Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Sue4 on November 9, 2001, at 11:36:19
Hi, I'm bipolar II, rapid cycling, more prone to deprssion than mania. I've been on Topomax 200 mg, neurontin 900 mg, prozac 20 mg. Recently, I dropped the 100 mg wellbutrin because it was too stimulating. My pdoc thinks I ought to add a 2nd mood stabilizer like trileptal, and I'm beginning to agree with him, albeit reluctantly...Has anyone had any experience with this combo? I feel some despair about anything getting better than what it is right now. I am not working in my career right now, altho I've gone back to school for postgrad work on a parttime basis (I'm commuting)in order to feel connection with people. But I wonder what's the use if I'm not going to apply that that degree. (There are no jobs in the area where I work and I have a proven track record of not lasting in my career at any job for a long time). I've got a supportive husband. But I feel very inadequate in school and don't know if I will be able to stay in the program because I don't seem to handle the stress of the workload; I do enjoy the intereaction with the students even though I am older. But I find the work tough going. The question I have to ask it whether two stabilizers could help me and how they would...is the ssress a problem I personally have or is it partly the illness; is my depression that I experience now me or part of the illness; am i failing intellectually as a result of my age (47) or is it part of my illness? I don't want to try trileptal, if in theory, it can do nothing for me. It may do nothing for me in reality, but I can deal with that, if it at least has the promise of helping me with other issues at the outstart. Any comments? Thanks. Sue
Posted by Mitch on November 9, 2001, at 13:46:08
In reply to Trileptal and topomax, posted by Sue4 on November 9, 2001, at 11:36:19
> Hi, I'm bipolar II, rapid cycling, more prone to deprssion than mania. I've been on Topomax 200 mg, neurontin 900 mg, prozac 20 mg. Recently, I dropped the 100 mg wellbutrin because it was too stimulating. My pdoc thinks I ought to add a 2nd mood stabilizer like trileptal, and I'm beginning to agree with him, albeit reluctantly...Has anyone had any experience with this combo? I feel some despair about anything getting better than what it is right now. I am not working in my career right now, altho I've gone back to school for postgrad work on a parttime basis (I'm commuting)in order to feel connection with people. But I wonder what's the use if I'm not going to apply that that degree. (There are no jobs in the area where I work and I have a proven track record of not lasting in my career at any job for a long time). I've got a supportive husband. But I feel very inadequate in school and don't know if I will be able to stay in the program because I don't seem to handle the stress of the workload; I do enjoy the intereaction with the students even though I am older. But I find the work tough going. The question I have to ask it whether two stabilizers could help me and how they would...is the ssress a problem I personally have or is it partly the illness; is my depression that I experience now me or part of the illness; am i failing intellectually as a result of my age (47) or is it part of my illness? I don't want to try trileptal, if in theory, it can do nothing for me. It may do nothing for me in reality, but I can deal with that, if it at least has the promise of helping me with other issues at the outstart. Any comments? Thanks. Sue
>
>Hi Sue,
I haven't heard any blaring success stories with Trileptal. I tried it for a while as a switch from Neurontin. The bad thing is it tends to provoke a lot of nausea in susceptible people. The *good* thing is it doesn't seem to blur cognition as much as Lithium, Depakote, or Topamax. In fact I got some antidepressant effect from it. Have you ever been on Tegretol? It is supposed to be very similar.
Mitch
Posted by Sue4 on November 9, 2001, at 15:34:23
In reply to Re: Trileptal and topomax » Sue4, posted by Mitch on November 9, 2001, at 13:46:08
I've never been on Tegrotol, although I've been on Depakote. Side effects of weight gain and heart pains made me stop. I've been on Topomax for a long time and have been able to go up to 200 mg (slowly) w/o any apparent cognitive side effects...my pdoc thinks I cycle too much on addition of antidepressants (wellbutrin and prozac)and that the neurontin isn't really all that effective. Yet he thinks I could handle the antidepressants with the addition of another anticonvulsant. Have you tried Lamictal?? My Pdoc doesn't seem all that excited about that. Sue
> I haven't heard any blaring success stories with Trileptal. I tried it for a while as a switch from Neurontin. The bad thing is it tends to provoke a lot of nausea in susceptible people. The *good* thing is it doesn't seem to blur cognition as much as Lithium, Depakote, or Topamax. In fact I got some antidepressant effect from it. Have you ever been on Tegretol? It is supposed to be very similar.
>
> Mitch
Posted by SLS on November 9, 2001, at 16:10:36
In reply to Re: Trileptal and topomax » Mitch, posted by Sue4 on November 9, 2001, at 15:34:23
> I've never been on Tegrotol, although I've been on Depakote. Side effects of weight gain and heart pains made me stop. I've been on Topomax for a long time and have been able to go up to 200 mg (slowly) w/o any apparent cognitive side effects...my pdoc thinks I cycle too much on addition of antidepressants (wellbutrin and prozac)and that the neurontin isn't really all that effective. Yet he thinks I could handle the antidepressants with the addition of another anticonvulsant.
I am extremely happy to hear that you have not suffered any cognitive impairments resulting from Topomax. Could you describe how you went about initiating treatment and the schedule you followed to increase the dosage? In what ways do you think Topomax is currently helping you.
Thanks.
> Have you tried Lamictal?? My Pdoc doesn't seem all that excited about that.
He should be. I try not to use the word "should" too often, but I think it is warranted here. Of all the anticonvulsants that are used as mood-stabilizers, Lamictal displays the strongest antidepressant properties. In fact, it has been known to cause mania. It has shown utility in both unipolar and bipolar depression, and is often successful in treating rapid-cyclicity when others drugs are not. It is generally well tolerated, and usually produces little, if any, cognitive side effects, although some people do experience memory problems at higher dosages. The biggest concern with Lamictal is that the dosage not be increased too quickly when beginning treatment. Some people develop a serious reaction (Steven's Johnson Syndrome) that includes a skin rash. However, many of these same people are able to successfully start all over again using the recommended dosing schedule.
I am currently taking 300mg of Lamictal. I have bipolar disorder. It is the only mood-stabilizer that helps me.
- Scott
Posted by Sue4 on November 9, 2001, at 20:58:14
In reply to Re: Trileptal and topomax » Sue4, posted by SLS on November 9, 2001, at 16:10:36
Hi Scott,
I initially started on Topomax in 1999, at a dose of 25 mg then titrated to 75 mg (25 mg per week). I stayed at that dose for about 6 months, switched pdocs who told me to tritate up by 25 mg weekly, aiming for 200 mg. I could only get up to 175 mg...then had to drop to 150 for about 6 months...went back up to 175 and then last summer went to 200 and that is where I have been ever since. I have experienced few side effects.... what has caused me to drop the dose as described above is a feeling that the dose is too strong, and "clamping down"...while I was able to function, it was like being hit with a steamroller...so I simply dropped the dose...the unpleasant effect disappeared immediately. I hung out at a plateau and when I felt I needed to increase the dose, I did (with my pdoc's approval) and 200mg is where I am now.
The topomax helps even me out, lesssens my overly sensitive nature and helps subdue my tendency to irritability. But alone it just isn't enought to take care of it all.
> I am extremely happy to hear that you have not suffered any cognitive impairments resulting from Topomax. Could you describe how you went about initiating treatment and the schedule you followed to increase the dosage? In what ways do you think Topomax is currently helping you.
>
> Thanks.
>
> > Have you tried Lamictal?? My Pdoc doesn't seem all that excited about that.
>
> He should be. I try not to use the word "should" too often, but I think it is warranted here. Of all the anticonvulsants that are used as mood-stabilizers, Lamictal displays the strongest antidepressant properties. In fact, it has been known to cause mania. It has shown utility in both unipolar and bipolar depression, and is often successful in treating rapid-cyclicity when others drugs are not. It is generally well tolerated, and usually produces little, if any, cognitive side effects, although some people do experience memory problems at higher dosages. The biggest concern with Lamictal is that the dosage not be increased too quickly when beginning treatment. Some people develop a serious reaction (Steven's Johnson Syndrome) that includes a skin rash. However, many of these same people are able to successfully start all over again using the recommended dosing schedule.
>
> I am currently taking 300mg of Lamictal. I have bipolar disorder. It is the only mood-stabilizer that helps me.
>
>
> - Scott
Posted by Mitch on November 10, 2001, at 0:53:50
In reply to Re: Trileptal and topomax » Mitch, posted by Sue4 on November 9, 2001, at 15:34:23
> I've never been on Tegrotol, although I've been on Depakote. Side effects of weight gain and heart pains made me stop. I've been on Topomax for a long time and have been able to go up to 200 mg (slowly) w/o any apparent cognitive side effects...my pdoc thinks I cycle too much on addition of antidepressants (wellbutrin and prozac)and that the neurontin isn't really all that effective. Yet he thinks I could handle the antidepressants with the addition of another anticonvulsant. Have you tried Lamictal?? My Pdoc doesn't seem all that excited about that. Sue
Hi Sue,
Wow, that is amazing you have gotten to that level on TOP without any major cognitive sfx (no wonder you probably don't need an AD)! I would agree that Neurontin is a relatively mild mood stabilizer that needs an adjunct to work well. Never tried Lamictal-want to avoid that one. I have a history of hives-skin reactions to meds and have to take allergy shots (for molds/dust systemic reactions) to prevent that. I believe that Topamax shares a similar mechanism of action to Tegretol/Trileptal (could someone enlighten us to what that is?-I think it is voltage-dependent sodium channels??). I think he is onto something. I would go for the Trileptal add-on. I definitely had an AD effect from it. I just got nauseated easily. Just start low-go slow on it, who knows? I have had a lot of cognitive blunting on GABA-affecting AED's like Depakote/Klonopin/Gabitril, etc. Maybe the sodium/calcium ion-channel affecting meds would be less blunting? Neurontin's mechanism of action isn't really GABA enhancement it is selective calcium-channel antagonism in the hippocampus, FWIW.
Posted by Sue4 on November 10, 2001, at 9:37:51
In reply to Re: Trileptal and topomax » Sue4, posted by Mitch on November 10, 2001, at 0:53:50
Who knows Mitch, maybe I've had the cognitive sfx with Topomax, but just don't know it, like I said, I am in postgrad school parttime...but I feel like I'm struggling compared to everyone else..it could be that at 47, these things are to be expected, especially when I've been "out of the ballpark" so to speak for such a long time and the illness has been part of my life since college though not diagnosed until recently...so my career never really took hold because I kept switching jobs and never stayed in one more than a year. I know that trileptal was used in Europe for quite awhile before being approved recently in the US by the FDA.
Btw, I was very motivated to stick with Topomax, I wanted it to work because after Depakote, I never, ever wanted to try a medication that required blood tests or gave me such horrible side effects. I would rather take my chances with the mortality issues associated w/ a diagnois of BPII than be given other very known associated mortality risk factors from the side effects of medications that supposedly help treat the BPII diagnosis. Thus, from this point on, I will only consider meds that do not require blood monitoring...trileptal is one of them....the nausea you experienced on trileptal, how long did it last...did you give it a sufficient trial?? Or do you think it had do to w/ the fact that it lowered the sodium in your blood levels, which is a side effect of trileptal??
> Hi Sue,
>
> Wow, that is amazing you have gotten to that level on TOP without any major cognitive sfx (no wonder you probably don't need an AD)! I would agree that Neurontin is a relatively mild mood stabilizer that needs an adjunct to work well. Never tried Lamictal-want to avoid that one. I have a history of hives-skin reactions to meds and have to take allergy shots (for molds/dust systemic reactions) to prevent that. I believe that Topamax shares a similar mechanism of action to Tegretol/Trileptal (could someone enlighten us to what that is?-I think it is voltage-dependent sodium channels??). I think he is onto something. I would go for the Trileptal add-on. I definitely had an AD effect from it. I just got nauseated easily. Just start low-go slow on it, who knows? I have had a lot of cognitive blunting on GABA-affecting AED's like Depakote/Klonopin/Gabitril, etc. Maybe the sodium/calcium ion-channel affecting meds would be less blunting? Neurontin's mechanism of action isn't really GABA enhancement it is selective calcium-channel antagonism in the hippocampus, FWIW.
Posted by Mitch on November 10, 2001, at 10:28:51
In reply to Re: Trileptal and topomax, posted by Sue4 on November 10, 2001, at 9:37:51
> Btw, I was very motivated to stick with Topomax, I wanted it to work because after Depakote, I never, ever wanted to try a medication that required blood tests or gave me such horrible side effects. I would rather take my chances with the mortality issues associated w/ a diagnois of BPII than be given other very known associated mortality risk factors from the side effects of medications that supposedly help treat the BPII diagnosis. Thus, from this point on, I will only consider meds that do not require blood monitoring...trileptal is one of them....the nausea you experienced on trileptal, how long did it last...did you give it a sufficient trial?? Or do you think it had do to w/ the fact that it lowered the sodium in your blood levels, which is a side effect of trileptal??
Hi Sue,
I wouldn't get too worried about needing blood tests for a med. I look at it more as an inconvenience. A lot of blood testing is "required" just to monitor the plasma level to see if you are "in the therapeutic range" (basically just to gather info for your pdoc and/or cover their ass-if blood level monitoring is recommended by the manufacturer).
As far as the Trileptal goes it was a switch from Neurontin. I am very very touchy with meds. Neurontin works really well for me in the 600-900mg/day range. However, I developed this spasm in my eustachian tubes-a periodic "thumping" and "clicking" in my ears whenever I take 300mg or more as a single dose. So we switched it to Trileptal. I started off very low-just 150mg/day for a week. Then titrated to 225mg/day for another week, then to 300mg/day. When I hit the 300mg/day dosage is when the nausea kicked in. It was similar in a way to the nausea you get from an SSRI. I don't know if it was due to lowered sodium or not. It is a fairly common sfx for it-so who knows? I also felt somewhat activated and "wirey". It could have been the withdrawal from the Neurontin, though. I was just on it about three or four weeks, max. I am back on lower dose Neurontin again, now.
Mitch
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