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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Adam Donahue on January 7, 2004, at 13:32:31
I was prescribed Lamictal yesterday as a treatment for bipolar II -- particularly the deep depression I was thrown into last week after I abruptly stopped taking Celexa on my pdoc's orders. (Bad move; after a week off Celexa, I became panicked, racy-headed, and very depressed -- never been that depressed. After a week back on the Celexa, I'm finally starting to come out of it.)
My question is, I'm currently taking lithium 150mg bid, 40mg Celexa, and now 25mg Lamictal tritrate up to 200mg. I know the Lamictal takes awhile to kick in -- particularly because you must up the dosage very slowly to prevent rash. So I plan to continue on Celexa 40 mg until I am on both it and Lamictal at full dosage, and then slowly drop the Celexa from my regimine. (Not all at once like I did at Christmas.)
Question: is the lithium strictly necessary? Or will Lamictal alone work as a good enough mood stabilizer? I'd prefer to take /fewer/ medicines ... Definitely more prone to depression than mania -- I've never had a full-blown manic episode, just looooong hypomanic episodes (long: four years, which makes me wonder if I'm hypo at all, but that's another question).
Advice appreciated.
Adam
Posted by HappyGirl on January 7, 2004, at 13:55:14
In reply to Celexa/Lamictal + Lithium for Bipolar II: Needed?, posted by Adam Donahue on January 7, 2004, at 13:32:31
Hi:
In anwser to your question,...
the reason why your pdoc. rxed both med., Lamictal and Lithium is because you have deeper form of depression. Lamical is a good quality for Bipolar depression, but this med. alone might not be able to alleviate your Bp depression.
In general, Bp II that your Bp matches is not milder form of Dep., rather serious form, then most of Bps have two form of AD, that might be in your case, as well.
Also, Lithium 150 mg., bid is lower dosage, ... a standard dosage is 900 mg. Your current dosage of the Lamictal is a sort at starter-dosage, then I feel your pdoc. is right on this combo. However, according your prognosis and reaction to the med. combo. you may ask your pdoc. to cut back one of med., that is mostly ikely 'Lithium.'
H.G.
Posted by Adam Donahue on January 7, 2004, at 14:08:33
In reply to Re: Celexa/Lamictal + Lithium for Bipolar II: Needed?, posted by HappyGirl on January 7, 2004, at 13:55:14
Thanks for the comments.
I was on 600 mg/day of Lithium, but after a few days of this my eyes would start to get baggy and I'd feel very tired. We decided to split the dose -- rather than my taking 300 mg once per day (at night), I'm taking 150 mg twice a day. I haven't really liked the Lithium, and if I get the depression under control, I may drop it completely in lieu of Lamictal + an AD. Perhaps not Celexa, but something else. Or maybe just Lamictal alone. I'm much more concerned about the depression than the mania, as the depression interferes with my life, while, so far, the hypomania has simply made be a bit hyper at times, but only once led to a problem -- drinking -- which I think is related to even more complex problems.
Adam
> Hi:
> In anwser to your question,...
> the reason why your pdoc. rxed both med., Lamictal and Lithium is because you have deeper form of depression. Lamical is a good quality for Bipolar depression, but this med. alone might not be able to alleviate your Bp depression.
> In general, Bp II that your Bp matches is not milder form of Dep., rather serious form, then most of Bps have two form of AD, that might be in your case, as well.
> Also, Lithium 150 mg., bid is lower dosage, ... a standard dosage is 900 mg. Your current dosage of the Lamictal is a sort at starter-dosage, then I feel your pdoc. is right on this combo. However, according your prognosis and reaction to the med. combo. you may ask your pdoc. to cut back one of med., that is mostly ikely 'Lithium.'
> H.G.
Posted by HappyGirl on January 7, 2004, at 14:53:53
In reply to Re: Celexa/Lamictal + Lithium for Bipolar II: Needed? » HappyGirl, posted by Adam Donahue on January 7, 2004, at 14:08:33
Hi Adam D.:
>> ... but after a few days of this my eyes would start to get baggy and I'd feel very tired. <<
Those are 'side effects' from Lithium. Your pdoc. might have said to you in regard to 'fluid intake,' you need to drink a lot of fluid whether juice or plain water from faucet, on taking Lithium. The 150 mg. each time is right, ... because Lithium has reputation to have some annoying side-effects such as 'trembling hands' that you may NOT like to hear, but has one. Then, if possible, other med. like Depakote or Triptal(newer version of Tegretol) might be considered.
Since I have no knowledge exact your Bp condition except severe form of depression, ... I can not say more on this. However, Bp II has, as in my previous response, serious form of Depression that debiliating you on daily activities, such as work or study. For this, you need some 'Stronger AD' to get it under control.
If side effects stated above, from Lithium keeps on, even one or two weeks, ... then you need to talk to your pdoc. for another form of med., ... that is my suggestion.
In my personal experience, my Bp(I have Bp II with rapid cycler since '98) got progressed as the times went. At the beginning, I had severe form of Dep. on the majority of my Bp, however manic(hypomanic) came, then the next, rageous form and go on, ... finally settled Bp II with rapid-cycler. Then, you can not predict what would happen on this symptoms, ... (Sorry, it makes you scared, ... but this is just only me, not anyone else, .. then keep your mind in good rest.) But, lucky Bps would stay as the same as the beginning of Dx(Hopefully, that is your case.) Then, you need to keep in good communication open with your pdoc. for now and future, as well.
H.G.
Posted by Adam Donahue on January 7, 2004, at 15:01:26
In reply to Re: Celexa/Lamictal + Lithium for Bipolar II: Needed?, posted by HappyGirl on January 7, 2004, at 14:53:53
Well, those 'side effects' are just not acceptable. Like I've said elsewhere, it's one thing to be 'stabilized', it's quite another to feel the drool running down your chin! [OK, it wasn't that bad, but you get the picture.]
So I'm on Lamictal now, which I'm told doesn't have the same side effect profile as lithium. I'm also taking Celexa as I slowly raise the Lamictal dose to a therapeutic range.
Has anyone used Lamictal as monotherapy for BP II?
Adam
> Hi Adam D.:
> >> ... but after a few days of this my eyes would start to get baggy and I'd feel very tired. <<
> Those are 'side effects' from Lithium. Your pdoc. might have said to you in regard to 'fluid intake,' you need to drink a lot of fluid whether juice or plain water from faucet, on taking Lithium. The 150 mg. each time is right, ... because Lithium has reputation to have some annoying side-effects such as 'trembling hands' that you may NOT like to hear, but has one. Then, if possible, other med. like Depakote or Triptal(newer version of Tegretol) might be considered.
>
> Since I have no knowledge exact your Bp condition except severe form of depression, ... I can not say more on this. However, Bp II has, as in my previous response, serious form of Depression that debiliating you on daily activities, such as work or study. For this, you need some 'Stronger AD' to get it under control.
> If side effects stated above, from Lithium keeps on, even one or two weeks, ... then you need to talk to your pdoc. for another form of med., ... that is my suggestion.
> In my personal experience, my Bp(I have Bp II with rapid cycler since '98) got progressed as the times went. At the beginning, I had severe form of Dep. on the majority of my Bp, however manic(hypomanic) came, then the next, rageous form and go on, ... finally settled Bp II with rapid-cycler. Then, you can not predict what would happen on this symptoms, ... (Sorry, it makes you scared, ... but this is just only me, not anyone else, .. then keep your mind in good rest.) But, lucky Bps would stay as the same as the beginning of Dx(Hopefully, that is your case.) Then, you need to keep in good communication open with your pdoc. for now and future, as well.
> H.G.
>
Posted by HappyGirl on January 8, 2004, at 0:34:04
In reply to Re: Lamictal as monotherapy for BPII? » HappyGirl, posted by Adam Donahue on January 7, 2004, at 15:01:26
Hi Adam D.:
I quite understand that those side-effects from Lithium .... not acceptable.
In my knowledge, Lamictal is good for the depressive side of Bp. However, I believe that Lithium is more for 'stabilization' on Bp. (BTW, Lithium has both effects, AD and manic sides.)In Bipolar, there are two poles, one for depression and other for manic. For this, I believe that your pdoc. rxed lithium that keeps you from aggrevating along with the purpose to stabilize Bp. In that regard, Lithium might be more effective than Lamictal. As you might know, Lamictal is originally designed for seizure-medication, ... not Bp. However, this med. is widely used among Bps, as well. On the oherhand, Lithium is exclusively made for Bipolar condition. It's one of the oldest Bp meds., but also one of the best meds on Bp, ... even some saying 'on the top list in regard to stabilize Bp.'
I know it's very sad that those meds. have side-effects for us to deal with, ... however if the effectiveness from Lithium is more than pain from the side-effect, then I would chose to take this med. that exactly happened to me at the beginning of taking Lithium.
In your case, ... however Lithium is NO way to take, then you may need to talk to your pdoc. before final decision made. Because, your pdoc. might have a good intention to rx this med., Lithium on your Bp. There are many other meds. to choose if Lithium is not acceptable, ... but one way or other, there are some annoying/bothersome side-effects to deal with. Then, you need to decide which med. is suitable/tolerable to your daily activities, such as work and study(if you're at College). That is my suggestion from the experience.
H.G.
Posted by Adam Donahue on January 8, 2004, at 12:52:47
In reply to Re: Lamictal as monotherapy for BPII?, posted by HappyGirl on January 8, 2004, at 0:34:04
Happy,
Wise words. I just -- I guess I refuse to accept that I'll need to take for the rest of my life a drug that makes me ponder the question: "Do I need to think today?" For better or worse, my energies have been a large part of who I am -- and now I'm being told to take a pill to make them go away. I just can't tolerate that.
My bipolar, aside from causing me only recently into a drinking spell, has /never/ caused me aggrevation, delusions, or any other negative effects besides being a bit hyper. But I'm not sure even lithium can make that go away! I was supremely depressed over the weekend, as I said, but still talked a mile-a-minute, in an enthusiastic way. And it's not a so-called mixed episode. THAT IS JUST THE WAY I AM!
On lithium + depression, I've lost my joy for life, curiousity and energy to succeed. I am off the lithium because I need that energy. So to answer your implied question, the side-effects of lithium are far worse than any mania I've experienced in my life so far. I have been depressed for a week or so during the recent episodes. I've been 'zonked' out on lithium for /three months/. (Perhaps this is lingering depression, in which case the lithium is not helping!) I choose the occasional depression over a life of dullness!
Now -- in the future, perhaps I'll experience the true discomfort of mania. And then my assessment of this situation might change. For now, I feel simply frustrated, unmotivated, and dulled. As I lower the dose of lithium, I can slowly feel the motivation coming back.
Adam
> Hi Adam D.:
> I quite understand that those side-effects from Lithium .... not acceptable.
> In my knowledge, Lamictal is good for the depressive side of Bp. However, I believe that Lithium is more for 'stabilization' on Bp. (BTW, Lithium has both effects, AD and manic sides.)
>
> In Bipolar, there are two poles, one for depression and other for manic. For this, I believe that your pdoc. rxed lithium that keeps you from aggrevating along with the purpose to stabilize Bp. In that regard, Lithium might be more effective than Lamictal. As you might know, Lamictal is originally designed for seizure-medication, ... not Bp. However, this med. is widely used among Bps, as well. On the oherhand, Lithium is exclusively made for Bipolar condition. It's one of the oldest Bp meds., but also one of the best meds on Bp, ... even some saying 'on the top list in regard to stabilize Bp.'
> I know it's very sad that those meds. have side-effects for us to deal with, ... however if the effectiveness from Lithium is more than pain from the side-effect, then I would chose to take this med. that exactly happened to me at the beginning of taking Lithium.
> In your case, ... however Lithium is NO way to take, then you may need to talk to your pdoc. before final decision made. Because, your pdoc. might have a good intention to rx this med., Lithium on your Bp. There are many other meds. to choose if Lithium is not acceptable, ... but one way or other, there are some annoying/bothersome side-effects to deal with. Then, you need to decide which med. is suitable/tolerable to your daily activities, such as work and study(if you're at College). That is my suggestion from the experience.
> H.G.
This is the end of the thread.
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