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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 39 to 63 of 82. Go back in thread:
Posted by colin wallace on June 5, 2003, at 5:13:09
In reply to Re: Lamictal success stories for Ritch » colin wallace, posted by katia on June 3, 2003, at 15:45:56
> Hi Colin,
> I noticed that you have a dx of bpII. When were you diagnosed? I'm going in for an appt. with a good pdoc in two weeks and have yet to receive a proper dx after a year of four different ADs. The more I research and hear about BPII, the more I think there's more going on with me than just unipolar depression. I have an inkling that's what my dx will be, that or some mixed state of depression/bipolar II. How long did it take you to be accurately dxed? and what was your med history like up to Lamictal? and what have your "symptoms" been? thanks.
> Katia
Hi Katia,Actually, from the word go (a little over three years ago) I knew that my depression wasn't run of the mill.When I took my first AD (fluoxetine)I experienced wild mood swings, euphoria,awful anger,panic, etc. etc.Unfortunately, my responses to every other AD I tried (without a mood stabilizer) were equally unpleasant-effexor was the worst, Remeron the least offensive, although my moods were still off the wall.
I had excellent results with Sam-e for a while, but again, no mood-stabilizer, eventual mixed state response.
It would take too long to detail every treatment option I've tried, suffice it to say that basically, the only things I've yet to try are the MAOI's and AP's.
The information I'd gleened from this board, and from other posters with similar responses led me believe I was somewhere on the BP side of things, although my GP was unconvinced-until that is, I went into full blown hypomania on Zoloft.
My initial diagnosis was 'double depression', but my psych. at the time conceded that I 'might' be BP 11.I think he agreed this, just to keep me happy!!
Actually, I've given up attaching too much importance on my diagnosis-I don't care to pin labels on myself, I'm only concerned about what works.
My new psych. however, does believe me to be BP11, and once I'd experienced stability on Lamictal, and began to react 'normally' to antidepressants, this was confirmed.
Best,
Col.
Posted by starlight on June 5, 2003, at 15:15:21
In reply to Re: Lamictal success stories for Ritch » starlight, posted by Ritch on June 4, 2003, at 23:53:43
Hi Ritch,
I had some skin sensations when I first started, but it was kind of like a heated feeling. It went away. As long as you go up slowly you should be fine.I increased another 50mgs today and feel good. Kind of numb but that's better than the pain of depression. I definitely get an anti anxiety effect. Just feel calmer. I like that feeling as I tend to be hypervigilant as a result of an extremely tulmutuous childhood that included physical and emotional abuse. I think we're probably a bit overconcerned at the idea of being susceptible to side effects. The amount of people who have adverse skin reactions is actually pretty small and like I said your risk is greatly reduced by starting in low doses.
I'm actually very interested in knowing how many people diagnosed with Bipolar suffered from abusive childhoods? Anyone have any information on that?
starlight
Posted by katia on June 5, 2003, at 15:31:50
In reply to Re: Lamictal success stories for Ritch » katia, posted by colin wallace on June 5, 2003, at 5:13:09
> Hi Katia,
>
> Actually, from the word go (a little over three years ago) I knew that my depression wasn't run of the mill.When I took my first AD (fluoxetine)I experienced wild mood swings, euphoria,awful anger,panic, etc. etc.Unfortunately, my responses to every other AD I tried (without a mood stabilizer) were equally unpleasant-effexor was the worst, Remeron the least offensive, although my moods were still off the wall.
> I had excellent results with Sam-e for a while, but again, no mood-stabilizer, eventual mixed state response.
> It would take too long to detail every treatment option I've tried, suffice it to say that basically, the only things I've yet to try are the MAOI's and AP's.
> The information I'd gleened from this board, and from other posters with similar responses led me believe I was somewhere on the BP side of things, although my GP was unconvinced-until that is, I went into full blown hypomania on Zoloft.
> My initial diagnosis was 'double depression', but my psych. at the time conceded that I 'might' be BP 11.I think he agreed this, just to keep me happy!!
> Actually, I've given up attaching too much importance on my diagnosis-I don't care to pin labels on myself, I'm only concerned about what works.
> My new psych. however, does believe me to be BP11, and once I'd experienced stability on Lamictal, and began to react 'normally' to antidepressants, this was confirmed.
>
>
> Best,
>
> Col.thanks for your response. Yes, I too don't care for labels, but in my opinion labels are an important container to define what's going on. I don't feel put into a box by it, but rather relieved to know what's going on with me and be able to treat it from there. As we all know there are multi-layers to depression and such; it's important to start giving some of these things a name so that we can get out of the box; have some freedom from it and self awareness about it. Without a name or label, then I feel mental disorders are not validated as such and not given the proper recognition and acknoweledgment. I think the non-labeling can work in reverse by making the stigma worse due to uneducation about it. anyway, those are my 2cents.
I was a zombie on Zoloft, but Serzone has had that hypomanic effect on me. And again, what were your "symptoms" when you say you went into full blown hypomania on Zoloft?
Glad to hear you've found the right med combo.
katia
Posted by Ritch on June 6, 2003, at 1:00:55
In reply to Re: Lamictal success stories for Ritch, posted by starlight on June 5, 2003, at 15:15:21
> Hi Ritch,
> I had some skin sensations when I first started, but it was kind of like a heated feeling. It went away. As long as you go up slowly you should be fine.
>
> I increased another 50mgs today and feel good. Kind of numb but that's better than the pain of depression. I definitely get an anti anxiety effect. Just feel calmer. I like that feeling as I tend to be hypervigilant as a result of an extremely tulmutuous childhood that included physical and emotional abuse. I think we're probably a bit overconcerned at the idea of being susceptible to side effects. The amount of people who have adverse skin reactions is actually pretty small and like I said your risk is greatly reduced by starting in low doses.
>
> I'm actually very interested in knowing how many people diagnosed with Bipolar suffered from abusive childhoods? Anyone have any information on that?
> starlightThanks for responding. So, Lamictal just seems to reduce anxiety generally? That's good. The incidence of rash is actually quite high with Lamictal-about 1 in 10 people *will* get a rash-statistically anyhow. I don't mind a simple rash (I would freak and stop though), I just don't want some kind of human pizza in the intensive care ward thing to go down!
Posted by starlight on June 6, 2003, at 15:10:17
In reply to Re: Lamictal success stories for Ritch » starlight, posted by Ritch on June 6, 2003, at 1:00:55
Hi Ritch,
After about 6 months of being on it, I noticed a tiny pinprick rash, got scared by it, talked to my doc and he wasn't concered at all. It resolved in a few days. I was actually talking about Stevens Johnson's Syndrome - that only a few people actually have that response. I think it's more like 1 in a thousand, (but don't remember the actual number) - but as long as you're titrating up slowly, you should be fine. The only think I don't like about lamictal is the expense! 116.00$ for my script yesterday. Burly!
Starlight
Posted by Ritch on June 7, 2003, at 0:21:25
In reply to Re: Lamictal success stories for Ritch, posted by starlight on June 6, 2003, at 15:10:17
> Hi Ritch,
> After about 6 months of being on it, I noticed a tiny pinprick rash, got scared by it, talked to my doc and he wasn't concered at all. It resolved in a few days. I was actually talking about Stevens Johnson's Syndrome - that only a few people actually have that response. I think it's more like 1 in a thousand, (but don't remember the actual number) - but as long as you're titrating up slowly, you should be fine. The only think I don't like about lamictal is the expense! 116.00$ for my script yesterday. Burly!
> Starlight
While we are on the expense end of things....
What was your script for: XXXmg bid X 30 tabs ?
IOW, how much per whatsize pill before insurance is applied (if any)?
Posted by lillabelle on June 8, 2003, at 4:34:38
In reply to Re: Lamictal success stories for Ritch, posted by starlight on June 6, 2003, at 15:10:17
hello to all lamictal users! I am definitely a bipolar 11 individual with some attention deficit thrown in for good measure. My depression is atypical, which means oversleeping when down (among other things). Like so many bi-polar's I had terrible responses to AD's. Wild mood swings, anger, numbness, insomnia or hyper-somnia to name just a few. Generally a horrible feeling of being drugged. Being treatment resistant for so long, I finally settled on 75mgs of serzone, 50mg of lamictal and 25mg of sulpride (an anti-p) The mood swings were better and I wasn't immobile, but I was tired all the time with an underlying depression that wouldn't budge.
Well,I endured two years of this combo, but after two years the depression and fatigue became intolerable and I knew I had to change meds.
So, after reading several posts on this board i decided one day to up my lamictal to 100mg, up the serzone to 200mg and drop the sulpride which was leaving me groggy all day. Suddenly the curtain lifted! I had energy, optimism. I got things done and felt good about myself. Now I have moved up to 125mg to see if I feel better still. The reason I was reluctant to up the lamictal in the past was because when I initally tried it (monotherapy) I had a kind of dysphoric mania. Anger attacks, irritablity and negative thoughts, swinging with a kind of unfocused hypomania and major cognitive impairment.( I teach in a college and my students noticed that I had temporarily lost my marbles._) After insulting several people, and feeling moronic,I cut back the lamictal and added the low dose of serzone. Later, still depressed I added on the dose of supride which seemed to help altho made me more tired than I already was.
Today, with the increase in lamictal and the dropped sulpride, I feel well for the first time in a very long time. I also experience no side effects and do not feel 'drugged'. However, when I move the dosage up I get the small, pinprick rash mentioned by some on this board. It's minor and usually clears after a week or so. The other side effect is insomnia. As it is severe I have started to take 50mg of trazadone at night to help me sleep, which it does too well. I cannot get up in the morning (luckily I am not working at present). As I live overseas in a country which bans all benzos I am at a loss for sleeping meds. I have tried lowering the traz. to 25mg but doesn't do the job. I'm wondering if buspar might help (it's available). The other comment I'd like to add, is that I read somewhere on this board, that lamictal,serzone, and trazadone all work on 'gaba'somehow in the brain, all have similar reactions. Does anyone know about this? Advise for the insomnia also greatly appreciated. Hope this helps some of you out there. Lamictal works splendidly for my bipolar 2, but only in conjunction with an AD. Also as everyone else has written one must take the time to let the med adust, by going slowly. It also seems to me that many have had good results with the 100mg to 150mg window. I want to remain on the lowest dose possible in case it stops working and then i have room to move up. Raising your AD of choice could also help the dreaded 'poop out'. One final comment: in the beginning of my raised lamictal treatment (100mg) I was still taking the 25mg of sulpride. I began to experience hand clenching and some slight tremor. Having read on this site that hand clenching could indicate tardive dyskinesia I stopped the sulpride and the hand clenching ceased. Lamictal seemed to enhance the sulpride as i think it does with other meds as well. Just an observation. Peace of mind to one and all.....lillabelle
Posted by Ritch on June 8, 2003, at 9:58:10
In reply to Positive experience with lamictal, posted by lillabelle on June 8, 2003, at 4:34:38
....
However, when I move the dosage up I get the small, pinprick rash mentioned by some on this board. It's minor and usually clears after a week or so. The other side effect is insomnia. As it is severe I have started to take 50mg of trazadone at night to help me sleep, which it does too well. I cannot get up in the morning (luckily I am not working at present). As I live overseas in a country which bans all benzos I am at a loss for sleeping meds. I have tried lowering the traz. to 25mg but doesn't do the job. I'm wondering if buspar might help (it's available). The other comment I'd like to add, is that I read somewhere on this board, that lamictal,serzone, and trazadone all work on 'gaba'somehow in the brain, all have similar reactions. Does anyone know about this? Advise for the insomnia also greatly appreciated.
....Hi, so you get a mild rash *every* time you increase your Lamictal dose? I'm not sure about the gaba question, but you have some major insomnia from the Lamictal? Is it difficulty getting to sleep or staying asleep? One major problem I have is with sleep disrupting meds. If Lamictal worsens early-morning awakenings when I'm depressed, I'll get more unstable for sure.
Posted by Ron Hill on June 8, 2003, at 10:17:06
In reply to Positive experience with lamictal, posted by lillabelle on June 8, 2003, at 4:34:38
Hi Lillabelle,
I can relate with many of your bipolar experiences. For background informational purposes, I am bipolar II and I take 600 mg/day of Lithobid for my hypomania, nutritional supplements for my atypical depressive side, and a nutritional supplement to treat my dysphoric mood states. I'm currently doing very well <knock on wood>.
> The other side effect is insomnia. As it is severe I have started to take 50mg of trazadone at night to help me sleep, which it does too well. I cannot get up in the morning (luckily I am not working at present). As I live overseas in a country which bans all benzos I am at a loss for sleeping meds. I have tried lowering the traz. to 25mg but doesn't do the job.
> Advise for the insomnia also greatly appreciated.
I take 800 mg of magnesium at bedtime each night. It is a GREAT sleep aid (for me) and it also seems to help my overall brain chemistry functioning. Specifically, I take 400 mg (measured as Mg) of magnesium citrate and 400 mg (measured as Mg) of magnesium malate each night.
Don't know if Mg will help you, but just thought I'd mention it in case it might.
-- Ron
Posted by Ron Hill on June 8, 2003, at 10:49:20
In reply to Re: Lamictal success stories for Ritch, posted by starlight on June 5, 2003, at 15:15:21
Starlight,
> I'm actually very interested in knowing how many people diagnosed with Bipolar suffered from abusive childhoods? Anyone have any information on that?
I don't have any formal research data, but for some time now I have been of the opinion that childhood trauma (abuse) is indeed correlated with the onset of bipolar disorder. My opinion has been formed by noticing that an inordinately high percentage of the bipolar patients that I talk to have a history of childhood abuse. I don't have scientific data, just an opinion based on personal observation.
If the correlation does indeed exist, the question then becomes does the actual abuse trigger the onset of the bipolar disorder (in those children with the preexisting genetic predisposition), or instead, is the correlation merely a reflection of the fact that the parents of abused children have a higher-than-normal (statistically speaking) incidence of bipolar disorder, and therefore, the children were genetically predetermine for the onset of bipolar disorder with or without the abuse.
In either case, the mental and physical abuse of children is horrific and we as a society must do all we can to stop it.
-- Ron
Posted by Peter S. on June 8, 2003, at 13:23:28
In reply to Positive experience with lamictal, posted by lillabelle on June 8, 2003, at 4:34:38
lillabelle,
Thanks for sharing your experience! It's great that you've found a combo that works. It's interesting that a mere change in dosage of your various meds did the trick. I'm adding Lexapro to my 50mg of Lamictal to see what happens. I have never heard exactly how Lamictal might work as an AD- all I know is that it has an energizing effect on me.
Best wishes,
Peter
> hello to all lamictal users! I am definitely a bipolar 11 individual with some attention deficit thrown in for good measure. My depression is atypical, which means oversleeping when down (among other things). Like so many bi-polar's I had terrible responses to AD's. Wild mood swings, anger, numbness, insomnia or hyper-somnia to name just a few. Generally a horrible feeling of being drugged. Being treatment resistant for so long, I finally settled on 75mgs of serzone, 50mg of lamictal and 25mg of sulpride (an anti-p) The mood swings were better and I wasn't immobile, but I was tired all the time with an underlying depression that wouldn't budge.
> Well,I endured two years of this combo, but after two years the depression and fatigue became intolerable and I knew I had to change meds.
> So, after reading several posts on this board i decided one day to up my lamictal to 100mg, up the serzone to 200mg and drop the sulpride which was leaving me groggy all day. Suddenly the curtain lifted! I had energy, optimism. I got things done and felt good about myself. Now I have moved up to 125mg to see if I feel better still. The reason I was reluctant to up the lamictal in the past was because when I initally tried it (monotherapy) I had a kind of dysphoric mania. Anger attacks, irritablity and negative thoughts, swinging with a kind of unfocused hypomania and major cognitive impairment.( I teach in a college and my students noticed that I had temporarily lost my marbles._) After insulting several people, and feeling moronic,I cut back the lamictal and added the low dose of serzone. Later, still depressed I added on the dose of supride which seemed to help altho made me more tired than I already was.
> Today, with the increase in lamictal and the dropped sulpride, I feel well for the first time in a very long time. I also experience no side effects and do not feel 'drugged'. However, when I move the dosage up I get the small, pinprick rash mentioned by some on this board. It's minor and usually clears after a week or so. The other side effect is insomnia. As it is severe I have started to take 50mg of trazadone at night to help me sleep, which it does too well. I cannot get up in the morning (luckily I am not working at present). As I live overseas in a country which bans all benzos I am at a loss for sleeping meds. I have tried lowering the traz. to 25mg but doesn't do the job. I'm wondering if buspar might help (it's available). The other comment I'd like to add, is that I read somewhere on this board, that lamictal,serzone, and trazadone all work on 'gaba'somehow in the brain, all have similar reactions. Does anyone know about this? Advise for the insomnia also greatly appreciated. Hope this helps some of you out there. Lamictal works splendidly for my bipolar 2, but only in conjunction with an AD. Also as everyone else has written one must take the time to let the med adust, by going slowly. It also seems to me that many have had good results with the 100mg to 150mg window. I want to remain on the lowest dose possible in case it stops working and then i have room to move up. Raising your AD of choice could also help the dreaded 'poop out'. One final comment: in the beginning of my raised lamictal treatment (100mg) I was still taking the 25mg of sulpride. I began to experience hand clenching and some slight tremor. Having read on this site that hand clenching could indicate tardive dyskinesia I stopped the sulpride and the hand clenching ceased. Lamictal seemed to enhance the sulpride as i think it does with other meds as well. Just an observation. Peace of mind to one and all.....lillabelle
Posted by starlight on June 9, 2003, at 13:22:34
In reply to Positive experience with lamictal, posted by lillabelle on June 8, 2003, at 4:34:38
Lillabelle,
What about Ambien for a sleep aid? It preserves REM sleep, which I think is pretty important. I've noticed a bit of jaw clenching at times on Lamictal.
starlight
Posted by starlight on June 9, 2003, at 13:25:16
In reply to Re: Lamictal expense stories » starlight, posted by Ritch on June 7, 2003, at 0:21:25
I think it's 180 pills, 25 mg sized. I don't know how much it is without the insurance, but I think I pay 20% of the cost so for 116.00$ that would be 580.00$ - expensive stuff eh? I'm going to try to get onto the scripts by mail stuff as I hope it will be cheaper.
Starlight
Posted by Ritch on June 9, 2003, at 13:59:28
In reply to Re: Lamictal expense stories, posted by starlight on June 9, 2003, at 13:25:16
> I think it's 180 pills, 25 mg sized. I don't know how much it is without the insurance, but I think I pay 20% of the cost so for 116.00$ that would be 580.00$ - expensive stuff eh? I'm going to try to get onto the scripts by mail stuff as I hope it will be cheaper.
> Starlight
Whew! I'd say it is expensive. I wonder if it would be a lot cheaper for you if your pdoc let you move up to 100mg/day, and you could take 1/2 a 100mg tab twice daily?
Posted by SpreadDaALoha on June 9, 2003, at 17:49:02
In reply to Positive experience with lamictal, posted by lillabelle on June 8, 2003, at 4:34:38
I developed a lot of acne while on Lamictal. I'm not sure, but I think the acne worsened as my dose increased. I think I was taking 300mg Lamictal (150x2).
I quit taking the lamictal because the acne was so bad. My doctor said that is not a common reaction (rash yes, but acne no). But when I quit the Lamictal, the acne went away...
Also, Lamictal's antidepressant effect seemed to not last and to be mild. But that was just for me.
Posted by Ritch on June 9, 2003, at 21:17:49
In reply to Lamictal and Acne, posted by SpreadDaALoha on June 9, 2003, at 17:49:02
> I developed a lot of acne while on Lamictal. I'm not sure, but I think the acne worsened as my dose increased. I think I was taking 300mg Lamictal (150x2).
>
> I quit taking the lamictal because the acne was so bad. My doctor said that is not a common reaction (rash yes, but acne no). But when I quit the Lamictal, the acne went away...
>
> Also, Lamictal's antidepressant effect seemed to not last and to be mild. But that was just for me.I definitely got acne from lithium and that's a fairly well documented side effect of lithium.
Posted by starlight on June 10, 2003, at 13:03:34
In reply to Re: Lamictal expense stories » starlight, posted by Ritch on June 9, 2003, at 13:59:28
I talked about that with the pharmacist, but will ask again to be sure I understood him correctly. I don't think there's much price difference at all.
starlight
Posted by lr on June 10, 2003, at 21:55:23
In reply to Re: Lamictal Experiences, posted by maryhelen on June 4, 2003, at 7:23:16
you could also try raising your parnate 10 more mg for more immediate effect--i have been taking parnate a long time but only recently started lamictal. so far signs are VERY good but 1. my very very good MD cautioned me against sudden lamictal raises--they could provoke a rash which could be permanent, even lifethreatening and could end all chance of using lamictal.
I have had mild insomnia, i counteract it with trazodone. also SEPARATE your dose of lamictal into 2 x a day.
> I posted on June 1st and felt great. Yesterday, I could feel my mood slipping.
>
> A situation with speaking with my boss is imperative to me, not because I am getting fired, but she had slandered me when I was away. I have to feel in top mental condition to be able to do this effectively,and I was.
>
> I am on Parnate 90 mg and 100 mg. Lamitcal. I tried reaching my pdoc to see if I should tirate another 25 mg, but can't wait, so I am today. I do understand that it may take him a bit to get back to me with hospitals closing in Toronto.
>
> Do you think this is okay? Do I take the extra dose in the morning, as I have done?
>
> Any help would be appreciated.
>
> maryhelen
Posted by fluffy on June 12, 2003, at 10:58:14
In reply to Re: Lamictal Experiences, posted by lr on June 10, 2003, at 21:55:23
Sorry to interrupt this thread for people asking other questions. I tried to wade through all the questions and answers, but didn't have the patience.
I've wanted to ask Ron Hill & Ritch some questions for awhile now, since I have read some informative posts from you two.
Here's my situation:
I'm a clear-cut case of Bipolar II. I have been titrating up on Lamictal for 11 weeks now, doing better than before, but my effect still "slips" if I don't titrate up within a couple of weeks. I still notice a fair amount of cycling--13 days "normal"--2 days hypomania--2-3 days of depression. There has been an overall reduction in my irritability, anger, anxiety & sleep problems, but only if I titrate up.
My question is this: Is it realistic to expect full relief of symptoms & cycling on medication? Is this the *best* it's going to get? I wonder if I should jack with this monotherapy thing and take the risk of feeling worse.
If I augement, would a pinch of Lithium do the trick? I know there are *many* meds to try. I just don't want to slip again.
I tend to get REALLY hypomanic late in the summer, and then REALLY depressed in the fall and winter. At other times, I'm just cyclothymic. What would be your next step?
Posted by fluffy on June 12, 2003, at 12:03:51
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 10:58:14
Everyone--
I read through the whole, meandering thread. But I think I found some useful information about what I can try next.
I'm going to a mood disorders clinic, so they may be weird about prescribing AD's. But it sounds like other BP II's on this strand had some interestingly *good* effects with AD's in conjunction with Lamictal. I'm pretty scared to try it because on AD's alone I had a really nasty mixed state.
Thanks everyone--
Please reply if you have any more advice or experiences!! (re: my post to Ritch and Ron Hill)
Posted by starlight on June 12, 2003, at 13:15:49
In reply to Re: Everyone on this thread--thanks!, posted by fluffy on June 12, 2003, at 12:03:51
Here's an interesting interaction. I hurt my upper back (doing yoga nonetheless) and my doc put me on a klonopin per night just to help me relax and though I like the relaxed feeing I get from it, it makes me so depressed.
The other thing that's frustrating to me is that when I'm depressed one of the first things that happens is suicidal ideation. Anyone else experience so much of that? It sucks, I have a great life, people who care about me, wonderful hobbies and a lot of talent - really - that's hard for people to conceptualize when someone says they have a lot of talent, but let's just say I'm recognized and respected by my peers for my creativity. But I get so down that just taking a bunch of pills and slipping away seems like it would be a nice viable option. I'm not actively suicidal - but I think about it.
starlight
Posted by fluffy on June 12, 2003, at 13:28:15
In reply to Re: Everyone on this thread--thanks!, posted by starlight on June 12, 2003, at 13:15:49
Hey Starlight--
I know what you mean. I think I can relate to you (as can many bipolars). I am also very accomplished in my field (hope it doesn't sound too egotistical) and have good friends and a good job. The minute I get depressed, though, I think--here we go again. The more I get depressed, the more I dread it happening again. I think that is what someone said about feeling prepared but in turn fatalistic on this thread. Depression is inevitable--and the loss of self esteem is devistating (esp. when you ARE accomplished and see good things you ONCE did before feeling depressed--it's oppressive to think you can't reach it anymore) And I suppose the suicidal thought comes from the repeated depressions. I have those thoughts too. I don't know if there's a magic bullet.
Your comiserating friend,
Katy
Posted by Ritch on June 12, 2003, at 13:52:28
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 10:58:14
> Sorry to interrupt this thread for people asking other questions. I tried to wade through all the questions and answers, but didn't have the patience.
>
> I've wanted to ask Ron Hill & Ritch some questions for awhile now, since I have read some informative posts from you two.
>
> Here's my situation:
>
> I'm a clear-cut case of Bipolar II. I have been titrating up on Lamictal for 11 weeks now, doing better than before, but my effect still "slips" if I don't titrate up within a couple of weeks. I still notice a fair amount of cycling--13 days "normal"--2 days hypomania--2-3 days of depression. There has been an overall reduction in my irritability, anger, anxiety & sleep problems, but only if I titrate up.
>
> My question is this: Is it realistic to expect full relief of symptoms & cycling on medication? Is this the *best* it's going to get? I wonder if I should jack with this monotherapy thing and take the risk of feeling worse.
>
> If I augement, would a pinch of Lithium do the trick? I know there are *many* meds to try. I just don't want to slip again.
>
> I tend to get REALLY hypomanic late in the summer, and then REALLY depressed in the fall and winter. At other times, I'm just cyclothymic. What would be your next step?Colin Wallace and others here are on Lamictal-I've never tried it yet. From what I understand from all the posts and other info I have read is that it is worthwhile to reach 200mg or so and hang in there a few weeks to realize the maximum benefit of the Lamictal. Your cycles are similar to mine. It is possible that your cycle length is too close to the titration frequency and the "slips" may be your natural "pattern" confusing things. See if you can either stay at your current dose of Lamictal "through" about 1.5x your cycle length and see if the "slip" fades AND/OR keep going up, but lengthen the time before your next scheduled increase to go beyond a full cycle length by some amount to try to separate the two effects somehow. If you start to get predominantly hypomanic in the late summer-I would wait for the symptoms to show first before reaching for the lithium. They might *not* show up or may be more attentuated than they have previously. If they do show up and are troublesome, lithium would be the thing to add if you don't want to hassle with the Lamictal blood levels jumping up by adding Depakote, although Depakote might work better than Li for you (given you are a rapid-cycler like me).
Posted by fluffy on June 12, 2003, at 16:17:12
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A' » fluffy, posted by Ritch on June 12, 2003, at 13:52:28
> Colin Wallace and others here are on Lamictal-I've never tried it yet. From what I understand from all the posts and other info I have read is that it is worthwhile to reach 200mg or so and hang in there a few weeks to realize the maximum benefit of the Lamictal. Your cycles are similar to mine. It is possible that your cycle length is too close to the titration frequency and the "slips" may be your natural "pattern" confusing things. See if you can either stay at your current dose of Lamictal "through" about 1.5x your cycle length and see if the "slip" fades AND/OR keep going up, but lengthen the time before your next scheduled increase to go beyond a full cycle length by some amount to try to separate the two effects somehow. If you start to get predominantly hypomanic in the late summer-I would wait for the symptoms to show first before reaching for the lithium. They might *not* show up or may be more attentuated than they have previously. If they do show up and are troublesome, lithium would be the thing to add if you don't want to hassle with the Lamictal blood levels jumping up by adding Depakote, although Depakote might work better than Li for you (given you are a rapid-cycler like me).Thanks Ritch--
Interesting point you make about my natural cycles. The peaks and valleys are less predominant now than before. I just reached 200 mg a little over a week ago. The study I'm participating in requires a dose of at least 200mg. I'll wait it out for another 2 weeks until my next appt.Is it Ritch or Mitch? I don't get it...inquiring minds want to know! And are you a doctor? Or a very experienced patient? Just curious..
Katy
Posted by starlight on June 12, 2003, at 17:21:19
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 16:17:12
Okay. Just got back from my appt. He wants me to raise to 200mgs on lamictal. Who else has found relief at this level? I took some klonopin for back pain and found it sent me right down the toilet moodwise. As a result he wants to increase it some more.
starlight
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