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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 89 to 113 of 458. Go back in thread:
Posted by Sabina on October 1, 2003, at 1:30:23
In reply to Re: BP2, FMS, and seroquel here » Sabina, posted by BarbaraCat on September 29, 2003, at 11:12:02
Hey Barbara and Bean (chicklet) both,
To begin with a side item, I wish you guys would consider posting on the social board so's I could feel freer about mentioning more non-med stuffs. I don’t want to be re-directed and it’s not so very bad over there. ;) Just a thought to think about?
Otherwise, sorry so disjointed a response, but I have been in a hormonal funk the past few daze.
Unfortunately, my hypomanic response to fibromyalgia is to push myself until I collapse in a heap and then can’t leave the bed for three days. I so seldom feel up to par that, when I am able to function enough to overdo, I do. I absolutely don't know when to say when. I’m working on finding a middle gear in my life. Fibro is my teacher. (I’m feeling philosophically optimistic tonight.) Back in the 40's, my grandmother was just considered crazy and/or lazy when she presented with the same (fibro) symptoms. Too bad I never really knew her, we’d have quite a talk now!
Like you, I believe that a lack of quality sleep is a prime issue with this condition. I dare anyone to live with as little sleep as I do at times and still manage to function properly, act normal, etc. I was dx’d w/ FMS in ‘97. Things went on fairly uneventfully (full time job, etc.) until a run-in w/ depo-provera (aka satan-in-a-syringe) last year, which began a flare-up of major, job and mind losing proportions. It was then that natural coping skills abandoned me and deep seated, long camouflaged chemical imbalances became unavoidable. It was all just too much to deal with at once.
Seroquel has definitely been the best option I’ve found so far, especially compared to the horrors of SSRI’s, which are routinely prescribed to fibro patients as a first line of defense, because god knows if you aren’t depressed when you're dx'd fibro, you will be soon enough just from dealing with it! Yes, Seroquel is the only thing I’m on...at the moment, apart from the occasional Xanax, Ultram, or Vicodin. I talked to my therapist about it just today, and I think that because I feel *so* much better than I did on Lexapro that I’m just now willing to admit that there’s still (much) room for improvement.
I’m just so thankful that I’m not actively planning my suicide or drinking almost daily as a coping mechanism, and that I'm rid of those demon racing thoughts (with me since childhood), that I almost don’t want to mess about with it. I feel almost like asking or trying for more or better would be ungrateful, in a way. Considering my dreadful history with psych meds (SSRI is a four letter word, as far as I’m concerned) , I’m more than a little reluctant to try anything else, even though my therapist has clients with fibro who’ve had great success with the Adderall. I do think I need something else, though what I don’t yet know.
I only seem to have serious (way too bad to pretend away) problems during certain points in my menstrual cycle. I’d *really* rather not get all strung out on some intricate cocktail that I may not need but one week out of the month, especially since I’m hoping to get pregnant next year and will have to go off them for awhile then, anyway. I’m planning to keep a journal for the next month, noting both emotional and physical problems to help me see any correlations and to help my pdoc make the best decision as to a second drug. Right this minute, I’m leaning toward Trileptil and/or Adderall, though I’d most wish for something I didn’t have to take full time. I already have to divide my Seroquel doses into four times a day to feel fully functional.
Half the time I feel like some neurasthenic Victorian lady, shutters drawn, sitting in a dimly lit room with orders to be quiet and not to read or think too much. I used to be so clever, overly think-y and creative. Now, I can seldom follow my own train of thought, much less anyone else’s. I’ve never tried Ambien, but good luck, certainly, with the au naturel approach. I know everyone’s so different, but I’ve had a very good response to Seroquel. So necessarily, it’s all the stuff I *haven’t* tried that terrifies me! No dry mouth here, and I can’t yet speak to withdrawal issues.
As far as other fibro measures, the water exercises have made more of a difference than anything else...by far and away. Even when I can barely summon the energy to straighten up the house, and can barely stand the idea of leaving the house, I can do this...mostly because I love the water so much. Did you happen to see my post on it? Even my husband has mentioned that I sleep better on the days that I go to the pool. Then there’s the sauna...oh so toasty on the old (oh so old) joints.http://www.dr-bob.org/babble/social/20030913/msgs/262093.html
Drifting off on Vicodin now...serious back pain tonight. Hope to hear from you again soon.
Bina
Posted by Chicklet on October 3, 2003, at 7:00:32
In reply to Re: BP2, FMS, and seroquel (long) » BarbaraCat, posted by Sabina on October 1, 2003, at 1:30:23
Posted by St. John on October 24, 2003, at 11:05:41
In reply to Lamictal side effects - itch! » HenryO, posted by Barbara Cat on August 4, 2003, at 2:49:50
I have unipolar, treatment resistent depression. My response to medication has been at best minimal, and this includes every type of antidepressant and almost all of their varieties. I have also been through a series of ECT treatments with no effective result. For 18 months I have been off all antidepressants and am pleased to be without their side effects. However, I remain depressed. In response to my resignation, my psychiatrist has recommended I consider Lamictal. Are their people out there who share my experience and have had results, good, bad, or nil, from the drug? Is it worth the effort? The absence of side effects, most prominently weight gain, from other antidepressants has been almost worth the emotional wasteland I inhabit. Thanks
Posted by Dalilah on October 24, 2003, at 11:45:01
In reply to Lamictal , posted by St. John on October 24, 2003, at 11:05:41
I too have tried almost every anti-depressant conceivable and was ready to try the ECT's when my doctor said - one more try: Lamictal. I am so amazed to tell you that it has made an incredible difference in my life. There are very few side effects, actually I've had none. I think that's a good sign that you're on the right med. No weight gain! The frustrating part is that you must do the creeper dose (because of potential for rash.) It takes a while to get up to therapeutic dose. I needed to get to 200 before it started to work and am stable at 250mg. I say, give it a try. It's not an antidepressant and I think that's good. They suck.
Dalilah
Posted by fluffy on October 24, 2003, at 11:52:03
In reply to Lamictal , posted by St. John on October 24, 2003, at 11:05:41
Hi St. John--
I most definitely responded to Lamictal. I was diagnosed bipolar II, though. If I hadn't volunteered more information to my pdoc, I might have been diagnosed unipolar. But I had a really bad reaction to SSRI's which alerted my pdoc to the bipolar II diagnosis.
Have you ever tried any mood stabilizers before? Did your doc try Lithium with an AD? If anything, it might be worth a try. It can't be worse than non-response to AD's or ECT, right?
Lamictal had a very activating response in me. Some people experience agitation. At first, I had a kind of activated tiredness. But it eventually went away. Other than that, no major side effects, except for a bit of a rash which also went away.
And I did clearly have an AD response. But I didn't have a FULL response, so I am augmenting with Trileptal currently to whomp the hypomania and rapid cycling I've had lately.
I've also read about Tegretol or Trileptal being successfully used in treatment resistant depressions.
I hope you feel better soon. I'm in the wasteland as well. Take care, and good luck!
Katy
(dx bipolar II, currently in a major depressive episode)200 mg Lamictal (7months)
1200 mg Trileptal (1 day)
2g fish oil (1 month)
7.5 mg Restoril for sleep (2 months)
Posted by St. John on October 24, 2003, at 11:58:59
In reply to Re: Lamictal , posted by fluffy on October 24, 2003, at 11:52:03
Thanks for the thoughtful and encouraging responses. I'm considering giving it a chance, but the return to the side effect merry-go round is a strong impediment. In less than a year off all AD's I lost 40 pounds without changing one thing about my lifestyle. That in itself is an antidepressant. I'd love to hear what others think about Lamictal as a treatment for resistent depression.
Posted by ginger C on October 24, 2003, at 13:26:11
In reply to Re: Lamictal , posted by St. John on October 24, 2003, at 11:58:59
I have been taking Lamictal for about two years as a mood stabilizer and I don't feel it has done much as far as my depression has gone.
Posted by galkeepinon on October 24, 2003, at 16:19:15
In reply to Lamictal , posted by St. John on October 24, 2003, at 11:05:41
Hi there, I've always had great results with Lamictal, never any side effects, or weight gain!
:-)
To me, it IS worth the effort to try it, if you don't you'll never know if it would have helped, and helped tremendously!
Good luck and hang in there!
Posted by BarbaraCat on October 24, 2003, at 22:09:44
In reply to Re: Lamictal , posted by fluffy on October 24, 2003, at 11:52:03
Hey Fluffy!
So there you are! Actually, I've been taking a sleeper from Bab but couldn't pass up the chance to say 'Hi'. Sorry you're in a funk. I go in and out but basically doing well since giving up alcohol. It was really contributing towards the dark bleak stuff. I'm still not sleeping well, however, and tiredness affects everything. Even the nights I break down and take Ambien I'm still jumpy and wakeful.You mention 2G fish oil. Have you ever tried taking more? The therapeutic dose was 9-12G in the research studies from Dr. Stoll, the father of fish oil, and stated anything below 4G showed no response. I think it helps. I know you now have gorgeous Asian priness fingernails, but maybe that's not why you're taking it. - BarbaraCat
Posted by BarbaraCat on October 24, 2003, at 22:41:04
In reply to Lamictal , posted by St. John on October 24, 2003, at 11:05:41
Hi St. John,
Interesting. I've only talked to people on this board who have used lamictal because of bipolar depression. I was originally dx'd with severe unipolar but responded fitfully to ADs, finally decompensating alltogether with constant panic disorder. It all turned out later to be bipolar mixed states depression. It was a hard recognition because I didn't think I ever had a manic episode. My idea of mania was the gleeful mad-hatter Hollywood version and it didn't ever mesh with what I was experiencing. Looking back I now recognize many classic episodes of hypomania and mania, but it mainly blurred together as an agitated mixed states depression that was getting worse with the years.The reason I metion this is to wonder if there might be another dx besides unipolar depression. This might explain alot about your treatment resistance. Not the ECT part, but the medications. Have you ever read "Why your depression isn't getting better", M. Bartos? Anyhow, just a thought since bipolar isn't always obvious.
As for lamictal, it's been very helpful for the depression but I have to use it with lithium. Each alone doesn't work and I either get very agitated (no lithium) or very depressed (no lamictal). The only side effect I've had is a bit of activation with each increase and now anytime I attempt to go past my current 125mg dose I start to get intense itching that is not the rash. I'd encourage you to give it a try. It's very different from any AD and might just work for you. But like Dalilah said, the slow ramp up can be frustrating. One other consideration is that if indeed you might be BP, lamictal without another mood stabilizer (lithium for me) can be quite agitating. But perhaps with unipolar that won't be a problem. Good luck and let us know. - BarbaraCat
Posted by St. John on October 24, 2003, at 23:07:54
In reply to Re: Lamictal » St. John, posted by BarbaraCat on October 24, 2003, at 22:41:04
Thanks Barbara for the information and insight. When my doc suggested the possibility of Lamictal working where other things haven't, he posed the possibility of "overlooked" mania, even though we've been working together for nearly 10 years and he can't see that there have been any indications of conventional bipolar disorder. He has just attended a workshop in Boston where one of the primary advocates of using Lamictal for unipolar disorder gave a presentation. Who the heck knows. The last time I sat before the Cambridge luminaries, it was for the Harvard/Mass General Bipolar clinic to consult. For an hour and a half, I answered questions to a shrink who typed furiously on a laptop. I figured he was taking notes and would use them for reflection and then evaluation. At the end of the 90 minutes, he said that he would provide me with an evaluation and report to give my doc. I asked when that might be available, and he said "as soon as Ms. X here prints it out." He then handed someone a disc that had the report he had written while we talked. The report was essentially a reiteration of what I'd said in response to his questions, ie, I read myself describing myself. His drug regimine was the last foray I've taken into the AD world. I'm convinced that anyone who has a answer to depression/mood disorders wouldn't sit on it, so I was skeptical on that trip to Boston, and I'm skeptical about yet another "guess what" imminating from the ivy halls. But all of what you say and what else I hear makes me waver on rejecting Lamictal out of hand. I'll let you know.
Posted by BarbaraCat on October 25, 2003, at 0:19:37
In reply to Re: Lamictal, posted by St. John on October 24, 2003, at 23:07:54
That's a funny but horrible story about your 'consultation'. Why didn't they just hire a court reporter? One wonders how these guys ever make it out of med school. What I find curious is how many of them never had a significant mood disorder but treat the field as an intellectual and pharmacological foray. Those are the ones to run like holy hell from. Fortunately there are many very gifted ones as well, but you don't really know until later.
Here are some questions you don't have to answer if you'd prefer not. What are the symptoms of your depression? Is it cyclical with normal days or is it always there? Vegetative, agitated or a mix? Do you ever get somatic symptoms, i.e., body pain, GI problems? What happened when you took SSRIs or other ADs? Normal side effects, yes, but anything else, like exacerbation of your symptoms, or was it that they just didn't do anything. You probably have, but have you had your thyroid checked? Low thyroid was a big contributor for me.
Not trying to diagnose or offer any unsolicited advice, it's just that my own experience of 'depression' was so bizarre that I felt like a strange and hopeless case, especially when none of the tried and true's were not only not working but making me worse. I'd imagine that you've gone through this kind of despair as well. Since being on the lithium/lam combo and finding a great naturopath who is treating other hormonal imbalances I can honestly say that this is the first time I've felt sustained health and hope in over 20 years. You're on my 'good wishes' list that you find a bright spot on your horizon. It's out there - it's only molecules. - Barbara
Posted by Dalilah on October 25, 2003, at 11:16:51
In reply to Re: Lamictal » St. John, posted by BarbaraCat on October 25, 2003, at 0:19:37
Hey St. John,
After reading Barbara's post, I have to agree. I first tried lamictal alone and it didn't do a thing for me. When I had it with lithium, it made a significant difference.
I too, had the switch from being diagnosed as unipolar to bipolar - it's quite common. But either way, you could try lithium. There is no rule that you must be bipolar to take it. I know some unipolars use it.
In the end, I think that the diagnosis doesn't really matter. There are so many different types of mental illness and so many variations of each diagnosis. All we care about is getting the meds that work for us, right?
Dalilah
Posted by ginger C on October 25, 2003, at 11:23:10
In reply to Re: Lamictal, posted by Dalilah on October 25, 2003, at 11:16:51
My doctor tried me on Topamax and Tegretol before trying Lamictal and by far the Lamictal has been the better drug for me along with lithium. However I have had to take two AD's in order to keep the depression under control.
Posted by BarbaraCat on October 25, 2003, at 11:41:37
In reply to Re: Lamictal, posted by Dalilah on October 25, 2003, at 11:16:51
Hi Dalilah,
What you said about diagnosis is so true. Our dx puts our complex symptoms into a neat little box and once there it's hard to see outside the box (or the bun). Our symptoms overlap into so many camps that it's hard to know if you're ADD, BP, OCD, BPD, GAD, jeez how can you tell and so what. How we're feeling needs to be a constant exploration and re-evaluation. You gotta find what works.Glad to hear you're doing so well. I recall not too long ago you were having a rough time and had just started with lamictal or were considering taking it. I'm not sure if you were on lithium also, but you were in somewhat of a turmoil about taking the meds. It's real heartening that things have worked out for you.
One of the things that keeps getting validated and keeps me taking my meds is to see the positive effects the right meds can make in someone else. I kinda recall where I was up until 1-1/2 years ago pre lithium/lamictal. It was so bad that my brain can't remember much of it, only that I was in deep pain. I read my journals from that time and go 'oh yeah, it really was that bad'. So even if I sometimes get tempted to go au natural thinking I'm so much better now, posts like yours keep me taking my meds like a good girl. - Barbara
> Hey St. John,
>
> After reading Barbara's post, I have to agree. I first tried lamictal alone and it didn't do a thing for me. When I had it with lithium, it made a significant difference.
>
> I too, had the switch from being diagnosed as unipolar to bipolar - it's quite common. But either way, you could try lithium. There is no rule that you must be bipolar to take it. I know some unipolars use it.
>
> In the end, I think that the diagnosis doesn't really matter. There are so many different types of mental illness and so many variations of each diagnosis. All we care about is getting the meds that work for us, right?
>
> Dalilah
Posted by BarbaraCat on October 25, 2003, at 11:44:03
In reply to Re: Lamictal, posted by ginger C on October 25, 2003, at 11:23:10
Hi Ginger,
Are you BP or unipolar? Guess it doesn't matter in the end if something works. - Barbara
> My doctor tried me on Topamax and Tegretol before trying Lamictal and by far the Lamictal has been the better drug for me along with lithium. However I have had to take two AD's in order to keep the depression under control.
Posted by katia on October 25, 2003, at 13:38:16
In reply to Re: Lamictal, posted by ginger C on October 25, 2003, at 11:23:10
Ginger,
Are you uni or bipolar? If bipolar, it's ok for you to take ADs?
katia
Posted by katia on October 25, 2003, at 13:41:01
In reply to Re: Lamictal » ginger C, posted by BarbaraCat on October 25, 2003, at 11:44:03
Hi,
Oops, i didn't read Barbara's post to you before I asked the same uni/bi question.
hey Barb,
How are you?
I just got back from yosemite for three days by myself camping.
I'll tell you about it the next link over at substance.....yeah.
katia
Posted by BarbaraCat on October 25, 2003, at 14:41:16
In reply to oops! same question » BarbaraCat, posted by katia on October 25, 2003, at 13:41:01
Hi Katia!
Good to hear from you. Yosemite, ahhhhhh... many fond memories. Yeah, let's meet up in substance. Give me a jingle when you're ready. BTW, I found Fluffy here too.
Posted by St. John on October 25, 2003, at 14:58:36
In reply to Re: Lamictal » St. John, posted by BarbaraCat on October 25, 2003, at 0:19:37
Barbara, thanks for your response. The "truth" of your empathy is profound and touching. I'm glad I found this list.
In response to your questions, the most appropriate round hole my square self has been hammered into is double depression, atypical. Since I was around 11 or 12, I've had cyclic major depression in a context of persistent dysthymia. I wake up feeling the best I'll feel and then as the day wears on, I become more depressed. I have terrific trouble concentrating, my sleep disruption results in too little instead of too much sleep, I retreat within myself, and while not anhedonic, I am nevertheless hopeless. I've never been hospitalized, but my depression has helped me fail to achieve what might have been called a somewhat promising future in my profession. i can do my work, but in fits and starts, and the good things I've done have been under survival pressure. I'm isolated and while people seem to like me, I don't form very enduring relationships. I've been married twice, once just out of college when I feared I'd be alone for the rest of my life (and in midst of a 3 year interval of major depression), and then again later in a relationship that lasted for about 18 years. My life is chaotic in the extreme and I live "successively" instead of "serially." I am an addictive personality. And overall, I view myself through the lens of what Calvin Trillin called in his friend Denny an "imposter syndrome." My response to AD's, MAOI, Tricyclics, SSRIs, Anticonfulsants, and the satanic ECT is essentially nil. Most drugs I've tried, if I didn't have acute side effects, have been pushed to their limits and combinations and adjutants have been part of the regimine. 18 months ago, after a year of Effexor virtually at its toxic limit, I took myself off medications and have enjoyed the clearing of the fog, but I remain citizen of the world of utter despair. I'd rather be deeply sad than fat and foggy, but I'd really rather not be sad, so I find myself thinking about Lomictal. I'm really glad you folks are out there.
Posted by katia on October 25, 2003, at 15:17:13
In reply to Re: Lamictal, posted by St. John on October 25, 2003, at 14:58:36
Hi St. John,
Have you tried any mood stabilizers pre-Lamictal?
I didn't see that on your list. A combo of mood stabilizers and ADs may help you.
cheers.
katia
Posted by katia on October 25, 2003, at 15:18:47
In reply to Re: oops! same question » katia, posted by BarbaraCat on October 25, 2003, at 14:41:16
Hi Barb,
Here is the link.
I'm still trying to work all this out with redirecting stuff!
http://www.dr-bob.org/babble/subs/20031014/msgs/273161.html
Posted by katia on October 25, 2003, at 18:54:23
In reply to Re: oops! same question » katia, posted by BarbaraCat on October 25, 2003, at 14:41:16
Hi Barb,
Just found this post from you regarding basal thermometers -** Nope. I wonder what it is. Let me know if you find out more about it. I've heard about inaccurate tests for sure. I've heard that TSH tests can be inaccurate and the best way to tell is taking the basal body temp first thing in the mornng even before you get up to pee. You shake out a mercury thermometer the night before, preferably a mercury basal one (they're getting hard to find), and stick it under the armpit (why the armpit I haven't the foggiest) for 10 minutes. If it's under 97.4 you're most likely hypothyroid. Mine was 96.4 pretty consistently just a while ago. Of course, with lithium my TSH was going through the roof. I'm hoping with the natural thyroid med I'll start evening out. There's been some controversy lately about if supplemental T3 is really needed. An endo study said this. There was a big storm of backlash on the about.thyroid.com site (a goldmine in case you haven't visited it). I dunno. I feel better on T3/T4 but it can make me jittery if I take too much at one time, so I split the it.
I bought one (a basal thermometer - an electronic one/battery operated, not mercury) and I stick it under my tongue for one minute until the beep. Is this as accurate as a mercury one under the arm? My body temp. has been low, but not like you describe. Average is 98.3. I'll keep monitoring it thru'out the month. See if the rise/fall is around my ovulation. (that's what this thermometer is for).
Did I tell you I recently read that a lot of rapid cyclers do well on hypothyroid meds? even if the tests indicate that they are not hypothyroid.katia
Posted by BarbaraCat on October 25, 2003, at 19:56:58
In reply to Re: oops! same question » BarbaraCat, posted by katia on October 25, 2003, at 15:18:47
> I'm still trying to work all this out with redirecting stuff!
>
>
**Me too. I'll follow you there in a trice.
Posted by BarbaraCat on October 25, 2003, at 21:09:27
In reply to Re: oops! same question » BarbaraCat, posted by katia on October 25, 2003, at 18:54:23
Hi Katia,
> I bought one (a basal thermometer - an electronic one/battery operated, not mercury) and I stick it under my tongue for one minute until the beep. Is this as accurate as a mercury one under the arm?**Good question - I wonder also. I bought a digital thermom recently. Is yours lavender with a cute little baby on the front? When I took my underarm temp with it it was much lower than my mouth temp so I don't know what to think. I haven't compared it with my mercury thermom yet but I've read many many times NOT to use digital but mercury thermoms. I really don't know why. Digitals are so much easier.
Aside from the digital vs. mercury question, perhaps the armpit is supposed to be a degree lower than oral, much like rectal temp is a degree higher? I think this is one of those self tests to figure out which method works best for us.
>>My body temp. has been low, but not like you describe. Average is 98.3.
**I'm not sure that my frigid 97.4 readings are accurate anymore, since I've been using the old armpit method. But maybe those armpit numbers mean something for basal tests that score on some kind of curve.
Are you taking it when you first wake up or after you've been up and about? If you're 98.3 when you first wake up - and this is before you even have that first pee or stretch - chances are you're not hypothyroid. Chances are you might be HYPERthyroid. But please don't quote me on this. As I understand it, morning temps should be no more than 97.6 until you start ambulating - a degree lower than the standard 98.6. That's why lower than 97.4 is considered hypothyroid, taking into account that normal waking should be 97.6.
Have you ever been checked for thyroid antibodies? (Hashmoto's antibodies is a test you have to plead and beg for in our typical HMO arena. Do NOT expect that it will be remotely suggested unless you ask for it.) Hashimoto's thryoiditis is an autoimmune form of thyroid disorder that's been implicated in bipolar disorder. It fluctuates up and down and mimics that good ol' rollercoaster ride we know so well. Hashitmoto's is a little blip in the normal thyroid disorder spectrum but no less frequent or severe.
>> Did I tell you I recently read that a lot of rapid cyclers do well on hypothyroid meds? even if the tests indicate that they are not hypothyroid.
**I haven't heard about it regarding rapid cyclers specifically and that's very interesting. You'd think that anything that's the least bit hyper inducing would throw rapid cyclers into a spin.
Thyroid hormone is being used as a general augmentor for pmeds with good results and the T3 form especially. But there's been alot of controversy lately about T3. Have you been to http://thyroid.about.com? If not, by all mean go there. It's mind boggling. Catcha later - Barbara
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