![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 38. Go back in thread:
Posted by Ritch on July 23, 2002, at 13:37:36
In reply to Re: Depakote, Lamictal Prozac??? » Ritch, posted by Geezer on July 23, 2002, at 12:15:57
> Hi Mitch,
>
> Thank you for the information about this complex situation. Its not a real heavy mix but difficult for me to figure out when I am sick and confused. I was not aware of the influence of various blood levels by using Lam. and Dep. at the same time, only aware of the slow titration of Lam. to avoid rash.
>
> In answer to your question about depressive symptoms. They are atypical, reactive, hypersomnia, limb ladency, etc. (no agitation or anxiety). Parnate was offered by new pdoc (probaby the right way to go) but he is not up to speed on Lam. and Dep. togeather. I wanted to try Prozac again because it had been so successful in the past, was not attracted to Parnate due to food restrictions (though no big deal), start-up side effects, and multiply daily dosing. Have to due a 6 to 8 week wash out now on the Prozac before going to Parnate (if I decide to do that). I DCed the Prozac this AM....just could not stand the dizziness and nausia any longer. Things seem slightly improved. I had a full trial on Zoloft (up to 200mg. for several weeks) about 8 months ago while on Dep. only.....no relief. I am about fed up with SSRIs. What would you think about a direct crossover to Wellbutrin? I tried it a year ago (prior to Dep.-never pushed the dose too high and not sure I took it long enough).
>
> Thanks for your help! Don't worry about comments - I clear everything with pdoc, he is pretty open and willing to work with me. Respect your opinion, follow your posts on the board, and I believe we have had correspondence in the past.
>
> Best regards
>
> Geezer
Hi,What you might want to do in the future.. is have a blood draw for *both* lamotrigine and Depakote (the exact same post dosing times, etc.), whenever you change medications (after a week or two), just to see if they are undulating around due to other unrelated med changes. Polypharmacy is a pain, huh? :) Just an idea here.. but I could *never* tolerate "therapeutic" doses of antidepressants of any kind. Just my own personal experience, but, smaller doses seem to work better (they are also less destabilizing). You could try the Wellbutrin and see how it goes. If you don't get agitated and anxious, you might find it helpful. I can't take much of it, however (too agitating and sleep disruptive). Since you stopped the Prozac, it will be a gentle, slow washout. You could try WB right off while the Prozac is washing out and see. If that bombs, you will at least have the Prozac out of your system, and the WB will wash out quicker than most others if you try the Parnate later on.
good luck,
Mitch
Posted by Geezer on July 23, 2002, at 14:14:35
In reply to Re: Depakote, Lamictal Prozac??? » Geezer, posted by Ritch on July 23, 2002, at 13:37:36
Thanks Mitch - always appreciate the help. Do you happen to know the blood level range for Lamictal?
Geezer
Posted by judy1 on July 23, 2002, at 17:59:06
In reply to Depakote, Lamictal Prozac???, posted by Geezer on July 22, 2002, at 18:40:49
Depakote is a depressing drug, prozac is infamous for mood instability and lamictal is excellent as monotherapy for bp2- try 200-300mg/day. Good luck, judy
Posted by Ritch on July 23, 2002, at 20:54:09
In reply to Re: Depakote, Lamictal Prozac??? » Ritch, posted by Geezer on July 23, 2002, at 14:14:35
> Thanks Mitch - always appreciate the help. Do you happen to know the blood level range for Lamictal?
>
> Geezer
Hi,
Evidently, blood levels are not routinely monitored for lamotrigine. I just checked the monograph for it. The only mention that comes close to your issue is the note that valproic acid decreases elmination of lamotrogine by about 50% and that maximum dose of lamotrigine with valproic acid is 150mg/day in two divided doses. Sounds like you are already there. I believe you can get a draw to show a baseline reading, and then have another draw done when you change medication. You mentioned dizziness while taking Prozac. Dizziness is probably one of the most common sfx with lamotrigine. Have you or your pdocs considered going with a three-way combo of VPA+Lamotrigine+Lithium?Mitch
Posted by Geezer on July 24, 2002, at 10:35:09
In reply to Re: Depakote, Lamictal Prozac???, posted by judy1 on July 23, 2002, at 17:59:06
> Depakote is a depressing drug, prozac is infamous for mood instability and lamictal is excellent as monotherapy for bp2- try 200-300mg/day. Good luck, judy
Thanks Judy,
I tried to start with Lamictal monotherapy in the beginning but due to some pdoc manipulation through a research program I find myself at my current situation. I will once again try slow reduction of Dep. Have you found any reports of people experiencing seizure with this approach - I have no history of seizures. Its a little difficult to know how to titrate down on Dep. and slowly titrate up on Lam.
Thanks for your help
Geezer
Posted by Geezer on July 24, 2002, at 10:40:54
In reply to Re: Depakote, Lamictal Prozac??? » Geezer, posted by Ritch on July 23, 2002, at 20:54:09
> > Thanks Mitch - always appreciate the help. Do you happen to know the blood level range for Lamictal?
> >
> > Geezer
>
>
> Hi,
> Evidently, blood levels are not routinely monitored for lamotrigine. I just checked the monograph for it. The only mention that comes close to your issue is the note that valproic acid decreases elmination of lamotrogine by about 50% and that maximum dose of lamotrigine with valproic acid is 150mg/day in two divided doses. Sounds like you are already there. I believe you can get a draw to show a baseline reading, and then have another draw done when you change medication. You mentioned dizziness while taking Prozac. Dizziness is probably one of the most common sfx with lamotrigine. Have you or your pdocs considered going with a three-way combo of VPA+Lamotrigine+Lithium?
>
> MitchMitch,
Thanks for doing the research....will discuss combo. with Pdoc.
Geezer
>
>
Posted by polarbear206 on July 24, 2002, at 15:14:13
In reply to Depakote, Lamictal Prozac???, posted by Geezer on July 22, 2002, at 18:40:49
Geezer,
I have been on Lamictal now for 5 months. This is a miricle drug for my bipolar 2. I have been able to wein down to very low doses of my ad's. I tried Lithium and Depakote in the past with no relief. My atypical depression was exacerbated with higher doses of the ssri's. The Maoi's in combo with Lamictal has a good success rate too. Is you bp depression dominated?? You may be on too many at the same time. The Lamictal has great antidepressant effects. I would continue to back off the Depakote and give the Lamictal a chance to work as your primary mood stabilizer. Could be polypharmacy working against you.
Posted by Geezer on July 24, 2002, at 16:01:02
In reply to Re: Depakote, Lamictal Prozac???, posted by polarbear206 on July 24, 2002, at 15:14:13
Hi polarbear,
Thanks so much for the reply re: Lamictal. Mitch and Judy have made very helpful suggestions as well. I think you have defined my next step...back off the Dep. slowly and see if the Lamictal holds well on its own. I could very well be "over stabilized" and it is difficult to see this (on my part) because the Depakote could be amplifing the atypical depressive symptoms from the Bipolar II. Anyhow, this would seem like the most conservative next step. Lithium (as both you and Mitch have mentioned) also has value-in low dose. I have taken Lith. before but it was always some pdoc that wanted to push it to the max.
You folks have no idea how much I appreciate the suggestions. This present episode has been going on for 13 months - getting a little difficult to hang on.
Thanks
Geezer
Posted by cybercafe on July 24, 2002, at 21:12:06
In reply to Re: Depakote, Lamictal Prozac??? » Ritch, posted by Geezer on July 23, 2002, at 12:15:57
Hey Geezer. I was taking Parnate once a day and had no side effects. Very easy drug to take -- and the diet isn't that big of a deal ... perhaps soy sauce is the most inconvenient
Posted by judy1 on July 24, 2002, at 22:26:17
In reply to Re: Depakote, Lamictal Prozac??? » judy1, posted by Geezer on July 24, 2002, at 10:35:09
I'm prone to seizures; I titrated down the depakote first before messing with lamictal doses hmmm- 1500mg depakote- I think about 250mg every 1-2 weeks. But I did it completely with my shrink's advice. Take care, judy
Posted by Fuscia on July 25, 2002, at 11:44:08
In reply to Re: Depakote, Lamictal Prozac??? » Geezer, posted by Ritch on July 22, 2002, at 21:53:25
Hi Mitch,
I was curious about the interaction as well and this is what I found at the rxlist monographs for valproate and lamotrigine.
"DEPAKOTE (Divalproex sodium) is a stable co-ordination compound comprised
of sodium valproate and valproic acid in a 1:1 molar relationship and formed
during the partial neutralization of valproic acid with 0.5 equivalent of sodium
hydroxide."Lamotrigine
http://www.rxlist.com/cgi/generic/lamotrigine_cp.htm"Valproic acid (VPA), however, actually decreases the clearance of
lamotrigine (i.e., more than doubles the elimination 11/2 of
lamotrigine),
whether given with or without EIAEDs.Accordingly, if lamotrigine is to
be
administered to a patient receiving VPA, lamotrigine must be given at a
reduced
dosage, less than half the dose used in patients not receiving VPA.""If taking Valproate concerning Lamactil (lamotrigine): In a steady-state study involving 10 healthy volunteers, the elimination half-life of lamotrigine increased from 26-70 hours with valproate co-administration (a 165% increase). The dose of lamotrigine should be reduced when co-administered with valproate.
Addition of Lamotrigine to a multi-drug regimen that includes VPA: dosage
reduction. Because VPA reduces the clearance of lamotrigine, the dosage of
lamotrigine in the presence of VPA is less than half of that required in its
absence."And other stuff of interest:
"CNS Effects: Sedative effects have occurred in patients receiving valproate
alone but occur most often in patients receiving combination therapy. Sedation
usually abates upon reduction of other antiepileptic medication."Geezer, I hope all goes well with you. As Mitch said, the worsening depression when attempting to lower Depakote could be just a withdrawal symptom as your brain tries to readjust, so hang in there. If you do try the Prozac again (assuming you have stopped taking it), and you still want to try it, then start out at a much lower dose than the recommended starting dose, which I believe is 20mg. Start out with 5mg or 10mg instead. This should help prevent the nausea and dizziness.
Take care, Fuscia
Posted by Ritch on July 25, 2002, at 19:17:21
In reply to Re: Depakote, Lamictal - Mitch and Geezer, posted by Fuscia on July 25, 2002, at 11:44:08
> Hi Mitch,
>
> I was curious about the interaction as well and this is what I found at the rxlist monographs for valproate and lamotrigine.
>
> "DEPAKOTE (Divalproex sodium) is a stable co-ordination compound comprised
> of sodium valproate and valproic acid in a 1:1 molar relationship and formed
> during the partial neutralization of valproic acid with 0.5 equivalent of sodium
> hydroxide."
>
> Lamotrigine
> http://www.rxlist.com/cgi/generic/lamotrigine_cp.htm
>
> "Valproic acid (VPA), however, actually decreases the clearance of
> lamotrigine (i.e., more than doubles the elimination 11/2 of
> lamotrigine),
> whether given with or without EIAEDs.Accordingly, if lamotrigine is to
> be
> administered to a patient receiving VPA, lamotrigine must be given at a
> reduced
> dosage, less than half the dose used in patients not receiving VPA."
>
> "If taking Valproate concerning Lamactil (lamotrigine): In a steady-state study involving 10 healthy volunteers, the elimination half-life of lamotrigine increased from 26-70 hours with valproate co-administration (a 165% increase). The dose of lamotrigine should be reduced when co-administered with valproate.
>
> Addition of Lamotrigine to a multi-drug regimen that includes VPA: dosage
> reduction. Because VPA reduces the clearance of lamotrigine, the dosage of
> lamotrigine in the presence of VPA is less than half of that required in its
> absence."
>
> And other stuff of interest:
>
> "CNS Effects: Sedative effects have occurred in patients receiving valproate
> alone but occur most often in patients receiving combination therapy. Sedation
> usually abates upon reduction of other antiepileptic medication."
>
> Geezer, I hope all goes well with you. As Mitch said, the worsening depression when attempting to lower Depakote could be just a withdrawal symptom as your brain tries to readjust, so hang in there. If you do try the Prozac again (assuming you have stopped taking it), and you still want to try it, then start out at a much lower dose than the recommended starting dose, which I believe is 20mg. Start out with 5mg or 10mg instead. This should help prevent the nausea and dizziness.
>
> Take care, Fuscia
>
Hi,Thanks for detailing that. That will be helpful information later on.
Mitch
Posted by Fuscia on July 26, 2002, at 20:42:18
In reply to Re: Depakote, Lamictal - Mitch and Geezer » Fuscia, posted by Ritch on July 25, 2002, at 19:17:21
Hi Ritch, not Mitch, and Hi Geezer,
Here is some more stuff on actions of Depakote and Lamictal
"Other Mood Stabilizing Agents
These new drugs (as well as the three mood stabilisers; lithium, valproic acid, and carbamazepine) are quite different from the antidepressants because they do not significantly increase levels of serotonin, dopamine, and norepinephrine in the brain. Instead, they seem to stimulate a transmitter substance called GABA (gamma-amino butyric acid) or inhibit a transmitter substance known as glutamate. GABA and glutamate are used by a large percentage of the nerves in the brain. The anticonvulsants that stimulate GABA tend to cause sleepiness. Medications in this category include valproic acid, as well as gabapentin (Neurontin), tiagabine (Gabitril), vigabatrin (Sabril), and several others. The anticonvulsants that inhibit glutamate tend to cause stimulation and anxiety. Medications in this category include felbamate (Felbatol), lamotrigine (Lamictal), topiramate (Topamax), and several others.
Although it is not known for certain why or how these drugs prevent epilepsy or stablize manic-depressive illness, it is known tha the GABA system and the glutamate system in the brain tend to compete with one another. This may be why drugs that stimulate GABA or inhibit glutamate are helful for epilepsy and for bipolar illness." From the book, Feeling Good, by David D. Burns, M.D.
GABA is one of the non-essential amino acids - that is, it can be made by the liver from other amino acids obtained from dietary sources. GABA acts as a neurotransmitter in the central nervous system. It is formed from another amino acid, glutamic acid. Its function is to decrease neuron activity and inhibit nerve cells from overfiring. Whereas the amino acid glutamic acid is an excitatory neurotransmitter that increases firing of neurons in the CNS." From the book, Prescription for Nutritional Healing, by Balch
This was informative for me for I didn't know that the different anticonvulsants used for mania in bi-polar disorder worked on either GABA or glutamate systems - I thought they all worked on the GABA system.
Take care, Fuscia
Posted by Geezer on July 26, 2002, at 21:11:15
In reply to Re: Depakote andLamictal actions- Ritch and Geezer, posted by Fuscia on July 26, 2002, at 20:42:18
Thanks Fuscia,
Maintained Lamictal at 100mg, D/Ced Prozac after 7 days (haven't been that sick for a long time). The big mistake was dropping Depakote to 500mg from 750mg. Took me out of the theraputic range and crashed very badly today. Your post is beginng to sink into my confused brain. I seem to need Lamictal and Depakote - if I could just overcome the terrable sedated feeling and bring the moderate depression under control.
I will answer your e-mail very soon.
Geezer
Posted by Ritch on July 27, 2002, at 8:55:41
In reply to Re: Depakote andLamictal actions- Ritch and Geezer, posted by Fuscia on July 26, 2002, at 20:42:18
> Hi Ritch, not Mitch, and Hi Geezer,
>
> Here is some more stuff on actions of Depakote and Lamictal
>
> "Other Mood Stabilizing Agents
>
> These new drugs (as well as the three mood stabilisers; lithium, valproic acid, and carbamazepine) are quite different from the antidepressants because they do not significantly increase levels of serotonin, dopamine, and norepinephrine in the brain. Instead, they seem to stimulate a transmitter substance called GABA (gamma-amino butyric acid) or inhibit a transmitter substance known as glutamate. GABA and glutamate are used by a large percentage of the nerves in the brain. The anticonvulsants that stimulate GABA tend to cause sleepiness. Medications in this category include valproic acid, as well as gabapentin (Neurontin), tiagabine (Gabitril), vigabatrin (Sabril), and several others. The anticonvulsants that inhibit glutamate tend to cause stimulation and anxiety. Medications in this category include felbamate (Felbatol), lamotrigine (Lamictal), topiramate (Topamax), and several others.
>
> Although it is not known for certain why or how these drugs prevent epilepsy or stablize manic-depressive illness, it is known tha the GABA system and the glutamate system in the brain tend to compete with one another. This may be why drugs that stimulate GABA or inhibit glutamate are helful for epilepsy and for bipolar illness." From the book, Feeling Good, by David D. Burns, M.D.
>
> GABA is one of the non-essential amino acids - that is, it can be made by the liver from other amino acids obtained from dietary sources. GABA acts as a neurotransmitter in the central nervous system. It is formed from another amino acid, glutamic acid. Its function is to decrease neuron activity and inhibit nerve cells from overfiring. Whereas the amino acid glutamic acid is an excitatory neurotransmitter that increases firing of neurons in the CNS." From the book, Prescription for Nutritional Healing, by Balch
>
> This was informative for me for I didn't know that the different anticonvulsants used for mania in bi-polar disorder worked on either GABA or glutamate systems - I thought they all worked on the GABA system.
>
> Take care, Fuscia
>
>
>Hi Fuscia,
That is the dilemma with most of the anticonvulsant antimanic agents-they make you generally calm, but tired and flat. I have got comorbid ADHD symptoms and higher doses of Depakote or Neurontin just "blank" me out cognitively. It is similar to taking a benzodiazepine at work and having to solve a complex problem. You need to be able to hold several things in your consciousness and to reason clearly and it is tough when you forget what you are doing every few minutes! If I try to take an "activating" antidepressant to compensate for it I sleep poorly and it worsens my cycling. If I take a stimulant I sleep OK, and I don't cycle, but I get panic! So, I can be attentive, but I am either more unstable or I am panicky. I think there is an underlying (more fundamental) mechanism to explain bipolar (other than it just like epilepsy, i.e.), which when "discovered" will bring more targeted medication without a lot of this hassle.
Mitch
Posted by cybercafe on July 27, 2002, at 11:23:20
In reply to Re: Depakote andLamictal actions- Ritch and Geezer » Fuscia, posted by Ritch on July 27, 2002, at 8:55:41
> That is the dilemma with most of the anticonvulsant antimanic agents-they make you generally calm, but tired and flat. I have got
hmm... have you tried lamotrigine? ... i heard it is supposed to be more antidepressant and less sedative like... though i havn't heard it being as good as gabapentin for anxiety
>comorbid ADHD symptoms and higher doses of Depakote or Neurontin just "blank" me out cognitively. It is similar to taking a benzodiazepine at work and having to solve a complex problem. You need to be able to hold several things in your consciousness and to
i'm curious as to whether you find gabapentin or depakote to be as bad as benzodiazepines in causing that stupor we all know and love
Posted by Ritch on July 27, 2002, at 11:55:55
In reply to Re: Depakote andLamictal actions- Ritch and Geezer, posted by cybercafe on July 27, 2002, at 11:23:20
> > That is the dilemma with most of the anticonvulsant antimanic agents-they make you generally calm, but tired and flat. I have got
>
> hmm... have you tried lamotrigine? ... i heard it is supposed to be more antidepressant and less sedative like... though i havn't heard it being as good as gabapentin for anxiety
>
> >comorbid ADHD symptoms and higher doses of Depakote or Neurontin just "blank" me out cognitively. It is similar to taking a benzodiazepine at work and having to solve a complex problem. You need to be able to hold several things in your consciousness and to
>
> i'm curious as to whether you find gabapentin or depakote to be as bad as benzodiazepines in causing that stupor we all know and love
>
>
Cyber,I haven't tried lamotrigine. The main reason is because I already have gotten skin reactions from other meds, and I already take allergy shots to prevent hives from dust and molds. Not only that, but if I got an even slight amount of itchiness or rash from it I would freak out and stop it (and it may have nothing to do with the drug). Also, I have heard stories about hypomania being induced by lamotrigine, and I definitely *need* a strong antimanic agent. That was why I went off gabapentin and back on depakote. Neurontin just wasn't controlling my temper and springtime hypomania, but just 250mg of depakote works like a charm---for that problem anyhow. I suppose I could add lamictal to my depakote, but that makes the rash thing more likely. Probably the best idea would be to add some lithium, but I can't tolerate the GI upset, and it causes *worse* cognitive problems than the depakote! Not to mention depressing thyroid function.. and I only have half a thyroid left. And my pdoc is afraid of T3/T4 augmentation.. and my TSH is about 1.4 anyways. I really wonder though if I could get my TSH down to about 1.0 if my cognitive symptoms would get better? Hmmm.
As far as cognitive sfx vis a vis Depakote, Neurontin, and benzos. Benzos are definitely the worst-oh yes! I can take just .25mg of Klonopin at work and I am just blitzed. Hey, I will tell you what: I'll list the meds that caused the most cognitive dysfunction with #1 being the worst:
1)Gabitril
2)Ativan + other higher dose benzos.
3)Remeron
4)Serzone (twice daily dosing)
5)Doxepin
6)Trazodone (just nighttime dosing)
7)Low-dose antipsychotics (any of them)
8)Lithium
9)Depakote
10) Gabapentin
Posted by cybercafe on July 28, 2002, at 1:18:07
In reply to Re: Depakote andLamictal actions- Ritch and Geezer » cybercafe, posted by Ritch on July 27, 2002, at 11:55:55
Thanks a lot for the info Ritch (Mitch?) ...I never realized antipsychotics caused less cognitive dysfunction (sedation?) than benzos or remeron
one thing i am really interested in following up on though -- where did you hear that lamotrigine can cause hypomania ?
cheers
cybercafe
Posted by colin wallace on July 28, 2002, at 4:54:14
In reply to Re: Depakote andLamictal actions- Ritch , posted by cybercafe on July 28, 2002, at 1:18:07
Cyber,
My psych. was unwilling to prescribe me lamotrigine due to its (supposed) capacity for causing hypomania.Was placed on depakote instead.
Personally, I believe the risks of becoming manic are much less with lamictal than with eg. prozac, but then again I'm not a psychiatrist.Col.
Posted by Ritch on July 28, 2002, at 10:17:06
In reply to Re: Depakote andLamictal actions- Ritch , posted by cybercafe on July 28, 2002, at 1:18:07
>
> Thanks a lot for the info Ritch (Mitch?) ...
>
> I never realized antipsychotics caused less cognitive dysfunction (sedation?) than benzos or remeron
>
> one thing i am really interested in following up on though -- where did you hear that lamotrigine can cause hypomania ?
>
> cheers
>
> cybercafe
>It's Mitch, but that is a long story! One thing to keep in mind about that "list" is it is based on my experiences, the doses vary a lot. IOW, If I could tolerate 100mg of Thorazine (i.e.), I would probably find it more than just a little difficult to do addition. However, it is easy for me to take a "standard" dose of a benzodiazepine, hence, it's position on the list. I heard about the lamotrigine induced mania here, so it is anecdotal of course. There may be some "formal" reporting of this in a medline abstract somewhere, but I don't know where it is. It is entirely possible that for some bipolar people, lamotrigine may not have a powerful enough of an antimanic effect to control a "natural" episode of mania or hypomania. It may not be "triggering" hypomania at all.
Mitch
Posted by Ron Hill on July 28, 2002, at 12:15:40
In reply to Re: Depakote andLamictal actions- Cybercafe, posted by colin wallace on July 28, 2002, at 4:54:14
> Personally, I believe the risks of becoming manic are much less with lamictal than with eg. prozac, but then again I'm not a psychiatrist.
You may not be a pdoc but IMHO you are correct.-- Ron
Posted by Fuscia on July 29, 2002, at 11:28:52
In reply to Re: Depakote andLamictal actions- Ritch and Geezer » Fuscia, posted by Ritch on July 27, 2002, at 8:55:41
I see and that is quite perplexing. Your name is Mitch from the post below, but I'm not sure if you go by Mitch or Ritch, but your input is "rich", Mitch .... ; )
I would think that if one were taking Depakote and Lamictal together, that dosing schedule might be important, such as taking Lamictal in morning and Depakote in the evening or bedtime. I'll have to read up more about these two drugs.
Since you are taking Depakote, have you ever thought about taking the amino acid tyrosine, which aids in mental alertness. Ask your doctor about this and try maybe a month's trial. L-Tyrosine should be taken on an empty stomach with 1,000mg of vitamin C and 50mg of vitamin B6 to help with absorption. Other suggestions would include L-glutamine, L-phenylalanine plus L-aspartic acid, taken as directed on an empty stomach. Take with water or juice. Do not take with milk. Addition of small amounts of vitamin C and vitamin B6 help with absorption. These amino acids are necessary for normal brain function, and also serve as fuel for the brain and prevent excess ammonia from damaging the brain. Caution: do not take phenylalanine if you suffer from panic attacks, diabetes, or high blood pressure. And another suggestion would be Dimethylaminoethanol (DMAE) as directed on label. Aids in memory and learning. Note: this supplement isn't intended for everyday use, but is best reserved for days when you need to be more focused and alert. Just some ideas.
I hope the best for you, Fuscia
Posted by Ritch on July 29, 2002, at 12:59:08
In reply to Re: Depakote and Lamictal actions- Ritch with an M, posted by Fuscia on July 29, 2002, at 11:28:52
> I see and that is quite perplexing. Your name is Mitch from the post below, but I'm not sure if you go by Mitch or Ritch, but your input is "rich", Mitch .... ; )
>
> I would think that if one were taking Depakote and Lamictal together, that dosing schedule might be important, such as taking Lamictal in morning and Depakote in the evening or bedtime. I'll have to read up more about these two drugs.
>
> Since you are taking Depakote, have you ever thought about taking the amino acid tyrosine, which aids in mental alertness. Ask your doctor about this and try maybe a month's trial. L-Tyrosine should be taken on an empty stomach with 1,000mg of vitamin C and 50mg of vitamin B6 to help with absorption. Other suggestions would include L-glutamine, L-phenylalanine plus L-aspartic acid, taken as directed on an empty stomach. Take with water or juice. Do not take with milk. Addition of small amounts of vitamin C and vitamin B6 help with absorption. These amino acids are necessary for normal brain function, and also serve as fuel for the brain and prevent excess ammonia from damaging the brain. Caution: do not take phenylalanine if you suffer from panic attacks, diabetes, or high blood pressure. And another suggestion would be Dimethylaminoethanol (DMAE) as directed on label. Aids in memory and learning. Note: this supplement isn't intended for everyday use, but is best reserved for days when you need to be more focused and alert. Just some ideas.
>
> I hope the best for you, Fuscia
Thanks for the ideas! I posted here a few months ago about craving Diet Coke (esp. when depressed), and we were wondering if it had to do with the aspartame and phenylalanine in the Diet Coke. The tyrosine sounds like a good try. I am already taking Flaxseed Oil and sublingual B-complex (which seems to help). I tried SAM-e for a while back in the spring and it seemed to make me a little too *wired*-especially in the mornings after I took it. So, that got stopped. Other things that seem to help: Eating smaller, more frequent meals (less carbs, more protein), intense cardiovascular exercise (more endorphins), midday sunlight exposure (whether it is summer or winter), and doing whatever it takes to get proper sleep (not too much or too little).As far as Lamictal and Depakote goes--I think that Lamictal can be dosed just once a day if the dose isn't too high (correct me anybody?), and I just take 250mg of Depakote at bedtime (no daytime dose). Your dosing idea sounds good (if both meds are at fairly low dosages). Perhaps 500mg of Depakote at bedtime + 100mg of Lamictal in the AM? Given that both being given together tend to elevate each other's blood levels that would probably put both of them in a "therapeutic range" for most bipolar folks.
Mitch
Posted by Ron Hill on July 29, 2002, at 16:11:04
In reply to Re: Depakote and Lamictal actions- Ritch with an M » Fuscia, posted by Ritch on July 29, 2002, at 12:59:08
Hi Mitch,
> ...I am already taking Flaxseed Oil and sublingual B-complex (which seems to help). I tried SAM-e for a while back in the spring and it seemed to make me a little too *wired*-especially in the mornings after I took it. So, that got stopped. Other things that seem to help: Eating smaller, more frequent meals (less carbs, more protein), intense cardiovascular exercise (more endorphins), midday sunlight exposure (whether it is summer or winter), and doing whatever it takes to get proper sleep (not too much or too little).
Everything you said in your paragraph above applies to me with one minor difference. For me, SAM-e worked wonderfully for five months, but then it began to induce episodes of flash rage. But everything else is exactly the same. A lot of us bipolar II folks travel common ground.
-- Ron
Posted by cybercafe on July 29, 2002, at 21:01:59
In reply to Re: Depakote and Lamictal actions- Ritch with an M » Fuscia, posted by Ritch on July 29, 2002, at 12:59:08
Hey Ritch, how much Flaxseed oil do you take?
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