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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 67 to 91 of 458. Go back in thread:
Posted by fluffy on September 28, 2003, at 15:50:08
In reply to Hey Fluffy, posted by Dalilah on September 28, 2003, at 12:55:57
Hi Dalilah--
I hope I didn't unnecesarilly frighten you with my comments about Lamictal. I went back to read your post from earlier in the thread, and you said that you hadn't felt better in years. And hey--that is fantastic!! Don't you worry about my doses and experiences that much if your experience has been a good one! We all have different brain chemestry, symptoms and positive or negative reactions to different drugs. Psychiatry is such a stab in the dark right now--but it's getting better.
But to really answer your question: I started the Lamictal (monotherapy) at 25mg and titrated up every two weeks. I seemed to hit some stability at 150mg. But i was enrolled in a study at a mood disorders center (like NIMH) which required that I get up to a dose of 200mg. I had SOME change at that dose (200mg) but still have had problems with sleep, irritability and a very rhythmic, rapid soft cycling. Lately it's been bad due to the change in the seasons (summer to fall is BAAAAD for me!).
I think I really need to have another mood stabilizer on board to compliment and reinforce the positive effects of Lamictal. That's why I'm shopping for a "mania cap". If Trileptal (don't know what dose) and Lamictal (200mg) stop the cycling but leave me feeling flat, then I may up the Lamictal another notch.
When I last upped my Lam dose to 250mg, I had slurred speach, unsteady-ness, and some cognitive probs, so we kept the dose at 200mg. Compared to lithium, though, the 250mg Lam side effects seem like cake to me!
So--I'm getting comfortable with this tweaking process by now, and I'm confident it will all come out in the wash. But I can really identify with your fears of meds not working and having to go back to the hospital. It's a scary prospect, but not one to be ashamed of. You have a doctor now, (one who is hopefully empathetic and knowledgable) and a diagnosis that "fits" and you will be taken care of. Even if your current regimine doesn't keep you fully in check, you'll probably just need fine tuning. Or you'll be able to stick it out better than before. Don't fret!
Glad you are feeling good now, Dalilah!
Take care,
Katy
Posted by fluffy on September 28, 2003, at 16:08:31
In reply to Re: Hey Fluffy » Dalilah, posted by BarbaraCat on September 28, 2003, at 13:28:10
Hi again Dalilah--
Just one more comment.. I suppose I said i was "tolerent" to Lam because I seemed to get SOME good effects at lower doses, but they didn't stick unless I went up. Seems that most people reach a threshold for any particular drug between a therapeautic dose and a dose that may cause unbearable side effects. For me right now, that threshold is 200mg, but for others it is waaay higher or waaaay lower.
Sorry for the negativity.
Katy
Posted by Dalilah on September 28, 2003, at 16:28:52
In reply to Dalilah--Lam tolerance, posted by fluffy on September 28, 2003, at 16:08:31
Thanks Katy and Barbara,
I think you're right. I start worrying and fretting too soon. But, as you know, it's not w/o precedent. When you've been through what we've been through and as many meds, it's hard to be totally positive or secure.
I'm feeling good at 250 but my doc and I are pushing it up to 275 then 300 to see what happens. If it's no better I'll head back to 250, where I feel great for the most part. Last week I was a little higher than I liked one day and yesterday I felt a little low, so I started to feel alarmed, like it was no longer working.
And joke of all jokes, I had the thought that maybe I don't need any of these meds anymore. Dangerous territory, I know. Anyhow I also need my lithium and a small amount of seroquel at night.
It is interesting how different this disease appears in everyone and the different reactions to meds. My sister is bipolar as well and we respond to the same meds more or less, but she needs more of some and I need more of others.
Thanks,
Dalilah
Posted by BarbaraCat on September 28, 2003, at 18:40:48
In reply to Re: Dalilah--Lam tolerance, posted by Dalilah on September 28, 2003, at 16:28:52
Hi Dalilah,
How is it with the Seroquel? I was taking Ambien for insomnia and stopped because of tolerance and potential exacerbation of depression. I still have problems sleeping and wonder if Seroquel might help since it's also an anti-psychotic and may benefit my BP condition.Do you feel hung over from it in the morning? Any motor disturbances? Dry mouth? Weight gain? Do you think it benefits the BP or is it mainly a sleep aid? Do you know if it interferes with stage IV sleep? I've got fibromyalgia and anything that affects deep sleep is a no-no. Anything other s/e? Thanks for any info on this. - Barbara
Posted by Dr. Bob on September 28, 2003, at 20:05:25
In reply to No no not abandonment w/o goodbyes! » katia, posted by Chicklet on September 27, 2003, at 10:31:31
> 4 MILLIGRAMS OF PROSOM!!!! Yes i'm yelling. That yelling thing is bullsh*t anyway. Uhoh. Look Dr. Bob...I said bullsh*t.
I see, please don't use language that could offend others, thanks.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by BarbaraCat on September 28, 2003, at 21:12:08
In reply to Re: Dalilah--Lam tolerance, posted by Dalilah on September 28, 2003, at 16:28:52
Hi Y'all,
Are you splitting your dose of Lam? Like in the am and pm? I'm ramping up real slow and wonder if I should weigh it a little more heavy in the am because of possible activation/insomnia? Any advice? - Barbara
Posted by Dalilah on September 28, 2003, at 21:21:45
In reply to Lam - split dose?, posted by BarbaraCat on September 28, 2003, at 21:12:08
Hi Barbara,
I take my Lamictal am and pm with the higher dose at night as prescribed by my doc. Eventually it may all be at night. But I've been in the am/pm state for so long I don't mind.
As far as seroquel, I only take 25mg at night and it does the trick for me. Helps me get a solid chunk of sleep. I have no side effects and it definately helps with the BP. How do I know. When I go down or try to go without it, I am in a very bad space heading down down down depression.
I don't know the answer to your question regarding stage IV sleep. I know nothing about that kind of thing.
-Dalilah
Posted by Sabina on September 29, 2003, at 0:45:44
In reply to Dalilah and anyone on Seroquel » Dalilah, posted by BarbaraCat on September 28, 2003, at 18:40:48
i also am bipolar and have fibromyalgia. i can't tolerate any ssri's (though god knows the docs tried to get me to take them!), but have had great success with seroquel. it's the only full time med i'm on, augmented by the occasional xanax and vicodin or ultram for pain. i currently have periods of serious premenstrual depression but my quality of life/peace of mind while on seroquel has improved dramatically from the dark place i was early this year. there has been some weight gain, but i suspect that's going to be reversible. since i feel more able to leave the house i am spending more time at the gym (in the pool), which is great for the fibromyalgia (and weight loss). the initial somnolance with seroquel has abated over time, especially since i space out my 100mg a day in 25mg doses. the only bad thing about seroquel (for me) was ultra vivid dreams featuring estranged folks from my past. yucky. after three months, though, it's gotten to be less troublesome/frequent. my sleep cycles are still screwed up occasiopnally, depending on how much pain i'm in from day to day, but i definitely sleep much better now. i no longer feel like i'm being tortured because of an inability to rest...not a good feeling, as i'm sure you know. good luck to you, and let me know how it goes, especially since we have the fibro/BP thing in common.
Posted by BarbaraCat on September 29, 2003, at 11:12:02
In reply to Re: BP2, FMS, and seroquel here » BarbaraCat, posted by Sabina on September 29, 2003, at 0:45:44
Hi Sabina,
Thanks so much for responding. I'm sorry for your BP and fibro, but happy for me that there's someone else who is aware of this very challenging (hell, it sucks!) dual condition. When a fibro flare strikes it leaves me incapable of physically dealing with anything, especially bipolar related difficulties. If I'm hypomanic, well too bad, there's no way to release or channel that skittery energy while lying in bed feeling like one big toothache, no energy, exhausted yet wired from anxiety and insomnia. Or depression, when getting up and doing something, anything, is hard enough yet there you are barely able to crawl to the bathroom, can't even escape it through sleep. Even if I can force myself to move, the old cognitive breakdown prevents me from doing simple things like remembering how to tie my shoelaces, assuming I'm able to find my shoes. I feel so dull and stupid which doesn't help with the magnified self-recrimination of depression. This is the extreme end during a flare, but it's always going on at a lesser level.I'd like to believe that getting a really good night's sleep is half the battle with fibro and if seroquel helps with this, then I'm all for it. I've weaned myself off ambien and valium for sleep and for the first time in a long time had a good rest last night, so I'm going to see if I can continue 'au natural'. I'd like to not add another med unless it's really going to benefit me.
Is it primarily for sleep or do you think it's helping your BP condition in other ways? I know that it's an antipsychotic. Since starting lithium 2 years ago I haven't had one of my horrible black mixed state depressions, but they were truly psychotic in their nightmarish quality. An antipsychotic would probably have helped alot then, but I wonder if it would be indicated now since psychosis hasn't been a problem. But maybe there are other benefits besides AP and sleep aid?
One of my concerns about seroquel is what I've read on this board as far as causing long term rebound insomnia once reducing or discontinuing. How about dry mouth? That was a big problem for me with nortriptyline and why I eventually stopped. I had a hard time talking without making smacking sounds with my parched lips.
Have you come up with any theories about why you've come down with fibro? My personal feeling is that it's probably genetic, but mainly stress based - chronic intense stress damaging the hypothalamus from doing it's hormonal job. I know this stress theory is very unpopular with many fibro advocacy groups, but it makes the most sense in my case. Having bipolar or fibro is bad enough, but having both together - yikes! Makes me wonder about their interrelation. Looking forward to hearing from you. - Barbara
Posted by BarbaraCat on September 29, 2003, at 11:20:10
In reply to Re: BP2, FMS, and seroquel here » BarbaraCat, posted by Sabina on September 29, 2003, at 0:45:44
Hi Sabina,
Wait, wait. I just reread your post. Do you mean that seroquel is the MAIN med you're on for BP? How could this be? No lithium, depakote, tegretol, lamictal, trileptal, topamax, dilantin - did I miss any? Were you on any of these previously? Yes, I know about SSRI's. They made me worse too, but lithium and Lam are helping - does squat for fibro however. But seroquel does it all for you? Now, that would be a miracle if it helped both fibro and BP!!! - Barbara
Posted by Chicklet on September 29, 2003, at 12:55:55
In reply to Re: BP2, FMS, and seroquel here » BarbaraCat, posted by Sabina on September 29, 2003, at 0:45:44
hey guys...sleep dep sucks. That's why i'm not around...first fell down the stairs and then biffed my head on a stone table later. No concussion but we went to the hospital anyway. Doc presribed seroquel to knock the heck out me and deposit my brain to the Land Of REMs...I fought right through 100 mg. Sucha a stubborn and willful gal, huh? At the ER they gave me Geodon which did end up prevailing but I had nasty s/e. I had tried Zyp in the past (actually for sleep too) and i felt like my head was spinning around (Exorcist style)...vomiting etc.
Oy- aren't we all so interesting? I think we should just love to be us because we have such diverse moods, wackadoodle neurotransmitters and uncannily (is that word i wonder. don't care) similar intellecutal.
I'd like to chat more about this famed Seroquel...I've read posts on it but never paid them any mind because it didn't apply to me...
> i also am bipolar and have fibromyalgia.
time med i'm on, augmented by the occasional xanax and vicodin or ultram for pain.>quality of life/peace of mind while on seroquel has improved dramatically from the dark place i was
Same goes for me with Provigil! I'll keep my paws crossed but...well you guys know.
Yo-yo. Dawg.>feel more able to leave the house i am spending more time at the gym (in the pool)
Isn't it so amazing...and evil at the same time- that exercise tends to help moods but the only time I can do it is when I feel good. Sooooo...? Oh I forgot you are the poolwoman! How inspirational!
>>ultra vivid dreams featuring estranged folks from my past. yucky.
Ewww. That IS yucky. I guess the people from your past are always there in the recesses of your frontal lobe somewhere! My dreams have been kooky on the Provig. And are wicked funny. A good time is had by all. I started talking in my sleep and my husband ends up laughing so hard (or I do, because i apparently guffaw while asleep now and then. Hmm what does that say about me?)
Also dreamed about cheese. ??? my husband had been trying to eat the red waxy part and I yapped at him because my impressionable nephew was going to see him and try it. Oh yeah, and I tsk and sigh. Funny schtuff.>>especially since we have the fibro/BP thing in common.
Ah yes, but what if we all start to cycle at the same time... ? :O
karen wants to sleep. really really.
I mean sleeeep.
hope eveybody's okelly dokelly...can't read many posts but am trying.Oh btw, What dose of lamictal did I sAY I was on? The correct answer would've been 550. i dunno what i wrote. 2 and 1/2 am, 3 pm.....
Posted by nmk on September 29, 2003, at 13:39:03
In reply to Re: Hey Fluffy » Dalilah, posted by BarbaraCat on September 28, 2003, at 13:28:10
Hi Barbara,
I just cried on your shoulder in a previous thread we had going on but I wish I would have caught your message to Dahlila first. Thanks for the great advice, I will try to keep it with me in this time of doom.
Gratefully,
Nicole
Posted by katia on September 29, 2003, at 14:50:50
In reply to Lam - split dose?, posted by BarbaraCat on September 28, 2003, at 21:12:08
Hi,
I've actually got 5mg pills, so I just take 2 for the moment in the am. I get a buzz for awhile after, so I don't think it'd be good at night.
katia
Posted by katia on September 29, 2003, at 14:55:07
In reply to Dalilah and anyone on Seroquel » Dalilah, posted by BarbaraCat on September 28, 2003, at 18:40:48
Hi Barb,
Don't know if you were following another thread or if it still is here; but it was about Seroquel (and the next day blues).
I've been taking it occassionally for sleep (1/4 of 25mg) and normally wake up off balance and a bit depressed. It helps with the sleep tho'. There were a few others experiencing what I experienced.
It's all individual as you know.
KatiaHi Dalilah,
> How is it with the Seroquel? I was taking Ambien for insomnia and stopped because of tolerance and potential exacerbation of depression. I still have problems sleeping and wonder if Seroquel might help since it's also an anti-psychotic and may benefit my BP condition.
>
> Do you feel hung over from it in the morning? Any motor disturbances? Dry mouth? Weight gain? Do you think it benefits the BP or is it mainly a sleep aid? Do you know if it interferes with stage IV sleep? I've got fibromyalgia and anything that affects deep sleep is a no-no. Anything other s/e? Thanks for any info on this. - Barbara
Posted by BarbaraCat on September 29, 2003, at 15:57:37
In reply to Ultra vivid to say the least!, posted by Chicklet on September 29, 2003, at 12:55:55
Posted by BarbaraCat on September 29, 2003, at 16:16:24
In reply to Re: Dalilah and anyone on Seroquel » BarbaraCat, posted by katia on September 29, 2003, at 14:55:07
Hi Katia,
It sure is individual. So many different med reactions by those of us with similar d/x's. I'd like to not take an AP, just one more thing, I hated Zyprexa (felt similar nextday disorientation) and don't need any more pork producers, thank you very much. I've been cooling it for the most past with glass o' D and been sleeping so much better. This past Saturday was a reality test. I was using some wine for cooking and thought 'oh, what the heck' and ended up drinking 1/2 the bottle thinking I'd been a good girl and probably wouldn't feel bad from it. Wrong. Didn't sleep well, woke up with a mild hangover and felt fried the whole day. Yesterday, no alcohol, slept great and feel pretty darn good today, like doing normal things - even got back into playing piano again and that is very satisfying.Hard liquor doesn't bother me at all the way wine does. Probably because I don't drink very much of it, but it also has a different effect on my bod. Problem is, it's wine, that pissy putrid swampwater, that I long for. Hope your days are continuing to feel lighter and brigher. - Barbara
Posted by Chicklet on September 29, 2003, at 17:01:50
In reply to Re: BP2, FMS, and seroquel here » Sabina, posted by BarbaraCat on September 29, 2003, at 11:12:02
Ok, just a little buttinsky...
muchas gracias for that aside about sero-q - I've been drinking like a..well, a ...camel (?) and had no idea why my mouth was so dry! It's been a tad incontinent, I mean inconvenient to be drinking so much water, diet vanilla coke, etc. Esp last night and the night before at the hospital. 'If she's nodding off like this there's no way she can go into the bathroom' was followed up with Kar lying on a cold, cardboard life preserver trying to go.
Oh that sero-q...what now, when my bladder is the size of an acorn?
May be time for some Butter Rum lifesavers.
Gawtta do whatcha gawtta do.man you guys- sound like the FM is really tough. Why, in addtion to everything else...?
Posted by Chicklet on September 29, 2003, at 17:31:31
In reply to Holy dry mouth, Batman! » BarbaraCat, posted by Chicklet on September 29, 2003, at 17:01:50
that I'd be trying to use the lifesavers as a bedpan.
It would take too many rolls
Ok that's enough. This is one of my silly stages in the sleep deprivation production.hey am I like the Lamictal stoner of this group? I feel like Cheech.
Posted by katia on September 29, 2003, at 17:57:26
In reply to Re: Dalilah and anyone on Seroquel » katia, posted by BarbaraCat on September 29, 2003, at 16:16:24
My days are indeed feeling brighter. It's so wonderful.
I have actually been partaking in the rancid skunk blood for the past three nights (2 - 2 1/2 per night).
I don't feel depressed for it. And I don't crave more when I do drink. Those are enough.
I'm in a good space right now. God don't let me lose it!!!!!!
Mild irritability flares up sometimes, but nothing is perfect.
Ah piano playing. I've actually been considering buying one (just a baby grand :-).
I miss it too. I think the Avro (sp?) has done it to us. What do you think? HAve you gotten it yet?
hugs,
Katia
Posted by BarbaraCat on September 29, 2003, at 20:58:51
In reply to Re: Dalilah and anyone on Seroquel » BarbaraCat, posted by katia on September 29, 2003, at 17:57:26
Vat is dees 'Avro' ting?
>I think the Avro (sp?) has done it to us. What do you think? HAve you gotten it yet?
Posted by Chicklet on September 30, 2003, at 4:03:13
In reply to Feel better soon, you wildwoman! (nm) » Chicklet, posted by BarbaraCat on September 29, 2003, at 15:57:37
Posted by Dr. Bob on September 30, 2003, at 18:57:45
In reply to Avro? » katia, posted by BarbaraCat on September 29, 2003, at 20:58:51
> Vat is dees 'Avro' ting?
Sorry to interrupt, but I'd like to redirect the discussion that doesn't have to do with medication to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20030913/msgs/264570.html
Thanks,
Bob
Posted by Sabina on October 1, 2003, at 1:30:23
In reply to Re: BP2, FMS, and seroquel here » Sabina, posted by BarbaraCat on September 29, 2003, at 11:12:02
Hey Barbara and Bean (chicklet) both,
To begin with a side item, I wish you guys would consider posting on the social board so's I could feel freer about mentioning more non-med stuffs. I don’t want to be re-directed and it’s not so very bad over there. ;) Just a thought to think about?
Otherwise, sorry so disjointed a response, but I have been in a hormonal funk the past few daze.
Unfortunately, my hypomanic response to fibromyalgia is to push myself until I collapse in a heap and then can’t leave the bed for three days. I so seldom feel up to par that, when I am able to function enough to overdo, I do. I absolutely don't know when to say when. I’m working on finding a middle gear in my life. Fibro is my teacher. (I’m feeling philosophically optimistic tonight.) Back in the 40's, my grandmother was just considered crazy and/or lazy when she presented with the same (fibro) symptoms. Too bad I never really knew her, we’d have quite a talk now!
Like you, I believe that a lack of quality sleep is a prime issue with this condition. I dare anyone to live with as little sleep as I do at times and still manage to function properly, act normal, etc. I was dx’d w/ FMS in ‘97. Things went on fairly uneventfully (full time job, etc.) until a run-in w/ depo-provera (aka satan-in-a-syringe) last year, which began a flare-up of major, job and mind losing proportions. It was then that natural coping skills abandoned me and deep seated, long camouflaged chemical imbalances became unavoidable. It was all just too much to deal with at once.
Seroquel has definitely been the best option I’ve found so far, especially compared to the horrors of SSRI’s, which are routinely prescribed to fibro patients as a first line of defense, because god knows if you aren’t depressed when you're dx'd fibro, you will be soon enough just from dealing with it! Yes, Seroquel is the only thing I’m on...at the moment, apart from the occasional Xanax, Ultram, or Vicodin. I talked to my therapist about it just today, and I think that because I feel *so* much better than I did on Lexapro that I’m just now willing to admit that there’s still (much) room for improvement.
I’m just so thankful that I’m not actively planning my suicide or drinking almost daily as a coping mechanism, and that I'm rid of those demon racing thoughts (with me since childhood), that I almost don’t want to mess about with it. I feel almost like asking or trying for more or better would be ungrateful, in a way. Considering my dreadful history with psych meds (SSRI is a four letter word, as far as I’m concerned) , I’m more than a little reluctant to try anything else, even though my therapist has clients with fibro who’ve had great success with the Adderall. I do think I need something else, though what I don’t yet know.
I only seem to have serious (way too bad to pretend away) problems during certain points in my menstrual cycle. I’d *really* rather not get all strung out on some intricate cocktail that I may not need but one week out of the month, especially since I’m hoping to get pregnant next year and will have to go off them for awhile then, anyway. I’m planning to keep a journal for the next month, noting both emotional and physical problems to help me see any correlations and to help my pdoc make the best decision as to a second drug. Right this minute, I’m leaning toward Trileptil and/or Adderall, though I’d most wish for something I didn’t have to take full time. I already have to divide my Seroquel doses into four times a day to feel fully functional.
Half the time I feel like some neurasthenic Victorian lady, shutters drawn, sitting in a dimly lit room with orders to be quiet and not to read or think too much. I used to be so clever, overly think-y and creative. Now, I can seldom follow my own train of thought, much less anyone else’s. I’ve never tried Ambien, but good luck, certainly, with the au naturel approach. I know everyone’s so different, but I’ve had a very good response to Seroquel. So necessarily, it’s all the stuff I *haven’t* tried that terrifies me! No dry mouth here, and I can’t yet speak to withdrawal issues.
As far as other fibro measures, the water exercises have made more of a difference than anything else...by far and away. Even when I can barely summon the energy to straighten up the house, and can barely stand the idea of leaving the house, I can do this...mostly because I love the water so much. Did you happen to see my post on it? Even my husband has mentioned that I sleep better on the days that I go to the pool. Then there’s the sauna...oh so toasty on the old (oh so old) joints.http://www.dr-bob.org/babble/social/20030913/msgs/262093.html
Drifting off on Vicodin now...serious back pain tonight. Hope to hear from you again soon.
Bina
Posted by Chicklet on October 3, 2003, at 7:00:32
In reply to Re: BP2, FMS, and seroquel (long) » BarbaraCat, posted by Sabina on October 1, 2003, at 1:30:23
Posted by St. John on October 24, 2003, at 11:05:41
In reply to Lamictal side effects - itch! » HenryO, posted by Barbara Cat on August 4, 2003, at 2:49:50
I have unipolar, treatment resistent depression. My response to medication has been at best minimal, and this includes every type of antidepressant and almost all of their varieties. I have also been through a series of ECT treatments with no effective result. For 18 months I have been off all antidepressants and am pleased to be without their side effects. However, I remain depressed. In response to my resignation, my psychiatrist has recommended I consider Lamictal. Are their people out there who share my experience and have had results, good, bad, or nil, from the drug? Is it worth the effort? The absence of side effects, most prominently weight gain, from other antidepressants has been almost worth the emotional wasteland I inhabit. Thanks
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