![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 46 to 70 of 82. Go back in thread:
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
Posted by Ron Hill on June 12, 2003, at 19:17:21
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 10:58:14
Hi Ms. Katy Fluffy,
> 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.
This sounds very similar to Colin Wallace's experience with Lamictal. Flag Colin down and get his input. He also found it necessary to continually bump up the dose to retain its effectiveness.
I have a couple questions:
Is this the first moodstabilizer prescribed for you?
How long ago did you get the BP II dx?
You mentioned your unfavorable reaction to an antidepressant without a moodstabilizer. What other meds have you tried and what were the overall results (Reader's Digest version is fine)?
How many years have you been taking psychotropic medications?
Why did your pdoc select Lamictal instead of lithium or Depakote?
> My question is this: Is it realistic to expect full relief of symptoms & cycling on medication?
Define "full relief". My short answer is yes (pretty much). You can certainly get closer than you are now with your cycling. However, it is a trial-and-error process to find a med combo that works best for you.
> Is this the *best* it's going to get?
No, it gets better. However, some medication trials may make your condition worse. Do your homework and, thereby, identify those medications with the highest probability of success for your individual case. See homework assignment at the end of my post.
> I wonder if I should jack with this monotherapy thing and take the risk of feeling worse.
You mean increase your Lamictal dose, correct? What dosage are you currently taking? Any rash so far? What is your pdoc’s advice regarding dosage increases? As you know, small incremental increases are advised to avoid getting a rash.
> If I augement, would a pinch of Lithium do the trick?Perhaps. Or maybe Depakote monotherapy, or maybe slow release lithium monotherapy. Or maybe Trileptal has a role to play in your med cocktail. Given the fact that hypomania is a significant component of you BP II, I would have thought that your pdoc would have tried a first-line moodstabilizer such as lithium or Depakote before prescribing Lamictal.
Ritch makes a good point when he said that Depakote might be a good moodstabilizer to try since it typically works well to control rapid cycling. But as he also pointed out, adding Depakote to Lamictal is tricky because Depakote elevates the blood levels of Lamictal. Depakote monotherapy might be something to try, but your pdoc would likely require a wash-out period (discontinue Lamictal a week or two prior to starting Depakote).
> 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?My bias is toward using either slow-release lithium monotherapy or Depakote monotherapy to get the hypomania under control. (I personally like a low-to-moderate dosage of Lithobid because it works so well for me, but YMMV) Then, if your depression and/or irritability are not adequately treated by the moodstabilizer monotherapy, then medication and/or nutritional supplements could be carefully added on as needed. On the other hand, however, Colin is currently obtaining good results using Lamictal and a pinch of Prozac.
Here is your homework assignment. Please read the treatment (i.e.; medication) sections of the following document and scan the other relevant portions of the paper.
http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
Please answer the questions above and stay in touch. Best Wishes.
-- Ron
Posted by Ritch on June 12, 2003, at 23:00:59
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 16:17:12
>
> > 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
>
>
>
Hi, I've just been "fooled" into thinking meds weren't working or they were triggering hypomania, or making me more depressed, etc., because my own cycling was the real culprit. I've been dx'ed BP-II for about 25 years, not a doctor. So, you are in a STUDY? Let us in on what's happening, if you don't mind...Mitch
Posted by fluffy on June 13, 2003, at 11:45:37
In reply to Re: Ask Colin Wallace for his input » fluffy, posted by Ron Hill on June 12, 2003, at 19:17:21
> Hi Ms. Katy Fluffy,
Hi there Ron Hill--Thanks for your reply and concern...all this stuff is confusing to me (as I'm sure it is to new BP folks)
> This sounds very similar to Colin Wallace's experience with Lamictal. Flag Colin down and get his input. He also found it necessary to continually bump up the dose to retain its effectiveness.
Colin--Are you out there?
> I have a couple questions:
>
> Is this the first moodstabilizer prescribed for you?No--It's not the first mood stabilizer. I had a really stupid doctor before who wouldn't/couldn't recognize that I was having a full-blown mixed state after being put on Lexapro for depression (after 5 weeks) I didn't sleep for 5 days, and I was knashing my teeth, wouldn't leave the house, contemplating suicide, driving to West Texas (crying the whole 10 hours), having many thoughts at the same time, etc.
First he put me on a *tiny* dose of neurontin with a full dose of Zoloft. (I feel he was humoring me). I told him I just felt like an anxious, agitated zombie after trying it for 3 weeks.
So he put me on 100mg of Tegretol--only after I had to convince him that I thought I might be bipolar...Then he wouldn't answer my calls--even though I felt like poop on a shingle. I bumped up to 200mg Tegretol a month later...then fell back into depression. That's about the time I found the mood disorder clinic I'm going to now.
Before all this, I was on Paxil for a year (for MAJOR panic attacks and FULL on depression), went off a year later because I thought I was "better" but I didn't have a manic spell on it. It wasn't until the second prescription (Lexapro, for major depression again), one year after I went off Paxil that I went manic. Looking back, I had hypomania before each depressive episode..it was especially prominent this last full episode.
> How long ago did you get the BP II dx?
It's been since last October/November. The mood disorder clinic confirmed through their incessant question and answer process.
> How many years have you been taking psychotropic medications?Again--refer to long paragraph above
> Why did your pdoc select Lamictal instead of lithium or Depakote?
I think because Tegretol was at such a low dose that it was doing *nothing* and essentially they had a clean slate to try something else on me. Also, because I was having a depressive phase that wouldn't lift. I joined in a study that randomly chose Lithium or Lamictal for BPII patients who are currently
depressed. I fit that bill perfectly. I got the Lamictal--I'm in the 11th week of the study. Free appointments, free meds, and the option to drop out if things get worse. I'm a professional guinea pig!> Define "full relief". My short answer is yes (pretty much). You can certainly get closer than you are now with your cycling. However, it is a trial-and-error process to find a med combo that works best for you.
>
I guess I mean *NO CYCLING* by full relief. I definitely feel that I'm cycling more softly, but still cycling.> You mean increase your Lamictal dose, correct? What dosage are you currently taking? Any rash so far? What is your pdoc’s advice regarding dosage increases? As you know, small incremental increases are advised to avoid getting a rash.
>
I'm currently on 200mg. No rash, except for the beginning--I had a flaky eczema type rash and tingly fingers and toes. Since I'm in a study, the normal clinical practices are rigid--the point of the study is to get up to a dose of at least 200mg. They may raise me still. After the study, I may add other stuff.Hope this answered your questions! Please reply back with any other input/opinions/suggestions.
Thanks!
Katy
Posted by Ritch on June 13, 2003, at 23:07:13
In reply to Reply to Ron Hill and Ritch--Colin Wallace??, posted by fluffy on June 13, 2003, at 11:45:37
>I think because Tegretol was at such a low dose that it was doing *nothing* and essentially they had a clean slate to try something else on me. Also, because I was having a depressive phase that wouldn't lift. I joined in a study that randomly chose Lithium or Lamictal for BPII patients who are currently
depressed. I fit that bill perfectly. I got the Lamictal--I'm in the 11th week of the study. Free appointments, free meds, and the option to drop out if things get worse. I'm a professional guinea pig!
>I'm currently on 200mg. No rash, except for the beginning--I had a flaky eczema type rash and tingly fingers and toes. Since I'm in a study, the normal clinical practices are rigid--the point of the study is to get up to a dose of at least 200mg. They may raise me still. After the study, I may add other stuff.>Hope this answered your questions! Please reply back with any other input/opinions/suggestions.
>Thanks!
Katy
Interesting info Katy. So, are you *only* on Lamictal-no other meds? I just wonder since you are in the study whether or not they would permit any other medications. You mentioned having problems with panic in the past-does the Lamictal seem to help with that in any way? Thanks for anymore info...
Posted by fluffy on June 14, 2003, at 11:44:58
In reply to Re: Reply to Ron Hill and Ritch--Colin Wallace?? » fluffy, posted by Ritch on June 13, 2003, at 23:07:13
>
>
> Interesting info Katy. So, are you *only* on Lamictal-no other meds? I just wonder since you are in the study whether or not they would permit any other medications. You mentioned having problems with panic in the past-does the Lamictal seem to help with that in any way? Thanks for anymore info...Yes--Right now I'm on Lamictal only. The study lasts 16 weeks, so I'm almost finished. The study does not permit any other medications, as it is to test Lamictal's effectiveness *only*. Plus, the head of the clinic (she's one of the best in her field) strongly believes in as few medications as possible being used, rather than polypharmacy. She's really big on fish oil and zyprexa as well as the *gold standards*. Most people who are part of the program use more than one med. The program is in place to 'follow' the patterns of bipolar patients for 5 years in order to gain a better understanding of the course of the illness. (This is funny to me--it sounds like I'm part of a cult!) Sometimes I get tired of the Q&A process with every appointment, but it's cool to know that my participation is helping to better the science to treat BP disorder.
I think Lamictal has *definitely* helped the panic symptoms over time. At first, I had a hefty hypomania bout, and panic came with it. But it calmed down once I had been on the Lam. for a few weeks. If I indeed have more panic problems during my problem time (usually late summer) then I'll augment.
Take care--
And thanks for the sound advice!
Katy
>
>
Posted by Ritch on June 15, 2003, at 9:23:21
In reply to Re: Reply to Ron Hill and Ritch--Colin Wallace??, posted by fluffy on June 14, 2003, at 11:44:58
Posted by Ron Hill on June 15, 2003, at 15:54:40
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A', posted by fluffy on June 12, 2003, at 10:58:14
Katy Fluff,
> 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.
After rereading my initial response to this post of yours, I feel I should have shown a little more enthusiasm regarding your idea of adding some lithium to your current Lamictal.
For some time I've thought that this might make a good combination for many bipolar patients, particularly those patients who struggle significantly with bipolar depression. Lithium would provide the bulk of the moodstabilization and Lamictal would provide the antidepressant contribution.
This might be worth a trial after the conclusion of your study. On the other hand, Colin Wallace added some Lithobid to his Lamictal/Prozac combo a few days ago and, the last I heard, it's not working out very well. Perhaps you've seen Colin's post on this subject in a thread further down on the PB page. There was a time when I wished I could try a Lithobid/Lamictal combination because, although Lithobid does a real good job controlling my hypomania, it does little or nothing for my atypical depression. So I wanted to add Lamictal to treat my depression. However, Lamictal give me a nasty rash over a significant portion of my body. Now, however, it is a moot point since I have my depression problem (and my irritability problem) solved using nutritional supplements.It is my opinion, however, that you will need more than just a pinch of lithium. If I were you, initially I’d shoot for a blood level of about 0.4 mEq/l and increase, if needed to fully control your hypomania, to 0.6 mEq/l. But all of this is just my opinion.
Dr. Charles Bowden is a leading expert in bipolar disorder. He recently gave a presentation regarding Maintenance Treatment of Bipolar Disorders at the University of Chicago. Dr. Bob has it on Grand Rounds. I think it is worth your time to watch it, so here is the link:
http://psychiatry.uchicago.edu/grounds/030303/
-- Ron
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