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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Sheilac on September 19, 2012, at 6:13:38
My doc is nuts I think. He said since I didn't get the rash after the first month, he wanted me to jump from 50mg up to 150mg for a week, then 200mg the next week. That is a fast jump. I was taking it slow by going up to 75mg, but yesterday after he was gruff with me on the phone I jumped up to 100mg.
He took me off everything else - Trileptal and lithium.
I like Lamictal as an antidepressant, but my gums feel weird again (I've tried Lamictal before). Plus, sleep is almost impossible. He can't believe Lamictal is activating for me. He said it should be making me sleepy. I feel like I'm on Adderall.
I am wondering if I can use a lower dose of Lamictal for antidepressant effects and add back something else to keep me grounded. He wants me to go up to between 200mg - 400mg Lamictal. But this last jump in dose produced weird itchy gums.
Is it possible to go back to 50mg Lamictal and use lithium and or Trileptal?
I think, given my history of medication sensitivity, the drastic jump he wants me to do in 2 weeks isn't so good.
Posted by SLS on September 19, 2012, at 7:59:02
In reply to Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 6:13:38
> My doc is nuts I think. He said since I didn't get the rash after the first month, he wanted me to jump from 50mg up to 150mg for a week, then 200mg the next week. That is a fast jump. I was taking it slow by going up to 75mg, but yesterday after he was gruff with me on the phone I jumped up to 100mg.
Your doctor is right about the schedule of dosage titration. However, this is what is prescribed for the average patient. You may not be the average patient, though.
> He took me off everything else - Trileptal and lithium.You have reported that Trileptal makes you feel more depressed. Do you think Lamictal might prevent this from happening? You might want to ask your doctor about using an antipsychotic as a mood-stabilizer.
How often does your doctor see Trileptal making his patients more depressed? I am surprised by your reaction, but chances are that you are not unique. Of course, there are other anticonvulsant mood stabilizers you can try. If your doctor opts for Depakote, just be sure to cut your dosage of Lamictal in half. That would leave you at 100 mg/days instead of 200 mg/day.
> But this last jump in dose produced weird itchy gums.
This is a significant reaction that must be watched. Chances are that this will pass. With me, itchy eyes occurred with every dosage increase. However, the mouth is where Stevens-Johnson Syndrome (SJS) usually begins. If it were me, I would continue with the Lamictal and monitor closely your itching gums. If it gets worse or spreads instead of getting better at a steady dosage, you should contact your doctor and express your concerns about SJS. SJS is uncommon, so I wouldn't get too worried about getting it just yet.
> Is it possible to go back to 50mg Lamictal and use lithium and or Trileptal?
Yes.
The same is true of antipsychotics. I am not sure which one makes sense for you as a first choice. Because of your anxiety and insomnia, Seroquel might be worth inquiring about. I like Abilify with Lamictal. Many people experience restlessness and insomnia in the beginning, but this usually disappears, leaving one less depressed with reduced anxiety.
- Scott
Posted by phillipa on September 19, 2012, at 9:50:23
In reply to Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 6:13:38
Sheila is there a reason your doc is making so many med changes at once? I forget are you bipolar? Personally I had a very strange but listed as rare side effect to lamictal at 50mg. I began producing huge amounts of saliva. To the point where all I could do is hold a cup under my mouth and spit. So Of course the doc took me off it. And it immediately went away. I also got angry I see in retrospect on the lamictal so I threw a plastic bottle at a store front in anger. So for me it wasn't a good med. Trileptal I took to augment an ad at 150mg and no side effects at all. I went off as the cost money wise was too expensive. I just don't know If I'd continue with the lamictal. But this is me. Phillipa
Posted by Sheilac on September 19, 2012, at 11:02:53
In reply to Re: Lamictal combo for everything? » Sheilac, posted by SLS on September 19, 2012, at 7:59:02
Wow, I didn't know you can go from 50mg to 100mg or 200mg so fast.
Besides the weird itchy gums, my husband noticed a lot of bruising on me. Today I dropped back down to 75mg of Lamictal and I was still hyper so I had to take 2mg of Klonopin.
You are correct about the Trileptal making me depressed, but the doc said that could be the stabilizing effect. I have experienced this sort of depression from a lot of mood stabilizers. I liked Trileptal though. I just needed something else with an antidepressant effect.
Given that I have stopped Lamictal numerous times due to gums blisters and sores, I am concerned and will keep an eye on these issues. Today dropping the dose helped.
I just wonder since I am so sensitive and sometimes experience the opposite effects, if combining Lamictal for depression and Trileptal for mood stabilization. It could be a good combo since I can't take antidepressants.
A little bit of meds go a long with me. My husband is concerned about the bruising though.
Antipsychotics tend to make me irritable and sometimes hypomanic and uncontrolabley hungry. Right now I need seroquel for sleep since Lamictal keeps me awake. If I didnt take it I would stay up 24 hours a day. But going up on seroquel would make me mean and binge eat.
I need to consider a combo. Maybe Lamictal for depression and Trileptal for mood stabilization would work. I do know I HAD to take 2mg Klonopin of else I would STILL me hypomanic. My doc wouldn't like that. But I can't take being crazy anymore. I need to feel calm.
I don't want to drop Lamictal because it is a good med - just not at 100mg.
What do you think?
Posted by SLS on September 19, 2012, at 12:10:12
In reply to Scott - Re: Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 11:02:53
> Wow, I didn't know you can go from 50mg to 100mg or 200mg so fast.
I know someone who does well at 100 mg/day.
> Besides the weird itchy gums, my husband noticed a lot of bruising on me.
This is no good. This could be the first sign of hemolytic anemia. Do you have any abnormal bleeding anywhere? The sores and blistering in your mouth are also no good. This could be the beginning of Stevens-Johnson Syndrome (SJS). I think your doctor should actually see these things for himself. If he tries to invalid your concerns, I would look for another doctor.
> Today I dropped back down to 75mg of Lamictal and I was still hyper so I had to take 2mg of Klonopin.
Something is wrong here. You should not have to be playing with your medication all of the time. It would be easy for me to blame your doctor for not paying enough attention to what you have to say. However, I wonder if you pay enough attention to what he has to say. If you don't follow his directions, he can't properly evaluate your reactions to different drugs and dosages. If his directions lead to greater suffering, then it is time for a second opinion.
You have to make some decisions here. You need to find out if you are having dangerous reactions to Lamictal:
1. Stevens-Johnson Syndrome
2. Hemolytic anemia.How do you propose to go about this?
If you are able to continue with Lamictal, what do you do to treat your hypomanic reaction to it (if that is indeed what you are experiencing)?
1. Add back Trileptal
2. Keep the Klonopin
3. Raise the dosage of Seroquel
4. Discontinue Lamictal
5. Choose another mood stabilizer to add to Lamictal
- anticonvulsant
- antipsychoticPersonally, I would stay at 50 - 100 mg/day of Lamictal and add back the Trileptal at 400 mg/day until you are able to establish medical supervision. If you feel depressed with the addition of Trileptal, at least you will have calmed down enough to start making better decisions. I am hoping you can tolerate the depression for a brief period in order to locate other doctors and obtain second opinions. For now, just let the depression happen. Hopefully, with Lamictal on board, this might not happen at all. I do agree with your doctor that there is a small possibility that you are misinterpreting your coming down from hypomania as depression when you take Trileptal. Allow enough time for your system to stabilize once you restart Trileptal.
Question: What is the very next thing that you will do?
Call the doctor? Self-medicate? Seek a second opinion?
- Scott
Posted by Sheilac on September 19, 2012, at 12:30:59
In reply to Re: Scott - Re: Lamictal combo for everything? » Sheilac, posted by SLS on September 19, 2012, at 12:10:12
I agree with you. I don't want to stop Lamictal, simply because it works for my depression. But I think adding back Trileptal would help even out the hypomania from Lamictal.
I just found out that this doc, like my previous doc is moving and downsizing his practice so I will have to find another doc.
My gums still itch, which is irritating.
I think 50mg of Lamictal may be ok. I will have to keep an eye on the bruising and gums.
Meanwhile, I will get a 2nd opinion from a doc closer to home in a couple of weeks. I would like to stick with a combo. I don't want to rely on Klonopin for constant Lamictal hypomania.
Maybe this 3rd doc will stay in practice and not close up shop.
Posted by Sheilac on September 19, 2012, at 12:39:13
In reply to Re: Scott - Re: Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 12:30:59
Is it possible to add something if depression becomes an issue with Trileptal? Is there a better alternative than Lamictal for depression?
Trileptal is great for keeping me stable, I just need to treat the depression. Or is low dose Lamictal the way to go?
Low dose geodon made me happy but hypomanic, maybe that's a good Trileptal combo.
I have to treat both hypomania and depression but can't find it all in one drug.
Not sure.
Posted by SLS on September 19, 2012, at 15:36:13
In reply to Re: Scott - Re: Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 12:39:13
> Is it possible to add something if depression becomes an issue with Trileptal? Is there a better alternative than Lamictal for depression?
You might want to restart the Trileptal and then increase the dosage of Lamictal back up to 100 mg/day gradually.
> Trileptal is great for keeping me stable, I just need to treat the depression. Or is low dose Lamictal the way to go?I don't think it works that way. You just need to discover what works. 200 mg/day works for me. Others need 300 mg/day and higher. For you, 100 mg/day might be just right. If you are very sensitive, perhaps 50 mg/day is sufficient. Try to be methodical in your approach, though. Add the Trileptal first 400 - 600 mg/day. Then watch what happens with the Lamictal at 50 mg/day. If you start to feel depressed, go to 75 mg/day of Lamictal for a week, then 100 mg/day if necessary. If you are already at 75 mg/day, stay there for another week. Monitor for rash and blisters in the mouth and excessive bruising and bleeding.
> Low dose geodon made me happy but hypomanic, maybe that's a good Trileptal combo.
Possibly. I am partial to Abilify in combination with Lamictal.
> I have to treat both hypomania and depression but can't find it all in one drug.
Possibly Latuda (lurasidone).
I don't have a problem with taking multiple drugs. I guess it is a mindset. Some people with cardiovascular disease must take three or more drugs. My grandmother needed five.
- Scott
Posted by Peter S. on September 19, 2012, at 16:02:14
In reply to Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 6:13:38
As I mentioned above- I only take 50mg- this is the optimal dose for me. Everyone has different chemistry/metabolism and I wouldn't push it if you don't feel comfortable with higher doses.
> My doc is nuts I think. He said since I didn't get the rash after the first month, he wanted me to jump from 50mg up to 150mg for a week, then 200mg the next week. That is a fast jump. I was taking it slow by going up to 75mg, but yesterday after he was gruff with me on the phone I jumped up to 100mg.
>
> He took me off everything else - Trileptal and lithium.
>
> I like Lamictal as an antidepressant, but my gums feel weird again (I've tried Lamictal before). Plus, sleep is almost impossible. He can't believe Lamictal is activating for me. He said it should be making me sleepy. I feel like I'm on Adderall.
>
> I am wondering if I can use a lower dose of Lamictal for antidepressant effects and add back something else to keep me grounded. He wants me to go up to between 200mg - 400mg Lamictal. But this last jump in dose produced weird itchy gums.
>
> Is it possible to go back to 50mg Lamictal and use lithium and or Trileptal?
>
> I think, given my history of medication sensitivity, the drastic jump he wants me to do in 2 weeks isn't so good.
Posted by sheilac on September 19, 2012, at 18:13:07
In reply to Re: Lamictal combo for everything?, posted by Peter S. on September 19, 2012, at 16:02:14
Peter, do you take anything else besides 50mg of Lamictal? Are you just treating depression?
Posted by sheilac on September 19, 2012, at 18:23:58
In reply to Re: Scott - Re: Lamictal combo for everything? » Sheilac, posted by SLS on September 19, 2012, at 15:36:13
I haven't heard of Latuda and my doc never mentioned it. Have to look that one up.
I couldn't take Geodon and Lamictal I would be manic! Same with Abilfy.
I could take Lamictal for the lows and Trileptal for the highs.
I get the idea of less meds is better and that is what this doc is trying to do.
He also insists that I take Lamictal twice a day, even though if I take it at dinner I am awake all night. So, I take it all in the morning.
It does give me a buzz, like Peter said. Its like too much coffee or adderall. It's odd, kind of like Geodon.
But, since antidepressants are definitely out of the question, I don't mind sticking with a lower dose of Lamictal for depression. It really works great for that.
Lamictal and Trileptal may be the answer. At least I will be happy and be able to finally get some sleep.
I just love how some docs like to argue with you and say that Geodon, Abilify, Lamictal are NOT activating even though I tell them they are, no matter how high the dose. It's like they just keep feeding me speed and can't understand why I am hypomanic and not sleeping. I swear I am not being difficult on purpose. I can't make this up. Even Ambien doesn't work.
Maybe I am an odd duck and a small dose works.
I just hope these cancker sores and itchy gums go away - and my husband would like the bruising to stop.
We'll see. I like the idea of going back to Trileptal twice a day like before and taking my Lamical in the morning. It might work out perfect. I just need a little antidepressant effect - not a rocket :)
Posted by SLS on September 19, 2012, at 19:42:21
In reply to Scott - Re: Lamictal combo for everything?, posted by sheilac on September 19, 2012, at 18:23:58
It sounds like you have a good plan.
What dosage of Trileptal will you start at?
Good luck!
- Scott
Posted by Peter S. on September 19, 2012, at 22:29:10
In reply to Scott - Re: Lamictal combo for everything?, posted by sheilac on September 19, 2012, at 18:23:58
Hey Sheliac- I also take 10mg of Prozac which doesn't do a lot but it seems to be better than nothing for depression. I've gone as high as 80mg and I just sleep a lot. When I first started taking prozac it was great but it pooped out on me. Also I take 300mg Neurontin- I'm not totally sure what this does but I think it mellows out the Lamictal a bit. Might be worth a try if you get too jittery. I also have lamictal XR when I really want to feel good all day- I just use occasionally because it's so expensive.
> I haven't heard of Latuda and my doc never mentioned it. Have to look that one up.
>
> I couldn't take Geodon and Lamictal I would be manic! Same with Abilfy.
>
> I could take Lamictal for the lows and Trileptal for the highs.
>
> I get the idea of less meds is better and that is what this doc is trying to do.
>
> He also insists that I take Lamictal twice a day, even though if I take it at dinner I am awake all night. So, I take it all in the morning.
>
> It does give me a buzz, like Peter said. Its like too much coffee or adderall. It's odd, kind of like Geodon.
>
> But, since antidepressants are definitely out of the question, I don't mind sticking with a lower dose of Lamictal for depression. It really works great for that.
>
> Lamictal and Trileptal may be the answer. At least I will be happy and be able to finally get some sleep.
>
> I just love how some docs like to argue with you and say that Geodon, Abilify, Lamictal are NOT activating even though I tell them they are, no matter how high the dose. It's like they just keep feeding me speed and can't understand why I am hypomanic and not sleeping. I swear I am not being difficult on purpose. I can't make this up. Even Ambien doesn't work.
>
> Maybe I am an odd duck and a small dose works.
>
> I just hope these cancker sores and itchy gums go away - and my husband would like the bruising to stop.
>
> We'll see. I like the idea of going back to Trileptal twice a day like before and taking my Lamical in the morning. It might work out perfect. I just need a little antidepressant effect - not a rocket :)
Posted by Sheilac on September 20, 2012, at 7:17:21
In reply to Re: Scott - Re: Lamictal combo for everything? » sheilac, posted by SLS on September 19, 2012, at 19:42:21
Scott, I will start out with 150mg twice a day of Trileptal. If I need more I will go up to 450 or 600 and keep Lamictal for depression.
Then, I will see what the new doc thinks and how I feel in a few weeks.
Posted by SLS on September 20, 2012, at 7:33:10
In reply to Scott - Re: Lamictal combo for everything?, posted by Sheilac on September 20, 2012, at 7:17:21
> Scott, I will start out with 150mg twice a day of Trileptal. If I need more I will go up to 450 or 600 and keep Lamictal for depression.
>
> Then, I will see what the new doc thinks and how I feel in a few weeks.:-)
- Scott
Posted by Peter S. on September 20, 2012, at 11:43:44
In reply to Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 6:13:38
Hi Sheilac,
I'd be curious to find what works for you since we seem to have similar chemistry based on our response to Lamictal. Do you primarily experience depression? Any antidepressants that have worked for you? I'd be interested in finding your experience with Trileptal.
Thanks,
> My doc is nuts I think. He said since I didn't get the rash after the first month, he wanted me to jump from 50mg up to 150mg for a week, then 200mg the next week. That is a fast jump. I was taking it slow by going up to 75mg, but yesterday after he was gruff with me on the phone I jumped up to 100mg.
>
> He took me off everything else - Trileptal and lithium.
>
> I like Lamictal as an antidepressant, but my gums feel weird again (I've tried Lamictal before). Plus, sleep is almost impossible. He can't believe Lamictal is activating for me. He said it should be making me sleepy. I feel like I'm on Adderall.
>
> I am wondering if I can use a lower dose of Lamictal for antidepressant effects and add back something else to keep me grounded. He wants me to go up to between 200mg - 400mg Lamictal. But this last jump in dose produced weird itchy gums.
>
> Is it possible to go back to 50mg Lamictal and use lithium and or Trileptal?
>
> I think, given my history of medication sensitivity, the drastic jump he wants me to do in 2 weeks isn't so good.
Posted by Sheilac on September 21, 2012, at 18:31:56
In reply to Re: Lamictal combo for everything? » Sheilac, posted by Peter S. on September 20, 2012, at 11:43:44
So far the past few days on 300mg of Trileptal have been great with 75mg of Lamictal. The Trileptal really keeps me grounded and sane. My mouth still feels funny so I may try to drop back to 50mg of Lamictal. I really like Lamictal for depression, but it just wasn't stabilizing.
Generally, I haven't really tolerated antidepressants very well. I can only take a tiny dose of any of the SSRIs. I guess if I had to go back to Prozac I would have to up my Trileptal to keep me from getting hypomanic.
Wellbutrin has always been a disaster for me. Makes me full blown manic. My doc says he's not surprised. He sees a lot of patients that react that way to Wellbutrin and he doesn't really like it.
Trileptal alone can leave me sane but feeling depressed. So I love Trileptal as a mood stabilizer but I have to add something for depression. Trileptal isn't a cure all for me but seems to be a good base.
Also, I have tried Tegretol, but it was too much for me. Trileptal is an easier drug for me to tolerate.
As a side note, since I have reduced Lamictal my vision has cleared up. I felt like I was going blind on Lamictal. My vision was so blurry.
I'll keep posting on how I'm doing with Trileptal and Lamictal. Not sure if I can stick with Lamictal if I keep having canker sores and mouth issues, but I would really like to.
Posted by phillipa on September 21, 2012, at 21:46:59
In reply to Peter: Lamictal, posted by Sheilac on September 21, 2012, at 18:31:56
Sheila didn't think you could take ad's. I'd definitely quit the lamital stick with trileptal and add an SSRI low dose. As you know I also take low doses of ads. Which one worked the best for you? Phillipa
Posted by phidippus on September 22, 2012, at 1:15:14
In reply to Lamictal combo for everything?, posted by Sheilac on September 19, 2012, at 6:13:38
>He can't believe Lamictal is activating for me.
You're not alone, Lamictal was very activating for me. Not to mention it made my OCD worse.
>this last jump in dose produced weird itchy gums
Monitor this closely. If this gets worse, it could be SJS-Steven-Johnson Syndrome-which can be fatal if detected too late.
> add back something else to keep me grounded
What do you mean by this? Do you feel too up on the Lamictal?
>Is it possible to go back to 50mg Lamictal and >use lithium and or Trileptal?
I wouldn't do all three. My vote is for Lithium if you feel you need to add something back.
Eric
Posted by Sheilac on September 22, 2012, at 7:50:02
In reply to Re: Lamictal combo for everything? » Sheilac, posted by phidippus on September 22, 2012, at 1:15:14
I will keep an eye on my itchy gums. Today I reduced my dose from 75mg to 50mg.
I guess what I meant to say is that by taking Trileptal I don't need anything for stability but for depression.
Lithium didn't help so much for depression when combined with Trileptal that's why doc took me off everything and made me start Lamictal only.
I felt hypomanic on Lamictal even up to 100mg. After almost 6 weeks I couldn't take it I needed some stability. Odd I know because we all like some mania.
I could probably take a low dose AD but I would have to up Trileptal.
Posted by SLS on September 22, 2012, at 9:13:15
In reply to Re: Lamictal combo for everything?, posted by Sheilac on September 22, 2012, at 7:50:02
> I will keep an eye on my itchy gums. Today I reduced my dose from 75mg to 50mg.
Can you describe what your sores look like? Where are they located? How big are they? What color are they? You could go to a dermatologist to have your mouth sores evaluated for SJS (Stevens-Johnson Syndrome). Your psychiatrist might not have enough experience with examining SJS to properly diagnose it. You wouldn't want to discontinue Lamictal for the wrong reasons. Of course, you wouldn't want to risk a more global SJS reaction. It is entirely possible that you will be okay at 50 mg of Lamictal. If you need to increase the dosage, I would suggest that you go to 75 mg rather than 100 mg. Sometimes, a rash can be avoided by titrating more gradually. It might not be how much you take, but how fast you get there that makes the difference. Often, someone who experiences a reaction with an aggressive titration schedule must discontinue it and restart it more gradually. It works.
I think you should stay on Trileptal, even if you feel more depressed on it temporarily.
How do you know that the depression you report with Trileptal isn't actually your baseline (unmedicated) depression? If you experience a mixed-state hypomania, you would expect to feel the depression that remains once the hypomania is eliminated. This is what you want Trileptal to do. Then, you can experiment with Lamictal or other drugs that have antidepressant properties. You need to take things one step at a time in a logical order if you are going to arrive at an optimal treatment. You might find it helpful to try minocycline if you must discontinue Lamictal.
Which antipsychotics have you tried, and what were your reactions to them? If you abandon Trileptal, you might have to go with one of them. The other mood stabilizer that might work is Depakote. If you do try Depakote, you would need to reduce your dosage of Lamictal by half. There is a pharmacokinetic interaction between these two drugs. It is my observation that more people report depression with Depakote than with Trileptal. However, I don't doubt that it would treat the hypomania successfully.
- Scott
Posted by phidippus on September 22, 2012, at 23:38:55
In reply to Re: Lamictal combo for everything?, posted by Sheilac on September 22, 2012, at 7:50:02
I don't know what the Lamictal is doing to you, but my sense is that you should get off of it and try Depakote.
Eric
This is the end of the thread.
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