on it`s own (for `resistant` people)
I cannot affort to declare inelligible any medication at this point. I am interested in trimipramine (Surmontil) because it is the "black sheep" of the tricyclic family. It doesn't appear to do the things that were considered important for a tricyclic to do, namely the inhibition of the reuptake of norepinephrine, and to a lesser extent, serotonin. That the drug works at all speaks to how little we understand about how antidepressants work and what are the psychobiological abnormalities that cause depression and bipolar disorder.
> As I said, it`s one of four medications I am taking (Lamotragine, Valproate, Trimipramine and Phenelzine).
Have you or any member of your family been diagnosed as having bipolar disorder?
> I will be coming off the Trimipramine in order to try out this new combination.
Don't you also have to discontinue Nardil before beginning Effexor?
> Sorry to not to have been of much use.
Don't be silly. Consider yourself well used. :-)
Thanks.
- Scott
Posted by Dr. Bob on March 14, 2001, at 1:59:39
In reply to Re: treatment resistant depression » sarai, posted by steve on March 12, 2001, at 18:29:07
> or do you advocate the mushroom treatment (feed them manure and keep them in the dark) for your charges?
What I posted above to you applies here, too.
Bob
Posted by sweetmarie on March 14, 2001, at 12:21:28
In reply to Re: treatment resistant depression » sweetmarie, posted by SLS on March 13, 2001, at 21:21:21
> Dear Anna,
>
> Thank you for replying to my question.
>
> > Trimipramine has had no side effects on me (as far as i know). It`s difficult to tell, though, as I am taking 4 different medications. I don`t feel `sedated` in any way, or at least not by Trimipramine. I am lethargic, but I think that`s to do with depression in general. In other words, my lethargy has not increased since I started taking Trimipramine. The side effects of the drug are basically the same as those of other Tricyclics (none of which spring to mind except the usual dry mouth, constipation, dizziness, possible weight gain etc.)
>
> > Are you thinking of taking Trimipramine?
>
> Yes.
>
> > I don`t know how effective it is on it`s own (for `resistant` people)
>
> I cannot affort to declare inelligible any medication at this point. I am interested in trimipramine (Surmontil) because it is the "black sheep" of the tricyclic family. It doesn't appear to do the things that were considered important for a tricyclic to do, namely the inhibition of the reuptake of norepinephrine, and to a lesser extent, serotonin. That the drug works at all speaks to how little we understand about how antidepressants work and what are the psychobiological abnormalities that cause depression and bipolar disorder.
>
> > As I said, it`s one of four medications I am taking (Lamotragine, Valproate, Trimipramine and Phenelzine).
>
> Have you or any member of your family been diagnosed as having bipolar disorder?
>
> > I will be coming off the Trimipramine in order to try out this new combination.
>
> Don't you also have to discontinue Nardil before beginning Effexor?
>
> > Sorry to not to have been of much use.
>
> Don't be silly. Consider yourself well used. :-)
>
> Thanks.
>
>
> - ScottScott,
I`m glad to have been of some use. Like you, I can`t afford to rule anything out (if that`s what you were saying). I`ve been very severely depressed for about 3 years, with all the stuff that goes with that (inability to work, have a social life, carry on any meaningful relationships with friends, etc.)
Nobody in my family has ever been diagnosed with Bipolar Disorder, and it has certainly never been suggested to me that I may have it. The only other person I know of who suffers at all from depression is my sister, who gets mild depression for short periods, and are adequately treated with a short course of anti-depressants. Her low moods are `reactive` though, unlike my illness which is genetically based, and I`ve suffered to differing degrees (from moderate to severe) most of my life. She has a very stressful job - she`s a psychiatric nurse (enough said, probably).
Re. discontinuing Nardil in order to start on Venlafaxine, you`re right - there should be a certain gap (about a week, I believe) before Venlafaxine can be commenced. Having said that, a friend of mine has just cganged from Nardil to Vanlafaxine, and her psychiatrist has overlapped the two. I don`t think that she`s suffered any side effects from this - apart from the severe depression she has been experiencing for slightly longer than me (we are quite a comfort to each other). This isn`t the `correct` way to do it, I`m sure though.
Good luck with the Trimpramine (if you choose to take it). How long have you been depressed? Is it moderate/severe? Whatever, you have all my sympathy - it is truly a hideous illness.
Anna.
Posted by SLS on March 14, 2001, at 22:44:38
In reply to Re: treatment resistant depression - Scott » SLS, posted by sweetmarie on March 14, 2001, at 12:21:28
Hi Anna.
> I`m glad to have been of some use. Like you, I can`t afford to rule anything out (if that`s what you were saying).Yup. That's the story.
> I`ve been very severely depressed for about 3 years, with all the stuff that goes with that (inability to work, have a social life, carry on any meaningful relationships with friends, etc.)
Yup. I know this story too. I am sorry that you had to tell it.
> Nobody in my family has ever been diagnosed with Bipolar Disorder, and it has certainly never been suggested to me that I may have it.
The reason I asked is because you having been taking two "mood-stabilizers", Lamictal (lamotrigine) and Epilim (valproate). This is a strategy that is generally associated with bipolar disorder rather than unipolar major depression. I am very interested to know how critical a role both play in getting you well.
> The only other person I know of who suffers at all from depression is my sister, who gets mild depression for short periods, and are adequately treated with a short course of anti-depressants. Her low moods are `reactive` though, unlike my illness which is genetically based,
Just for the sake of extending understanding, and not as an attempt at diagnosis, all of the features you described above can be symptoms of a "soft" bipolar presentation. My sister has followed exactly the same scenario, her bipolarity being evidenced by a hypomania induced by Nardil, an MAO-inhibitor antidepressant. Bipolar disorders are extremely heritable (genetic) and very often appear among siblings, although not necessarily to the same degree.
> and I`ve suffered to differing degrees (from moderate to severe) most of my life.
I get pissed whenever I have to read a story like yours. Damn it.
> She has a very stressful job - she`s a psychiatric nurse (enough said, probably).
Again, for the sake of understanding, stress can precipitate an episode of an otherwise dormant bipolar illness. This also true of many other mental illnesses. A mild episode can remit spontaneously if the stress is removed or mitigated. I have seen this happen with my sister over the last six months. Thus, episodic mild depressions are no less facilitated via a genetic terrain than are chronic and severe presentations.
> Re. discontinuing Nardil in order to start on Venlafaxine, you`re right - there should be a certain gap (about a week, I believe) before Venlafaxine can be commenced. Having said that, a friend of mine has just cganged from Nardil to Vanlafaxine, and her psychiatrist has overlapped the two. I don`t think that she`s suffered any side effects from this - apart from the severe depression she has been experiencing for slightly longer than me (we are quite a comfort to each other). This isn`t the `correct` way to do it, I`m sure though.
All I can say is that I know of no way to confidently predict which people will experience a life-threatening reaction to such a combination and which will not. Once upon a time, in an act of desperation, I decided to take a nibble off a small piece of venlafaxine (Effexor) to see how it would react with the Parnate I was taking. Within ten or fifteen minutes, I experienced vertigo and I had to lay down. I couldn't get myself to sit up in bed. I became incoherent and hardly knew where I was. I made no sense at all when speaking to my parents. I told them not to worry about me, that I understood what I did wrong, and that I simply had to reboot the system. No problem.
I can't emphasize enough what a tiny amount of Effexor I bit off. Because of its short half-life, I chose Effexor purposely to test for the potential of developing serotonin syndrome when combining a serotonin reuptake inhibitor with an MAOI. If something went wrong, it should dissipate relatively quickly. It did. So did my notions of trying it ever again.
> Good luck with the Trimpramine (if you choose to take it).
> How long have you been depressed?
With the exception of a 6-month remission brought about by a combination of antidepressants, 24 years.
> Is it moderate/severe?
Severe. (I have been accused of being overly proud of this).
It was an honor to be assessed as being the most severely depressed research patient enrolled at the NIH during my nine-month stay there. Although there was this one guy who was an ultra rapid-cycler whose depressed state during the first three to six hours following a switch into his depressive phase seemed worse than mine. I envied him, though. After three days of depression, he would swing into a controllable hypomania that would last for eight. Gosh, what I could accomplish in eight days out of every eleven...
> Whatever, you have all my sympathy - it is truly a hideous illness.
Yup.
Thanks, Anna.
- Scott
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