Posted by sweetmarie on March 11, 2001, at 15:05:20
In reply to Re: treatment resistant depression » sweetmarie, posted by JahL on March 11, 2001, at 13:51:24
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> > > Now I`m really worried. I suppose that I`m reluctant to speak to my psychiatrist about this, as I don`t want hoer to think that I`m questioning her judgement.
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> I know UK pdocs don't take kindly to patients questioning their judgement but what if you printed out a few of these posts & presented them to yr pdoc, expressing yr concern? The other thing to do is visit the GlaxoWellcome site & download the Lamotrigine PDF. This gives clear dosing guidelines (which you can print out), which do not concur with those of yr pdoc. Yr pdoc cannot argue with the manufacturer's recommendations.
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> If you're concurrently on VPA, Lamotrigine shld be increased by 12.5mg/week. Mine & phillybob's regimes are conservative bearing in mind neither of us takes VPA.
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> > >I guess that the other thing I could do is to take it into my own hands, and drop back to 100 mg myself. As I am seeing her in 4 weeks, this should be easy to do. In other words, I could go back to 100 mg for the next couple of weeks, and then up to 200 mg. I don`t want to take it further than that myself. The other thing is that I am juggling this increase with decreasing the Valproate. So, I`m coming off the Valproate at a rate of 200 mg per 5/6 days (I was on 1000 mg). It`s really bloody complicated I can tell you. I don`t like this set-up at all; I thought that the whole reason for my going into hospital was that this could all be managed there. Frankly, I feel too ill to be doing it myself. Still, that`s the way it is - and I`m perfectly capable of ringing my psychiatrist and asking her to spell it out more clearly for me. Or at least double check the report sent to her by the professor, and see what he actually says. I`m really confused.
> >
> > Anna.
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> I don't feel comfortable actually recommending you independently change yr dose, however the rash is more of a concern. I can't see what damage reducing the dose wld do (except possibly inducing epileptics fits in those susceptible), whereas exacerbating the rash, which higher doses are more likely to do, wld be dangerous.
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> This is a toughie, Anna. Perhaps yr Lamotrigine trial is best left until you are under the close supervision of the hospital prof. As you say, you shld'nt be expected to deal with this yourself.
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> J.I was kind of thinking along those lines myself. After I posted that last post, I spoke to my sister (a psych nurse), who basically said that I should do whatever feels O.K. for me within the framework given to me by my consultant and the professor. She suggested that I say on 100 mg for another week, and instead of going right up to 200 mg, go up to 150 mg for a couple of weeks. Then 200 mg. By that point, I should be going to go into hospital (I was given a waiting time of 5/6 weeks on Monday, which is now 4/5 weeks, which should tie in with this arrangement. As for the Valproate; I`m not entirely sure. My consultant has told me to decrease from 1000 mg to nothing in weekly 200 mg intervals. In the light of the new arrangement I`ve made with the Lamotragine, I think I`ll slow this down (maybe 200 mg decrease over a week and a half instead of a week). There is something here called `the medication helpline`, who deal exclusively with psychiatric medication questions. I`m going to give them a ring. If Im still confused, I am going to have to `bite the bullet`, and get in touch with my psychiatrist. After all, that`s what she`s there for (and gets very well paid for it, I`m quite sure).
I`ll let you know how I get on.
Anna.
poster:sweetmarie
thread:55847
URL: http://www.dr-bob.org/babble/20010310/msgs/56225.html