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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 JohnX2 on April 15, 2002, at 20:16:30
I was wondering how lithium stacks up against Zyprexa and Lamictal for particular (hypo)manic symptoms.particularly (more mild symptoms):
- psychomotor agitation
- anxiety
- anger
- racing thoughtsmore severe symptoms (fleeting):
- paranoia (feelings of conspiracies, etc)
- derealization/depersonalization/detachment
- grandiose thought patterns
- bad insomnia
- intense rage
- violent mood swings
I like to just take zyprexa with my Lamictal/Topamax/Serzone since Zyprexa fixes the lingering problems quite nicely and closes the book. But I got the TD (dystonia) in my hand (a clenching) and restless legs so I try to avoid zyprexa, despite how wonderful it is. BTW, the residual TD symptoms from prior high dose Zyprexa administration have all but disappeared.I'm in the process of getting some lab testing done in preperation for Lithium trial, so i was wondering what I may expect.
One thing I think is happening is that the Topamax is the culprit in these wild manic swings, as lowering the dose has decreased the symptoms substantially. I was thinking maybe I could dump or lower topamax, raise Serzone (because either med is to treat myofacial pain and depression, and I *don't* think Serzone of the 2 makes me (hypo)manic), and possibly bump Lamictal dose up.
Previously bumping Lamictal above 150 mg would make the myofacial pain worse (is Lamictal a SRI at higher doses, SRI activity this seems to correlate to my pain)? But maybe with the strong Serzone (blocks bad serotonin receptors), then I can tolerate stronger Lamital (knock out the bad cycling).
I think the stronger dose of Serzone has some of the beneficial anti-serotonin 5-ht2 receptor qualities that the additive Zyprexa was giving me.
As you can see I am grasping to avoid Li. I don't know why???, Maybe I just don't think I can deal with side effects. Pooped out from medicine trials. Are the LI side effects really that bad? The PDR scares the shit out of me.
These bad (hypo)manic symptoms are out of line for me and I really think they are Topamax related.
Sorry for the ramble.
Thanks for any input.
John
Posted by Ron Hill on April 15, 2002, at 20:43:41
In reply to Help,Li vs. Zyprexa vs Lamictal for manic symptoms, posted by JohnX2 on April 15, 2002, at 20:16:30
John,
> I was wondering how lithium stacks up against Zyprexa and Lamictal for particular (hypo)manic symptoms.I've never taken Zyprexa so I can't be a lot of help. However, if it were my decision, I'd pick Li (which is neuroprotective at lower doses) over an anti-psychotic medication (with the potential TD issues) any day of the week.
> As you can see I am grasping to avoid Li. I don't know why???, Maybe I just don't think I can deal with side effects. Pooped out from medicine trials. Are the LI side effects really that bad?
John, I am VERY sensitive to medication side effects and yet Lithobid was easy for me to get used to. Frequent urination for a week and that was about it. Keep in mind, however, I only take 600 mg/day (0.40 blood level). What dose do you and your pdoc plan to start at?
>The PDR scares the shit out of me.
Don't believe everything you read!
> Sorry for the ramble.What ramble? Best wishes!
-- Ron
Posted by rainbowlight on April 15, 2002, at 20:45:24
In reply to Help,Li vs. Zyprexa vs Lamictal for manic symptoms, posted by JohnX2 on April 15, 2002, at 20:16:30
Hi John. I have been on Lithium and Lamictal (at different times). I have found that with the Lamictal I have a higher range of emotions. On Lithium I felt dull/flattened emotions and I had the hand tremors. I prefer the Lamictal. The only problem I have had with Lamictal is that I cannot sleep on my own (it's too activating) and I have to take a sleep med with it.
Posted by Ritch on April 15, 2002, at 23:37:20
In reply to Help,Li vs. Zyprexa vs Lamictal for manic symptoms, posted by JohnX2 on April 15, 2002, at 20:16:30
>
> I was wondering how lithium stacks up against Zyprexa and Lamictal for particular (hypo)manic symptoms.
>
> particularly (more mild symptoms):
>
> - psychomotor agitation
> - anxiety
> - anger
> - racing thoughts
>
> more severe symptoms (fleeting):
> - paranoia (feelings of conspiracies, etc)
> - derealization/depersonalization/detachment
> - grandiose thought patterns
> - bad insomnia
> - intense rage
> - violent mood swings
>
>
> I like to just take zyprexa with my Lamictal/Topamax/Serzone since Zyprexa fixes the lingering problems quite nicely and closes the book. But I got the TD (dystonia) in my hand (a clenching) and restless legs so I try to avoid zyprexa, despite how wonderful it is. BTW, the residual TD symptoms from prior high dose Zyprexa administration have all but disappeared.
>
> I'm in the process of getting some lab testing done in preperation for Lithium trial, so i was wondering what I may expect.
>
> One thing I think is happening is that the Topamax is the culprit in these wild manic swings, as lowering the dose has decreased the symptoms substantially. I was thinking maybe I could dump or lower topamax, raise Serzone (because either med is to treat myofacial pain and depression, and I *don't* think Serzone of the 2 makes me (hypo)manic), and possibly bump Lamictal dose up.
>
> Previously bumping Lamictal above 150 mg would make the myofacial pain worse (is Lamictal a SRI at higher doses, SRI activity this seems to correlate to my pain)? But maybe with the strong Serzone (blocks bad serotonin receptors), then I can tolerate stronger Lamital (knock out the bad cycling).
>
> I think the stronger dose of Serzone has some of the beneficial anti-serotonin 5-ht2 receptor qualities that the additive Zyprexa was giving me.
>
> As you can see I am grasping to avoid Li. I don't know why???, Maybe I just don't think I can deal with side effects. Pooped out from medicine trials. Are the LI side effects really that bad? The PDR scares the shit out of me.
>
> These bad (hypo)manic symptoms are out of line for me and I really think they are Topamax related.
>
> Sorry for the ramble.
>
> Thanks for any input.
> John
Hi there RipVanWinkle! I was fixin' to post something to you about whether you had already started the lithium-given your quietness lately. I am glad you are as sparky as ever.Lithium is good and fairly reliable for the things you listed:
> - psychomotor agitation
> - anxiety
> - anger
> - racing thoughtsYou mentioned some more serious thingies:
> more severe symptoms (fleeting):
> - paranoia (feelings of conspiracies, etc)
> - derealization/depersonalization/detachment
> - grandiose thought patterns
> - bad insomnia
> - intense rage
> - violent mood swingsI found it to be a fairly decent anti-psychotic for paranoia and fairly decent for sleep, however I think the remainder of things on the "fleeting" list respond much better to Depakote-primarily the rages and rapid mood flips. Also, derealization/depersonalization tend to be worse with GABA meds (IMO). Perhaps a *combo* of Topamax (which affects GABA) at a lower dose, combined with a low dose of lithium, AND Lamictal at your "sweet spot" of 150mg would be the trick. Forget the Zyprexa altogether.
Go for the Li trial,
what the heck.Mitch
Posted by JohnX2 on April 16, 2002, at 0:44:14
In reply to Re: Help,Li vs. Zyprexa vs Lamictal for manic symptoms » JohnX2, posted by Ritch on April 15, 2002, at 23:37:20
> >
> > I was wondering how lithium stacks up against Zyprexa and Lamictal for particular (hypo)manic symptoms.
> >
> > particularly (more mild symptoms):
> >
> > - psychomotor agitation
> > - anxiety
> > - anger
> > - racing thoughts
> >
> > more severe symptoms (fleeting):
> > - paranoia (feelings of conspiracies, etc)
> > - derealization/depersonalization/detachment
> > - grandiose thought patterns
> > - bad insomnia
> > - intense rage
> > - violent mood swings
> >
> >
> > I like to just take zyprexa with my Lamictal/Topamax/Serzone since Zyprexa fixes the lingering problems quite nicely and closes the book. But I got the TD (dystonia) in my hand (a clenching) and restless legs so I try to avoid zyprexa, despite how wonderful it is. BTW, the residual TD symptoms from prior high dose Zyprexa administration have all but disappeared.
> >
> > I'm in the process of getting some lab testing done in preperation for Lithium trial, so i was wondering what I may expect.
> >
> > One thing I think is happening is that the Topamax is the culprit in these wild manic swings, as lowering the dose has decreased the symptoms substantially. I was thinking maybe I could dump or lower topamax, raise Serzone (because either med is to treat myofacial pain and depression, and I *don't* think Serzone of the 2 makes me (hypo)manic), and possibly bump Lamictal dose up.
> >
> > Previously bumping Lamictal above 150 mg would make the myofacial pain worse (is Lamictal a SRI at higher doses, SRI activity this seems to correlate to my pain)? But maybe with the strong Serzone (blocks bad serotonin receptors), then I can tolerate stronger Lamital (knock out the bad cycling).
> >
> > I think the stronger dose of Serzone has some of the beneficial anti-serotonin 5-ht2 receptor qualities that the additive Zyprexa was giving me.
> >
> > As you can see I am grasping to avoid Li. I don't know why???, Maybe I just don't think I can deal with side effects. Pooped out from medicine trials. Are the LI side effects really that bad? The PDR scares the shit out of me.
> >
> > These bad (hypo)manic symptoms are out of line for me and I really think they are Topamax related.
> >
> > Sorry for the ramble.
> >
> > Thanks for any input.
> > John
>
>
> Hi there RipVanWinkle! I was fixin' to post something to you about whether you had already started the lithium-given your quietness lately. I am glad you are as sparky as ever.
>
> Lithium is good and fairly reliable for the things you listed:
> > - psychomotor agitation
> > - anxiety
> > - anger
> > - racing thoughts
>
> You mentioned some more serious thingies:
> > more severe symptoms (fleeting):
> > - paranoia (feelings of conspiracies, etc)
> > - derealization/depersonalization/detachment
> > - grandiose thought patterns
> > - bad insomnia
> > - intense rage
> > - violent mood swings
>
> I found it to be a fairly decent anti-psychotic for paranoia and fairly decent for sleep, however I think the remainder of things on the "fleeting" list respond much better to Depakote-primarily the rages and rapid mood flips. Also, derealization/depersonalization tend to be worse with GABA meds (IMO). Perhaps a *combo* of Topamax (which affects GABA) at a lower dose, combined with a low dose of lithium, AND Lamictal at your "sweet spot" of 150mg would be the trick. Forget the Zyprexa altogether.
>
> Go for the Li trial,
> what the heck.
>
> MitchLately I'm getting pins and needles in my hands.
I think it is the topamax. I'm getting nervous about being on too many meds.
Last time I took Serzone at a stronger dose it had a substantial anxiolytic response with absolutely no hypomania (very stable response), I was on no mood stabilizer at the time. Good AD response, and it completly alleviated my myofacial pain. No other AD pre mood-stabilizer did this (they all were non responders, or hypomanic response followed by poop-out). This time Serzone is not making feel the least bit drugged out (no cognitive impairment). Last time I felt drugged out and got into a fender-bender, so i quit the med.I'm just wondering if I can get my meds down to:
Lamictal + Serzone
before trying:
Lamictal + Serzone + Topamax + Lithium.
*Before* I added Serzone I had some wild hypomanic swings, this was shortly after topamax augmentation and during klonopin taper.
I wish I could take Depakote, but it is a placebo for me. Trileptal gives me crushing myofacial pain, but a nice AD response.
John
Posted by Ritch on April 16, 2002, at 9:18:39
In reply to Re: Help,Li vs. Zyprexa vs Lamictal for manic symptoms, posted by JohnX2 on April 16, 2002, at 0:44:14
> Lately I'm getting pins and needles in my hands.
> I think it is the topamax. I'm getting nervous about being on too many meds.
>
>
> Last time I took Serzone at a stronger dose it had a substantial anxiolytic response with absolutely no hypomania (very stable response), I was on no mood stabilizer at the time. Good AD response, and it completly alleviated my myofacial pain. No other AD pre mood-stabilizer did this (they all were non responders, or hypomanic response followed by poop-out). This time Serzone is not making feel the least bit drugged out (no cognitive impairment). Last time I felt drugged out and got into a fender-bender, so i quit the med.
>
> I'm just wondering if I can get my meds down to:
>
> Lamictal + Serzone
>
> before trying:
>
> Lamictal + Serzone + Topamax + Lithium.
>
> *Before* I added Serzone I had some wild hypomanic swings, this was shortly after topamax augmentation and during klonopin taper.
>
> I wish I could take Depakote, but it is a placebo for me. Trileptal gives me crushing myofacial pain, but a nice AD response.
>
> John
Hmmm. Well, Topamax gave me quite a bit of tingles-needles-pins (paresthesia) at just 50mg/day. You mentioned that TOP seemed to trigger hypomania at the higher doses, and Serzone seems to have some sustainable positive efect. Of course you have already found your Lamictal dose of 150mg/day. I think you are right about delaying the lithium trial for a while. It sounds like the next step would be to do just one thing: Start tapering the Topamax. The Serzone is helping your myofacial pain. It would be nice if it could do it on its own??good luck,
Tell us what happens either way.Mitch
Posted by Bekka H. on April 17, 2002, at 0:46:09
In reply to Re: Help,Li vs. Zyprexa vs Lamictal for manic symptoms, posted by rainbowlight on April 15, 2002, at 20:45:24
Hi Rainbow,
May I ask what you take to help you sleep? I tried Lamictal with other meds and by itself, and I had the worst insomnia. I will probably give Lamictal another try next month. Several people here have suggested either Neurontin or Klonopin at night to counteract the Lamictal-induced insomnia.
Thanks.
Bekka
Posted by JohnX2 on April 17, 2002, at 1:11:34
In reply to Re: Help,Li vs. Zyprexa vs Lamictal for manic symptoms » JohnX2, posted by Ritch on April 16, 2002, at 9:18:39
Hi Gang,Thanks for the feedback.
I'm going to 1st test out the
Lamictal + high dose Serzone combo + ditch/lower Topamax. Any doubting thomases?Just give it a quick 1-2 week run.
I haven't felt some of the good benefits I felt from my last Serzone trial at the stronger dose.I'm next to positive that the Topamax is the root of my hypomanic swings.
Its interesting that with the Lamictal in place, the Serzone does not make me feel dizzy or drugged out at all. Do you think this is because the Lamictal is guard banding the glutamate effects caused by Serzone? I know that Serzone last time kinda felt like when I started lamictal...hard to walk straight lines, dizzy, etc. Ramblings...
Also, I would like to know if Lamictal has serotonin reuptake properties. The Lamictal at doses above 150 mg induces myofacial pain (tension headaches, tight jaw) and flattens my mood. And this is consistent with medicines that are SSRIs (like Zoloft). Anyone know about this? If the Serzone blocks this, then I may be able to push my Lamictal to a higher dose for better mood stabilization....
Thanks for listening to my drivel.
John
> > Lately I'm getting pins and needles in my hands.
> > I think it is the topamax. I'm getting nervous about being on too many meds.
> >
> >
> > Last time I took Serzone at a stronger dose it had a substantial anxiolytic response with absolutely no hypomania (very stable response), I was on no mood stabilizer at the time. Good AD response, and it completly alleviated my myofacial pain. No other AD pre mood-stabilizer did this (they all were non responders, or hypomanic response followed by poop-out). This time Serzone is not making feel the least bit drugged out (no cognitive impairment). Last time I felt drugged out and got into a fender-bender, so i quit the med.
> >
> > I'm just wondering if I can get my meds down to:
> >
> > Lamictal + Serzone
> >
> > before trying:
> >
> > Lamictal + Serzone + Topamax + Lithium.
> >
> > *Before* I added Serzone I had some wild hypomanic swings, this was shortly after topamax augmentation and during klonopin taper.
> >
> > I wish I could take Depakote, but it is a placebo for me. Trileptal gives me crushing myofacial pain, but a nice AD response.
> >
> > John
>
>
> Hmmm. Well, Topamax gave me quite a bit of tingles-needles-pins (paresthesia) at just 50mg/day. You mentioned that TOP seemed to trigger hypomania at the higher doses, and Serzone seems to have some sustainable positive efect. Of course you have already found your Lamictal dose of 150mg/day. I think you are right about delaying the lithium trial for a while. It sounds like the next step would be to do just one thing: Start tapering the Topamax. The Serzone is helping your myofacial pain. It would be nice if it could do it on its own??
>
> good luck,
> Tell us what happens either way.
>
> Mitch
Posted by JohnX2 on April 17, 2002, at 1:15:04
In reply to Lamictal - rainbow light, posted by Bekka H. on April 17, 2002, at 0:46:09
> Hi Rainbow,
>
> May I ask what you take to help you sleep? I tried Lamictal with other meds and by itself, and I had the worst insomnia. I will probably give Lamictal another try next month. Several people here have suggested either Neurontin or Klonopin at night to counteract the Lamictal-induced insomnia.
>
> Thanks.
> BekkaHi Bekka,
Sorry to hear about the Lamictal failure.
You seemed to make it past the rash worry?Couple more augmentation ideas (the others are good too):
How about Remeron or Serzone augmentation?Take Care,
John
Posted by rainbowlight on April 17, 2002, at 17:39:42
In reply to Lamictal - rainbow light, posted by Bekka H. on April 17, 2002, at 0:46:09
I have to take Restoril to put me to sleep. I don't like the idea of being on a sleep med every night, but the Lamictal has worked so well for me that I figured it was worth it. I can't sleep on my own while on Lamictal, even if I take it in the morning.
Posted by judy1 on April 17, 2002, at 17:43:56
In reply to Re: Update , posted by JohnX2 on April 17, 2002, at 1:11:34
Wow, I would be higher than a kite on that combo. Lamictal made me hypomanic, well maybe manic and I can't take serzone. Topomax made me feel stupid- isn't that interesting that you had the opposite effect? Are you sure the serzone doesn't mess up your cycling? If you have pain, do any of the 'normal' pain-killers work? Like narcotics- also great AD. Take care, Judy
Posted by judy1 on April 17, 2002, at 17:46:38
In reply to Re: Update » JohnX2, posted by judy1 on April 17, 2002, at 17:43:56
Sorry! I didn't mean to be unsupportive. When I did that big study (STEP-BD) they were very into lamictal, so I'm sure it will work for you, and isn't it nice to have simplicity?- Take care again- Judy
Posted by JohnX2 on April 17, 2002, at 20:24:15
In reply to Re: Update » JohnX2, posted by judy1 on April 17, 2002, at 17:43:56
> Wow, I would be higher than a kite on that combo. Lamictal made me hypomanic, well maybe manic and I can't take serzone. Topomax made me feel stupid- isn't that interesting that you had the opposite effect? Are you sure the serzone doesn't mess up your cycling? If you have pain, do any of the 'normal' pain-killers work? Like narcotics- also great AD. Take care, Judy
Hi Judy,
*Thanks* for your support.
I seem to be one of a few "lone gun-man" on Topamax cognition. No stupidity. But at the strong dose it makes me very agitated and we have come to the conclusion that it fuels hypomania pretty bad. A great adjunct for depression. When I lower the dose I feel mild atypical depression and less agitation.
It seems as though my headaches/pain are exacerbated by serotonergic medicines. Zoloft was really bad. Serzone blocks nasty serotonin receptors, which then increases dopamine in an area of the brain where dopamine dampens contractions of facial muscles. Topamax and Klonopin help to, but they work by slowing serotonin conductance (SWAG). I grew tolerant to Klonopin, which was a Godsend when I found it (the pain was excruciating). A lot of people complain of SSRI induced tension headaches and bruxism (jaw tension).
Lamictal at the higher doses also does this to me; I don't know why but it does seem to have serotonergic properties from some reports that I have read. This limits my ability to push the Lamictal dose to 150 mg (so no hypomania). Maybe with more Serzone, I can push the Lamictal too...Serzone in the past has no bad manic or poop out for me (without a mood stabilizer, unique) and for some reason with Lamictal it isn't making me drugged out. Go figure. Last time on Serzone I was so drowsy and fender-bendered my car and said I would never touch it again. Strange how the meds interact.
So hope is higher Serzone will alleviate residual mild depression and pain, and ditch Topamax.
Just a turkey shoot. Pretty close to hitting the home stretch, if I need to do Lithium so be it, but I think this is worth a quick shot (less medicine is more..)
Never thought about narcotics...
Regards,
John
Posted by Bekka H. on April 17, 2002, at 20:58:47
In reply to Re: Lamictal - rainbow light » Bekka H., posted by JohnX2 on April 17, 2002, at 1:15:04
Hi John,
Well, I wouldn't say that I failed Lamictal or that it failed me -- yet. I'm going to give it another try in a few weeks, and I'm going to start with the baby tablets -- 2mg tablets! I know the titration will take an eternity, but I'd really like to make it work. Of all the drugs I've read about here and on other boards, Lamictal seems to have the most positive responses from the broadest range of people with the broadest range of diagnoses. If I get insomnia again, I might try Neurontin and/or Klonopin with the Lamictal, but I like to keep things simple. I'm a "poor metabolizer," so the less I take, the better. Thanks for mentioning the Remeron, etc. I will keep that in mind.
Bekka
Posted by Bekka H. on April 17, 2002, at 21:01:53
In reply to Bekka - I take Restoril, posted by rainbowlight on April 17, 2002, at 17:39:42
Hi Rainbow.
Thanks for the mention of the Restoril. I am keeping a folder with everyone's suggestions for Lamictal augmentation and/or sleep suggestions while on Lamictal because I'd really like to give it a fair trial. You sound like me as far as the insomnia goes. I even had insomnia on 12.5 mg!!!
Bekka
Posted by rainbowlight on April 17, 2002, at 21:53:20
In reply to Re: Bekka - I take Restoril -- rainbow light, posted by Bekka H. on April 17, 2002, at 21:01:53
After reading a ton of boards, I cannot believe my old pdoc started me on 50 mgs. of Lamictal and a few days later raised it to 100 mgs. Yikes! What was he thinking? I guess I got lucky, I didn't have a bad reaction to it. I only had the typical bad headache for a few days.
This is the end of the thread.
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