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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 bidatheraptor on July 6, 2008, at 22:42:35
i have bipolar 2. i am taking lamictal and topamax and it's bad! i'm super anxious and suicidal all the time. I've been on Lamictal almost 5 years, so obviously it's Topamax which I've been on 2 weeks.
Does anyone take Lamictal with another mood stabilizer?
I need help, please please help me. I'm going down. I've wanted to kill myself every day for a month now. I looked through my medication cabinet today, and I looked through it yesterday too. I keep feeling more hopeless.
Here is a description of me off of meds (which hasn't happened in over 5 years, I'm still way way better mentally than that):
constantly suicidal, crying every night, anxious, depressed mixed states-racing suicidal thoughts, major cutting and burning of myself. as far as mania, hypomanic, never full-blown mania but spending out of control, eating out of control, getting into debt, being a sh*tty person, saying things i don't mean or want to say, binge eating, throwing up, just being CRAZY.
I did really well for three years. I would say I literally had NO symptoms of mental illness. In the past 2 years, the Lamictal has slowly stopped being as effective. Now I would say that I have the symptoms of a person with clinical depression--which is, obviously, still better than before. But I am crying all the time, suicidal, isolating, not leaving my house except to work, sleeping for 14 hours, etc. It doesn't matter if it's better than before. It's too painful. My Dr. is nice but asks what I want because I've been taking RX since high school. So does anyone here have suggestions? or does anyone here have words of comfort?
because seriously, at some point, with mental illness, you don't have anyone to talk to anymore. i'm married, and my husband is great, but you know what? he can only hear me say i want to kill myself so many times. you know?
it. gets. boring.
Posted by Phillipa on July 7, 2008, at 0:41:54
In reply to Lamictal combinations, posted by bidatheraptor on July 6, 2008, at 22:42:35
Welcome to babble glad you're here. I have no knowledge of your grave condition so I offer you my prayers and thoughts that you will find a solution to your med problem. If you are suicidal with a plan please call an emergency number. If not get your pdoc on the phone in the am and tell him how grave your situation is. Many kind words to you. Love and Hope Phillipa
Posted by SLS on July 7, 2008, at 4:31:28
In reply to Lamictal combinations, posted by bidatheraptor on July 6, 2008, at 22:42:35
Try adding wellbutrin to Lamictal. My doctor and his collegues have had a great deal of success with this combination.
I had taken Lamictal + Topamax for a few months. I received a slight antidepressant effect. I started low and increased the dosage slowly, and I suffered little, if any, cognitive disturbance. Know, however, that Topamax can be a powerful anti-manic mood stabilizer.
- Scott
Posted by Bonnie_CA on July 7, 2008, at 4:41:15
In reply to Lamictal combinations, posted by bidatheraptor on July 6, 2008, at 22:42:35
I take Seroquel with Lamictal. The sedating effects of Seroquel put me to sleep, counteracts with the activating effects of Lamictal. I've been doing really well, which is why I haven't been here for awhile.
-Bonnie
Posted by BPPsychFellow on July 7, 2008, at 10:32:01
In reply to Lamictal combinations, posted by bidatheraptor on July 6, 2008, at 22:42:35
I'm sorry for your awful return of symptoms. It sounds like your current mood episode is very similar to the one you had 5 years ago. Bipolar disorder is cyclical so this isn't so unusual. Remember, mood episodes don't last forever! I hope you and your doctor can find a med adjustment that will get rid of it quickly (and keep it from coming back). Rather than attacking the current mood episode, concentrate on stopping the cycling (i.e. strengthen your mood stabilizer regimen).
What combination of drugs did you take 5 years ago to stabilize your mood? What works in the past often works again.
I wouldn't give up on the Lamictal; I ask my patients to keep it on board to delay the time until the next episode. As far as Topamax, I don't prescribe it. Topamax does not have approval as a mood stabilizer and doesn't have the best evidence. I stick to drugs that have been proven in the most rigorous studies: lithium, valproate, carbamazepine, lamotrigine. Those four drugs can be used in combination to work in synergy. Now, in my opinion, olanzapine and quetiapine are the best options as add-ons for a breakthrough episode like you are having.
I always like to point out: all decisions about your treatment must be discussed with your own doctor. Views expressed here are simply my opinions.
You will feel better again. Stick it out. Make a few appointments to meet with your psychologist while you wait for the mood stabilizers to smooth things out.
Regards -- BPPsychFellow
Posted by blueboy on July 9, 2008, at 8:26:37
In reply to Lamictal combinations, posted by bidatheraptor on July 6, 2008, at 22:42:35
> i have bipolar 2. i am taking lamictal and topamax and it's bad! i'm super anxious and suicidal all the time. I've been on Lamictal almost 5 years, so obviously it's Topamax which I've been on 2 weeks.
> Does anyone take Lamictal with another mood stabilizer?
> I need help, please please help me. I'm going down. I've wanted to kill myself every day for a month now. I looked through my medication cabinet today, and I looked through it yesterday too. I keep feeling more hopeless.
> Here is a description of me off of meds (which hasn't happened in over 5 years, I'm still way way better mentally than that):
> constantly suicidal, crying every night, anxious, depressed mixed states-racing suicidal thoughts, major cutting and burning of myself. as far as mania, hypomanic, never full-blown mania but spending out of control, eating out of control, getting into debt, being a sh*tty person, saying things i don't mean or want to say, binge eating, throwing up, just being CRAZY.
> I did really well for three years. I would say I literally had NO symptoms of mental illness. In the past 2 years, the Lamictal has slowly stopped being as effective. Now I would say that I have the symptoms of a person with clinical depression--which is, obviously, still better than before. But I am crying all the time, suicidal, isolating, not leaving my house except to work, sleeping for 14 hours, etc. It doesn't matter if it's better than before. It's too painful. My Dr. is nice but asks what I want because I've been taking RX since high school. So does anyone here have suggestions? or does anyone here have words of comfort?
> because seriously, at some point, with mental illness, you don't have anyone to talk to anymore. i'm married, and my husband is great, but you know what? he can only hear me say i want to kill myself so many times. you know?
> it. gets. boring.My first instinct would be to get off the Topomax ASAP. BPP suggested the use of low-dosage lithium, which might be worth a try.
If you haven't tried it, get some cognitive-behavioral therapy. It will help. If nothing else, it reminds you that the terrible feelings and disturbing behavior will get better in the future. One of the worst things about depression is that it clouds your mind. Like, if your mind is clear and you are in pain, knowing that it is going to get better in the future can really help you get through it.
It does sound like a bit of a poop out, if you are feeling depressed, since preventing bipolar depression is supposedly Lamictal's strong suit.
How much Lamictal are you taking? And how big are you? Maybe you want to consider increasing the dosage, if the side effects are not bad.
I have found that a temporary large dose of Klonopin before bedtime helps me out a LOT. I realize there's a big question about whether this would help you, because in my case, some of my pain comes from insomnia and the resulting lack of sleep. Still, Klonopin makes me feel a lot better the next day than Ambien, so it's more than just getting sleep.
And HANG IN THERE! I'm married also, and I know how distressing it can be to have a spouse and feel like you are a burden. But I realize, from looking at other couples where one of them is sick, how much your life can mean even when your symptoms are at their bottom.
Can you find some sort of support group and manage to get to it? I bet your husband would drive you. My last bad mixed episode, I was out of town on vacation with other people, and the various suicide hotlines I called were not helpful. I managed to get to an AA meeting, of all things, and the people there were a big help to me. (Of course, on the negative side, this isn't an option for a lot of people, but on the positive side, AA isn't a suicide or depression group either and they helped anyway.)
Posted by elanor roosevelt on July 10, 2008, at 23:43:58
In reply to Re: Lamictal combinations, posted by blueboy on July 9, 2008, at 8:26:37
lose the topomax
it can be nasty
Posted by NOS Patient on July 15, 2008, at 21:01:18
In reply to Re: Lamictal combinations, posted by elanor roosevelt on July 10, 2008, at 23:43:58
I was on Lamictal (150-200mg QD) for about 4 years, but always with Neurontin. Don't remember what dose the Neurontin was started at, but I know I took 4800mg (1600 TID) during that whole period. UNfortunately, I stopped both after a long period of "high functioning" w/ minimal symptoms.
However, many MDs have remarked at the extremely high dose of the Neurontin & wondered how I was awake (much less a full-time college student). Everyone's different. Maybe I have a fast metabolism for drugs.
Anywho, the Lamictal + Neurontin combo was considered "typical" and kind of popular amongst MDs I've spoken with.
Hope this helps.
Posted by theo on July 17, 2008, at 22:34:40
In reply to Re: Lamictal combinations, posted by SLS on July 7, 2008, at 4:31:28
> Try adding wellbutrin to Lamictal. My doctor and his collegues have had a great deal of success with this combination.
>
> I had taken Lamictal + Topamax for a few months. I received a slight antidepressant effect. I started low and increased the dosage slowly, and I suffered little, if any, cognitive disturbance. Know, however, that Topamax can be a powerful anti-manic mood stabilizer.
>
>
> - ScottWhich version of Wellbutrin? XL? Do you take them both together or do you take the Lamictal at night?
Posted by BGB on July 20, 2008, at 2:45:11
In reply to Lamictal combinations, posted by bidatheraptor on July 6, 2008, at 22:42:35
I used to take Lamictal 200mg with Depakote ER 2,000mg, which kept the mania at bay for almost 10 years. I have been extremely depressed and suicidal for quite a while now, so I wanted off of the Depakote as I read it could cause suicidal thoughts. I switched to Trileptal (oxcarbazepine), which is a newer relative of Tegretol (carbemazepine), which BPP mentioned. It is available as a generic now, although it is still quite expensive (almost $400/mo).
The Trileptal is equally as effective as the Depakote in keeping the manic episodes at bay, and I haven't noticed any side effects at all from it. Unfortunately, it has had no effect on my depression or suicidality. I still think of killing myself every waking second.
But, at least I am not crazy and homicidal. I tried to go off of the Trileptal (without my doctor's consent or knowledge) and almost murdered someone--literally. The Trileptal has been wonderful for keeping my thoughts of murdering people at bay...now I just want to kill me again and not other people, which I think is kind of important. ;)
By the way, I also take 60mg of Cymbalta and 400mg of Wellbutrin SR for depression. I was on 120mg of Cymbalta, 600mg of Wellbutrin SR, 60mg of Remeron, and 75mcg of Cytomel for my depression (even though my thyroid levels were all in the "good" range). Cytomel made me homicidal and manic, by the way. If your doctor recommends adding a thyroid hormone to augment your antidepressants, even if you have a normal thyroid level, be careful and go slowly. A lot of people really benefit from this augmentation strategy, but my doctor gave me too much too quickly and that really messed me up big time. I'll never f*** with my thyroid ever again!
I didn't notice any worsening of my depression dropping the Remeron and reducing the Wellbutrin and Cymbalta. I may in fact feel a teeny, tiny bit better, although not enough to make a real difference. My point being that more and more and more antidepressants doesn't necessarily bring more relief. Question your doctor if s/he just keeps upping your doses and adding on AD's. If it's not helping then there's no reason to keep on doing it.
Best of luck to you! I know you must be in hell right now. Keep us updated on how you are doing and what you are taking.
Posted by BGB on July 20, 2008, at 3:11:24
In reply to Re: Lamictal combinations, posted by BGB on July 20, 2008, at 2:45:11
I just wanted to add that my decision to discontinue Trileptal without my psychiatrist's approval or knowledge was probably one of the dumbest things I've ever done in my life. Please don't discontinue the Topamax without your doctor's consent!!!
Be well and hang in there! Hopefully, it gets better.
This is the end of the thread.
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