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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 68 to 92 of 133. Go back in thread:
Posted by sweetmarie on March 25, 2001, at 6:33:41
In reply to Re: treatment resistant depre, [LONG] » sweetmarie, posted by dove on March 24, 2001, at 15:26:18
> >
> How long have you been trying medications? Has this combination improved your life significantly (i.e. are you able to function/see friends/go out etc? That`s all I`m asking of a medication really. The rest I can tackle myself (relationships, work, whatever).
> >
>
> I spent much of my childhood and teen-age years self-medicating, except for a stint on Tegretol (AED). I wasn't even prescribed the Tegretol for a mood-disorder but for my fainting/blackout episodes, labeling them seizures. I told doctors that I had depression, and they told me I needed more sunshine (which, looking back, was partially true), and I needed to eat better, needed to gain some weight (wish I had that problem still ;-) needed more vitamin C, more exercise, ect... I also had blinding migraines, still do; however, I now use preventative meds. And it was through my search for migraine relief (and making sure I wasn't having little strokes because I would "faint" or black-out before they came on) that I tried my first med that opened my eyes to an entirely new world that I had only dreamt of.
>
> I was prescribed Verapamil, a calcium-channel blocker used for heart-disease and treating migraines. It was like an OD on beautiful shiny reality, and I was flying. When they felt it was effecting the way my heart beats and causing me to gain weight they moved me to Amitriptyline. The Ami does quell my migraines but I fell into a deep depression after the Verapamil was removed. I kept telling my Internal Medicine Doc, and my other non-specialist doc's that I was depressed and had lost that feeling of being "normal". They all said it would take some time to feel the effects of Amitriptyline and that it was "after-all" an antidepressant!
>
> But I've never been that stable again, nor has the world been that beautiful, alive and real again. I finally received a referral and the permission to see a psych-doc, who dxed me with (in order of importance by his criteria): ADHD, OCD, GAD, Panic Disorder, PTSD, and Rapid Cycling Bi-polar, and I may have forgotten a few. Over time, with different doc's and different dxes, multiple therapists and multiple med trials, I've come to the point where the meds are kind of like a life-preserver in a raging sea, and I have to do some legwork myself to push that life-preserver back to safety. I also know that some meds try to drown me, while others keep me afloat; and that it's really hard to distinguish between the two when you're taking multiple meds.
>
> I have lost contact with all but my very best friend, who lives so far away that we rarely see each other but do talk on the phone every other month or so. I have been bound to the house for some time now, well over five years really. That is, until quite recently. A combination of events and med additions within the last 3-4 months have given me a little more strength, still not what my husband wants to see, but a major step for me.
>
> The primary med that started a slow change and some improvement is Neurontin, and then the addition of Klonopin, and then the addition of low-dose Prozac.
>
> The primary events are my Mom being dxed with Lymphoma and Thyroid cancer, missing my best friend's (who lives far away) marriage this past December and subsequently her Dad being dxed with Leukemia and throat cancer, my childhood and beloved Minister's sudden death at the age of 46, my Aunt's attempted suicide (resulting in hospitalization, ECT, and subsequent recovery); then my eldest son's Grandpa being dxed with cancer in the form of an inoperative and terminal brain tumor (who has a mere three weeks left even though there were no symptoms until last week.), and his Great Grandpa being dxed with Alzheimer's.
>
> So, I still don't want to go outside, or anywhere else, but I do feel more alive. I believe I'm still in the detached-unreality part of real comprehension of the losses. I cried and cried after learning of all and each illness and death, then I became settled enough to speak about these events without falling apart, but deep down there's a lot of fear. I've been writing at P-Babble for over three (1998?) years now, and my presence has been sporadic for the last year or so. I fear writing because all these things and more are wrapped around each other in my heart, soul and mind; and I can't seem to open up without everything surfacing and baring just a little too much flesh, and I then feel vulnerable and overwhelmed resulting in withdrawal once again.
>
> So, after my longgggg sob-story, I think there are meds that can help anyone and everyone at least a little, but it can be a tough journey finding them. Are you struggling with major (double?) depression and one of the anxiety/panic disorders (i.e. agoraphobia)? There are some extremely wise and intelligent, as well as beautiful and kind, people on this board; who share their med/chemical knowledge freely. Sometimes the meds that are "suppose to do the job" don't, and ones that aren't suppose to do the job do indeed do the job.
>
> I'd also be afraid of being in-patient, I was almost committed against my will in December 1999 and I totally freaked. However, if there really wasn't anything but darkness inside of me, and I was really near the end of no turning back, and I had a family whom I loved and who loved me; I would probably check myself in. Remember, there are different strategies and different "experts" all over the world, and though you may feel *this* expert is your last hope, it isn't! I promise you it isn't.
>
> My latest p-doc (also honored with the title "expert") has me taking Adderall, Serzone, Neurontin, Klonopin, Prozac, and Amitriptyline. The combo becomes a little complicated when trying to take 6-8 Neurontin Caplets, 4 Adderall tabs, 4 Serzone Tabs, 3 Klonopin miniature tabs, ect... but the combo is having some beneficial effect, a might bit slow, but better than no!
>
> Don't lose hope, that is probably one of the most important things you need to hold onto, even though it's probably the hardest; after-all, isn't depression all about losing hope. My prayers, thoughts, and hope are with you. I may not post all that often, but I still read, and my eyes and ears will be vigilantly with you on your journey.
>
> dovedove,
P.S. to my previous posting.
You say that you responded well to one med combo; as I`m sure I mentioned, I responded very well with Dothiepin (and saw the world in a way I`d never seen it before, it was incredible). Surely, having responded to a medication (or medications), then it shows that this is possible and the odds are in our favour in finding another. This may be convaluted logic, but it seems kind of reasonable to me.
Anna.
Posted by Censerd on March 26, 2001, at 12:35:47
In reply to Re: treatment resistant depre, [LONG] » dove, posted by sweetmarie on March 25, 2001, at 6:33:41
> Hi all, I've never posted here before but always stop by to read and this is a topic I can totally relate to! I am 31 and have been being treated for depression off and on since I was 13. Meds were started at 17 and didn't go well, tried them again at 22 with no success - just lots of bad side effects! After my daughter was born in 1993, I gained a lot of weight (I'd always been heavy but gained even more) I had weight loss surgery and lost over 100 lbs. I thought this would give me the energy and motivation I needed to get off the couch and be able to play with my daughter - it didn't help any, I was/am skinny but still had no energy and a bad temper to boot! So I tried to get help again from my regular doc - she said she thought I had a-typical depression. Medication merry go round started again and I ended up on Celexa for about 1 year as it had the least side effects of any but they were too much to stay on any longer (mostly intenstinal stuff). She said to try Lithobid (lithium) as maybe I had bi-polar II since I wasn't responding to any AD's like I should. So now I had to go to a psychiatrist for med management. He didn't do much for me except write out prescriptions. My insurance changed so I had to change doc's again. First visit she said she wondered if I had ADD. I said no way, not me! Next visit she said what about ADD? and told me to research and read a book or 2 and let her know what I thought. Well, I borrowed a book from a friend and after reading just the introduction in "Driven to Distraction" my jaw hit the floor!!! This was me to a T! Well, to try and make a long post a little shorter, after tests and appointment I was diagnosed with ADD 3 weeks ago. I now take a combo of Ritalin and Concerta and I feel like crying because for the first time in my life that I can remember - I am sleeping well at night and - here's the big one - I actually feel awake during the day! I am capable of getting things done! I'm not a dynamo yet because I have to figure out how to do the stuff I haven't been doing for years but now I know I can get there!
The point of this gawd awful long post is to offer everyone on the med merry go round some hope and encouragement. I thought I had no more hope of every feeling "normal" or having energy, it just took perserverence and a lot more tries but so far - it's definately been worth it.
So to everyone who made it through this post - thanks for reading and keep perservering - there is a med, support group, or something for all of us.
Chris
Posted by sweetmarie on March 27, 2001, at 14:24:57
In reply to Re: treatment resistant depression-Lamictal » sweetmarie, posted by JahL on March 23, 2001, at 11:47:53
> > > > I've had high-dose trials of all the meds you mention, & many more besides. All w/out significant success...that was until I started Lamotrigine just over 2 wks ago. I'm only just up to 37.5mg but already the improvement has been dramatic (see 'BIPOLAR EXPERT' thread 4 details).
>
> > > >At yr current 25mg dose I can almost *guarantee* (tho' definitely no expert) you won't feel significant remission of yr depression. The proposed 250mg will give Lamotrigine scope to work it's magic (I'm biased).
>
> > > >You are fortunate to have found such a forward-thinking UK pdoc-I can't even find one to prescribe Lamotr. monotherapy, let alone such 'power combos'. I have to order mine from abroad (tut,tut,eh steve?). It's just a shame you have to reside in hospital.
>
> > > >I have high hopes for the Lamotrigine (which has the most anti-depressive profile of the mood-stabilizers); you may even find the Venlafaxine+Mirtazapine become/are redundant!
>
>
> > I`m sorry to bug you. You mentioned Lactimal working it`s `magic` - does this mean that it has had an effect, or just that you are expecting it to?
>
> HI Anna.
>
> The 'magic' I speak of refers to sporadic rpts I have read of Lamotrigine vanquishing resistant depression where all else had failed. Of course these give no guarantee.
>
> I'm only on 67.5mg but already there are robust improvements in cognition, co-ordination & social phobia. No great improvement in mood but that generally requires higher doses (which I'm building up to).
>
> > I am now on 200 mg (since March 18th - 6 days now), and so far I don`t feel a thing. Do you reckon it`s too early to know? The intended dose that I`m aiming for is 250 mg, but I`m leaving that until I go into Hospital in 3 weeks or so. Am I being impatient? (I expect I am, only I`m just so ill).
>
> If you're impatient then so am I; this cautious upwards titration goes against my nature.
>
> 250 sounds like a good dose if it's the only anti-convulsant you're taking. I have read that for some a *month+* @ therapeutic doses is required for a response. I think there's a lot of guesswork involved since Lamotrigine's use in mood disorders is a fairly recent development.
>
> > Again, sorry to hassle you (you don`t have to answer this if you don`t want to).
>
> No worries!
>
> J.Jah,
I spoke to the `medication helpline` (a helpline that specifically deals with psychiatric medications, based in the Affective Disorders Unit at the Maudsley Hospital in London) regarding Lamotragine. The woman I spoke to told me that there wasn`t too much info about the drug as it`s so new (as we know). However, she was able to look into a file they have about it. She quoted a case study of a woman who had been on Lamotragine for 7 weeks, felt completely well and went back to work (a concept that I can`t even think about - I haven`t worked for 3 years now). Also, she found a research project, which quoted `4 +` weeks for any effect. This was helpful as far as it went, but like I said, info about Lamotragine is pretty thin on the ground as yet.
I have a question that I meant t ask her, and was wondering if you knew the answer. Do I count ALL the weeks that I have been on an increased dose, or the weeks that I have been on the top dose, or rather the optimum dose for me (250 mg)? Do you know? I`ve always been a bit hazy on this whole time-scale business.
Cheers,
Anna.
Posted by Christina on March 27, 2001, at 15:34:29
In reply to Re: treatment resistant depre, [LONG] » dove, posted by sweetmarie on March 25, 2001, at 6:33:41
> P.S. to my previous posting.
>
> You say that you responded well to one med combo; as I`m sure I mentioned, I responded very well with Dothiepin (and saw the world in a way I`d never seen it before, it was incredible). Surely, having responded to a medication (or medications), then it shows that this is possible and the odds are in our favour in finding another. This may be convaluted logic, but it seems kind of reasonable to me.
>
> Anna.Anna:
What sort of drug is Dothiepin? Is that the Brand name? Is is something only available in the UK?You mentioned that it helped you. Are you still on it?
I'm very curious. I've been on all sorts of med cocktails for depression, and I haven't had much luck.
Posted by JahL on March 27, 2001, at 16:36:19
In reply to Re: treatment resistant depression-Lamictal » JahL, posted by sweetmarie on March 27, 2001, at 14:24:57
> > I spoke to the `medication helpline` (a helpline that specifically deals with psychiatric medications, based in the Affective Disorders Unit at the Maudsley Hospital in London) regarding Lamotragine. The woman I spoke to told me that there wasn`t too much info about the drug as it`s so new (as we know). However, she was able to look into a file they have about it. She quoted a case study of a woman who had been on Lamotragine for 7 weeks, felt completely well and went back to workThe 'magic'?!
> >(a concept that I can`t even think about - I haven`t worked for 3 years now). Also, she found a research project, which quoted `4 +` weeks for any effect. This was helpful as far as it went, but like I said, info about Lamotragine is pretty thin on the ground as yet.
> > I have a question that I meant t ask her, and was wondering if you knew the answer. Do I count ALL the weeks that I have been on an increased dose, or the weeks that I have been on the top dose, or rather the optimum dose for me (250 mg)? Do you know? I`ve always been a bit hazy on this whole time-scale business.Hi Anna.
I'm pretty sure it's 4wks (not set in stone of course) *from* when you reach a therapeutic dose (ie one that will provoke a response in you) So if 250mg is going to work then it might take 4 wks @ this dose before you begin improving.
I guess the secret is to continue gradually increasing the dose (thus testing a good dose range) until you get a result. Then you can gradually titrate downwards until yr response begins to remit. Just above this point is yr optimal dose.
J.
Posted by sweetmarie on March 28, 2001, at 3:43:01
In reply to Re: treatment resistant depression » sweetmarie, posted by Christina on March 27, 2001, at 15:34:29
>
> > P.S. to my previous posting.
> >
> > You say that you responded well to one med combo; as I`m sure I mentioned, I responded very well with Dothiepin (and saw the world in a way I`d never seen it before, it was incredible). Surely, having responded to a medication (or medications), then it shows that this is possible and the odds are in our favour in finding another. This may be convaluted logic, but it seems kind of reasonable to me.
> >
> > Anna.
>
> Anna:
> What sort of drug is Dothiepin? Is that the Brand name? Is is something only available in the UK?
>
> You mentioned that it helped you. Are you still on it?
>
> I'm very curious. I've been on all sorts of med cocktails for depression, and I haven't had much luck.Christina,
Dothiepin is a tricyclic anti-depressant. It is available in the States, under the brand name Prothiedin (I think I`m right in saying). I can`t remember the generic (if that`s the correct word) name for it, but it can be easily found on one of the medication web-sites.
It was the first anti-depressant I was prescribed, and it worked for me 100%. It worked so well that, in conjunction with my GP, I came off it after a year. The depression came back almost immediately (worse than before in fact), so I went back onto it. Unfortunately, it failed to have any effect at all 2nd time around, although I persisted with it (at all levels of dosage) for a further 18 months. Since then, nothing has worked (I won`t bore you with details, but I`ve recently done a tally of all the meds I`ve been on since then and come up with the total of 12 - not including all the different permutations of those. Also ECT didn`t work). So, no I`m not still on it, but curse my folly in discontinuing it all the time. I thought I was a bit freakish that it didn`t work 2nd time (what was wrong with me? etc), but I`ve since found out that this is not uncommon at all.
Anyway, I wish you luck if you decide to give it a try.
Anna.
Posted by sweetmarie on March 28, 2001, at 3:54:12
In reply to Re: treatment resistant depression-Lamictal » sweetmarie, posted by JahL on March 27, 2001, at 16:36:19
>
> > > I spoke to the `medication helpline` (a helpline that specifically deals with psychiatric medications, based in the Affective Disorders Unit at the Maudsley Hospital in London) regarding Lamotragine. The woman I spoke to told me that there wasn`t too much info about the drug as it`s so new (as we know). However, she was able to look into a file they have about it. She quoted a case study of a woman who had been on Lamotragine for 7 weeks, felt completely well and went back to work
>
> The 'magic'?!
>
> > >(a concept that I can`t even think about - I haven`t worked for 3 years now). Also, she found a research project, which quoted `4 +` weeks for any effect. This was helpful as far as it went, but like I said, info about Lamotragine is pretty thin on the ground as yet.
>
> > > I have a question that I meant t ask her, and was wondering if you knew the answer. Do I count ALL the weeks that I have been on an increased dose, or the weeks that I have been on the top dose, or rather the optimum dose for me (250 mg)? Do you know? I`ve always been a bit hazy on this whole time-scale business.
>
> Hi Anna.
>
> I'm pretty sure it's 4wks (not set in stone of course) *from* when you reach a therapeutic dose (ie one that will provoke a response in you) So if 250mg is going to work then it might take 4 wks @ this dose before you begin improving.
>
> I guess the secret is to continue gradually increasing the dose (thus testing a good dose range) until you get a result. Then you can gradually titrate downwards until yr response begins to remit. Just above this point is yr optimal dose.
>
> J.Jah,
Thanks. As you know, I haven`t increased the dosage slowly at all (25 mg - 250 mg in about 4 weeks). I think, however that this is because of the fact that I`am simultaneously coming off my other meds, and tend to become very ill indeed when I do this - iller than I am at the moment, which is pretty ******* ill (nearly catatonic, as I`m sure I`ve mentioned before). This is my theory anyway, and it was made as a result of past experience by my consultant (of my reaction to med changes).
I`m actually hoping that the Lactimal will `do the job` on it`s own - hence the question. In other words, I`m hoping that the Venlafaxine and Mirtazapine will not be necessary. This is my hope anyway, but if it doesn`t happen, so be it (at the end of the day, I don`t actually give a monkeys haow many drugs I take, so long as they are successful. And don`t make me look like the Michelin man, which is what Nardil has done).
Cheers,
Anna.
Posted by SLS on March 28, 2001, at 8:48:10
In reply to Re: treatment resistant depression » Christina, posted by sweetmarie on March 28, 2001, at 3:43:01
Hi Anna.
> It [dothiepin] was the first anti-depressant I was prescribed, and it worked for me 100%. It worked so well that, in conjunction with my GP, I came off it after a year. The depression came back almost immediately (worse than before in fact), so I went back onto it. Unfortunately, it failed to have any effect at all 2nd time around, although I persisted with it (at all levels of dosage) for a further 18 months.
> So, no I`m not still on it, but curse my folly in discontinuing it all the time
I know you realize that you made a perfectly logical decision with the information you were provided; a decision driven by a very understandable desire to discontinue a drug, along with its side effects, that is no longer needed. It is also understandable that you should not want to "rely" on any drug to remain healthy. People with all sorts of illnesses want to be able to live without the drugs they are taking. Many of them petition their doctors to discontinue their medication. It is the responsibility of the doctor to council the patient as to whether or not they should and, ideally, to explain to the patient why. It seems that your doctor at the time did not possess the information regarding antidepressant continuation. At that time, perhaps psychiatry had not yet recognize the potential for post-discontinuation treatment-resistance. Perhaps it was, but your G.P. was without the expertise to remain current with psychiatric issues. Either way, your decision at that time made sense.
"What if...?"
20/20 hindsight provides an unfair advantage for those who have it in advance. I can look back 13 years ago and isolate a single decision made by my doctor that resulted in the loss of my late 20's, all of my 30's, and still counting. I can look back on some of my own treatment decisions that, in retrospect, could have prevented me from getting well. Still, I remember how human I was at the time I made these decisions, and try not to place too much weight upon my shoulders for the blame and guilt I feel for having made them.
I know 12 drugs sounds like a big number. It is. However, compared to some of the people here, you have plenty more treatment possibilities ahead of you than you have had behind you. You should remain optimistic.
I do not regard your decision to discontinue dothiepin as "folly", whether you were counciled properly or not. I wish that I had followed some of my doctors' advise instead of f____ing (follying) around. I try to learn from my past so that I can provide myself with a better chance of having a future.
Sincerely,
Scott
Posted by sweetmarie on March 28, 2001, at 11:35:39
In reply to Re: treatment resistant depression » sweetmarie, posted by SLS on March 28, 2001, at 8:48:10
> Hi Anna.
>
> > It [dothiepin] was the first anti-depressant I was prescribed, and it worked for me 100%. It worked so well that, in conjunction with my GP, I came off it after a year. The depression came back almost immediately (worse than before in fact), so I went back onto it. Unfortunately, it failed to have any effect at all 2nd time around, although I persisted with it (at all levels of dosage) for a further 18 months.
>
> > So, no I`m not still on it, but curse my folly in discontinuing it all the time
>
> I know you realize that you made a perfectly logical decision with the information you were provided; a decision driven by a very understandable desire to discontinue a drug, along with its side effects, that is no longer needed. It is also understandable that you should not want to "rely" on any drug to remain healthy. People with all sorts of illnesses want to be able to live without the drugs they are taking. Many of them petition their doctors to discontinue their medication. It is the responsibility of the doctor to council the patient as to whether or not they should and, ideally, to explain to the patient why. It seems that your doctor at the time did not possess the information regarding antidepressant continuation. At that time, perhaps psychiatry had not yet recognize the potential for post-discontinuation treatment-resistance. Perhaps it was, but your G.P. was without the expertise to remain current with psychiatric issues. Either way, your decision at that time made sense.>
> "What if...?"
>
> 20/20 hindsight provides an unfair advantage for those who have it in advance. I can look back 13 years ago and isolate a single decision made by my doctor that resulted in the loss of my late 20's, all of my 30's, and still counting. I can look back on some of my own treatment decisions that, in retrospect, could have prevented me from getting well. Still, I remember how human I was at the time I made these decisions, and try not to place too much weight upon my shoulders for the blame and guilt I feel for having made them.> > I know 12 drugs sounds like a big number. It is. However, compared to some of the people here, you have plenty more treatment possibilities ahead of you than you have had behind you. You should remain optimistic.
>
> I do not regard your decision to discontinue dothiepin as "folly", whether you were counciled properly or not. I wish that I had followed some of my doctors' advise instead of f____ing (follying) around. I try to learn from my past so that I can provide myself with a better chance of having a future.
>
>
> Sincerely,
> ScottDear Scott,
I appreciate your reponse to my post. You`re absolutely right of course: how could my GP have known that I would subsequently be treatment resistant - after all, it was the very 1st medication I had ever taken for depression. As you also point out, it`s doubtful that a GP would be up to scratch with psychiatric medications (after all, a good many psychiatric doctors aren`t either). There really isn`t much point in looking back and wishing it could have been different - as my mother says, it`s where I am now and the future that counts. As you know, mothers have an inherent knack of being `right` (hmmmm...) I do feel though, that it probably bodes well in the sense that I have responded in the past, so it can`t be completely outside of my capabilities (convaluted logic? - maybe).
I`m interested to know what you meant by a decision made 13 years ago, which screwed up your late 20s etc. What was that (don`t tell me if you don`t want to - I`m just curious). Up until 3 years ago, I hadn`t actually been treated by a psych doctor at all - I had always been treated by my GP (first of all in Cambridge where I used to live, and then by my GP here in Leeds). It wasn`t until 3 years ago (almost to the day) that my GP realized that I needed `proper` help. Although I know that this is a waste of time, I do find myself asking the question how come it took them so long to refer me on to a psychiatric proffessional. After all, I had been on quite a few different med with them (Dothiepin, Seroxat, Prozac, Favorin, Lustral, Reboxetine and Venlafaxine - all these spanning 7 years with no results at all). As it turned out, the psychiatrist I was referred to was a complete w****r (I feel very strongly about this man - he`s totally incompetent to say the least, and whilst I was `under` him - 18 months - he put me on Imipramine, and when that failed to work, he tried ECT and when that failed, he told me that there was nothing further he could do for me). Two other of my friends have left him (as I did), and one of them made a formal complaint against him. He`s still practising though. I don`t know quite why I`m telling you all this, except for the fact that I feel, as you obviously do, that much time has been wasted. It astonishes me that I wasn`t actually diagnosed treatment resistant until I came under the care of my current psychiatrist. The facts were all there ... Still, I guess now that it has been recognised, it can be properly treated. Also, having seen the specialist, the diagnosis is even more accurate, which I`m hoping will narrow the field even further. Hindsight is all very well, but it really ought to be something we learn from, rather than something we beat ourselves up over (which I do on a regular basis).
Anyway, I won`t go on any more. How is the Lamotragine situation (I could have got this wrong, but didn`t you say that you had started taking it)?
Cheers,
Anna.
Posted by sweetmarie on March 31, 2001, at 6:53:13
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on March 10, 2001, at 6:22:05
> > Okay, sweetmarie, I did not want to alarm you but I thought you were in a hospital setting. Please read the following quote from Dr. Ivan Goldberg's depression central ( http://www.psycom.net/depression.central.lamotrigine.html ):
> >
> > "14. Which side-effects are severe enough to force people to discontinue lamotrigine?
> >
> > The side-effect of lamotrigine that most often causes the drug to be discontinued is a rash. Rashes can be mild, similar to a slight sunburn, or can be quite severe resembling a severe case of poison-ivy. The more severe the rash the less likely it is that the individual will be able to continue the medication. ALL rashes should be reported to the physicians prescribing the lamotrigine.
> >
> > A rash is more likely to develop when the initial doses of lamotrigine are high or when lamotrigine is too rapidly started when someone is taking valproate.
> >
> > It is important that people taking lamotrigine who develop a rash immediately contact their physician as there have been a few deaths in people who have developed lamotrigine-induced rashes."
> >
> > I think the name of the deadly rash problem is Steven-Johnson's Syndrome. It does not seem that your prescribing doc is aware of this? How much of an increase in dosage has he/she prescribed for you?
> >
> > Again, best wishes.
>
> The rash is similar to a `dry skin rash`, of the kind I have always had on my upper arms, except now it`s got worse and is more noticeable. It`s interesting that you make the Vaproate connection, as I am also taking this. However, I am coming off this - slowly decreasing the dosage until I come off altogether. Possibly this will help. I will certainly point the rash out to the psych doctors when I go into hospital (if it`s still there).
>
> sweetmariePhillybob,
Re. my rash. It`s not (as you quoted) anything like sunburn or poison ivy reaction. I have since found out that it is `folliculitis`, which is an infection of the hair follicles - each follicle develops a tiny spot type thing. I`ve always had this on my legs, but only very mildly. I`m wondering therefore, whether it IS anything to do with the Lamictal; maybe it`s the result of one of the other drugs, or even the result of the combination. It could have absoutely nothing to do with my meds, although it`s a bit wierd that it`s developed since going onto this combination. I`m almost 100% sure that it is not dangerous, but I still really hate it (although I suppose that this ought to be secondary to my health, but nonetheless ...)
Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
Any ideas appreciated.
Anna.
Posted by phillybob on April 1, 2001, at 22:52:52
In reply to Re: treatment resistant depression » sweetmarie, posted by sweetmarie on March 31, 2001, at 6:53:13
> > Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
Hi, Anna. Just back from a weekend trip (or holiday as the Brits might say?). Anyway, I myself have not heard of what you are talking about but have always imagined (I'd hypothesize, but I'm not sure if I believe my imagination that strongly) that when one puts something foreign into the body (i.e. medication) that the body can and might act funky ... thus, your exacerbation of an existing problem?Anyhow, I'm glad that you have found out what the rash is. With that information, you should be able to rest much better. Now, just to get up to a therapeutic dose for an appropriate amount of time and hoping it works, eh?
I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
Hope you are doing well!
[P.S. Just got a DVD player and am in the midst of watching Dylan's last accoustic shows in England in '65 (?) in the documentary "Don't Look Back." The intro with Subterranean Homesick Blues is worth the bucks so far! Also, got "Man in the Sand" which is a documentary on the making of the Mermaid Avenue albums which are Woody Guthrie songs sung by Billy Bragg and my fave, Wilco]
Posted by sweetmarie on April 2, 2001, at 6:26:31
In reply to Re: treatment resistant depression , posted by phillybob on April 1, 2001, at 22:52:52
> > > Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
>
>
> Hi, Anna. Just back from a weekend trip (or holiday as the Brits might say?). Anyway, I myself have not heard of what you are talking about but have always imagined (I'd hypothesize, but I'm not sure if I believe my imagination that strongly) that when one puts something foreign into the body (i.e. medication) that the body can and might act funky ... thus, your exacerbation of an existing problem?
>
> Anyhow, I'm glad that you have found out what the rash is. With that information, you should be able to rest much better. Now, just to get up to a therapeutic dose for an appropriate amount of time and hoping it works, eh?
>
> I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
>
> Hope you are doing well!
>
> [P.S. Just got a DVD player and am in the midst of watching Dylan's last accoustic shows in England in '65 (?) in the documentary "Don't Look Back." The intro with Subterranean Homesick Blues is worth the bucks so far! Also, got "Man in the Sand" which is a documentary on the making of the Mermaid Avenue albums which are Woody Guthrie songs sung by Billy Bragg and my fave, Wilco]Phillybob
Thanks for your reply. I guess you could be right about the rash/whatever the hell it is. When I first went to my GP about it, she asked whether I`d just begun any different drug treatment, and I said I hadn`t. I actually don`t think I had - in fact, I think that this was PRE Lamictal. I dunno, my mind plays tricks on me since I`ve been feeling this ill (3 whole years now - I don`t know how I`ve coped! I have though). The most recent theory I`ve come up with is that the skin condidion has something to do with mood/body metabolism or something. The reason for this line of thought, is that when I was first very ill - 6 years ago (the first time that I have had to take time off work with it), I developed acne on the lower half of my face, and all over my chest (pleasant!). This cleared up when I started feeling (a tad) better. It`s all very confusing, but I`m telling myself to put it on the `back burner` until such a time as I am better (if of course this ever happens). I just really bloody hate it ... Still. That`s life.
[I have `Don`t Look Back` on video (it is his 1965 tour of England). Definitely worth watching - just don`t watch it too much. Did you spot Allen Ginsberg in the background of the `Subterranean Homesick Bluse` bit at the beginning? I don`t know quite why he was there ...]
Anna.
P.S. I`ve been on the `terapeutic dose` of Lamictal (250 mg) for a week and a half, and absolutely no change. Still early days I guess, and it was never intended as a medication on it`s own - i.e. it is meant as a part of a combination (Mirtazapine/Venlafaxine/Lamotragine). I was just hoping that the others would be unnecessary.
Posted by sweetmarie on April 2, 2001, at 6:31:24
In reply to Re: treatment resistant depression » phillybob, posted by sweetmarie on April 2, 2001, at 6:26:31
> > > > Have you heard of this condition? Has anyone? Any clue as to whether it could be medication related? Maybe someone else has developed the same thing?
> >
> >
> > Hi, Anna. Just back from a weekend trip (or holiday as the Brits might say?). Anyway, I myself have not heard of what you are talking about but have always imagined (I'd hypothesize, but I'm not sure if I believe my imagination that strongly) that when one puts something foreign into the body (i.e. medication) that the body can and might act funky ... thus, your exacerbation of an existing problem?
> >
> > Anyhow, I'm glad that you have found out what the rash is. With that information, you should be able to rest much better. Now, just to get up to a therapeutic dose for an appropriate amount of time and hoping it works, eh?
> >
> > I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
> >
> > Hope you are doing well!
> >
> > [P.S. Just got a DVD player and am in the midst of watching Dylan's last accoustic shows in England in '65 (?) in the documentary "Don't Look Back." The intro with Subterranean Homesick Blues is worth the bucks so far! Also, got "Man in the Sand" which is a documentary on the making of the Mermaid Avenue albums which are Woody Guthrie songs sung by Billy Bragg and my fave, Wilco]
>
> Phillybob
>
> Thanks for your reply. I guess you could be right about the rash/whatever the hell it is. When I first went to my GP about it, she asked whether I`d just begun any different drug treatment, and I said I hadn`t. I actually don`t think I had - in fact, I think that this was PRE Lamictal. I dunno, my mind plays tricks on me since I`ve been feeling this ill (3 whole years now - I don`t know how I`ve coped! I have though). The most recent theory I`ve come up with is that the skin condidion has something to do with mood/body metabolism or something. The reason for this line of thought, is that when I was first very ill - 6 years ago (the first time that I have had to take time off work with it), I developed acne on the lower half of my face, and all over my chest (pleasant!). This cleared up when I started feeling (a tad) better. It`s all very confusing, but I`m telling myself to put it on the `back burner` until such a time as I am better (if of course this ever happens). I just really bloody hate it ... Still. That`s life.
>
> [I have `Don`t Look Back` on video (it is his 1965 tour of England). Definitely worth watching - just don`t watch it too much. Did you spot Allen Ginsberg in the background of the `Subterranean Homesick Bluse` bit at the beginning? I don`t know quite why he was there ...]
>
> Anna.
>
> P.S. I`ve been on the `terapeutic dose` of Lamictal (250 mg) for a week and a half, and absolutely no change. Still early days I guess, and it was never intended as a medication on it`s own - i.e. it is meant as a part of a combination (Mirtazapine/Venlafaxine/Lamotragine). I was just hoping that the others would be unnecessary.p.p.s.
That should be `Subterrenean Homesick Blues` and `therapeutic`, although you probably didn`t need telling (don`t like making `typos` - bit anal retentive when it comes to spelling)
Anna.
Posted by SLS on April 2, 2001, at 9:50:36
In reply to Re: treatment resistant depression , posted by phillybob on April 1, 2001, at 22:52:52
Hi PhillyBob.
> I myself am still only at 50 mg/day of Lamictal ... taking it very slowly. However, to help pass the time (as I build up), I've added 5mg 2 times/day of Adderal (which works well for my younger brother) and since I seemed to have some positive effects in the past with Ritalin which then petered out, I thought it was worth a shot ... so far (3 days), I'm better than I was and think my patience in building up the Lamictal will hold out.
It sounds like a good plan to me. I hope the Adderall continues to give you what you want. I am curious if your doctor prescribed it and who's idea it was.
By the way, I need to take 300mg of Lamictal to receive any benefit from it.
Thanks.
- Scott
Posted by phillybob on April 2, 2001, at 12:43:33
In reply to Re: treatment resistant depression , posted by SLS on April 2, 2001, at 9:50:36
> I am curious if your doctor prescribed it [the Adderall] and who's idea it was.
>
> By the way, I need to take 300mg of Lamictal to receive any benefit from it.
>
> Thanks.
>
>
> - ScottHi, Scott. The Adderall was my idea after some thinkin' about my past brief experiences with Ritalin and recently talkin' with the younger bro about his experiences. I definitely have always had ADD problems but never got past a Ritalin trial, for some reason. I remember reading John L's concise analysis and discussion of "line of fire" approaches to depression treatment, including benign and fast-acting stimulants ( http://www.dr-bob.org/babble/20000209/msgs/20873.html ). Anyway, the pdoc and I discussed Adderall and Dexadrine and felt, based upon my bro's success, Adderall would be worth a trial right now.
Nonetheless, based upon my brief (almost 2 months) but "total" "cure" for my symptoms (atypical-type AD-treatment-resistent depression ... an oxymoron?) with Topamax, I think this class of "neuromodulatory" drugs would have good long-term efficacy for me. [From the Topamax Experiences thread ( http://www.dr-bob.org/babble/20001231/msgs/50878.html ), I discontinued Topamax due to a bad side effect of receding gums; however, I would certainly re-visit it at a lower dose in the future as an adjunct for a partial or in lieu of a failed Lamictal response.]
My pdoc is very receptive to what I have to say due to my fondness for research and his own broad experience with most all meds. Bottomline, if it makes sense, he's game. He was, however, a bit more squeamish about the Lamictal trial due to his concerns about the rash (Steven-Johnson's). Ultimately, he's been quite fine as a professional in keeping my impatience in cheque (i.e. taking the titration slowly).
(I actually had, years ago, fairly exhausted the bulk of my psychotherapy needs with another counselor who happened to be my pdoc's daughter! Of course, there is still on-going ancillary psychotherapy-type discussions with my pdoc as I fine tune my understanding of my life and reactions to life.)
What kind of benefit do you think you receive from Lamictal? (Also, I forgot, what other meds are you taking and at what dosages?)
Posted by sweetmarie on April 2, 2001, at 13:52:20
In reply to Re: treatment resistant depression » SLS, posted by phillybob on April 2, 2001, at 12:43:33
> > I am curious if your doctor prescribed it [the Adderall] and who's idea it was.
> >
> > By the way, I need to take 300mg of Lamictal to receive any benefit from it.
> >
> > Thanks.
> >
> >
> > - Scott
>
> Hi, Scott. The Adderall was my idea after some thinkin' about my past brief experiences with Ritalin and recently talkin' with the younger bro about his experiences. I definitely have always had ADD problems but never got past a Ritalin trial, for some reason. I remember reading John L's concise analysis and discussion of "line of fire" approaches to depression treatment, including benign and fast-acting stimulants ( http://www.dr-bob.org/babble/20000209/msgs/20873.html ). Anyway, the pdoc and I discussed Adderall and Dexadrine and felt, based upon my bro's success, Adderall would be worth a trial right now.
>
> Nonetheless, based upon my brief (almost 2 months) but "total" "cure" for my symptoms (atypical-type AD-treatment-resistent depression ... an oxymoron?) with Topamax, I think this class of "neuromodulatory" drugs would have good long-term efficacy for me. [From the Topamax Experiences thread ( http://www.dr-bob.org/babble/20001231/msgs/50878.html ), I discontinued Topamax due to a bad side effect of receding gums; however, I would certainly re-visit it at a lower dose in the future as an adjunct for a partial or in lieu of a failed Lamictal response.]>
> My pdoc is very receptive to what I have to say due to my fondness for research and his own broad experience with most all meds. Bottomline, if it makes sense, he's game. He was, however, a bit more squeamish about the Lamictal trial due to his concerns about the rash (Steven-Johnson's). Ultimately, he's been quite fine as a professional in keeping my impatience in cheque (i.e. taking the titration slowly).
>
> (I actually had, years ago, fairly exhausted the bulk of my psychotherapy needs with another counselor who happened to be my pdoc's daughter! Of course, there is still on-going ancillary psychotherapy-type discussions with my pdoc as I fine tune my understanding of my life and reactions to life.)
>
> What kind of benefit do you think you receive from Lamictal? (Also, I forgot, what other meds are you taking and at what dosages?)Phillybob,
What is ADD? Also, how would you define atypical depression? I sort of know what this is - I was diagnosed as having atypical depression, but I`m fairy sure that this was a misdiagnosis (the psychiatrist didn`t really know his arse from his elbow, and labelled any depression he couldn`t treat as `atypical`). Also, what kind of medication is Adderal (i.e. a tranq or what)? During you `well` period, what caused it to end? What is your brother`s illness (if this is not a personal question)? Your psychiatrist (psycdoctor, as I think you call them) seems pretty switched on. I`m not sure about my new psychiatrist, as I haven`t actually been `under him` yet. It`s rather a confusing situation: I retain my own psychiatrist (in my area - we are allotted psychiatrists according to area here. There is no choice unless you kick up a fuss like I did). However, she has referred me to this specialist geezer at another hospital which deals exclusively in treatment resistant depression, so will now be acting on his instruction. I have totally forgotten why I`m telling you this ... I think that I was trying to say that it`s very hard to find a psychiatrist who will actually act on any input from the patient. My psychiatrist was very sniffy when I suggested something to her, and I have a feeling that this professor guy will be the same. Having said that, he is supposedly one of the best with treatment resistant depression, so I hope it won`t come to that. How do you come upon all this info - is it via the Net? I wouldn`t have a clue about neurotransmitters etc. Anyway, sorry for this long, drawn-out and pretty pointless message. Give the anarchist a cigarette!
Scott,
I thought that you were gradually increasing the Lactimal - you seem to be saying that you are on 300 mg. Have you been on it before, or have you pushed yourself up to this dosage? Or have I got the wrong end of the stick? You say that it has an effect - how much of an effect, and how long did it take to achieve it?
Let me know,
Anna.
Posted by phillybob on April 2, 2001, at 14:40:39
In reply to Re: treatment resistant depression , posted by sweetmarie on April 2, 2001, at 13:52:20
> What is ADD?
Attention Deficit Disorder (usually co-morbid with Hyperactivity Disorder thus often seen in conjunction with ADHD ... Attention Deficit Hyperactivity Disorder) ... I think. You can use the search feature here or follow the links I posted and read those discussion threads.
(A non-psychology search engine that I find especially valuable is http://www.google.com/ ; by clicking on the "cached" area of what it finds in the search, you can actually see the words that you requested to be searched as highlights when scrolling through a document! very time effective)
>Also, how would you define atypical depression?
Again, following the links above'll get you to what I personally consider my symptoms to be. Really, I am not inclined to box myself in with any diagnosis. I just know what symptoms and experiences I have had and try to address it from there: periods of more severe depression broken up by just a plain old low level depression with a tendency for short sub-hypomanic episodes (growing up, naturally occurring, but now only AD med-induced). For example, AD's (Anti-Depressants) do not work (at least as monotherapy) for me. I either get a positive response for a short period while on an AD but then it "poops out" or I have a short-lived positive response upon discontinuation of the AD. Or, I have no response or a bad response to the AD.
>Also, what kind of medication is Adderal (i.e. a tranq or what)?
Adderral is a stimulant (like Ritalin and Dexadrine).
>During your `well` period, what caused it to end?
Follow the Topamax experiences thread in my last post to get a clear picture. Basically, I had to stop the drug, causing the "well" period to end. I stopped due to one major side effect (gum recession) which may have been because I was taking too high of a dose or increased it too rapidly (?).
>What is your brother`s illness?
Just good old-fashioned ADD (and a bit of family environment issues compounding the problem).
>Your psychiatrist (psycdoctor, as I think you call them) seems pretty switched on. I`m not sure about my new psychiatrist, as I haven`t actually been `under him` yet.
Our pdocs here in the states are private (i.e. they may be more profit-motivated ... success equals better word of mouth and professional respect and, hopefully, more personal satisfaction in helping clients). Some, however are just "tools" of the big pharmacology companies and/or health insurance companies. I pay real money to my pdoc (a big ouch from my wallet!).
>How do you come upon all this info - is it via the Net? I wouldn`t have a clue about neurotransmitters etc.
Just use the search engines and read, read, read. Your understanding of your situation and possible "cures" will help you talk more confidently with your psychiatrist about options. Hopefully, though, what you are being prescribed now will be what you need! P.S. I really don't know much about neurotransmitters, either. I personally don't feel the need to get that technical and just rely on a more rudimentary understanding of what classes of what drugs do what things symptomatically. Maybe, after I achieve long-term remission, I'll look into it, though.
Regards, Pbob (kind of like Pdoc, huh?)
Posted by sweetmarie on April 3, 2001, at 6:14:16
In reply to Re: treatment resistant depression--ditto » JohnL, posted by Shar on March 8, 2001, at 19:22:48
> My pdoc recently added .5 mg Risperdal to my cocktail of wellbutrin and effexor, and klnonpin at night. It worked (I felt relief from depression) within a few days. We upped it to .75 because I was having the "feeling ok then the bottom falls out" plus "rage reactions" and doc said increase could help me stay feeling better for 24 hours, plus rage reaction could be a rx to withdrawal when .50 couldn't get me thru 24 hours.
>
> BTW, I have not felt this good in years. Years! It is incredible. Zoloft also worked well for me, but pooped out. I am praying this will not poop out.
>
> Shar
> > I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
> >
> > The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
> >
> > The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
> >
> > There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> > JohnShar,
Haven`t heard from you in awhile. I was wondering whether the combination you went onto (the Ritalin, Welbutrin, Efexor and Klonpin) has continues to work, i.e. has it managed to sustain you? Also, How long is `years`? That probably sounds a bit of a stupid question, but I hope you know what I mean.
Anyway, I hope it`s still doing the trick; let me know,
Anna.
Posted by sweetmarie on April 3, 2001, at 6:19:12
In reply to Re: treatment resistant depression--ditto » JohnL, posted by Shar on March 8, 2001, at 19:22:48
> My pdoc recently added .5 mg Risperdal to my cocktail of wellbutrin and effexor, and klnonpin at night. It worked (I felt relief from depression) within a few days. We upped it to .75 because I was having the "feeling ok then the bottom falls out" plus "rage reactions" and doc said increase could help me stay feeling better for 24 hours, plus rage reaction could be a rx to withdrawal when .50 couldn't get me thru 24 hours.
>
> BTW, I have not felt this good in years. Years! It is incredible. Zoloft also worked well for me, but pooped out. I am praying this will not poop out.
>
> Shar
>
>
>
>
> > I sound like a broken record because I say this so often, but as I see it there are a small handful of drugs that could prove very helpful to you. None of them have yet been tried. The only reason I suggest these drugs is because they have proven to be helpful to quite a few folks here that have had trouble with more straight forward treatments. Including me.
> >
> > The broken record drugs I'm referring to are Zyprexa, Amisulpride, Adrafinil, Risperdal, or any combination of two of them (not Zyprexa+Risperdal together though). Any of them, or any combination of them, seem to work especially well with a little bit of an SSRI in the background.
> >
> > The drugs you are on or have tried are far more harsh than any of these drugs I've mentioned. Since you can handle the side effects of the other drugs, then the ones I mentioned will seem like candy. Except for one thing. They will probably work.
> >
> > There are various theories as to what causes depression. The most popular one is a deficiency in neurotransmitters. Increasing them is what antidepressants do. You have pretty much exhausted that theory in your case. Time to explore other ones. That's where the drugs I mentioned come into play.
> > JohnShar,
In my previous post I put `Ritalin` - I meant `Risperdal`. Sorry.
Anna.
Posted by SLS on April 3, 2001, at 9:02:17
In reply to Re: treatment resistant depression , posted by sweetmarie on April 2, 2001, at 13:52:20
Hi Anna.
> I thought that you were gradually increasing the Lactimal - you seem to be saying that you are on 300 mg. Have you been on it before, or have you pushed yourself up to this dosage? Or have I got the wrong end of the stick? You say that it has an effect - how much of an effect, and how long did it take to achieve it?
> Let me know,
O.K.
You may have seen a post in which I described the way I went about increasing the dosage of Lamictal. I have been taking 300mg for over a year.
I used the following titration schedule, although I currently see others using more gradual schedules:
25 x 2 weeks
50 x 2 weeks
100 x 1 week
add 50 x 1 weekI have used this schedule three times. It might make sense to spend a week at 75mg between 50mg and 100mg. A few times, I would feel a mild itching on my eyelids around the eyelashes on dosage increases.
* When Lamictal is being combined with Depakote, it is critical to use no more than half of the above dosages. Depakote slows down the rate at which the body eliminates Lamictal.
I am not a good person to compare notes to. The first time I tried it, I had just discontinued a combination of the antidepressants Nardil and desipramine. I often experience a brief improvement when I discontinue certain drugs, including these. It would be difficult to separate this improvement and my response to Lamictal. However, I am not surprised by some people's descriptions of feeling improvements at dosages of 50mg and lower when they are first beginning treatment. This is probably temporary in most cases. I haven't seen too many people finding 50mg to be their optimal dosage to treat depression. Dosages of between 100mg and 300mg seems to be the effective range. One person reported needing 400mg.
How long does it take to work for depression? I don't know. Like so many other drugs, I think it is variable. For me, I felt a small improvement during the first few weeks at 25mg and 50mg. that was intermittant. I would say that there was a more sustained effect when I reached 100mg. It was necessary for me to raise the dosage in order to maintain an improvement. I found that 300mg was an optimal dosage. I lose the effect if I lower the dosage. If you are tolerating the drug well, I would consider targeting 200mg and remaining there for several weeks. If you are treating a true rapid-cycling bipolar disorder, you cannot fully evaluate the effectiveness of any drug, including Lamictal, unless you take it for several months.
When I first tried Lamictal, its antidepressant effect became synergistic with the improvement I received from discontinuing the antidepressants just prior to starting it. I felt substantially improved. I found myself going out and enjoying myself. I couldn't keep myself in the house. I had no use for the T.V. There were just so many other things to do. I had no hesitency to walk into a night-club by myself and striking up conversations with anyone who's ear was close enough to hear me. What fun.
It was nice to be able to read and comprehend too. Eventually, things sought their own level and I was left with only a slight improvement. Today, I continue to take Lamictal because it does help a bit when it is combined with an antidepressant.Sooo...
You might feel a moderate improvement during the first two weeks that might or might not fade. If it fades, don't get upset. It is probably a very good sign that you will experience a long-term improvement at dosages between 100mg and 300mg. Some previous investigations studying the use of Lamictal in bipolar depression found the average effective dosage to be 187mg.
I wish I could give you more concrete answers. It makes sense for you to follow other people's experiences on Psycho-Babble to get a better idea of the range of responses that are possible with Lamictal.
Lamictal is a good drug with few side effects that is worth trying.
- Good luck.
Posted by lois on April 3, 2001, at 12:59:14
In reply to Re: treatment resistant depression , posted by SLS on April 3, 2001, at 9:02:17
How can you tell if you have too *much* lamictal aside from being manic?I worked up to 400 mgs and had slight improvement in depression each time I upped by 25 mgs for about 4 days and then pooped out, only to improve again after another increase of 25 mgs.
Now on 400 mgs for abour 2 weeks I stopped noticing improvement and seem more anxious and fatigued (depressed?) Hard for me to tell whether I am borderline agitated manic or borderline agitated depressed).
Any thoughts? I just don't want to keep going up and up and up.Any thoughts about what too much might feel like? I see my p doc tomorrow.
Thx.
Lois
Posted by SLS on April 3, 2001, at 21:36:12
In reply to Re: treatment resistant depression » SLS, posted by lois on April 3, 2001, at 12:59:14
Hi Lois.
> How can you tell if you have too *much* lamictal aside from being manic?In general, Lamictal will not produce a manic reaction. There have been a few reports, but it seems to occur infrequently. I guess what I'm trying to say is that mania is not to be expected as the result of taking too much Lamictal.
> I worked up to 400 mgs and had slight improvement in depression each time I upped by 25 mgs for about 4 days and then pooped out, only to improve again after another increase of 25 mgs.
This is similar to my own experience. Since Lamictal has shown itself to be capable of producing any improvement in your condition, I would consider optimizing the dosage and continue taking it as you try adding other drugs to it. I think this makes sense if you are bipolar. Lamictal can be combined with just about any drug. However, it is important that when combining Lamictal with Depakote, the dosage of Lamictal be reduced by half. The reason for this is that Depakote hinders the body from eliminating it. Blood levels of Lamictal will remain the same.
> Now on 400 mgs for about 2 weeks I stopped noticing improvement and seem more anxious and fatigued (depressed?) Hard for me to tell whether I am borderline agitated manic or borderline agitated depressed).
When I tried taking 400mg of Lamictal, I experienced significant problems with memory. I don't recall if I felt fatigued, but sleepiness and dizziness are listed as possible side-effects. I guess fatigue is possible, but you probably won't be sure until you reduce the dosage. Based upon what I see here on Psycho-Babble, my guess is that you won't need to take more than 300mg. You and your doctor will need to evaluate the desirability of continuing with Lamictal. If your case involves a stubborn mixed-state (depression + mania together), combining mood stabilizers may be necessary. Such cases are usually thought of as being the bipolar II subtype. Depakote is usually thought of as the first choice of mood stabilizer. You could try adding Neurontin to Lamictal first because it is the easiest and has few side effects. Unless you have already had a negative experience with Depakote, I would consider combining it with Lamictal with the understanding that you will need to reduce the dosage of Lamictal.
> Any thoughts? I just don't want to keep going up and up and up.Any thoughts about what too much might feel like? I see my p doc tomorrow.
I hope I gave you some relevant information to work with. I will be interested to see what decision you and your doctor arrive at.
Good luck.
- Scott
I hope this stuff helps.
Posted by sweetmarie on April 4, 2001, at 6:42:21
In reply to Re: treatment resistant depression , posted by SLS on April 3, 2001, at 9:02:17
> Hi Anna.
>
> > I thought that you were gradually increasing the Lactimal - you seem to be saying that you are on 300 mg. Have you been on it before, or have you pushed yourself up to this dosage? Or have I got the wrong end of the stick? You say that it has an effect - how much of an effect, and how long did it take to achieve it?
>
> > Let me know,
>
> O.K.
>
> You may have seen a post in which I described the way I went about increasing the dosage of Lamictal. I have been taking 300mg for over a year.
>
> I used the following titration schedule, although I currently see others using more gradual schedules:
>
> 25 x 2 weeks
> 50 x 2 weeks
> 100 x 1 week
> add 50 x 1 week
>
> I have used this schedule three times. It might make sense to spend a week at 75mg between 50mg and 100mg. A few times, I would feel a mild itching on my eyelids around the eyelashes on dosage increases.
>
> * When Lamictal is being combined with Depakote, it is critical to use no more than half of the above dosages. Depakote slows down the rate at which the body eliminates Lamictal.
>
> I am not a good person to compare notes to. The first time I tried it, I had just discontinued a combination of the antidepressants Nardil and desipramine. I often experience a brief improvement when I discontinue certain drugs, including these. It would be difficult to separate this improvement and my response to Lamictal. However, I am not surprised by some people's descriptions of feeling improvements at dosages of 50mg and lower when they are first beginning treatment. This is probably temporary in most cases. I haven't seen too many people finding 50mg to be their optimal dosage to treat depression. Dosages of between 100mg and 300mg seems to be the effective range. One person reported needing 400mg.
>
> How long does it take to work for depression? I don't know. Like so many other drugs, I think it is variable. For me, I felt a small improvement during the first few weeks at 25mg and 50mg. that was intermittant. I would say that there was a more sustained effect when I reached 100mg. It was necessary for me to raise the dosage in order to maintain an improvement. I found that 300mg was an optimal dosage. I lose the effect if I lower the dosage. If you are tolerating the drug well, I would consider targeting 200mg and remaining there for several weeks. If you are treating a true rapid-cycling bipolar disorder, you cannot fully evaluate the effectiveness of any drug, including Lamictal, unless you take it for several months.
>
> When I first tried Lamictal, its antidepressant effect became synergistic with the improvement I received from discontinuing the antidepressants just prior to starting it. I felt substantially improved. I found myself going out and enjoying myself. I couldn't keep myself in the house. I had no use for the T.V. There were just so many other things to do. I had no hesitency to walk into a night-club by myself and striking up conversations with anyone who's ear was close enough to hear me. What fun.
> It was nice to be able to read and comprehend too. Eventually, things sought their own level and I was left with only a slight improvement. Today, I continue to take Lamictal because it does help a bit when it is combined with an antidepressant.
>
> Sooo...
>
> You might feel a moderate improvement during the first two weeks that might or might not fade. If it fades, don't get upset. It is probably a very good sign that you will experience a long-term improvement at dosages between 100mg and 300mg. Some previous investigations studying the use of Lamictal in bipolar depression found the average effective dosage to be 187mg.
>
> I wish I could give you more concrete answers. It makes sense for you to follow other people's experiences on Psycho-Babble to get a better idea of the range of responses that are possible with Lamictal.
>
> Lamictal is a good drug with few side effects that is worth trying.
>
> - Good luck.Scott,
Thanks for clearing that up.
I don`t have bipolar - just good old severe unipolar depression (`double` to be precise - Dysthymia and major severe episode). The Lamictal was always intended to be part of a combination (Venlafaxine/Mirtazapine/Lamotragine). However due to the `juggling` that`s going on at the moment, as I withdraw from my current meds, Lamictal is the only `new` one I`ve started (the Venlafaxine and Mirtazapine have yet to be added, which will happen when I go into hospital - about 4 weeks` time). It`s all very confusing, but I have been on Lamictal for about 8 months now as part of my current combination (which is useless) at a dosage of 25 mg. The new `regime` has the dosage of Lamictal as 250 mg, which I have now been on for about a week and a half. I was hoping that the Lamictal would be effective on it`s own, i.e. that I wouldn`t have to go onto the others. It sounds like clutching at straws I know, but I still thought it was a possibility. However, seems not.
I can certainly relate to the `meds working initially but bottoming out after a while` syndrome. I think that this is almost worse than them not working at all, as I never cease to think `this is it!`, only to be blown out of the water. `False dawns`, I call thse times. I should learn, really, but it`s so hard to even imagine what it`s like to be depressed during these `well` phases. Over the past 3 years, this has happened to me twice - once with Nardil, and also with Tryptophan (about 3 weeks in both cases). I make plans, ring friends, buzz around all over the place in the car etc etc. The rest of my family are visibly over-joyed, and then the bottom falls out. The other spooky thing is that I have random good days (they are usually only days - maybe 2 days if I`m lucky), when something really awful has happened to me, e.g. about a year and a half ago my boyfriend finished with me, and I was really upset - upset, but NOT depressed. This lasted only a short time, but it was thoroughly inappropriate (if you see what I mean). It had nothing to do with relief or any psychological reason like that (I seriously thought he was the `one`), it`s just very bizarre indeed.
Anyway, enough already. I just hope that one day I`ll be able to see my much neglected - but very loyal - friends again. I`ve had virtually no contact with them for 3+ years. I feel like I`ve been lying on (or in) my bed forever, just chainsmoking and wondering when `all this` will go away. Someday, I hope ... and hopefully before I`m too old to have kids (still, that`s about 6/7 years away).
Enough! I`ll quit the moaning now.
Hope you`re O.K.
Anna.
Posted by SLS on April 4, 2001, at 10:05:04
In reply to Re: treatment resistant depression » SLS, posted by sweetmarie on April 4, 2001, at 6:42:21
Anna...
It's like I'm looking in the mirror! My story reflects yours so closely. If I were writing the book, there would be a happy ending/beginning for both of us by the time you finish reading this sentence.
Did it work?
Crap. I was hoping...
> I don`t have bipolar - just good old severe unipolar depression (`double` to be precise - Dysthymia and major severe episode).Have you known an extended period of time in which you were not suffering an episode of major depression, but experienced unmistakable dysthymia?
> The new `regime` has the dosage of Lamictal as 250 mg, which I have now been on for about a week and a half. I was hoping that the Lamictal would be effective on it`s own, i.e. that I wouldn`t have to go onto the others.
I've been there.
> It sounds like clutching at straws I know, but I still thought it was a possibility. However, seems not.
I always think about and hope for such possibilities, regardless of my treatment-resistant history.
The brain is a "black-box". You put stuff in. You get something out. But you are not sure what exactly happens while it is in there. Hopefully, it is becoming more of a gray-box. It is difficult to guarantee how someone will react to any given drug, so it is reasonable to hope for such positive possibilities.
> I can certainly relate to the `meds working initially but bottoming out after a while` syndrome. I think that this is almost worse than them not working at all, as I never cease to think `this is it!
Me too. Exactly!
> `False dawns`, I call these times.
Wow. Perfect.
This is a very moving description. I fell quiet when I read it. I could never have conveyed this experience as well.
> I should learn, really, but it`s so hard to even imagine what it`s like to be depressed during these `well` phases.
This is exactly what I experience. It almost makes no sense that one should "forget" how depression feels after only a few days, or even a fraction of a day. Depression is an altered state of consciousness beyond imagination. Even during a brief "blip" of improvement, I forget how bad the depressed state is. I am convinced that should I lose the improvement, I will be strong enough to endure depression again. No.
> Over the past 3 years, this has happened to me twice - once with Nardil, and also with Tryptophan (about 3 weeks in both cases). I make plans, ring friends, buzz around all over the place in the car etc etc.
:-)
I can't help but to smile. I know this very well.
> The rest of my family are visibly over-joyed,
My family becomes happy, but they are also confused by who they are looking at. I become a person for which they need an introduction. They are unfamiliar with my personality. I become energetic, optimistic, positive, assertive, uninhibited, effective, engaging, and unabashedly vocal in public. I become impelled to know and understand everything. I know how difficult this is for my family. This is saddening for me to say, but they almost prefer me the other way. They never get a chance to learn about and accept the "new" (real) me before I disappear again.
> and then the bottom falls out.
I know what you mean.
> The other spooky thing is that I have random good days (they are usually only days - maybe 2 days if I`m lucky), when something really awful has happened to me, e.g.
Are you saying that you experience a rapid and significant improvement of your depressive state when you are faced with certain stressful situations?
> about a year and a half ago my boyfriend finished with me, and I was really upset - upset, but NOT depressed.
> This lasted only a short time, but it was thoroughly inappropriate (if you see what I mean).
No, I don't. I am reluctant to ask you to describe the details, as it is personal and might be something that you would like to remain private.
I guess what I am curious about is whether you consider this "inappropriateness" to be mania.
It might not have been. I can understand how such a traumatic event can make an otherwise depressed person become activated because of extreme emotional distress and anxiety. Such might cause an exagerrated and continuous "fight or flight" state in your nervous system which includes the secretion of large amounts of adrenaline. This would not be mania.
However, if the traumatic event did produce a true hypomanic mixed-state reaction where depression and mania occured at the same time, it is important that your doctors fully evaluate the possibility that you may have bipolar tendencies. If this is the case, it might help to explain your previous lack of success with the type of treatment that has been employed. You might need to focus a bit more on mood-stabilizers along with antideprssants.
I am not advocating one explanation over the other, if indeed any explanation is needed at all.
> It had nothing to do with relief or any psychological reason like that (I seriously thought he was the `one`), it`s just very bizarre indeed.
I am still confused. I don't know what was bizarre, but that's O.K. From my own experience, I know how being in love with someone who has decided to walk away can cause one to lose control and do some pretty desperate and embarrasing things. It is amazing how suddenly I gain enough energy to be an idiot.
I am struggling to better understand what you have been experiencing. Don't pay too much attention to my guess-work. I just wanted to help sort things out.
> Anyway, enough already. I just hope that one day I`ll be able to see my much neglected - but very loyal - friends again. I`ve had virtually no contact with them for 3+ years. I feel like I`ve been lying on (or in) my bed forever, just chainsmoking and wondering when `all this` will go away. Someday, I hope ... and hopefully before I`m too old to have kids (still, that`s about 6/7 years away).
Sigh... I know. I know.
> Enough! I`ll quit the moaning now.
O.K.
It's my turn now.
:-)
> Hope you`re O.K.
Thanks.
Ditto.
Sincerely,
Scott
Posted by sweetmarie on April 4, 2001, at 13:35:52
In reply to Re: treatment resistant depression » sweetmarie, posted by SLS on April 4, 2001, at 10:05:04
> Anna...
>
If I were writing the book, there would be a happy ending/beginning for both of us by the time you finish reading this
sentence.
>
> Did it work?Frankly, no. (Sadly) >
> Crap. I was hoping...
>
>
> > I don`t have bipolar - just good old severe unipolar depression (`double` to be precise - Dysthymia and major severe episode).
>
> Have you known an extended period of time in which you were not suffering an episode of major depression, but experienced unmistakable dysthymia?I have had periods when I haven`t even had Dysthymia (or at least, haven`t been depressed at all). My parents say that I was always a sad child, and I know this to be true. I can actually remember my first `brush` with depression, when I was 5 years old. I think that Mum and Dad considered taking me to a child psychologist a few times, but decided that it would `stigmatise` me (I also think that childhood depression wasn`t really recognised in the late 60s/early 70s). I was O.K. up until age 7, when we moved city, and then was pretty much depressed until I got to age 13, and was clear from then until I was about 18. Things went a bit wonky when I went away to college, but it wasn`t severe, and not constant. I first recognised it (the depression) for what it was when I was about 22 (I suppose I thought that everyone felt as I did), and when I started my first job, I went onto Dothiepin, which as I`m sure I`ve mentioned was 99% effective, for the first year I was on it (it was an extraordinary experience). From then until now (approx 11 years), I have had periods of being well, which seem to have nothing to do with any medication I`ve been on. For example, the 2nd half of 1993 was a complete nightmare (severe depression city), but myself and my (then) boyfriend went away for New Years (93/94), and I woke up on New Years Day feeling terrific, which lasted for about 4/5 months (with the odd `down` day). Then again, in 1995, I had about 6 months practically depression free. However, this went all arse about face in the October when I went into the slump I`m still in. I was working 10/11 hour days (commuting to London from where I lived - Cambridge), and doing 2 peoples` work as my boss was off sick, with depression (!). She`s fine now - responded to the 3rd anti-d she was given. I try very hard not to be resentful of this. I think that after 2 years of this (it was a good hour and a half both ways on the train), my brain just couldn`t take it. And the rest, as they say, is history. >
> > The new `regime` has the dosage of Lamictal as 250 mg, which I have now been on for about a week and a half. I was hoping that the Lamictal would be effective on it`s own, i.e. that I wouldn`t have to go onto the others.
>
> I've been there.Yeah? Bollocks isn`t it? >
> > I always think about and hope for such possibilities, regardless of my treatment-resistant history.
How long is that? Have you had `well` periods, unconnected with meds? >
> The brain is a "black-box". You put stuff in. You get something out. But you are not sure what exactly happens while it is in there. Hopefully, it is becoming more of a gray-box. It is difficult to guarantee how someone will react to any given drug, so it is reasonable to hope for such positive possibilities.
I think that - finally - I`ve been referred to where I should have been referred to years ago (this specialist geezer). What I`m hoping is that with this new (and more specific) diagnosis, the field will be narrowed and therefore the medication range can be narrowed, or at least be a bit more accurate. My current psychiatrist (who I really rate), was really quite out of her depth with me and for the past year or so, was kind of chucking meds together and hoping for the best. >
> This is a very moving description. I fell quiet when I read it. I could never have conveyed this experience as well.
Thanks. Writing is about the only thing I`m any good at. >
I become energetic, optimistic, positive, assertive, uninhibited, effective, engaging, and unabashedly vocal in public. I become impelled to know and understand everything. I know how difficult this is for my family. This is saddening for me to say, but they almost prefer me the other way. They never get a chance to learn about and accept the "new" (real) me before I disappear again.
I`m just the same. The `real` me is totally different to this shadow-type person I am at the moment. I`m dead lively, funny (so I`m told), good to be with etc. I`m none of these things when I`m ill. I even look crap - pale, black rings round my eyes, and the latest insult - the Nardil has put 3 stone on me, and I`ve gone up 4 dress sizes, with bugger-all change in my mood. >
> > The other spooky thing is that I have random good days (they are usually only days - maybe 2 days if I`m lucky), when something really awful has happened to me, e.g.
>
> Are you saying that you experience a rapid and significant improvement of your depressive state when you are faced with certain stressful situations?
>
> > about a year and a half ago my boyfriend finished with me, and I was really upset - upset, but NOT depressed.
>
> > This lasted only a short time, but it was thoroughly inappropriate (if you see what I mean).
>
> No, I don't. I am reluctant to ask you to describe the details, as it is personal and might be something that you would like to remain private.
>
> I guess what I am curious about is whether you consider this "inappropriateness" to be mania.
>
> It might not have been. I can understand how such a traumatic event can make an otherwise depressed person become activated because of extreme emotional distress and anxiety. Such might cause an exagerrated and continuous "fight or flight" state in your nervous system which includes the secretion of large amounts of adrenaline. This would not be mania.
>
> However, if the traumatic event did produce a true hypomanic mixed-state reaction where depression and mania occured at the same time, it is important that your doctors fully evaluate the possibility that you may have bipolar tendencies. If this is the case, it might help to explain your previous lack of success with the type of treatment that has been employed. You might need to focus a bit more on mood-stabilizers along with antideprssants.This episode was frankly a `hiding to nowhere` situation. Without going into too many details, he was also ill - depression with the added `bonuses` of paranoia and self-harming tendencies. A recipe for disaster, basically. You could be right - it could be about `rallying` in the face of adversity as a self-protective thing. F*** knows. I wasn`t high though - just `normal` (if you see what I mean). I do tend to get terribly excited when I feel better, and probably overdo things. I`ve never felt in any way `high` -more the way I know I`ve felt during my `well` periods. As for mood-stabilisers, I`ve been on Lithium (for about 10 months), I`m currently on Valproate (which I think is a mood stabiliser ?). Neither had any effect, positive or otherwise. >
>
> I am still confused. I don't know what was bizarre,What was bizarre, was my initial calm reaction to this devastating piece of news. I was staying with my parents at the time, and after coming off the phone, I calmly got into my car, drove around to the flat and trashed anything that was his, or had any connotations. I felt fine, having been severely depressed wall-to-wall up until that point, and it only lasted 3 days. That`s what`s odd.
but that's O.K. From my own experience, I know how being in love with someone who has decided to walk away can cause one to lose control and do some pretty desperate and embarrasing things. It is amazing how suddenly I gain enough energy to be an idiot.I`ve done that too - been there, done that and had the hang-over, as they say. >
> I am struggling to better understand what you have been experiencing. Don't pay too much attention to my guess-work. I just wanted to help sort things out.
It`s good of you to want to help. It`s severe depression, pure and simple (I`m almost 100% sure). The immobilising kind that makes every task (except rolling a cigarette, lighting it and smoking it), feel like scaling the Matterhorn. It`s a crock of shit - but then, you know that don`t you?
Are you bipolar? I`m sure you`ve said, but my memory is like a sieve. I have a success story about someone with bipolar (even if you`re not, it`s still an encouraging story). A friend who I met in hospital has had bipolar disorder for the last 12 years (or at least that was when it was diagnosed). After slogging on and on through different drug combinations, suicidal times etc, she finally hit on the `right` combination (her doctors did, rather). She`s been well for a year now - she still has to take shit-loads of medications every day, but she`s really well.
I try to think about her when I`m feeling terrible. It CAN happen, and I`m sure it will within our lifetime. Advances are being made all the time. This isn`t much use just now, I know, but ... it`s something I guess.
All good things,
Anna.
p.s. sorry this is so long.
>
>
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