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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Sheilac on July 16, 2012, at 5:45:15
Actually, I think what works best is the following:
Morning
2mg Klonopin
150mg Lithium
150mg Trileptal
5mg Adderall XREvening
2 mg Klonopin
150mg Lithium
150 mg TrileptalI have tried even halfing the dose of Wellbutrin but it still messes with my moods.
For some reason a small dose of Adderall works for my depression.
Is 4mg of Klonopin a day too much? It doesn't dull the antidepressant effects I get from Adderall, it just helps keep me even.
If I go to 600mg a day of Trileptal for mood stabilizer, then I have to go to 10mg a day of Adderall. And 600mg of Trileptal makes me sleep all day (300mg day and 300mg night)
Would it be better to try and slowly up my Trileptal instead of taking 4mg of Klonopin a day?
Seems to me if low doses work, I should stick with them.
I have always have a problem with Wellbutrin.
Is going higher on Trileptal and using Wellbutrin better in the long run than staying low on Trileptal and using more Klonopin?
Posted by SLS on July 16, 2012, at 7:54:03
In reply to Opinion on Trileptal vs Klonopin, posted by Sheilac on July 16, 2012, at 5:45:15
Hi SheilaC
Why do you feel it necessary to take Wellbutrin?
Why is Wellbutrin preferable for you to take instead of one of the many other antidepressants available?
You could perhaps get rid of the Wellbutrin and add Abilify.
What about Lamictal without the Wellbutrin?
- Scott
Posted by Sheilac on July 16, 2012, at 8:08:13
In reply to Re: Opinion on Trileptal vs Klonopin » Sheilac, posted by SLS on July 16, 2012, at 7:54:03
I've failed all the usual antidepressants and got the awful side effect from Lamictal (that would have been a great drug for me to be on).
Doc put me on Lith for depression, but above 450mg I lose my hair and it started causing depression instead of fixing it.
So doc said Wellbutrin for depression, but it has always caused mania.
Actually, 600mg Trileptal makes me sleep all day and causes depression.
I've experienced depression from all the anti-manic drugs.
Adderall doesn't seem as strong ad Wellbutrin to me (weird).
Abilify made me eat like a horse and gain weight, no luck there.
Not sure what the solution is.
I wasn't sure if using low dose Adderall was ok and also if 4mg of Klonopin is ok. Klonopin seems to work faster and better as anti-manic and doesn't cause depression.
Not sure if the low dose Lith is helping or not? Maybe that combined with low dose Trileptal is ok?
Posted by Sheilac on July 16, 2012, at 8:20:15
In reply to Scott: Opinion on Trileptal vs Klonopin, posted by Sheilac on July 16, 2012, at 8:08:13
Don't see doc for a month or so. Kinda worried. My sibling and their kids are visiting and I need to be cool and calm.
Not sure what solution is. Without Klonopin, Trileptal and Lithium I will freak out after a cup of coffee.
I want to have a personality, but not sure what to do.
Do I increase my nightly dose of Lithium or Trileptal, just slightly? Do I just stay on my current doses and keep Klonopin handy?
I guess I'm just freaking out.
Too much Trileptal makes me depressed and flat. Do I just need to take more Lithium?
Posted by SLS on July 16, 2012, at 8:51:41
In reply to Re: Scott: Opinion on Trileptal vs Klonopin, posted by Sheilac on July 16, 2012, at 8:20:15
Hi.
I really don't have definitive answers to your questions. Preventing mania takes precedence over temporarily experiencing moderate depression due to drug side effects. That might mean going with Trileptal at a dosage you know is effective and enduring the depression for a few days while you have visitors. Perhaps a high dosage of Klonopin would work as well. I cannot not predict.
Have you ever taken an amphetamine without taking Wellbutrin at the same time? If so, which other drugs were you taking with it?
What is your history of taking monoamine oxidase inhibitors (MAOI)?
What happened when you took Effexor?
If Abilify helped, you might also respond to a drug called cariprazine. It is new, and still needs to be approved by the US FDA. However, we might see it as early as the beginning of next year. I am hoping that it will work at least as well as Abilify, but without the weight gain and elevation of triglycerides that Abilify can cause.
- Scott
Posted by Sheilac on July 16, 2012, at 9:09:16
In reply to Re: Scott: Opinion on Trileptal vs Klonopin » Sheilac, posted by SLS on July 16, 2012, at 8:51:41
Scott, right now I have dropped the Wellbutrin bacause it caused more mania and I am only using Adderall for depression.
I have avoided MAOIs because of the diet restrictions.
Maybe if I up the Trileptal slightly I won't experience the tiredness and depression.
You think increasing the Trileptal would be better than increasing the Lith?
I wish the Trileptal worked on depression. That would be magic.
Right now the low dose Adderall is giving me anxiety, even with the 2mg Klonopin.
Feel like I'm crawling out of my skin. I don't want to be a zombie, and I do want to have energy and personality, but I don't want depression.
I think the Adderall and coffe and the added stress of guests is pushing me over the edge.
Maybe take 225mg of Trileptal instead of 150mg morning and night and see if that helps?
I mean, how much Klonopin can a person take before it just gets rediculous?!
Posted by Phillipa on July 16, 2012, at 10:23:51
In reply to : Scott: Opinion on Trileptal vs Klonopin, posted by Sheilac on July 16, 2012, at 9:09:16
Hate to butt in but was reading and seeing the coffee and how it makes things worse. Could you switch to decaf? Maybe same as me coffee is not longer good for you. I used to have times when coffee was great and finally stopped and switched to tea. I would crash and burn with guests staying with me. So for me anyway a med wouldn't help this problem at all. I always suggest a good hotel and offer to pay if someone is passing through as having guests would be to disrupting for me. Phillipa
Posted by SLS on July 16, 2012, at 11:50:01
In reply to : Scott: Opinion on Trileptal vs Klonopin, posted by Sheilac on July 16, 2012, at 9:09:16
I am guessing that you would profit from taking a minimum of 600 mg/day (300 b.i.d.) of Triletal for now. What does your doctor say about all of this?
If you feel that your illness is serious enough, you might need to compromise and take a serious medication to treat it successfully = MAOI. (Of course, all of these drugs are serious). For me, the diet restrictions are pretty easy to get along with, and certainly worth the trade off in my feeling better. Of course, there is no guarantee that you won't have an adverse reaction to one of these drugs.
What about Effexor?
I would like to know what you mean by "manic". Can you describe your experiences?
- Scott
Posted by sheilac on July 16, 2012, at 13:55:04
In reply to Re: : Scott: Opinion on Trileptal vs Klonopin » Sheilac, posted by SLS on July 16, 2012, at 11:50:01
Scott,
I guess what I am experiencing right now is more anxiety induced hypo mania. If I am around other people (like other hyper family members) I can easily get angry and have outbursts.
I think the problem is that I am trying to treat the depression with either Wellbutrin or Adderall. For a few days, either of these meds works fine, but then the hypo or even mania comes out. I've had terrible experiences with SSRIs and SNRIS. Last time I tried Lexapro, Pristiq and Effexor they gave me such stomach cramps it wasn't worth it.
I sleep well with melatonin and love my one cup of morning coffee. But coffee combined with Wellbutrin or Adderall is like fire to my brain and mood. Bad news.
This weekend I tried taking 300mg of Trileptal instead of my usual 150mg and the 300mg put me to sleep for a 4 hour nap. Didn't get much done. I would love for the Trileptal to give me an antidepressant feel, but don't know that it does. I will have to work my way up to 600mg a day of Trileptal (doc likes 600mg too). I don't have a week to sleep. I can do 225mg of Trileptal in morning and 300mg at night.
I'm afraid of depression, but also afraid of feeling flat and having no personality. Don't know if Trileptal will do that. Hopefully not at 600mg.
Not sure if the 300mg a day of Lithium is really acting as an antidepressant.
I guess I will have to drop the Wellbutrin and Adderall and up my Trileptal to get through the week. Maybe with additional Trileptal I won't need as much Klonopin.
Now my issue is: Will my depression magically go away? Is the Lithium doing anything at all? Do I need to add in a low dose antidepressant?
But what antidepressant? If Wellbutrin and Adderall made me feel energized and happy, what other med would work? Or could I go back to taking a low dose of either one of those if I upped my Trileptal?
Posted by sheilac on July 16, 2012, at 15:54:45
In reply to Scott: Meds and Mania, posted by sheilac on July 16, 2012, at 13:55:04
After taking more Trileptal this afternoon I got a terrible headache. I forgot that Trileptal at higher doses gives me a headache.
I also took another 150mg Lithium.
I feel pretty blah this afternoon.
I'm not sure what the answer is.
Maybe a good night's sleep, a cup of coffee with breakfast, Klonopin for anxiety and no Adderall or Wellbutin. That could work as long as it doesn't lead me down a road of too much caffeine.
I'm just not sure anymore.
Stay on low dose Trileptal, up the Lithium and take low dose Adderall and Klonopin?
It seems like its all a crap shoot.
Right now I need some Aleve for my Trileptal headache.
Posted by SLS on July 16, 2012, at 16:51:56
In reply to Re: Scott: Meds and Mania, posted by sheilac on July 16, 2012, at 15:54:45
If you ask me - and I guess you have - I would continue with Trileptal at 600 mg/day for now. Give your brain a chance to find some sort of equilibrium. It is being battered from every direction with constantly changing drugs and dosages. You really can't evaluate what a drug will if you don't allow time for things to settle in. Trileptal is not notorious for producing flattened affect or cognitive dulling like Tegretol is. Depakote and Topamax are worth considering for BPII mixed-states, but Trileptal is recognized as being a good choice disorders for which anger and rage predominate. It is good for impulse-control.
I think you need to begin thinking about allowing more time for drugs to work and have side effects dissipate.
- Scott
Posted by sheilac on July 16, 2012, at 17:03:21
In reply to Re: Scott: Meds and Mania » sheilac, posted by SLS on July 16, 2012, at 16:51:56
When I tried to up the Trileptal it gives me terrible headaches.
I've been on both Trileptal and Lithium for months - at low doses, but for months.
Would it be better to stay on the 300mg of Trileptal a day and up the Lithium?
Of course, I worry about harming my kidneys in the long run with Lithium, and it dose cause some hairloss.
Maybe the Trileptal headaches will go away. But today has been blinding.
I wish I could just use Klonopin as my mood stabilizer. I don't have any side effects from that.
I just want to be able to take my small dose of Adderall XR for depression and have a cup of coffee.
Posted by SLS on July 16, 2012, at 17:09:12
In reply to Scott: Meds and Mania, posted by sheilac on July 16, 2012, at 17:03:21
You have too many things going on in order for me to feel comfortable offering you any more suggestions. I think you need to work more closely with your doctor.
I hope your headache disappears. It is a rather common side effect of Trileptal. However, I have no idea whether or not it dissipates with continued use.
- Scott
Posted by sheilac on July 16, 2012, at 17:16:57
In reply to Re: Scott: Meds and Mania » sheilac, posted by SLS on July 16, 2012, at 17:09:12
Scott, thanks for the insight.
I have wondered if I have too many meds going on at one time. A little of this and a little of that seems odd to me.
I guess that is why I am wondering if I need to get down to a more refined regime.
I appreciate my doc offering me either Wellbutrin or Adderall. But I'm not sure about the low dose of everything else. Seems odd.
Seems like a lot of folks do fine on a few meds.
I don't want to be one of those people that take 7 meds.
I don't know. My doc is closing her practice and I don't see her for another month, which will be our last session. Then I will be on to a new doc.
I wonder if 300mg of Trileptal a day even helps?
Maybe several drugs at low doses do help. Not sure.
Maybe I need to increase my Lithium instead up taking more and more Klonopin.
Right now I won't stop any of the meds until I talk to my doc on the phone (if I can get her on the phone). But, I would like to be able to take low dose Adderall for depression and ADD, but I need more of a mood stabilizer and maybe that is Lithium, combined with some Klonopin and it will be ok.
Posted by brynb on July 17, 2012, at 10:51:22
In reply to Re: Scott: Meds and Mania » sheilac, posted by SLS on July 16, 2012, at 16:51:56
> Trileptal is not notorious for producing flattened affect or cognitive dulling like Tegretol is. Depakote and Topamax are worth considering for BPII mixed-states, but Trileptal is recognized as being a good choice disorders for which anger and rage predominate. It is good for impulse-control.
>scott-
i'm in a similar boat here. (depression is my main issue, though.) if i do have mania/hypomania, it presents as anxiety, irritability, rage and poor impulse control. i'm taking 300 mg of lithium and already feel dull/cognitive blunting, but i think it is helping my mood (though i'm still irritable off and on). per your comment above re: trileptal, do you think it's a better option over lithium?
thanks,
b
Posted by SLS on July 17, 2012, at 11:45:11
In reply to Re: Scott: Meds and Mania » SLS, posted by brynb on July 17, 2012, at 10:51:22
> > Trileptal is not notorious for producing flattened affect or cognitive dulling like Tegretol is. Depakote and Topamax are worth considering for BPII mixed-states, but Trileptal is recognized as being a good choice disorders for which anger and rage predominate. It is good for impulse-control.
> >
>
> scott-
>
> i'm in a similar boat here. (depression is my main issue, though.) if i do have mania/hypomania, it presents as anxiety, irritability, rage and poor impulse control. i'm taking 300 mg of lithium and already feel dull/cognitive blunting, but i think it is helping my mood (though i'm still irritable off and on). per your comment above re: trileptal, do you think it's a better option over lithium?
>
> thanks,
First of all, I don't think 300 mg of lithium will be effective at controlling mania - if you indeed have it. Depression sometimes presents with anger and irritablity, particularly in young people. However, lithium 300 mg can help with depression. You might have no better choice but to continue with the lithium and hope that the side effects are only startup effects, and that they disappear within a few weeks. As to choosing one drug over another, it would be hard to guess at without having more information. There is no reason why you can't remain on your low dose of lithium and add 600 mg of Trileptal. If you end up feeling great, you can then try to remove the lithium to see if it is necessary.
- Scott
Posted by brynb on July 17, 2012, at 13:26:21
In reply to Re: Scott: Meds and Mania » brynb, posted by SLS on July 17, 2012, at 11:45:11
Thanks, Scott. I'm hoping the Lithium side effects will eventually disappear. Still not sure if I'm on the bipolar spectrum, though it seems I probably am. My pdoc wasn't quick to give a definitive diagnosis, which is probably a good thing.
At 38, my depression has only worsened over the years (and it first presented at 14/15). The episodes are more debilitating and severe now. I've tried many meds, but Lexapro was the one I stayed on the longest. However, it's not effective on its own; it poops out, doesn't prevent depressive episodes, and I still have irritability, swings, etc.
I also get manic from some drugs, Neurontin in particular. (It recently sent me into a full-blown manic state.) Of course my pdoc thinks this is strange, but I've heard others say they've had a similar reaction.
Thanks again...
-b
Posted by Sheilac on July 17, 2012, at 15:49:29
In reply to Re: Scott: Meds and Mania » SLS, posted by brynb on July 17, 2012, at 10:51:22
B - I don't know if Trileptal is a better match than lithium. Higher doses of Trileptal give me severe headaches. Higher doses of Lithium make my hair thin out.
Right now I'm taking low doses of both, but I think I might try going higher on the Lithium.
This is the end of the thread.
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