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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by 3 Beer Effect on March 23, 2002, at 23:31:20
I have a weird form of Bipolar in that I have never had a manic episode except ones that were SSRI (Zoloft) medication induced. Zoloft 100 mg was the only medicine that lifted me out of my severe depression- I felt happy for the first time in years, but I couldn't sleep, sometimes for days at a time, which impaired my judgement & made me act like a manic idiot, eventally resulting in self destructive behavior, drinking & Xanax (from Thailand), & Benadryl to alleviate insomnia & an arrest for DUI. Celexa 40 mg didn't do much (no mania) but also gave me insomnia. The doctors said that the insomnia was a result of "SSRI induced mania". The only other drug that makes me "manic" seems to be alcohol- but I guess everyone runs around & acts like an idiot after one too many.
Oddly enough, Dexedrine, Adderall, Cocaine, Marijuana, Remeron never made me manic. Effexor XR made me feel like a dying elderly man (i'm only 23). I might just have ADD, since Bipolar II & ADD symptom criteria have a great deal of overlap & SSRIs make ADHD worse.
Right now I am taking Lamictal 100 mg, but its seems like a placebo pill with no perceptible effects except slight drowsiness, & I am starting to lapse back into a severe depression (which feels like falling down a dark bottomless well with no bottom).
So my main problem is severe (don't leave my room) depression w/ social phobia & only have mania from basically one type of medication (SSRIS).Most importantly--------My main question is what dose of Lamictal is about equivalent in antidepressant potency to Zoloft 100 mg or Prozac 20 mg? (I've never taken Prozac but i've read that Zoloft 100 mg & Prozac 20 mg are about the same in efficacy).
If I could find the right dose of Lamictal to work up to that would be great, but I don't know what that is (besides it would approximate the same 'happy, optimistic' feeling as Zoloft 100 mg. My doctor is not willing to let me increase the Lamictal dose on my own until I can't tolerate it, so increasing the Lamictal will be a long drawn out process. I doubt he will raise it past 150 mg when I see him on Wednesday (25 mg increase every 1 or 2 weeks), even though theoretically he could raise it 25/week which would put me at 200 for the next appointment (I now see the psychiatrist once a month b/c most of these psych meds never seem to work very well). Doesn't each dose increase take a month to work?
What is the point of splitting the dosages as the dose is increased if the half-life is 32.8 hours? Right now at 100 mg I take it at bedtime since it makes me very slightly drowsy- most people said it was a stimulating med oddly enough.
What are the side effects of the higher dose ranges, so far i've had no side effects, or any effect at all for that matter.
Hopefully, Lamictal won't end up being another med that doesn't work for me (I've tried just about everything else- running out of options for an anti-depressant) like Remeron or Neurontin- both which turned me into a somnolent zombie.
Posted by jazzdog on March 24, 2002, at 13:17:16
In reply to Lamictal- what AD dose= Zoloft 100 mg/Prozac 20 mg, posted by 3 Beer Effect on March 23, 2002, at 23:31:20
I'm on 200 mg. lamictal with zoloft. I've been told that a therapeutic dose is at least 150, and I've heard of people going as high as 600mg to achieve an antidepressant, rather than mood-stabillizing, effect. I'm aiming for 250 to 300 mg - I didn't really feel any benefit under 150. Also, I believe 50 mg Zoloft equals 20 mg. Prozac, so 100 Zoloft is 40 Prozac.
Posted by Mr.Scott on March 25, 2002, at 18:54:26
In reply to Lamictal- what AD dose= Zoloft 100 mg/Prozac 20 mg, posted by 3 Beer Effect on March 23, 2002, at 23:31:20
My doc says it's a subtle drug..and that after a time people just notice they aren't as high or low and that it may take months to evaluate.Why not see if a tiny pinch of some AD along with it might help without making you go crazy like 100mg of Zoloft does.
Scott
Posted by Zo on March 26, 2002, at 4:35:37
In reply to Lamictal- what AD dose= Zoloft 100 mg/Prozac 20 mg, posted by 3 Beer Effect on March 23, 2002, at 23:31:20
Subtle, yes--but also hit me with a wham, when it hit: Depression's over! All gone! Subtle in that it doesn't feel like I'm on anything. Zoloft *not* a good idea. One of *the* manic ADs. How about a little Effexor, or Wellbutrin, to tide you over? I'm still on 225mg Effexor and 10mg Dex -- no, Dex never made me high either, not for a minute -- but it took the Lamictal topper to fix me.
And you are *lucky* your pdoc won't let you rush. Going real slow is not only the way to avoid The Rash--in which case one loses out on a great drug--it is the only way to work one's way up to the tolerable dose. I rushed my dose, and thought it was an awful med, til someone advised me. I am so grateful, now. . .
Good luck!
Zo
Posted by JohnX2 on March 26, 2002, at 4:45:53
In reply to Re: Lamictal- what AD dose= Zoloft 100 mg/Prozac 2 » 3 Beer Effect, posted by Zo on March 26, 2002, at 4:35:37
Lamictal has erased my Major Depression. Period.
It is a suble medication doing the job in the background with no side effects for me. It is non-intrusive like the ADs in my experience. However, it also doesn't have that major "PUNCH" like I got on wellbutrin or zoloft (with all the side effects, etc). Lamictal just makes me feel like "me" and not depressed. The ADs make me feel like someone else (which can be good or bad).Regards,
John
> Subtle, yes--but also hit me with a wham, when it hit: Depression's over! All gone! Subtle in that it doesn't feel like I'm on anything. Zoloft *not* a good idea. One of *the* manic ADs. How about a little Effexor, or Wellbutrin, to tide you over? I'm still on 225mg Effexor and 10mg Dex -- no, Dex never made me high either, not for a minute -- but it took the Lamictal topper to fix me.
>
> And you are *lucky* your pdoc won't let you rush. Going real slow is not only the way to avoid The Rash--in which case one loses out on a great drug--it is the only way to work one's way up to the tolerable dose. I rushed my dose, and thought it was an awful med, til someone advised me. I am so grateful, now. . .
>
> Good luck!
> Zo
Posted by colin wallace on March 26, 2002, at 9:05:56
In reply to Lamictal- what AD dose= Zoloft 100 mg/Prozac 20 mg, posted by 3 Beer Effect on March 23, 2002, at 23:31:20
3 Beers,
This may well sound overly simplistic, but have you tried a subtherapeutic dose of Zoloft? I wrote off almost two years of my life playing medication roulette, and nobody EVER suggested that I may in fact need far LESS of an antidepressant, not the opposite.I'm not bipolar (as far as I know), but therapeutic doses (especially SSRI's) have pushed me into hyper-agitated states that(I'm certain) approximated mania .I became a danger to myself and others on a full dose SSRI.I'm known as an equable character, but I could have killed on 75mg effexor, or even 20mg prozac.I actually took myself off to the other side of the world to detox. the stuff, despite warnings that I would relapse horribly if I did- I didn't, and far from it.I figured out that I needed to set my own mental pitch as far as meds were concerned, and when I pitch low enough, the effects are stunning.A little sam-e, a mini dose of Zoloft(12.5), and my mental acuity has returned, along with my optimism.If Zoloft worked for you, perhaps you just need to bring things into focus by sliding back down the scale a little.
I'm sure sam-e could help you at 23, if it 's to help you at all.I'm only 33, and fitter than most 23 yr. olds.
Needless to say, do your own thinking, sift through the dross, and reach your own informed conclusions, as I'm sure you will.Col.
Posted by Zo on March 26, 2002, at 16:56:57
In reply to Re: Lamictal- what AD dose= Zoloft 100 mg/Prozac 20 mg, posted by colin wallace on March 26, 2002, at 9:05:56
That's a good message that should be all *over* this board, there's alot of territory to experiment with in the "sub-normal" doses. I know med sensitive people who take teeny amounts of this and that. . .and it works for them. I usually level off at way less than the high-normal dose. There *is* no such thing as a "recommended dose"
People ought to just take these known to be helpful substances and experiment from a few molecules on up.
My pdoc has one guy who takes 1 Ativan every other day, and does well on it. He has over 300 of us "kooks" and is fascinated with our individual tweaked results.
Zo
Posted by colin wallace on March 27, 2002, at 3:31:32
In reply to Re: Really Small Doses Can Work! » colin wallace, posted by Zo on March 26, 2002, at 16:56:57
I've often wondered about this- from the time when I was thrown into such a mindless rage on a mid/high (150mg) dose of effexor that I actually bit my tooth in half!After I'd withdrawn (another story)from the stuff, I got to thinking about how many other poor unfortunates had possibly gone right over the edge, or worse, due to the initiation of these 'normal' doses.Given that (from memory) the larger percentage of suicides occur within the first 30 days of AD therapy, and whilst the patient is taking doses toward the higher range, would it not make more sense,as you said, to err on the side of caution and aim/stay low, for the first month at least!
Maybe pharm companies should introduce 'induction' doses , designed for the first few weeks of treatment.
(I also woke up in a muddy ditch on a mountainside with a mangled mountain bike and eyes like pool-balls, completely disorientated, after starting Lofepramine at 150mg!!)
Posted by Hattree on March 27, 2002, at 10:02:12
In reply to Re: Lamictal- what AD dose= Zoloft 100 mg/Prozac 20 mg, posted by colin wallace on March 26, 2002, at 9:05:56
I have often wondered whether that the standard starting doses prescribed (particularly of SSRI's) are too high, particularly for women, causing people to give up on potentially helpful meds.
I used to benefit unmistakalbly from a microscopic dose of Prozac.
Posted by Steeler Tookahn on March 27, 2002, at 13:15:56
In reply to Re: Doses » colin wallace, posted by Hattree on March 27, 2002, at 10:02:12
Your talk of beneficial smaller doses makes me wonder. When going off of a medication that has stopped working, I often find there is a day or two of improvement. Neither the doctor nor I ever expect this as it should be a linear return to depression as the med. clears the body. I wonder if we couldn't be hitting a therapeutic dose at a lower range.
Just a thought,
Steeler
Posted by colin wallace on March 27, 2002, at 15:42:12
In reply to Re: Doses, posted by Steeler Tookahn on March 27, 2002, at 13:15:56
That's exactly how I first became aware of my low AD tolerance threshold....
This is the end of the thread.
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