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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Maximus on August 2, 2002, at 21:32:26
Sorry for this reccurent subject,
But i just wanted to tell you the new orientation of my medecine. I talked to my pdoc at the end of the day. And she wants to re-challenge the Lamictal, but, with the Lithium this time. She said that the Lithium will keep the little agitation at bay.
At the end, she said that the new and modern treatment for the bipolar I-II disorder is definitively the combo Lamictal + Lithium. It is begining to be well established.
Anyway,
Thanks to you, i'll keep you in touch.
Posted by Squiggles on August 2, 2002, at 21:42:58
In reply to Lamictal, update, posted by Maximus on August 2, 2002, at 21:32:26
Interesting - i wonder what the advantage
of this augmentation is over the old
just lithium dose with Rivotril and/or some
other benzo.I will have to look up Lamictal as i know
nothing about it.Squiggles
Posted by Maximus on August 2, 2002, at 23:03:52
In reply to Re: Lamictal, update » Maximus, posted by Squiggles on August 2, 2002, at 21:42:58
> Interesting - i wonder what the advantage
> of this augmentation is over the old
> just lithium dose with Rivotril and/or some
> other benzo.Well, actually i can not speak for myself yet. "Fingers crossed". However, my pdoc went at so much conferences and contributed at many studies (in that direction), than i tend to believe her.
Grosso modo, here's why:
1- Lithium is "probably" the best anti-manic/hypomanic agent. Lithium is a very well known med. But the Lithium is also "so and so" (generally) for the depression. And Li does almost nothing for the "rapid cyclers". So many many bipolars need an antidepressant for their depression. Not a big deal.
2- Lamictal is without a doubt the best agent (anticonvulsant) for the bipolar depression. More and more studies tend to prove it. The side effect profile is indeed very low. Lamictal is also marvelous for the rapid cycling condition. But its anti-manic properties are weaker than Lithium.
3- There is absolutely no interaction between Lithium and Lamictal. In combo, we need a lower dose of each other. Moreover, in combo the need for a benzo is almost nil.
Their mechanism of action is extremely complicated. But the most important is their action on glutamate receptors via also their own mechanism.
But as you know, in psychiatry, there is no panacea and of course no "one fit for all".
Hope that helps!
Posted by Squiggles on August 2, 2002, at 23:10:19
In reply to Re: Lamictal, update » » Squiggles, posted by Maximus on August 2, 2002, at 23:03:52
Sounds good, with one serious reservation;
how do you get a person off Rivotril if
you have been using it as an adjunct instead
for many years - i almost killed myself
trying to get off and now have to raise the
dose;I grant you that starting the therapy this
way may indeed be an improvement, but for
old-timers it may prove fatal.Squiggles
Posted by Maximus on August 2, 2002, at 23:37:37
In reply to Re: Lamictal, update » » Squiggles » Maximus, posted by Squiggles on August 2, 2002, at 23:10:19
> Sounds good, with one serious reservation;
> how do you get a person off Rivotril if
> you have been using it as an adjunct instead
> for many years - i almost killed myself
> trying to get off and now have to raise the
> dose;While i'm not a doctor you may still need a benzo for your personal condition. But if you still need Rivotril, you don't have to discontinue it, no? As a general rule, we always get off from a benzo with the help of another benzo (yes) or better, an anticonvulsant. No offense (really), but getting off cold turkey from a benzo is very "amateur" from a doctor, imho of course.
> I grant you that starting the therapy this
> way may indeed be an improvement, but for
> old-timers it may prove fatal.Thanks to you. But you wrote "fatal". In what way exactly?
Thanks
Posted by Squiggles on August 2, 2002, at 23:46:45
In reply to Re: Lamictal, update » » Squiggles » , posted by Maximus on August 2, 2002, at 23:37:37
I am probably boring everyone to tears
in repeating my misadventure with trying
to get off Rivotril. I took 2 years to
do it; the dose was 1.0mg - minimum therapeutic;
I had been taking it for 15 years; near the end
i had a stroke/seizure episode that left
me seriously ill for a month - i won't go
into the gorry details but i can tell you if
you want.I did not have trouble getting of Xanax.
Both are benzos but the clonazepam was different;
My dr. never recommended me getting off Rivotril
but let me do my own thing so to speak - i was
not given something to get off with - i used
time (two years on the slow schedule).I think i was close to death with something
like encephalitis - still feel the remnant
effects after a yr. I refuse to go through that
again, and I hope my dr. is not influenced in
any way to make me.Squiggles
Posted by Maximus on August 3, 2002, at 0:09:11
In reply to Re: Lamictal, update » » Squiggles » » Maximus, posted by Squiggles on August 2, 2002, at 23:46:45
It is a scary story indeed. I'm glad you feel better today. Clonazepam is very nasty sometimes. The most potent and effective benzo, but at what cost...
Posted by Squiggles on August 3, 2002, at 0:14:01
In reply to Re: Lamictal, update » » Squiggles » » , posted by Maximus on August 3, 2002, at 0:09:11
There's something strange about it - i'm sure
of it, but i don't know what it is; I am
convinced that the chemist who first made it
knows - everyone says it is in the class of
benzodiazepines, and simply an anti-convulsant
like all the rest - but i am very doubtful of that;
i think it's different chemically - i wish
i could communicate with the scientist who
revised it from the older class of benzos.Squiggles
This is the end of the thread.
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