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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 Peter on October 15, 2002, at 13:26:36
Hi all:
Things have really sucked lately. I'm soft bipolar w/more depressive features/SP/ADD/panic, and who knows what else. I've tried just about everything over the last 8 years and can't seem to settle on a med regime once and for all. I was doing ok for the last few months on zoloft 100mg/depakote 750mg/klonopin 2mg/adderall 50mg/ambien 5-10mg combo until I started cycling -my sleep got awful, and my mood deteriorated. So first my pdoc decided to target my sleep problems and prescribed 30mg restoril which seemed to make things worse. Then he upped my klonopin so I'm now taking 3mg altogether at bedtime, and .5mg during the day. I was getting to bed at 6-7a.m. My doctor decided to add lithium (eskalith), which after a few days gave me extreme tremors, nausea, and weakness. So since I'd already tried Neurontin (didn't work), depakote, and Lithium, my pdoc and I decided lamictal would be a good choice as far as something that targets biploars w/dominant depressive features-wow, maybe even as a monotherapy drug! The problem is that he said I'd have to first taper down to a tiny amount of my zoloft before starting lamictal, since the lamictal and zoloft actions would overlap in a bad way. I had been on zoloft for almost a year, and within my first 4 days of taper, I became almost suicidal. So I upped the dose from 50 to 75mg-I couldn't handle the taper. Now I don't know what to do. I've resumed 30mg restoril + 3mg klonopin + 5mg ambien + 3mg melatonin every night. In my opinion, the zoloft/adderall combo has helped my day-to-day symptoms (social phobia, depression) more than anything else I've tried. Yet, it's this overarching, bipolar tendency lurking in the background that leaps upon me sporadically and puts everything out of wack that's the main problem. Obviously the depakote is tolerable but not effective enough. Considering the situation with the lithium and the problems with starting lamictal, I did some research and came upon Trileptal. The APA seems like it's very supportive of the drug for bipolar mania/mixed/maintenance. It has a low side-effect profile (much lower than Tegratol, from which it was derived), no known drug interactions with antidepressants or depakote, no bloodtests required, and is considered by many at least as if not more effective than Tegratol. So, in this way, I can begin it immediately,and stay on zoloft+adderall, with a chance that it would help my bp better than depakote (or maybe use it in conjunction with depakote). Does anyone have any input for me about this idea (which I plan to introduce to my pdoc at tomorrow's session), or any positive experiences on Trileptal?
Thanks in advance,
Peter
Posted by JohnX2 on October 15, 2002, at 17:26:48
In reply to HELP-I'm sick of this! Trileptal as last resort?, posted by Peter on October 15, 2002, at 13:26:36
Peter,Trileptal was the best antidepressant and antianxiety medicine of all the AEDs I tried.
Unfortunately it triggered a quirk I had with
regards to headaches. Worth a quick trial.
A robust AD response doesn't seem to be the norm
however; more a mood stabilizer.Do you know if Trileptal can be taken with
Serzone? I thought maybe there is a drug
interaction. The Serone fixes my headaches.Take Care.
> Hi all:
> Things have really sucked lately. I'm soft bipolar w/more depressive features/SP/ADD/panic, and who knows what else. I've tried just about everything over the last 8 years and can't seem to settle on a med regime once and for all. I was doing ok for the last few months on zoloft 100mg/depakote 750mg/klonopin 2mg/adderall 50mg/ambien 5-10mg combo until I started cycling -my sleep got awful, and my mood deteriorated. So first my pdoc decided to target my sleep problems and prescribed 30mg restoril which seemed to make things worse. Then he upped my klonopin so I'm now taking 3mg altogether at bedtime, and .5mg during the day. I was getting to bed at 6-7a.m. My doctor decided to add lithium (eskalith), which after a few days gave me extreme tremors, nausea, and weakness. So since I'd already tried Neurontin (didn't work), depakote, and Lithium, my pdoc and I decided lamictal would be a good choice as far as something that targets biploars w/dominant depressive features-wow, maybe even as a monotherapy drug! The problem is that he said I'd have to first taper down to a tiny amount of my zoloft before starting lamictal, since the lamictal and zoloft actions would overlap in a bad way. I had been on zoloft for almost a year, and within my first 4 days of taper, I became almost suicidal. So I upped the dose from 50 to 75mg-I couldn't handle the taper. Now I don't know what to do. I've resumed 30mg restoril + 3mg klonopin + 5mg ambien + 3mg melatonin every night. In my opinion, the zoloft/adderall combo has helped my day-to-day symptoms (social phobia, depression) more than anything else I've tried. Yet, it's this overarching, bipolar tendency lurking in the background that leaps upon me sporadically and puts everything out of wack that's the main problem. Obviously the depakote is tolerable but not effective enough. Considering the situation with the lithium and the problems with starting lamictal, I did some research and came upon Trileptal. The APA seems like it's very supportive of the drug for bipolar mania/mixed/maintenance. It has a low side-effect profile (much lower than Tegratol, from which it was derived), no known drug interactions with antidepressants or depakote, no bloodtests required, and is considered by many at least as if not more effective than Tegratol. So, in this way, I can begin it immediately,and stay on zoloft+adderall, with a chance that it would help my bp better than depakote (or maybe use it in conjunction with depakote). Does anyone have any input for me about this idea (which I plan to introduce to my pdoc at tomorrow's session), or any positive experiences on Trileptal?
> Thanks in advance,
> Peter
Posted by polarbear206 on October 15, 2002, at 20:09:17
In reply to HELP-I'm sick of this! Trileptal as last resort?, posted by Peter on October 15, 2002, at 13:26:36
> Hi all:
> Things have really sucked lately. I'm soft bipolar w/more depressive features/SP/ADD/panic, and who knows what else. I've tried just about everything over the last 8 years and can't seem to settle on a med regime once and for all. I was doing ok for the last few months on zoloft 100mg/depakote 750mg/klonopin 2mg/adderall 50mg/ambien 5-10mg combo until I started cycling -my sleep got awful, and my mood deteriorated. So first my pdoc decided to target my sleep problems and prescribed 30mg restoril which seemed to make things worse. Then he upped my klonopin so I'm now taking 3mg altogether at bedtime, and .5mg during the day. I was getting to bed at 6-7a.m. My doctor decided to add lithium (eskalith), which after a few days gave me extreme tremors, nausea, and weakness. So since I'd already tried Neurontin (didn't work), depakote, and Lithium, my pdoc and I decided lamictal would be a good choice as far as something that targets biploars w/dominant depressive features-wow, maybe even as a monotherapy drug! The problem is that he said I'd have to first taper down to a tiny amount of my zoloft before starting lamictal, since the lamictal and zoloft actions would overlap in a bad way. I had been on zoloft for almost a year, and within my first 4 days of taper, I became almost suicidal. So I upped the dose from 50 to 75mg-I couldn't handle the taper. Now I don't know what to do. I've resumed 30mg restoril + 3mg klonopin + 5mg ambien + 3mg melatonin every night. In my opinion, the zoloft/adderall combo has helped my day-to-day symptoms (social phobia, depression) more than anything else I've tried. Yet, it's this overarching, bipolar tendency lurking in the background that leaps upon me sporadically and puts everything out of wack that's the main problem. Obviously the depakote is tolerable but not effective enough. Considering the situation with the lithium and the problems with starting lamictal, I did some research and came upon Trileptal. The APA seems like it's very supportive of the drug for bipolar mania/mixed/maintenance. It has a low side-effect profile (much lower than Tegratol, from which it was derived), no known drug interactions with antidepressants or depakote, no bloodtests required, and is considered by many at least as if not more effective than Tegratol. So, in this way, I can begin it immediately,and stay on zoloft+adderall, with a chance that it would help my bp better than depakote (or maybe use it in conjunction with depakote). Does anyone have any input for me about this idea (which I plan to introduce to my pdoc at tomorrow's session), or any positive experiences on Trileptal?
> Thanks in advance,
> PeterPeter,
I don't understand why your pdoc won't let you start the Lamictal at the same time with tapering the Zoloft? You need to taper very slowly down on the Zoloft. A 50mg drop is too much. Try dropping to 75mg. I started to taper on my antidepressant after I went up to 25mg of Lamictal twice a day. I was on 100mg of Imipramine and 15mg of Paxil when I started the Lamictal. You have to be very patient also with titrating the Lamictal. This drug has done wonders for my "soft" bipolar. I've been on it since spring. I'm down to 50mg of Imipramine and 7.5mg of Paxil. I'm up to 100mg of Lamictal daily.
Laura
Posted by McPac on October 15, 2002, at 20:26:59
In reply to HELP-I'm sick of this! Trileptal as last resort?, posted by Peter on October 15, 2002, at 13:26:36
"The problem is that he said I'd have to first taper down to a tiny amount of my zoloft before starting lamictal, since the lamictal and zoloft actions would overlap in a bad way."
>>>>>>>>>>>>>>Lamictal will allow you to take LESS Zoloft and still get the positive Zoloft effect (it 'magnifies' Zoloft, so to speak, so, for instance, a much smaller Zoloft dose will still give you good results). Many people can greatly lower their Zoloft dose when taking Lamictal for that reason. Ask your Dr. to let you begin the Lamictal while still taking 50 mg. of Zoloft; then, as you raise the Lamictal you can try lowering the Zoloft.
Posted by Peter on October 16, 2002, at 2:43:35
In reply to Re: HELP-I'm sick of this! Trileptal as last resort? » Peter, posted by JohnX2 on October 15, 2002, at 17:26:48
> Do you know if Trileptal can be taken with
> Serzone? I thought maybe there is a drug
> interaction. The Serone fixes my headaches.
>
> Take Care.
>
Hi John:
"Trileptal may be safely combined with Lamictal, Depakote, and lithium, as well as with antidepressants and antipsychotic medications" (http://www.bipolarchild.com/newsletters/0108.html). There's also a cool site which has both a great article about trileptal AND further links to legit APA clinical resources treatment guidlines that support the claims of trileptal safety profile and efficacy for bipolar. I'm sure those links further touch upon trileptal's interactions with other drugs. Here's the article-the links are at the end past the conclusion: http://www.psycheducation.org/depression/meds/trileptal.htm
BTW, did you actually find an anti-anxiety effect with the trileptal? In what way? Was it like a Neurontin dulling/spaced-out/detached/I don't care type of way,or more of a non-sedating relief of anxiety? I'm taking klonopin And depakote AND restoril, and, honestly, the dulling, sedating effects leave me worse off than the anxiety I'm trying to treat!
All the best,
Peter
Posted by Peter on October 16, 2002, at 13:07:15
In reply to Re: HELP-I'm sick of this! Trileptal as last resort?, posted by polarbear206 on October 15, 2002, at 20:09:17
> I don't understand why your pdoc won't let you start the Lamictal at the same time with tapering the Zoloft? You need to taper very slowly down on the Zoloft. A 50mg drop is too much. Try dropping to 75mg. I started to taper on my antidepressant after I went up to 25mg of Lamictal twice a day. I was on 100mg of Imipramine and 15mg of Paxil when I started the Lamictal. You have to be very patient also with titrating the Lamictal. This drug has done wonders for my "soft" bipolar. I've been on it since spring. I'm down to 50mg of Imipramine and 7.5mg of Paxil. I'm up to 100mg of Lamictal daily.
>
> Laura
>Hi Laura:
Quick question: you said 'you have to be very patient with titrating the lamictal.' How long did it take for you until the Lamictal started working? (specifically at the rate you were titrating it, adding it to the AD's you were taking, which is what I would be doing if my pdoc agrees to start it up while I'm still taking zoloft)?
Thanks alot for your help,
Peter
Posted by polarbear206 on October 16, 2002, at 16:15:56
In reply to Re: HELP-I'm sick of this! Trileptal as last resor, posted by Peter on October 16, 2002, at 13:07:15
> > I don't understand why your pdoc won't let you start the Lamictal at the same time with tapering the Zoloft? You need to taper very slowly down on the Zoloft. A 50mg drop is too much. Try dropping to 75mg. I started to taper on my antidepressant after I went up to 25mg of Lamictal twice a day. I was on 100mg of Imipramine and 15mg of Paxil when I started the Lamictal. You have to be very patient also with titrating the Lamictal. This drug has done wonders for my "soft" bipolar. I've been on it since spring. I'm down to 50mg of Imipramine and 7.5mg of Paxil. I'm up to 100mg of Lamictal daily.
> >
> > Laura
>
> >Hi Laura:
> Quick question: you said 'you have to be very patient with titrating the lamictal.' How long did it take for you until the Lamictal started working? (specifically at the rate you were titrating it, adding it to the AD's you were taking, which is what I would be doing if my pdoc agrees to start it up while I'm still taking zoloft)?
> Thanks alot for your help,
> Peter
>
>
>Peter,
I noticed it was starting to take hold after about 2 weeks. I took 25mg for 1 week, then up to 50mg. Many people get a initial boost right away. This often will fade some in the begining. That's why I said about being patient for a true therapuetic response. Most of us lower the a/d's after 2 weeks of increasing the Lamictal. This drug works great for me. NO side effects. NO weight gain.
Laura.
Posted by JohnX2 on October 17, 2002, at 15:03:26
In reply to Re: HELP-I'm sick of this! Trileptal as last resor » JohnX2, posted by Peter on October 16, 2002, at 2:43:35
> > Do you know if Trileptal can be taken with
> > Serzone? I thought maybe there is a drug
> > interaction. The Serone fixes my headaches.
> >
> > Take Care.
> >
> Hi John:
> "Trileptal may be safely combined with Lamictal, Depakote, and lithium, as well as with antidepressants and antipsychotic medications" (http://www.bipolarchild.com/newsletters/0108.html). There's also a cool site which has both a great article about trileptal AND further links to legit APA clinical resources treatment guidlines that support the claims of trileptal safety profile and efficacy for bipolar. I'm sure those links further touch upon trileptal's interactions with other drugs. Here's the article-the links are at the end past the conclusion: http://www.psycheducation.org/depression/meds/trileptal.htm
> BTW, did you actually find an anti-anxiety effect with the trileptal? In what way? Was it like a Neurontin dulling/spaced-out/detached/I don't care type of way,or more of a non-sedating relief of anxiety? I'm taking klonopin And depakote AND restoril, and, honestly, the dulling, sedating effects leave me worse off than the anxiety I'm trying to treat!
> All the best,
> PeterIt's hard for me to sometimes differentiate between
agitation and anxiety, but I definately felt some sort of "Gabaergic" like effect on the Trileptal.
But medicine didn't make me drowsy. It seemed to clear up my racing thoughts which was good for me
and gave me more focus as a result.I have a good friend who is on the sister med Tegetrol and he has both epilepsy and panic attacks/GAD. He told me when the neuro upped the
dose to a certain point (prescribed for epilepsy) the medicine also substantially helped with the
panic/anxiety.Just a few anecdotal reports..
Good Luck
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