![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 68 to 92 of 1085. Go back in thread:
Posted by SLS on March 21, 2001, at 7:25:41
In reply to Re: Topamax Experiences: Long Term Use, posted by phillybob on March 20, 2001, at 22:21:39
Lamictal (lamotrigine) titration schedule for depression and bipolar disorder:
25mg x 2 weeks
50mg x 2 weeks
* (75 x 1 weeks)
100mg x 2 weeks
+50 x 1 week
Average dosage = 200mg
Range = 50mg - 300mg
(50mg does not usually provide the maximum relief)I have seen a few people taking 400mg, which is actually the average dosage for Lamictal when used in epilepsy.
I used a twice a day schedule.
e.g. 25mg = 12.5mg at breakfast and dinner.This is the schedule recommended to me when Lamictal is not being added to any other anticonvulsant. It is somewhat slower than that which is recommended in the PDR, because the PDR assumes that one is adding it to another anticonvulsant. The EXCEPTION is DEPAKOTE (valproate). The dosage of Lamictal MUST be reduced by 50%, and the titration schedule twice as slow.
* I stuck this in there for the hell of it. I guess if someone feels that they are particularly sensitive to Lamictal, it might make sense. Whenever I increased the dosage, I would feel some itching in my eyes that would disappear in one or two days. Without any data supporting the idea, I took this to be an indicator of my having a sensitivity to Lamictal, and that it gave evidence that the slower titration schedule chosen by my doctor was justified.
- Scott
Posted by Bob on March 21, 2001, at 21:36:48
In reply to Re: Topamax Experiences: Long Term Use, posted by phillybob on March 20, 2001, at 22:21:39
> > > What kind of titration rate did you undertake out of curiosity? Did you get any sort of rash as you ramped up?
>
> I've barely titrated thus far with Lamictal which I'm trialing as monotherapy. 12.5 mg/day for about 10 days, now on 25 mg/day for almost a week. Tomorrow, gonna see the pdoc and probably move to 37.5 mg/day. I want to go real slow because I think I may have shot past my therapeutic dose with topiramate and, oh yeah, I'm weary of the rash. You can follow my trials (and Jah's too) here: http://www.dr-bob.org/babble/20010319/msgs/56941.html
>
> Best wishes. As I posted in this thread, comin' off of topamax gave me most of the side effects I had in titrating up on the stuff. I liked the med, though. I was sayin' "euthymic." Now, I'm breathin'. I say there is a huge difference, but I think Lamictal has some promise for me (though, I'll say what I said early on with the Topamax: I might need to add something as an adjunct).****************
I wouldn't be suprised if I end up having to augment these antiseizure drugs with something else also (say, an SSRI?) Keep me posted as to how your Lamictal thing goes. It is disappoint to me, but not suprising to hear that all the side effects are experienced coming off medecine, the same as going on! Thanks for the link to your progress about Lamictal.
Bob
Posted by Bob on March 21, 2001, at 21:38:33
In reply to Re: Topamax Experiences: Long Term Use, posted by SLS on March 21, 2001, at 7:02:05
> Perhaps you can look into Gabitril (tiagabine). It is a relatively new anticonvulsant that I don't think I have seen anyone here try. It was mentioned as something to try by a doctor with whom I consulted last year. I suffer from bipolar depression. I have certainly placed it on my list, although I have not researched it enough to be comfortable to take it sight unseen.
>
>
> - Scott
>
>
> > Also, you might recall, I drank tons of water to help with the kidney issues (never had any) and took a B Complex "Stress" vitamin which helped greatly with the tingling AND the cognitive difficulties. I would revisit Topamax in the future, though at a lower dosage, if the Lamictal doesn't pan out. So far, so good; I'm takin' it much slower than the Topamax. I learned my lesson. Patience.*******************
How much B-Vitamin Complex did you take to reduce the tingling and confusion problems?
Bob
Posted by Bob on March 21, 2001, at 21:43:51
In reply to Re: Topamax Experiences: Long Term Use, posted by SLS on March 21, 2001, at 7:25:41
> Lamictal (lamotrigine) titration schedule for depression and bipolar disorder:
>
>
> 25mg x 2 weeks
> 50mg x 2 weeks
> * (75 x 1 weeks)
> 100mg x 2 weeks
> +50 x 1 week
>
>
> Average dosage = 200mg
> Range = 50mg - 300mg
> (50mg does not usually provide the maximum relief)
>
> I have seen a few people taking 400mg, which is actually the average dosage for Lamictal when used in epilepsy.
>
>
> I used a twice a day schedule.
> e.g. 25mg = 12.5mg at breakfast and dinner.
>
> This is the schedule recommended to me when Lamictal is not being added to any other anticonvulsant. It is somewhat slower than that which is recommended in the PDR, because the PDR assumes that one is adding it to another anticonvulsant. The EXCEPTION is DEPAKOTE (valproate). The dosage of Lamictal MUST be reduced by 50%, and the titration schedule twice as slow.
>
> * I stuck this in there for the hell of it. I guess if someone feels that they are particularly sensitive to Lamictal, it might make sense. Whenever I increased the dosage, I would feel some itching in my eyes that would disappear in one or two days. Without any data supporting the idea, I took this to be an indicator of my having a sensitivity to Lamictal, and that it gave evidence that the slower titration schedule chosen by my doctor was justified.
>
>
> - Scott***********************
It's not a bad idea to go even slower then this schedule recommends, if you can afford the luxury. If I remember correctly (and it was a while ago so I may not be recalling correctly) I followed the schedule recommended in the package, got a rash, and my doctor asked me to stop; so I couldn't find out if Lamictal would help me. I am still thinking about trying the med again. I think the slower you can ramp up on the med, the better.
Bob
Posted by phillybob on March 21, 2001, at 23:11:26
In reply to Re: Topamax Experiences: Long Term Use, posted by Bob on March 21, 2001, at 21:38:33
> How much B-Vitamin Complex did you take to reduce the tingling and confusion problems?
I am taking Twinlab's "Stress B-Complex Caps." The bottle recommends to take 2 of them, but I only take one. Just divide these numbers in half (got it from their website):
"Two hard gelatin capsules supply:
Vitamin C 1000 mg
Vitamin B-1 (thiamine) 50 mg
Vitamin B-2 (riboflavin) 50 mg
Vitamin B-6 (pyridoxine) 50 mg
Niacinamide 100 mg
Pantothenic Acid (d-calcium
pantothenate) 250 mg
Vitamin B-12 (cobalamin concentrate) 250 mcg
Biotin 100 mcg
PABA (para-aminobenzoic acid) 50 mg
Folic Acid 400 mcg
Choline Bitartrate 100 mg
Inositol 100 mg"The way I was lead to believe, the B's kind of work in conjunction with each other. You can likely find another brand with similar stuff. An excellent site on vitamin info is http://healthwell.com/
Regards.
Posted by maribeth on March 24, 2001, at 8:08:56
In reply to Re: Topamax Experiences: Long Term Use, posted by phillybob on March 21, 2001, at 23:11:26
> > How much B-Vitamin Complex did you take to reduce the tingling and confusion problems?
>
> I am taking Twinlab's "Stress B-Complex Caps." The bottle recommends to take 2 of them, but I only take one. Just divide these numbers in half (got it from their website):
>
> "Two hard gelatin capsules supply:
> Vitamin C 1000 mg
> Vitamin B-1 (thiamine) 50 mg
> Vitamin B-2 (riboflavin) 50 mg
> Vitamin B-6 (pyridoxine) 50 mg
> Niacinamide 100 mg
> Pantothenic Acid (d-calcium
> pantothenate) 250 mg
> Vitamin B-12 (cobalamin concentrate) 250 mcg
> Biotin 100 mcg
> PABA (para-aminobenzoic acid) 50 mg
> Folic Acid 400 mcg
> Choline Bitartrate 100 mg
> Inositol 100 mg"
>
> The way I was lead to believe, the B's kind of work in conjunction with each other. You can likely find another brand with similar stuff. An excellent site on vitamin info is http://healthwell.com/
>
> Regards.Hi ya'll
Long time no post. We seem to have drifted from Topamax to Lamictal, so I'll drift us back! Since I last postedI have been titrated
up to 450 mgm of Topamax and all of the aformentioned side effects have disappeared. No mouth problems, no kidney stones, ( I have
been drinking about two quarts of water a day all along) and my mood is quite even. I am not sure what the answer is here -- I'm
sorry that you all have had difficulty, but for me the higher dose seems to have worked. Maribeth
Posted by sherry gomez on March 24, 2001, at 10:27:54
In reply to Re: Topamax Experiences: Long Term Use, posted by maribeth on March 24, 2001, at 8:08:56
> > > How much B-Vitamin Complex did you take to reduce the tingling and confusion problems?
> >
> > I am taking Twinlab's "Stress B-Complex Caps." The bottle recommends to take 2 of them, but I only take one. Just divide these numbers in half (got it from their website):
> >
> > "Two hard gelatin capsules supply:
> > Vitamin C 1000 mg
> > Vitamin B-1 (thiamine) 50 mg
> > Vitamin B-2 (riboflavin) 50 mg
> > Vitamin B-6 (pyridoxine) 50 mg
> > Niacinamide 100 mg
> > Pantothenic Acid (d-calcium
> > pantothenate) 250 mg
> > Vitamin B-12 (cobalamin concentrate) 250 mcg
> > Biotin 100 mcg
> > PABA (para-aminobenzoic acid) 50 mg
> > Folic Acid 400 mcg
> > Choline Bitartrate 100 mg
> > Inositol 100 mg"
> >
> > The way I was lead to believe, the B's kind of work in conjunction with each other. You can likely find another brand with similar stuff. An excellent site on vitamin info is http://healthwell.com/
> >
> > Regards.
>
> Hi ya'll
> Long time no post. We seem to have drifted from Topamax to Lamictal, so I'll drift us back! Since I last postedI have been titrated
> up to 450 mgm of Topamax and all of the aformentioned side effects have disappeared. No mouth problems, no kidney stones, ( I have
> been drinking about two quarts of water a day all along) and my mood is quite even. I am not sure what the answer is here -- I'm
> sorry that you all have had difficulty, but for me the higher dose seems to have worked. Maribeth>I too am still taking Topamax and along with depakote, I no longer have the sores in my mouth.. but I drink alot of water too....
Posted by Bob on March 24, 2001, at 22:57:44
In reply to Re: Topamax Experiences: Long Term Use, posted by sherry gomez on March 24, 2001, at 10:27:54
> > > > How much B-Vitamin Complex did you take to reduce the tingling and confusion problems?
> > >
> > > I am taking Twinlab's "Stress B-Complex Caps." The bottle recommends to take 2 of them, but I only take one. Just divide these numbers in half (got it from their website):
> > >
> > > "Two hard gelatin capsules supply:
> > > Vitamin C 1000 mg
> > > Vitamin B-1 (thiamine) 50 mg
> > > Vitamin B-2 (riboflavin) 50 mg
> > > Vitamin B-6 (pyridoxine) 50 mg
> > > Niacinamide 100 mg
> > > Pantothenic Acid (d-calcium
> > > pantothenate) 250 mg
> > > Vitamin B-12 (cobalamin concentrate) 250 mcg
> > > Biotin 100 mcg
> > > PABA (para-aminobenzoic acid) 50 mg
> > > Folic Acid 400 mcg
> > > Choline Bitartrate 100 mg
> > > Inositol 100 mg"
> > >
> > > The way I was lead to believe, the B's kind of work in conjunction with each other. You can likely find another brand with similar stuff. An excellent site on vitamin info is http://healthwell.com/
> > >
> > > Regards.
> >
> > Hi ya'll
> > Long time no post. We seem to have drifted from Topamax to Lamictal, so I'll drift us back! Since I last postedI have been titrated
> > up to 450 mgm of Topamax and all of the aformentioned side effects have disappeared. No mouth problems, no kidney stones, ( I have
> > been drinking about two quarts of water a day all along) and my mood is quite even. I am not sure what the answer is here -- I'm
> > sorry that you all have had difficulty, but for me the higher dose seems to have worked. Maribeth
>
> >I too am still taking Topamax and along with depakote, I no longer have the sores in my mouth.. but I drink alot of water too....**********
It is excellent to hear that the higher doses of topomax are producing good results for some people. I am hanging in there with 225mg at the moment - I just upped the dose last week so am still experiencing side effects. I am still on the fence as to whether I will stick with it. There seems to be a contingent of people who have defected over to Lamictal, but I am not ready to give up on Topomax quite yet. It has given me my lighter weight body back. I am disheartened by the cognitive problems and lack of antidepressant effects though.
Bob
Posted by Lexie on March 25, 2001, at 8:27:21
In reply to Re: Topamax Experiences: Long Term Use, posted by Bob on March 24, 2001, at 22:57:44
> > > > > How much B-Vitamin Complex did you take to reduce the tingling and confusion problems?
> > > >
> > > > I am taking Twinlab's "Stress B-Complex Caps." The bottle recommends to take 2 of them, but I only take one. Just divide these numbers in half (got it from their website):
> > > >
> > > > "Two hard gelatin capsules supply:
> > > > Vitamin C 1000 mg
> > > > Vitamin B-1 (thiamine) 50 mg
> > > > Vitamin B-2 (riboflavin) 50 mg
> > > > Vitamin B-6 (pyridoxine) 50 mg
> > > > Niacinamide 100 mg
> > > > Pantothenic Acid (d-calcium
> > > > pantothenate) 250 mg
> > > > Vitamin B-12 (cobalamin concentrate) 250 mcg
> > > > Biotin 100 mcg
> > > > PABA (para-aminobenzoic acid) 50 mg
> > > > Folic Acid 400 mcg
> > > > Choline Bitartrate 100 mg
> > > > Inositol 100 mg"
> > > >
> > > > The way I was lead to believe, the B's kind of work in conjunction with each other. You can likely find another brand with similar stuff. An excellent site on vitamin info is http://healthwell.com/
> > > >
> > > > Regards.
> > >
> > > Hi ya'll
> > > Long time no post. We seem to have drifted from Topamax to Lamictal, so I'll drift us back! Since I last postedI have been titrated
> > > up to 450 mgm of Topamax and all of the aformentioned side effects have disappeared. No mouth problems, no kidney stones, ( I have
> > > been drinking about two quarts of water a day all along) and my mood is quite even. I am not sure what the answer is here -- I'm
> > > sorry that you all have had difficulty, but for me the higher dose seems to have worked. Maribeth
> >
> > >I too am still taking Topamax and along with depakote, I no longer have the sores in my mouth.. but I drink alot of water too....
>
> **********
>
> It is excellent to hear that the higher doses of topomax are producing good results for some people. I am hanging in there with 225mg at the moment - I just upped the dose last week so am still experiencing side effects. I am still on the fence as to whether I will stick with it. There seems to be a contingent of people who have defected over to Lamictal, but I am not ready to give up on Topomax quite yet. It has given me my lighter weight body back. I am disheartened by the cognitive problems and lack of antidepressant effects though.
>
> Bob>HI Bob
You sound like I did. The Topamax did nothing for an AD it helped me to lose the weight I had gained on the other meds. That is why my Pdoc added the Lamictal for it's AD quality. Did you consider both? I have done well with both of these drugs combined. As you will see by my post later on this page he is considering changing my meds to Geodon and Topamax then Geodon alone. I am not sure why. It could be that after one year I am continueing to lose weight and under my weight for my height. I hope you have been well. I have been going through a tough personal time. It is nice to come back and visit my friends here. Glad to see you and phillybob keeping the worlds longest post going. I HOPE you missed me. Smiles, Lexie
Posted by phillybob on March 25, 2001, at 17:20:23
In reply to Re: Topamax Experiences: Long Term Use, posted by Lexie on March 25, 2001, at 8:27:21
Hi, Lexie (a.k.a. Lamictal/Topamax Poster Child)!
It's good to hear back from you. I thought I read and feared that you took yourself off of all meds! Tsk, tsk for thinkin' of it (if that was you talkin' such nonsense). I know when I find something that works, I'm going to stay on it for at least 9 months before evaluating it, and even then, will likely just stay on it.
As you suggested for Bob, I might re-add a small dose of Topamax to my Lamictal mix at some point if I need to. But, for now, just monotherapy with the Lamictal. I can stand just tryin' one, so I will. I like the idea of keeping with the one drug until I get up to therapeutic doses, so I can evaluate it without clouding it with other drugs' effects. I am my own science lab. :) (aren't we all?)
Bob, I don't think the Topamax is supposed to have any AD effects. For me, though, when I was taking it, having energy back was enough to feel great again. I was probably generating my own AD effects at that point.
Cognitive difficulties were not an issue for me after a while (same thing for Jeapordy queen, Maribeth, I believe). Have you tried a Stress B Complex tab yet?
Keep 'em coming, we may not be the longest thread yet, but I have faith we can get there, if we all work together on this, mates! :)~
Posted by grapebubblegum on March 25, 2001, at 20:54:39
In reply to Re: Topamax Experiences: Long Term Use, posted by phillybob on March 25, 2001, at 17:20:23
I guess this thread should have its own website, it is so long. Forgive me for not reading every post, but I was fascinated by the quote you posted, Phillybob (hey, I have a brother Bob in Philly but I don't think you are him) about differentiating between bipolar and plain old depression. To make it short (and to recap what I wrote in another thread):
My dad was a card-carrying bipolar for many years, hospitalized several times and treated last I heard with Tegretol among other meds. My mom has some sort of personality disorder involving controlling others and has had alcoholism problems. Now, I myself have been diagnosed with depression with or without panic disorder over the last 15 years (I'm 35, but the panic attacks started around age 10 or 12.) I have never felt "depressed" but I can see that a lot of symptoms of depression are there when I am not treated with SSRI's and the klonopin that I take as needed (rarely) for panic attacks. My son, though, who is only 5 has been recently diagnosed with bipolar disorder. His pdoc admits that he went in large part on family history in making that diagnosis. Zyprexa was started and it made great improvements in my son but the weight he put on in one month was alarming. He was switched to topomax and has done PHENOMENALLY well, like he is a new person and I couldn't be happier about that. My question: Although I fail out on the traditional "mania" tests, should I re-consider my usual ill-fitting "depression" diagnosis and see if maybe topomax might work for me? My very sharp pdoc suggested trying whatever works well on my son. We ruled out the zyprexa early because of the weight-gain effect. I am having trouble understanding the difference between depression and bipolar disorder. I understand the manic component should be there in bipolar... but is that a hard and fast rule? Does the depression in bipolar people differ from the "typical" depression symptoms? Mine has always been atypical anyway, e.g. oversleeping rather than insomnia.
Posted by phillybob on March 26, 2001, at 6:42:49
In reply to Re: Topamax Experiences: Long Term Use, posted by grapebubblegum on March 25, 2001, at 20:54:39
The best answer to your question, brother ... er ... I mean ... Grape Ape :) ... is to read many, many posts here and you will learn a lot about the various manifestations of the various illnesses variously sickening us.
That, I'm sure you're doing, but you may have missed this following post within this very same thread: http://www.dr-bob.org/babble/20001231/msgs/51384.html
The article linked and cut and pasted within is one of the favorites that I've come across. It puts the mania on hold as a diagnosis tool, in favor of a lessor sub-hypomanic criteria. It's interesting and makes a lot of sense to me.
How much Topamax is your son taking and how long has he been on it? It's great to hear of someone being treated so successfully at such an early age, before the illness wreaks havoc on one's life. Best wishes.
P.S. Doesn't sound like we are literally brothers to me, too.
Posted by grapebubblegum on March 26, 2001, at 15:37:04
In reply to Re: Topamax Experiences: Long Term Use, posted by phillybob on March 26, 2001, at 6:42:49
Thanks, PhillyBob. That cut-n-paste is exactly what piqued my interest. I bookmarked Dr. Hume's "How the World Works" reading list because it looks like interesting material and I'm also going to search for Dr. Ivan Goldberg's page. (Hey, does it qualify as sub-manic behavior to collect and hoard and relentlessly seek out new sources of reading material that I never get around to reading because I am too busy making sure I have found ALL the books I want to read but can't possibly read in a lifetime? j/k *I think*)
I don't think you are my brother but I KNOW I am DEFINITELY not your brother because females rarely achieve that status even in this day and age of equal opportunity. ;o)
Posted by grapebubblegum on March 26, 2001, at 15:46:25
In reply to Re: Topamax Experiences: Long Term Use, posted by grapebubblegum on March 26, 2001, at 15:37:04
Oops, I forgot to answer the question. My son is on 25 mg. every morning with instructions to add another 25 mg. in the afternoon if needed, but I haven't noticed the need yet. He has only been taking topomax for about two weeks but the improvement has been dramatic. I posted about in on the kidzpsychobabble board, and here's the link to that post: http://www.dr-bob.org/babble/child/20000813/msgs/135.html
Posted by phillybob on March 26, 2001, at 16:00:13
In reply to Re: Topamax Experiences: Long Term Use, posted by grapebubblegum on March 26, 2001, at 15:37:04
> (Hey, does it qualify as sub-manic behavior to collect and hoard and relentlessly seek out new sources of reading material that I never get around to reading because I am too busy making sure I have found ALL the books I want to read but can't possibly read in a lifetime? j/k *I think*)
Yep. :)
[at least I do it, but seriously don't think it's anything more than a little OCD type behavior in a personality sense of the diagnosis, not problematic unless it gets in the way of any other productivity ... mine is problematic, I do believe, but not worthy of any cure more than perhaps a time management course (know any good ones?) ... my "Favorites" list is, oh let's just say, fairly long ... but I know everything that's there!] :)
Okay, sis, I'm done.
Posted by janedoe on March 30, 2001, at 16:32:41
In reply to Re: Topamax Experiences: Long Term Use, posted by grapebubblegum on March 25, 2001, at 20:54:39
Hi folks, I'm so glad I found this site. I just started taking topamax this week, dose 25mg. to start. Before I started reading your posts I assumed they would just be more negativity. What a pleasant surprise. Topamax sounded like a good med for my symtoms but those are some scary side effects. Anyway, I just wanted to say thanks to many of you for allaying some of my fears and sharing some of your life.
Posted by JOEI on March 30, 2001, at 17:29:03
In reply to Re: Topamax Experiences: Long Term Use, posted by janedoe on March 30, 2001, at 16:32:41
> Hi folks, I'm so glad I found this site. I just started taking topamax this week, dose 25mg. to start. Before I started reading your posts I assumed they would just be more negativity. What a pleasant surprise. Topamax sounded like a good med for my symtoms but those are some scary side effects. Anyway, I just wanted to say thanks to many of you for allaying some of my fears and sharing some of your life.
started taking topimax 50mg per day with lamictal
and clonazepam works great.
Posted by lois on April 1, 2001, at 9:29:38
In reply to Re: Topamax Experiences: Long Term Use, posted by JOEI on March 30, 2001, at 17:29:03
> started taking topimax 50mg per day with lamictal and clonazepam works great.JOEI,
I've worked my way up to 75 mg topamax at night, over the past month and 400mgs lamictal( I have been on for months) during the day.Also on clonapin and ad's.Sleep is OK,but am lethargic during the day.Could it be the lamictal dose or the ad's I hope to cut back on soon? I really want to stay on the T and L combo if I can adjust things.I've been on most all the other mood stablizers. Thx.
Lois
Posted by Bob on April 1, 2001, at 22:00:41
In reply to Re: Topamax Experiences: Long Term Use » JOEI, posted by lois on April 1, 2001, at 9:29:38
>
> > started taking topimax 50mg per day with lamictal and clonazepam works great.
>
> JOEI,
>
> I've worked my way up to 75 mg topamax at night, over the past month and 400mgs lamictal( I have been on for months) during the day.Also on clonapin and ad's.Sleep is OK,but am lethargic during the day.Could it be the lamictal dose or the ad's I hope to cut back on soon? I really want to stay on the T and L combo if I can adjust things.I've been on most all the other mood stablizers. Thx.
> Lois> > > > > > > > > > > >
May I ask why your doc decided to add Topomax at this point after you've been taking 400mg of Lamictal for awhile?
Just curious.
Bob
Posted by phillybob on April 1, 2001, at 22:55:14
In reply to Re: Topamax Experiences: Long Term Use, posted by Bob on April 1, 2001, at 22:00:41
> May I ask why your doc decided to add Topomax at this point after you've been taking 400mg of Lamictal for awhile?
>
> Just curious.
Make that 2 Bobs who are curious. What kind of effects did that dosage of Lamictal seem to have for you?
Posted by Dawn Setzer on April 12, 2001, at 13:13:38
In reply to Re: Topamax Experiences?, posted by Lexie on January 23, 2001, at 5:00:53
> > > >
> >
> > Lexie:
> >
> > Just a couple of quick questions... I am a relative newcomer to this thread.
> >
> > How long did it take you to build up to, and then stabilize on those high doses of lamictal and topomax; in other words, to get where you are now?
> >
> > Is that all you are taking is those two meds, or are you supplementing with others? Are you getting good AD effects from them?
> >
> > Bob
>
> I took just Topamax from June to September and got relief at about the 250 level and the optimum relief at 400. Topamax helped me mostly with the anger and acting out highs. I was experiencing a lot of suicidal thoughts and severe depression when my doctor added the Lamictal. It was added in a starter pack slowly because you can get a sometimes very serious rash if started to quickly. The manufacture makes a started pack that your doctor will give you at no charge (mine did). That takes 5 weeks at the end of 5 weeks you are up to 150 it still goes slowly from there it was the beginning of November and tons of support from Noa that kept going without giving up to make it to the 500 level, my doctor says that for my condition Topamax max's out at 400 and Lamictal max's out at 600, I plan to stay where I am with the Lamictal. I take no other AD's the Lamictal is more than I could have ever hoped for. I am sure the results are not for everyone, but it worked for me. My doctor has been known as one of the best in my area for Medication issue's. I am VERY lucky. I am also very lucky to insurance, without it these meds would cost 600.00 per month. Good Luck, LexieThis is the first time I've participated in one of these threads and will apologize in advance if I've jumped in at the wrong place. I'm starting my first dose of topamax tonight and a bit nervous about it. I have a diagnosis of ADD, but my experience and symptoms are classically bipolar. My pdoc is WONDERFUL and has pointed out that the two are closely related along with PMS, migraines, etc., all of which I experience.
I have been on every antidepressant in the book and none have worked for me. SSRI's make me anxious and angry after the first few weeks, lamictal had no effect whatsoever. In fact, I generally have responses or side effects that are the exact opposite of indications.
I currently take dexedrine, 20 mg in the morning and 15 in the afternoon. Helps with my functioning but I feel anxious and manic. I'm unwilling to give it up because it at least allows me to function somewhat. I've had problems with insomnia for a couple of years and now it's reached critical mass. Up for three days at a time with no sleep in sight. Neurontin was great for anxiety, but I experienced binging (history of eating disorders), sexual side effects (not for the better!) and fluid retention. Next was trazadone which caused an almost immediate 5 lb weight gain and bloating in spite of increased urinary frequency. I am gettin a few hours of sleep here and there, but never before 4:00 or 5:00 in the morning.
I'm at the point of wondering how I will ever be able to function normally or even minimally enough to get up and go to work every day. Unfortunately, I'm not independently wealthy, so this is simply not acceptable! This of course, increases my anxiety, guilt, etc.
I start on my first, very low dose (12.5 mg) of Topamax tonight. I've done a lot of research and have some concerns about this drug. These threads have been a sourse of comfort and information and I thank you all for sharing your experiences and insight. Has anyone out there been helped with extreme insomnia by Topamax? How about sexual side effects in woman and fluid
retention? Must admit it would not be a bad thing for me if I lost my taste for carbonated and caffeinated beverages. A bit addicted, must admit and along with the dexedrine leaves me quite agitated most of the time. I know, I know, it also contributes to the insomnia, but early on the dexedrine actually helped me to sleep!I'm not usually afraid to try new drugs, as I often don't experience the indicated side effects. I guess I'm just hoping this will work and feeling a bit hopeless and like I've run out of options. I'd sooner take nothing at all than deal with the even worse side effects of lithium, etc. Benzodiazapines aren't an option due to a history of alchohol abuse and the likelyhood that my insomnia will be a long term struggle. Ah, but I do babble on......
Thanks in advance for sharing your wisdom and experiences with this drug!
Peawee
Posted by phillybob on April 12, 2001, at 14:30:58
In reply to Re: About to start on Topomax, posted by Dawn Setzer on April 12, 2001, at 13:13:38
Hi, Dawn! Sounds like this could really work for you if my dx and success on this med, albeit brief, was any indication. I'm in the process of titrating up on Lamictal right now (currently, at 100mg/day along with a trial of Adderall). Topamax was really great for me, though, and I will certainly re-consider it, though, at a lower dosage, if need be.
My only advice to you would be, say once you reach 100 mg/day or so, is to hang out at that dosage for a while to see if it is enough before titrating up. But others have not necessarily had the side effect that I had (though it is a side effect, the gum recession, per my pdoc).
As far as sleep, for me, in the beginning, it would let me (and cause me) to sleep a bit, but then eventually, at the higher doses, I was takin' it in the day (split doses, I think) without sleepiness and no problem sleeping at night. (that's only a problem for me now with the Adderall, but I'm still tinkering).
What dose of Lamictal had you gone up to? I fear I will have the same non-response as you or a partial response which, if I can get the Adderall runnin' properly, will allow me to decide to stay pat or not.
Good luck! Keep us posted. This is as fine of a place to post your experiences for this drug as any!
Posted by Lainie on April 12, 2001, at 21:30:57
In reply to Re: About to start on Topomax » Dawn Setzer, posted by phillybob on April 12, 2001, at 14:30:58
>I'm totally new to this thread and appear to have a pretty different situation from everyone who's posted since 1/4/01, which is as far back as I find available for viewing, anyway. You all appear to be taking Topamax for depression and/or bipolar and/or mood disorders (and now Dawn has added ADD to the list).
My lifelong problem is migraines, now diagnosed as rebound headaches caused by the narcotics and ergotamine suppositories my (former) neurologists have supplied me with daily for many years. I'm now (for the past three weeks) seeing an internist and clinical psych at a headache clinic here in N. CA who have had me withdraw from all rebound-causing pain meds, even OTC, and I've been off them for 7 days now, but am still "allowed" to take my Imitrex tabs up to 3 times a week (soon to be down to 2) twice a day. Don't know if you can imagine how bad the other four days of the week are.
I started on Topamax 3 wks. ago and am now up to 25 mg. AM and 50 mg. PM, have had terrible insomnia so have upped my dose of Serzone (antidepressant) from 100 mg. PM to 150 mg. PM. I also take 15 mg. Paxil (10 AM, 5 PM), 10 mg. Klonapin (5 AM, 5 PM), and 20 mg. Propranolol PM.
For the insomnia I'm taking 2 Restoril at 9 PM and 1 Sonata when I invariable wake up again at 2 or 3 or 4 AM because everything I read says I HAVE to get sleep.
Does anyone know anyone else using Topamax to prevent migraines? I know from this thread that we're supposed to get up to at least 200 mg. for it to really take effect, but if this insomnia doesn't get better I might not be able to make it that far.
I wear an ice pack as a lovely head decoration most days, take bubble baths with candles 2-3 times a day, do my relaxation in bed 2-3 times a day, and try not to do anything too taxing - all this is possible because I quit my hugely stressful job the end of September; I had to do something about the daily migraines or lose my mind or my life.
Thanks for letting me get all this off my chest. I've enjoyed reading all your experiences - you are a refreshingly literate group and you all hang in there through thick and thin - as must we all!
Posted by Cateb on April 14, 2001, at 19:21:37
In reply to Re: Recently Started on Topamax, posted by Lainie on April 12, 2001, at 21:30:57
Lainie, I too have suffered from devastating migraines as my primary complaint since I was 19. And until 1996 I had never had a problem with depression. I am currently on Topamax after Pamelor and later Depakote both caused too many side effects (though all three had an effect on them). I also use a LOT of Imitrex injections and nasal sprays.
After having my first child in 1996, I also developed a severe depression problem, and after my second child in 1998, it blossomed into bipolar II with rapid cycling. So I was treated with meds that could also tackle migraines. Thus I'm now on Zoloft, Wellbutrin and Topamax. For me the Topamax only began to help the migraines at 400 mg, and it never has helped the mood swings in my opinion. I've been on it at that dose for 3 months. I've lost 30 pounds in three months, had constant diarrhea, and had a constant "white noise" type of scream inside my head...I don't sleep well at all. I feel constantly agitated. Joyless about life, food, art, my family, everything. I finally dropped back to 300 mg on my own and am about to drop to 200 tonight. I have just taken things into my own hands; I felt my life was in danger I was so close to the edge. Ironically, the agitation caused me to take my migraine narcotics (which I needed less for the migraines at the 400mg dose) to dull that awful Topamax feeling. They were the only things in my chemical war chest that actually helped...
Having said this, for others on this thread, they have found Topamax excellent, and if I didn't get the agitation, I could have appreciated the headache reduction. You clearly have a very different background and may find relief.
I would also like to point out that I got good results from Depakote, though I had some problems there with weight gain, lethargy and hair loss at 500mg. And lastly, Pamelor, an old tricyclic, worked very well with side effects of constipation and dry mouth, but the bigger problem for me there was that if I missed a dose or dropped even 5 mg I would get massive withdrawal headaches immediately and my husband would need to miss work I would be so sick. Perhaps I'm just too sensitive to drugs...
I wish you luck and if you want to talk more, I check this board weekly to get hope and inspiration from the others here, and to learn more. If you know of a good migraine support group on the web, let me know.
Posted by kp2001 on April 15, 2001, at 13:06:06
In reply to Re: Topomax question, posted by Lexie on January 23, 2001, at 5:08:42
hi
ive just started topomax but
i was expecting something totally different
on a topomax forum i thought topomax was for adhd
i have adhd which is short for attention difficency and hyperactivity disorder
and im taking topomaxim getting headaches the cloudiness u people were talking about in the forum and exrteeeme laziness
what do u guys think
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