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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 79. Go back in thread:
Posted by katia on September 21, 2003, at 15:39:58
In reply to Lamictal possibly DANGEROUS, posted by HenryO on September 19, 2003, at 4:08:17
> What do you mean you started out right away at 400mg? If you mean that you did not build up your dose slowly over several weeks and months. STOP IMMEDIATELY.
>
> There is a chance, a small chance, but a real chance that one can get a fatal rash from Lamictal.
>
> You must increase the dose starting at 25mg or less, by 25mg a week at the very quickest. Slower is better. As you go you must watch carefully for any sign of a rash. If you get a skin reaction stop taking the med and go to the hospital.
>
> I am taking Lamictal 200mg daily. It has been a great med for me. It works better than anything I've ever been on. But, you should have been advised strongly about how to take it. 400mg is a big dose.
Hi Henry-O,
What else have you tried? What is your dx? I'm just starting Lamictal at 5mg per every two weeks! Talk about a sloooow ride.
Are you only on lam? For the moment, I'm combining it with 750mg Depakote. But am probably switching off of the Depakote due to the risk of PCOS.
thanks.
katia
Posted by DayByDay on September 21, 2003, at 23:30:37
In reply to Lamictal possibly DANGEROUS, posted by HenryO on September 19, 2003, at 4:08:17
> What do you mean you started out right away at 400mg? If you mean that you did not build up your dose slowly over several weeks and months. STOP IMMEDIATELY.
>
> There is a chance, a small chance, but a real chance that one can get a fatal rash from Lamictal.
>
> You must increase the dose starting at 25mg or less, by 25mg a week at the very quickest. Slower is better. As you go you must watch carefully for any sign of a rash. If you get a skin reaction stop taking the med and go to the hospital.
>
> I am taking Lamictal 200mg daily. It has been a great med for me. It works better than anything I've ever been on. But, you should have been advised strongly about how to take it. 400mg is a big dose.-------------------------------------------------
My doctor told to go with the 25mg/day for to weeks before going to 50mg/day all the time carefully watching for the potential development of the dangerous rash.
Posted by HenryO on September 22, 2003, at 2:48:14
In reply to Re: Lamictal possibly DANGEROUS » HenryO, posted by katia on September 21, 2003, at 15:39:58
katia, as far as I'm concerened my dx is depression, it gets worse seasonally or whenever it wants to. I am currently on Lamictal only, 200mg daily. The build up you are doing sounds pretty slow, maybe it's because of worries about interactions. I wouldn't know about that. The advice I got about taking Lamictal is exactly the same as DayByDay describes.
As far as what I've tried:
Prozac
Effexor
Wellbutrin
Ritalin
Reboxetine
Adderal
Nuerontin
Escolith
Strettera
Klonapin
Trazadone
Resperdal, and I am sitting here knowing that I have forgotten twelve others. I've never been on Depakote though.
Posted by HenryO on September 22, 2003, at 3:03:33
In reply to lamictal and sweating, posted by borderliner21 on September 18, 2003, at 18:26:59
borderliner21, are you there? How are things going Lamictal wise, and in general?
Posted by DayByDay on September 22, 2003, at 8:08:11
In reply to Lamictal possibly DANGEROUS, posted by HenryO on September 19, 2003, at 4:08:17
HenryO says:
> I am taking Lamictal 200mg daily. It has been a great med for me. It works better than anything I've ever been on.My question to Henry or anyone else is: How well does Lamictal monotherapy work with treating depression (I know you can use is as maintanence to prevent the recurrence of depression) I´m a
BPIII meaning I can´t take SSRI´s only (at least the one´s I´ve tried) and adding
moodstablisers to them doesn´t seem to help me from having mixed mania symptoms.
- tried combining with depakote(which by the way made me psychotic, hallucinating and confused-really scary) zyprexa and lithium.When does the effect become noticable, when does it peak and how does it feel. Can Lamictal only
help with anxiety and OCD as well???
Posted by BarbaraCat on September 22, 2003, at 14:38:22
In reply to How does lamictal feel and how much does it help??, posted by DayByDay on September 22, 2003, at 8:08:11
Hello Day,
I have BP-2 with severe mixed states depression, and it may possibly be BP-1 but who'se counting. Was on SSRI's and other major depression meds for over 20 years thinking it was major unipolar depression. Had the standard SSRI poop out then aggravation with periodic hellish psychotic depressions even on large doses of SSRI's (all of 'em) before realizing it was classic BP mixed states.Went on Lithium and it didn't provide the AD relief, although it did relieve the psychotic nature of the depressions. Added Lam and it was great, no depression, no agitation. I'm hypothyroid and lithium aggravates that condition so I stopped lithium hoping, as you are, that Lamictal would provide adequate monotherapy. Within a short time I started experiencing the agitation and dread that heralds a mixed states coming on, along with frazzled disorganization. Lamictal was not enough to overcome the agitatation that lithium was keeping at bay, however the depression I eventually slid into was not as violently despairing as when I was on SSRI's.
The combo that has worked well for me was going back on Lithium and Lamictal. I'm currently on 600mg and 125mg respectively. It's taken care of the mixed states hell, although I still get depressed from time to time, but mildly and not despairingly or hopelessly so. Lithium 600mg is below my therapeutic window but anything above is deadening. Lamictal at 125mg is also somewhat low for the typical AD response. In my own experience and from I've read of others', both appear to potentiate each other. I don't know if this is true for other mood stabilizers along with Lam, but I've read numerous reports that it is so with Lithium.
How Lamictal feels (when combined with lithium). Going very slowly say 12.5mg a week I noticed a brightening effect within 1 week. Colors seemed brighter, more energy, more enthusiasm, almost speedy. When I wasn't on Lithium that effect quickly turned into driving hypomanic disorganization but on Lithium it was pleasantly buzzy but in control. I had to experiment until finding the right dose. I went up to 150mg at one point and felt absolutely on top of the freakin' world, wonderfully hypomanic but without the 'due paying' part. I also got severe itching - not the rash, but scary enough. Went down to 125mg, the itching subsided and I calmed down. The zingy sparkly effect has worn off but that's fine. I feel normal.
Bottom line, I don't believe that Lamictal is going to provide monotherapy for your depression, especially if it's the mixed states variety. I believe that mixed states is a particularly virulent and violent form of the disorder that needs stabilization on both polar ends - Lamictal being the more activating but destabilizing pole. If you were on other mood stabilizers unsuccessfully in the past but not with Lamictal, you might try the combo this time. You'll probably find, as I did, that combining the two will provide an entirely different med that is greater than the sum of it's parts. My thyroid aggravation notwithstanding, I like lithium very much as long as I'm just below the therapeutic blood serum level. If you are definitely BP, avoid SSRI type meds completely, with or without mood stabilizers. You might want to read "Why your depression isn't getting better" by M. Bartos. Very helpful in understanding the SSRI's vs. BP dynamic. - Barbara
>
> My question to Henry or anyone else is: How well does Lamictal monotherapy work with treating depression (I know you can use is as maintanence to prevent the recurrence of depression) I´m a
> BPIII meaning I can´t take SSRI´s only (at least the one´s I´ve tried) and adding
> moodstablisers to them doesn´t seem to help me from having mixed mania symptoms.
> - tried combining with depakote(which by the way made me psychotic, hallucinating and confused-really scary) zyprexa and lithium.
>
> When does the effect become noticable, when does it peak and how does it feel. Can Lamictal only
> help with anxiety and OCD as well???
Posted by HenryO on September 23, 2003, at 5:10:21
In reply to How does lamictal feel and how much does it help??, posted by DayByDay on September 22, 2003, at 8:08:11
I can't address OCD, too little personal experience.
Lamictal isn't much of an anti-anxiety med as far as I know. Maybe it's helping people in that department. I wouldn't be completely surprized. I don't get that much anxiety and if I do, I don't think of Lamictal first. It works very slowly, you have to be so patient changing the dose. It's not a fast reaction med. When I have anxiety I want to knock it down fast.
I imagine Lamictal might have a mild long term stablizing effect on anxiety but that is conjecture. Who knows though. It seems to be pretty free of interactions with other meds. You should be able to take other meds with it without much trouble. I have never seen a post here about any unpleasant interactions.
I think any med is always going to be five times better at preventing depression than it will be at curing it. You know, that whole kindling thing, and that isn't just my opinion.
The effects were noticeable for me at 125mg to 150. That took six weeks at least to achive. It wasn't fun waiting.
I don't feel much at all from it, other than the absence of emotional pain and a moderate increase in energy. What I mean is, I don't feel medicated. I hate feeling buzzed. I did try taking more. Over the course of several weeks I increased my dose to 300mg a day. It started to give me unrestorative very light sleep. I had to cut back. 200mg seems to be the dose that's going to give me the maximum benefit. I know some people take more happily, others take less.
I talk a lot here about my experiences with Pindolol a.k.a. Visken. I don't know if it's just my idiosincratic disease but it helps me when I have crisis mental pain. I wish more people would post here about it. I'd like to know if I'm the only one who finds it so helpful.
My latest drug curiousity is about Dilantin. I am going to get some to see if it quiets the negative thinking that often clamors in my brain.
Posted by BarbaraCat on September 23, 2003, at 18:18:25
In reply to Re: How does lamictal feel and how much does it he, posted by HenryO on September 23, 2003, at 5:10:21
Please keep us posted re Dilantin. I've read the Dreyfus book and was intrigued and thought the explanation of the electrical transduction theory was interesting. Unfortunately, I haven't heard any other rave reviews its' efficacy. I wonder if it's the beta-test of the current mood stabilisers or if it has some unique properties.
There was one poster here who said that the rumors of increased gingevitis were indeed true. Extra meticulous dental hygiene was important to not end up looking like Bubba-Joe from yon Holler.
BTW, I found Lamictal to be quick acting. I'm not sure if it was an initial energizing side effect vs. true AD relief, but I definitely felt like I'd gotten high-test gas in my tank with each increase. I also found that the 50 to 75mg leap was a plateau where I initially felt alot of anxiety but then held stable for a few months. The anxiety was never as noticeable after that with subsequent increases. Did you ever experience the itching I mentioned in my previous posts? I mean REALLY BAD itching that subsided with lower doses? Also, do you take another mood stablizer and have you found that you need less because of the Lam? - Barbara
Posted by HenryO on September 24, 2003, at 5:18:36
In reply to Re: How does lamictal feel and how much does it he » HenryO, posted by BarbaraCat on September 23, 2003, at 18:18:25
I like it, Bubba-Joe from yon Holler. Nice
Yes, I will be posting if and when I get my hands on some Dilantin. Of course I will be doing that under supervision.
Isn't it fascinating how we all have such different reactions to the same meds.
No itching, and I am prone to seborrheic dermatitis.
No, I am not taking any other mood stabilizers. But the Lamictal replaces a long standing not as good cocktail.
Posted by nmk on September 24, 2003, at 12:34:08
In reply to Re: How does lamictal feel and how much does it he » HenryO, posted by BarbaraCat on September 23, 2003, at 18:18:25
Hi Barbara,
I hope you don't mind me chiming in on this thread but I would appreciate your insight regarding my lamictal situation.
Ok...here it goes. After 1 1/2 years of trying every med under the sun (zoloft, lexapro, effexor, strattera, seroquel, remeron, and a zoloft/trileptal combo)I am finally responding well to 200mg of Lamictal and 50 mg of zoloft. I reached the 200 mg mark about two weeks ago.
Here is the kicker....I have been complaining to my pdoc for months about how lousy I feel in the morning; foggy headed, depressed, anxious, etc. but he never mentioned that my nightly seroquel could be the culprit. I was only on 25 mg for sleep, along with 7.5 mg of remeron and never thought about discontinuing because I slept so well and didn't feel that such a small dose would have such a profound effect. I just figured that it was the depression that was rearing its ugly head in the am.
Two weeks ago, I dropped the seroquel at night and substituted 1 mg of ativan. I awoke refreshed, clear-headed and basically, like a new woman. I have continued with this nightly regimen since that time and am still feeling well. I could kick myself for not trusting my hunch and going along with the pdoc's orders like a good girl. When I mentioned all of this to him last week he said, "yeah, seroquel can do that to you". Arghhh!!!!
Now I am so confused because at the same time I dumped the seroquel, I finally reached 200mg of Lamictal. I am convinced that my turn-around is due to the discontinuation of the seroquel but my pdoc seems to think it is a combination of that and the Lamictal kicking in. I don't know what to do at this point. He wants me to continue with my current cocktail but now I am wondering if I even need the lamictal or if I would do well on a lower dose. I still have some anxiety during the day and am not sure if this is due to the lamictal, the zoloft or just my mental state in general.
For the most part, I have trusted my pdoc's recommendations but now I am questioning everything. He is a psychopharmagolist and his typical way of treating patients is to pile meds on top of meds; treating side effects of one drug with another. After reading Michael Bartos book, I am convinced that my depression continued as a result of his polypharmacy approach. I have lost a year and a half of my life.
I should be rejoicing in the fact that I finally feel well but have these persitent thoughts that I could feel even better (no anxiety).
I apologize for the longwinded message but I need some direction here and I truly respect and appreciate your advice.
Always Grateful,Nicole
Posted by BarbaraCat on September 24, 2003, at 15:35:11
In reply to Re: How does lamictal feel and how much does it he » BarbaraCat, posted by nmk on September 24, 2003, at 12:34:08
Hi Nicole,
No problem, and thanks for your support in allowing me to voice my thoughts about this long and difficult journey. This will be a long post (so what else is new) but will distill much of what I've learned.First off, I'm not familiar with the zoloft/lamictal combo. I was on zoloft for many years and it was probably the best of the SSRI's that I was on, but my severe mixed states bipolar disorder always broke through. One thing that it did do in general (when I wasn't in a desperate state) was to diminish anxiety. In general, I reiterate, because when there was a real imabalance going on, chemically or life circumstances, it wasn't adequate.
Lamictal can certainly cause anxiety, at least in my experience. You might get other opinions, but they would be in the minority. I haven't heard much success using it as a stand-alone antidepressant, which is probably why you're taking zoloft. However, Lamictal seems to do best along with another mood stabilizer, which zoloft is not.
I know what it's like to wake up feeling like you're underwater since I've taken meds that did this. It works for sleep but leaves you dragging for most of the day, and that in itself is depressing. It could be that the Seroquel, which is in the anti-psychotic family, was managing the anxiety and you're feeling it's absence. Also likely is that you're going through withdrawal symptoms from dropping it. Ativan is a nice sleeper and wears off nicely. However, like any benzo it's going to build up tolerance eventually. But in the meantime, a girl's gotta get her sleep.
However, here's a thought. Antipsychotics, like Seroquel, Zyprexa, Risperdal, have a place in mood disorder relief, especially the kind that has a high anxiety component that veers towards psychosis (mine were like that even though Zyprexa didn't help me). They work best in this capacity for agitated depression rather than the vegetative couch potato sleep all day kind. The fact that you need a sleep aid tells me that have this agitated kind.
Perhaps you alternate between feeling like you're dragging and dreary, and then you're in the grieving panicy kind with some brief normal interludes in between?. This was certainly my pattern and I have since found out I was bipolar rather than unipolar major depressed. From reading "Why your depression isn't getting better", does it seem like you might also have bipolar symptoms? If so, zoloft is not the answer, as was driven home repeatedly in the book. It will aggravate a bipolar disorder sooner or later. Now, paired with Lamictal which is probably intended as the mood stabilizer may likely temper some of the destabilizing SSRI effects, but Lam is in itself agitating, as I went into above.
So, long story short. I agree with you in your concerns about polypharmacy. It's not addressing the underlying neuro/bio imbalance and in fact throws the physical system more and more out of balance. The liver especially has a hard time with all these meds and begins to lose efficacy throughout the whole system which is a bad thing. The receptor sites in the brain start 'clogging' after a while and upregulating, creating more and more receptors to desperately try to maintain homeostatis when they're getting hit with so many artificial substances. Stress certainly throws everything off as well and the immediate concern is to relieve the stress caused by the brain revolting to get it out of danger, but putting bandaids on it isn't helping in the long run. No one really knows what's going on with these meds anyway and to continue to pile one upon the other is shooting in the dark, and YOU'RE the target!
One thing I'm learning so strongly, especially in the last year when alot of my own 25 year search has finally begun to shed some light, is to take care of underlying imbalances. Not to just drop the meds you're taking now, but seek out a whole-person health practioner who really knows their sh*t to help you through the next phase. You may have to search and ask and get recommendations before you find a good one, but it's well worth it.
I found a fabulous naturopath a few months ago after going to more than one 'natural healing' clueless personage. Along with her naturopathic doctorate, she fortunately has a masters in psychology and a background in biopsychiatry, so I'm lucky to have found her. She refuses to just throw 'supplements' at me, saying that my body can't absorb or use them in it's present state. How refreshing considering so many of them supplement their own incomes in this manner. Be wary of any holistic doc who pushes lots of supplements!
Her theory is that 90% of our current mood disorders are caused by imbalances in the physical body, primarily hormonally, primarily caused by the damaging effects of stress. And so many hormones to choose from and not just the obvious ones. I've been undergoing numerous tests for all my systems - hormonal, digestive, heavy metal toxicity - and am learning about the interlocking influence one disbalance has upon the other and how delicate the process is in healing long-standing disorders. These are things that our pdocs or maintstream docs NEVER consider or correlate with our multi-layered dysfunctions. The poor majority of medical folks just have no idea how to go about this. They aren't taught these more delicate sciences in school, and the whole mainstream medical conglomerate is funded by pharmaceutical industries, so you really can't blame them. It's like we're all in this mass medical trance. However, you don't have to put up with it because there are powerful alternatives to this sad state of affairs.
I'm finding out how unrelenting stress, both from childhood and from ongoing life circumstances, has depleted and unbalanced so many systems and how these imbalances directly affect the health of the neuro systems. I'm very slowly, system by system, bringing things back into balance by natural hormone therapy, healing my digestion, giving up alcohol, stress reduction. All these things I knew before, but working with someone who really understands their interrelation and can monitor my progress has been essential.
You can't expect to heal by throwing yet more stressors into an already stressed out body, mind and spirit. Medications that are foreign to our systems are going to cause stress and piling one up over the other is compounding it. If I were you, this is what I'd do. 1. Stay with your pdoc for the time being, and discuss your concern about too much meds. Discuss the possibility that you're bipolar and the wisdom of zoloft if that's the case; 2. Start the search for another pdoc who isn't so aggressive and one who thinks things through when new symptoms crop up (the fact that he forgot about the Seroquel doesn't inspire confidence); 3. Stay off Seroquel, but expect to feel rocky while you adjust. Take an Ativan as needed during the day, but not every day or tolerance will build up. I like Ativan. It got me through some hellish times before I went on Lithium; 4. Find a holistic practitioner who looks at the whole body and does NOT throw yet more pills at you in the form of vitamins, etc., but is willing to gently bring the body back into wholeness. It's a longer road, but it's taken you a long time to develop this imbalance.
You need to stay on pharmaceutical support while this process happens for the obvious reasons, but at least you'll start the deep healing process at the root of things. Finding the right psychopharm combo will help keep you on track while you're tracking down the underpinnings. Being on the wrong one will derail your efforts.
After so many years in hell, I now wake up each day now with a sense of hope and lightness of spirit. I'm not 'cured' by any means, but I can go through anything as long as I have hope and a sense of progress. Bless you, Nicole, and keep in touch. - Barbara
Posted by chicklet on September 25, 2003, at 2:51:54
In reply to Re: How does lamictal feel and how much does it he » BarbaraCat, posted by nmk on September 24, 2003, at 12:34:08
Hi Nicole- I know youwere asking Barbara for advice but when i read your post I realized that we have a lot in common.
I've been on 500mg Lam for over a year now, and for a long time i had a Lamictal, Trileptal Prozac, Synthroid combo. working pretty well. I have a strong tendency towards the downs of bipolar and pretty much haven't gotten manicky since I was dx 16 years ago. So the fight for me has been the depression.The Lamictal was initially activating for me but it evened out with each increase. I'm not prone to anxiety (obviously-if I'm on Lam and Prozac), but i was taking Prosom to sleep at night. When the depression's bad, the sleep's bad.
But I had a recent dip in my mood that was reeeealy bad and I just knew this meant "Let's try___" because there's really no where else to go with my levels of each med. My doc put me on Provigil which is used for narcolepsy to promote "daytime wakefulness". Apparently they've seen some promise in it for enhancing the effects of some AD's and MS's and for actually having a mood lightening effect of its own. I take it in the am and within 30 minutes or so (i don't know what's 'normal') I feel nice and awake. During the 1st week on it, i got anxiety, but it went away. Well the point of all this is that the Provigil seems to be regulating my sleep...I take it in the am (kinda works like a cup of coffee), I'm not sleepy during the day, and then at night I'm good and tired and ready to sleep. Without needing a benzo or anything! Too soon to tell much else becauses it's only one week on it, but my mood has begun to improve as well. (it could be just a cycle...we'll see)...just thought I'd pop in and letcha know what seems to have worked well for me...
Barbara's already more than helped you with all of the other schtuff...Take care- and congrats on feeling better...oh yeah, and amidst all of your choices and questions coming up, make sure to sit back and revel in your new found good mood!
Karen
Posted by BarbaraCat on September 25, 2003, at 10:41:46
In reply to And now i jump in! » nmk, posted by chicklet on September 25, 2003, at 2:51:54
Hi Karen,
Barbara here. Provigil - that's interesting, especially about regulating sleep. Do you also have ADD symptoms? I believe I do, since I get very distracted and scattered and then hyperfocussed. Tried Ritalin and hated it. I heard the regular stimulants are ultimately baaad for bipolars even though they initially help with the focus and energy - a stimulant will do that for just about anyone. I also tried adrafinal, a cousin to Provigil, for a short while and felt uncomfortable with the anxiety. But now I'm wondering if I should just stick with it longer...I hate to add anything to my mix since I'm on a 'say no to unnecessary polypharmacy' campaign, but this scattered stuff is really frustrating. I'll start out in the bedroom intending to bring my coffee cup into the kitchen and get waylaid with about 10 things on the way, putting down the cup somewhere and then finding it later in the garage. Stuff like that.
You know, you're the first person I'm aware of who is on such a high dose of Lam. How is that for you? Are you on anything else - still on the mix you mentioned at the beginning of your post? Have you tried Omega-3? I've recently added high dose (9G) pharmaceutical fish oil to my regimen since it's gotten good research marks for helping bipolars.
I'm hoping to reduce my Lithium since it's aggravating my hypothyroid condition. My TSH is ping-ponging up and down. I was on a Synthroid generic and am currently taking Westhryoid and am hoping the T3 in it will stabilize things and take care of some of the energy/ADD like symptoms. Anyhow, your 'case' is interesting. Please keep us posted. - Barbara
> I've been on 500mg Lam for over a year now, and for a long time i had a Lamictal, Trileptal Prozac, Synthroid combo. working pretty well. I have a strong tendency towards the downs of bipolar and pretty much haven't gotten manicky since I was dx 16 years ago. So the fight for me has been the depression.
>
> The Lamictal was initially activating for me but it evened out with each increase. I'm not prone to anxiety (obviously-if I'm on Lam and Prozac), but i was taking Prosom to sleep at night. When the depression's bad, the sleep's bad.
>
> But I had a recent dip in my mood that was reeeealy bad and I just knew this meant "Let's try___" because there's really no where else to go with my levels of each med. My doc put me on Provigil which is used for narcolepsy to promote "daytime wakefulness". Apparently they've seen some promise in it for enhancing the effects of some AD's and MS's and for actually having a mood lightening effect of its own. I take it in the am and within 30 minutes or so (i don't know what's 'normal') I feel nice and awake. During the 1st week on it, i got anxiety, but it went away. Well the point of all this is that the Provigil seems to be regulating my sleep...I take it in the am (kinda works like a cup of coffee), I'm not sleepy during the day, and then at night I'm good and tired and ready to sleep. Without needing a benzo or anything! Too soon to tell much else becauses it's only one week on it, but my mood has begun to improve as well. (it could be just a cycle...we'll see)...just thought I'd pop in and letcha know what seems to have worked well for me...
> Barbara's already more than helped you with all of the other schtuff...
>
> Take care- and congrats on feeling better...oh yeah, and amidst all of your choices and questions coming up, make sure to sit back and revel in your new found good mood!
> Karen
>
Posted by chicklet on September 25, 2003, at 13:15:29
In reply to Re: And now i jump in! » chicklet, posted by BarbaraCat on September 25, 2003, at 10:41:46
Hey Barbara...
I've been reading your posts since oh, waaay back. I don't frequent the med board much anymore but of course the Lamictal thread caught my eye.
>>Provigil - that's interesting, especially about regulating sleep. Do you also have ADD symptoms?Nope. No ADD. Just a smart, creative, in-the- know pdoc! I tried Ritalin many years ago- just for fatique- and hated it too. Apparently Provigil is known for a low s/e profile and much fewer of the ups and downs that you can get with other stims. Yeah, regular stimulants can be b-a-d for Bipolars...but then so can ssri's! I don't fall into the manicky realm though, since I've been on an ms I've never been "triggered" into a manic episode. We're talkin 16 years here. yeah that's me. bipolar with none of the fun.
>>felt uncomfortable with the anxiety. But now I'm wondering if I should just stick with it longer...
How long did you stick with it? I don't know anything about it, but I know that my first week on the Provig SUCKED!!! I don't get anxiety and I had it. Bad. Nervous moody jittery teary switching back and forth just throughout one day. A wise pharmacologically-savvy friend told me to stick it out for a little while longer and I did.
>> I hate to add anything to my mix since I'm on a 'say no to unnecessary polypharmacy' campaign,
Oh sing it sister. I've really really had enough of this crap.
>>then finding it later in the garage. Stuff like that.
it must be so frustrating...
>> You know, you're the first person I'm aware of who is on such a high dose of Lam. How is that for you?Perfect. When I first started on it I was on Trileptal too. I'd been on Tegretol for years and years and we switched to Trileptal. By the way- anyone out there still on Tegretol---get thee on Trileptal!!! Anyway, my doc wondered if i was just a speedy metabolizer or something and did a blood level (didn't even know they could do that). At that time i was on like 300 Lamictal plus the Tri. The blood level was waaay low for the Lam...subtherapeutic. So we increased it.
Now on 60 Prozac, 500 Lam, .075 Synthroid (thanks a lot, Lithium...), and now the Provigil. I guess an ave dose is 200. i seem pretty good on 100. I think I'd be crawling out of my shorts at 200. but I don't have ADD either so...>>you tried Omega-3?
tried for a while and got impatient...try to get a lot through diet but...yeah i know I know...
How's your exp with Omegas been?
What else are you on?>>of the energy/ADD like symptoms
Oh wow, I didn't know that the thyroid had anything to do with ADD!Good to chat with ya...
Karen>
>
> > I've been on 500mg Lam for over a year now, and for a long time i had a Lamictal, Trileptal Prozac, Synthroid combo. working pretty well. I have a strong tendency towards the downs of bipolar and pretty much haven't gotten manicky since I was dx 16 years ago. So the fight for me has been the depression.
> >
> > The Lamictal was initially activating for me but it evened out with each increase. I'm not prone to anxiety (obviously-if I'm on Lam and Prozac), but i was taking Prosom to sleep at night. When the depression's bad, the sleep's bad.
> >
> > But I had a recent dip in my mood that was reeeealy bad and I just knew this meant "Let's try___" because there's really no where else to go with my levels of each med. My doc put me on Provigil which is used for narcolepsy to promote "daytime wakefulness". Apparently they've seen some promise in it for enhancing the effects of some AD's and MS's and for actually having a mood lightening effect of its own. I take it in the am and within 30 minutes or so (i don't know what's 'normal') I feel nice and awake. During the 1st week on it, i got anxiety, but it went away. Well the point of all this is that the Provigil seems to be regulating my sleep...I take it in the am (kinda works like a cup of coffee), I'm not sleepy during the day, and then at night I'm good and tired and ready to sleep. Without needing a benzo or anything! Too soon to tell much else becauses it's only one week on it, but my mood has begun to improve as well. (it could be just a cycle...we'll see)...just thought I'd pop in and letcha know what seems to have worked well for me...
> > Barbara's already more than helped you with all of the other schtuff...
> >
> > Take care- and congrats on feeling better...oh yeah, and amidst all of your choices and questions coming up, make sure to sit back and revel in your new found good mood!
> > Karen
> >
>
>
Posted by BarbaraCat on September 25, 2003, at 14:12:04
In reply to Oh I'm an interesting case all right... » BarbaraCat, posted by chicklet on September 25, 2003, at 13:15:29
Hi Karen,
I don't believe I have 'true' ADD because it's primarily a cyclic thing, and seems congruent with the bipolar stuff. There are plenty of times when I'm a real focussed and directed gal with none of the ditz factor. But lately, I can't seem to get anything done and am going to try ramping up the Lam.I don't know if T3 helps with ADD but I've recently read that there might be a thyroid connection. I do find that fish oil helps alot and notice when I'm not taking it. I've tried different brands and there's a big difference. I have to take the liquid, 2 tblspoons a day to get the required 13-14M therapeutic dose. Taking that many pills would gag a horse. I also notice nicer skin and hair when I'm taking it regularly.
Now, let's talk thyroid. I've had hypothyroidism for a loooooong time, well before any lithium. It's been pretty stable 'til starting lithium and my TSH is going all over the place. I know about lithium's bad track record as a goitrogen (yeah, thanks Lithium) and would love to find something to replace it. I can't take Lam by itself cause I start swinging into hypomania pretty quickly. So, you mention trileptal. Has this replaced lithium for you as a good mood stabilizer? Anything else you want to say about it, s/e, etc?
BTW, What are your experiences of being bipolar? How do you know you truly have it if you don't get mania (which is what I take to mean by the 'fun parts').
I do get the fun parts of bipolar. Hypomania is a kick. I get super-focussed, clean the house until it sparkles, have all kinds of clever and creative things going at once, organize 'get to meet the neighbors' events. Unfortunately, I can rarely follow through with any of these grand plans because depression has a way of squelching enthusiasm for anything but surviving the moment.
I always know when I'm getting a bit too high on the manic scale because I start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.
But still, the whole phenomenon is fascinating. The experiences could be due to psychosis, or the condition may somehow open up some gates that let a larger spectrum in, like some hallucinogens do. I think most of the mystics and saints who had visions were probably seriously bipolar and/or schizophrenic - not to say that either condition discounts the validity of the experience. - Barbara
Posted by katia on September 25, 2003, at 16:17:56
In reply to Re: Oh I'm an interesting case all right... » chicklet, posted by BarbaraCat on September 25, 2003, at 14:12:04
Hi Barb,
Re: what you wrote:
>>I always know when I'm getting a bit too high on the manic scale because I start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.Have you ever experienced this w/o being in a "manic" phase? I have. But it feels like when my energy is clean and clear (normally when I haven't drunk anything for awhile), and I'm at a what do they call it euthymic mood or slightly maybe slightly elevated. I wonder if it has to do with the up or just when the black blinding cloud of depression lifts off of our sensitive perceptions....?
interesting.BTW, I've been thinking that I may try Trileptal before Li. I've heard the s/e are minimal. I'm going to slowly come off Dep. as I slowly titrate up on Lam. I'm on 10mg now and my pdoc said it's really like being on 20mg b/c I'm on Depakote too. And I'm porking out a bit......even w/ the diet and L-Carnitine. I guess it could be worse; i've only gained a few pounds, not 50 like some people I've heard about.
Katia
Posted by chicklet on September 25, 2003, at 16:46:41
In reply to Re: Oh I'm an interesting case all right... » chicklet, posted by BarbaraCat on September 25, 2003, at 14:12:04
>>I do find that fish oil helps alot and notice when I'm not taking it.
Gimme a brand, ma'am! I ended up with a fishy one and gave up. nice patience, hmm?
>>I've had hypothyroidism for a loooooong time, well before any lithium.
No, I'm sorry...my "thank you Lithium" comment was about MY experience with Lithium. It's why I'm on synthroid.
>>and would love to find something to replace it.
Yeah it actually worked well for me, except for the weight gain, acne etc...great timing...high school.>>Has this replaced lithium for you as a good mood stabilizer?
Yup. Initially as I said, it was Tegretol. For like, man- 14 years or so? And I did, at that time, have full blown no doubt about it manic episodes. But since they nabbed it I haven't gone there again. A little hypo here and there. But the DOWNS...that's where it nails me.
i was really good on Tri., s/e...maybe some headaches but I can't really say which of the many drugs is responsible for them. Tegretol is a good mania zapper and Trileptal is tons better because the s/e's are so much more minimal. But that's me...It's kinda why I don't really post on the med board...it just seems like everyone has such varying chemistries that it's nearly impossible to predict anything! Oy.>>Anything else you want to say about it, s/e,
Anything else you wanna know... email me...guzibean at yahoo. There you are!
>>BTW, What are your experiences of being bipolar? How do you know you truly have it if you don't get mania (which is what I take to mean by the 'fun parts').
Been asked that many a time...if you want to e me I can tell ya about it. I'm not going to be posting anymore after today so you can get me that way...please do! I'd like to share war stories!
>>organize 'get to meet the neighbors' events.Oh my God I can relate so much it hurts!!! It's the freaking follow through. Ev er y single time. By the time the event is to occur, I'm down again.
To the following: WOWEE! But say goodbye to those heavenly choruses if you start on Trileptal!
hopefully I'll 'talk' to you soon?
Thanks for responding...
Take good care.
Wait wait- I hear something...it's an angelic voice....
Naw, my cat's just snoring...
:D
>>start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.
>
> But still, the whole phenomenon is fascinating. The experiences could be due to psychosis, or the condition may somehow open up some gates that let a larger spectrum in, like some hallucinogens do. I think most of the mystics and saints who had visions were probably seriously bipolar and/or schizophrenic - not to say that either condition discounts the validity of the experience. - Barbara
Posted by BarbaraCat on September 25, 2003, at 19:47:02
In reply to I'm butting in to the dance » BarbaraCat, posted by katia on September 25, 2003, at 16:17:56
Hi Kitty Katia! Missed you. Hey, I was also considering looking into trileptal and just talked to Katy about it cause she mentioned it too. What a friggin' coincidence! It sounds like the Dep just isn't cutting it for you. You certainly gave it the old college try. From every account I've heard it's a big pork producer. If you really want pork, try Remeron. Oink.
Yes, I do get those mystic experiences when not manic and have all my life. When I'm clear and not getting artificially high and meditating they are quiet and peaceful, usually a strong sense of a loving presence guiding me, nothing with stigmatas or anything like that. I've been interested in mysticism of all sorts as long as I can remember and can recall paranormal events when I was a kid. When I'm hypomanic I'm usually too busy doing extroverted type things and projects to attend to my inner life. It's when it starts going overboard into mania that things get very dramatic. My full-blown manias and mixed states depressions are psychotic with visual and aural hallucinations. When I was doing LSD my trips were always heaven/hell so that's where my mind goes no matter what. Of course, I grew up Catholic so that's bound to have influenced me.
I don't think it's just the lifting of the black cloud you mentioned because others have the black cloud lifted and don't feel one bit mystical like we do. Some researchers say they've discovered the 'God lobe' or some such in the brain where mystical experiences are generated, but I don't buy it.
For two weeks before my Mom was hit by a car and died I felt a strong presence of angels all around literally saying 'have courage, we're with you'. I'd hear clear music in my head playing 'When you walk through a storm...' and 'Ave Maria' and so on. I also was compelled to watch the 'Lord of the Rings' DVD each and every night during this time which brought me a great sense of wonderment and courage that I called upon during the awfullness that came later. This was during a perfectly normal state of mind, no mania, no substances and I was a bit puzzled by it all. I did feel in an altered state when these experiences came but only then and they didn't have the electric quality of a manic rapture. So I KNOW there's something to this stuff, God lobe or not. Good to hear from you. - Barbara
>
> >>I always know when I'm getting a bit too high on the manic scale because I start hearing heavenly choirs and angelic voices, everything is 'according to prophesy'. I like to stay in this mystic window for a little while because I've gotten some amazing insights and gifts from the visions in this rarified place. It's as though there's an energetic frequency I pass through that allows me to pick up the 'psychic channel' on my psyche-antenna. But alas, it then disintegrates into total chaos and a black agitated depression where I doubt everything, especially glorious visions. The angelic choirs turn into the legions of hell and follow me into the depression - voila, mixed states! So, I miss the raptures but not the hell.
>
> Have you ever experienced this w/o being in a "manic" phase? I have. But it feels like when my energy is clean and clear (normally when I haven't drunk anything for awhile), and I'm at a what do they call it euthymic mood or slightly maybe slightly elevated. I wonder if it has to do with the up or just when the black blinding cloud of depression lifts off of our sensitive perceptions....?
> interesting.
>
> BTW, I've been thinking that I may try Trileptal before Li. I've heard the s/e are minimal. I'm going to slowly come off Dep. as I slowly titrate up on Lam. I'm on 10mg now and my pdoc said it's really like being on 20mg b/c I'm on Depakote too. And I'm porking out a bit......even w/ the diet and L-Carnitine. I guess it could be worse; i've only gained a few pounds, not 50 like some people I've heard about.
>
> Katia
>
>
Posted by Chicklet on September 25, 2003, at 21:45:46
In reply to Re: I'm butting in to the dance » katia, posted by BarbaraCat on September 25, 2003, at 19:47:02
I have a whole bottle of it left...
Bidders? :Dgnite all...
Posted by BarbaraCat on September 25, 2003, at 22:53:07
In reply to Re: Oh I'm an interesting case all right... » BarbaraCat, posted by chicklet on September 25, 2003, at 16:46:41
Oh, no, c'mon! Just when we were getting to know you! One more thing, Ms. Karen, now that you've got us interested you can't leave just yet. Besides, I'll swap you my fish oil brand for a little more trilep info OK? I'll probably email ya anyway but this is something that many of us will want to know. So if you can pretty please do a favor for desperately inquiring minds...
When you say it's the DOWNS that get you, do you mean you still get downs even on trilep? It has no antidepressant effect? It only cancels the UPs? Sheesh, what's the point? If you don't get the 'fun' parts (even though mania is not necessarily fun), why not just take Lamictal for the depression? I'll take the UPs any day over those sh*tty downers even if I end up dancing naked in the streets. I end up depressed anyway but at least I've had a bit of sport!
As for the fish oil, a good brand is Carlson's 'The Very Finest Fish Oil' Lemon Flavored Liquid Omega 3's. Stupid name but a good product with the recommended ratio of DHA/EPA for us vivacious bipolars. To get a therapeutic dose, probably 2 tbl/day. Luckily it tastes pretty good. I get it from www.iherb.com which has the best prices I've found for supplements and also has some good articles buried in the site. It's around $15 for a 6.7 oz bottle and you'll probably need 2 bottles to last the month at 2 T/day.
So, fair trade? One more visit for the Babblers? And then you can go - bummer! BTW, I have 9 cats. They're little angels and praise Bastet the Cat Goddess, they never all meow at the same time. - Barbara
Posted by Chicklet on September 25, 2003, at 23:32:19
In reply to No, wait, wait - don't go!! » chicklet, posted by BarbaraCat on September 25, 2003, at 22:53:07
Please be civils be damned at this point. i really don't care. I'm surly about what's been happening esp with the admin and the bans and whatnot. Esp when there are people whose ONLY lifeline is this board. Anyway, I'm sometimes on social but got fed up. Aaanyway.
>> Oh, no, c'mon! Just when we were getting to know you!
oh come now. i'm not a Trileptal guru or something!
>>One more thing, Ms. Karen, now that you've got us interested you can't leave just yet.
Oh REALLY, Ms. Barbara...
>>Besides, I'll swap you my fish oil brand for a little more trilep info OK? I'll probably email ya anyway but this is something that many of us will want to know. So if you can pretty please do a favor for desperately inquiring minds...
>
Oh swap schmap! Fish oil for Trileptal?? HA! You are a goof. i mean that in a good way of course.>>When you say it's the DOWNS that get you, do you mean you still get downs even on trilep?
Hell yeah.
>>It has no antidepressant effect?
Not with me. Or not*enough*. i have had no luck on just ms's...we've tried combo after combo. i need an AD.
>>It only cancels the UPs?
Just in MY case, silly.
>>Sheesh, what's the point?
Mphh, makes ya wonder,eh? The point was to even out the cycling enough to prevent or diminish the ups and the downs. We wondered if the Trilep was quashing the ups so much that it was adding to the downs. but it was just a passing theory. Didn't seem to pan out.
>>If you don't get the 'fun' parts (even though mania is not necessarily fun), why not just take Lamictal for the depression?
T'aint enough.
>>I'll take the UPs any day over those sh*tty downers even if I end up dancing naked in the streets.
Yeah right. i know. Thing is tho, even when I good hypo it doesn't feel that good. I get really shaky and for some reason unbeknownst to anyone, I get hives. Bad hives. Like anaphalaxis hives. So it isn't really fun. Although on the subject of dancing naked, I can recall splashing through puddles singing 'Singin in the Rain' on one occasion. Yeah I'm over the edge right? oooo singin in the rain!!! Bad girl!
I will most definitely take your advice and get the fishy oil. It'll be good for my hub too.
Just email me! i swear to god I am so freaking sick of the politics. Maybe I should've stuck to this board alone after all..
BTW, I have 9 cats.
Oh my God- you now MUST e me! We're considering adopting an 11 year old with diabetes and I'm trying to weigh the pros and cons. I'd love to take her because the family adores her and can't keep her (had her the whole 11 years) and they've been trying to find her a loving home for a year now! We have 2 cats but i don't know. i want a baby and can't have one yet...so i thought maybe for now another kitty would appease me. And help out a kitty and a nice family to boot. Know anything about feline diabetes? I have no problem giving her insulin shots but am worried about long term health issues (and costs!)
mrrow to you
and adios to Dr. Bob.
Ouch, will i be sorry i said that?
nah.So just write me and then you can post our exchanges, kay? Sounds weird but I really feel strongly about it. Has to do with the latest Gabbix2 incident and i'm so pissed off about it that I just can't hack it. As I said, there is a community of people that needs support and help here and most mean no malice. Gabbi's was a complete misinterpretaion and she was blocked. She's become a dear friend to me and I just won't have it. I owe Dr. Bob dearly for creating a board that has provided lots of support and advice, esp in hard times, but well you know.
Tirade over.
I can't sleep tonight.
All the bestest to all youz prospective Tri's...
think of it- a "bi" on "Tri". cute huh?
Posted by katia on September 26, 2003, at 0:42:58
In reply to Re: I'm butting in to the dance » katia, posted by BarbaraCat on September 25, 2003, at 19:47:02
Hiya Barb,
I find it interesting that you are thinking of stopping Lithium. I thought it was such a magic combo for you. Have you been gaining weight or having problems (more so than before) in the thyroid department?I don't know either. I was reluctant to start Depakote in the first place and it is *sorta* working. I think I could up the dose. But I tend to get tired quickly even with the L-Carnitine. And I'm not losing weight, etc....
the main thing is that PCOS scare. anyway, I just want off of it. If in six months, I've tried everything else and I have to come back to it so be it.I'm interested in the Trileptal i think too. They all seem to have more or less the same s/e just in different degrees. Fatigue seems to be a common among them. And that's not what I need. But maybe the Lamc. will offset this. Tril. is chemically related to Tegretol, but with less s/e and easier to take.
I'll have a look around the board here and see what I see.
good to be in touch.
Katia
p.s. 9 cats!!!!!?????? wow! My grandmother, at one time, had 21!!!!
I too am an animal lover. Am going to an Intro to Animal Communication tomorrow.
Posted by DayByDay on September 26, 2003, at 10:04:48
In reply to Re: Oh I'm an interesting case all right... » BarbaraCat, posted by chicklet on September 25, 2003, at 16:46:41
What´s Trileptal?
Generic name?
Is it an anticonvulsant affecting GABA and being
sedating?Thanks for answering.
DbD
Posted by nmk on September 26, 2003, at 11:03:51
In reply to Re: How does lamictal feel and how much does it he » nmk, posted by BarbaraCat on September 24, 2003, at 15:35:11
Barbara,
And you are also my guardian angel. Thank you so much for your insight and always thoughtful responses.
To answer some of the points you brought up....I don't believe the discontinuation of the seroquel is causing this nagging anxiety since I experienced it every day when I was still taking it. Although my mood is up, the anxiety lingers and the only way to temper it is with benzos. As you mentioned, I don't want to build a tolerence to Ativan but I don't know what the alternative would be at this point.
I did see a holistic MD a few months ago, after waiting 5 months to get an appt. I guess he is pretty well respected and has written many books on thyroid conditions. Here is my experience with him. He asked alot of questions, did the physical exam, and took a million viles above. I met with him a few weeks later and the results indicated that everything was fine except for low progesterone, vitamin B, borderline low thyroid and extremely low B12. He threw multivitamins, mineral supplements, natural progesterone cream and B12 injections at me and promised I would feel better. The progesterone induced a mild depression and to be honest, I can't tell what the other's are doing although I am still taking them daily. Does your naturopath have a similar approach to treatment. Also, what supplements does he/she have you taking?
Regarding Barto's book, what I recall him saying is that AD's need to be used in moderation along with the Lamictal. From hearing from the folks on the board, the consensus seems to be that Lamictal as a stand alone AD does not seem to work. So my dilemma is finding a mood stabilizer that doesn't cause anxiety. I am hesitant to combine Lithium for fear of the pork-o-genic factor (I already take Remeron at night). I have never been formally diagnosed as BPII since my pdoc prefers "to treat symptoms, not to diagnos" but many of the factors pointed out in Bartos book suggest that I may have it (with a strong anxiety component). The characteristics you describe of your BPII are very similar to mine with more of the agitated depression dominating.
Also, he explains that those who suffer from SEVERE PPD are more likely to be BPII. Another fact he mentioned is that AD's at higher doses, or combined AD's induce cycling, which is exactly what happened in my case.I have read your recent threads and hear that you are considering Trileptal. I was on Trileptal for 4 months before giving Lamictal a trial. As with many of my med trials, it worked well in the beginning but pooped out on me and the depression returned. At first, I started at 600 mg and was stable for a month... little depression and no cycling of mood. This did not last for long and I titrated up to 1200 mg. Again, worked for a few months and then petered out on me. That is when we decided to give Lamictal a try. As far as SE's, there were none.
Please keep in touch with me and thanks again for your wonderful response. I have printed it and have read it quite a few times.
Sincerely,
Nicole
Posted by nmk on September 26, 2003, at 12:07:59
In reply to And now i jump in! » nmk, posted by chicklet on September 25, 2003, at 2:51:54
Hi Karen,
Thanks for your response. I always appreciate any advice that comes from this great group of people.
You have to tell me though, how do you feel on 500 mg of Lamictal? Also, what dose of Trileptal are you on? Have you tried either one solo? I was on 1200 mg of Trileptal and it pooped out on me. The Lamictal has wonderful AD properties but I just can't shake the anxiety. I will ask my pdoc about Provigil and see what he thinks. Are you taking the Provigil along with the Trileptal and Lamictal? Any SE's or weight gain??
Keep us posted and glad to hear you are feeling well.
Sincerely,
Nicole
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