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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Peter on January 18, 2003, at 23:35:00
Hi all:
Well, My pdoc gave me a script for nortriptyline 5 days ago because I was so depressed and anxious and the lamictal I had been taking for months wasn't kicking in. The thing is, my mood suddenly started improving without my taking the nortrip. So I asked my doc what to do and he said my improving mood was probably a sign that the Lamictal was in fact helping me, but I had just needed a bit more time for the zoloft I had dropped the week before to get out of my system. In addition, I had just reduced my adderall by 10mg (40 to 30mg) the day before he prescribed the nortrip., so that reduction also might have been beginning to 'unmask' the lamictal benefits.
So he told me to NOT begin the nortrip., and see how I feel over the next week. However, within 2 more days, I started getting into that awful funk again, and I began to just get very irritable and depressed. So I have no idea what to do. I described in another post that my pdoc, whom I've been seeing since '97, has diagnosed me with cyclical moods-mild bipolar, but also differing degrees of SP and other anxieties. You see, at first we were hoping that the Lamictal could end up covering a broad spectrum of my symptoms and thus alleviating the need for me to take 7 meds-that it could simplify my cocktail.
On the other hand, a doc I went to recently for a consultation diagnosed me with 'depressive-anxiety' and NOT bipolar. My normal pdoc had said that I start getting impulsive and ovrdrinking after a few months on an SSRI because of a hypomanic switch. But the consultation doc said that's no real evidence that I'm bipolar-I could just react badly to long-term SSRI treatment-so she recommended that I try a TCA. It wasn't until the awful depression I was experiencing that my original pdoc sort of caved in and decided to go for the nortrip. with me-but he said that if his theory over the years is correct about my bipolarity, TCA's are WORSE than SSRI's when it comes to manic switches. So I just thought it would be best to put the nortrip aside and give the lamictal more time-that is, UNTIL these terrible day-to-day extreme depressive episodes started hitting me!
Now I'm considering just taking the damn pill so I could at least begin to be functional again. But I worry that if MY pdoc is right, even if I feel better for a spell, I might go ballistic or something after a few months. So I don't know what to do-if I should start the nortrip or try 'waiting it out' a bit longer with a chance that what I'm experiencing are just residual zoloft withdrawel symptoms or something (been off of zoloft for a bit over 2 weeks, and I'm only on 50mg lamictal). So I don't know if I'm experiencing severe bipolar swings (in which case taking the nortrip isn't a good idea) OR medication-induced mood swings (bad reaction to the lamictal, etc.), OR if I'm just very symptomatic now with varying degrees of depression/irritability/anxiety that are unrelated to bipolarity (which would correspond with what the consultation pdoc said). Any opinions? Likewise, does nortrip help with irritability or worsen it? Cause it's the really irritable kind of depression I've been experiencing lately. Thanks and sorry for the length.
Peter
Posted by Phil on January 19, 2003, at 0:09:01
In reply to Very Confused-need some advice, posted by Peter on January 18, 2003, at 23:35:00
I'm not bipolar so I can't be of a lot of help here. Still, from what I know of SSRI's, I agree with the consulting doc. If that's all your doc is basing his DX on, I'm skeptical.
Someone should be able to give you a more informed opinion here.
Phil
Posted by Ritch on January 19, 2003, at 9:41:45
In reply to Very Confused-need some advice, posted by Peter on January 18, 2003, at 23:35:00
> Hi all:
> Well, My pdoc gave me a script for nortriptyline 5 days ago because I was so depressed and anxious and the lamictal I had been taking for months wasn't kicking in. The thing is, my mood suddenly started improving without my taking the nortrip. So I asked my doc what to do and he said my improving mood was probably a sign that the Lamictal was in fact helping me, but I had just needed a bit more time for the zoloft I had dropped the week before to get out of my system. In addition, I had just reduced my adderall by 10mg (40 to 30mg) the day before he prescribed the nortrip., so that reduction also might have been beginning to 'unmask' the lamictal benefits.
> So he told me to NOT begin the nortrip., and see how I feel over the next week. However, within 2 more days, I started getting into that awful funk again, and I began to just get very irritable and depressed. So I have no idea what to do. I described in another post that my pdoc, whom I've been seeing since '97, has diagnosed me with cyclical moods-mild bipolar, but also differing degrees of SP and other anxieties. You see, at first we were hoping that the Lamictal could end up covering a broad spectrum of my symptoms and thus alleviating the need for me to take 7 meds-that it could simplify my cocktail.
> On the other hand, a doc I went to recently for a consultation diagnosed me with 'depressive-anxiety' and NOT bipolar. My normal pdoc had said that I start getting impulsive and ovrdrinking after a few months on an SSRI because of a hypomanic switch. But the consultation doc said that's no real evidence that I'm bipolar-I could just react badly to long-term SSRI treatment-so she recommended that I try a TCA. It wasn't until the awful depression I was experiencing that my original pdoc sort of caved in and decided to go for the nortrip. with me-but he said that if his theory over the years is correct about my bipolarity, TCA's are WORSE than SSRI's when it comes to manic switches. So I just thought it would be best to put the nortrip aside and give the lamictal more time-that is, UNTIL these terrible day-to-day extreme depressive episodes started hitting me!
> Now I'm considering just taking the damn pill so I could at least begin to be functional again. But I worry that if MY pdoc is right, even if I feel better for a spell, I might go ballistic or something after a few months. So I don't know what to do-if I should start the nortrip or try 'waiting it out' a bit longer with a chance that what I'm experiencing are just residual zoloft withdrawel symptoms or something (been off of zoloft for a bit over 2 weeks, and I'm only on 50mg lamictal). So I don't know if I'm experiencing severe bipolar swings (in which case taking the nortrip isn't a good idea) OR medication-induced mood swings (bad reaction to the lamictal, etc.), OR if I'm just very symptomatic now with varying degrees of depression/irritability/anxiety that are unrelated to bipolarity (which would correspond with what the consultation pdoc said). Any opinions? Likewise, does nortrip help with irritability or worsen it? Cause it's the really irritable kind of depression I've been experiencing lately. Thanks and sorry for the length.
> Peter
Peter, I would follow your current pdoc's advice about not taking the nortrip. just yet. From what you say in this post it really does sound like rapid-cycling bipolar. You mentioned dropping the Adderall a bit and things improving somewhat. It also sounds like SSRI's are setting you off badly as well. You might talk to your pdoc about another dose-reduction of your Zoloft (if you haven't stopped it already), and dropping your Adderall back to 20mg for a while and see if you improve some more. Hope this helps some..
Posted by Peter on January 19, 2003, at 14:39:14
In reply to Re: Very Confused-need some advice » Peter, posted by Ritch on January 19, 2003, at 9:41:45
> Peter, I would follow your current pdoc's advice about not taking the nortrip. just yet. From what you say in this post it really does sound like rapid-cycling bipolar. You mentioned dropping the Adderall a bit and things improving somewhat. It also sounds like SSRI's are setting you off badly as well. You might talk to your pdoc about another dose-reduction of your Zoloft (if you haven't stopped it already), and dropping your Adderall back to 20mg for a while and see if you improve some more. Hope this helps some..
> Hi Mitch:
The only problem is that the Adderall for the past year has been the only med that has helped me with my lack of motivation/lethargy/SP. And when I took it with the zoloft, I found that that they balanced out each others' negative effects-the SSRI took the agitation edge off the adderall, while the adderall decreased the impulsivity of the SSRI. But, the instability did come after a few months, and my impulsivity increased again. But at least it seemed like I was more on the right track than I am now! And I'm just sick of waiting while my mood keeps getting worse; the lamictal isn't doing crap and I'm cold/depressed/irritable/withdrawn/utterly lethargic & unmotivated. And I've been completely off the zoloft for over 2 weeks. I'm sorry for always being the victim on these posts and never the contributor.
Thanks for helping out, though-you always do,
Peter
Posted by Ritch on January 19, 2003, at 21:40:19
In reply to Re: Very Confused-need some advice » Ritch, posted by Peter on January 19, 2003, at 14:39:14
> > Peter, I would follow your current pdoc's advice about not taking the nortrip. just yet. From what you say in this post it really does sound like rapid-cycling bipolar. You mentioned dropping the Adderall a bit and things improving somewhat. It also sounds like SSRI's are setting you off badly as well. You might talk to your pdoc about another dose-reduction of your Zoloft (if you haven't stopped it already), and dropping your Adderall back to 20mg for a while and see if you improve some more. Hope this helps some..
> > Hi Mitch:
> The only problem is that the Adderall for the past year has been the only med that has helped me with my lack of motivation/lethargy/SP. And when I took it with the zoloft, I found that that they balanced out each others' negative effects-the SSRI took the agitation edge off the adderall, while the adderall decreased the impulsivity of the SSRI. But, the instability did come after a few months, and my impulsivity increased again. But at least it seemed like I was more on the right track than I am now! And I'm just sick of waiting while my mood keeps getting worse; the lamictal isn't doing crap and I'm cold/depressed/irritable/withdrawn/utterly lethargic & unmotivated. And I've been completely off the zoloft for over 2 weeks. I'm sorry for always being the victim on these posts and never the contributor.
> Thanks for helping out, though-you always do,
> Peter
>That's OK. You have a lot of similar symptoms that I have, so I want to see you do better, and wonder what will wind up working for you, because it may likely work for me as well! I got some similar effects with taking Adderall and Effexor (at much lower doses though), in regards to them "balancing" one another. It is like the Adderall does "hit" a particularly important circuit/pathway in a positive way, but it is like a bad keyboard player that gets the major and minor keys mixed up somehow. FWIW, you might *still* need a tiny dose of Zoloft (maybe 12.5mg every other day) for awhile to stay stable. The worst type of withdrawal I have ever experienced was trying to stop an SSRI. It wasn't "brain zaps" and all the usual stuff you hear about, it is more of an existential thing (a psychic thing), and it is like the "coldness/withdrawn" feelings you talk about. Perhaps a lower-dose continuation of the Zoloft/Adderall (with less "tweakiness") with the same dose of Lamictal given a little time and then see how you get along? No sense giving up totally on stuff that works, maybe just back off the dose to settle things? --Mitch
Posted by Peter on January 20, 2003, at 2:46:08
In reply to Re: Very Confused-need some advice » Peter, posted by Ritch on January 19, 2003, at 21:40:19
> That's OK. You have a lot of similar symptoms that I have, so I want to see you do better, and wonder what will wind up working for you, because it may likely work for me as well! I got some similar effects with taking Adderall and Effexor (at much lower doses though), in regards to them "balancing" one another. It is like the Adderall does "hit" a particularly important circuit/pathway in a positive way, but it is like a bad keyboard player that gets the major and minor keys mixed up somehow. FWIW, you might *still* need a tiny dose of Zoloft (maybe 12.5mg every other day) for awhile to stay stable. The worst type of withdrawal I have ever experienced was trying to stop an SSRI. It wasn't "brain zaps" and all the usual stuff you hear about, it is more of an existential thing (a psychic thing), and it is like the "coldness/withdrawn" feelings you talk about. Perhaps a lower-dose continuation of the Zoloft/Adderall (with less "tweakiness") with the same dose of Lamictal given a little time and then see how you get along? No sense giving up totally on stuff that works, maybe just back off the dose to settle things? --Mitch
> Yeah, Iknow what you mean. Coming off the zoloft so fast really sucked-felt like when I used to experience withdrawl from all sorts of nasty street drugs. I got an email back from my pdoc tonight, and he said I shouldn't take the nortrip.-that my sudden mood cycling even after a period of improvement is normal, andI shouldn't be surpised by it atleast until we get up to a higher dose of lamictal. So, he told me to up the lamictal from 50mg to 75mg starting tomorrow. He believes in the antidepressant AND stabilizing effects of lamictal-that they're sufficient to render the med somewhat of an equivalent of taking a mood stabilizer + an AD, but with much less of a chance of (hypo)mania-switching. Your idea about some low-dose zoloft in the interim sounds extremely sensible to me, but he wants me off the zoloft now completely. It's just gonna require more waiting, and I gotta hang in there. Oh-another thing about coming off the zoloft-those crazy electric shock sensations up the arms and legs (in addition to all the other stuff). Crazy. And I thought zoloft was supposed to be the easiest of the sri's to stop-except for maybe celexa. Interestingly, I never had such problems stopping paxil, which I think is supposed to be the worst for withdrawal. Oh well; since we share similar symptoms, have you ever tried lamictal?
Peter
Posted by Ritch on January 20, 2003, at 9:30:34
In reply to Re: Very Confused-need some advice » Ritch, posted by Peter on January 20, 2003, at 2:46:08
> > Yeah, Iknow what you mean. Coming off the zoloft so fast really sucked-felt like when I used to experience withdrawl from all sorts of nasty street drugs. I got an email back from my pdoc tonight, and he said I shouldn't take the nortrip.-that my sudden mood cycling even after a period of improvement is normal, andI shouldn't be surpised by it atleast until we get up to a higher dose of lamictal. So, he told me to up the lamictal from 50mg to 75mg starting tomorrow. He believes in the antidepressant AND stabilizing effects of lamictal-that they're sufficient to render the med somewhat of an equivalent of taking a mood stabilizer + an AD, but with much less of a chance of (hypo)mania-switching. Your idea about some low-dose zoloft in the interim sounds extremely sensible to me, but he wants me off the zoloft now completely. It's just gonna require more waiting, and I gotta hang in there. Oh-another thing about coming off the zoloft-those crazy electric shock sensations up the arms and legs (in addition to all the other stuff). Crazy. And I thought zoloft was supposed to be the easiest of the sri's to stop-except for maybe celexa. Interestingly, I never had such problems stopping paxil, which I think is supposed to be the worst for withdrawal. Oh well; since we share similar symptoms, have you ever tried lamictal?
> PeterNope, I haven't tried it. I think I would need to be seeing a different pdoc to get that one. I have had a few allergic skin reactions to meds in the past and my pdoc is hesitant (and I am a little uptight about taking it as well). I take Depakote and the mix of Dep/Lamictal is the most troublesome. I want to continue the Dep., regardless, so that adds to the safety issue of it for me. I'm getting by reasonably well on what I am taking now, so I don't really want to rock the boat a whole bunch. Fortunately, my depressions are seasonal and predictable, but it would be nice to take a "mood stabilizer" that had as good an antidepressant response as lithium did. Can't take lithium anymore. Lamictal would be the next logical choice.
Posted by Ilene on January 20, 2003, at 12:37:12
In reply to Re: Very Confused-need some advice » Peter, posted by Ritch on January 20, 2003, at 9:30:34
> > > Yeah, Iknow what you mean. Coming off the zoloft so fast really sucked-felt like when I used to experience withdrawl from all sorts of nasty street drugs. I got an email back from my pdoc tonight, and he said I shouldn't take the nortrip.-that my sudden mood cycling even after a period of improvement is normal, andI shouldn't be surpised by it atleast until we get up to a higher dose of lamictal. So, he told me to up the lamictal from 50mg to 75mg starting tomorrow. He believes in the antidepressant AND stabilizing effects of lamictal-that they're sufficient to render the med somewhat of an equivalent of taking a mood stabilizer + an AD, but with much less of a chance of (hypo)mania-switching. Your idea about some low-dose zoloft in the interim sounds extremely sensible to me, but he wants me off the zoloft now completely. It's just gonna require more waiting, and I gotta hang in there. Oh-another thing about coming off the zoloft-those crazy electric shock sensations up the arms and legs (in addition to all the other stuff). Crazy. And I thought zoloft was supposed to be the easiest of the sri's to stop-except for maybe celexa. Interestingly, I never had such problems stopping paxil, which I think is supposed to be the worst for withdrawal. Oh well; since we share similar symptoms, have you ever tried lamictal?
> > Peter
>
> Nope, I haven't tried it. I think I would need to be seeing a different pdoc to get that one. I have had a few allergic skin reactions to meds in the past and my pdoc is hesitant (and I am a little uptight about taking it as well). I take Depakote and the mix of Dep/Lamictal is the most troublesome. I want to continue the Dep., regardless, so that adds to the safety issue of it for me. I'm getting by reasonably well on what I am taking now, so I don't really want to rock the boat a whole bunch. Fortunately, my depressions are seasonal and predictable, but it would be nice to take a "mood stabilizer" that had as good an antidepressant response as lithium did. Can't take lithium anymore. Lamictal would be the next logical choice.
I'm new--this is my first post--but from my quick zip through these posts (sorry, not concentrating well right now)--I have some comments.I used to think I was just a treatment-resistant atypical depressive, but after reading up on bipolar II disorders I realize I have symptoms of "soft" bipolarity. Part of it is genetic (I'll go into this later if anyone is interested). Now I think SSRIs can be dangerous for some people and wonder if all those years on prozac, celexa, and some that I can't remember whether I actually took (zoloft? paxil?) made me worse. Prozac worked at first. It was great while it lasted. However, prozac threw a cyber-friend into psychosis.
So I think you shouldn't take SSRIs if there is *any *indication you are bipolar. It can be very hard to diagnose. You may not have overt mood swings. Dr. Phelps has a good site about this. (http://www.psycheducation.org/)
I was incapacitated for 3 days coming off Effexor. It doesn't seem that withdrawal from heroin could be any worse (don't know, never done it). Never had a problem w/ any other AD.
Now I'm doing 450 mg. wellbutrin, small doses of neurontin & amitryptyline at bedtime, and slowly increasing doses of lamictal. Tonight I go up to 100 mg. So far I haven't had any sides, but I'm not exactly the most functional human on the planet.
Oh yeah, I take 200 mg. provigil. Used to do dexedrine, but it eventually made me feel too disordered. Ritalin was the *worst*. It was like having squirrels in the brain.
BTW, wellbutrin (bupropion) seems to be the AD that bipolars tolerate well.
The horrible skin condition that lamictal causes is really really really horrible, but it's fairly rare. Also, use of lamictal as a mood stabilizer is still off-label AFAIK, and I think the dosages that epilectics (I think) use are much higher. I think.
Posted by Ritch on January 20, 2003, at 13:48:00
In reply to Re: Very Confused-need some advice, posted by Ilene on January 20, 2003, at 12:37:12
> > > > Yeah, Iknow what you mean. Coming off the zoloft so fast really sucked-felt like when I used to experience withdrawl from all sorts of nasty street drugs. I got an email back from my pdoc tonight, and he said I shouldn't take the nortrip.-that my sudden mood cycling even after a period of improvement is normal, andI shouldn't be surpised by it atleast until we get up to a higher dose of lamictal. So, he told me to up the lamictal from 50mg to 75mg starting tomorrow. He believes in the antidepressant AND stabilizing effects of lamictal-that they're sufficient to render the med somewhat of an equivalent of taking a mood stabilizer + an AD, but with much less of a chance of (hypo)mania-switching. Your idea about some low-dose zoloft in the interim sounds extremely sensible to me, but he wants me off the zoloft now completely. It's just gonna require more waiting, and I gotta hang in there. Oh-another thing about coming off the zoloft-those crazy electric shock sensations up the arms and legs (in addition to all the other stuff). Crazy. And I thought zoloft was supposed to be the easiest of the sri's to stop-except for maybe celexa. Interestingly, I never had such problems stopping paxil, which I think is supposed to be the worst for withdrawal. Oh well; since we share similar symptoms, have you ever tried lamictal?
> > > Peter
> >
> > Nope, I haven't tried it. I think I would need to be seeing a different pdoc to get that one. I have had a few allergic skin reactions to meds in the past and my pdoc is hesitant (and I am a little uptight about taking it as well). I take Depakote and the mix of Dep/Lamictal is the most troublesome. I want to continue the Dep., regardless, so that adds to the safety issue of it for me. I'm getting by reasonably well on what I am taking now, so I don't really want to rock the boat a whole bunch. Fortunately, my depressions are seasonal and predictable, but it would be nice to take a "mood stabilizer" that had as good an antidepressant response as lithium did. Can't take lithium anymore. Lamictal would be the next logical choice.
>
>
> I'm new--this is my first post--but from my quick zip through these posts (sorry, not concentrating well right now)--I have some comments.
>
> I used to think I was just a treatment-resistant atypical depressive, but after reading up on bipolar II disorders I realize I have symptoms of "soft" bipolarity. Part of it is genetic (I'll go into this later if anyone is interested). Now I think SSRIs can be dangerous for some people and wonder if all those years on prozac, celexa, and some that I can't remember whether I actually took (zoloft? paxil?) made me worse. Prozac worked at first. It was great while it lasted. However, prozac threw a cyber-friend into psychosis.
>
> So I think you shouldn't take SSRIs if there is *any *indication you are bipolar. It can be very hard to diagnose. You may not have overt mood swings. Dr. Phelps has a good site about this. (http://www.psycheducation.org/)
>
> I was incapacitated for 3 days coming off Effexor. It doesn't seem that withdrawal from heroin could be any worse (don't know, never done it). Never had a problem w/ any other AD.
>
> Now I'm doing 450 mg. wellbutrin, small doses of neurontin & amitryptyline at bedtime, and slowly increasing doses of lamictal. Tonight I go up to 100 mg. So far I haven't had any sides, but I'm not exactly the most functional human on the planet.
>
> Oh yeah, I take 200 mg. provigil. Used to do dexedrine, but it eventually made me feel too disordered. Ritalin was the *worst*. It was like having squirrels in the brain.
>
> BTW, wellbutrin (bupropion) seems to be the AD that bipolars tolerate well.
>
> The horrible skin condition that lamictal causes is really really really horrible, but it's fairly rare. Also, use of lamictal as a mood stabilizer is still off-label AFAIK, and I think the dosages that epilectics (I think) use are much higher. I think.
>
>
>Hi, welcome. I have read in Dr. Phelp's site quite a bit and I generally do agree with the philosophy regarding antidepressant use in bipolars (and personally get clearly hypomanic on standard doses of SSRI's). I just think it is a little "absolutist", and in the real world low doses of AD's (at times higher doses), are needed and often tolerated without trouble. FWIW, I can't handle Wellbutrin due to comorbid anxiety disorders. WB, also has precipitated hypomania, but much less so than SSRI's. So, how has your experience been with Provigil versus stimulants (can you be more specific)? thanks..
Posted by Peter on January 21, 2003, at 2:38:26
In reply to Re: Very Confused-need some advice, posted by Ilene on January 20, 2003, at 12:37:12
> I used to think I was just a treatment-resistant atypical depressive, but after reading up on bipolar II disorders I realize I have symptoms of "soft" bipolarity. Part of it is genetic (I'll go into this later if anyone is interested). Now I think SSRIs can be dangerous for some people and wonder if all those years on prozac, celexa, and some that I can't remember whether I actually took (zoloft? paxil?) made me worse. Prozac worked at first. It was great while it lasted. However, prozac threw a cyber-friend into psychosis.
> Yep-the SSRI's are certainly mysterious. For those of us w/soft bipolar-which is sometimes even difficult to distinguish from 'normal' mood swings-the SSRI's can be effective to an extent, even if only temporarily, and especially for those with comorbid anxiety, social phobia, etc..But many pdocs who believe in the 'bipolar spectrum' theory find that one's response to SSRI therapy can be a tell-tale sign of their being bipolar or no-i.e, if you flip out or get too impulsive, or, as one doctor put it to me 'too confident' (how ridiculous is that!) than you're immediately labled as bipolar; and if your swings aren't very evident, you get the DSMIV 'bipolar otherwise unspecified' diagnosis.
> So I think you shouldn't take SSRIs if there is *any *indication you are bipolar. It can be very hard to diagnose. You may not have overt mood swings. Dr. Phelps has a good site about this. (http://www.psycheducation.org/)
> I've heard of that site-gonna check it out. Thanks.
> I was incapacitated for 3 days coming off Effexor. It doesn't seem that withdrawal from heroin could be any worse (don't know, never done it). Never had a problem w/ any other AD.
> Yes, I've been fortunate enough to not experience full-blown withdrawal from effexor (only had a short trial with it), but I've heard it's the most difficult to come off of.
> Now I'm doing 450 mg. wellbutrin, small doses of neurontin & amitryptyline at bedtime, and slowly increasing doses of lamictal. Tonight I go up to 100 mg. So far I haven't had any sides, but I'm not exactly the most functional human on the planet.
> I tried Wellbutrin for a very short period, but gave it up 'cause I just felt agitated from it-perhaps it wasn't a fair trial. I just went up to 75mg lamictal today; BTW, do you find that with each dose increment there's an increase in irritability? I've heard this from others and I experience it myself-pretty annoying.
> Oh yeah, I take 200 mg. provigil. Used to do dexedrine, but it eventually made me feel too disordered. Ritalin was the *worst*. It was like having squirrels in the brain.
> I'm very curious about the provigil-I've really heard great things about it. I've taken stimulants and their extended-release versions (ritalin/concerta, adderall/adderallXR). I'm still taking 30mg adderall, but, while it's been beneficial in many ways, it seems that it agitates me when my mood is low-it sometimes just adds to my instability! I've mentioned provigil to my pdoc, and I don't think he's too keen on letting me check it out, though I've heard it's much smoother and 'cleaner' than 'mainstream' stims. What has your experience with it been like? Have you been taking it for ADD?
> The horrible skin condition that lamictal causes is really really really horrible, but it's fairly rare. Also, use of lamictal as a mood stabilizer is still off-label AFAIK, and I think the dosages that epilectics (I think) use are much higher. I think.
> Yes, the rash is supposed to be terrible, and for the first few months my hypochondriacal tendencies kicked in and I was paranoid at the slightest sign of rash. But, as you said, it's very rare; the chances of it occuring are greatly reduced with slow, gradual titration and a small starting dose. Also, to my relief, I learned that the really bad one covers the whole body and it's nasty-hives and sores all over. But if it doesn't happen within the first few weeks, all is usually well-especially for those using it off-label in lower-than-epilepsy doses, as you said. Once it works, I've heard great things about it, as being a real breakthrough for many for depression (bipolar or even treatment-resistant unilateral) and associated comorbid conditions (anxiety, SP), and, of course, mixed moods, cyclothymia, rapid-cycling and all those wonderful hard-to-treat elements of the bipolar realms.-I'm just waiting for the damn thing to kick in!
> Good to hear from you. Welcome!
> Peter
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