Posted by Ron Hill on February 9, 2001, at 12:53:18
In reply to Re: Lamictal restart dosage help: attn:Ron » JohnL, posted by Sulpicia on February 7, 2001, at 18:34:24
Liz,
I wish I knew the best med combo for your daughter (and you), but I don't. Someday this branch of medicine may advance to the point of accurate medication diagnosis, but in the meantime "educated trial and error" is the best there is.
Based on the small amount I know about your daughter’s symptoms, I would guess that the depressive aspect of her BP is more frequent and more pronounced than the mania aspect. If this is true (and at the risk of stating the obvious), your daughter’s trial and error process likely has two components. First, what med (or med combo) works best as a mood stabilizer and, second, what med (or med combo) works best as an AD in your daughter’s case?
How long did the Lamictal/Wellbutrin combination work prior to the rash problem? For whatever reason, sometimes a restart of a med does not work the second time around.
If the Lamictal is currently functioning as a satisfactory MS, then perhaps it is time to focus on the AD trial and error portion of the equation. If the Lamictal is not satisfactory, then, if it were me, I would attack the MS trial and error first. For the MS, I would spend time on the Internet reading the studies done on the other AED’s (anti-epileptic meds) that you have not tried yet. It’s too bad that lithium doesn’t agree with her. I would also follow up on John’s recommendation and read the research studies on Zyprexa (I know nothing about this med).
Okay, now the AD trial and error. You mentioned that your daughter is suffering with irritability. As you know, this is a fairly common side effect of Wellbutrin. In fact, on one occasion when I temporarily increased my Wellbutrin from 100 to 150 mg/day, I became very irritable. My layman's overly simplistic hypothesis is that the irritability occurs when my norepinephrine (or maybe dopamine?) becomes high relative to my serotonin levels. In other words, my theory is Wellbutrin induced irritability might be overcome via addition of a medication that raises serotonin.
An increase in Serotonin makes me happy, carefree, and very "un-anal", but can also take away my drive, motivation, and enthusiasm. Increasing my norepinephrine (and/or dopamine?) restores a good amount of drive, motivation, and enthusiasm, but can make me grumpy and irritable. Therefore, Prozac and Wellbutrin together in the right proportions work for me (right now anyway).
Some people advocate short trial periods (2 weeks or so) of various medications until you hit on one that shows good results in the mini trial. Then give the med that shows initial promise a longer trial.
Liz, I don’t think I’ve helped you much with this post, but I did want to respond to your request. I wish I knew the recipe. Here’s my philosophy:
The cup is always have full, it is never half empty. Problems are merely solutions waiting to be found; I just have to be smart enough to uncover one of the already existing solutions.
Your are clearly an intelligent Lady. Good luck as you conduct your “educated trial and error” procedure to find one of the existing solutions applicable to your daughter's situation.
-- Ron
------------------------------------------------> > Hi Guys --
> Well, this morning the adderall stopped working so my daughter is bedridden again, and very unhappy of course. Lamictal up to 100 mgs w/out trouble.
> I guess in consultation w/pdoc the next step should be Zyprexa. Does this mean stopping or weaning her from the wellbutrin or could we do a simultaneous intro and withdrawal?
> I'm terrified to think of her being *more* depressed. At least she'll see the pdoc on Saturday -- he has that wonderful gift of giving her hope. He acts like her situation is the most normal thing in the world and that the course of bipolar is always like this. LOL.
> I'm also afraid I'm at the limit of how much I can support her; I can't take a leave from grad school and I'm in the midst of an AD switch myself. Not a good place to be when others are depending on me.
>
> Any thoughts?
>
> Liz
poster:Ron Hill
thread:52762
URL: http://www.dr-bob.org/babble/20010131/msgs/53596.html