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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 cactus on September 3, 2009, at 1:15:35
Well I've slowly titrated up to 100mg and it hasn't done a thing for my black mood swing. I was thinking I should be feeling at least something by now, but nothing has happened. If anything it's made me more irritable but the mood swings are still the same. I thought it was helping at first but maybe it was just a placebo effect. What's your thoughts.
Posted by alchemy on September 3, 2009, at 18:12:27
In reply to Lamictal 1 month on, posted by cactus on September 3, 2009, at 1:15:35
Are you on anything that might help the irritability? Depression? Lamictal is known to take a while to work. How long have you been on 100 mg? Sorry, I don't know what to suggest.
Posted by bleauberry on September 3, 2009, at 18:16:34
In reply to Lamictal 1 month on, posted by cactus on September 3, 2009, at 1:15:35
I'm sorry you are struggling.
It is a difficult thing to judge. On one hand, there should have been at least a distant hint of something by now. The absence of that is not promising of the future.
On the other hand, some would claim the dose is not high enough, and it needs at least another month.
So it is a very tough call. You kind of have to be your own best judge. In a head to head trial of Lamictal versus Zyprexa, both were already working at one month in those that responded.
Here is a factor to seriously consider. Is your Lamictal generic or brand? Seriously, failures on generic Lamictal abound. Relapses are frequent when switched from brand to generic. If you are not on brand, you have not had a fair trial. The clinical studies for FDA approval used brand, not generic. We always get into heated debates here when the generic vs brand thing comes up, so I don't want to get that started again. But it is worth knowing that in the archives here, other forums, and my own doctor's experiences, brand and generic are not equal. Theoretically the same, yes, clinically the same, no.
Posted by cactus on September 4, 2009, at 5:07:39
In reply to Re: Lamictal 1 month on, posted by bleauberry on September 3, 2009, at 18:16:34
Yes I am on real lamictal, edronax (reboxetine) and clonazepam (which doesn't depress me) The pdoc thinks the Edronax has pooped out after 4 months and want's me to drop it and replace it with cymbalta. I have always reacted very badly to SSRI/SNRI's especially when I have to stop them, so basically I'm terrified to take it. I don't know what to do. I swore black and blue I'd never take one again. I don't think the edronax it the only culprit in this scenario. Things are getting worse with lamictal and he wants me up to 150mg in 2 weeks. I just don't know what to do. I'm so messed up at the moment and have had wicked insomnia for months. Very unpeaceful C at the moment who is on the verge of totally losing it.
Posted by alchemy on September 4, 2009, at 17:54:19
In reply to Re: Saw pdoc today raising Lamitcal?? and more » bleauberry, posted by cactus on September 4, 2009, at 5:07:39
> "I have always reacted very badly to SSRI/SNRI's especially when I have to stop them, so basically I'm terrified to take it."
----- Why does your dr think you should take them again? Did they make you cycle up & down? It is common to use an ssri with a mood stabiizer. But if it was completely hell, I'm not sure what he is thinking.
> "Things are getting worse with lamictal and he wants me up to 150mg in 2 weeks."
----- Is it both the depression & the irritability? If it is just the irritability, maybe adding a benzo for a while might help. If the depression is getting worse, I don't know why he would increase it. I had some agitation when starting Lamictal, but I'm ok now. When I started it I looked for some positive stories on this board:
- Quintal 4/3/08: "I was taking it for about 2-3 months before I noticed the full effect...I had been taking Klonopin prior to Lamictal, and think it may have been masking some of the Lamictal side effects like irritability and insommnia. Maybe a small doese of something like Valium might help with the irritability in the short term, at least until you reach the right dose."
- Colin Wallace 6/3/03: "Titrating can be difficult at first, wit many experiencing a degree of irritability which can be managed by taking smaller increments."
- Barbaracat 8/31/03: "I got a little agitation with each weekly 12.5 increase, but had been through that before & knew it passed."---- But if SSRI/SNRIs and Lamictal make you more depressed...in my opinion, that makes no sense.
Posted by bleauberry on September 4, 2009, at 20:12:48
In reply to Lamictal 1 month on, posted by cactus on September 3, 2009, at 1:15:35
I think the previous post of alchemy was quite telling. Excellent take.
I'm sorry, I mean no disrespect. You have to highly respect anyone who has gone through 8 years of schooling, years of residency, and then specialty training. But when I see a doctor who takes into account that his patient has had very bad experiences with reuptake inhibitors and of all the choices available makes a choice of a reuptake inhibitor, I just shake my head in amazement. I cannot understand that kind of non-logic no matter how hard I try. All those years of specialty schooling, and somehow along the journey the gift of logic was lost.
Clinical studies. It is hard to find the detailed statistics of patients who got worse on meds. The few I have found indicate something in the 5% to 10% range. Most abstracts of studies lump them into the category of "discontinued due to side effects or inefficacy", but without the full detailed report, you can't see that some of them deteriorated on the med above and beyond issues of side effects. Hey, depression and irritation are just two of the things listed on Lamictal's label side effects as things that happened during clinical trials often enough to warrant printing. Does every doctor think, "Oh, that only happens to other patients, not mine."?
Your gut instincts are your best guide. Even below your conscious thought levels, your body knows what is right or wrong. If you are feeling reuptake inhibitors and lamictal are wrong, those feelings have to be considered and respected.
I've been off meds for three years now. A few mini-trials of days or a couple weeks scattered in there. I am not well or I wouldn't be here. But I am well enough to get by without meds. With those kinds of eyes, what I see here a very lot is people getting in deep water with meds that are: not working; making them worse; piling another med on top of one of those; and wondering the whole time why they aren't getting better and what the next med should be to yet add another to the whole darn debacle. Blows my mind to witness it day after day. The unfortunate thing is that those who are in that deep water cannot see it happening and actually deny it is happening. I've been in that deep water and I know what that blindness is like. Very deceptive. Very often when people ask, "Why is this happening to me?", the answer could likely be, "It's the meds".
Thankfully there are far more people helped by the meds. They are usually not found at psychiatric forums because they have no need, things are going ok. They outnumber us here. Pbabble is a different population.
With a history of 3 or 4 med failures or bad reactions, my personal opinion is that it is extremely reasonable to abandon the whole "new drug" philosophy and go back to the gold standards. Parnate, Ritalin, Amitriptyline, Nardil.
I wish I had something of suggestive value for you. All I can say is I totally disagree with the doctor's approach. I fear it getting you into more trouble, and I am suspect of the lamictal the same as you are. If it had shown at least a hint of something good at this point, maybe, just maybe, I might give it the benefit of the doubt.
Posted by cactus on September 4, 2009, at 23:06:40
In reply to Re: Lamictal 1 month on, posted by bleauberry on September 4, 2009, at 20:12:48
Thanks guys, you have just helped me make up my mind.
Current Rx
125mg Lamictal
10mg Edronax
6mg ClonazepamI stopped the Edronax cold turkey, there is no withdrawal from it. I needed a 24hr washout before taking the cymbalta. I took one this morning and have never had such severe nausea with a smashing headache from any SSRI/SNRI including luvox, prozac, aropax(paroxetine), cipramil (celexa), zoloft and the worst offender of all efexor xr.
I'll lower the Lamictal until I'm off it, and I'll ditch the cymbalta. Once settled I'll start lowering my clonazepam.
Bleauberry, on my last visit he said if Edronax doesn't work he'll trial me on Parnate. He didn't even mention it. I can't believe you mentioned it. This is a new pdoc I've only seen about 6 times. I have to admit I thought he was fantastic until this happened. I wrote a list of everything I have tried over the last 17+ years and the 1st thing he said was. There seems to be nothing wrong with your serotonin levels and that's why you react badly to all meds that are SSRI/SNRI or serotonin based. He told me that he thought my adrenal system was not working so well and that's why I have responded much better to things like Edronax, DA's and modafinil, etc....
Alchemy and bleauberry, thankyou so much!!!! You have both said exactly what I was thinking. Peace C
This is the end of the thread.
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