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Dr. Bob is Robert Hsiung, MD,
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Posted by tendency on March 30, 2005, at 17:58:16
In reply to Re: switch to trileptal from lamictal? » tendency, posted by Minnie-Haha on March 30, 2005, at 15:01:59
> I think the Trileptal would ve likely to help with the irritability and anger (these two are more closely tied to the manic side of bipolar disorder; Trileptal works well on the manic side), but I wouldn't expect it to do much for depression. If you're taking Lamictal and T3, I'd think you're more likely to be leaning toward the anger/irritability side. How's your sleep? Maybe Trileptal and an AD would work well for you? If you don't want to take a prescription AD, I think at least one person here is mixing a prescription MS with St. John's Wort.
>i didnt realize that the anger/irritability was associated with mania.
i think the lamictal is pretty much a bust. ill wean off it and think ill try trileptal and then, if that doesnt work, give neurontin a shot.
maybe ill go for xyrem as well.
Posted by Minnie-Haha on March 30, 2005, at 18:43:26
In reply to Re: switch to trileptal from lamictal? » Minnie-Haha, posted by tendency on March 30, 2005, at 17:58:16
> i didnt realize that the anger/irritability was associated with mania.
Yeah. For instance, in Dysphoric Mania. There's a recent thread here on this:http://www.dr-bob.org/babble/20050222/msgs/461961.html
Of course, there are many things that can cause irritability and anger. For instance, anxiety can cause it. So is it important to know what's causing it? I think it can help you spend less time tracking down the right therapy for you, but it seems like a lot of folks (myself included) have to go through trial and error. Oh, it'll be great when you can get a medical test to DX bipolar disorder (or whatever), but until then... Sigh.
Are you working closely with a doctor? Hopefully a pdoc? You really need someone you can see regularly and be objective while you go through your trial periods.
Good luck.
>
> i think the lamictal is pretty much a bust. ill wean off it and think ill try trileptal and then, if that doesnt work, give neurontin a shot.
>
> maybe ill go for xyrem as well.
Posted by tendency on March 30, 2005, at 19:23:06
In reply to Re: switch to trileptal from lamictal? » tendency, posted by Minnie-Haha on March 30, 2005, at 18:43:26
> Of course, there are many things that can cause irritability and anger. For instance, anxiety can cause it. So is it important to know what's causing it? I think it can help you spend less time tracking down the right therapy for you, but it seems like a lot of folks (myself included) have to go through trial and error. Oh, it'll be great when you can get a medical test to DX bipolar disorder (or whatever), but until then... Sigh.
>
> Are you working closely with a doctor? Hopefully a pdoc? You really need someone you can see regularly and be objective while you go through your trial periods.
>
> Good luck.
>yes, ive been to several pdocs including going to the amen clinic where they do brain imaging. all pdocs (including brain imaging) came back with same dianoses:
- bpII
- depression
- add
- anger issuesso, first med ive tried has been lamictal. ill keep plodding along. thanks for advice.
Posted by theo on March 31, 2005, at 15:28:29
In reply to Re: switch to trileptal from lamictal? » tendency, posted by Minnie-Haha on March 29, 2005, at 18:58:20
> > What are your opinions on trileptal vs. lamictal? I'm BP II and have been on lamicatal (100mg x 2) for about 10 months. Seems to work ok but I'm still fairly depressed. Might trileptal be worth a shot? How do its side effects compare to lamictal? Thanks.
>
> You don't say whether or not you're on an antidepressant. My opinion is that it's pretty hard to treat depression with a mood stabilizer alone. If any MS were going to do it, I'd think it would be Lamictal. (I was on it for a couple of months and was starting to see some improvement, but I got a rash and had to quit.)
>
> I've used Trileptal for a long time and though it keeps me from feeling suicidal, it really doesn't do much to lift me out of depression. My first MS was Depakote, but I also took an AD with it, and it (the Depakote) made me gain 30 pounds in 2 years, so that's when I first switched to Trileptal.
>
> If you're really in a deep-down funk, I think you'll probably need to add an AD.
>Did the Depakote help you from felling suicidal and with low end depressions, any AD effects at all?
Posted by theo on March 31, 2005, at 15:32:00
In reply to Re: switch to trileptal from lamictal?, posted by tendency on March 29, 2005, at 19:03:01
I just stopped Lamictal after 8 months because it made me irritable and anxious, especially when you make a dose increase which is common because it poops out just when you start feeling good, at least that was my unfortunate experience.
Posted by theo on March 31, 2005, at 16:08:26
In reply to Re: switch to trileptal from lamictal? » Minnie-Haha, posted by tendency on March 30, 2005, at 19:23:06
>
> > Of course, there are many things that can cause irritability and anger. For instance, anxiety can cause it. So is it important to know what's causing it? I think it can help you spend less time tracking down the right therapy for you, but it seems like a lot of folks (myself included) have to go through trial and error. Oh, it'll be great when you can get a medical test to DX bipolar disorder (or whatever), but until then... Sigh.
> >
> > Are you working closely with a doctor? Hopefully a pdoc? You really need someone you can see regularly and be objective while you go through your trial periods.
> >
> > Good luck.
> >
>
> yes, ive been to several pdocs including going to the amen clinic where they do brain imaging. all pdocs (including brain imaging) came back with same dianoses:
>
> - bpII
> - depression
> - add
> - anger issues
>
> so, first med ive tried has been lamictal. ill keep plodding along. thanks for advice.
>
>How was the brain imaging at Amen? I've thought about doing that, but like you said, after $6,000.00 and some visual images, I would probably end up with the same diagnosis on the same meds. I guess the good thing would be being able to see some visual proof versus a doctors guess. But even then, there is still the hit and miss of trying different classes of meds.
Posted by tendency on March 31, 2005, at 17:45:29
In reply to Re: switch to trileptal from lamictal? » tendency, posted by theo on March 31, 2005, at 16:08:26
> >
> How was the brain imaging at Amen? I've thought about doing that, but like you said, after $6,000.00 and some visual images, I would probably end up with the same diagnosis on the same meds. I guess the good thing would be being able to see some visual proof versus a doctors guess. But even then, there is still the hit and miss of trying different classes of meds.
i was quite impressed. seems to be the closest thing there is to a definitive medical diagnoses as pdocs rely upon there clinical experience. it's really an art form more than hard science (in my opinion) which i why the amen clinic so appealed to me.
it wasnt $6K. if memory servers it was around $1K per scan and i did two as that is necessary for an add diagnoses.
what impressed me the most is how amen (who reviews each scan and writes up his interpretation along with med recommendations) was able to nail my diagnoses so accurately based solely upon the imaging. he's seeing so many of these (i think around 15k) that he's been able to rather accurately correlate the brain images with different ailments.
unfortunately for me it was worse than i had hoped but at the same time was very reassuring for another opinion. i had been in denial for many years about my condition and seeing this 'hard evidence' is what convinced me i had to take this more serious and look for medical treatment.
all in all, definitely worth it.
Posted by tendency on March 31, 2005, at 17:47:30
In reply to Re: switch to trileptal from lamictal? » tendency, posted by theo on March 31, 2005, at 15:32:00
> I just stopped Lamictal after 8 months because it made me irritable and anxious, especially when you make a dose increase which is common because it poops out just when you start feeling good, at least that was my unfortunate experience.
what ive been noticing too is that my irritability and anxiousness seem to have worsened and am tapering lamictal to see if that's the culprit.
have you changed to a different mood stabilizer theo? if so, how is it working for you?
Posted by Minnie-Haha on March 31, 2005, at 19:22:46
In reply to Re: switch to trileptal from lamictal? » Minnie-Haha, posted by theo on March 31, 2005, at 15:28:29
> Did the Depakote help you from felling suicidal...
My gut feeling would be yes, but I was taking an AD with it at the same time. Trileptal alone (my current MS) keeps me from feeling truly suicidal, but it doesn't really lift my spirits like an AD.
> ... and with low end depressions, any AD effects at all?
Since I was taking it with an AD, hard to say. My guess would be no. Maybe others could comment on there experiences with Depakote and depression?
Posted by theo on March 31, 2005, at 19:57:51
In reply to Re: switch to trileptal from lamictal? » theo, posted by tendency on March 31, 2005, at 17:47:30
> > I just stopped Lamictal after 8 months because it made me irritable and anxious, especially when you make a dose increase which is common because it poops out just when you start feeling good, at least that was my unfortunate experience.
>
> what ive been noticing too is that my irritability and anxiousness seem to have worsened and am tapering lamictal to see if that's the culprit.
>
> have you changed to a different mood stabilizer theo? if so, how is it working for you?
>
>No, I took a break from meds to see what's really bothering me versus side effects from meds. It's been about 6 weeks so far and I feel like I need to start something for mild moodiness and constant low grade depression. I go to my doc in the morning, don't know which direction to go so I'll see what he says.
Posted by Ritch on April 1, 2005, at 0:30:31
In reply to Re: switch to trileptal from lamictal?, posted by Minnie-Haha on March 31, 2005, at 19:22:46
> > Did the Depakote help you from felling suicidal...
>
> My gut feeling would be yes, but I was taking an AD with it at the same time. Trileptal alone (my current MS) keeps me from feeling truly suicidal, but it doesn't really lift my spirits like an AD.
>
> > ... and with low end depressions, any AD effects at all?
>
> Since I was taking it with an AD, hard to say. My guess would be no. Maybe others could comment on there experiences with Depakote and depression?
>
>I'm off all AD's right now, and just taking Depakote(same dose) and clonazepam(same dose) with fishoil. I've been off the slight dose of Celexa I was taking for about three weeks now. I'm feeling more stable and less grouchy, and .. no panic anxiety creeping back in.. however I'm normally on the high side this time of year. The experiment is to see if the depression that usually kicks in by mid-June (thereabouts) will be manageable without an AD, or just not happen (antidepressant induced cycling?). So far so good. I'm skeptical, though. If it does kick in again and I need an AD, I don't want any SSRI's/Cymbalta/Effexor, that's for sure.
Posted by ed_uk on April 1, 2005, at 10:47:10
In reply to Re: switch to trileptal from lamictal? » Minnie-Haha, posted by Ritch on April 1, 2005, at 0:30:31
Hi Mitch!
>I don't want any SSRI's/Cymbalta/Effexor, that's for sure.
What would you choose? Do you respond to MAOIs?
Regards,
Ed.
Posted by Ritch on April 3, 2005, at 15:21:24
In reply to Re: switch to trileptal from lamictal? » Ritch, posted by ed_uk on April 1, 2005, at 10:47:10
> Hi Mitch!
>
> >I don't want any SSRI's/Cymbalta/Effexor, that's for sure.
>
> What would you choose? Do you respond to MAOIs?
>
> Regards,
> Ed.
Hi Ed,Sorry, I missed this post entirely! I have never tried an MAOI. If moclobemide was available here in the US I would be willing to give that a shot.. but my depressions aren't that severe and I think I could do without the side effects from the conventional MAOI's. I'm not really sure what I would ask my pdoc about. I've tried nearly everything else already. I think the easiest thing would be just to add a little gabapentin for the summertime depression (that's worked before), and then just see if a light box will do for the wintertime one. I'm doing an *experiment* right now with taking only Depakote and clonazepam (with fishoil), and its working very well.. anyhow, I'm wondering if the summertime depression ... might not happen. Wishful thinking, but who knows? Since I've been off lithium since 1998, I've never tried seeing if my cycling would settle down during a high period on just antimanics, enough that a seasonal depression (summertime) could be "averted". If that works out.. I think the light box for winter, might just do the trick..
-- Mitch
Posted by ed_uk on April 3, 2005, at 16:03:15
In reply to Re: switch to trileptal from lamictal? » ed_uk, posted by Ritch on April 3, 2005, at 15:21:24
Hi Mitch!
>I think the easiest thing would be just to add a little gabapentin for the summertime depression (that's worked before), and then just see if a light box will do for the wintertime one.
That sounds like a good idea. I remember you saying that the gabapentin made you a little hypomanic, did it ever cause irritability or any other unpleasant symptoms?
Kind regards,
Ed.
Posted by Ritch on April 4, 2005, at 10:17:25
In reply to Re: switch to trileptal from lamictal? » Ritch, posted by ed_uk on April 3, 2005, at 16:03:15
> Hi Mitch!
>
> >I think the easiest thing would be just to add a little gabapentin for the summertime depression (that's worked before), and then just see if a light box will do for the wintertime one.
>
> That sounds like a good idea. I remember you saying that the gabapentin made you a little hypomanic, did it ever cause irritability or any other unpleasant symptoms?
>
> Kind regards,
> Ed.No, gabapentin never caused any irritability like antidepressants have.. that's what is different about it. But, it *does* seem to have a subtle hypomanic induction and a strangely stimulating effect. It also causes an annoying bit of mental "fuzziness" and memory trouble during the day at the same time. I've got a positive feeling that this experiment w/o the AD's might get me through this summer-maybe I won't need anything else. I think I'll mention the moclo import idea to my pdoc though..
Posted by ed_uk on April 4, 2005, at 10:22:45
In reply to Re: switch to trileptal from lamictal? » ed_uk, posted by Ritch on April 4, 2005, at 10:17:25
Hi Mitch!
>it *does* seem to have a subtle hypomanic induction and a strangely stimulating effect.
Sounds nice!
>It also causes an annoying bit of mental "fuzziness" and memory trouble during the day at the same time.
What dose were you on?
Ed.
Posted by Ritch on April 4, 2005, at 13:19:20
In reply to Re: switch to trileptal from lamictal? » Ritch, posted by ed_uk on April 4, 2005, at 10:22:45
> Hi Mitch!
>
> >it *does* seem to have a subtle hypomanic induction and a strangely stimulating effect.
>
> Sounds nice!
>
> >It also causes an annoying bit of mental "fuzziness" and memory trouble during the day at the same time.
>
> What dose were you on?
>
> Ed.Geez, come to think of it even 100mg at bedtime seems to fog up my head the next day just a little, the dose I was on the longest was 100mg 3x daily.
Posted by ed_uk on April 4, 2005, at 17:04:50
In reply to Re: switch to trileptal from lamictal? » ed_uk, posted by Ritch on April 4, 2005, at 13:19:20
Hi!
Does it treat your depression at 100mg/day?
Ed.
Posted by Ritch on April 4, 2005, at 23:15:16
In reply to Re: switch to trileptal from lamictal? » Ritch, posted by ed_uk on April 4, 2005, at 17:04:50
> Hi!
>
> Does it treat your depression at 100mg/day?
>
> Ed.Yes, very oddly enough, it really seems to. It doesn't make sense, but it does really help.
Posted by ed_uk on April 5, 2005, at 7:17:13
In reply to Re: switch to trileptal from lamictal? » ed_uk, posted by Ritch on April 4, 2005, at 23:15:16
Hi Mitch!
Perhaps you will try Lyrica once it's available in the US?
Ed.
Posted by banga on April 5, 2005, at 9:05:18
In reply to Re: switch to trileptal from lamictal? » Ritch, posted by ed_uk on April 5, 2005, at 7:17:13
Hi Ed!
Is lithium considered much more potent for mania than trileptal in general, or is it rather individual?
Posted by ed_uk on April 5, 2005, at 9:18:48
In reply to Re: switch to trileptal from lamictal?, posted by banga on April 5, 2005, at 9:05:18
Hi B!
For the treatment and prophylaxis of mania, lithium salts have been studied more extensively than any other drug. Trileptal hasn't been studied much at all (for mania) but it would be expected to be effective based on it's similarity to Tegretol. There are no trials comparing lithium to Trileptal in the treatment of mania.
>....or is it rather individual?
In psychopharm, everything is individual!
Ed xx
PS. I think you said that your cousin gained too much weight on lithium, perhaps she would do well on a lower dose with less weight gain. I think this is well worth considering.
Posted by Ritch on April 5, 2005, at 9:22:58
In reply to Re: switch to trileptal from lamictal? » Ritch, posted by ed_uk on April 5, 2005, at 7:17:13
> Hi Mitch!
>
> Perhaps you will try Lyrica once it's available in the US?
>
> Ed.I did mention it the last visit.. but there will not be any samples available as in previous times.. since it doesn't carry an indication for psych use. Doesn't pregabalin carry a GAD indication in continental Europe?
Posted by ed_uk on April 5, 2005, at 9:44:14
In reply to Re: switch to trileptal from lamictal? » ed_uk, posted by Ritch on April 5, 2005, at 9:22:58
Hi Mitch!
>Doesn't pregabalin carry a GAD indication in continental Europe?
I'm not sure. In the UK it's approved for epilepsy and neuropathic pain but not GAD.
Ed.
Posted by ed_uk on April 5, 2005, at 9:52:27
In reply to Re: switch to trileptal from lamictal?, posted by banga on April 5, 2005, at 9:05:18
PS. Banga,
In the treatment of 'classical' manic-depression ie. Bipolar I, dramatic grandiose manias, no mood-incongruent psychotic features, no rapid cycling etc...... lithium is often the most effective drug. I don't know much about your cousin, yet I suspect lithium may be more effective than Trileptal. You did mention that she had side effects though... and it won't be effective if she doesn't take it!!! Trilepal may be less likely to cause weight gain, which is why I suggested it. Trileptal might possibly be more useful lithium for rapid-cycling/mixed states and other non-classical presentations. It is unfortunate that Trileptal has not been well studied. I definitely think it's worth thinking about low-dose lithium prophylaxis, I suspect that some doctors may prescribe excessive doses which are poorly tolerated.
Ed xxx
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