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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by sheilac on July 24, 2012, at 8:43:07
My Pdoc which I don't see for another month has me on 300mg Trileptal and 300mg Lithium. She would like me to pick one and go up to 600mg. Since Trileptal makes me depressed, I have been trying 600mg of Lithium the past week. I have diarrhea and am sweating. Lithium seems to be making me feel pretty normal, but can't take these side effects. Maybe drop to 450mg?
She also has pretty much let me take as much Klonopin as I need. (1mg - 4mg)
She also had me on 75mg Wellbutrin for depression, but that made me anxious and irritable. So I stopped taking it.
Saw regular MD yesterday and she really feels I am ADHD and need Adderall. She said if I have anxiety from it I may need a higher dose - which I refused, so she said zoloft would help with the Adderall induced anxiety. She said anxiety was a clear indication that I needed a higher dose of Adderall - that a higher dose would calm me down.
In the past SSRIs have given me anxiety. So I'm not sure how zoloft is supposed to help my Adderall anxiety!
So today I took the Adderall and zoloft, 1mg Klonopin and no morning Lithium. I feel like a jittery mess. I don't feel like I am getting the good benefits from Adderall.I think I need to dump the zoloft as SSRIs make me crazy. Maybe go down to 450mg of Lithium (maybe I won't have the sweats and diarrhea) 2mg of Klonopin a day, Adderall during the day and that's it.
I hate that my regular MD and PDoc disagree.
My Pdoc doesn't have a problem with me taking Adderall, she even said it might help with the depression.
I'm a light weight. What should I do?
Morning:
150mg Lithium
1mg Klonopin
5mg Adderall XR breakfast
5mg Adderall XR LunchDinner:
300mg Lithium
1mg KlonopinMost mood stabilizers makes me depressed. Wellbutrin makes me manic, SSRIs make me bounce off the walls. Tiny dose adderall can be ok if used with a mood stabilizer.
I wish I could tolerate more Lithum, or I wish there were an easier tolerated mood stabilizer.
Posted by Phillipa on July 24, 2012, at 10:48:43
In reply to Feel like crap on meds..., posted by sheilac on July 24, 2012, at 8:43:07
Just trileptal and klonopin for now maybe? Too many med changes at once at a recipe for disaster. Too many changes going on at once. Think might be time for a second opinion from a pdoc? Phillipa
Posted by sheilac on July 24, 2012, at 11:01:15
In reply to Re: Feel like crap on meds... » sheilac, posted by Phillipa on July 24, 2012, at 10:48:43
Yea, I agree. I don't like the idea from my regular MD about just using zoloft and adderall. That sounds like a disaster.
My pdoc doesn't have a problem with me stopping Wellbutrin and using Adderall, but only if I am on a mood stabilizer and klonopin.
I wish I could just take Trileptal as my mood stabilizer, it just makes me depressed passed 300mg. I can go higher on Lithium, but only to 450mg without problems. Don't know if I could get away with just 450mg of Lithium?
So, we'll see what she says. I am definitely not taking zoloft. Yuk.
Posted by SLS on July 24, 2012, at 15:54:43
In reply to Phillipa: Feel like crap on meds..., posted by sheilac on July 24, 2012, at 11:01:15
I really think that you need to slow down and listen to your doctor. You might be sabotaging your best chance at treatment success by not giving lithium or Trileptal time to work and allowing for the startup side effects to dissipate. Even your depressive reaction to Trileptal might pass quickly. For how many consecutive days have you ever taken Trileptal at 600 mg/day?
The GI side effects of lithium often pass. Perhaps you can reduce the lithium to 450 mg/day for a few days and then return to 600 mg/day.
If, after having been stable on lithium for awhile, nausea returns or develops, this is a sign of toxicity, and you should contact your doctor immediately.
- Scott
Posted by Sheilac on July 24, 2012, at 18:15:29
In reply to Re: Feel like crap on meds... » sheilac, posted by SLS on July 24, 2012, at 15:54:43
My doc would rather I pick just one. Either lithium or Trileptal.
Which do you think is better, safer med?
Posted by linkadge on July 24, 2012, at 18:25:24
In reply to Feel like crap on meds..., posted by sheilac on July 24, 2012, at 8:43:07
No help, I know but ..... welcome to the club
Posted by SLS on July 24, 2012, at 18:57:06
In reply to Scott- Feel like crap on meds..., posted by Sheilac on July 24, 2012, at 18:15:29
> My doc would rather I pick just one. Either lithium or Trileptal.
>
> Which do you think is better, safer med?
More effective? With these drugs, there really is no such thing. Each person's neurobiology is unique. There are some people for whom lithium is useless or worse. I'm sure the same can be said of Trileptal.Safer? I guess Trileptal would be considered safer. Toxicity is not generally a concern with Trileptal as it is with lithium. Lithium can interfere with kidney and thyroid function, sometimes damaging them. With Trileptal, the only thing to worry about is hyponatremia (low blood sodium). This occurs infrequently.
If a mixed-state hypomania with impairments in impulse control is the main problem, it can be argued that Trileptal would be worth trying first. However, you are now reporting that lithium is working at 600 mg/day. This is not really a high dosage. It is still below the average dosage range of 900 - 1500 mg/day used for bipolar disorder. The side effects of lithium are dosage-dependent, so 600 mg/day might be a very safe and tolerable dosage for you. If, after an extended period of stability on lithium you wish to try switching to Trileptal, you can work with your doctor as to how to go about this. Of course, having your lithium blood level tested at any dosage is important.
Do what works for now. You can try substituting drugs anytime. I take lithium, even though it might not be critical to my treatment response. I do think it helps, but I also like the ideas of its contributing to the recovery of brain tissue and to its possibly preventing Alzheimers Disease.
It is up to you as to how much time you are willing to invest in experimenting with drugs while continuing to feel like crap. You can go with lithium and feel better, knowing that there are moderate risks to the kidneys, thyroid gland, and the potential to develop of toxicity. However, if you can afford to feel bad for another few weeks, you should know rather quickly if Trileptal will produce an improvement in your condition. You should have an answer in a few weeks. If it is going to help with mania, I would expect it to work within three days at dosages of 600 mg/day or higher. If your depression gets worse than usual and stays worse for longer than a week, I would consider aborting the trial.
Just to remind you, some people respond better to a combination of lithium + Trileptal than to either drug alone.
- Scott
Posted by Sheilac on July 24, 2012, at 19:16:13
In reply to Re: Scott- Feel like crap on meds... » Sheilac, posted by SLS on July 24, 2012, at 18:57:06
I hear what you're saying and I am concerned about kidneys and thyroid.
Like you said, my doc did start me on a combo of both. 300mg Lithium and 300mg Trileptal. But I didn't feel like it was keeping the agitation away. At first she just had me on Trileptal and I got depressed so she added the lithium.
Maybe for better, safer stability I go up to 450mg of Trileptal and stay with 300mg of lithium for the depression.
Being that Trileptal alone makes me depressed, going up on it and using lithium to fight some of the depression might be good.
I wonder if I will need to aim higher like 600mg of Trileptal. Isn't lithium more of an antidepressant at 300mg?
I still have Klonopin and low dose adderall.
Posted by SLS on July 25, 2012, at 6:02:11
In reply to Scott- lithium Trileptal combo ., posted by Sheilac on July 24, 2012, at 19:16:13
> I hear what you're saying and I am concerned about kidneys and thyroid.
>
> Like you said, my doc did start me on a combo of both. 300mg Lithium and 300mg Trileptal. But I didn't feel like it was keeping the agitation away.It is likely that you would need to take a minimum of 600 mg/day of Trileptal for it to treat the agitation and impulsivity. I can't see how taking anything less makes sense.
> At first she just had me on Trileptal and I got depressed so she added the lithium.
I think I already asked this, but for how many consecutive days did you take Trileptal 600 mg?
> Maybe for better, safer stability I go up to 450mg of Trileptal and stay with 300mg of lithium for the depression.
Again, I don't think it makes sense to take anything less than 600 mg/day of Trileptal. Perhaps you need to give this dosage a week or two to determine its potential for making you feel worse. Perhaps Trileptal is producing some mood-flattening as a temporary startup side effect. It usually doesn't, but we all know that there are always exceptions when it comes to the brain and psychotropic drugs.
> Being that Trileptal alone makes me depressed, going up on it and using lithium to fight some of the depression might be good.Personally, if I were in your place, I would try lithium 600 mg/day, simply because you report that you are already having success with it. If symptoms persist, I would then combine lithium 600 mg/day with Trilepal 600 mg/day.
> Isn't lithium more of an antidepressant at 300mg?
Lithium is not more of antidepressant at 300 mg/day than it is at higher dosages. It is just less of an antimanic at the lower dosages. However, some people experience mood-flattening at higher dosages.
What do you think?
- Scott
Posted by Sheilac on July 25, 2012, at 12:38:34
In reply to Re: Scott- lithium Trileptal combo . » Sheilac, posted by SLS on July 25, 2012, at 6:02:11
I think that even 450mg of Lithium helps me. If I could take 600mg without explosive diarrhea I would. Maybe in time I can make it up to 600mg lithium.
I know for sure, since being on 300mg - 450mg of Trileptal a day that it makes me very depressed. More depressed than I have been in years. I have been taking Trileptal since April. I'm not sure I would be alive if I went to 600mg.
This past week starting with 600mg and then reducing to 450mg has been good. I feel stable and even happy, like I'm getting a tiny antidepressant feel from the lithium.
As I've said before (and an old doc confirmed - something about my metabolism - slow I think?), I have never been able to make it to a therapeutic dose of any psych med. something about how my liver is slow to break down the meds. One time Wellbutrin XL 150 lasted 3 days! Same thing with the lowest dose of Prozac and Vyvance.
So, maybe the diarrhea will go away at 600mg and I can go from 450mg to 600mg.
But for now I am doing well on 450mg lithium, 2mg Klonopin and 10mg adderall XL.
Do you think my body will get used to 450mg of lithium and allow me to move up to 600mg with having to wear a diaper?
Back when I first tried lithium my doc wanted me on 600mg and I was a zombie.
Posted by SLS on July 25, 2012, at 13:41:21
In reply to Re: Scott- lithium Trileptal combo ., posted by Sheilac on July 25, 2012, at 12:38:34
> I think that even 450mg of Lithium helps me. If I could take 600mg without explosive diarrhea I would. Maybe in time I can make it up to 600mg lithium.
That sound like a good plan.
> I know for sure, since being on 300mg - 450mg of Trileptal a day that it makes me very depressed. More depressed than I have been in years. I have been taking Trileptal since April. I'm not sure I would be alive if I went to 600mg.
That is far worse than just flat affect. I guess Trileptal is not the right drug for you.
> This past week starting with 600mg and then reducing to 450mg has been good. I feel stable and even happy, like I'm getting a tiny antidepressant feel from the lithium.
That's great! You may have found your answer. I hope so.
> I have never been able to make it to a therapeutic dose of any psych med
You are not alone in this. It may have more to do with drug mechanisms and brain chemistry rather than liver metabolism, though.
> So, maybe the diarrhea will go away at 600mg and I can go from 450mg to 600mg.
The diarrhea might return at 600 mg/day, but it will hopefully be less severe and eventually disappear. My experience with lithium was similar to yours in the beginning of treatment.
Okay, then. You have a plan to follow. Let's hope that the lithium is the right drug for you. Your response to it thus far is encouraging. Try to be patient. If you are tempted to make any changes to your plan, perhaps it is best to communicate this to your doctor so that he can provide some input.
Good luck!
- Scott
Posted by sheilac on July 25, 2012, at 15:17:13
In reply to Re: Scott- lithium Trileptal combo . » Sheilac, posted by SLS on July 25, 2012, at 13:41:21
Thanks for all your support of my wacky ways!
Posted by novelagent on July 26, 2012, at 13:41:55
In reply to Feel like crap on meds..., posted by sheilac on July 24, 2012, at 8:43:07
I would ask for Dexedrine or Vyvanse, which is Dexedrine time-released, which will give less anxiety than Adderall will.
I usually would say the Adderall is giving anxiety because it's too high of a dose, but clearly at your dose, that's not the case. I would say you haven't given Adderall a fair shot, and would experiment with the dose (under your doc's supervision) but would suggest taking Dexedrine or Vyvanse instead.
For the klonopin, it's critical that you take that at the same hour of the day each day, or else your blood levels will be all messed up, causing all sorts of side effects, and even AD/HD-like symptoms and fatigue. It takes 3-4 days of taking it regularly for such side effects to pass.
It's critical you're not off by more than an hour on any mood stabalizer, or else you'll feel like sh**. If you can get by with an antipsychotic you take at the same time of day each day (same problem of dosing applies) I would take that instead as a mood stabalizer.
> My Pdoc which I don't see for another month has me on 300mg Trileptal and 300mg Lithium. She would like me to pick one and go up to 600mg. Since Trileptal makes me depressed, I have been trying 600mg of Lithium the past week. I have diarrhea and am sweating. Lithium seems to be making me feel pretty normal, but can't take these side effects. Maybe drop to 450mg?
>
> She also has pretty much let me take as much Klonopin as I need. (1mg - 4mg)
>
> She also had me on 75mg Wellbutrin for depression, but that made me anxious and irritable. So I stopped taking it.
>
> Saw regular MD yesterday and she really feels I am ADHD and need Adderall. She said if I have anxiety from it I may need a higher dose - which I refused, so she said zoloft would help with the Adderall induced anxiety. She said anxiety was a clear indication that I needed a higher dose of Adderall - that a higher dose would calm me down.
>
> In the past SSRIs have given me anxiety. So I'm not sure how zoloft is supposed to help my Adderall anxiety!
>
>
> So today I took the Adderall and zoloft, 1mg Klonopin and no morning Lithium. I feel like a jittery mess. I don't feel like I am getting the good benefits from Adderall.
>
> I think I need to dump the zoloft as SSRIs make me crazy. Maybe go down to 450mg of Lithium (maybe I won't have the sweats and diarrhea) 2mg of Klonopin a day, Adderall during the day and that's it.
>
> I hate that my regular MD and PDoc disagree.
>
> My Pdoc doesn't have a problem with me taking Adderall, she even said it might help with the depression.
>
> I'm a light weight. What should I do?
>
> Morning:
> 150mg Lithium
> 1mg Klonopin
> 5mg Adderall XR breakfast
> 5mg Adderall XR Lunch
>
> Dinner:
> 300mg Lithium
> 1mg Klonopin
>
> Most mood stabilizers makes me depressed. Wellbutrin makes me manic, SSRIs make me bounce off the walls. Tiny dose adderall can be ok if used with a mood stabilizer.
>
> I wish I could tolerate more Lithum, or I wish there were an easier tolerated mood stabilizer.
>
>
Posted by novelagent on July 26, 2012, at 13:44:22
In reply to Feel like crap on meds..., posted by sheilac on July 24, 2012, at 8:43:07
Aricept gave me GI side effects, but taking Pepto Bismo capsules once in the morning and then at lunch made them go away. I trust you're doing that, and not living with the side effect =P
Posted by phidippus on July 26, 2012, at 22:36:51
In reply to Feel like crap on meds..., posted by sheilac on July 24, 2012, at 8:43:07
At 450 mg of Lithium, all you are going to get is side effects. The GI problems and sweats will pass. Takes about a week.
Rather than adderall, why don't you talk to your docs about Vyvanse? It doesn't cause the same anxiety issues.
Eric
This is the end of the thread.
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