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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Maximus on August 1, 2002, at 16:27:47
Hi,
My dx: bpII. (i.e. very few moments of hypomania but very often deep depressions).
I took Lamictal for 6 months with complete success, until anxiety spells and panic attacks strike me like a mad.
I was taking 200 mg of Lamictal. First, i tried to increase it. It was worse. Next, i tried to decrease it. It was a little bit better but still. After i added a benzo (rivotril) without success. Now i'm completely off Lamictal. The side effects are gone!!!
Lamictal is indeed a strange animal.
Actually i'm taking Effexor 150 mg a day and Rivotril (clonazepam) 1 mg a day. But i have to be on a mood stabilizer as soon as possible. I'm going to see my pdoc next week.
What is worried me is the choice of the mood stablizer. I've been on:
- Lithium: effective with an AD but i hated the blood drawns and weight gain.
- Neurontin: most expensive sugar pill. But it was relatively effective as an anti-anxiety med.
- Epival-Depakote: probably good for "hardcore" bipolars. But put me on eternal "zombification" without counting the weight gain.
- Topamax: never tried.
- New AP: never tried one of them.
Well, if you have any comments, experiences or suggestions, you're welcome.
Posted by Ron Hill on August 1, 2002, at 17:33:11
In reply to Lamictal, honey moon is over!, posted by Maximus on August 1, 2002, at 16:27:47
Colin,
I've previously wondered if Lamictal would affect you in a similar fashion as it has affected Maximus.
(Is the correct word "affect" or "effect"? I probably outta look that up.)
-- Ron
--------------> Hi,
>
> My dx: bpII. (i.e. very few moments of hypomania but very often deep depressions).
>
> I took Lamictal for 6 months with complete success, until anxiety spells and panic attacks strike me like a mad.
>
> I was taking 200 mg of Lamictal. First, i tried to increase it. It was worse. Next, i tried to decrease it. It was a little bit better but still. After i added a benzo (rivotril) without success. Now i'm completely off Lamictal. The side effects are gone!!!
>
> Lamictal is indeed a strange animal.
>
> Actually i'm taking Effexor 150 mg a day and Rivotril (clonazepam) 1 mg a day. But i have to be on a mood stabilizer as soon as possible. I'm going to see my pdoc next week.
>
> What is worried me is the choice of the mood stablizer. I've been on:
>
> - Lithium: effective with an AD but i hated the blood drawns and weight gain.
>
> - Neurontin: most expensive sugar pill. But it was relatively effective as an anti-anxiety med.
>
> - Epival-Depakote: probably good for "hardcore" bipolars. But put me on eternal "zombification" without counting the weight gain.
>
> - Topamax: never tried.
>
> - New AP: never tried one of them.
>
>
> Well, if you have any comments, experiences or suggestions, you're welcome.
>
>
>
>
>
Posted by utopizen on August 1, 2002, at 19:42:21
In reply to Lamictal, honey moon is over!, posted by Maximus on August 1, 2002, at 16:27:47
Neurontin, according to my p-doc, failed as a mood stablizer, but luckily I'm fortunate to have a boring, stable mood-- with anxiety.
It does wonders, I just take it as needed, 800mg/day, in the morning. But if I try it every day, after a week or two I'm just as anxious as usual until I give it a vacation. Wish that wasn't the case, because it's no science to how to dose it properly. One day, 800mg is super, maybe too much. Another two weeks worth of 800mg, and suddenly no feeling at all from it- and I don't know how many more hundreds to add, and when it'll take effect-- which ranges from 1-3 hrs.
Posted by Ritch on August 1, 2002, at 22:18:05
In reply to Lamictal, honey moon is over!, posted by Maximus on August 1, 2002, at 16:27:47
> Hi,
>
> My dx: bpII. (i.e. very few moments of hypomania but very often deep depressions).
>
> I took Lamictal for 6 months with complete success, until anxiety spells and panic attacks strike me like a mad.
>
> I was taking 200 mg of Lamictal. First, i tried to increase it. It was worse. Next, i tried to decrease it. It was a little bit better but still. After i added a benzo (rivotril) without success. Now i'm completely off Lamictal. The side effects are gone!!!
>
> Lamictal is indeed a strange animal.
>
> Actually i'm taking Effexor 150 mg a day and Rivotril (clonazepam) 1 mg a day. But i have to be on a mood stabilizer as soon as possible. I'm going to see my pdoc next week.
>
> What is worried me is the choice of the mood stablizer. I've been on:
>
> - Lithium: effective with an AD but i hated the blood drawns and weight gain.
>
> - Neurontin: most expensive sugar pill. But it was relatively effective as an anti-anxiety med.
>
> - Epival-Depakote: probably good for "hardcore" bipolars. But put me on eternal "zombification" without counting the weight gain.
>
> - Topamax: never tried.
>
> - New AP: never tried one of them.
>
>
> Well, if you have any comments, experiences or suggestions, you're welcome.
>
>
>
>
>Well, Depakote and Lithium is out due to weight gain right? You might lose weight on Topamax, but I don't think you will like its Fz (zombification factor)! Neurontin is too expensive.. Lamictal made you panic...
Hmm.. I would say give some generic Tegretol a try (carbamazepine).Mitch
Posted by Maximus on August 1, 2002, at 22:41:49
In reply to Re: Lamictal, honey moon is over! » Maximus, posted by Ritch on August 1, 2002, at 22:18:05
> Well, Depakote and Lithium is out due to weight gain right? You might lose weight on Topamax, but I don't think you will like its Fz (zombification factor)! Neurontin is too expensive.. Lamictal made you panic...
> Hmm.. I would say give some generic Tegretol a try (carbamazepine).
Well, Depakote is out of question but not Lithium. I did gain less weight with Li. Neurontin is simply and purely not a mood stabilizer. At best Neurontin is a good add-on as an anti-anxiety agent.
Tegretol. My pdoc did not mention it. Why? I don't know. May be the side effects are legion?
Thanks.
Posted by cybercafe on August 2, 2002, at 2:53:42
In reply to Re: Lamictal, honey moon is over!, posted by utopizen on August 1, 2002, at 19:42:21
> It does wonders, I just take it as needed, 800mg/day, in the morning. But if I try it every day, after a week or two I'm just as anxious as usual until I give it a vacation. Wish that wasn't the case, because it's no science to how to dose it properly. One day, 800mg is super, maybe too much. Another two weeks worth of 800mg, and suddenly no feeling at all from it- and I don't know how many more hundreds to add, and when it'll take effect-- which ranges from 1-3 hrs.
hmmm.. i actually went up to 2700 mg ....
.. i tell my doc it's a tardive placebo effect ...
Posted by cybercafe on August 2, 2002, at 2:55:27
In reply to Re: Lamictal, honey moon is over! » Maximus, posted by Ritch on August 1, 2002, at 22:18:05
> Well, Depakote and Lithium is out due to weight gain right? You might lose weight on Topamax, but I don't think you will like its Fz
weight gain is the only side effect of lithium??
i want some!!
Posted by Maximus on August 2, 2002, at 8:19:43
In reply to Re: Lamictal, honey moon is over!, posted by cybercafe on August 2, 2002, at 2:55:27
> weight gain is the only side effect of lithium??
Unfortunately. Thyroid problems occur as a "long term" side effect. There is also the annoying blood tests done every six months. Moreover, the lithium must be in a particular range, i.e., 0.6 -0.8 for an euthymic (normal) state and between 0.8 - 1.0 for a depressed or manic state.
And of course, you have to have your kidneys monitored because Lithium is a kind of toxic salt for the body.
All of that appear big but the protocol is not so bad if you are a good responder to Lithium. But keep in mind that lithium does nothing for a rapid cycler.
Posted by Ritch on August 2, 2002, at 10:12:18
In reply to Re: Lamictal, honey moon is over!, posted by Maximus on August 1, 2002, at 22:41:49
> > Well, Depakote and Lithium is out due to weight gain right? You might lose weight on Topamax, but I don't think you will like its Fz (zombification factor)! Neurontin is too expensive.. Lamictal made you panic...
> > Hmm.. I would say give some generic Tegretol a try (carbamazepine).
>
>
> Well, Depakote is out of question but not Lithium. I did gain less weight with Li. Neurontin is simply and purely not a mood stabilizer. At best Neurontin is a good add-on as an anti-anxiety agent.
>
> Tegretol. My pdoc did not mention it. Why? I don't know. May be the side effects are legion?
>
> Thanks.
>
>
Probably because you have to have blood work done to make sure you aren't developing a blood disorder (it has a rare propensity to cause that). Also, you will need to get a blood level to make sure it isn't too high (like lithium). But, the "real-world" hassles with Tegretol is mainly that its blood levels can skyrocket depending on what other medications you are taking (drug-drug interactions). There was a Navy vet in one of my classes at college who switched from lithium to Tegretol because he was complaining his memory (on his high lithium dose) was shot, and he claimed his mental functioning was better on Tegretol (but he didn't tell me what dose he was taking).Mitch
Posted by inertia on August 2, 2002, at 10:54:13
In reply to Re: Lamictal, honey moon is over!, posted by cybercafe on August 2, 2002, at 2:53:42
> > It does wonders, I just take it as needed, 800mg/day, in the morning. But if I try it every day, after a week or two I'm just as anxious as usual until I give it a vacation. Wish that wasn't the case, because it's no science to how to dose it properly. One day, 800mg is super, maybe too much. Another two weeks worth of 800mg, and suddenly no feeling at all from it- and I don't know how many more hundreds to add, and when it'll take effect-- which ranges from 1-3 hrs.
>
> hmmm.. i actually went up to 2700 mg ....
>
> .. i tell my doc it's a tardive placebo effect ...
>
I have Lamictal poop-out too. When you give it a vacation, how long do you wait until you start it again? You went up to 2700 mg? I think that's probably a world record! Did your pdoc know? At that level (2700 mg), did you have any side effects? The poop-out is very frustrating, but it's good to know that it works again if you give it a break? Does it still work as well as the first time you used it?
Posted by colin wallace on August 2, 2002, at 14:01:40
In reply to Re: Colin Wallace - Lamictal, posted by Ron Hill on August 1, 2002, at 17:33:11
>
> I've previously wondered if Lamictal would affect you in a similar fashion as it has affected Maximus.
> > -- RonYeah Ron,
I'm beginning to wonder, based on the info I've dug up, whether this med has the potential to cause me some anxiety/insomnia too.
Much of the info.I've unearthed seems a little contradictary concerning its activating properties.Some sources swear by its efficacy in treating bipolar11.
If I do trial lamictal, it will either be in conjunction with lithium , or singly. I'm very wary of combining it with depakote.
Incidentally,I wondered what dose of dep. did you take, and whether you experienced any eventualwithdrawal?(I'm at 400mg).
At this instant (8pm) I feel very addled and jittery- although I've been fine all day.
Undoubted (mild) SSRI withdrawal creeping in in waves-I recognize it!
Just tried to answer the above 'depakote insomnia' post, but I'm making too may mistakes and can't concentrate.Seeya soon,
Col.
ps. I'd go with 'affect', but grammar was never my strong point!
Posted by Geezer on August 2, 2002, at 17:33:51
In reply to Re: Colin Wallace - Lamictal, posted by colin wallace on August 2, 2002, at 14:01:40
Hi Colin,
Excuse me for jumping in here. I have been taking Lamictal 150mg. with Depakote 750mg. I can't say the Lamictal has done a d*** thing for me - maybe made me more of a "zombie" (total fatigue and depressed). I think your idea to try it alone or with Lith. would probably be wise. I have received no activating or AD effect from it. I tried adding Prozac (first 20mg/day then tried 10mg./day for depression).....what a disaster....got lots of nausea and dizziness.
As for my DX, 2 pdocs say unipolar major depression, 2 say bipolar II. In any case the ADs don't work and the ACs put me to sleep. Re: your effect/affect comment - may make a fool of myself here (haven't viewed the complete thread). Effect is the result of an action Ex: an AD may have a good effect on depression. Affect refers to mood Ex: Bipolar II is an affective mood disorder.
Best regards,
Geezer
Posted by colin wallace on August 2, 2002, at 17:55:57
In reply to Re: Colin Wallace - Lamictal » colin wallace, posted by Geezer on August 2, 2002, at 17:33:51
Hey Geezer,
>
> Excuse me for jumping in here. I have been taking Lamictal 150mg. with Depakote 750mg. I can't say the Lamictal has done a d*** thing for me - maybe made me more of a "zombie" (total fatigue and depressed). I think your idea to try it alone or with Lith. would probably be wise. I have received no activating or AD effect from it. I tried adding Prozac (first 20mg/day then tried 10mg./day for depression).....what a disaster....got lots of nausea and dizziness.Have you thought about maybe dropping the dose of depakote to see whether it may be stifling any AD effect that may or may not be being produced by the lamicatal?
Prozac sent me into the stratosphere
with a rocket up my ***...I didn't like that effect-not at all how I'd hoped it would affect me...he said, affectedly....
Aaaargh!! See what insomnia does to a guy...!
>
Still, it's good to know another member of the exclusive bipolar11 club.
Hope your depression lifts soon though.Cheers,
Col.
Posted by Maximus on August 2, 2002, at 18:39:12
In reply to Re: Colin Wallace - Lamictal » colin wallace, posted by Geezer on August 2, 2002, at 17:33:51
> Excuse me for jumping in here. I have been taking Lamictal 150mg. with Depakote 750mg. I can't say the Lamictal has done a d*** thing for me - maybe made me more of a "zombie" (total fatigue and depressed).
Hi Geezer,
Just a tip of mine, if you mind.
Lamictal increases the Depakote serum and the later decreases the Lamictal one. It is a fact and it is very well documented. So Lamictal + Depakote is really not a good idea. Finally, i'm pretty sure your big bad side effects were due to the augmentation of the Depakote serum (depression, lethargy, fatigue, etc). Try the Lamictal alone or in combination with Li. It is sure and effective.
Good Luck!
Posted by Geezer on August 2, 2002, at 21:23:04
In reply to Re: Lamictal » » Geezer, posted by Maximus on August 2, 2002, at 18:39:12
> > Excuse me for jumping in here. I have been taking Lamictal 150mg. with Depakote 750mg. I can't say the Lamictal has done a d*** thing for me - maybe made me more of a "zombie" (total fatigue and depressed).
>
> Hi Geezer,
>
> Just a tip of mine, if you mind.
>
> Lamictal increases the Depakote serum and the later decreases the Lamictal one. It is a fact and it is very well documented. So Lamictal + Depakote is really not a good idea. Finally, i'm pretty sure your big bad side effects were due to the augmentation of the Depakote serum (depression, lethargy, fatigue, etc). Try the Lamictal alone or in combination with Li. It is sure and effective.
>
> Good Luck!Thanks Maximus,
Can you tell me how bad the withdrawal is from the Depakote and would you think there would be a danger of convulsions (never had them before). Colin has indicated the same approach you recommend and I am grateful to you both. Just a little worried. I have been going through this mess for 13 months......its getting real old.
Thanks
Geezer
Posted by Maximus on August 2, 2002, at 21:58:56
In reply to Re: Lamictal » » Geezer » Maximus, posted by Geezer on August 2, 2002, at 21:23:04
> Can you tell me how bad the withdrawal is from the Depakote and would you think there would be a danger of convulsions (never had them before). Colin has indicated the same approach you recommend and I am grateful to you both. Just a little worried. I have been going through this mess for 13 months......its getting real old.
Well, from my short experience with Depakote (4 months at 750 mg), i got off completely of Depakote in 1 day. I had absolutely no problem to cease this med. In fact, i was better than ever (not hypomanic). Nope, no convulsion at all. If there is one thing i would "fear" (a little), it is the rebound of anxiety and/or hypomania. To be careful, take a benzo with you.
However, i think you might talk of your "project" to your doc/pdoc. We never know...
Good luck!
Posted by Ritch on August 3, 2002, at 0:39:44
In reply to Re: Colin Wallace - Lamictal, posted by colin wallace on August 2, 2002, at 14:01:40
>........ Incidentally,I wondered what dose of dep. did you take, and whether you experienced any eventualwithdrawal?(I'm at 400mg).
> At this instant (8pm) I feel very addled and jittery- although I've been fine all day....
Colin,Just an FYI, but VPA only has a half-life of 11-17 hrs or so. You might find that taking your Epilim in two divided doses of 200mg each might work better for you-i.e., 200mg at bedtime and 200mg 12 hrs. later.
Mitch
Posted by Ritch on August 3, 2002, at 0:46:32
In reply to Re: Lamictal » » Geezer » Maximus, posted by Geezer on August 2, 2002, at 21:23:04
> Can you tell me how bad the withdrawal is from the Depakote and would you think there would be a danger of convulsions (never had them before). Colin has indicated the same approach you recommend and I am grateful to you both. Just a little worried. I have been going through this mess for 13 months......its getting real old.
>
> Thanks
>
> Geezer
>
>Geezer,
The first time I withdrew from Depakote a neurologist told me to halve the dose first and stay at that dose for one week, then halve it again, until you get to 125mg/day, then do that for one week and you are done. So, if you are at 750mg/day.... you could drop to 500mg/day for five days, and then drop to 250mg/day for a week, and then to 125mg/day for another week, then to zero. Then you could start adding lithium or upping your Lamictal.
hope this helps,
Mitch
Posted by colin wallace on August 3, 2002, at 4:53:51
In reply to Re: Colin Wallace - Depakote withdrawal? » colin wallace, posted by Ritch on August 3, 2002, at 0:39:44
Hi Mitch,
>
> Just an FYI, but VPA only has a half-life of 11-17 hrs or so. You might find that taking your Epilim in two divided doses of 200mg each might work better for you-i.e., 200mg at bedtime and 200mg 12 hrs. later.
>
Thanks Mitch,I did try the 200mg divided dosed for a few days, but it really didn't feel so good at all.I actually woke at 4am with a completely 'dead' leg!No circulation at all,as if someone had tied a torniquet around my groin in my sleep.Never had that before(too active for circulatory probs).Lasted all day too.Wierd.
200mg caps the anger/levels things out, but I'd hoped as they are slow-release, I wouldn't get any probs.Still, as you say, its the half-life that's important.
Strange thing is, despite the startup hiccups(insomnia!! nightmare/wierd dreams/pins 'n needles) I'm feeling much better as a whole.If such a small dose as 200mg can hit the target, then great-otherwise I'll try 400mg divided, as of next week.Cheers Mitch,
Col.
Posted by Maximus on August 3, 2002, at 15:03:43
In reply to Re: Lamictal » » Geezer » Maximus » Geezer, posted by Ritch on August 3, 2002, at 0:46:32
> The first time I withdrew from Depakote a neurologist told me to halve the dose first and stay at that dose for one week, then halve it again, until you get to 125mg/day, then do that for one week and you are done.
A strange neurologist indeed! I bet they are all different. Anyway, the neurologist to who i spoke with, told me that you can get off of Valproate in 4 days (whatever your dose) only with absolutely no risk of convulsion.
Just another opinion.
Posted by Ron Hill on August 3, 2002, at 15:27:58
In reply to Re: Colin Wallace - Lamictal, posted by colin wallace on August 2, 2002, at 14:01:40
Hi Colin,
> Incidentally,I wondered what dose of dep. did you take, and whether you experienced any eventualwithdrawal?(I'm at 400mg).
At the time (roughly two and one-half years ago), I think was taking 750 mg/day of Depakote and 40 mg of Paxil. A great combo if the goal is weight gain and apathy. I did a cold turkey withdrawal and the SSRI withdrawal killed me; dizziness, nausea, insomnia, etc. I was very depressed on this combo and the depression continued after withdrawal, but did not seem to worsen.
I had determined that meds were not for me and I would be better off trying to get back to where I had been all of my life prior to starting meds, which focused on a rigorous daily exercise program to keep the depression demon at bay. But the depression and apathy continued (and exercise never started) so roughly four months after quitting the Depakote/Paxil my wife insisted that I see a new pdoc and he put me on Lithobid for the first time. That helped, but did not resolve my depression so I began trying various SSRI's and other AD's as an add-on to the Lithobid. Similarly to your experience with AD's, they would work at first but then leave me high and dry with anhedonia and anergy. I played that game for a little over a year and then last fall my pdoc told me to try SAM-e. You know the story from that point on.
As an aside, here is my layman's hunch of why SAM-e worked wonderfully for five months and then started to induce irritability and flash rage: I wonder if long term SSRI use reduces dopamine levels in some patients and SAM-e functions to restore said levels to normal. However, once fully restored, additional SAM-e consumption becomes detrimental because it begins to raise the dopamine (and/or norapinphrine?) level(s) too high. Well there you have it; the latest Dr. Ron (a.k.a. Dr. BS) theory.
Colin, although I've posted the story here in years past, I don't know if I have ever shared with you how I was initially introduced to psychotropic medication six years ago by idiotic pdoc who, without conducting any formal testing or screening, decided I was ADHD and stared feeding me (a bipolar II) Ritalin and Paxil. I think he misdiagnosed me as ADHD based primarily on the fact that I was hyperactive as a child. I guess he was not a believer in the existence of Childhood On-set Bipolar Disorder (which is applicable to me). The resulting mania derailed my career and, generally speaking, screwed up my life. The mania felt really good, but all the while I was flushing my career etc down the toilet. I was single (never married) at the time and convinced that I could do no wrong. NOT!!
I'm happy to be on level ground with 600 mg/day Lithobid. I reiterate my story here periodically solely in hopes that a reader of the post might be spared the pain of this type of misdiagnosis.
-- Ron
Posted by Ritch on August 3, 2002, at 22:11:46
In reply to Re: Lamictal » » Ritch, posted by Maximus on August 3, 2002, at 15:03:43
> > The first time I withdrew from Depakote a neurologist told me to halve the dose first and stay at that dose for one week, then halve it again, until you get to 125mg/day, then do that for one week and you are done.
>
> A strange neurologist indeed! I bet they are all different. Anyway, the neurologist to who i spoke with, told me that you can get off of Valproate in 4 days (whatever your dose) only with absolutely no risk of convulsion.
>
> Just another opinion.I should have clarified things. The neurologist I was seeing wasn't worried about *seizures* as a result of stopping Depakote, he was concerned about agitation and anxiety as a result, which did occur despite the downward titration.
Mitch
This is the end of the thread.
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