![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 48. This is the beginning of the thread.
Posted by SLS on June 11, 2005, at 15:58:46
I am beginning to respond to the addition of Trileptal 600mg. Quantitatively, the improvement is only mild. However, qualitatively, it is very broad in the features of depression that are beginning to improve. It is a true antidepressant response. I have a good feeling about this. Improvement is very gradual, but the trend is towards remission. Will it poop-out? Who can say? I am betting on full remission. It is logical.
Currently:Lamictal 150mg
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Trileptal 600mg
- Scott
Posted by Phillipa on June 11, 2005, at 18:14:49
In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46
I certainly hope so for your sake. You've been trying for so long and using so many med combos. May this be the right one for you! Fondly, Phillipa
Posted by ed_uk on June 11, 2005, at 18:22:17
In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46
Hi Scott,
That's great :-) Keep us updated, I hope Trileptal is the one!
Kind regards,
Ed.
Posted by stresser on June 11, 2005, at 20:48:12
In reply to Re: Trileptal 600mg » SLS, posted by ed_uk on June 11, 2005, at 18:22:17
Scott,
Let you know how you are doing! I have my fingers crossed for you! -L
Posted by Maxime on June 11, 2005, at 22:02:06
In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46
> I am beginning to respond to the addition of Trileptal 600mg. Quantitatively, the improvement is only mild. However, qualitatively, it is very broad in the features of depression that are beginning to improve. It is a true antidepressant response. I have a good feeling about this. Improvement is very gradual, but the trend is towards remission. Will it poop-out? Who can say? I am betting on full remission. It is logical.
>Maybe I should try 600 instead of 450. I could use less depression.
I'm glad you are feeling some improvement Scott.
Maxime
> Currently:
>
> Lamictal 150mg
> Parnate 80mg
> nortriptyline 100mg
> Abilify 10mg
> Trileptal 600mg
>
>
> - Scott
Posted by Minnie-Haha on June 12, 2005, at 12:23:16
In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46
Posted by emme on June 12, 2005, at 13:38:05
In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46
Terrific! I'm so glad this is helping you. You're long overdue for a little relief.
em
Posted by SLS on June 12, 2005, at 16:15:01
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 12, 2005, at 13:38:05
Hi Emme.
> Terrific! I'm so glad this is helping you. You're long overdue for a little relief.
Thanks.
I'm having a difficult time deciding whether or not to reduce the dosage to 450mg. I experience a sort of apathy and mood flattening that feels muddy. I am sure this is the result of the Trileptal. Cognition is not too badly affected, but I would like to be without any of these side effects. They would have a negative impact on my quality of life were they to continue. Of course, I do not want to jeapordize my response to this drug. Maybe I could just try reducing it for a few days, but when would be a good time to try this experiment? I gotta think about this.
What would you do?
- Scott
Posted by ed_uk on June 12, 2005, at 17:26:28
In reply to Re: Trileptal 600mg » emme, posted by SLS on June 12, 2005, at 16:15:01
Hi Scott,
>I experience a sort of apathy and mood flattening that feels muddy. I am sure this is the result of the Trileptal. Cognition is not too badly affected, but I would like to be without any of these side effects.
Perhaps the side effects would decrease if you reduced your Lamictal dose??? Too many ion channels being inhibited?!
~Ed
Posted by emme on June 12, 2005, at 18:32:07
In reply to Re: Trileptal 600mg » emme, posted by SLS on June 12, 2005, at 16:15:01
> I'm having a difficult time deciding whether or not to reduce the dosage to 450mg. I experience a sort of apathy and mood flattening that feels muddy. I am sure this is the result of the Trileptal. Cognition is not too badly affected, but I would like to be without any of these side effects. They would have a negative impact on my quality of life were they to continue. Of course, I do not want to jeapordize my response to this drug. Maybe I could just try reducing it for a few days, but when would be a good time to try this experiment? I gotta think about this.
>
> What would you do?Apathy and flatness are bad things. Apathy has really done a number on my quality of life (or lack of one). I forget - how long have you been on the 600 mg? Do you feel like you've been at 600 mg long enough for things to settle in and for you to have achieved the full effect? If possible, I'd scootch the dose down bit by bit rather than jump to 450 and miss an optimal dose in between. If you don't want to chop the tabs, there's an oral suspension.
em
Posted by woolav on June 12, 2005, at 21:25:22
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 12, 2005, at 18:32:07
Hey scott, i dont know about most of the meds you are on, besides of course trileptal and lamictal. Are any of the other meds like an AD? Because if you remember I take 600mg of tri and 300 of lamictal and when i stopped taking prozac, i began going into a depressive state. I feel better now that i am back on it.
by the way, what is your dx??
S
Posted by SLS on June 13, 2005, at 7:19:31
In reply to Re: Trileptal 600mg » SLS, posted by ed_uk on June 12, 2005, at 17:26:28
> Hi Scott,
>
> >I experience a sort of apathy and mood flattening that feels muddy. I am sure this is the result of the Trileptal. Cognition is not too badly affected, but I would like to be without any of these side effects.
>
> Perhaps the side effects would decrease if you reduced your Lamictal dose??? Too many ion channels being inhibited?!
>
> ~Ed
Ed.Great idea!
You're a real smart guy, Ed. :-) I already thought of that, and will probably try to remove Lamictal once a robust antidepressant response is firmly in place. Otherwise, it might confuse the issue.
I am quite relieved that you're on the case! You are stunningly accurate. Thanks.
- Scott
Posted by SLS on June 13, 2005, at 7:26:43
In reply to Re: Trileptal 600mg---sls, posted by woolav on June 12, 2005, at 21:25:22
> Hey scott, i dont know about most of the meds you are on, besides of course trileptal and lamictal. Are any of the other meds like an AD? Because if you remember I take 600mg of tri and 300 of lamictal and when i stopped taking prozac, i began going into a depressive state. I feel better now that i am back on it.
> by the way, what is your dx??
> SI'm on two antidepressants: Parnate and nortriptyline. I'm sure that I would not be able to do without them.
My diagnosis? I remain severely depressed every moment of every day of every year. However, I have had manic reactions to medication on 4 occasions. Since the manic reactions were severe and included psychoses, I am probably more like a bipolar I than a bipolar II. The depression also looks bipolar. It is very anergic, psychomotor retardation, impaired cognition, and a deficit syndrome (negative symptoms). They gave it a name... NOS. :-) In the next DSM, there will probably be a category in which a case like mine will fall into - bipolar III.
- Scott
Posted by ed_uk on June 13, 2005, at 7:28:13
In reply to Re: Trileptal 600mg » ed_uk, posted by SLS on June 13, 2005, at 7:19:31
Hi Scott,
What a kind thing to say! Thank you :-)
Kind regards,
Ed.
Posted by SLS on June 13, 2005, at 7:46:26
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 12, 2005, at 18:32:07
Hi Emme.
> > I'm having a difficult time deciding whether or not to reduce the dosage to 450mg. I experience a sort of apathy and mood flattening that feels muddy. I am sure this is the result of the Trileptal. Cognition is not too badly affected, but I would like to be without any of these side effects. They would have a negative impact on my quality of life were they to continue. Of course, I do not want to jeapordize my response to this drug. Maybe I could just try reducing it for a few days, but when would be a good time to try this experiment? I gotta think about this.
> > What would you do?
> Apathy and flatness are bad things.
Very.
> Apathy has really done a number on my quality of life (or lack of one).
That really sucks. I'm sorry to here that. Abilify helps me with motivation. I have heard this from others as well. Amotivation and anergia can combine to allow one's life to become very disorganized and in disarray. Over time, it becomes unmanageable.
> I forget - how long have you been on the 600 mg?
About a week. How impatient is that!
> Do you feel like you've been at 600 mg long enough for things to settle in and for you to have achieved the full effect?
No.
> If possible, I'd scootch the dose down bit by bit rather than jump to 450 and miss an optimal dose in between. If you don't want to chop the tabs, there's an oral suspension.
I guess it makes the most sense to stick to 600mg in order to realize the full potential of this drug before lowering the dosage. Yes. It makes sense. But who says that anything I do makes sense? I am impatient and intolerant of cognitive side effects. I want to hurry up and get rid of them if I think I can by making a simple dosage adjustment. So, going down to 450mg for a few days is a very appealing idea, although it might not be logical... I feel sort of like "Do as I say and not as I do."
I guess I'm just obsessed with feeling well. It's a vice of mine. :-)
- Scott
Posted by emme on June 13, 2005, at 10:24:02
In reply to Re: Trileptal 600mg » emme, posted by SLS on June 13, 2005, at 7:46:26
Hi Scott,
> > Apathy and flatness are bad things.
>
> Very.Very very.
> > Apathy has really done a number on my quality of life (or lack of one).
>
> That really sucks. Abilify helps me with motivation..... Amotivation and anergia can combine to allow one's life to become very disorganized and in disarray. Over time, it becomes unmanageable.Yeah, I wonder how many pdocs really appreciate this. I'm lucky. I don't think mine knows how it feels directly, but at least she knows it's a problem we need to fix.
I've taken Abilify before. It was great at first, but after a while it faded out and it made me pretty antsy. Maybe I should consider trying it again.> > I forget - how long have you been on the 600 mg?
>
> About a week. How impatient is that!Well, a week can seem like an eternity when you ain't gettin' nothin' done!
> > Do you feel like you've been at 600 mg long enough for things to settle in and for you to have achieved the full effect?
>
> No.To be honest, I don't know how long it typically takes to really get up to speed with this one. Can you ride out a few more days with it?
> I guess I'm just obsessed with feeling well. It's a vice of mine. :-)
I think we should shoot high. What's the sense of a partial recovery if we can't be fully alive? But then I've been accused of not being willing to scale back my expectations or accept limitations even though I've been pretty debilitated. Hmph.
Now, about my contuining tiredness. I'm down to 150 mg Lamictal and 1.25 mg memantine. I feel less drugged on the lower doses, but I'm still very very floppy and don't have any initiative. I can't decide if it's the Lamictal making me tired all this time. It had seemed activating when I first started it and I sleep less at night on it. I may just still have fatigue as a symptom of depression. I'm at a loss. Have you found that Lamictal makes you tired?
I know there are options to counteract fatigue, but I have to be very careful with stimulating drugs b/c I get pushed into anxiety and overstimulation very easily.
Thoughts?
em
Posted by SLS on June 13, 2005, at 15:12:12
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 13, 2005, at 10:24:02
Hi Emme.
Actually, I think it might be worth discontinuing the memantine briefly to see if it isn't the culprit. I think we had a conversation about this earlier in the year. We both reacted to memantine in the same way the second time around - weakness and fatigue. I have not had Lamictal affect me this way - even at 450mg. I just experienced some cognitive impairments.
- Scott
Posted by emme on June 13, 2005, at 20:46:13
In reply to Re: Trileptal 600mg, posted by SLS on June 13, 2005, at 15:12:12
Hi Scott,
Thanks for your input.
> Actually, I think it might be worth discontinuing the memantine briefly to see if it isn't the culprit.
I thought of that, but I don't think my doctor will like that idea b/c it's been so hard to find things that work for my depression. It’s hard for me to believe the microdose I’m taking now is making me a zombie, but anything is possible.
> I think we had a conversation about this earlier in the year. We both reacted to memantine in the same way the second time around - weakness and fatigue.
Yeah, you're right, we did. I'm glad one of us has a memory. :)
> I have not had Lamictal affect me this way - even at 450mg. I just experienced some cognitive impairments.
When I've been on minimal meds, with mostly lamictal and a benzo, it hasn't killed the depression and I've been tired and apathetic. So maybe Lamictal makes me tired in the long run even though it seemed activating at the outset. Either that or the fatigue is caused by depression.
Anyway, my options for adding antidepressant power aren’t great.
My last two tries with Paxil made me terribly irritable or too sedated.
Celexa went south after about 6 weeks.
Lex = apathetic and numb beyond belief.
Wellbutrin: 37.5 did nothing. 75 was awfully stimulating.
(All of these with Lamictal.)
Effexor made me feel sick and increased my pulse hugely, but the dose may have been too high.My pdoc isn’t keen on me having tricyclics around b/c of their lethality in overdose (plus higher s/e profiles).
MAOIs = my dietary habits would make the diet very difficult.
Selegiline = what appeared to me to be cycling. Much better w/o it.
SSRIs haven’t panned out for the long term, but maybe try prozac anyway?Provigil = inconsistent response. Sometimes okay, sometimes too stimulating, sometimes does nothing. I keep some on hand.
I have poor prescription coverage (only 50%), so it helps if everything else is either generic or if I can get by with small doses and sample packs.
I gotta get less tired and have more spark and initiative. It's going to hit situation cricital if I don't become more productive.
I’m getting more impatient and less and less willing to put up with side effects. And I complain a lot. :)em
Posted by SLS on June 14, 2005, at 16:38:43
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 13, 2005, at 20:46:13
Hi Emme.
> Hi Scott,
>
> Thanks for your input.
> > Actually, I think it might be worth discontinuing the memantine briefly to see if it isn't the culprit.
> I thought of that, but I don't think my doctor will like that idea b/c it's been so hard to find things that work for my depression.I was thinking in terms of a few days - even with its long half-life. Being off of it a full week should be plenty of time to see if a trend establishes itself.
> It’s hard for me to believe the microdose I’m taking now is making me a zombie, but anything is possible.
:-)
A little logic here, Emme. This same microdose is capable of exerting a psychotropic effect as an antidepressant - why not also as a cause of other psychotropic effects that are undesirable?
> > I think we had a conversation about this earlier in the year. We both reacted to memantine in the same way the second time around - weakness and fatigue.
> Yeah, you're right, we did. I'm glad one of us has a memory. :)
> > I have not had Lamictal affect me this way - even at 450mg. I just experienced some cognitive impairments.
> When I've been on minimal meds, with mostly lamictal and a benzo, it hasn't killed the depression and I've been tired and apathetic. So maybe Lamictal makes me tired in the long run even though it seemed activating at the outset. Either that or the fatigue is caused by depression.How much Lamictal are you taking? It is possible that it is causing some flattening of affect that feels like apathy and making you a bit "stupid".
> Anyway, my options for adding antidepressant power aren’t great.Then how about mood stabilizers?
> My last two tries with Paxil made me terribly irritable or too sedated.
Irritability is not necessarily a bad thing. If it is a startup side effect, it might pass. Irritability also emerges as a sign of improvement of depression.
> Celexa went south after about 6 weeks.
Can you describe the magnitude and scope of your response to Celexa. Did you feel you had reached remission?
> Lex = apathetic and numb beyond belief.
Me too.
> Wellbutrin: 37.5 did nothing. 75 was awfully stimulating.
Stimulation is a good thing, even if it feels uncomfortable in the beginning. How long were you on 75mg before you discontinued it?
> Effexor made me feel sick and increased my pulse hugely, but the dose may have been too high.
Don't worry about pulse. People all too often discontinue TCAs simply because their heart rates increases to 100-120 bpm. This is tragic. This is an expected effect, and a sign that the drug is doing what it is supposed to do, even if only peripherally.
> My pdoc isn’t keen on me having tricyclics around b/c of their lethality in overdose
Awe, poor doctor doesn't want to take the risks necessary to get the patient well. Oh, how I empathize with him - NOT. How often have you attempted suicide?
> (plus higher s/e profiles).
You want to play - you've got to pay. Get tough. The side effects are more nuissances than anything else, and I would much rather have a dry mouth than anorgasmia and apathy. In my mind, the side effect profile of tricyclics are favorable. I like nortriptyline followed by desipramine. If you don't respond to one, you might respond to the other. It happens.
> MAOIs = my dietary habits would make the diet very difficult.
Come on, Emme. Do a little self-talk here. That is a pretty poor reason not to join the life of the living again. Life is waiting for you, Emme. Pay the price and get on with it. You will find that it is a very small one.
> Selegiline = what appeared to me to be cycling. Much better w/o it.
Hmm.
Can you describe in better detail what you experienced?
> SSRIs haven’t panned out for the long term, but maybe try prozac anyway?
Prozac is a drug that makes no sense to neglect. It is different from all the other SSRIs in several ways. It is more noradrenergic and binds to certain 5-HT receptors. However, I would go for nortriptyline or an MAOI first if I were in your situation. You might prefer to start with Nardil because it is less amphetamine-like than Parnate. Even this amphetamine effect is only temporary in my experience. I would not give up before trying both drugs. They are far too different to generalize your experience of one to the others.
> I gotta get less tired and have more spark and initiative.Parnate?
One nice thing about Parnate is that it is safer than Nardil to add a TCA to it. You can also add Wellbutrin to it. The only true contraindication is a SRI and clomipramine.
Listen, these stimulating drugs that cause complete insomnia are the ones that are going to blow a hole through your wall of treatment-resistance. Just go for it. Treat the insomnia aggressively when it appears. Then just sit back and get well.
I guess I should acknowledge that a drug does not have to be stimulating to make you feel less tired and have more spark and initiative. Anything that attacks the depression effectively will resolve these things, even if it is sedating at first. Nardil is no less apt to treat your anergia than Parnate.
> It's going to hit situation cricital if I don't become more productive.
How so?
> I’m getting more impatient and less and less willing to put up with side effects. And I complain a lot. :)
ME TOO!
It is quite a paradox. The less treatable you are the less treatment you are willing to tolerate.
Get well.
Oh, about me, I decided to stay at 600mg of Trileptal and allow the cognitive stuff to pass. I was encouraged by what a doctor I spoke to yesterday had to say. The "yuckies" should dissipate entirely.
- Scott
Posted by emme on June 14, 2005, at 23:48:10
In reply to Re: Trileptal 600mg » emme, posted by SLS on June 14, 2005, at 16:38:43
Hi Scott,
>I was thinking in terms of a few days - even with its long half-life. Being off of it a full week should be plenty of time to see if a trend establishes itself.
I’ll think about bringing that up when I see my doctor next.
> A little logic here, Emme.
Er..are you teasing, or are you angry and frustrated with me?
> This same microdose is capable of exerting a psychotropic effect as an antidepressant - why not also as a cause of other psychotropic effects that are undesirable?
Yeah, I know. Point taken. :)
>How much Lamictal are you taking? It is possible that it is causing some flattening of affect that feels like apathy and making you a bit "stupid".
150 mg right now. I dunno…it doesn’t feel flat the way Lex or higher dose Memantine did. But if I’m flattened, I might not be aware of it b/c I’ve been on Lamictal for a long time.
> Then how about mood stabilizers?
The others really haven’t panned out. Trileptal didn’t really seem to help me. Topomax, lithium, Zonegran, all either didn’t help or made me worse. Given my symptoms, we haven’t had depakote on the radar.
>> My last two tries with Paxil made me terribly irritable or too sedated.
> Irritability is not necessarily a bad thing. If it is a startup side effect, it might pass. Irritability also emerges as a sign of improvement of depression.I know irritability can pass. I understated things. Unfortunately this showed up as something closer to rage, with me yelling at people on the phone and throwing things (food, a bowl) down the hall at work. It was pretty disturbing.. The other time I tried it with Lamictal it made me too sedated.
> Can you describe the magnitude and scope of your response to Celexa. Did you feel you had reached remission?
Not full remission, but a definite improvement. Then after 6 weeks or so I became very depressed again and my moods were erratic.
>Stimulation is a good thing, even if it feels uncomfortable in the beginning. How long were you on 75mg before you discontinued it?
I forget how long I was on it last time. For several months I was on it with Serzone and did well. Then things changed and I wasn’t able to tolerate its stimulating effects as well.
> Don't worry about pulse. People all too often discontinue TCAs simply because their heart rates increases to 100-120 bpm. This is tragic. This is an expected effect, and a sign that the drug is doing what it is supposed to do, even if only peripherally.
But how does one exercise or even do fun outdoor things like hiking or biking if your pulse is too high to begin with?
The overstimulation I had with Wellbutrin – and Effexor - is actually a problem. I feel pretty ill when my body is that revved and it runs me into the ground until I cannot function. It’s difficult for me to find the right amount of activation w/o going too far – like looking for the Holy Grail.
> Awe, poor doctor doesn't want to take the risks necessary to get the patient well. Oh, how I empathize with him - NOT. How often have you attempted suicide?
Not fair to judge her on one issue. She’s a conscientious doctor and a good pharmacologist. I don’t think she’s opposed to any class of drugs. I think she was nervous about me having tricyclics at that point b/c I have had so many suicidal thoughts (never attempted). She’s generally open to my input and I think I’ll ask again.
> You want to play - you've got to pay. Get tough.
Ouch. That really hurt. Let’s see….sedation, wired-ness, insomnia, sweating/hot flashes, weak arms and legs, incessant yawning, reduced stamina, feeling icy cold, water retention, burning hot face, postural hypotension, the list goes on. I’m tough and I’ve been playing and paying and trying to be patient. Like the rest of us, I put up with side effects as best I can if the drug is helping.
> and I would much rather have a dry mouth than anorgasmia and apathy.
If it were discrete things like dry mouth and anorgasmia that would be easier to deal with. Heck, I even *liked* the visual trails I had with Serzone. :~). I’m tired of feeling just plain ill overall on some of these drugs – and having my functioning compromised. We both hate cognitive effects and we agreed that apathy can trash your life.
> In my mind, the side effect profiles of tricyclics are favorable. I like nortriptyline followed by desipramine. If you don't respond to one, you might respond to the other. It happens.
That’s good that you find them acceptable. It seems that those two are pretty well liked around here.
>> MAOIs = my dietary habits would make the diet very difficult.
> Come on, Emme. Do a little self-talk here. That is a pretty poor reason not to join the life of the living again. Life is waiting for you, Emme. Pay the price and get on with it. You will find that it is a very small one.Ouch. That really hurt. I’m starting to feel attacked here.
I know the diet is manageable for a lot of people. I’ve thought about it and read a lot of posts and references on the diet. Because of my lifestyle and social life, navigating the diet would be a greater price for me than you realize. I feel much more grounded psychologically if I can keep at least some aspects of my lifestyle intact. As a dyed-in-the-wool vegetarian, I eat a lot of questionable ingredients. When I meet with friends for dinner or go to parties, there are lots of questionable foods. Now I’m not going to say *never ever* or *completely impossible*, but the MAOIs have been low on my list. This may seem trivial to you, but it means an awful lot to me. (That’s why I asked my doctor about tricyclics.)
A psychopharmacologist that I had a consultation with thought that MAOIs might not be a good choice based on how I did with Selegiline, so it may be a moot point.>> Selegiline = what appeared to me to be cycling. Much better w/o it.
>Can you describe in better detail what you experienced?Selegiline gave me some really great, perky, good mood days and yanked me out of some slumps. It seemed really helpful. But over time I was also having periods when the stimulation it would make me too anxious, and then periods when I was very depressed. I was having a number of bad crashes, where my mood would dive right off the cliff and I’d be in intense emotional torment for a day or two and then feel exhausted and burnt out afterwards. I was always trying to either calm down jitteriness or drag myself out of a low, or recover from a bad hell-day. A lot of that eased up when I stopped taking Selegiline.
> Prozac is a drug that makes no sense to neglect. It is different from all the other SSRIs in several ways. It is more noradrenergic and binds to certain 5-HT receptors.
I often wonder why doctors rush to the other SSRIs before trying Prozac.
> Listen, these stimulating drugs that cause complete insomnia are the ones that are going to blow a hole through your wall of treatment-resistance. Just go for it. Treat the insomnia aggressively when it appears. Then just sit back and get well.
Some sort of kick seems to be in order. The general crappy feeling is a worse problem than the insomnia. Benzos or seroquel could help some of that (in addition to insomnia). If my doctor doesn’t have any more appealing ideas, I think I’ll try to reopen discussion on the tricyclics and prozac for starters. I make no promises yet on the MAOIs.
>> It's going to hit situation critical if I don't become more productive.
>How so?Gotta find more work and get a professional life back. More of a personal life wouldn’t hurt either.
>> I’m getting more impatient and less and less willing to put up with side effects. And I complain a lot. :)
> ME TOO!I think you report, not complain. You never whine.
>It is quite a paradox. The less treatable you are the less treatment you are willing to tolerate.
I think part of being hard to treat is the difficulty tolerating meds. And the worse we tolerate meds, the more frustrated we get trying to take them. After a while, you get burned out.
>Get well.
Thanks. I hope you do too.
> Oh, about me, I decided to stay at 600mg of Trileptal and allow the cognitive stuff to pass. I was encouraged by what a doctor I spoke to yesterday had to say. The "yuckies" should dissipate entirely.
Did he say how long it typically takes for this to pass? Good luck. Hang in there.
em
Posted by SLS on June 15, 2005, at 7:00:27
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 14, 2005, at 23:48:10
Hi Emme.
I apologize for the tone I took with you in my last post. I was frustrated that you aren't doing well, and that so many treatments seemed to be excluded from consideration. Now I see that they have been considered and understand more why they have not been placed high on your list of things to try. I guess I poked at you just to make sure. Sorry. It is hard to watch someone else suffer if you think there is something available to treat the illness that they haven't tried yet. I like you, so I think I was overly stiff with my tone.
Again, I apologize.
> If my doctor doesn’t have any more appealing ideas, I think I’ll try to reopen discussion on the tricyclics and prozac for starters. I make no promises yet on the MAOIs.
Obviously, I didn't have an appreciation for the fact that you have had suicidal ideations in the past. Perhaps your doctor could give you only enough TCA medication to last one week at a time if there are safety concerns. Weekly visits over the first three weeks is probably indicated anyway. You might like nortriptyline better than desipramine. For me, it has always seemed like a milder drug with more mood brightening effect.
I think your short-term plan makes a lot of sense. I think I would have tried Prozac again at some point because I never gave it a fair trial at dosages above 20mg.
Do you think your acting out by throwing things is a sign of a mixed state, or is it due to the irritability that can often accompany depression? When I was younger and the depression was first beginning to manifest, irritability was a primary symptom. I do believe I had my fair share of acting out. However, although I hadn't experienced any overt manias, perhaps the irritability and rage indicated a bipolar temperament or bipolar diathesis.
I'm glad you have not completely excluded MAOIs. I guess it is my hopes that you will respond to them as robustly as I did when I first began taking them. It was in 1987 that I was brought into remission with a combination of Parnate and desipramine.
If what you experience as irritability is actually episodes of rage, you might consider returning to Trileptal or Tegretol if you have not responded fully to antidepressants or if it persists afterwards.
Don't forget about Keppra. I had a consultation with a doctor who found it enormously effective for one of his bipolar patients who cycled between mixed states and depression. He found that it was effective for her as monotherapy.
Paradoxically, many people report irritability as a startup side effect with Keppra.
On another note, I am getting scared that I am beginning to plateau with Trileptal. I know that I can be very impatient with a drug unless I am convinced that there is a trend towards improvement beyond a month of the beginnings of a response.
The doctor I spoke to didn't say exactly how long it takes for the cognitive or affective side effects of Trileptal to dissipate, but he gave me the impression that it doesn't linger for very long at all. I find that it comes in waves. I don't recall it being present yesterday at a dosage of 600mg. This morning there is a slight residual. I believe it will pass completely. I did feel something positive even at 300mg, so perhaps you can find utility in a relatively low dosage.
I'm really hoping you get well *soon*. You deserve it.
- Scott
Posted by Ron Hill on June 15, 2005, at 17:00:56
In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46
Scott,
I hope it works. You deserve relief.
-- Ron
-------------------------> I am beginning to respond to the addition of Trileptal 600mg. Quantitatively, the improvement is only mild. However, qualitatively, it is very broad in the features of depression that are beginning to improve. It is a true antidepressant response. I have a good feeling about this. Improvement is very gradual, but the trend is towards remission. Will it poop-out? Who can say? I am betting on full remission. It is logical.
>
>
> Currently:
>
> Lamictal 150mg
> Parnate 80mg
> nortriptyline 100mg
> Abilify 10mg
> Trileptal 600mg
>
>
> - Scott
Posted by emme on June 15, 2005, at 17:28:09
In reply to Re: Trileptal 600mg » emme, posted by SLS on June 15, 2005, at 7:00:27
Hi Scott,> I apologize for the tone I took with you in my last post. I was frustrated that you aren't doing well, and that so many treatments seemed to be excluded from consideration. Now I see that they have been considered and understand more why they have not been placed high on your list of things to try. I guess I poked at you just to make sure. Sorry. It is hard to watch someone else suffer if you think there is something available to treat the illness that they haven't tried yet. I like you, so I think I was overly stiff with my tone.
Thanks. I’ll let ya get away with it this time. ;)
I appreciate the kindness that motivated your post even if a few lines landed badly. I know you’re a very good person. I tend to be sensitive – maybe oversensitive – and electronic media make it easy to miscommunicate. Next time you poke at me, I’ll know what it means.> Perhaps your doctor could give you only enough TCA medication to last one week at a time if there are safety concerns.
That’s true.
> Do you think your acting out by throwing things is a sign of a mixed state, or is it due to the irritability that can often accompany depression?
Tough distinction, isn’t it? Every once in a blue moon I have some sort of nasty but brief outburst. These are pretty rare but distressing. In this case, my doctor took this as a sign of bipolar tendencies and had me stop the Paxil since it happened within about a week of starting it. She had already suspected a few soft bipolar signs. I’ve actually never been 100% convinced I’m bipolar, but I’m not convinced I’m NOT either. So I don’t get hung up on having a label.
> Don't forget about Keppra. I had a consultation with a doctor who found it enormously effective for one of his bipolar patients who cycled between mixed states and depression. He found that it was effective for her as monotherapy.
I liked it. It’s on my list of “helpful things that I can tolerate a teeny bit of”. Of course w/o Selegiline in my system, I didn’t need to keep taking it regularly.
> On another note, I am getting scared that I am beginning to plateau with Trileptal. I know that I can be very impatient with a drug unless I am convinced that there is a trend towards improvement beyond a month of the beginnings of a response.
You’re not sliding backwards, though, are you? It’s still easing your depression? I completely understand about being impatient. I believe that even if a drug starts helping fairly quickly, it can still take time for your brain to recover after being down for so long. IF the drug is tolerable and you are sustaining some benefit, it’s probably worth seeing how much additional improvement you see over the next couple of months or so. You’ve got nothing to loose.
> The doctor I spoke to didn't say exactly how long it takes for the cognitive or affective side effects of Trileptal to dissipate, but he gave me the impression that it doesn't linger for very long at all. I find that it comes in waves. I don't recall it being present yesterday at a dosage of 600mg.
Okay, so this sounds potentially workable. Are you finding Trileptal energizing or calming?
> I'm really hoping you get well *soon*. You deserve it.Thanks. I’m hoping the same for you.
em
Posted by SLS on June 15, 2005, at 19:26:42
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 15, 2005, at 17:28:09
Hi Emme.
I'm glad that I am forgiven.
:-)
It is difficult to say whether I feel energized by Trileptal or not. Not really. However, I have more mental energy and motivation to do stuff. I know that sounds contradictory, but the balance between motivation and energy does not feel stimulating. I don't feel like I am taking a stimulating drug. It is more of a mitigation of the depression than it is an input of nervous energy.
- Scott
Posted by SLS on June 15, 2005, at 19:28:17
In reply to Re: Trileptal 600mg » SLS, posted by Ron Hill on June 15, 2005, at 17:00:56
> Scott,
>
> I hope it works. You deserve relief.
>
> -- Ron
Thanks, Ron. It is always nice to see your name appear on the board. I hope we get to see more of you.:-)
Be well.
- Scott
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