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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by catmint on March 9, 2003, at 4:59:38
I am starting to cycle badly on Lamictal alone.
I am a crying mess the past three days,
Any hope for me?
::Amy
Posted by Ron Hill on March 9, 2003, at 9:39:31
In reply to Lamical and Lithium-Does it work for you?, posted by catmint on March 9, 2003, at 4:59:38
Amy,
> I am starting to cycle badly on Lamictal alone.
> I am a crying mess the past three days,
> Any hope for me?There is plenty of hope for you Amy! What dose of Lamictal are you currently up to?
-- Ron
Posted by Maximus on March 9, 2003, at 12:00:12
In reply to Lamical and Lithium-Does it work for you?, posted by catmint on March 9, 2003, at 4:59:38
> I am starting to cycle badly on Lamictal alone.
> I am a crying mess the past three days,
> Any hope for me?
Hi Amy,That's what i take, e.g Lamictal + Lithium. Generally this is now the best combo for the treatment of bipolar disorder. This is the new treatment, the new modern approach. Lithium for mania/hypomania + Lamictal for the depression and rapid cycles of the bipolar depression. I don't need anything else.
Any questions?
Good luck!
Max.
Posted by Maximus on March 9, 2003, at 12:04:51
In reply to Re: Lamictal and Lithium = best match » catmint, posted by Maximus on March 9, 2003, at 12:00:12
I forgot,
That link speaks for itself:
http://psychiatry.uchicago.edu/grounds/030303/
Take a look at the slide show. And you'll see that Lamictal alone does nothing for mania/hypomania.
Bye!
Posted by catmint on March 9, 2003, at 16:42:13
In reply to Re: Lamical and Lithium-Does it work for you? » catmint, posted by Ron Hill on March 9, 2003, at 9:39:31
> Amy,
>
> > I am starting to cycle badly on Lamictal alone.
> > I am a crying mess the past three days,
> > Any hope for me?
>
> There is plenty of hope for you Amy! What dose of Lamictal are you currently up to?
>
> -- RonHey Ron,
I'm up to 75 mg, but backed off today to 50. I am realizing that I cannot be on Lamictal as monotherapy. I am getting so irritable and have had a horrible 4 days, making me think I am in a very dysphoric manic episode.
So... it's one of 4 things next:
1)Depakote and NADH
2)Trileptal and "
3)Lithium and Lamictal
4)no medsI'm making an emergency appt. with pdoc asap. to discuss what to do next.
I have sooo many questions, mainly about Lithium. I'm scared to take that cause of side effects.
Thanks Ron,
::Amy
Posted by catmint on March 9, 2003, at 16:50:56
In reply to Re: Lamictal and Lithium = best match » catmint, posted by Maximus on March 9, 2003, at 12:00:12
> > I am starting to cycle badly on Lamictal alone.
> > I am a crying mess the past three days,
> > Any hope for me?
>
>
> Hi Amy,
>
> That's what i take, e.g Lamictal + Lithium. Generally this is now the best combo for the treatment of bipolar disorder. This is the new treatment, the new modern approach. Lithium for mania/hypomania + Lamictal for the depression and rapid cycles of the bipolar depression. I don't need anything else.
>
> Any questions?
>
> Good luck!
>
> Max.
>
>
Hi Max,
I'm glad your back on PB. Yes, I have many questions about this combo.
1)How long have you been on it?
2)At what dosages?
3)Weight gain from Lithium? and,I can't think of anything else at the moment so...add anything if you have the time please!!!
Thanks much,
::Amy
Posted by JackD on March 9, 2003, at 18:21:43
In reply to Re: Lamictal and Lithium = best match » Maximus, posted by catmint on March 9, 2003, at 16:50:56
I'm on Lamictal + Lithium too, which seems to work somewhat well, except the Lamictal antidepressant effect only lasts a few weeks and then wears off, at which point i can either add an AD or up the Lamictal (i'm all the way up to 400). I don't tolerate AD's well.
Got any ideas of how to maintain the AD effect of Lamictal, because otherwise this WOULD be the best match, at least for me.
Posted by Maximus on March 9, 2003, at 19:55:21
In reply to Re: Lamictal and Lithium = best match » Maximus, posted by catmint on March 9, 2003, at 16:50:56
> I'm glad your back on PB. Yes, I have many questions about this combo.
> 1)How long have you been on it?
> 2)At what dosages?
> 3)Weight gain from Lithium? and,
>
> I can't think of anything else at the moment so...add anything if you have the time please!!!
> Thanks much,Hi there Amy,
1- I have been on this combo for 3 years now. So far the best.
2- My blood level of Lithium is 0.7 and i take 250 mg of Lamictal.
3- I have no weight gain from Lithium! I drink a lot of water and i have reduced a little bit my carbohydrate intake. I take the sustained release formulation of Lithium, e.g., Duralith (here in Canada).
4- I have no side effects, except a blurred vision from the Lamictal. I mean, it takes a little more time to focus.
You obviously need another mood stabilizer. If you are really bipolar i wonder why your pdoc has put you on Lamictal alone. It's an aberration! Anyway you're now aware of this. That's a beginning.
If that is a clue, i have had to find a psychiatrist specialized in bipolar disorder. Now that one rocks and rules :-) And she's always at the "bleeding edge" information.
If other questions feel free to ask!
Bye!
Max.
Posted by Maximus on March 9, 2003, at 20:18:53
In reply to Re: Lamictal and Lithium = best match-Max, posted by JackD on March 9, 2003, at 18:21:43
> I'm on Lamictal + Lithium too, which seems to work somewhat well, except the Lamictal antidepressant effect only lasts a few weeks and then wears off, at which point i can either add an AD or up the Lamictal (i'm all the way up to 400). I don't tolerate AD's well.
>
> Got any ideas of how to maintain the AD effect of Lamictal, because otherwise this WOULD be the best match, at least for me.Hi Jack,
What i've read, heard and even discussed with my pdoc is the following strategy. Reduce your Lamictal down to 300 mg and add a tiny dose of TCA (not SSRI), like Desipramine at 25 mg. That will do the job for sure without any side effect. You might talk of that with your pdoc.
Bye!
Max.
Posted by cybercafe on March 10, 2003, at 0:20:55
In reply to Re: Lamictal and Lithium = best match » catmint, posted by Maximus on March 9, 2003, at 19:55:21
> 1- I have been on this combo for 3 years now. So far the best.
>
> 2- My blood level of Lithium is 0.7 and i take 250 mg of Lamictal.
>
> 3- I have no weight gain from Lithium! I drink a lot of water and i have reduced a little bit my carbohydrate intake. I take the sustained release formulation of Lithium, e.g., Duralith (here in Canada).
>
> 4- I have no side effects, except a blurred vision from the Lamictal. I mean, it takes a little more time to focus.how bad are lithium side effects? is tremor unavoidable and are you running ot the toilet every 30 min?
these are my (probably exaggerated) fears
Posted by Maximus on March 10, 2003, at 7:14:55
In reply to Re: Lamictal and Lithium = best match, posted by cybercafe on March 10, 2003, at 0:20:55
> how bad are lithium side effects? is tremor unavoidable and are you running ot the toilet every 30 min?
> these are my (probably exaggerated) fearsHi Cyber,
Nice to see you back.
What side effects??? I don't have any side effects. Those side effects (mentioned in your posts) with Lithium are rare. If they occur then your blood level of Lithium is too high. Clear and simple. However a **good and knowledgeable** psychiatrist will put you on the low therapeutic level (0.6) of Lithium for the maintenance therapy.
Hope this helps!
Max.
Posted by Ron Hill on March 10, 2003, at 11:09:10
In reply to Re: Lamical and Lithium-Does it work for you? » Ron Hill, posted by catmint on March 9, 2003, at 16:42:13
Hey Amy,
> I'm up to 75 mg, but backed off today to 50. I am realizing that I cannot be on Lamictal as monotherapy. I am getting so irritable and have had a horrible 4 days, making me think I am in a very dysphoric manic episode.
> So... it's one of 4 things next:
> 1)Depakote and NADH
Maybe, but Depakote worsened your depression when you tried it last fall. Also (as you probably know) if you choose to take Depakote, your pdoc may want to wash-out the Lamictal to avoid the possible Depakote/Lamictal interaction.
> 2)Trileptal and "
Does the quotation mark mean ditto what is above in Option 1 (i.e.; NADH)? I've never tried Trileptal but I've read good things about it. The APA does not currently view it as a "first-line" moodstabilizer in the treatment of bipolar disorder. But that, in and of itself, does not necessarily mean that it would not work as the mood stabilization backbone in your particular rx. It is a second-line or third-line moodstabilizer, however.
> 3)Lithium and Lamictal
IMHO, this is an option worthy of discussing with your pdoc. I am, however, becoming somewhat concerned by the number of people that experience an erratic effectiveness with Lamictal. Will the erratic antidepressant effectiveness continue even after a first-line moodstabilizer is put in place? Or, on the other hand, is Lamictal mono-therapy functioning erratically in some BP II patients precisely because it does not provide enough mood stabilization power (in and of its self) to corral and contain its own antidepressant qualities? In other words, unchecked by adequate mood stabilization, perhaps the antidepressant qualities of Lamictal cause the BP II patient to periodically cycle into dysphoric (or euphoric) hypomania . If my latter speculation is correct (and I’m not suggesting that it is), then perhaps the co-administration of a first-line moodstabilizer with Lamictal would smooth out its otherwise erratic effectiveness.
I did a short trial with Lamictal a few years ago and I really liked the way it felt in my brain, but unfortunately, I am highly susceptible to rash and Lamictal gave me a bad one.
> 4)no meds
You’ve tried this one before and it didn’t work. I see no reason to think it would work this time.
May I add two more possible options?
5) Lithium and an MAOI
6) Lithium and Enada NADH
As you know, the sixth option is what is working for me. It might work for you or it might not.
I have sooo many questions, mainly about Lithium. I'm scared to take that cause of side effects.
What side effects? Are you still concerned about possible weight gain? In the low-to-mid dosage range, lithium does not typically cause a lot of side effects (but, as always, YMMV). I am VERY sensitive to side effects and yet I have no problems at all with 600 mg/day of Lithobid. My lithium blood level is in the lower part of the therapeutic range at 0.4 mEq/l. The more typical maintenance dose range is 0.6 – 0.8 mEq/l. As I’ve said before, 0.6 mEq/l might be a good initial target blood level for you.
Stay in touch Amy.
-- Ron
Posted by colin wallace on March 10, 2003, at 11:14:32
In reply to Re: Lamictal and Lithium = best match-Max » JackD, posted by Maximus on March 9, 2003, at 20:18:53
> What i've read, heard and even discussed with my pdoc is the following strategy. Reduce your Lamictal down to 300 mg and add a tiny dose of TCA (not SSRI), like Desipramine at 25 mg. That will do the job for sure without any side effect. You might talk of that with your pdoc.
>
> Bye!
>
> Max.Max,
I like the concept of the lithium/lamictal combo.,but would be hesitant to say the least, about adding a low dose tricyclic where depression continues to slip through the net.
I take 300mg of Lamictal, and will shortly be discussing adding an additional med. with a bipolar specialist psych.I may well go for lithium too.
Funnily enough,at one point I was keen on adding a low dose of Lofepramine(metabolized to Desipramine if I remember rightly)but as you probably know,all current opinion seems unequivocally set against TCA's as the worst culprits for precipitating mania in bipolars.
My own experience has been that SSRI's are far more likely to do so(seems your psych. agrees with this?)but I just wondered why she suggested the TCA in particular over an SSRI?
I'm guessing here that perhaps keeping the TCA dosage marginal will negate any destabilizing effect, but I can't see why this shouldn't apply to an SSRI, or indeed any other AD.
I'd love to know the reasoning here, because if I thought it was safe, I'd opt for a low dose(noradrenergic)TCA over an SSRI anyday.Glad you've been kept well for 3 years too-that's good to hear.
Col.
ps.Just ditched a tiny dose of Prozac aswell myself,as I don't really trust it in the long term.
Posted by Maximus on March 10, 2003, at 12:18:05
In reply to Re: Lamictal and Lithium = best match-Max » Maximus, posted by colin wallace on March 10, 2003, at 11:14:32
Hi Colin,
> I like the concept of the lithium/lamictal combo.,but would be hesitant to say the least, about adding a low dose tricyclic where depression continues to slip through the net.We have to be on the combo Lithium + Lamictal for a while BEFORE adding a TCA.
> I take 300mg of Lamictal, and will shortly be discussing adding an additional med. with a bipolar specialist psych.I may well go for lithium too.
I coudn't encourage you enough to go for Lithium + Lamictal. I don't know your DX (bipolar?) but if you are bipolar i don't understand why you are on Lamictal alone. I'm glad you're going to see a bipolar psychiatrist. You are already a winner.
> I'm guessing here that perhaps keeping the TCA dosage marginal will negate any destabilizing effect, but I can't see why this shouldn't apply to an SSRI, or indeed any other AD.
Again, it was in that context, that if the antidepressant effect of Lamictal (AND Lithium) isn't enough then and only then you can add a very small dose of TCA.
> I'd love to know the reasoning here, because if I thought it was safe, I'd opt for a low dose(noradrenergic)TCA over an SSRI anyday.
Okay i will do my best. She (bipolar psychiatrist too) explained to me that a bipolar depression is different chemically than an unipolar depression. It is more deep, more serious and more "neuro-vegetative". Yes she told me what i already knew, that a TCA was a "bigger trigger" than an SSRI. But then again, an SSRI lacks often the punch to lift up a bipolar depression. This is why it is critical and imperative to have a good anti-manic med with.
But don't worry. Most of us respond well to a Lithium + Lamictal combo or if you want to an anti-manic + Lamictal combo.
> Glad you've been kept well for 3 years too-that's good to hear.
Many thanks Colin and good luck to you!
Max.
Posted by JackD on March 10, 2003, at 13:39:47
In reply to Re: Lamictal and Lithium = best match-Max » JackD, posted by Maximus on March 9, 2003, at 20:18:53
Hey thanks for the advice, will do! My shrink is intent on using Nortripytiline whenever I mention TCA's. But I'll give it shot. Also I agree with your post before saying that Lamictal alone is a poor bipolar management medicine; it's an adjunct if anything if you ask me.
Posted by cybercafe on March 10, 2003, at 15:29:39
In reply to Re: Lamictal and Lithium = best match » cybercafe, posted by Maximus on March 10, 2003, at 7:14:55
> > how bad are lithium side effects? is tremor unavoidable and are you running ot the toilet every 30 min?
> > these are my (probably exaggerated) fears
>
> Hi Cyber,
>
> Nice to see you back.
>
> What side effects??? I don't have any side effects. Those side effects (mentioned in your posts) with Lithium are rare. If they occur then your blood level of Lithium is too high. Clear and simple. However a **good and knowledgeable** psychiatrist will put you on the low therapeutic level (0.6) of Lithium for the maintenance therapy.
>
> Hope this helps!Thanks for replying Max.
No side effects?! that sounds too good to be true... not even fatigue or hypersomnia?
Hmm... are you type 1 or type 2 may i ask?
Posted by Maximus on March 10, 2003, at 16:26:15
In reply to Re: Lamictal and Lithium = best match, posted by cybercafe on March 10, 2003, at 15:29:39
> Hmm... are you type 1 or type 2 may i ask?
My dx is bipolar, mainly deep depression (with rapid cycles) with some euphoric/hypomanic states. I have never had a full blown manic episode of my life.
Bye.
This is the end of the thread.
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