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Re: Erin

Posted by JohnL on July 11, 1999, at 5:54:00

In reply to Question for JohnL, posted by Erin on July 11, 1999, at 1:24:24

> John-
> I took my first dose of 50 mg last night- really didn't have too many problems (just a tad bit sleepy). I have a few questions about the slow initial dosage- Why did your doctor recommend the slow dosage increase (by 25 mg weekly, instead of the jump from 100 to 200 mg after a one week period) before hitting the 200 mg mark? It seems like the therapeutic dosage is at least 200 mg and if I read it correctly it looked like your was about 275 mg. Are some people's ideal dosing range lower than 200 mg? I hope that what I asked is somewhat clear- I may have to clarify later.
> I'm augmenting my 50 mg dose with 1 mg of Lorazepam at night to help me sleep. My anxiety level seems to have increase more in the evening when I have time to contemplate my situation.
> I think I remember reading that you might be dealing with BiPolar II. What did your doctor recommend for dealing with the hypomanic times? I'm still trying to figure out if that's what I'm dealing with. I don't remember ever having a manic episode but I may have had a hypomanic episode where I was incredibly irritated and agitated. I've never had the wilder side of a manic episode I've read about in books. I really need to get some more recent info about this condition- any recommendations?
> Thanks again for your time and consideration,
> Erin

Hello Erin. I'm certainly no expert, just a troubled patient struggling to get better. But I have learned a lot in my travels and I will try my best to answer your good questions.

First, I have heard of people doing fine at lower doses, but you are correct that at least 200mg is considered therapeutic. Usually 300mg-600mg. I even heard of one case at 1000mg in addition to Zoloft! Holy cow! That person must be tough as a tank. The purpose of increasing in small steps is three-fold: 1)It's easier to get the body used to side effects, 2)Serzone can give unexpected erratic results when increased too fast. By that I mean worsening depression, excessive sedation, agitation, and who knows what else. 3)That is the method used by a doctor who has discovered it works best through painful trial and error. It really seems to me to be a finicky drug. I got up to 200mg real fast because, like you, the side effects seemed so easy to handle. But looking back I still believe that was what caused the drug to act so weird with me. And perhaps others who have tried it too. It's really hard to argue against a doctor's successful approach, even if we can't pinpoint exactly why it is successful.

I may be dealing with Bipolar II, but 3 psychiatrists, a family doc, and a counselor are all in disagreement on that. I think I've had hypomania before, but without agitation, just lots of energy and creativity. I wouldn't mind getting stuck there..."the manic advantage" they call it. Never had a real mania. That would be a completely different picture, quite crippling and scary I would think.

There are no clearcut bounderies, and one form of hypomania is called a mixed state, because it has irritation and agitation mixed in with it. I've never had that, but it sounds like you maybe have. That's a maybe...3 different doctors, 3 different answers.

In any case, an anticonvulsant treats those symptoms. I take 25mg Lamictal (very low dose), and may go higher. I find it does wonders. It helps the depression, it smooths my moods, it calms by bladder and I go to the bathroom a lot less, and it quiets my tinnitus. Of all the mood stabilizers, Lamictal and Neurontin are the newer ones with a much easier side effect profile, and stronger action on depression. In addition, I'm in my 2nd week of Prozac+Naltrexone. If I need a real good night's sleep, I take a crumb (maybe 5mg) of Remeron which I have lots leftover.

For more info on Lamictal or Neurontin, click on tips at the top of the page, then go down to search and push that button. You'll have a huge page of topics to explore, with bipolar, anticonvusant, and Lamictal issues to choose from. Nice talking with you, and wishing you a smooth day. JohnL.




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