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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Sooshi on January 9, 2004, at 21:37:18
I've been on Topamax for about 2 months, 200mg for about a month, and I feel as though I've reached a total plateau...I can hardly tell I'm on the medication at all anymore. I was feeling quite good for the last month, with my mood quite upbeat for the first time in ages. Now I'm experiencing a real flat affect....just blah. (I'm Bipolar II-Depressed, and take Effexor Xr also.) Pdoc doesn't want to increase Effexor (I'm on 300mg). I'm wondering if I should go up on the Topamax? Is anyone else taking Topa for BP? What is your dosage?
Thanks.
P.S. Lamictal did nothing for me.
Weight loss/appetite loss has also stopped.
Posted by Karen_kay on January 9, 2004, at 22:14:55
In reply to Topamax Dosage Increase?, posted by Sooshi on January 9, 2004, at 21:37:18
Hi Sooshi, I love sushi! Yummy...
Anyhoooo...
I'm dx Bipolar I Disorder and my dose of Topamax is 300 mgs. I was also on 200 mgs and felt good at first then got to a plateau. I talked to my Pdoc and he raised it to 300 mgs, but I don't and can't take and AD or I go into a manic episode. Once I went up to 300 mgs I felt great, and I mean GREAT!!!!! but I started having severe cognitive problems for about 1-2 months. If you do go up, are you prepared to stick that out? Mine were to the point that I couldn't spell and I got the letter "e" confused with the letter "i"... But, I stuck it out and it did go away. And I am VERY medication tolerant. I usually have little to no side effects with medications.Why are you against going up on the AD instead? I know that upping the Topamax worked for me, but that is the only medication I'm on. If you're up for the possible side effects, I'd say try it. It's possible that if you go up very slow, then it won't happen. Did you have cognition problems when you tirated up to 200?
I'd say consider all of your options. Sorry to be long winded here. Just telling you my experience :) If you had good effects in the past tirating up to 200, ask your Pdoc about going up to 300. If not, I'd say try the effexor instead.... Just my personal opinion, though you didn't ask.....Should I send this? What's the worst that could happen :)
Posted by Sooshi on January 10, 2004, at 9:40:15
In reply to Re: Topamax Dosage Increase?, posted by Karen_kay on January 9, 2004, at 22:14:55
Yes, I'm glad you sent your message, Karen! I, too am pretty med tolerant, and I adjusted well to the Topamax side effects. I had some of the cognitive "stupids", mostly just unable to recall what the heck I was talking about, but that has dissipated.
I'm not against going up on the AD...the Pdoc just thinks that I'm already on such a high dose (300mg) that he doesn't want to go any higher. I don't know how high one can go on Effexor??? But I've always had to go to the limit with AD's...they have never pulled me out of my depressions...that is why we have added mood stabilizers lately....
I'd really like to try going up on the Topa. I just wanted to see what dosages others were on , since I don't know what a therapeutic dosage is, just that 200mg seems to be the norm??
Hopefully others will chime in and let me know what their experiences are?
Thanks again, Karen!
Posted by kattay on January 10, 2004, at 9:45:41
In reply to Re: Topamax Dosage Increase?, posted by Karen_kay on January 9, 2004, at 22:14:55
I took topomax about a year ago and didn't have a good experience. Maybe I should've waited it out but the topomax made me go psycho. It put me on this emotional rollercoaster that was too much. I was bawling one minute and really raging the next. If i remember right, my dose was 400mg. I did become what i called stupid. I'm glad to hear that it can go away. I couldn't read. I couldn't remember little things. I was a mess. I even became suicidal. I couldn't handle the emotional pain. But, not everyone is like that. I would take it real slow. I rushed too fast. That might have been my problem. I got the instructions for titrating it up all mixed up and went up too fast.
Posted by SLS on January 10, 2004, at 10:01:42
In reply to Re: Topamax Dosage Increase?, posted by Karen_kay on January 9, 2004, at 22:14:55
> I'm dx Bipolar I Disorder and my dose of Topamax is 300 mgs. I was also on 200 mgs and felt good at first then got to a plateau. I talked to my Pdoc and he raised it to 300 mgs, but I don't and can't take and AD or I go into a manic episode. Once I went up to 300 mgs I felt great, and I mean GREAT!!!!!
Did Topamax bring you out of depression? I'm not sure from your description.
- Scott
Posted by Karen_kay on January 10, 2004, at 22:24:59
In reply to Re: Topamax Dosage Increase? » Karen_kay, posted by SLS on January 10, 2004, at 10:01:42
> Did Topamax bring you out of depression? I'm not sure from your description.
>
>
> - ScottHi Scott! In a heartbeat! I could tell results almost immediately. But, I had been severly depressed for quite a while with AD induced manic states in between. From what I have heard, Topamax is known to aggravate depression, but in my case, it totally lifted me from my depression. But, I still wasn't "completely 100 %" and I knew it, so I asked if we could go higher and my Pdoc raised me to 300 mgs without hesitation. I haven't been depressed since and that was this past July (or June?). Granted, that hasn't been that long, but that is the longest I've been able to tolerate a mood stabilizer without it pooping out on me or without becoming severely depressed again, or worse having to add an antipsychotic because I begin hallucinating. So, I'm holding out hope. And I feel absolutely wonderful!
Posted by Karen_kay on January 10, 2004, at 22:32:08
In reply to Re: Topamax Dosage Increase? » Karen_kay, posted by Sooshi on January 10, 2004, at 9:40:15
I don't know what the norm is? I don't think that 300 mgs is a high dose to take. I don't have any side effects that I notice on a daily basis, except that just yesterday I had a problem with word finding. But, was it the Topamax or just a regular lapse of cognition? It's hard to say... I don't notice it on an on-going basis. I'd say from my posts that other than typing errors, and boy do I have those!!!, and civility problems :) I'm fine. I'd suggest tirating up then, but be sure to GO SLOW, or be aware..... You may forget what you were talking about. What were we just talking about again????
Posted by Sooshi on January 11, 2004, at 10:40:35
In reply to Re: Topamax Dosage Increase? » Sooshi, posted by Karen_kay on January 10, 2004, at 22:32:08
Do you think I could be experiencing Topamax poop-out? Is there is even such a thing with mood stabilizers (or anti-seizure meds, as Topa actually is)???
If I am, would simply increasing the dose do the trick, or would adding something else to the mix help? Oh geez, I just don't know what to do...all I know is that my depression is creeping back...I feel even worse this morning........
Posted by helenag on January 11, 2004, at 14:20:50
In reply to Topamax Dosage Increase?, posted by Sooshi on January 9, 2004, at 21:37:18
I am also on Effexor XR 300mg and on Topamax, but am at 300mg, upped from 200mg because of increased depression. It seemed to have helped a lot. AM also on seroquel 12.5mg twice a day and 50mg at bedtime. The depression from the "plateau" you describe deepened so much for me, (I also get tremendous anxiety so much so that I can't sit still) that I wound up in the hospital.
The increase from 200mg to 300mg was not slowly titrated. My pdoc upped it straight away to 300mg. I had the expected pins and needles in hands and feet and still get those on occasion. The cognitive effects are with me on a daily basis, though, and those I live with. Forgetting names, words, etc. etc. Wracking my brain... A small price to pay, in my book, for the relief from depression and anxiety. The only thing that sometimes bothers me is the lack of appetite. I have already lost almost 40 pounds since last year. I did start out to lose weight from Weight Watchers, but once I became ill and then on the topamax this spring, I really lost weight without trying. Since on topamax I have lost about 25 pounds. The depression took most of my appetite away, too.
So, to answer to question, I'd suggest that you give the topamax increase a go if that is what your pdoc suggests. helen.
Posted by Sooshi on January 12, 2004, at 12:38:34
In reply to Re: topamax dosage increase? » Sooshi, posted by helenag on January 11, 2004, at 14:20:50
Helen, thanks for responding! Your situation sounds so much like mine. I, too, suffer from severe anxiety and was even agoraphobic for 2 years of my life (didn't leave my house, not once) and panic attacks, but with CBT (cognitive behavorial therapy, I overcame it almost 10 years ago...now I have a generalized anxiety caused by the depression which is controlled by the meds (and CBT), until they start to poop out!
I will definately ask my Pdoc about increasing the Topa to 300mg and see what he thinks. I need to do something at this point....
My cognitive se's from the Topa are still with me, but not nearly as bad as they were at the beginning. I fully expect them to return when I increase to 300....My feet fall asleep so easily and tingle like MAD! My lips and fingers occasionally tingle, not much...
I don't seem to be dropping the weight like some of the others who have been on Topa. I lost an initial 16lbs during the first two months. I haven't had any real huge loss of appetite...I just feel fuller at each meal, and stop eating sooner. But, come PMS time, I pig out as usual. I'm still losing weight gradually, (maybe 1/2lb week?) and that's fine with me. I'm not taking this for weight loss anyway.
I still have such high hopes that this drug will help me.......
Posted by Karen_kay on January 13, 2004, at 16:14:05
In reply to Re: topamax dosage increase? » helenag, posted by Sooshi on January 12, 2004, at 12:38:34
Topamax has helped me tremendously! The uppage (is that a word?) to 300 is what I needed to be "cured" of my depression completely! The 200 dose helped quite a bit, but at 300, all signs of depression are gone for me. But, be sure you tirate slowly. From what I've read here and elsewhere, the tiration up is what causes the cognitive side effects. Don't quote me on this but I think it's 25 every couple of weeks... So, jsut go slow... And if you do get the side effects, try to stick them out. I had them, but I stuck it out and I'm telling you topamax is the drug for me. I'm not saying it is your wonder drug, but it is surely mine. Yahoo! I'd do a commercial if my butt wasn't so big :)
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