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Dr. Bob is Robert Hsiung, MD,
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Posted by Janelle on March 19, 2002, at 22:51:24
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP » Peter, posted by Ron Hill on March 19, 2002, at 21:27:11
Posted by Ron Hill on March 19, 2002, at 23:13:34
In reply to What does AED stand for? (nm), posted by Janelle on March 19, 2002, at 22:51:24
Posted by Peter on March 19, 2002, at 23:22:27
In reply to What does AED stand for? (nm), posted by Janelle on March 19, 2002, at 22:51:24
Thanks for your feedback everyone. I'm not so terrified about starting Lithium now. I'm actually looking forward to it. What I'm not looking forward to is the difficult time of tapering what I'm on now-Neurontin, Adderall, and Klonopin. It's the klonopin I'm especially concerned with; although I'm taking a relatively small dose (1.25-1.5mg daily), I've been on it for @3 years. I really want to get off of it, because I'm pretty sure that it's been keeping my mood down. I'm sure when I'm once and for all off of it, I'll feel energized and more alive, but I'm not looking forward to the withdrawl that can occur. Anyway, that SAMe option looks very interesting, Ron. I'll bring it up tomorrow at my pdoc session. But first things first-getting off all the current stuff and starting lithium. It will probably be a few months until I'm stabilized on lithium and free of all this other medication-well, I've gotta get through it, even though I'm sure it'll be hard. WISH ME LUCK!! Thanks again to everyone for your input/advice/comfort.
Peter
Posted by Ritch on March 19, 2002, at 23:48:19
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
> Hello all:
> Well, after another trial with a new medication cocktail prescribed by my pdoc, I'm still miserable. Since 1997, this guy has had me on various combinations of depakote, neurontin, a slew of SSRI's, Wellbutrin, Effexor, dopamine agonists, stimulants, klonopin, and more. He had diagnosed me with mild bipolar, some panic, social phobia, and possible ADD. I still continued to have problems-bad mood swings and times when I just couldn't go outside because I was depressed/anxious. When I opened my cabinet and saw hundreds of pill viles, it dawned on me that I needed another opinion from a second pdoc. This just isn't working, I thought. So, it was suggested that I have a consultation with NYC-based Donald F Klein, supposedly one of the best. He came to the conclusion that I am in fact bipolar, and that my anxiety/panic/depression stems from my BP. He said I should taper off all the meds I'm on now (Neurontin, adderall, and klonopin), and begin a simple combo of Lithium and Depakote. I always thought Lithium was only prescribed for people with intense BP I, with acute manias and suicidal depressions. I've never had acute mania-in fact, I don't ever recall having a manic episode, but he thinks I am BP. Does anyone know if Lithium can be used for milder BP disorder? If so, does anyone have any succes stories? I would love to once and for all be stabilized without constantly switching from one cocktail to the next for the rest of my life! Finally, I'm aware of the need for monitering and blood checks while on Lithium, but is it safe and effective at the right dose? Does it help depressive states characterized by apprehension, social phobia, and irritability? Thanks,
> Peter
Wow, you have really been going through the mill. I agree to *some* extent with your new pdoc's opinions. I went through this myself about 15 years ago when I started college for the 2nd time. I was on Lithium monotherapy (600mg/day), but still was having breakthrough panic attacks. Well, the first thing that was thought of was..."The bipolar is not being controlled properly, we need to increase the lithium". Well, increasing the lithium created more GI distress, which was what was precipitating the panic attacks anyways. So, they *finally* gave me some Lomotil (opioid+anticholinergic), and voila! the panic attacks diminished. Well, that certainly seemed to throw a kink into their theories at the time. I wound up on *less* lithium+diazepam+lomotil, and things worked out much better. You could try the Depakote+lithium combo and see what happens. Hey, it is a trial.. If they are full of crap, you will be able to tell relatively quickly!Mitch
Posted by Saffron on March 20, 2002, at 9:25:34
In reply to Lithium for BPII or cyclothymia? NEED HELP, posted by Peter on March 19, 2002, at 17:26:43
Hey there,
I think I have the same situation that you do, also diagnosed recently, or within the last year or so. BPII- with the withdrawn distance, and i turn to alchohol to feel something. I have states where i get this depressed anxiety, not a mania, but a time where im depressed and yet i need some sort of action in order to pinch myself? i dont know if thats what you mean, but thats how they told me they knew i was in this boat. they suggested Lithium to me but it made me nervous and im girly about weight gain so i wanted to get away from depacote so I've been trying topamax and i really like it, it takes away all that depressed anxiety. you may want to give that a go, for a few weeks it made me feel really great.
however, its been slowing down and we've been having to up the dosage recently so i may be moving over to lithium or depacoat, please let me know how your trial works out, i think we may have the same disorder. sorry- iknow you asked for help and you got a bunch of people telling you to go for it and tell them what you find. do you have a therapist as well as a psychiatrist? meds are part of it, but my main thing is the therapy, actually.
Posted by Peter on March 20, 2002, at 14:33:10
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP, posted by Saffron on March 20, 2002, at 9:25:34
Hi Saffron:
>I have states where i get this depressed anxiety, not a mania, but a time where im depressed and yet i need some sort of action in order to pinch myself?
I know what you mean. This is similar to what I've experienced-that mixed anxiety/depression. With me, I usually don't want to be around anyone and I get irritable. So if I do have to go out, I feel like I need to drink in order to wash over that antisocial, depressed anxiety.
> I've been trying topamax and i really like it, it takes away all that depressed anxiety. you may want to give that a go, for a few weeks it made me feel really great.
I haven't discussed that one with my pdoc. I spoke to him today and informed him of the other doctor's opinion that I start lithium, and he said it sounds good- but first, for the next few days, he wants to increase my Neurontin dose to a more therapeutic level. He thinks Neurontin would be great for me, once we get the levels right: very few side-effects and anti-anxiety effects. He said he wouldn't prescribe it for a BPI person with intense mania, but he thinks it would be good for my mild, anxiety-laced mood swings.
> do you have a therapist as well as a psychiatrist? meds are part of it, but my main thing is the therapy, actually.
I was in therapy for years. Personally, I got sick of the intrusive nature of it and the fact that it got me more stressed out, over-analyzing myself all the time. But it was probably just the wrong therapist for me; I'm thinking of pursuing less psychodynamic therapy and more cognitive-behavioral therapy, which I've never tried and heard is good. Thanks for your input. I wish you the best.
Peter
Posted by Peter on March 21, 2002, at 2:26:31
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP » Saffron, posted by Peter on March 20, 2002, at 14:33:10
Ok, here's the deal. I went back to my normal pdoc today whom I've been seeing since 1997. He had already discussed everything with the other pdoc -Donald Klein- who I went to see for a second opinion. As a stated earlier, Dr. Klein recommended that I taper off everything and start Lithium and a little depakote. My pdoc today told me that we can do this if I want, and it might be good for me, but he reminded me that I have a very mild bipolar case (with some hypomania and depression), and that the reason he never put me on Lithium is because it is more effective for BPI patients with acute mania. So he always thought, since I have more mild, mixed states, that the anticonvulsants would be better for me, even though they have more sedating properties than Lithium. Depakote was too sedating for me, but he really thinks the drug I'm on now, Neurontin, would be great for me because it's 'lighter' than depakote, can even-out mild bipolar mood swings, and it targets anxiety, and I'm a really anxious person. In addition, it has a very low side-effect profile, and there are no excess precautions like with Lithium (looking out for dehydration, etc.) and no blood tests required, because it all goes straight out the urine, with no kidney retention. So before we discuss me going on lithium any further, he wants me to increase my neurontin dose to a more therapeutic level and see how I tolerate it for the next few days. I'm now on 700mg daily and he has me going up to 900mg daily. It would be great if such a generally mild drug works well for me, so I can stick with it. But what concerns me is I'm also on adderall (20mg XR in the a.m. and 10mg regular early p.m), which he prescribed me because I was falling into depression from the early sedating effects of the neurontin!! Not to mention my klonopin 1.5mg daily for anxiety. So I've really got a cocktail here of 'off label' uses (adderall for depression, etc.). And the adderall is wierd-it makes me feel good, gives me drive and motivation, but also sometimes makes me very withdrawn and obsessive. But I like it; it just disturbs me a bit because it sometimes makes me feel a bit 'high' and that reminds me of my drug addiction years, and the association makes me feel guilty and wierd. On the other hand, even though it's a complex, perhaps unconventional cocktail, it might work well once the Neurontin is stablized at a higher dose. It gets confusing, but do you think it's worth it to stick with this combo with a chance that Neurontin might be good for me, in which case I wouldn't have to do the big shift over to Lithium, which is obviously a more heavy-duty drug? I'm trying to weigh the pros and cons of both sides and I just get more and more confused. What's the better choice? Any advice? Sorry and thanks.
Peter D
Posted by judy1 on March 21, 2002, at 2:55:00
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
since your case is so mild, i think neurontin may be helpful. i agree with it's low side effects and lack of blood tests, it ceratinly is worth the try. 1.5mg klonopin/day isn't all that high (I take 6mg/day) for anxiety. sorry i'm not familiar with adderall (I am dxed bp1 and panic disorder) so it would probably do a real number on me. BTW I went over 2100 mg of neurontin and it wasn't helpful- i do need the heavier stuff. wish you the best (and don't worry about 3 drug, there are people on this board on 6 or 7 at a time. take care- judy
Posted by Peter on March 21, 2002, at 16:48:35
In reply to Re: Very upset and confused-please help » Peter, posted by judy1 on March 21, 2002, at 2:55:00
Thanks for your encouragement, Judy. I guess I'd just feel more comfortable if Neurontin works and I don't have to take Lithium. I can understand that Lithium works great for many people, but why take it if a milder drug works? The only other thing I'm considering is switching the adderall. It sometimes feels good (like a 'high'), but it also tends to make me very withdrawn and nervous in public. The addictiveness also bothers me. So I'm actually thinking of suggesting a replacement for the adderall-I'm thinking effexor might be a good idea. I know I stated that I tried alot of SSRI's and they made me emotionally numb and caused alcohol/drug cravings. But effexor is different, because it also effects nueropinephrine(sp?). I tried effexor once, but it was during a very unhealthy, crazy time in my life when I was taking ecstacy and getting drunk all the time, so I don't really know how it effected me compared to normal SSRI's. I'm thinking it might be a good drug for me to try now with the Neurontin and klonopin instead of continuing adderall or switching over to Lithium. Anyone have good experience with effexor XR?
Posted by Mr.Scott on March 21, 2002, at 22:12:57
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
Easier said than done, but try not to stress yourself out. This is a process and it's going to take some time. As long as you stay engaged and keep trying to find an answer, you will!
Better to fully explore one regimen than jump to another before it's fully explored lest you have to jump back again because your not sure you fully explored it.
I think there is some truth to the fact that Lithium is better for BPI, but everyone is different. Off label usage is good thing not a bad thing. Those huge sample studies conducted to get drugs like Paxil approved for GAD by the FDA are great until you get into a clinical setting with an individual for whom Paxil doesn't do anything except make them emotional numb, overweight, and impotent and maybe a little less anxious. Suddenly the whole one size fits all solution goes out the window. From the sound of it, you would not have been labeled Bipolar at all a few years ago. Only now is everyone suddenly bipolar whereas we were all ADD a few years back.
You'll get to the right place...But never as fast as you want I'm afraid.
Scott
Posted by Peter on March 21, 2002, at 22:40:09
In reply to Re: Very upset and confused-please help » Peter, posted by Mr.Scott on March 21, 2002, at 22:12:57
Never mind that whole idea about going on effexor-my doctor rejected it. So, it looks like I've just gotta try Lithium even though I'm not BP1. He's going to see how Lithium/Neurontin combo works since Neurontin has supposed anti-anxiety affects. I'm just so sick of all this. I realize it's alot of trial and error, but man, since 1997 I've been switching drug cocktails like a bat outta hell. Not to mention that everytime I switch meds I get completely stressed out, as you can probably tell from all my incessant ramblings on this post. Now I'm freaked out about the whole dehydration thing with Lithium and the need for all those blood tests. This sucks. Whatever. I'm gonna go stare at the wall and bask in my self-pity.
Peter
Posted by Ritch on March 21, 2002, at 22:40:39
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
> Ok, here's the deal. I went back to my normal pdoc today whom I've been seeing since 1997. He had already discussed everything with the other pdoc -Donald Klein- who I went to see for a second opinion. As a stated earlier, Dr. Klein recommended that I taper off everything and start Lithium and a little depakote. My pdoc today told me that we can do this if I want, and it might be good for me, but he reminded me that I have a very mild bipolar case (with some hypomania and depression), and that the reason he never put me on Lithium is because it is more effective for BPI patients with acute mania. So he always thought, since I have more mild, mixed states, that the anticonvulsants would be better for me, even though they have more sedating properties than Lithium. Depakote was too sedating for me, but he really thinks the drug I'm on now, Neurontin, would be great for me because it's 'lighter' than depakote, can even-out mild bipolar mood swings, and it targets anxiety, and I'm a really anxious person. In addition, it has a very low side-effect profile, and there are no excess precautions like with Lithium (looking out for dehydration, etc.) and no blood tests required, because it all goes straight out the urine, with no kidney retention. So before we discuss me going on lithium any further, he wants me to increase my neurontin dose to a more therapeutic level and see how I tolerate it for the next few days. I'm now on 700mg daily and he has me going up to 900mg daily. It would be great if such a generally mild drug works well for me, so I can stick with it. But what concerns me is I'm also on adderall (20mg XR in the a.m. and 10mg regular early p.m), which he prescribed me because I was falling into depression from the early sedating effects of the neurontin!! Not to mention my klonopin 1.5mg daily for anxiety. So I've really got a cocktail here of 'off label' uses (adderall for depression, etc.). And the adderall is wierd-it makes me feel good, gives me drive and motivation, but also sometimes makes me very withdrawn and obsessive. But I like it; it just disturbs me a bit because it sometimes makes me feel a bit 'high' and that reminds me of my drug addiction years, and the association makes me feel guilty and wierd. On the other hand, even though it's a complex, perhaps unconventional cocktail, it might work well once the Neurontin is stablized at a higher dose. It gets confusing, but do you think it's worth it to stick with this combo with a chance that Neurontin might be good for me, in which case I wouldn't have to do the big shift over to Lithium, which is obviously a more heavy-duty drug? I'm trying to weigh the pros and cons of both sides and I just get more and more confused. What's the better choice? Any advice? Sorry and thanks.
> Peter D
Hi Peter, What about leaving your Adderall the same, and your Neurontin the same and just add on a *little* Depakote. Maybe 125mg at bedtime and see what happens. I have just restarted dexedrine lately with Neurontin+Klonopin and adding on the 125mg of Depakote at bedtime improved my sleep and settled me down anxiety-wise the next day. I have tried 250mg Depakote at bedtime and I sleep just a *little* too much. But, I am only taking 5mg dexedrine a day. Maybe if I increased to 250mg depakote at bedtime and also increased the dexedrine to a 10mg spansule midday...Mitch
Posted by Ritch on March 21, 2002, at 22:44:30
In reply to Re: Very upset and confused-please help, posted by Peter on March 21, 2002, at 16:48:35
> Thanks for your encouragement, Judy. I guess I'd just feel more comfortable if Neurontin works and I don't have to take Lithium. I can understand that Lithium works great for many people, but why take it if a milder drug works? The only other thing I'm considering is switching the adderall. It sometimes feels good (like a 'high'), but it also tends to make me very withdrawn and nervous in public. The addictiveness also bothers me. So I'm actually thinking of suggesting a replacement for the adderall-I'm thinking effexor might be a good idea. I know I stated that I tried alot of SSRI's and they made me emotionally numb and caused alcohol/drug cravings. But effexor is different, because it also effects nueropinephrine(sp?). I tried effexor once, but it was during a very unhealthy, crazy time in my life when I was taking ecstacy and getting drunk all the time, so I don't really know how it effected me compared to normal SSRI's. I'm thinking it might be a good drug for me to try now with the Neurontin and klonopin instead of continuing adderall or switching over to Lithium. Anyone have good experience with effexor XR?
Peter,
Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
Mitch
Posted by judy1 on March 22, 2002, at 0:57:50
In reply to Thanks everyone but I'm just sick of it all, posted by Peter on March 21, 2002, at 22:40:09
first of all, you DON'T have to take a med that makes you uncomfortable- and lithium certainly falls in that category. i had better luck (like the last poster) with depakote. i also agree that bipolar is way too over-diagnosed. i have clear manic and depressed episodes (psychotic) and a family history and am most definitely bipolar. effexor is a very stimulating drug and anxiety sounds like your main problem. if klonopin helps, have you ever tried a higher dose or xanax instead? how long have you been off street drugs (i was on also for years and i truly believe it took my brain at least a year to 'normalize'. i know how difficult this is- i've stopped meds many times- but maybe in your case simpler is better, just use what has worked in the past - klonopin and adderal- and play with doses. i wish you the best- judy
Posted by Peter on March 22, 2002, at 1:37:58
In reply to Re: Thanks everyone but I'm just sick of it all » Peter, posted by judy1 on March 22, 2002, at 0:57:50
> if klonopin helps, have you ever tried a higher dose or xanax instead?
Hi Judy: Thanks for being such a great help to me. I'm really encouraged by all of you giving of your time to share your experience and help one another. To answer your question, I was originally prescribed klonopin @3 years ago and have always stayed below the 2mg threshold my doc set for me. When I first took it, it was a wonder drug for months; I had lots of social phobia and panic back then, and I noticed an immediate difference-I could socialize, go to museums by myself, and go to restaurants without panicking and losing my appetite. It was great! But as the years went on, klonopin lost its 'flare' and really became a preventative drug for me-I no longer felt the sense of elevated mood it had first given me, but it just worked to ward off panic attacks. I'm sure my SP would have been worse now had I not been on klonopin all these years, but it's still not so good. I usually avoid most parties and gatherings of people I don't know, and I still have some trouble meeting new people. The problem is, when I've tried to take more klonopin, it really sedates me, which in itself renders me more withdrawn and antisocial. I don't know if I'd want to switch to xanax, with it's shorter duration and all.
>how long have you been off street drugs (i was on also for years and i truly believe it took my brain at least a year to 'normalize'. i know how difficult this is- i've stopped meds many times- but maybe in your case simpler is better, just use what has worked in the past - klonopin and adderal- and play with doses. i wish you the best- judy
I've been off street drugs since '97, though I've relapsed 2-3 times since (the last time about two years ago) due to SSRI-induced emotional numbness and hypomania. My doc insists on me being on some sort of mood stabilizer (he thinks Neurontin) if I were to stick with the klonopin and adderal. But because the adderall, though it elevates my mood at times, seems to be making me a bit more withdrawn and causing me to hyperfocus on repetitive actions, its not on the whole beneficial for me. Also, it makes my hands freezing, which is a definite hindrance for a pianist! So, even though the thought of lithium makes me feel uncomfortable, I'm thinking it's really the last hope I have for a simple, effective drug that will keep me stable while helping my depressive episodes and the hypomania I've been told I portray (though I still don't see it-maybe I'm just in denial). My doc wants me to stay on klonopin for my constant anxiety/worry and he believes that even staying on Neurontin at the right dose with lithium can be a good combo for me. He has assured me that the isues about blood monitering and precautions about dehydration are not as bad as I think; he also said many people experience no side-effects at all, like they're just taking a mineral (which I guess, in essence, they are). If he thinks lithium is the best choice for me, I just want to get going with the blood tests and start it ASAP so I don't have to sit here agonizing over it for weeks. So, if he really thinks it's best for me, I might be able to start it next week, and we'll taper off the adderall as we find the right lithium blood level for me. That's it in a nutshell. I'm trying not to keep on stressing and your input has helped me tremendously, but it looks like Lithium is the only way to go at this point, according to my current pdoc and the other doc I saw for a consultation. BTW, what meds are you taking?
Peter
Posted by Peter on March 22, 2002, at 1:56:41
In reply to Re: Very upset and confused-please help » Peter, posted by Ritch on March 21, 2002, at 22:44:30
> Peter,
>
> Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
>
> Mitch
Hi Mitch:
Thanks for the input. I have heard about that whole l-isomer causing havoc in the adderall, and that plain dexedrine is smoother. I gotta tell you, the adderall is such a wierd drug for me-over a 10 minute period I'll feel good and then slightly aprehensive and nervous! It must be that l-isomer! Well, I'd like to see if my pdoc would let me try Dex. spansules, but he's made it quite clear to me that starting lithium and tapering off adderall is the best thing for me to do now. I'm overly stressing myself out about Lithium and the precautions necessary for those taking it, but he told me it's no where near as bad as I think. In fact, he said, combined with Neurontin (which has added anxiety-targeting effects) it could really help me feel better, even though I'm not a severe, classic BP1 candidate. I evidently have mild BPII, but he still thinks it's worth a try. I just gotta stop overthinking and go for it. Thanks for your help.
Peter
Posted by Peter on March 22, 2002, at 18:18:50
In reply to Re: Very upset and confused-please help » Peter, posted by Ritch on March 21, 2002, at 22:44:30
> Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
>
> Mitch:
I'm still wavering about the Lithium, even though I just posted what sounded like a final decision of trying it out. Well, I'm like that-indecisiveness and worry are my two middle names. You said you're on Neurontin+klonopin+dex. What dose of Neurontin and klonopin are you on and how do you divide the doses? If I don't switch to Lithium, I'd like to try dex spansules, but I heard they're shorter-acting than adderall XR. Is this true? Already, I have to take a 10mg normal adderall around 6pm in addition to my morning 20mgXR dose. Also, I like the idea that dex is smoother than adderall-already I have freezing hands all the time, a high heart- rate, and extreme dry mouth.
Posted by Ritch on March 22, 2002, at 23:21:55
In reply to Dex question » Ritch, posted by Peter on March 22, 2002, at 18:18:50
>
> > Since you are already on an amphetamine, why not try Dexedrine spansules? I feel a calming effect within an hour or so after taking my dose in the afternoon. When I was on Adderall I would feel a "wavy" combination of calmed and agitated. Also, on the dexedrine I don't have *any* dry mouth, and my heart rate isn't nearly as elevated. There *is* a big difference between the two.
> >
> > Mitch:
> I'm still wavering about the Lithium, even though I just posted what sounded like a final decision of trying it out. Well, I'm like that-indecisiveness and worry are my two middle names. You said you're on Neurontin+klonopin+dex. What dose of Neurontin and klonopin are you on and how do you divide the doses? If I don't switch to Lithium, I'd like to try dex spansules, but I heard they're shorter-acting than adderall XR. Is this true? Already, I have to take a 10mg normal adderall around 6pm in addition to my morning 20mgXR dose. Also, I like the idea that dex is smoother than adderall-already I have freezing hands all the time, a high heart- rate, and extreme dry mouth.
Peter,My current med trailmix is(for BPII, ADHD, SP):
Depakote, 125-250mg at bedtime
Klonopin, .5mg bedtime + up to .5mg daytime PRN
Neurontin, 100mg 3x daily
Dexedrine IR, 5mg mid-afternoon
Celexa, approx. 2mg every other day AM
Supplements (200mg SAMe AM, 1G flax oil at lunch, etcetera vitamins)
Diphenhydramine, 12.5mg PRN midday/evening for muscle spasms, dystonia.The next step for me is to try the Spansules (10mg). It doesn't really bug me to *crash* that much. In the morning, coffee works just fine with the SAMe and B12 stuff. I just need the dex. for work. Otherwise, every single freaking noise in the office stops me in my tracks and I lose my place and get frustrated and pissed. Tonite, we had the intercom playing rock muzac, and a coworker had a portable radio on with a basketball game *simultaneously* (WITH other people talking all around me!). I just typed away and didn't miss a lick! Yes, the dexedrine is much smoother than Adderall. I also had mild motor *tics* with the Adderall-I also was a little restless (but not as bad as SSRI's). When I take my dose in the afternoon and it starts to kickin I feel a simultaneous calming, alerting feeling with a little hike in my heartrate. I used to "freeze" around people on Adderall and Wellbutrin, but this doesn't happen to me. Watch out with taking it with other stuff, though. When I take my tiny dose of Celexa and I take the tiny dose of dexedrine in the afternoon I get really *wirey*. If I take much of the Celexa without the dex. I get wirey too-it just really boosts it a lot. However.. I found before that the SSRI triggers most of my mood cycling, and Adderall seemed to dampen it (without the AD). Since Dex. is only a portion of the Adderall one would think that it would do likewise. I am increasing the number of days without SSRI to see if any panic/social anxiety begins to return, and also to check my cycling.
good luck,
Mitch
Posted by katia on January 4, 2004, at 1:56:56
In reply to Re: Lithium for BPII or cyclothymia? NEED HELP » Peter, posted by Ron Hill on March 19, 2002, at 21:27:11
HI Ron,
I noticed on one of your posts you said you developed the rash on Lamictal. I just developed a rash this morning. I'm on 200mg of lam for over a month and over four months on it total. I started Lithium 2 weeks ago and just upped the total dose to 900mg in the evening two days ago. This rash is sore and is like poison oak and is on my arms, inner thighs, stomach and chest. And it hasn't gone away upon awakening. My pdoc is taking me off of Lamcital but I'm wondering if it's not the Lithium???
You said severe? What is that? My rash is pretty much covering most of my body and I"m scared. Did you have a sore throat? Did the rash hurt and feel tight like? Were there tiny bumps? Did it itch? I'm worried this is the severe one. How long did it last?
Thanks.
Katia
Posted by AnneL on January 4, 2004, at 9:56:01
In reply to Lithium or Lamictal rash?? » Ron Hill, posted by katia on January 4, 2004, at 1:56:56
Katia,
Lamictal has been associated in rare cases of causing SJS. I would like to add that many, many other medications, such as common antibiotics have also been associated with SJS.
A benign rash will occur in approximately 10 to 11 percent of those taking it. The problem that you are currently facing is whether or not a seemingly benign rash is actually a precursor to SJS. This is the reason why most pdocs will request that the patient stop Lamictal at the onset of any rash. However, that being said, some pdocs who are becoming very experienced with Lamictal in the Bipolar patient (Calabrese, J.
Huang, et al., Lauren Marangell, M.D.) and are referring patients to a dermatologist experienced with SJS to assist with making determinations as to whether it is SJS or a benign rash. The concept is that if a proper diagnosis is made before 3 days, the patient can resume Lamictal at their last dose without having to restart at the slow titration level. How up-to-date your Pdoc is with recent research into the SJS/Lamictal debate and current management trends will determine how your Pdoc addresses your rash. Obviously, a Pdoc cannot diagnose SJS, only a dermatologist who has actually seen and treated cases of SJS is qualified to make this diagnosis.
The problem is that many Pdocs may not be up-to-date on the emergence of other treatment options available in the decision-making tree when a rash appears. Step 1: Get a referral to a dermatologist who is experienced in SJS. Step #2:
Research the professionals who are named in the following text. I hope that you will be able to continue Lamictal after your rash has been diagnosed as benign or that you receive steriod treatment immediately if it is suspect. :) AnneLDr. Joseph Calabrese appears to have the most experience with Lamictal. Here are some articles and links that I think may be helpful to you:
J Clin Psychiatry. 2002 Nov;63(11):1012-9.
Rash in multicenter trials of lamotrigine in mood disorders: clinical relevance and management.
PsychEducation.org
PsychEducation.org (Dr. Jim Phelps)
Details on the Lamotrigine Rash"First, do we know how this medication compares with others which are also recognized to cause "Stevens-Johnson Syndrome", and other severe skin reactions (e.g. TEN)? Is is more likely to cause this than Tegretol, for example? There are only two studies I've found so far that speak to this "relative frequency" question, and both are limited by the very small numbers of patients taking lamotrigine, so at this point I'm not sure anyone can really answer that question.
In one study, the rash rate for anticonvulsants generally was given as 2.5%,Sharma whereas the rate usually given for lamotrigine is 10% when the medication is started according to the manufacturer's recommended rates (25 mg to start). However, in one of those studies the rash rate on placebo was 5%, probably because of all the attention given to "the rash" when explaining to patients the risk of the pills they were about to take. So, for now we can say that it appears the risk of lamotrigine is somewhat higher than carbamazepine, but it's not clear how much higher.
Just for comparison, here are rates for kids getting rashes on antibiotics:Ibia
Penicillin 7.4%
Sulpha-based 8.5%
Cephalosporins 2.6%
One cephalosporin
called Ceclor 12.3%If rash, then what?
There are ways to identify the rashes that carry great risk (e.g. Stevens-Johnson syndrome; TEN; . The problem is that simple rashes, lacking the known danger signs, can also be risky, so it's not easy to say "oh, this rash is safe". And since there is a very low rate of severe skin reactions that can (rarely) even be fatal, any rash that appears while a person is taking lamotrigine should raise concern.What are the signs of great risk? Here are the versions I've heard so far: s
"Anything above the neck"
"Around or in the mouth"
"Soft tissues (like mucous membranes of mouth, nose, eyes -- including the membrane over the eye (conjunctiva), so a red, sore eye counts) (or the anus, also a mucous membrane, also counts)
"Anything on the face"
Obviously these all describe nearly the same area, but the "soft tissues" version is the most specific.Three strategies for rash
Stop for any rash anywhere.
Have a dermatologist you can get patients in to see within 24-48 hours; hold the doses until seen.
Stop for any rash above the neck; for anything else, reduce the dose to the previous level, and hold it there until you can tell whether the rash is going away (if so, continue upward again but more slowly and/or by smaller steps; use Benadryl or topical Caladryl to control itching while you're waiting).
Why the hurry to see the dermatologist? Well, the obvious reason is because if there is a risk, you want to stop right away. Secondly, if the medication is stopped for more than 3 days (for any reason), the patient must start again from the very beginning of the dose steps. Therefore if the patient can be evaluated very quickly, she can stop the medication, get a "green light" from the dermatologist, and resume the medication at the same dose.If you don't have a dermatologist handy, then strategy #2 may not be practical. That leaves #1 and #3. Number 3 has been recommended in several meetings I've attended, e.g. by Dr. Lauren Marangell at the Menninger Utah meeting, Winter 2002. She spoke confidently of that approach there. There is at least one article which notes having used this approach successfully.e.g.Huang But at a more recent meeting, the manufacturer's representatives were more cautious: by their account, if you can't do #2, you should do #1."
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Posted by katia on January 4, 2004, at 16:06:24
In reply to Re: Lithium or Lamictal rash?? » katia, posted by AnneL on January 4, 2004, at 9:56:01
Hi Anne,
Thanks for your long post. My pdoc advised me yesterday to stop completely. However, after thinking about it, I think the lam. was increased with the increase in Lithium. I don't have any sore in my eyes or mouth. I just hate to stop it as it seemed to have helped. Oh well, if I"m on Lithium then I can take an AD. I'll go that route before trying Lam. again.
thanks again,
Katia
Posted by Ron Hill on January 5, 2004, at 15:15:12
In reply to Lithium or Lamictal rash?? » Ron Hill, posted by katia on January 4, 2004, at 1:56:56
Hi Katia,
> I noticed on one of your posts you said you developed the rash on Lamictal. I just developed a rash this morning. I'm on 200mg of lam for over a month and over four months on it total. I started Lithium 2 weeks ago and just upped the total dose to 900mg in the evening two days ago. This rash is sore and is like poison oak and is on my arms, inner thighs, stomach and chest. And it hasn't gone away upon awakening. My pdoc is taking me off of Lamcital but I'm wondering if it's not the Lithium???
My initial reaction is to agree with you and wonder if lithium is causing the rash. If you have been taking Lamictal for four months without a rash problem, and then two weeks after starting lithium, a rash shows up, the first thing I would look at is the possibility that lithium (or lithium in the presence of Lamictal) is causing the rash. If Lamictal were the culprit, I would think that it would have showed up very soon after starting the medication. On the other hand, you description of your rash sounds a lot like the rash I had on Lamictal. But all this is just my layman's opinion. You pdoc knows more than I do.
Currently, I typically take 300 mg/day of Lithobid. However, if I start to feel a little hypomanic, I raise my daily dosage to 450 mg or 600 mg. Lithobid causes a rash for me, primarily on my face. The severity of the rash seems to increase as I increase the lithium dosage. However, the severity of the rash also seems to change periodically (for some unknown reason) without changing the lithium dosage. Go figure! At any rate, I work with my dermatologist to keep the problem in check. The rash caused by Lithobid is no where near as bad as the rash I had with Lamictal.
As an aside, 900 mg/day of lithium seems like a large dose for you. If my memory serves me right, you are bipolar II (not BP I), correct? If I were in your shoes, I would chat with your pdoc about the possibility of reducing your lithium dosage to; say about 600 mg/day. A lot of research indicates that low doses of lithium are actually neuroprotective. However, high levels of lithium pose a higher risk of thyroid damage, etc. Just a thought.
> You said severe? What is that? My rash is pretty much covering most of my body and I"m scared.
Severe in that several blotches of rash occurred over a sizeable portion of my body. My rash was not SJS, however.
> Did you have a sore throat?
No
> Did the rash hurt and feel tight like?
No.
> Were there tiny bumps?
No, scaly.
Did it itch?
YES! Like crazy.
> I'm worried this is the severe one. How long did it last?
Until I quit taking Lamictal. Depakote gave me a similar rash, just not as pervasive.
-- Ron
Posted by katia on January 5, 2004, at 15:51:52
In reply to Re: Lithium or Lamictal rash?? » katia, posted by Ron Hill on January 5, 2004, at 15:15:12
Hi Ron,
Thanks for getting back to me. I'm BPII - you're right. Are the dosing schedules/amounts the same across the board for Li? I'm on Eskalith CR. If so, you're only on 300mg? Wow! is that enough? Anything else you take? Oh, yeah now I remember - you take tons more minerals and things.Have you experienced this mind stupor on Lithium?
My rash is subsiding - thank god. I stopped the lamictal yesterday.
Katia
Posted by Ron Hill on January 5, 2004, at 16:22:13
In reply to Re: Lithium or Lamictal rash?? » Ron Hill, posted by katia on January 5, 2004, at 15:51:52
Katia,
> Thanks for getting back to me. I'm BPII - you're right. Are the dosing schedules/amounts the same across the board for Li? I'm on Eskalith CR.
I think that all lithium carbonate medications are similar with regard to dosage amounts independent of brand name. However, I'd have to look it up to be sure. What lithium blood level is your doctor hoping to achieve in your case?
> If so, you're only on 300mg? Wow! is that enough?
Most of the time, yes. If hypomania starts to poke its head out, I have to corral it by increasing to 450 or 600 mg/day until the hypomania subsides.
> Anything else you take? Oh, yeah now I remember - you take tons more minerals and things.
Here is my current cocktail:
300 mg/day Lithobid (moodstabilizer).
300 mg/day St. John’s Wort (provides some good antidepressant effectiveness).
L-theanine (increases dopamine and GABA, reduces cortisol; treats irritability). Currently, I take 200 mg of l-theanine PRN (as needed) to treat irritability. Lately, I have not needed to take it very often. But when I do, it calms my irritability for about five hours. Until a couple of weeks ago, I had been taking 400 mg/day of l-theanine for about seven weeks. However, I fell into a deep depressive episode, and I decided to err on the side of caution and reduce my dosage of l-theanine because some research indicates that it can reduce serotonin levels. I don’t know for fact that l-theanine contributed to my depressive episode. Perhaps I was just cycling (bipolar II).
250 mg/day of TMG.
Small pocket-full of vitamins and minerals per day (most notably, 800 mg/day of magnesium taken at bedtime to improve sleep and overall brain functioning).
Three teaspoons of Carlson’s Fish Oil per day.
About four cups of green tea per day.
Exercise (1 – 2 hours/day; reduces depression and irritability but can increase hypomania, thereby, requiring a temporary increase in the amount of moodstabilizer).
NO REFINED SUGAR!!
No alcohol (and no recreational drugs since the 70's).
Zone diet.
> Have you experienced this mind stupor on Lithium?
At 900 mg/day I would. Even at 600 mg/day I experience a dulling sensation.
> My rash is subsiding - thank god. I stopped the lamictal yesterday.
Good!
-- Ron
Posted by katia on January 5, 2004, at 16:38:15
In reply to Re: Lithium » katia, posted by Ron Hill on January 5, 2004, at 16:22:13
Interestingly such small doses. I might just have to try it. I was hoping to stay on Lithium b/c I wanted to go on an antidepressant. and for the brain qualities etc. (I can't speak properly I"m in a lithium stupor).
Maybe I'll reduce it down.
I'm going on antabuse soon as I need a bit of help with the quitting of drinking...
katia
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