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Re: Neurontin vs Depakote Ron Hill

Posted by Ritch on July 30, 2002, at 11:01:53

In reply to Re: Neurontin vs Depakote Ritch, posted by Ron Hill on July 30, 2002, at 9:37:57

> Mitch,
> > ...that's when I flipped from Neurontin back to Depakote.
> What prompted you to desire this change? Was the Neurontin causing some cognitive blunting and/or forgetfulness? What other side effects did you experience with Neurontin? The reason I ask is that for a couple of years I've been trying to decide whether or not to give gabapentin a trial as an add-on to my 600 mg/day Lithobid.
> The supposed benign side effects profile of gabapentin is attractive to me because I am hypersensitive to medication side effects. Also it is purported to reduce irritability and, although the SAM-e rage thing disappeared shortly after discontinuation of the substance, I have always had some irritable mood problems associated with my BP II disorder.
> I liked Lamictal when I tried it years ago, (but the rash side effect was intolerable). Therefore, I think my brain chemistry would benefit from an AED add-on if I could find one with tolerable side effects.
> How long did you take gabapentin? Thanks much for you time, Mitch.
> -- Ron

Hi Ron,

It is a long story, but I will try to explain it as best I can. I was on lithium for probabably 20 years, but I could only tolerate 300-450mg/day because of GI upset. So, it wasn't really a high enough dose to really be effective at controlling my cycling. So, I flipped to Depakote back in 1997, my depression worsened, but there wasn't any hypomania. So, I spent a lot of time flipping between different low-dose AD's (and low-dose AD combos)with the Depakote to get the breakthrough depressions under control. I was on a combo of Depakote+Klonopin+Celexa when I added Neurontin in 1999. I immediately felt a *lot* better. It was during a major depression and it nearly lifted entirely. That was at 300mg tid of Neurontin. Well, I screwed up big time and stopped all of the other meds (because I thought I had found the *one* with Neurontin). Well, anxiety and panic started to return with a vengeance (possibly also a Depakote withdrawal, too), and I wound up on Neurontin+Celexa+Klonopin. My pdoc and I decided to try to bump up the Neurontin (since I was responding well to it). I went to 1800mg/day and got bad depersonalization and cognitive "blanking" from it (this has happened with Gabitril and Topamax, too at higher doses). I dropped the dose down to 1200mg/day for a while. Then I started getting all of these eustachian tube "thumps" in my ear canals. It was annoying as hell-kind of a myoclonus thing. So, I dropped the dose all the way down to 100mg 4x daily and stayed on that with Celexa+Klonopin for quite a while. Well, this spring I had some pronounced hypomanic situations and the gabapentin just wasn't a high enough dose to prevent it so we added some Depakote back in. It helped right away and my hostility level went way down. Then, when I started into my summertime depression this year I was just so TIRED. I knew the Depakote was keeping my anger under control and I didn't want to reduce that one so I could wake up. So, the Neurontin got axed so I wouldn't be so drowsy during the daytime. I was considering a stimulant this time around (with Neurontin+Depakote+Celexa+Klonopin), but geez! just *too* many meds! We tried a string of different stimulants back in the Spring and they helped, but I tend to get this "cascading" panic reaction to stimulants. They work OK for quite some time and then I slowly become more and more panicky. Yuck, didn't want to go there. So, I am on a med minimalism tack now. Three meds now: Depakote+Klonopin+Effexor. I found low-dose Effexor to be a little less tiring than low-dose Celexa. Whew! I hope that clarifies things. In short I think Neurontin is quite useful, but I can't tolerate higher doses of the stuff (or much of anything else either!),





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