![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by ciaolavida on July 16, 2006, at 12:24:26
In reply to Re: lamictal not working?, posted by Racer on July 16, 2006, at 12:12:14
It's called ultradian cylcing... it was set off my lexapro.
Posted by SLS on July 16, 2006, at 12:30:20
In reply to lamictal not working?, posted by ciaolavida on July 16, 2006, at 11:52:15
> I've been taking lamictal for 6 weeks and the dose is up to 200 mg. My problem is that the cycling is still just as bad as before, and the severity is nearly as bad, too. (6 or more cycles a day, really REALLY low lows and pretty high highs). Does this mean that lamictal just won't work for me? I'm so confused because it seems to work so well for everyone, and I'm just so sick of it.
True ultradian rapid cyclicity is extremely rare. It is often mistaken for the mood lability seen in borderline personality and related disorders. This does not mean that mood stabilizers do not have a place in their treatment. They do. However, there are specific psychosocial treatments that are designed to aid in the recovery from these illnesses, so accurate diagnosis is important.
I have never seen any medical literature suggesting that Lamictal was successful at treating ultradian bipolar disorder, perhaps because there are so few cases to treat. It is true, however, that Lamictal has been suggested for rapid-cyclicity in general. What other drugs have you tried?
The problem with treating rapid-cyclicity is that it often takes many months before the drug begins to penetrate the cycle. I am unaware of any way to predict which treatments will work in advance. It often makes sense to use two or more mood stabilizers at the same time, if for no other reason but to save time and avoid performing multiple drug trials.
Perhaps you don't cycle, but are really suffering from a mixed-state bipolar presentation. Mood lability / mood-swings / cycling are often the words used by sufferers to describe what they experience. This is easier to treat, and might include antidepressants along with mood stabilizers.
- Scott
Posted by SLS on July 16, 2006, at 12:36:07
In reply to Re: lamictal not working?, posted by ciaolavida on July 16, 2006, at 12:24:26
> It's called ultradian cylcing... it was set off my lexapro.
Hmm.
This would seem to rule-out borderline personality disorder (BPD).
Gosh. A real ultradian cycler?
Can you describe what your highs and lows look like? I would still want to rule out a mixed-state. They can be pretty nasty. I know someone who does well with Topamax and Zoloft. Her mood during the day was extremely labile on Topamax alone.
- Scott
Posted by ciaolavida on July 16, 2006, at 12:45:44
In reply to Re: lamictal not working?, posted by SLS on July 16, 2006, at 12:36:07
There's defininitely no mixed states! This morning I was slightly depressed for a few hours which turned into a deep depression in which I was suicidal, then it went straight up into hypomania, cleaning my room talking 100 miles a minute, screaming, dancing, etc. Since then it has gone down a little but I'm still going pretty strong and about to go swimming because usually when I swim a lot it brings me down some. I can also be angry in hypomanic states and irritable in depressed states. I have experienced a few mixed states but it's been extremely rare. I have a mood chart I created myself where you can see the waves throughout the day, up and down up and down, but I don't know if there's so way I can post it on here so you can see. The colors switch each day so you can tell one from the other. Anyway, I imagine this is very hard to treat. I've had my thyroid checked which turned out fine and I don't really qualify as borderline. My doctor diagnosed me bipolar II- ultradian. It's a pain for sure!!
> > It's called ultradian cylcing... it was set off my lexapro.
>
> Hmm.
>
> This would seem to rule-out borderline personality disorder (BPD).
>
> Gosh. A real ultradian cycler?
>
> Can you describe what your highs and lows look like? I would still want to rule out a mixed-state. They can be pretty nasty. I know someone who does well with Topamax and Zoloft. Her mood during the day was extremely labile on Topamax alone.
>
>
> - Scott
>
>
>
>
Posted by Phillipa on July 16, 2006, at 13:53:15
In reply to Re: lamictal not working?, posted by Racer on July 16, 2006, at 12:12:14
Racer don't tell me that I'm trying to stay on it despite side effects. Were you on it long and did you do the starter pack titration? Love Phillipa ps what Ad were you taking it with then?
Posted by SLS on July 16, 2006, at 15:00:25
In reply to Re: lamictal not working?, posted by ciaolavida on July 16, 2006, at 12:45:44
> There's defininitely no mixed states! This morning I was slightly depressed for a few hours which turned into a deep depression in which I was suicidal, then it went straight up into hypomania, cleaning my room talking 100 miles a minute, screaming, dancing, etc.
How is your energy level when you are depressed? Do you become anergic or have psychomotor retardation?
I know what it is like to have your mood shift completely from one pole to the other within 30-45 minutes. I was an ultra-rapid cycler for a number of years. However, my cycle had a period of 11 days. I cannot fathom how exhausting it must be to go through 6 mood shifts a day.
I guess what you do with your treatment will depend on how many treatment failures you have thusfar encountered. How long have you been treating this ultradian cycling condition?
If you have been trying for quite some time, you might have to try combinations like lithium + Lamictal + (Tegretol or Trileptal) + Topamax + Zyprexa.
I know that's a lot of stuff, but it beats taking a few years to go through all of the permutations. I'm not sure where I would place Depakote. Just know that you would need to reduce the dosage of Lamictal by 1/2 if you were to combine these drugs because of their pharmacokinetic interaction. I think most people would disagree with me with the place lithium has in this cocktail since you are bipolar II. I don't know. I guess my feeling is that this enigma of a drug has some effect on time-keeping mechanisms.
- Scott
Posted by ciaolavida on July 16, 2006, at 16:08:58
In reply to Re: lamictal not working? » ciaolavida, posted by SLS on July 16, 2006, at 15:00:25
Scott-
When I'm depressed I can hardly get out of bed. When I'm manic I can't stop moving (my foot literally shakes like crazy if I'm told to sit still.) It's pretty awful, I'm not going to lie! I didn't realize ultradian was so rare, though. I've only been getting treatment the past 6 weeks (when I started on the lamictal). I'm supposed to get back into college in 5 weeks and my psychiatrist is 100% totally and completely convinced that I'll be ready (I think he must be the single most optomistic man to walk to planet) and, depending on my mood, I can either agree or disagree. The point is though, I could never handle school like this. My mood can literally go to the polar opposite in the snap of a finger. I've heard horror stories of people who can't get back to normal for years. Ugh! I can't imagine dealing with this that long. Last night I wanted to go to the hospital because I was feeling suicidal but today I want to go on a road trip so you just never know! Actually a few hours ago I was ready to go to the hospital again. Yea, it's really difficult for me but also takes a huge toll on my mother who has to deal with "don't leave me! LETS GO TO AFRICA! Wait, you don't like me do you? GO AWAY. Why are you talking to me?" All within a few minutes. I can't imagine what it must be like to be her. Okay sorry I'm rambling so I'm gonna just shut up now.
Moral of the story, lamictal isn't doing it. At least not alone, and I don't know what's going to help but I need to figure it out in 4 weeks, 6 days and counting...
Posted by SLS on July 16, 2006, at 19:20:33
In reply to Re: lamictal not working?, posted by ciaolavida on July 16, 2006, at 16:08:58
> Scott-
>
> When I'm depressed I can hardly get out of bed. When I'm manic I can't stop moving (my foot literally shakes like crazy if I'm told to sit still.) It's pretty awful, I'm not going to lie! I didn't realize ultradian was so rare, though. I've only been getting treatment the past 6 weeks (when I started on the lamictal). I'm supposed to get back into college in 5 weeks and my psychiatrist is 100% totally and completely convinced that I'll be ready (I think he must be the single most optomistic man to walk to planet) and, depending on my mood, I can either agree or disagree. The point is though, I could never handle school like this. My mood can literally go to the polar opposite in the snap of a finger. I've heard horror stories of people who can't get back to normal for years. Ugh! I can't imagine dealing with this that long. Last night I wanted to go to the hospital because I was feeling suicidal but today I want to go on a road trip so you just never know! Actually a few hours ago I was ready to go to the hospital again. Yea, it's really difficult for me but also takes a huge toll on my mother who has to deal with "don't leave me! LETS GO TO AFRICA! Wait, you don't like me do you? GO AWAY. Why are you talking to me?" All within a few minutes. I can't imagine what it must be like to be her. Okay sorry I'm rambling so I'm gonna just shut up now.
>
> Moral of the story, lamictal isn't doing it. At least not alone, and I don't know what's going to help but I need to figure it out in 4 weeks, 6 days and counting...
I am glad that you decided to stop by and pay us a visit here at Psycho-Babble. You are probably the first bona-fide ultradian rapid-cycler I have encountered here. I hope your cycling disappears just as suddenly as it appeared. Rapid cycling is not so much a subtype of bipolar disorder as it is a phase in its course. For me, it lasted approximately two years. However, during those two years, it was dramatic and extraordinarily regular. I could keep a calendar by it. In the long-term, my guess is that this phase will be temporary for you. However, I can't guess as to how long it will last or whether or not it will be self-limiting in the short-term. Let's hope your doctor's optimism is justified.You sound pretty spunky. I have a feeling you are going to beat this thing. There might be a bit more of the ride to come, so hold on...
- Scott
Posted by ciaolavida on July 16, 2006, at 21:52:23
In reply to Re: lamictal not working?, posted by SLS on July 16, 2006, at 19:20:33
Spunky, huh? Only half the time (not including now). But I do sincerely hope I beat this. I highly doubt it happens in 5 weeks. Psycho-babbles very first ultradian cycler? I can't believe that! What an honor. Time to go take my lamictal that's not working and cry. I gotta call my psych in the morning, there's no way I can deal with this. There should be bipolar rehab.
Posted by SLS on July 17, 2006, at 4:38:18
In reply to Re: lamictal not working?, posted by ciaolavida on July 16, 2006, at 21:52:23
> Spunky, huh? Only half the time (not including now). But I do sincerely hope I beat this. I highly doubt it happens in 5 weeks. Psycho-babbles very first ultradian cycler? I can't believe that! What an honor. Time to go take my lamictal that's not working and cry. I gotta call my psych in the morning, there's no way I can deal with this. There should be bipolar rehab.
My thought is that a drug like Zyprexa might provide you with more immediate relief.
- Scott
Posted by ciaolavida on July 17, 2006, at 10:50:49
In reply to Re: lamictal not working?, posted by SLS on July 17, 2006, at 4:38:18
Zyprexa? Isn't that one of those weight-gainers? I certainly cannot deal with that as I'm a 20 year old girl who would most certainly be rejected by society if she gained the average 60 pounds I hear of. Seriously though, I've been on seroquel, risperdal, and abilify. The antipsychotics hate me and I hate them (at least the feelings mutual). I gained 10 pounds on seroquel and 5 on risperdal and on the abilify I felt so sick I wanted to sleep my life away. Besides, I'm not psychotic! I mean really, my dog has only talked to me, oh, two or three times! (I'm only kidding... maybe). Anyway, if zyprexa is in this group of drugs that cause major weight gain, there's no way anyone will make me choke that thing down. If I had to choose between cow-dom and insanity, I would most certainly choose insanity.
PS. I know I will most definitely get some (I can't think of the word here but you know what I'm talking about) for this. But please remember, I'm a superficial young woman!
Posted by Emme on July 17, 2006, at 11:39:22
In reply to Re: lamictal not working?, posted by ciaolavida on July 17, 2006, at 10:50:49
> Zyprexa? Isn't that one of those weight-gainers? I certainly cannot deal with that as I'm a 20 year old girl who would most certainly be rejected by society if she gained the average 60 pounds I hear of.
Yes, it can pack on the pounds. But you might do okay weight-wise with a very tiny dose for a very short period of time to control the worst of your symptoms while you consider longer term options.
My pdoc says it's a drug that many people can just take prn when things get bad. It can be a real depression-buster. I don't want to take it long term because of the sedation and weight issues, but I was amazed at how well it worked in the few weeks I took it.
Posted by greywolf on July 18, 2006, at 0:28:13
In reply to Re: lamictal not working?, posted by SLS on July 17, 2006, at 4:38:18
Could it be that you were taken up to 200mg/day too quickly? I recently started Lamictal, and it was my impression after talking with my doctor that Lamictal's one of those meds where more isn't necessarily better--that you can experience therapeutic benefit at 100mg or even less, and that cranking it up too quickly can diminish or even negate its effectiveness.
Posted by Phillipa on July 18, 2006, at 0:37:21
In reply to Re: lamictal not working?, posted by greywolf on July 18, 2006, at 0:28:13
Really? At what dose can you benefit for augmentation? I'm only on 25mg now. What dose are you on? Love Phillipa
Posted by ciaolavida on July 18, 2006, at 8:27:26
In reply to Re: lamictal not working?, posted by greywolf on July 18, 2006, at 0:28:13
It could be that it's not working... but the thing is, it isn't helping with the depression either! It's just making things worse. Increasing the number of cycles in a day. Yesterday it was 11. Yes... that's right, ELEVEN cycles!!!
Posted by ciaolavida on July 18, 2006, at 8:41:42
In reply to Re: lamictal not working? » ciaolavida, posted by Emme on July 17, 2006, at 11:39:22
I'm SO sensitive to meds, I gained 12 pounds on seroquel in two weeks!! I'm just now almost lost it all. I don't want to have to deal with a weight gain again :(
Posted by Emme on July 18, 2006, at 9:22:18
In reply to Re: lamictal not working? » Emme, posted by ciaolavida on July 18, 2006, at 8:41:42
> I'm SO sensitive to meds, I gained 12 pounds on seroquel in two weeks!!
Eek. Such an extreme gain sounds like it might have been water. Or at least part water. How long has it taken you to lose it?
Abilify made you feel ill, right? Was the dose too high? I felt an effect with a mere 2.5 mg every other day.
What other mood stabilizers have you tried? What about Trileptal?
Posted by ciaolavida on July 18, 2006, at 10:24:14
In reply to Re: lamictal not working? » ciaolavida, posted by Emme on July 18, 2006, at 9:22:18
My doctor just put me on lithium... I was sobbing about the weight gain and he didn't even care. I HATE weight gain. There's so many other options I don't even understand.
Posted by greywolf on July 18, 2006, at 10:51:49
In reply to Re: lamictal not working? » greywolf, posted by ciaolavida on July 18, 2006, at 8:27:26
I think you might want to get a second opinion. From what I know of Lamictal, it works well for traditional rapid cycling, but is not very effective alone for ultradian.
And, frankly, there's still enough debate about ultradian cycling that you might want to get another professional opinion. You may find that another doctor has an entirely different opinion of your mood volatility and, more importantly, how to treat it.
Posted by greywolf on July 18, 2006, at 10:54:31
In reply to Re: lamictal not working? » greywolf, posted by Phillipa on July 18, 2006, at 0:37:21
Phillippa, I don't know this from personal experience, but anectdotal reports suggest therapeutic benefits may be experience at 100mg or even less.
Posted by ciaolavida on July 18, 2006, at 11:51:24
In reply to Re: lamictal not working?, posted by greywolf on July 18, 2006, at 10:51:49
I dunno, I really like my pdoc. He is experienced and compassionate. I'm just gonna try this stupid lamictal and lithium combo and see how it works. At this point I'm not making it back to see in a month anyway so I might as well let him play with my drugs another year.
Posted by greywolf on July 18, 2006, at 16:08:25
In reply to Re: lamictal not working?, posted by ciaolavida on July 18, 2006, at 11:51:24
Well, whatever you do, best of luck. I hope that you find relief through the treatment you're receiving now.
Posted by Phillipa on July 18, 2006, at 21:56:20
In reply to Re: lamictal not working?, posted by greywolf on July 18, 2006, at 16:08:25
Thanks greywolf I'd heard 200mg. Love Phillipa
Posted by greywolf on July 18, 2006, at 23:44:35
In reply to Re: lamictal not working? » greywolf, posted by Phillipa on July 18, 2006, at 21:56:20
Phillippa, my layman's understanding is that there is no reliable way of establishing therapeutic blood levels of Lamictal, and that the experience of a benefit varies widely regardless of titration method.
I don't know how reliable Crazymeds is overall, but it does have a pretty good analysis of Lamictal. It and other med sites have suggested that while the rule of thumb is to shoot for the 100-200mg range, some people have a positive response much earlier in treatment and at lower dosages.
I'm very concerned with this drug to take it as slow as I can and identify any positive response at the earliest possible stage. I've been on so many other meds where I was either started off at too high a dose or was increased too soon or didn't get far enough that I want to squeeze everything I can out of this one. Especially since they can't add in additional meds I need for the OCD until they get the BP under control.
Posted by SLS on July 19, 2006, at 6:20:37
In reply to Re: lamictal not working? » Phillipa, posted by greywolf on July 18, 2006, at 23:44:35
> Phillippa, my layman's understanding is that there is no reliable way of establishing therapeutic blood levels of Lamictal, and that the experience of a benefit varies widely regardless of titration method.
>
> I don't know how reliable Crazymeds is overall, but it does have a pretty good analysis of Lamictal. It and other med sites have suggested that while the rule of thumb is to shoot for the 100-200mg range, some people have a positive response much earlier in treatment and at lower dosages.
>
> I'm very concerned with this drug to take it as slow as I can and identify any positive response at the earliest possible stage. I've been on so many other meds where I was either started off at too high a dose or was increased too soon or didn't get far enough that I want to squeeze everything I can out of this one. Especially since they can't add in additional meds I need for the OCD until they get the BP under control.
Lamictal can be a tease.It will give you a short burst of improvement at dosages as low as 25-50mg and again upon dosage increases. You are lucky if it sticks at 200-300mg. Some people even get a brief kick from it when they reduce the dosage. You can become convinced that you need dosages between 300-400mg because lowering the dosage brings on depression. However, this might actually be a rebound depression that passes within a day or two, allowing you to find a lower dosage to stabilize at.
Of course, Lamictal does work more reliably for many people.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.