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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 greywolf on July 13, 2006, at 10:23:52
Hi everyone. Been off for a while working on work and my life. Trying to get some control of this BP and OCD.
Started seeing a CBT specialist in OCD treatment for the first time (the others, years ago, were generalists). Also got in to see a new psydoc who other docs say is the expert in our area regarding pharmaceutical treatments. So, at least things are in progress and I'm not treading water anymore.
The plan is to get the bipolar under better control before adding in meds that can help with the OCD. Right now I've finished several weeks of Depakote ER 1500mg/day (apparently a middle of the road dosage), and I continue to take Xanax up to 4mg/day.
I had my blood work done yesterday, and my doctor wants me to stop the Depakote so I can switch over to Lamictal this weekend (once he confirms that I had a Depakote blood level that was sufficient for therapeutic relief, but wasn't providing it, justifying the change in meds). My BP is dominated more by depression, which the Depakote isn't helping with, and he thinks Lamictal will help there.
I'm starting at 25mg/day, ramping up to 100mg/day. He'll see where I'm at at the next 6-week appointment, then will probably take it up to 200mg/day before adding in a med for the OCD.
I've read some pretty bad things about Lamictal making people ill. I'd like to know what it's reasonable to expect during the initiation period, not worst case scenarios. Anyone got thoughts on this?
Posted by SLS on July 13, 2006, at 10:38:48
In reply to Switching from Depakote to Lamictal, posted by greywolf on July 13, 2006, at 10:23:52
Do you plan to discontinue the Depakote before you begin the Lamictal? Depakote doubles the blood levels of Lamictal and multiplies several fold the risk of your developing a serious rash reaction.
What schedule are you going to follow to titrate up to 100mg?
25mg x 2 weeks
50mg x 2 weeks
100mg x 1 week
200mg
- Scott
Posted by greywolf on July 13, 2006, at 10:43:53
In reply to Re: Switching from Depakote to Lamictal, posted by SLS on July 13, 2006, at 10:38:48
I'll be off the Depakote for 6 days before I start the Lamictal. I don't know what the titration schedule is because I can't read the script (damn doctors' handwriting). I should say that I don't remember because he explained it to me. I know that it's over several weeks.
Thanks for the response.
Posted by Phillipa on July 13, 2006, at 15:25:35
In reply to Re: Switching from Depakote to Lamictal, posted by SLS on July 13, 2006, at 10:38:48
That's what they put me on the starter pack. Only side effect excess salivation which the pharmacist said is an uncommon annoying side effect. Constant spitting. Jakeman has it too. Nothing worse at 25mg. Love Phillipa
Posted by psychosage on July 13, 2006, at 23:40:14
In reply to Switching from Depakote to Lamictal, posted by greywolf on July 13, 2006, at 10:23:52
> Hi everyone. Been off for a while working on work and my life. Trying to get some control of this BP and OCD.
>
> Started seeing a CBT specialist in OCD treatment for the first time (the others, years ago, were generalists). Also got in to see a new psydoc who other docs say is the expert in our area regarding pharmaceutical treatments. So, at least things are in progress and I'm not treading water anymore.
>
> The plan is to get the bipolar under better control before adding in meds that can help with the OCD. Right now I've finished several weeks of Depakote ER 1500mg/day (apparently a middle of the road dosage), and I continue to take Xanax up to 4mg/day.
>
> I had my blood work done yesterday, and my doctor wants me to stop the Depakote so I can switch over to Lamictal this weekend (once he confirms that I had a Depakote blood level that was sufficient for therapeutic relief, but wasn't providing it, justifying the change in meds). My BP is dominated more by depression, which the Depakote isn't helping with, and he thinks Lamictal will help there.
>
> I'm starting at 25mg/day, ramping up to 100mg/day. He'll see where I'm at at the next 6-week appointment, then will probably take it up to 200mg/day before adding in a med for the OCD.
>
> I've read some pretty bad things about Lamictal making people ill. I'd like to know what it's reasonable to expect during the initiation period, not worst case scenarios. Anyone got thoughts on this?
>
>
It didn't make me tired until I hit 200mg, and it started to feel like an antidepressant immediately. You might feel a bit of activation. It made me a little hypomanic at first. I didn't leap from 100 to 200mg. I went to 125, 150, 175 for a week each.The usual complaints are headache, dizziness, and perhaps some general itchiness which I had a few times, but no rash.
I think the bad reports were from people who could not tolerate it, but I think a lot more do better with Lamictal side effects than with Depakote. If you don't get a rash then you have a large chance of benefiting from it.
Posted by greywolf on July 14, 2006, at 8:52:57
In reply to Re: Switching from Depakote to Lamictal, posted by psychosage on July 13, 2006, at 23:40:14
Thanks, Psychosage. It's good to hear from you and the others who've kindly responded that the odds are that the SEs will be minimal.
Posted by Phillipa on July 14, 2006, at 20:03:39
In reply to Re: Switching from Depakote to Lamictal » psychosage, posted by greywolf on July 14, 2006, at 8:52:57
There's a starter pack your doc should haven you. Has pills at 25mg for two weeks then 50mg for two weeks then l00mg for a week. So that's the titration from the manufacturer. Love Phillipa
This is the end of the thread.
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