![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 56 to 80 of 82. Go back in thread:
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
Posted by colin wallace on June 15, 2003, at 17:16:56
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A' » fluffy, posted by Ron Hill on June 15, 2003, at 15:54:40
> 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.
>
Hi there Katy,Sorry, I seem to have missed this thread somehow.As you probably know(if you've scoured the dusty archives)I've been taking Lamictal for a year, with superb results.
It has been the only med., after of a multitude of treatment failures, to have any significant impact on my depression.In fact, I would say that Lamictal monotherapy did actually allow mw to achieve complete 'remission' after 3 or 4 months at 200mg.
However, in common with the experiences of quite a few others, I found that I needed to chase the dose to maintain the effects and prevent breakthrough depression.
I had decided early on that, if I reached 300mg and still felt the need to titrate, then at this stage I'd begin plans to augment with an AD, another moodstabilizer, or both.
In short, I gave it until 400mg before bringing in reinforcements in the form of Prozac, which allowed me to recapture the Lamictal effect with some consistency, and also to lower the dose back down to a manageable 250mg.
Insofar as augmentation is concerned, you do at least have plenty of options if called for;
lithium in concert with a low dose tricyclic AD is considered by some to be very effective(look for Maximus' posts in the archives).
Personally, I like the principle of this option, although lithium and I didn't hit it off.But it works like a charm for some.
A couple of us here have had success with adding a small dose of Prozac -interestingly,I was never able to tolerate it pre-Lamictal, yet now they seem to provide complementary effects.
To my mind, the biggest advantage offered by Lamictal is the relative freedom to try different augmentation strategies, without undermining your previous AD gains/stability.
I'd go with monotherapy for as long as is feasible,and plan ahead as necessary, should you find yourself running into high-end doses to achieve results.Best,
Col.
Posted by fluffy on June 15, 2003, at 17:27:43
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A' » fluffy, posted by Ron Hill on June 15, 2003, at 15:54:40
Ron--
Thanks for your last post. I guess I've heard that Lithium has an antidepressant quality as well. And since it is compatible with Lamictal, it's a less complicted alternative for an add-on.
I'm quite frightened of SSRI's now, after my last *scary* experience with them. I'm just glad I'm alive after that.If I might ask, Ron--What kind of nutritional supplements do you take? I know nothing of this approach to treating depression, except that fish oil can help and that magnesium can help sleep disturbance.
On another topic, though...
Lately, I've noticed that I feel REALLY, REALLY sedated in the afternoons. It can fade by evening, but I feel like I'm going to sleep standing up. (maybe 'cause I work in a bookstore...it's sometimes VERY boring). But even then, it doesn't feel like just being sleepy..I feel like I got konked on the head, and 'poof' I'm sleepy for 4 hours, starting at the same time of day. It doesn't feel like depression sleepiness either, because I don't have the accompanying self esteem problems. Could this be related to my Lamictal dose and/or timing of dose? My next appt. with my pdoc isn't for awhile.If anyone has experience with this, let me know.
Posted by Maxime on June 15, 2003, at 19:29:13
In reply to Lamictal-I'm so sleepy! Ron Hill-what supplements?, posted by fluffy on June 15, 2003, at 17:27:43
I've just started Lamictal and I have to take it night. It makes me VERY tired, dizzy and nauseous.
I'm not at a high enough dose where I need to split it.
Max
Posted by starlight on June 16, 2003, at 14:30:52
In reply to Re: Lamictal-I'm so sleepy! , posted by Maxime on June 15, 2003, at 19:29:13
Hi All,
I ended up having to take a couple of klonopin's for back pain, and that sent me spiraling down, ick! So then he upped my dose of lamictal to 200mgs. So far the only thing I've experienced thusfar has been nausea. I'm a bit tired, but that's from staying up too late. I do feel a bit better, but would love to find just one drug that did the trick! Yesterday the nausea was really bad. He thought that rather than the klonopin affecting me, that it was just my regular mood swing. I find that I swing moods alot more - I can be depressed over a long period, but am beginning to think that I swing as frequently as once or twice every two weeks or so. I can go from having loads of energy and a cheerful outlook to wanting to throw myself in front of a truck overnight. Anyone else like that?
starlight
starlight
Posted by Ron Hill on June 17, 2003, at 12:22:57
In reply to Lamictal-I'm so sleepy! Ron Hill-what supplements?, posted by fluffy on June 15, 2003, at 17:27:43
Hi Ms. Katy Fluff,
> I guess I've heard that Lithium has an antidepressant quality as well.
Yeah, I've heard the same thing. So apparently it does for some people, but not for me.
> And since it is compatible with Lamictal, it's a less complicted alternative for an add-on.
Yeah, makes sense.
> I'm quite frightened of SSRI's now, after my last *scary* experience with them. I'm just glad I'm alive after that.
For a bipolar patient, taking an SSRI without a moodstabilizer can be disastrous. Some BP II folks find benefit from adding a low dose of an SSRI to a moodstabilizer but others, like me do not.
> If I might ask, Ron--What kind of nutritional supplements do you take? I know nothing of this approach to treating depression, except that fish oil can help and that magnesium can help sleep disturbance.
As it stands today, I’m doing exceptionally well (thanks in no small part to the information given to me by posters to this board). I feel confident that my current cocktail is going to last long-term, but I have learned over the years that there are no guarantees with any of this stuff.
In answer to your question, I currently take 600 mg/day of Lithobid for my hypomania, 2.5 mg once or twice a week of ENADA NADH in conjunction with 250 mg/day of TMG for my depression, and a 125 mg dose of niacin (vitamin B3) twice or three times per day to control my dysphoric mood states (irritability to the tenth power).
ENADA NADH is the supplement that is most responsible for keeping my atypical depression at bay. However, it can cause irritability if I take too much. TMG seems to work in a favorable synergistic way with the Enada NADH.
The benefit I find in adding TMG is that it seems to extend the time period of effectiveness for a given dose of ENADA NADH. In other words, without TMG, a 2.5 mg dose of ENADA NADH loses its effectiveness after about four days. But with TMG, it can last for almost a week. Therefore, TMG indirectly reduces my irritability by reducing my ENADA NADH dosing frequency. I think TMG is also providing a mild antidepressant effect.
However, the supplement that fixed my irritable (dysphoric) mood states is niacin. The effect is profound. The addition of niacin allows me the flexibility of taking 2.5 mg of ENADA NADH twice a week if I need the more frequent dosing to manage my atypical depressive symptoms. In addition to doing an amazing job on my irritability, I believe that niacin is providing me a slight antidepressant effect.
I’m told that niacinamide (another form of vitamin B3) is even better than niacin for irritability. Therefore, I may conduct a trial of niacinamide (either with or without niacin).
Like you, I take various vitamins, minerals, and fish oil. I also take a daily capsule of phosphatidyl serine (PS). It is thought that PS promotes cell membrane placidity (more supple) and, thereby, improves the functioning of the neurotransmitter receptors. PS is kind of spendie at a retail price of roughly $0.75 per capsule (containing 100 mg of PS). The PS, vitamins, minerals, and fish oil are all beneficial for me, but not as profound in effect as ENADA NADH.
I take 20 ml (4 tsp)/day of fish oil. It helps stabilize my mood and I believe it provides a slight antidepressant effect.
I take 800 mg of magnesium at bedtime each night and it knocks me out like turning off a light and keeps me asleep throughout the night like a hibernating bear. I awake the next morning feeling refreshed and restored. YMMV. I'm also convinced that the magnesium exerts positive effects on my brainchemistry functioning throughout the day. Larry Hoover can say it better than I, but not all forms of magnesium are created equal when it comes to absorption. I take 400 mg/day (measured as Mg) of magnesium citrate and 400 mg/day (measured as Mg) of magnesium malate. If it causes diarrhea, back off on the dosage.
Katy, please reply with a list of the specific symptoms of the depressive side of your BP II. It is my opinion that ENADA NADH is best suited to treat atypical depressive symptoms (e.g.; anhedonia, anergy, low motivation, apathy, hypersomnia, etc) attributable to dopaminergic pathway problems. If your depression is not atypical, other supplements (or medications) might serve you better.
> On another topic, though...
> Lately, I've noticed that I feel REALLY, REALLY sedated in the afternoons. It can fade by evening, but I feel like I'm going to sleep standing up. (maybe 'cause I work in a bookstore...it's sometimes VERY boring). But even then, it doesn't feel like just being sleepy..I feel like I got konked on the head, and 'poof' I'm sleepy for 4 hours, starting at the same time of day. It doesn't feel like depression sleepiness either, because I don't have the accompanying self esteem problems. Could this be related to my Lamictal dose and/or timing of dose? My next appt. with my pdoc isn't for awhile.Do you take your Lamictal once a day or twice a day? Maxime’s recommendation to take your Lamictal at bedtime might be worth a try if you are dosing once a day.
-- Ron
Here are some of the links discussing ENADA NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10047,00.html#Cautions
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
Posted by fluffy on June 18, 2003, at 11:17:06
In reply to Re: Lamictal-I'm so sleepy! Ron Hill-what supplements? » fluffy, posted by Ron Hill on June 17, 2003, at 12:22:57
Thanks for the info, Ron Hill. WOW- Seems like you're quite the scientist with this. Glad you got some good information that helped you find stability on this board. And through VITAMINS! That's great.
Let's see...I always thought my depression was typical, not atypical.
I seem to get a little mixed before I crash into full depression. I have ruminations (negative), can't sleep, panic attacks and general anxiety. Then I experience:NO thoughts-just a blank slate
NO memory (in general, a poor cognitive state)
NO appetite--I just can't taste anything
Slowness
Oversleeping
Low self esteem
Crying spells
Eventually suicidal ideationIs that atypical?
I think I will consult my doc about supplements, as they are not against more "radical" solutions to symptoms. This clinic is very forward thinking.BTW, the sleepiness seems to be not so bad the past couple of days. I have cut down on heavy carbos and eaten vitamin rich foods (esp. for lunch) and cut down on caffeine intake in the morning (to avoid the "crash" in the afternoons).
Posted by fluffy on June 18, 2003, at 12:00:53
In reply to Re: Lamictal-I'm so sleepy! , posted by starlight on June 16, 2003, at 14:30:52
> Hi All,
> I ended up having to take a couple of klonopin's for back pain, and that sent me spiraling down, ick! So then he upped my dose of lamictal to 200mgs. So far the only thing I've experienced thusfar has been nausea. I'm a bit tired, but that's from staying up too late. I do feel a bit better, but would love to find just one drug that did the trick! Yesterday the nausea was really bad. He thought that rather than the klonopin affecting me, that it was just my regular mood swing. I find that I swing moods alot more - I can be depressed over a long period, but am beginning to think that I swing as frequently as once or twice every two weeks or so. I can go from having loads of energy and a cheerful outlook to wanting to throw myself in front of a truck overnight. Anyone else like that?
> starlight
Hey Starlight--You read my mind. I was thinking about this the other day. I never noticed before that I was a "rapid cycler" until recently. I have had seasonal bouts of anxiety and depression that I could trace over the past 3 years or so. (I'm 29 now.) But I never noticed that my mood would undulate from week to week until the past 4-5 months. (after having taken SSRI's for 2 years and then stopping)
I wonder if hormones come into play? I have an IUD (with hormones) that I got for birth control--and I notice that I have had swings more often. Or maybe because I'm keeping a hawk's eye out on my mood changes now (with being AWARE that I'm bipolar, and testing new meds)
I also have had prolonged periods of depression--and I didn't notice any "rapid cycling". But as of late....
How is this possible? Am I a rapid cycler, or have I always been cyclothymic with bouts of major depression?
I'm curious too.
Katy
Posted by katia on June 18, 2003, at 14:23:22
In reply to Starlight--Same problem!, posted by fluffy on June 18, 2003, at 12:00:53
> > Hi All,
> > I ended up having to take a couple of klonopin's for back pain, and that sent me spiraling down, ick! So then he upped my dose of lamictal to 200mgs. So far the only thing I've experienced thusfar has been nausea. I'm a bit tired, but that's from staying up too late. I do feel a bit better, but would love to find just one drug that did the trick! Yesterday the nausea was really bad. He thought that rather than the klonopin affecting me, that it was just my regular mood swing. I find that I swing moods alot more - I can be depressed over a long period, but am beginning to think that I swing as frequently as once or twice every two weeks or so. I can go from having loads of energy and a cheerful outlook to wanting to throw myself in front of a truck overnight. Anyone else like that?
> > starlight
>
>
> Hey Starlight--
>
> You read my mind. I was thinking about this the other day. I never noticed before that I was a "rapid cycler" until recently. I have had seasonal bouts of anxiety and depression that I could trace over the past 3 years or so. (I'm 29 now.) But I never noticed that my mood would undulate from week to week until the past 4-5 months. (after having taken SSRI's for 2 years and then stopping)
>
> I wonder if hormones come into play? I have an IUD (with hormones) that I got for birth control--and I notice that I have had swings more often. Or maybe because I'm keeping a hawk's eye out on my mood changes now (with being AWARE that I'm bipolar, and testing new meds)
>
> I also have had prolonged periods of depression--and I didn't notice any "rapid cycling". But as of late....
>
> How is this possible? Am I a rapid cycler, or have I always been cyclothymic with bouts of major depression?
>
> I'm curious too.
> KatyDitto on the board. Yes, it's amazing what we discover about ourselves when we stay aware. I just had my appt. with a new pdoc. I've been taking ADs all year thinking I just (not that that's not enough) had depression; but nothing worked,etc. (see previous posts). My new pdoc seems to also think that I'm falling in the bipolar spectrum - somewhere around BPII and BPMixed. He also said that it's only recently in psychiatry that this broad spectrum opened up so people were/are being misdiagnosed for anxiety or depression when in fact there's more to BP than BPI (classic manic depression).
He's given me a very detailed mood chart that I have to fill out everyday for the next three weeks and he started me on 25mg Seroquel cut in halves/quarter/thirds (whatever ends up after my lovely pill cutter) for sleep. So far I'm sleeping a lot but I feel so groggy in the morning. I'm staying on the 50mg Serzone for now b/c he wants to do one thing at a time.
Mood swings are so hard to track because when you're in a low or high; it feels as though it's normal and this is always how it's been. AND for me it's normally mixed; so it's not so clear cut. It's also hard to find language to describe the subtlties of these feelings that I took for so long as "just me".
katia
Posted by starlight on June 18, 2003, at 14:41:56
In reply to Starlight--Same problem!, posted by fluffy on June 18, 2003, at 12:00:53
Hi Katy,
It's really interesting to me. Even when I'm depressed, I can still have a lot of energy, but just notice all the terrible things, or have more suicidal ideation. It's like running and thinking things are hopeless and wondering what in the hell I'm doing here at the same time. I can still get things accomplished, though it might take a bit more for me to get motivated, I can still operate.The rapid cycling thing is still something I'm getting used to, but as I look back I can definitely see the pattern.
Even as I look back into my youth and early twenties I can see serious swings from elated to seriously depressed, though I would say that I've suffered overall from more depression than elation. The best was the morning I woke up and was literally buzzing with great energy. Loved it, loved life and felt amazing. It made me feel like those sales seminars when the speaker says he bounces up in the morning looking forward to getting to work and starting his day. But that was on wellbutrin........bummer that had to stop. Bummer! I liked that feeling, would like that to happen every day.
Hormones definitely have an effect. I've never, ever been able to take birth control pills, no matter what the dose specifically for the reason that they throw me down like nobody's business. Horrible mental side effects for me. It doesn't take long either, about 5 days and I'm done. It's too bad really, because it would be nice to not have to use condoms, but cest la vie'.
I would like to know about rapid cyclers.
starlight
Posted by katia on June 18, 2003, at 15:35:16
In reply to Re: Starlight--Same problem!, posted by starlight on June 18, 2003, at 14:41:56
> Hi Katy,
> It's really interesting to me. Even when I'm depressed, I can still have a lot of energy, but just notice all the terrible things, or have more suicidal ideation. It's like running and thinking things are hopeless and wondering what in the hell I'm doing here at the same time. I can still get things accomplished, though it might take a bit more for me to get motivated, I can still operate.
>
> The rapid cycling thing is still something I'm getting used to, but as I look back I can definitely see the pattern.
>
> Even as I look back into my youth and early twenties I can see serious swings from elated to seriously depressed, though I would say that I've suffered overall from more depression than elation. The best was the morning I woke up and was literally buzzing with great energy. Loved it, loved life and felt amazing. It made me feel like those sales seminars when the speaker says he bounces up in the morning looking forward to getting to work and starting his day. But that was on wellbutrin........bummer that had to stop. Bummer! I liked that feeling, would like that to happen every day.
>
> Hormones definitely have an effect. I've never, ever been able to take birth control pills, no matter what the dose specifically for the reason that they throw me down like nobody's business. Horrible mental side effects for me. It doesn't take long either, about 5 days and I'm done. It's too bad really, because it would be nice to not have to use condoms, but cest la vie'.
>
> I would like to know about rapid cyclers.
> starlightSame with me. Could never take the pill; made me crazy(ier). It's been a big source of a lot of grief for me too. I'm the same; more up than down and it's a rarity that I wake up and feel happy and excited about starting the day.
katia
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.