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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 Emme on August 6, 2002, at 11:43:41
Hi All,
I'm begging for lots of input these days. Here's the deal. My white blood cell count has been a little low since at least sometime in June. It's not dangerously low. It's holding steady so far at 3.5. I'm taking Neurontin, Lamictal, clonazepam, atenolol, and sometimes a teeny dash of Seroquel.
I was curious as to whether anyone else has had a lowered WBC count that was attributable to meds. I'm going to see a hematologist tomorrow at my internist's request - I think/hope she's just being cautious.
I looked in the PDR and it looks like both Neurontin and Lamictal have some potential to decrease WBC counts. But it looked like that was pretty uncommon. I've been on both drugs before and had normal WBC, though the dosage was slightly lower and I hadn't been on as long. Although Lamictal is working out now, I did feel a bit fluish at times during the titration up, which makes me think there's some sort of immune system response...
And while I'm at it, it seems to be happening again. After *really* strenuous exercise (like many hours of tough yard work this weekend), I'm very tired the next day, and then mega-jitteriness physical anxiety symptoms pop up. It happened for days after a hiking trip, and I occasionally experience it on a smaller scale after a physically demanding day. Anyone notice a correlation between physical activity and anxiety symptoms? Ritch/Mitch thought the intensity of exercise knocked something loose in my HPA axis, which does make some sense. My other theory is that I don't eat enough to compensate for the activity and my blood sugar rides low for a while. Just a thought.... My internist found nothing really wrong during the extreme phsycial fight-or-flight stuff.
Thanks for your help,
Emme
Posted by Shawn. T. on August 6, 2002, at 23:36:22
In reply to Anyone had lowered WBC count?, posted by Emme on August 6, 2002, at 11:43:41
Based on all of that information, my guess is that your IL-6 levels are high. White blood cell counts won't explain your problems. I apologize if the following isn't in layman's terms; we're not exactly dealing with simple material (some people would like to think everything is as simple as increasing serotonin levels, that is anything but true). Lamictal is probably the culprit (I'm basing that on the pharmacology of each of the drugs that you are taking). You could also see about having your TNF-alpha, TNF-gamma, IL-1Ra, IL-2, IL-10, and IL-4 levels checked if you really want to be thorough (I don't know how much something like that costs). IL stands for interleukin and TNF stands for tumor necrosis factor. IL-2 would probably be the most important interleukin to get checked out besides IL-6. IL-6 is involved in the production of B lymphoctyes (B cells), which are responsible for making antibodies. High levels of IL-6 cause a problem because they attracts inflammatory cells (even in the brain). Dr. Michael Maes has done a large amount of work on the involvement between IL-6 and psychological stress. He has also shown that after chronic serotonin reuptake inhibition in vivo, IL-6 levels are significantly increased. In vitro studies have shown otherwise, but such studies only imply that the people conducting them do not understand long-term in vivo serotonin reuptake inhibition pharmacology. Serotonin has been implicated in the proliferation of IL-6 cells, and Lamictal, among other things, is a serotonin reuptake inhibitor. That leads to increased extracellular serotonin levels and increased numbers of IL-6 cells. I am of the opinion that serotonin receptor 5-HT2a is mostly responsible for serotonin's effects upon IL-6 levels in the body. I am somewhat tempted to say that it may be IL-2 levels instead, but I can't say for sure (IL-6 seems more likely based on the description of your problems). Chronic tricyclic antidepressant (amitryptiline) administration has been shown to increase IL-2 levels, and that might be a better comparison drug due to its ability to inhibit noradrenaline. IL-2 causes T-cells to proliferate. Amitryptiline has a number of effects besides serotonin and noradrenaline reuptake inhibition, so it's hard to say.
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=29720049
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=16410965
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=7154585
http://biopsychiatry.com/cytokine.htm
Shawn
Posted by Emme on August 8, 2002, at 7:03:13
In reply to Re: Anyone had lowered WBC count?, posted by Shawn. T. on August 6, 2002, at 23:36:22
I was not of the opinion that WBC counts would *explain* my problems, but rather that it was either a *result* of a drug or a result of some other cause.
I was looking for responses from people who might have had *personal* experience in this, and what their doctors thought of it.
In the past I have taken an SSRI for an extended period without any blood abnormalities. Although I cannot take the time to look at every article you have looked at, my experience and those of the many people I know who've been on SSRI's for long periods of time are inconsistent with what you say - that is, no blood abnormalities.
The hematologist I just saw thought that based on clinical experience as well as it's pharmacologic properties, Neurontin was the most likely culprit. Lamictal would be considered as a second possibility, but that remains to be seen. She did not feel there is currently any danger as every other blood parameter is normal and I don't have any other suspicious symptoms such as swollen lymph nodes, fevers, sweats. She did not order any involved or unusal blood tests - just monitoring CBC over the next several weeks and seeing how it goes for the time being.
She is a reputable and experienced specialist at a teaching institution. She is not symplifying a complicated system, but has the experience and wisdom to plan a reasonable and sensible approach without unncessary testing - until appropriately indicated.
I will not be posting on this board for at least the next several months. Anyone who wishes to know why can see Psycho Babble Administration.
> Based on all of that information, my guess is that your IL-6 levels are high. White blood cell counts won't explain your problems. I apologize if the following isn't in layman's terms; we're not exactly dealing with simple material (some people would like to think everything is as simple as increasing serotonin levels, that is anything but true). Lamictal is probably the culprit (I'm basing that on the pharmacology of each of the drugs that you are taking). You could also see about having your TNF-alpha, TNF-gamma, IL-1Ra, IL-2, IL-10, and IL-4 levels checked if you really want to be thorough (I don't know how much something like that costs). IL stands for interleukin and TNF stands for tumor necrosis factor. IL-2 would probably be the most important interleukin to get checked out besides IL-6. IL-6 is involved in the production of B lymphoctyes (B cells), which are responsible for making antibodies. High levels of IL-6 cause a problem because they attracts inflammatory cells (even in the brain). Dr. Michael Maes has done a large amount of work on the involvement between IL-6 and psychological stress. He has also shown that after chronic serotonin reuptake inhibition in vivo, IL-6 levels are significantly increased. In vitro studies have shown otherwise, but such studies only imply that the people conducting them do not understand long-term in vivo serotonin reuptake inhibition pharmacology. Serotonin has been implicated in the proliferation of IL-6 cells, and Lamictal, among other things, is a serotonin reuptake inhibitor. That leads to increased extracellular serotonin levels and increased numbers of IL-6 cells. I am of the opinion that serotonin receptor 5-HT2a is mostly responsible for serotonin's effects upon IL-6 levels in the body. I am somewhat tempted to say that it may be IL-2 levels instead, but I can't say for sure (IL-6 seems more likely based on the description of your problems). Chronic tricyclic antidepressant (amitryptiline) administration has been shown to increase IL-2 levels, and that might be a better comparison drug due to its ability to inhibit noradrenaline. IL-2 causes T-cells to proliferate. Amitryptiline has a number of effects besides serotonin and noradrenaline reuptake inhibition, so it's hard to say.
>
> http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=29720049
>
> http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=16410965
>
> http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=7154585
>
> http://biopsychiatry.com/cytokine.htm
>
> Shawn
Posted by Shawn. T. on August 8, 2002, at 23:08:36
In reply to Re: Anyone had lowered WBC count? » Shawn. T., posted by Emme on August 8, 2002, at 7:03:13
You stay; I'll go somewhere else. I have tried to back up almost everything that I have said with references, answering questions when necessary. I'm pretty sure that no one wants to hear what I have to say about the danger of SSRI's, so I will talk to someone else about this issue. Apparently there is no room on this board for those who wish to apply rationalitity rather than subjectivity alone to mental health issues. Anyone that wants to ask me any questions can e-mail midu2@yahoo.com. I find it a bit disheartening that you attack my reasoning at the same time that you admit that you do not read the cited references; I wouldn't expect such a thing from a former scientist. The true danger is the power held by drug companies; this is what I have been trying to expose. When commercialism takes precedent over academics is when I begin to fear for people's lives. Ignorance is not bliss in the world of mental health.
Shawn
Posted by Dr. Bob on August 9, 2002, at 11:38:59
In reply to Re: Anyone had lowered WBC count?, posted by Shawn. T. on August 8, 2002, at 23:08:36
> Apparently there is no room on this board for those who wish to apply rationalitity rather than subjectivity alone to mental health issues... I find it a bit disheartening that you attack my reasoning at the same time that you admit that you do not read the cited references; I wouldn't expect such a thing from a former scientist... Ignorance is not bliss in the world of mental health.
I'd like there to be room here for different approaches. That means yours, but also others, so please don't post anything that could lead people to feel accused or put down, 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 oracle on August 9, 2002, at 12:35:38
In reply to Re: Anyone had lowered WBC count?, posted by Shawn. T. on August 8, 2002, at 23:08:36
Apparently there is no room on this board for those who wish to apply rationalitity rather than subjectivity alone to mental health issues. Anyone that wants to ask me any questions can e-mail midu2@yahoo.com. I find it a bit disheartening that you attack my reasoning at the same time that you admit that you do not read the cited references; I wouldn't expect such a thing from a former scientist.
Seem to me it is the hematologist that disagrees
with you, also.
Posted by zani on November 21, 2004, at 23:19:36
In reply to Anyone had lowered WBC count?, posted by Emme on August 6, 2002, at 11:43:41
A long time Lamictal user, after nearly 6 years of 500mg. daily I've noted no adverse reactions and personally recommend this product to other folks who're able to tolerate it. I use it to moderate bi-polar. It works splendedly where none of the other stuff has, -and trust that I'd run through gazoobers of vials of pharmastuff.
As it happens, I am noting a lower-than-normal White Cell count. (Better than elevated, I say!)
Given the severity of my blessing/curse illness, I accept this possible side-effect and go on with the business of being alive and healthy.Since it was through a recent CBC w/differential that this factor came to light, I'll follow up on this matter and possibly Post here any update if it seems likely to help broaden understanding of the properties of this good drug...
Glaxo has a terrific "patient assistance program" affording poor folks medication at no cost; very handy for recovering nutz such as myself. ;)
zani
This is the end of the thread.
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