![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by petters on November 8, 2001, at 6:40:24
Hi Scott...
I forgott mention, that I also saw an artikel from DR. I Goldberg. He paid attantion to when Lamictal not was sufficient in bipolar depression. He recommend Topomax as an add on strategi. Since I know your only mood stabilizar are Lamictal if I don´t remember wrong.
By the way: Have you tried Flupenthixol in low dosage. Or do you have Etilefrinhydoklorid in U.S? It´s a med for hypotension, but in low dosage it´s benefit for some depressed person, especeliy with astenia, and anergia as I know you sometimes suffer from.
Stay Well...
Petters
Posted by SLS on November 8, 2001, at 10:32:27
In reply to Refractary bipolar depression To Scott !!!, posted by petters on November 8, 2001, at 6:40:24
> Hi Scott...
Hi Petters.
> I forgott mention, that I also saw an artikel from DR. I Goldberg. He paid attantion to when Lamictal not was sufficient in bipolar depression. He recommend Topomax as an add on strategi. Since I know your only mood stabilizar are Lamictal if I don´t remember wrong.
You remember correctly. Topomax was the first anticonvulsant my doctor mentioned if we are to add another mood stabilizer. I guess he must have heard good things about it from his colleagues at NYU (New York University). I am excited by what you say about the Lamictal + Topomax combination. I am worried about the cognitive side effects, though (slow-thinking, memory).
If you don’t mind my asking, how do you know so much about psychiatry? Your observations and suggestions are very astute and intelligent. I very, VERY much appreciate your contributions.
> By the way: Have you tried Flupenthixol in low dosage.There are four “typical” neuroleptics that are candidates that I would consider. Flupenthixol is one of them. The other three are molindone, sulpiride, and amisulpride. Molindone is available in the US. Sulpiride and amisulpride are not, but I can get them from England. I currently have enough sulpiride to conduct a trial. A Dr. Levine in New York who specializes in TRD (Treatment Resistant Depression) prefers to use sulpiride. In his words, he says that amisulpride is too much of an antipsychotic.
> Or do you have Etilefrinhydoklorid in U.S? It´s a med for hypotension, but in low dosage it´s benefit for some depressed person, especeliy with astenia, and anergia as I know you sometimes suffer from.
I never heard of this drug. Is it a ACE inhibitor (Angiotensin Converting Enzyme inhibitor)? There is some evidence that captopril (Capoten), an ACE inhibitor, has some antidepressant properties.
> Stay Well...
You too.
- Scott
Posted by petters on November 8, 2001, at 13:17:09
In reply to Re: Refractary bipolar depression To Scott !!! » petters, posted by SLS on November 8, 2001, at 10:32:27
> > Hi Scott...
>
> Hi Petters.
>
> > I forgott mention, that I also saw an artikel from DR. I Goldberg. He paid attantion to when Lamictal not was sufficient in bipolar depression. He recommend Topomax as an add on strategi. Since I know your only mood stabilizar are Lamictal if I don´t remember wrong.
>
> You remember correctly. Topomax was the first anticonvulsant my doctor mentioned if we are to add another mood stabilizer. I guess he must have heard good things about it from his colleagues at NYU (New York University). I am excited by what you say about the Lamictal + Topomax combination. I am worried about the cognitive side effects, though (slow-thinking, memory).
>
> If you don’t mind my asking, how do you know so much about psychiatry? Your observations and suggestions are very astute and intelligent. I very, VERY much appreciate your contributions.
>
> > By the way: Have you tried Flupenthixol in low dosage.
>
> There are four “typical” neuroleptics that are candidates that I would consider. Flupenthixol is one of them. The other three are molindone, sulpiride, and amisulpride. Molindone is available in the US. Sulpiride and amisulpride are not, but I can get them from England. I currently have enough sulpiride to conduct a trial. A Dr. Levine in New York who specializes in TRD (Treatment Resistant Depression) prefers to use sulpiride. In his words, he says that amisulpride is too much of an antipsychotic.
>
> > Or do you have Etilefrinhydoklorid in U.S? It´s a med for hypotension, but in low dosage it´s benefit for some depressed person, especeliy with astenia, and anergia as I know you sometimes suffer from.
>
> I never heard of this drug. Is it a ACE inhibitor (Angiotensin Converting Enzyme inhibitor)? There is some evidence that captopril (Capoten), an ACE inhibitor, has some antidepressant properties.
>
> > Stay Well...
>
> You too.
>
>
> - ScottHi Scott...
Yes, I have been working as nurse in psychiatry for many years,mostly with affective disorders. I have also have depression since age 17.
Effortil ( Etilefrinhydroklorid) is an alfa- betareceptor activation, as I say I have seen anecdotely reports especely from astenia.
I know you wait for Memantine. I will check when we can get i here in Sweden. I would like to help you with this med, if possible. I know Germany has got it.
I think a am bipolar 2. The diagnosis of bipolar 2 is crucial, we don´t have the diagnosis in my country. What do you think about this sypmtoms...?
P.S Without any meds I have all symptoms below. And with meds with not full remission I have most consentration problem, anhedonia and emotionell numbed.Phobic anxiety, social phobia ( with ssri or Venlafaxine ok with this symptom)
Interpersonal sensitivity
OCD
Nightmare
Somatization
Guilt
Distractibility
Psychomotor reardation. ( Without serotonerg drug, high state of anxiety, and therfore restless)
Worsening in the evening ( when serve melancolic,I had tre episod) serve anxiety at morning. But nowedays worsening in the evening, and carbocrawing.
Self-pity
Mood lability, and daydreaming.
Irritability, distratrtibility, sometimes racing thoughts, this despite the presence of hypersomnia.Any thougts.....
Sincerely
Petters
Posted by ben on November 8, 2001, at 13:26:06
In reply to Re: Refractary bipolar depression To Scott !!! » petters, posted by SLS on November 8, 2001, at 10:32:27
> > Hi Scott...
>
> Hi Petters.
>
> > I forgott mention, that I also saw an artikel from DR. I Goldberg. He paid attantion to when Lamictal not was sufficient in bipolar depression. He recommend Topomax as an add on strategi. Since I know your only mood stabilizar are Lamictal if I don´t remember wrong.
>
> You remember correctly. Topomax was the first anticonvulsant my doctor mentioned if we are to add another mood stabilizer. I guess he must have heard good things about it from his colleagues at NYU (New York University). I am excited by what you say about the Lamictal + Topomax combination. I am worried about the cognitive side effects, though (slow-thinking, memory).
>
> If you don’t mind my asking, how do you know so much about psychiatry? Your observations and suggestions are very astute and intelligent. I very, VERY much appreciate your contributions.
>
> > By the way: Have you tried Flupenthixol in low dosage.
>
> There are four “typical” neuroleptics that are candidates that I would consider. Flupenthixol is one of them. The other three are molindone, sulpiride, and amisulpride. Molindone is available in the US. Sulpiride and amisulpride are not, but I can get them from England. I currently have enough sulpiride to conduct a trial. A Dr. Levine in New York who specializes in TRD (Treatment Resistant Depression) prefers to use sulpiride. In his words, he says that amisulpride is too much of an antipsychotic.
>
> > Or do you have Etilefrinhydoklorid in U.S? It´s a med for hypotension, but in low dosage it´s benefit for some depressed person, especeliy with astenia, and anergia as I know you sometimes suffer from.
>
> I never heard of this drug. Is it a ACE inhibitor (Angiotensin Converting Enzyme inhibitor)? There is some evidence that captopril (Capoten), an ACE inhibitor, has some antidepressant properties.
>
> > Stay Well...
>
> You too.
>
>
> - Scott
Hi pettersFor your information Etilefrinhydrochlorid (trademark: Effortil) is a so called sympathomimetic. It stimulates alpha 1 and a little bit alpha/beta 2 receptors. It is very similar to the neuroendocrine transmitters noradrenaline and adrenaline.
I wouldnt try it as an AD because it can make high blood pressure (hypotension is the real indication) and people often develop tolerance to it. It could be a try worth if you have hypotension and dont take others AD in combination (dangers interactions are possible). Did you tried d-amphetamine (Dexedrine) or methylphenidate (Ritalin) to overcome your astenia ? And some possible targets: Checked your thyroid hormones ? Iron status ? Vitamine B12 ?
Discuss this issues with your doc.Good luck
Ben
Posted by JohnX2 on November 8, 2001, at 21:21:06
In reply to Re: Refractary bipolar depression To Scott !!! » petters, posted by SLS on November 8, 2001, at 10:32:27
I heard about this topomax + lamictal combo
and am also very curious. Seems they work
orhoganally, one focusing on NMDA (lamictal) and
the other AMPA and GABAa. Supposedly a
synergy is achieved. My 1st neurologist wanted
to put me on topomax instead of klonopin and at
1st I was hesistant. I later read that topomax
has the same action at GabaA receptors increasing
the open channel conductice of CL- ions. So I
thought it was a good idea, but my other doctors
weren't so hot. Seems topomax by itself stinks
for bipolar.-john
> > Hi Scott...
>
> Hi Petters.
>
> > I forgott mention, that I also saw an artikel from DR. I Goldberg. He paid attantion to when Lamictal not was sufficient in bipolar depression. He recommend Topomax as an add on strategi. Since I know your only mood stabilizar are Lamictal if I don´t remember wrong.
>
> You remember correctly. Topomax was the first anticonvulsant my doctor mentioned if we are to add another mood stabilizer. I guess he must have heard good things about it from his colleagues at NYU (New York University). I am excited by what you say about the Lamictal + Topomax combination. I am worried about the cognitive side effects, though (slow-thinking, memory).
>
> If you don’t mind my asking, how do you know so much about psychiatry? Your observations and suggestions are very astute and intelligent. I very, VERY much appreciate your contributions.
>
> > By the way: Have you tried Flupenthixol in low dosage.
>
> There are four “typical” neuroleptics that are candidates that I would consider. Flupenthixol is one of them. The other three are molindone, sulpiride, and amisulpride. Molindone is available in the US. Sulpiride and amisulpride are not, but I can get them from England. I currently have enough sulpiride to conduct a trial. A Dr. Levine in New York who specializes in TRD (Treatment Resistant Depression) prefers to use sulpiride. In his words, he says that amisulpride is too much of an antipsychotic.
>
> > Or do you have Etilefrinhydoklorid in U.S? It´s a med for hypotension, but in low dosage it´s benefit for some depressed person, especeliy with astenia, and anergia as I know you sometimes suffer from.
>
> I never heard of this drug. Is it a ACE inhibitor (Angiotensin Converting Enzyme inhibitor)? There is some evidence that captopril (Capoten), an ACE inhibitor, has some antidepressant properties.
>
> > Stay Well...
>
> You too.
>
>
> - Scott
Posted by jazzdog on November 9, 2001, at 11:23:35
In reply to Re: Refractary bipolar depression To Scott !!!, posted by JohnX2 on November 8, 2001, at 21:21:06
>
> I heard about this topomax + lamictal combo
> and am also very curious. Seems they work
> orhoganally, one focusing on NMDA (lamictal) and
> the other AMPA and GABAa.Hi John - I'm just learning a bit about brain chemistry, so forgive the naive questions. Is lamictal an NMDA receptor agonist? Is that why it works to enhance cognition and treat depersonalization / derealization? I've just started a tiny dose of lamictal - 6.5 mg to tritrate slowly up to 150 + - along with 50 mg sertraline to treat my derealization and poor cognition. I've also got lifelong depression, so any help there will be good too. The thing is, I could swear that my head cleared for about half an hour the first day I took it. Is this possible on such a tiny dose, or am I imagining things? I'm usually pretty good at self-assessment for drug reactions, so I'm hoping it's the former. Lamictal is the only treatment so far for chronic derealization, and I so badly want to escape this waking dream. Thanks - Jane
Posted by jazzdog on November 9, 2001, at 11:26:16
In reply to Re: Refractary bipolar depression To Scott !!!, posted by JohnX2 on November 8, 2001, at 21:21:06
I meant to address the previous message to JohnX2. Sorry.
Posted by SLS on November 9, 2001, at 12:56:36
In reply to Re: Refractary bipolar depression To Scott !!!, posted by petters on November 8, 2001, at 13:17:09
Dear Petters,
I wish I had more time to compose a response, but I have to start getting ready for a trip to Washington D.C. I did not put things in a good order. Sorry. I hope it helps.
> I think a am bipolar 2. The diagnosis of bipolar 2 is crucial, we don´t have the diagnosis in my country. What do you think about this sypmtoms...?
Why are you diagnosed as bipolar and not unipolar?
----------------------
The important difference between bipolar I and bipolar II is mania versus hypomania.
"A diagnosis of bipolar I disorder is made when a person has experienced at least one episode of severe mania; a diagnosis of bipolar II disorder is made when a person has experienced at least one hypomanic episode but has not met the criteria for a full manic episode."
See: http://www.nimh.nih.gov/publicat/bipolarresfact.cfm
----------------------
The first question to be asked is about mania:
1. Do you have mania?
2. How would you describe it?
3. Is it severe or psychotic, or only hypomania?
4. Do you experience pure euphoria without irritability, anger, or
dysphoria (mixed-state)?
5. Do you experience and express uncontrollable rage?
5. Do you sleep less than 4 hours and function well during the day?
6. Do you talk too much and too fast?
7. Do you experience periods of intense sexual excitement?----------------------
Diagnostic Descriptions:
Bipolar I:
http://www.mentalhealth.com/dis1/p21-md02.htmlBipolar II:
http://www.mentalhealth.com/dis1/p21-md05.html-----------------------
"
Bipolar Disorder Often Mistaken for Major DepressionDetecting Those with Bipolar II: A Study
Those who ended up with bipolar II (and not unipolar):
Had longer, more frequent depressive episodes, and earlier in life.
Were more likely to be involved in substance abuse.
Tended to also suffer from anxiety disorders such as obsessive-compulsive tendencies, panic attacks, and anxiety-related physical complaints. The presence of three traits predicted who would end up with bipolar II: mood swings, depression nonetheless punctuated by "excitement," and intense daydreaming"
See: http://cbshealthwatch.medscape.com/cx/viewarticle/24_3
----------------------------
Bipolar II depression most often looks like "atypical depression". Your depression resembles atypical depression. Your symptoms are consistent with this.IMPORTANT: I haven't been able to find detailed information describing the differences between bipolar I and bipolar II depression. I read one recent article that reported no differences. However, it is my impression that bipolar I depression might show melancholic and psychotic symptoms more often, and possibly greater severity. I am not sure.
"there was overrepresentation in the BP II (versus unipolar) group of "suicidal thoughts, guilt feelings, depersonalization and derealization, and atypical features such as hypersomnia and weight gain."
See: http://www.mcmanweb.com/article-137.htm
---------------------------------
- Scott
>
> I think a am bipolar 2. The diagnosis of bipolar 2 is crucial, we don´t have the diagnosis in my country. What do you think about this sypmtoms...?
> P.S Without any meds I have all symptoms below. And with meds with not full remission I have most consentration problem, anhedonia and emotionell numbed.
>
> Phobic anxiety, social phobia ( with ssri or Venlafaxine ok with this symptom)
> Interpersonal sensitivity
> OCD
> Nightmare
> Somatization
> Guilt
> Distractibility
> Psychomotor reardation. ( Without serotonerg drug, high state of anxiety, and therfore restless)
> Worsening in the evening ( when serve melancolic,I had tre episod) serve anxiety at morning. But nowedays worsening in the evening, and carbocrawing.
> Self-pity
> Mood lability, and daydreaming.
> Irritability, distratrtibility, sometimes racing thoughts, this despite the presence of hypersomnia.
>
> Any thougts.....
>
> Sincerely
>
> Petters
Posted by SLS on November 9, 2001, at 12:59:23
In reply to Re: Refractary bipolar depression To Scott !!!, posted by jazzdog on November 9, 2001, at 11:23:35
> >
> > I heard about this topomax + lamictal combo
> > and am also very curious. Seems they work
> > orhoganally, one focusing on NMDA (lamictal) and
> > the other AMPA and GABAa.
>
> Hi John - I'm just learning a bit about brain chemistry, so forgive the naive questions. Is lamictal an NMDA receptor agonist? Is that why it works to enhance cognition and treat depersonalization / derealization? I've just started a tiny dose of lamictal - 6.5 mg to tritrate slowly up to 150 + - along with 50 mg sertraline to treat my derealization and poor cognition. I've also got lifelong depression, so any help there will be good too. The thing is, I could swear that my head cleared for about half an hour the first day I took it. Is this possible on such a tiny dose, or am I imagining things? I'm usually pretty good at self-assessment for drug reactions, so I'm hoping it's the former. Lamictal is the only treatment so far for chronic derealization, and I so badly want to escape this waking dream. Thanks - Jane
Hi Jane.Have you ever tried Zyprexa?
Just curious.
- Scott
Posted by jazzdog on November 9, 2001, at 14:42:59
In reply to Re: Refractary bipolar depression To Scott !!! » jazzdog, posted by SLS on November 9, 2001, at 12:59:23
Hi Jane.
>
> Have you ever tried Zyprexa?
>
> Just curious.
>
>
> - Scott
Hi Scott -No, other than zoloft, I've never experimented with psychotropic drugs. Though I did take benzos, and became addicted - clean and sober for ten years now. To be honest, I feel a bit guilty about being on this site, even though I've been diagnosed dysthymic, depressive, and bipolar. I know how tempting it is for me to look for all my answers in pill form.
yours, Jane
Posted by SLS on November 9, 2001, at 15:48:48
In reply to Re: Refractary bipolar depression To Scott !!! » SLS, posted by jazzdog on November 9, 2001, at 14:42:59
> Hi Jane.
> >
> > Have you ever tried Zyprexa?
> >
> > Just curious.
> >
> >
> > - Scott
>
>
> Hi Scott -
>
> No, other than zoloft, I've never experimented with psychotropic drugs. Though I did take benzos, and became addicted - clean and sober for ten years now. To be honest, I feel a bit guilty about being on this site, even though I've been diagnosed dysthymic, depressive, and bipolar. I know how tempting it is for me to look for all my answers in pill form.
>
> yours, Jane
Hi Jane.I don't know that you should have anything to feel guilty about. I think I would feel guilty if I didn't encourage you to pursue a biological treatment for a biological illness.
There is an interplay between brain and mind. The mind is facilitated by the brain while the brain is sculpted by the mind. The two are inextricable. If you indeed have a biological vulnerability to mood-disorders, it might be that this vulnerability allowed psychological stresses in your past to cause a breakdown in the system, although this is not always necessary. Once triggered, these abnormalities in brain function can become self-sustaining, necessitating a biological intervention to help restore the system to a more normal state. However, if psychological issues remain unresolved, the continuing stress can cause the system to breakdown again, despite continued biological treatment. This phenomenon is known as medication breakthrough. It is often productive to use both biological and psychological therapies in order to treat the illness as a whole, thereby encouraging a healthier interaction between mind and body (brain).
Substance abuse quite frequently accompanies bipolar disorder.
Hang out here for a little while. Perhaps you will find things that are relevant to your situation in life. However, it is important to understand that Psycho-Babble is not a gathering of professionals and does not represent the consensus of the medical community. Perhaps this a good thing. It is a good practice to try to validate what is said here using other sources. Speaking for myself, I've been known to be wrong.
Good luck.
- Scott
Posted by pat c. on November 10, 2001, at 7:47:39
In reply to Refractary depression To Scott !!!, posted by petters on November 9, 2001, at 12:26:23
Sounds like atypical depression to me.
Have you tried an MAOI like Nardil (be careful of weight gain)
Pat
Posted by SLS on November 10, 2001, at 8:50:56
In reply to Re: Refractary depression To Scott !!!, posted by pat c. on November 10, 2001, at 7:47:39
Hi Pat.
> Sounds like atypical depression to me.
That was my initial impression also.
I think it is important for Petters to more thoroughly evaluate whether a true mania ever occurred. I am hoping that my questions will help to determine this.
The phrase "racing thoughts" is often used by people with anxious depression or comorbid anxiety. This might be the case with Petters given the description of "Phobic anxiety, social phobia". By itself, I would not use the phrase "racing thoughts" as being sufficient to diagnose bipolar disorder. Aside from this, I don't see anything else that would be consistent with bipolar disorder and inconsistent with unipolar (atypical) disorder. Since Lamictal and adjunctive lithium are often beneficial in treating atypical depression, Petter's improvement while using these drugs does not exclude unipolar depression.
One of the features that sticks out in my mind is OCD.
Petters - Is your OCD episodic or steady and chronic. What exactly are your OCD symptoms? By the way, I never asked you. Are you male or female? I am not familiar with the name "Petters". I feel silly :-)
- Scott
------------------------------------------------------Eur Arch Psychiatry Clin Neurosci 1998;248(5):240-4 Related Articles, Books, LinkOut
Episodic course in obsessive-compulsive disorder.Perugi G, Akiskal HS, Gemignani A, Pfanner C, Presta S, Milanfranchi A, Lensi P, Ravagli S, Maremmani I, Cassano GB.
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy.
The course of obsessive-compulsive disorder (OCD) is variable, ranging from episodic to chronic. We hypothesised that the former course is more likely to be related to bipolar mood disorders. With the use of a specially constructed OCD questionnaire, we studied 135 patients fulfilling DSM-III-R criteria for OCD with an illness duration of at least 10 years and divided by course: 27.4% were episodic and 72.6% chronic. We compared clinical and familial characteristics and comorbidity. Univariate analyses showed that episodic OCD had a significantly lower rate of checking rituals and a significantly higher rate of a positive family history for mood disorder. Multivariate stepwise discriminant analysis revealed a positive and significant relationship between episodic course, family history for mood disorders, lifetime comorbidity for panic and bipolar-II disorders, late age at onset and negative correlation with generalized anxiety disorder. These data suggest that the episodic course of OCD has important clinical correlates which are related to cyclic mood disorders. This correlation has implications for treatment and research strategies on the aetiology within a subpopulation of OCD.
PMID: 9840370 [PubMed - indexed for MEDLINE]
------------------------------------------------------
Posted by Dinah on November 10, 2001, at 9:24:35
In reply to Re: Refractary depression To Scott !!!, posted by SLS on November 10, 2001, at 8:50:56
Wow Scott,
Thanks for posting this about episodic OCD. It might well explain why my pdoc wrote that he was treating me for a mood disorder with obsessive compulsive symptoms rather than just saying OCD. I've been wondering about that, but he is very anti-diagnosis, and will never be specific with me. It may well explain why his emphasis is on mood stabilizers as well. Very enlightening.
Thanks,
Dinah
Posted by JohnX2 on November 11, 2001, at 8:53:05
In reply to Re: Refractary bipolar depression To Scott !!!, posted by jazzdog on November 9, 2001, at 11:23:35
Hi Jane,Sorry I didn't get back to you sooner.
I believe a lot of disorders like
depersonalization/derelializtion,post-traumatic
stress-disorder,borderline personality disorder
are not well studied scientifically but seem
to be getting a lot of momentum in the scientific
community as vanilla depression,psychosis,mania
have been beaten to death (no pun intended).
It seems a lot of treatment resistant depression is
co-morbid with other disorders that have no known "proven"
treatment path.Regarding lamictal. It acts primarily by
stabilizing electrolytes (positive,negative
charges) that would stimulate the nmda receptor.
So as such it likely "bands" the eltrical impulses
required to stimulate these neurons to stabilize
them. I think in some cases this would dampen
transmission, put could imagine in other cases
it would indirectly stimulate transmission (say
if another part of the brain that was dampened
somehow in an inverse way stimulated
another). There are areas of the brain where
nmda, which is generally stimulatory, is an input
to gaba neurons, which generally inhibit transmission,
and vice-versa. Lamictal also has some mode of action that is
not totally well understood that is believed to be related to
its anti-depressant qualities; possibly some sort of chemical re-uptake
inhibition.I believe it is possible to get a rapid
response on Lamictal, as it is for any med. I have
read anecdotal evidence of it working quickly for
impulsiveness. Not typical...
but possible. I got a very short lived, rapid response
from lamictal at a low dose (25 mg) when I started.
This happened to me both times I started the med.
I felt a lot less anxious (kind of like xanax) and
a little more in touch with the world. I have had
problems with impulsivness and I also have feelings
of detachment (I don't feel like I can connect emotionally
to people). A lot of disorders related to
blunted affect, depersonalization, schizophernia,
ptsd, blah blah seem to be boiling down to dysfunctional
nmda receptor workings. At least that is what I
have been reading. What exactly are the symptoms of
depersonalization?There are people on pbabble who have studied
lamictal more closely than myself and may have
more insight why it is being found usefull for
these more "fringe" disorders.regards,
john
> >
> > I heard about this topomax + lamictal combo
> > and am also very curious. Seems they work
> > orhoganally, one focusing on NMDA (lamictal) and
> > the other AMPA and GABAa.
>
> Hi John - I'm just learning a bit about brain chemistry, so forgive the naive questions. Is lamictal an NMDA receptor agonist? Is that why it works to enhance cognition and treat depersonalization / derealization? I've just started a tiny dose of lamictal - 6.5 mg to tritrate slowly up to 150 + - along with 50 mg sertraline to treat my derealization and poor cognition. I've also got lifelong depression, so any help there will be good too. The thing is, I could swear that my head cleared for about half an hour the first day I took it. Is this possible on such a tiny dose, or am I imagining things? I'm usually pretty good at self-assessment for drug reactions, so I'm hoping it's the former. Lamictal is the only treatment so far for chronic derealization, and I so badly want to escape this waking dream. Thanks - Jane
Posted by jazzdog on November 11, 2001, at 18:09:52
In reply to Re: Refractary bipolar depression To Scott !!! » jazzdog, posted by JohnX2 on November 11, 2001, at 8:53:05
Hi John -
Thanks for your message. Perhaps the reason the Maudsley is finding some success with this treatment is that depersonalization and derealization are reactions to excessive NMDA stimulation - parts of the brain get overexcited and 'stuck' there. Some people describe lamictal as more clearly separating the waking and dreaming states - any thoughts on how that might work?
The symptoms of depersonalization involve feeling radically cut off from one's body, and incorporate everything from out of body experiences to not recognizing oneself in the mirror. Derealization involves a sense of unreality - life feels two-dimensional, as though viewed through glass or on a movie screen. Essentially, life becomes a waking dream, with a distorted time sense, emotional detachment, and a lack of a continuous and coherent sense of self. Both dp and dr are symptoms of all kinds of illnesses - depression, schizophrenia, ptss, panic disorder, etc. In my case, the derealization is chronic and lifelong, and therefore qualifies as a primary disorder all on its own. It's the least understood of all the dissociative states, and the least researched - I think this is because people with derealization seem normal from the outside - they're functional, not delusional, etc. Inside, however, there's a sense of radical disconnection with the environment and, of course, with the people in it.
cheers, Jane
This is the end of the thread.
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