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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by brynb on October 9, 2012, at 13:51:29
Hi All,
My pdoc added Lamictal to my current regimen as both a mood stabilizer and an antidepressant. I currently take lithium (450 mg) and Lexapro (20 mg), and on some days, Tramadol (50 mg).
I experienced a dip in mood (a very minor depression) back in August, but it seems as though lithium and Tramadol kept it at bay. Shortly after, in September, I started having insomnia and hypomania. That lasted about 3 weeks. I upped my Lithium dose (and yes, I realize it's still a low dose) and it helped. I was still a bit hypomanic at times, but the hypomania was quelled and I started sleeping again.
Here's the thing: after upping the lithium dose, I started sleeping a lot and feeling extremely tired. Is that because I was cycling out of a hypomanic period and hadn't been sleeping?
Now my pdoc added Lamictal (which I tried years ago and didn't like, though I don't remember why, so I agreed to at least try it again) and since I started it, my depression is coming back. My mood is low and all I'm doing is sleeping.
Any input is appreciated...
Thanks.
-b
Posted by Christ_empowered on October 9, 2012, at 14:46:47
In reply to Is Lamictal making me depressed?, posted by brynb on October 9, 2012, at 13:51:29
I guess its possible (?). When I hit 200 on lamictal--it was supposed to be a mood stabilizer w/ some mood elevating properties, on top of ongoing Abilify treatment--I almost hit a low. I definitely lost the mild mood elevating (no mania or euphoria or anything; just improved mood and all that goes with it) effect I'd gotten while at 100.
I wanted to go back to 100, but my shrink was all "no, you need 2 mood stabilizers," so I tried to stick it out at 200.
Point of this story...maybe a lower dose? Or are you already on a low dose? When you say "depression," what do you mean?
Posted by phillipa on October 9, 2012, at 15:36:58
In reply to Re: Is Lamictal making me depressed?, posted by Christ_empowered on October 9, 2012, at 14:46:47
Don't know where you live but here the temp dropped over 20 degrees and dark and gloomy? Change of season Depression? Phillipa
Posted by brynb on October 9, 2012, at 15:52:34
In reply to Re: Is Lamictal making me depressed?, posted by Christ_empowered on October 9, 2012, at 14:46:47
> I guess its possible (?). When I hit 200 on lamictal--it was supposed to be a mood stabilizer w/ some mood elevating properties, on top of ongoing Abilify treatment--I almost hit a low. I definitely lost the mild mood elevating (no mania or euphoria or anything; just improved mood and all that goes with it) effect I'd gotten while at 100.
>
> I wanted to go back to 100, but my shrink was all "no, you need 2 mood stabilizers," so I tried to stick it out at 200.
>
> Point of this story...maybe a lower dose? Or are you already on a low dose? When you say "depression," what do you mean?My depression is usually characterized by low mood, lethargy and anxiety, but it varies. If I'm in a severe depressive episode, I can't move out of bed or shower or function at all, and generally feel like I'm losing my mind. Right now, though, it's just a low mood, lack of motivation, excessive sleep and exhaustion. I'm only on 25 mg as I just started and am titrating up...
Posted by brynb on October 9, 2012, at 15:56:12
In reply to Re: Is Lamictal making me depressed?, posted by phillipa on October 9, 2012, at 15:36:58
> Don't know where you live but here the temp dropped over 20 degrees and dark and gloomy? Change of season Depression? Phillipa
Hi Philllipa,
Could be. I live in New York and have no doubt that I'm affected by the change of seasons. Unfortunately, with starting a new med (Lamictal), the change of season, etc., it seems there are a few variables here that come into play...
Posted by brynb on October 10, 2012, at 14:13:15
In reply to Re: Is Lamictal making me depressed?, posted by brynb on October 9, 2012, at 15:56:12
Posted by brynb on October 10, 2012, at 15:27:41
In reply to Should I just stop it for a week or so? (nm), posted by brynb on October 10, 2012, at 14:13:15
Is it really necessary if I'm feeling okay on the higher dose of lithium?
Posted by Christ_empowered on October 10, 2012, at 22:45:58
In reply to And, why add Lamictal?, posted by brynb on October 10, 2012, at 15:27:41
hmmmm...do you have other stuff going on? Sometimes, lamictal is used off label. I think it helps some people with PTSD, for inatance.
Also, sometimes shrinks just add meds. I can't explain it. I thought I was perfectly stable @ 15 Abilify, for instance. My shrink..not so much. She doubled the Abilify and added Neurontin in one session w/o the presence of psychosis. Helped, yes, but...I dunno *why* it happened, exactly. Must be some kinda shrink-y wisdom.
Posted by brynb on October 11, 2012, at 10:35:24
In reply to Re: And, why add Lamictal?, posted by Christ_empowered on October 10, 2012, at 22:45:58
> hmmmm...do you have other stuff going on? Sometimes, lamictal is used off label. I think it helps some people with PTSD, for inatance.
>
> Also, sometimes shrinks just add meds. I can't explain it. I thought I was perfectly stable @ 15 Abilify, for instance. My shrink..not so much. She doubled the Abilify and added Neurontin in one session w/o the presence of psychosis. Helped, yes, but...I dunno *why* it happened, exactly. Must be some kinda shrink-y wisdom.
>
>
Hi Ce,Yeah, that makes sense.
I don't want to go up on lithium because at the lower dose, I haven't experienced side effects (and my pdoc knows I'm afraid I'll experience them at higher doses).
I'm not definitively diagnosed with bipolar 2, but we're leaning toward that dx, especially as the recent hypomania and insomnia got better when I went up on lithium (and it's becoming more apparent with more insight/hindsight I have on my history). I think Lamictal was added to address my typically most prominent symptom, which is depression, and as an extra mood stabilizer. My pdoc is conservative with meds, and I trust him. He mentioned something about using Lamictal to replace lithium if I do well on it. Why, I wonder? I haven't had issues with lithium...maybe because I'm a woman of child-bearing age? Seriously, I can't figure it out.
I'm confused. And depressed :/.
-b
Posted by Christ_empowered on October 11, 2012, at 12:28:59
In reply to Re: And, why add Lamictal? » Christ_empowered, posted by brynb on October 11, 2012, at 10:35:24
Sounds like a good pdoc. No blood work with lamictal, helps depression, usually doesn't cause significant cognitive problems, doesn't usually worsen depression, can apparently help with hypomania (I have a relative on it for this), and its just all around "cleaner" than lithium. No tremor, no toxicity, so on and so forth. Plus, if you're not in need of a strong anti-(hypo)manic, you have all kindsa flexibility in dosing. I would guess-timate that you could go anywhere from 100-400mgs/day to get whatever effect(s) you need to function better.
Personally, I'd take lamictal over lithium any day of the week.
Posted by brynb on October 11, 2012, at 13:33:18
In reply to Re: And, why add Lamictal?, posted by Christ_empowered on October 11, 2012, at 12:28:59
> Sounds like a good pdoc. No blood work with lamictal, helps depression, usually doesn't cause significant cognitive problems, doesn't usually worsen depression, can apparently help with hypomania (I have a relative on it for this), and its just all around "cleaner" than lithium. No tremor, no toxicity, so on and so forth. Plus, if you're not in need of a strong anti-(hypo)manic, you have all kindsa flexibility in dosing. I would guess-timate that you could go anywhere from 100-400mgs/day to get whatever effect(s) you need to function better.
> Personally, I'd take lamictal over lithium any day of the week.
Put like that, it makes total sense! But I still attribute lithium to preventing me from falling into a bad depression recently. Can Lamictal do that? I also like that lithium has neuroprotective properties. Kinda like a good side effect.Thanks for your feedback...
Posted by Christ_empowered on October 11, 2012, at 14:11:38
In reply to Re: And, why add Lamictal? » Christ_empowered, posted by brynb on October 11, 2012, at 13:33:18
From what I understand (and I could be wrong--I don't do medicatin' for a living, lol), the data shows that Lamictal can delay time to next depressive episode considerably. That's about all you can expect from a mood-elevator. Also, it doesn't usually cause/worsen depression (problem with lithium, depakote, and sometimes neuroleptics), doesn't usually induce agitation or (hypo)mania, and it can have anti-(hypo)manic effects. Its also been studied in some forms of psychosis (w/ conventional treatment). Sometimes it works for people with lingering psychotic issues, so its an interesting medication.
Plus, its generic now, so the cost difference between lamictal and lithium aren't as significant, especially since lamictal usually doesn't require blood work (I've heard some docs do it, for rapid or slow metabolizers and people on cocktails, and epileptics who need certain blood levels...not usually issues for people with mood issues).
I just recommend you try lamictal because it seems a lot safer, over the long haul, than lithium. Its your body though.
Posted by phidippus on October 12, 2012, at 17:31:02
In reply to Is Lamictal making me depressed?, posted by brynb on October 9, 2012, at 13:51:29
>Is that because I was cycling out of a hypomanic period and hadn't been sleeping?
I don't like the addition of the lamictal. All you needed was to raise your lithium. Poo poo on your shrink.
How much Lamictal are you taking?
Eric
Posted by brynb on October 13, 2012, at 15:37:07
In reply to Re: Is Lamictal making me depressed?, posted by phidippus on October 12, 2012, at 17:31:02
> >Is that because I was cycling out of a hypomanic period and hadn't been sleeping?
>
> I don't like the addition of the lamictal. All you needed was to raise your lithium. Poo poo on your shrink.
>
> How much Lamictal are you taking?
>
> EricHi Eric,
I just started my titration, so I'm only at 25 mg. I was afraid of getting the typical lithium side effects if I went up, but I don't even remember if I mentioned that at the time. I dunno. I'm confused.
Posted by Christ_empowered on October 13, 2012, at 18:58:48
In reply to Re: Is Lamictal making me depressed? » phidippus, posted by brynb on October 13, 2012, at 15:37:07
I go to www.allexperts.com now and then to ask about...stuff. Mental problems, spiritual issues, whatever.
Anyway, they have a great shrink on there, Dr. Ivan Goldberg. Private practice in New York, very good with meds from what I've read elsewhere. He wrote to one person that he uses lithium+lamictal for people who switch between the more (hypo)manic and depressed phases on a fairly regular basis. I guess it helps avoid antidepressants, neuroleptics, and lithium levels (or additional meds) that might worsen depression.
I might go back on Lamictal myself. I need something to control agitation and help lift my mood a notch so I'm not as lazy and apathetic all the time. Antidepressants are out, so its probably gonna be Lamictal on top of Abilify. Maybe we can compare progress notes.
Posted by brynb on October 14, 2012, at 9:49:51
In reply to Re: Is Lamictal making me depressed?, posted by Christ_empowered on October 13, 2012, at 18:58:48
Thanks for all of that excellent info! I like my current pdoc a lot, but it's great to have another name of someone here in NYC.
The theory behind combining lithium and lamictal makes sense. I'll keep you posted on how I'm doing, and please let me know what you decide to do and how you are coming along.
Thanks again, Ce =).
-b
Posted by Raisinb on October 14, 2012, at 11:44:28
In reply to Is Lamictal making me depressed?, posted by brynb on October 9, 2012, at 13:51:29
I'm late to this thread but after having read the whole thing I think it is unlikely that such a small dose of Lamictal is making you depressed. I think your illness is just doing its thing--cycling--and the Lithium has some control over it, but not complete control. Lithium is usually better at controlling mania and hypomania than depression. That is probably why your doc wants to add in the Lamictal. I would stick it out for a few weeks and titrate up to a dose that is likely to do something. Just watch out for the rash, as I'm sure you know.
This is the end of the thread.
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