![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 45. Go back in thread:
Posted by Ritch on February 26, 2003, at 10:16:12
In reply to Re: Lamictal and Pre-emptive Strikes » Ritch, posted by catmint on February 25, 2003, at 23:57:13
> Ritch,
> Thanks for your post.
> Did Trileptal help at all with irritability?
> I really did not get irritable on Depakote, it works wonders for that. No fights with anyone while on it! But, it made my depression way worse, so I switched to Lamictal.
> Talk to you soon.
> ::AmyAmy, it (Trileptal) didn't seem to help much on the irritability issues (just depression and cycling). Depakote looks like a for sure keeper for me despite being a little depressogenic. I have to combine it with other stuff to level that out.
Posted by colin wallace on February 26, 2003, at 11:18:32
In reply to Re: Lamictal and Pre-emptive Strikes » catmint, posted by Ritch on February 26, 2003, at 10:16:12
Hi there Ritch,
Cheers for your previous response by the way- you're a good man to share ideas with.
You mentioned that someone had posted previously on some success with a low dose combo.of Lamictal/Valproate/thyroid.
I think at first I'm going to opt for the Trileptal to augment my Lamictal(if necessary).
That extra oxygen molecule makes Trileptal seem far superior to plain Tegretol in terms of tolerability and side-effects.
If that bottoms out(or I'm refused the med.,as seems more likey!)then my options may be limited to a cautious trial of Divalproex(seems to be better tolerated than Valproate)and an AD.
I wondered have you heard of any other reasons not to combine Lamictal/Valproate(apart from the obvious decreased clearance of Lam. and increased risk of rash).
I'm sure that these risks can be greatly reduced by dose adjustment and a very cautious introduction of Depakote anyhow(seeing as I'm already past the LAM. rash risk).Waddaya reckon??
Posted by Ritch on February 26, 2003, at 13:29:31
In reply to Rich..., posted by colin wallace on February 26, 2003, at 11:18:32
> Hi there Ritch,
>
> Cheers for your previous response by the way- you're a good man to share ideas with.
> You mentioned that someone had posted previously on some success with a low dose combo.of Lamictal/Valproate/thyroid.
> I think at first I'm going to opt for the Trileptal to augment my Lamictal(if necessary).
> That extra oxygen molecule makes Trileptal seem far superior to plain Tegretol in terms of tolerability and side-effects.
> If that bottoms out(or I'm refused the med.,as seems more likey!)then my options may be limited to a cautious trial of Divalproex(seems to be better tolerated than Valproate)and an AD.
> I wondered have you heard of any other reasons not to combine Lamictal/Valproate(apart from the obvious decreased clearance of Lam. and increased risk of rash).
> I'm sure that these risks can be greatly reduced by dose adjustment and a very cautious introduction of Depakote anyhow(seeing as I'm already past the LAM. rash risk).
>
> Waddaya reckon??Colin,
From what I understand the rash thing is associated much more frequently with coadministration with valproate period. I *suspect* it has to do with both meds having a tendency to double each other's levels. So, if you are already on Lamictal and you add some Depakote (i.e.), your Lamictal blood level should jump up considerably (similar to a too quick dose titration of the Lamictal), thereby bringing on the increased risk of the rash due to a sudden lurch in the Lamictal blood levels. That's just my hunch though. There may be some oddball interaction that has nothing to do with the relative change in either blood levels of valproate or lamotrigine that increases the risk of TEN or SJS. ??? I would give the Trileptal a shot because 1) You haven't tried it yet, and 2) There isn't a contraindication of taking it with the Lamictal. I always will save the scary sh*t for last! I just read that post about the VPA+LTG+thyroid working well and it seemed to make pretty good sense. The VPA works good for hostility/mania, the LTG for depression, and the thyroid is good for the cycling. Yet another thing that sounds good on paper, though.....
Posted by Ritch on February 26, 2003, at 13:52:25
In reply to Re: Rich... » colin wallace, posted by Ritch on February 26, 2003, at 13:29:31
> > Hi there Ritch,
> >
> > Cheers for your previous response by the way- you're a good man to share ideas with.
> > You mentioned that someone had posted previously on some success with a low dose combo.of Lamictal/Valproate/thyroid.
> > I think at first I'm going to opt for the Trileptal to augment my Lamictal(if necessary).
> > That extra oxygen molecule makes Trileptal seem far superior to plain Tegretol in terms of tolerability and side-effects.
> > If that bottoms out(or I'm refused the med.,as seems more likey!)then my options may be limited to a cautious trial of Divalproex(seems to be better tolerated than Valproate)and an AD.
> > I wondered have you heard of any other reasons not to combine Lamictal/Valproate(apart from the obvious decreased clearance of Lam. and increased risk of rash).
> > I'm sure that these risks can be greatly reduced by dose adjustment and a very cautious introduction of Depakote anyhow(seeing as I'm already past the LAM. rash risk).
> >
> > Waddaya reckon??
>
> Colin,
>
> From what I understand the rash thing is associated much more frequently with coadministration with valproate period. I *suspect* it has to do with both meds having a tendency to double each other's levels. So, if you are already on Lamictal and you add some Depakote (i.e.), your Lamictal blood level should jump up considerably (similar to a too quick dose titration of the Lamictal), thereby bringing on the increased risk of the rash due to a sudden lurch in the Lamictal blood levels. That's just my hunch though. There may be some oddball interaction that has nothing to do with the relative change in either blood levels of valproate or lamotrigine that increases the risk of TEN or SJS. ??? I would give the Trileptal a shot because 1) You haven't tried it yet, and 2) There isn't a contraindication of taking it with the Lamictal. I always will save the scary sh*t for last! I just read that post about the VPA+LTG+thyroid working well and it seemed to make pretty good sense. The VPA works good for hostility/mania, the LTG for depression, and the thyroid is good for the cycling. Yet another thing that sounds good on paper, though.....
>
>OH, just wanted to add something if you aren't aware of this already, but maximum dosage of Lamictal isn't supposed to exceed 150mg/day (75mg bid) if you take VPA with it. This would approximate a 300mg dose of Lamictal without the VPA. Your doc doesn't want to exceed 150mg of Lamictal anyhow... so you could get yourself under med. *supervision* and ask them about adding some 100mg Epilim to that dose level and watch things closely. If you want to try that down the road. Just some thoughts.... That way let the NHS pay for all of your meds.
Posted by catmint on February 26, 2003, at 14:36:29
In reply to Re: Lamictal and Pre-emptive Strikes, posted by colin wallace on February 26, 2003, at 7:50:31
Thanks Col. I am feeling much better on day two at 50 mg. Titrating 25 a week only leaves me 10 weeks until I reach 300 though. Might try to stretch it out to every 2 weeks? Are our brains just becoming tolerant to the stuff?
I'ts great to have been keeping in touch with you all this time.
Good luck on going back to work. Keep riding your bike for sure no matter what.
Talk to you soon!
::Amy
Posted by catmint on February 26, 2003, at 15:10:53
In reply to Re: Lamictal and Pre-emptive Strikes » catmint, posted by Ron Hill on February 26, 2003, at 9:42:11
> What did the Neurontin feel like? Did it help your irritability? What was your highest dose?
>The Nuerontin felt good at first, like a kind-of buzzed, ralaxed feeling, but it had no mood stabilizing effects whatsoever. I also was taking Wellbutrin and Prozac with it, and began to fall apart after a year. I ended up smoking a lot of pot to try to help with the irritability, but it only ended up messing me up even worse, I was in a perpetual mixed state, smoking cigarretes, not sleeping well, having those night terrors I told you about, and occasional auditory hallucinations. I quit my job right after 9/11, and in a manic state, went out and bought a bunch of batteries,and film, and packed my backpack. I was paranoid that my boyfriend was going to be drafted and I wanted to get ready to move to Canada. Needless to say, I was going bonkers. I then became severely depressed and agitated and literally began tearing my hair out in an attempt to end the pain I felt. At the time I was in an outpatient program for mentally ill people who were on sick leave from work, it did help somewhat, but I mostly was either hyper and agitated or lying on the floor crying. My pdoc and I talked about hospitalization, which she told my I did not want to do unless I felt that I needed someone to watch me in case I was suicidal. Well, I had my boyfriend to take care of me and my son, so I rode it out at home, I quit all meds, still smoked pot, which I later quit, and somehow stabilized. That didn't last long, I then became euphiorically manic, over the summer and thought I was cured! LOL. THe depression inevitably hit hard in the fall and I started Depkote, tried to add Wellbutrin (no go), then Prozac(terrible).I then had my first trial of Lam. which gave me a rash. I then quit all meds again, convinced that psychiatry was ruining my life and there was no hope for me. After more misery, I opted to give Lamictal a second chance which brings us up to date.
I should add that I wasn't diagnosed until I was 32, after many years of illness. I knew I was depressed but not bipolar, the mania I had was mostly dysphoric, but occasionally I would freak out and think I was someone I wasn't, invite complete strangers into my home, spend lots of money I didn't have, drive recklessly, have delusions, and so on.
Ron, thanks for your interest.
::Amy
Posted by Ron Hill on February 26, 2003, at 20:52:51
In reply to Re: Lamictal and Pre-emptive Strikes » Ron Hill, posted by catmint on February 26, 2003, at 15:10:53
Amy,
Thanks for taking time to tell me some of your dx and Rx background.
May I be bold and tell you what I would do if I were in your shoes? What follows is merely my opinion. Please treat it as such. Obviously, I’m not a pdoc. I’m only a peer offering my opinion.
It seems clear to me that the first order of business should be to get an effective moodstabilizer on board ASAP. I would choose a first line moodstabilizer (see the APA document “PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH BIPOLAR DISORDER (Revision)), and since Depakote does not agree with you, that leaves lithium. Please beware; I have a personal bias in favor of lithium because it has worked well for me. However, it may or may not work well for you. If it were me, I'd choose a slow-release brand of lithium (I like Lithobid). Further, I'd start out in the low-to-mid dose range shooting for a blood level around 0.6 mEq/l. Side effects are less likely at the lower dose levels, but if it does not provide enough mood stabilization, the dosage may need to be increased.
If it were me, I'd keep the Lamictal in place and continue to ramp it up slowly. If your irritability is causing irreparable damage to your relationships, perhaps your pdoc would be willing to prescribe a benzo to get you by until the lithium and Lamictal get you stabilized. However, I’d try to avoid the benzo if you can get by without it. If you still have trouble with depression after the lithium is on board and the Lamictal is ramped up, then it might be time to investigate the feasibility of adding an MAOI. If it were me, I would not add an SSRI, SNRI, or TCA.
The material contained herein is provided for informational purposes only and should not be considered as medical advice or instruction. Consult your health care professional for advice relating to a medical problem or condition.
Best wishes, Amy, and let me know how it goes.
-- Ron
-----------------------------------------
> > What did the Neurontin feel like? Did it help your irritability? What was your highest dose?
>
> >The Nuerontin felt good at first, like a kind-of buzzed, ralaxed feeling, but it had no mood stabilizing effects whatsoever. I also was taking Wellbutrin and Prozac with it, and began to fall apart after a year. I ended up smoking a lot of pot to try to help with the irritability, but it only ended up messing me up even worse, I was in a perpetual mixed state, smoking cigarretes, not sleeping well, having those night terrors I told you about, and occasional auditory hallucinations. I quit my job right after 9/11, and in a manic state, went out and bought a bunch of batteries,and film, and packed my backpack. I was paranoid that my boyfriend was going to be drafted and I wanted to get ready to move to Canada. Needless to say, I was going bonkers. I then became severely depressed and agitated and literally began tearing my hair out in an attempt to end the pain I felt. At the time I was in an outpatient program for mentally ill people who were on sick leave from work, it did help somewhat, but I mostly was either hyper and agitated or lying on the floor crying. My pdoc and I talked about hospitalization, which she told my I did not want to do unless I felt that I needed someone to watch me in case I was suicidal. Well, I had my boyfriend to take care of me and my son, so I rode it out at home, I quit all meds, still smoked pot, which I later quit, and somehow stabilized. That didn't last long, I then became euphiorically manic, over the summer and thought I was cured! LOL. THe depression inevitably hit hard in the fall and I started Depkote, tried to add Wellbutrin (no go), then Prozac(terrible).I then had my first trial of Lam. which gave me a rash. I then quit all meds again, convinced that psychiatry was ruining my life and there was no hope for me. After more misery, I opted to give Lamictal a second chance which brings us up to date.
>
> I should add that I wasn't diagnosed until I was 32, after many years of illness. I knew I was depressed but not bipolar, the mania I had was mostly dysphoric, but occasionally I would freak out and think I was someone I wasn't, invite complete strangers into my home, spend lots of money I didn't have, drive recklessly, have delusions, and so on.
>
> Ron, thanks for your interest.
>
> ::Amy
Posted by catmint on February 27, 2003, at 1:04:33
In reply to Re: Lamictal and Pre-emptive Strikes » catmint, posted by Ron Hill on February 26, 2003, at 20:52:51
Posted by colin wallace on February 27, 2003, at 3:44:07
In reply to Re: Lamictal and Pre-emptive Strikes » colin wallace, posted by catmint on February 26, 2003, at 14:36:29
> Thanks Col. I am feeling much better on day two at 50 mg. Titrating 25 a week only leaves me 10 weeks until I reach 300 though. Might try to stretch it out to every 2 weeks? Are our brains just becoming tolerant to the stuff?
> I'ts great to have been keeping in touch with you all this time.
> Good luck on going back to work. Keep riding your bike for sure no matter what.
> Talk to you soon!
> ::Amy
Amy,What I meant here was, if you can possibly get away with it,then try raising by 25mg a week to take you safely up to 100mg.
Here, you're going to find that the effects are much less unpredictable and you'll get some solid stability in place.
You can pause at 100mg, and gauge your own reaction better in a normalized state of mind.
Remember, some people don't lose the effect at all-it's not inevitable.
Personally, I can see you hitting 200mg in the future, but I reckon you won't need to escalate so quickly after 100mg.
Try a 25mg raise anyhow(or try 12.5mg every four or five days at least)and get yourself up to 100mg ASAP.Trick is not to let yourself crash completely before you titrate-if you do that, then it's much harder to regain the effect.
Try to outpace this thing,aim to get to at at least 150mg, and let's see where you stand.
You may well need an add-on at some stage, but as you move up the Lam.ladder, you'll be able to make a more educated guess based on your reactions.
And Ron and Mitch have some very sound recommendations for augmentation here,so there are plenty of tricks left in the bag.
I can't deny I'm struggling now myself(funny,my biking has become a lot more half-assed too-felt weak and lethargic yesterday).
I get to see my YDUP on 6th March, and I'm gonna hit him......with some ideas!!Seeya soon,
Col.
Posted by colin wallace on February 27, 2003, at 3:45:26
In reply to Re: Lamictal and Pre-emptive Strikes » colin wallace, posted by KrissyP on February 26, 2003, at 1:01:16
Posted by colin wallace on February 27, 2003, at 5:24:28
In reply to More info....Colin, posted by Ritch on February 26, 2003, at 13:52:25
> >OH, just wanted to add something if you aren't aware of this already, but maximum dosage of Lamictal isn't supposed to exceed 150mg/day (75mg bid) if you take VPA with it. This would approximate a 300mg dose of Lamictal without the VPA. Your doc doesn't want to exceed 150mg of Lamictal anyhow... so you could get yourself under med. *supervision* and ask them about adding some 100mg Epilim to that dose level and watch things closely. If you want to try that down the road. Just some thoughts.... That way let the NHS pay for all of your meds.
Mitch,This made me smile (crafty!)as exactly the same thing had dawned on me.Trouble is, I'm at 250mg now, and still struggling(a little better though).I need to keep up the pressure, 'cos if I lose this AD effect, I'm screwed.I'm aiming for 300 mgs,and then(if necessary) VPA could be an option- whilst reducing Lamictal.Trouble is, undoubtedly I'd quickly need to add a dreaded AD then.Dodgy business as yer know.
As you say, adding Trileptal makes more sense initially.MAY get away without adding the AD then.
Right now I'm gutted, because I've had to let my new job go.It took me three years to get well enough to get there,and I dropped the ball because I couldn't titrate more than 25mg a MONTH, whereas I could safely do 50MG a WEEK, having been on LAM for over six months.In fact, I jumped up by 50mg last week -no probs whatsoever, but it was too late by then-I'd lost way too much ground to recover quickly enough.I'm totally deflated.Almost defeated, but never quite defeated.
It's like being kicked back off a high cliff that exhausted me in the first place.
I'm gonna get drunker than a skittle(?)on the weekend, have promiscuous sex with complete abandon,(pretty gal or uglier than a warthog-who cares?), make myself sick for a couple of days, boot my bike around the garden- and start all over again!!
Lifes a real hoot ain't it?Keep grinning,
Col.
Posted by Ritch on February 27, 2003, at 9:27:40
In reply to Re: More info....Colin » Ritch, posted by colin wallace on February 27, 2003, at 5:24:28
Posted by Geezer on February 27, 2003, at 10:48:32
In reply to Lamictal Doses.. » catmint, posted by colin wallace on February 27, 2003, at 3:44:07
Hi Colin,
It is likely you are already aware of this (it may have been in this thread and I have over looked it). In any case if you decide to combind Lamictal with Trileptal be aware the Trileptal will reduce the serum level of the Lamictal (the reverse of using Lam. with Depakote). Please-I am no expert on psychotropic drugs so please check this info. I am taking 300mg of Trileptal at present and find it to be the least objectionable of the ACs. I had good luck with Lamictal about a year ago but at a time when nothing was working well (prior to my ECT series) so I may give it another try. Truth is I have seen 4 pdocs in 2 years - 2 say Major Depression Recurrent, Meloncholic (now chronic after 30 years), and 2 say Bipolar II. After 30 years of treatment I am down to treating symptoms-don't worry much about DX anymore. I have terrible energa and fatigue - almost to the point of narcolepsy(sp) but I don't fit the DX.
Current Meds.
Trileptal 300mg.
Provigil 300mg. (lasts for four hours)
Klonopin 2mg.
Prozac 10mg.I am about to add the largest dose of Concerta I can tolerate. Dex. solves all my problems but I build a tolerance quickly and have a history of abuse.
Always enjoy your posts, just wanted to make that point about Trileptal & Lamictal.
Very best of luck to you.
Geezer
Posted by Ron Hill on February 27, 2003, at 11:14:29
In reply to Re: More info....Colin » Ritch, posted by colin wallace on February 27, 2003, at 5:24:28
Colin,
> I'm gonna get drunker than a skittle(?)on the weekend, have promiscuous sex with complete abandon, ... make myself sick for a couple of days, ... and start all over again!!
Oh yeah, this sounds like a great Rx for improved mood stability. NOT!! It's a shame youth has to wasted on young people. Just kidding, Colin. :)
On a serious note, I'm sorry to hear about your job.
-- Ron
Posted by Ron Hill on February 27, 2003, at 11:52:40
In reply to Re: Lamictal Doses.., posted by Geezer on February 27, 2003, at 10:48:32
Greezer,
At the risk of sounding presumptuous, I wonder if Enada NADH might help your anerga and fatigue? IMHO, based on what you have written, you sound like a good candidate for someone who might be helped by it. Therefore, it may be worth your time to do some reading on the topic. It has done a great job in treating these symptoms for me. I'll place some links below and if you want to talk about it, let me know.
I am BP II. I take 600 mg/day of Lithobid (which does a good job of controlling my hypomania) and I take an OTC called Enada NADH (coenzyme 1) to treat my atypical depression (low motivation, anergy, anhedonia, hypersomnia) and my dysphoric mood states (extreme irritability). I'm only in the fifth week of my Enada NADH trial, so it remains to be seen whether it will provide long-term effectiveness. Time will tell. But so far, the results have been truly remarkable
-- Ron
Here are some of the links discussing Enada NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10047,00.html#Cautions
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
-------------------------------------
> Hi Colin,
>
> It is likely you are already aware of this (it may have been in this thread and I have over looked it). In any case if you decide to combind Lamictal with Trileptal be aware the Trileptal will reduce the serum level of the Lamictal (the reverse of using Lam. with Depakote). Please-I am no expert on psychotropic drugs so please check this info. I am taking 300mg of Trileptal at present and find it to be the least objectionable of the ACs. I had good luck with Lamictal about a year ago but at a time when nothing was working well (prior to my ECT series) so I may give it another try. Truth is I have seen 4 pdocs in 2 years - 2 say Major Depression Recurrent, Meloncholic (now chronic after 30 years), and 2 say Bipolar II. After 30 years of treatment I am down to treating symptoms-don't worry much about DX anymore. I have terrible energa and fatigue - almost to the point of narcolepsy(sp) but I don't fit the DX.
>
> Current Meds.
> Trileptal 300mg.
> Provigil 300mg. (lasts for four hours)
> Klonopin 2mg.
> Prozac 10mg.
>
> I am about to add the largest dose of Concerta I can tolerate. Dex. solves all my problems but I build a tolerance quickly and have a history of abuse.
>
> Always enjoy your posts, just wanted to make that point about Trileptal & Lamictal.
>
> Very best of luck to you.
>
> Geezer
Posted by colin wallace on February 27, 2003, at 12:25:12
In reply to Re: Rx for Improved Mood Stabiliztion » colin wallace, posted by Ron Hill on February 27, 2003, at 11:14:29
> Colin,
>
> > I'm gonna get drunker than a skittle(?)on the weekend, have promiscuous sex with complete abandon, ... make myself sick for a couple of days, ... and start all over again!!
>
> Oh yeah, this sounds like a great Rx for improved mood stability. NOT!! It's a shame youth has to wasted on young people. Just kidding, Colin. :)
>
> On a serious note, I'm sorry to hear about your job.
>
> -- RonVery accurate there Ron!My youth was utterly wasted (but hey, I was young).
Now I'm knocking on towards 35,so the way I look at it, I can re-live my youth, and it won't be wasted-because I'm no longer young!!*_-As for the job-levity aside for a moment- I somehow managed to scrape top marks on my assessment day/tests etc., and was really looking forward to it.But when I failed to raise my dose properly,I started to get ill and confused,and at one point couldn't even work out how to walk through a revolving door.Rather than embarass myself by attempting a new job in that state, I had to pass it up.Live to fight another day I suppose.
Col.
Posted by Geezer on February 27, 2003, at 21:34:39
In reply to Re: Anerga and Fatigue » Geezer, posted by Ron Hill on February 27, 2003, at 11:52:40
Thanks Ron,
Not presumptuous at all. I very much appreciate the suggestion. I have been following your writings on the board and agree it is certainly worth a try. I will get some tomorrow - can you remind me about the dosage etc. I will read the links you recommended. Please keep me up to date on how you are doing.
Best regards,
Geezer
Posted by colin wallace on February 28, 2003, at 4:29:09
In reply to Re: Lamictal Doses.., posted by Geezer on February 27, 2003, at 10:48:32
> Hi Colin,
>
> It is likely you are already aware of this (it may have been in this thread and I have over looked it). In any case if you decide to combind Lamictal with Trileptal be aware the Trileptal will reduce the serum level of the Lamictal (the reverse of using Lam. with Depakote). Please-I am no expert on psychotropic drugs so please check this info. I am taking 300mg of Trileptal at present and find it to be the least objectionable of the ACs. I had good luck with Lamictal about a year ago but at a time when nothing was working well (prior to my ECT series) so I may give it another try. Truth is I have seen 4 pdocs in 2 years - 2 say Major Depression Recurrent, Meloncholic (now chronic after 30 years), and 2 say Bipolar II. After 30 years of treatment I am down to treating symptoms-don't worry much about DX anymore. I have terrible energa and fatigue - almost to the point of narcolepsy(sp) but I don't fit the DX.
>
> Current Meds.
> Trileptal 300mg.
> Provigil 300mg. (lasts for four hours)
> Klonopin 2mg.
> Prozac 10mg.
>
> I am about to add the largest dose of Concerta I can tolerate. Dex. solves all my problems but I build a tolerance quickly and have a history of abuse.
>
> Always enjoy your posts, just wanted to make that point about Trileptal & Lamictal.
>
> Very best of luck to you.
>
> GeezerWotcher Geezer,
I couldn't agree with you more when you say that after many years of treatment, you've decided that symptom management is more important than a firm diagnosis(though the latter would be nice too).
I've had three differing diagnoses over the years, but in fairness, unless you have a clear-cut condition such as an obvious bipolar1 etc. it can be difficult to square the blurred edges between conditions with common ground(such as ADD,BPD,BP11 etc.)
I reckon the only way around this is to see a good, 'modern' psych. on a regular monthly basis for as many years as it takes-but who can afford that?!I can't,I'm lucky if I can squeeze twice a year.
I'm not really familiar with some of the meds you take, but I understand the misery of anerga and fatigue- this was one of my biggest problems for a year or so(along with severe anxiety which became severe depression).
As for the Trileptal,I could have sworn that the problem of it increasing the clearance of certain meds(including Lam.)only applied to Tegretol.Quote:
" Although Trileptal has less risk of drug-to-drug interaction than Tegretol, it can increase the rate of elimination, and reduce the effectiveness of some drugs--notably oral contraceptives (parents of adolescents, please make note!) and one calcium channel blocker, in particular, Felodipine. Therefore, Trileptal may be safely combined with Lamictal, Depakote, and lithium, as well as with antidepressants and antipsychotic medications."
Here're the links I took this info. from, but of course,there may be info. out there which contradicts this-I hope there isn't though!!http://www.epilepsy.dk/Handbook/Prophylactic-treatment-uk.asp#OXCARBAZEPINE
http://www.bipolarchild.com/newsletters/0108.html
Cheers Geezer,
Col.
Posted by Ron Hill on February 28, 2003, at 12:16:04
In reply to Re: Anerga and Fatigue » Ron Hill, posted by Geezer on February 27, 2003, at 21:34:39
Geezer,
>can you remind me about the dosage etc.
Here is a link to a recent post discussing my dosage history:
http://www.dr-bob.org/babble/20030224/msgs/203343.html
I have a feeling that Enada NADH might help you with your anergy and fatigue, but then again, it might not. However, as I see it, there is little or no downside to an Enada NADH trial (other than the cost).
My latest “theory” is that initially my “NADH reservoir” was much depleted and by following the 5 – 10 mg/day dosage guidelines provided in the directions on the box, my “NADH reservoir” filled up in about four weeks. Once full, however, all I need is a maintenance dose (which is substantially less than the dosage guidelines on the box). Further, taking more than a maintenance dose is actually counterproductive. My “theories”, however, are subject to change on an on-going basis.
-- Ron
Posted by catmint on February 28, 2003, at 23:48:37
In reply to Lamictal and Pre-emptive Strikes , posted by colin wallace on February 24, 2003, at 13:40:48
Hi there,
I saw my pdoc on Thursday. He agreed with what you guys have been telling me, that I'm not even within therapuetic range yet, so no wonder I'm still cycling. He said the range for BP is between 100-400 mg. I'm going to take your advice, Colin, and titrate every 5 days or so by 12.5 until I hit 100. He said that he has not heard of the Lamictal losing it's effect once the right level is obtained. None of his patients have expressed this to him. Colin, I sincerely hope that you can continue with Lamictal monotherapy. As you know, adding on more meds just confuses things. I hear you that you want to be prepared for when the bad weather hits, and the subsequent depression, but who knows, it is entirely possible that once you reach a saturation point (is that what it's called?), you won't need to add anything. Are you still taking Prozac occasionally? How about the NADH?Anyway, back to my appointment. He said that he won't consider add ons at this time. I asked him what about Klonopin for the irritability that I get at night and in the morning. Not even!
I don't care, I think that that will go away when I get rolling again with the increases.
He then got really quiet, you know, like psych. people do, and asked me how my therapy was going. I told him that she (my psychologist) is a bit strange and her "energetic healing" makes me uncomfortable, like she does this wierd shit when I am doing a visualization or meditation. She takes these long drawn out breaths, and once I fluttered my eyes so I could see what the heck she was doing and she had her arm in the air holding her fingers in a circle. I'm thinking, "OK! this kind-of bugs! Huh?He agreed and suggested Jungian analysis, that it makes you delve into your unconcious if the ego is willing and can open one up to who they really are. He said that a good Jungian analyst helped him during the five years he saw him. I'm thinking, "Ok, I'll see if I can budget in two sessions a month at $100 a pop" Yea, right! I'm afraid it's either the quack that the state pays for or nada! All of that aside, I do believe that a good Psydoc can help.
Write back!
::Amy
Posted by Ron Hill on March 2, 2003, at 8:50:02
In reply to Re: Lamictal and Pre-emptive Strikes-Col,Ron et al, posted by catmint on February 28, 2003, at 23:48:37
Hi Amy,
Best wishes in getting your Lamictal ramped up. Please let us know how it goes.
-- Ron
----------------------------------------> Hi there,
> I saw my pdoc on Thursday. He agreed with what you guys have been telling me, that I'm not even within therapuetic range yet, so no wonder I'm still cycling. He said the range for BP is between 100-400 mg. I'm going to take your advice, Colin, and titrate every 5 days or so by 12.5 until I hit 100. He said that he has not heard of the Lamictal losing it's effect once the right level is obtained. None of his patients have expressed this to him. Colin, I sincerely hope that you can continue with Lamictal monotherapy. As you know, adding on more meds just confuses things. I hear you that you want to be prepared for when the bad weather hits, and the subsequent depression, but who knows, it is entirely possible that once you reach a saturation point (is that what it's called?), you won't need to add anything. Are you still taking Prozac occasionally? How about the NADH?
>
> Anyway, back to my appointment. He said that he won't consider add ons at this time. I asked him what about Klonopin for the irritability that I get at night and in the morning. Not even!
> I don't care, I think that that will go away when I get rolling again with the increases.
> He then got really quiet, you know, like psych. people do, and asked me how my therapy was going. I told him that she (my psychologist) is a bit strange and her "energetic healing" makes me uncomfortable, like she does this wierd shit when I am doing a visualization or meditation. She takes these long drawn out breaths, and once I fluttered my eyes so I could see what the heck she was doing and she had her arm in the air holding her fingers in a circle. I'm thinking, "OK! this kind-of bugs! Huh?
>
> He agreed and suggested Jungian analysis, that it makes you delve into your unconcious if the ego is willing and can open one up to who they really are. He said that a good Jungian analyst helped him during the five years he saw him. I'm thinking, "Ok, I'll see if I can budget in two sessions a month at $100 a pop" Yea, right! I'm afraid it's either the quack that the state pays for or nada! All of that aside, I do believe that a good Psydoc can help.
> Write back!
> ::Amy
Posted by colin wallace on March 3, 2003, at 7:51:15
In reply to Re: Lamictal Monothearpy » catmint, posted by Ron Hill on March 2, 2003, at 8:50:02
>
> > Hi there,
> > I saw my pdoc on Thursday. He agreed with what you guys have been telling me, that I'm not even within therapuetic range yet, so no wonder I'm still cycling. He said the range for BP is between 100-400 mg. I'm going to take your advice, Colin, and titrate every 5 days or so by 12.5 until I hit 100. He said that he has not heard of the Lamictal losing it's effect once the right level is obtained. None of his patients have expressed this to him. Colin, I sincerely hope that you can continue with Lamictal monotherapy. As you know, adding on more meds just confuses things. I hear you that you want to be prepared for when the bad weather hits, and the subsequent depression, but who knows, it is entirely possible that once you reach a saturation point (is that what it's called?), you won't need to add anything. Are you still taking Prozac occasionally? How about the NADH?
> >
> > Anyway, back to my appointment. He said that he won't consider add ons at this time. I asked him what about Klonopin for the irritability that I get at night and in the morning. Not even!
> > I don't care, I think that that will go away when I get rolling again with the increases.
> > He then got really quiet, you know, like psych. people do, and asked me how my therapy was going. I told him that she (my psychologist) is a bit strange and her "energetic healing" makes me uncomfortable, like she does this wierd shit when I am doing a visualization or meditation. She takes these long drawn out breaths, and once I fluttered my eyes so I could see what the heck she was doing and she had her arm in the air holding her fingers in a circle. I'm thinking, "OK! this kind-of bugs! Huh?
> >
> > He agreed and suggested Jungian analysis, that it makes you delve into your unconcious if the ego is willing and can open one up to who they really are. He said that a good Jungian analyst helped him during the five years he saw him. I'm thinking, "Ok, I'll see if I can budget in two sessions a month at $100 a pop" Yea, right! I'm afraid it's either the quack that the state pays for or nada! All of that aside, I do believe that a good Psydoc can help.
> > Write back!
> > ::Amy
Hi there Amy,I'm glad that you have a Pdoc. with experience with Lamictal.That counts for a lot, and should be quite reassuring for you.And of course, he's absolutely right about your dose being too low at the minute for you to properly bring the stabilty to heel.
As for me, well quite honestly I'm struggling badly to bring things back to norm.
This is directly a result of my GP. forcing me to halt my titration at 100/150mg for way too long(he was only prepared to go up by 25mg monthly).
I had warned that each time I 'crash', it gets that much harder to pull myself out of it- and the 'mixed-states' get worse too(kindling-theory)
in action methinks.
I'm now slowly starting to pull things back together-just reached 300mg-but the damage has been done.You can't stop a runaway train with a pebble, as I'd pointed out.Anyway,gonna see my YDNP on Thurs. so we'll see what happens.Will have to go for an add-on, or hammer it with a higher dose...Blah,Blah...
Laughed at the image of your psychologist doing wierd arm circles- bet she talks to plants too.Probably owns a pet triffid, keeps in the attic...don't fall asleep whatever you do.
Jungian analysis?They set great store by dreams ya know, so I'd be stuck in a straight-jacket rightaway,'cos mine are really off the wall.
Still, any form of talking to someone should be helpful.Have you ever read The Dice Man, by...
Luke Rhinehardt(?)if I remember rightly.
It's about this nutty psychiatrist who suddenly doesn't give a shit and starts to make major life decisions by rolling a dice.Whether to sleep with his best friend's wife etc.Really funny.May try it myself.Keep us posted.
Col.
Posted by colin wallace on March 3, 2003, at 8:44:34
In reply to Re: Lamictal Monotherapy » Ron Hill, posted by colin wallace on March 3, 2003, at 7:51:15
Posted by catmint on March 3, 2003, at 23:47:55
In reply to Re: Lamictal Monotherapy » Ron Hill, posted by colin wallace on March 3, 2003, at 7:51:15
Posted by Ron Hill on March 4, 2003, at 13:11:51
In reply to Re: Talk to you soon Col! (nm), posted by catmint on March 3, 2003, at 23:47:55
Amy & Colin,
If you haven’t already, watch the Grand Rounds presentation by Charles L. Bowden, MD entitled “Maintenance Treatment of Bipolar Disorders”. In particular, I found his discussion of Lamictal, Depakote, and lithium to be worthwhile.
http://psychiatry.uchicago.edu/grounds/030303/
-- Ron
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.