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Re: HELP-I'm sick of this! Trileptal as last resort?

Posted by polarbear206 on October 15, 2002, at 20:09:17

In reply to HELP-I'm sick of this! Trileptal as last resort?, posted by Peter on October 15, 2002, at 13:26:36

> Hi all:
> Things have really sucked lately. I'm soft bipolar w/more depressive features/SP/ADD/panic, and who knows what else. I've tried just about everything over the last 8 years and can't seem to settle on a med regime once and for all. I was doing ok for the last few months on zoloft 100mg/depakote 750mg/klonopin 2mg/adderall 50mg/ambien 5-10mg combo until I started cycling -my sleep got awful, and my mood deteriorated. So first my pdoc decided to target my sleep problems and prescribed 30mg restoril which seemed to make things worse. Then he upped my klonopin so I'm now taking 3mg altogether at bedtime, and .5mg during the day. I was getting to bed at 6-7a.m. My doctor decided to add lithium (eskalith), which after a few days gave me extreme tremors, nausea, and weakness. So since I'd already tried Neurontin (didn't work), depakote, and Lithium, my pdoc and I decided lamictal would be a good choice as far as something that targets biploars w/dominant depressive features-wow, maybe even as a monotherapy drug! The problem is that he said I'd have to first taper down to a tiny amount of my zoloft before starting lamictal, since the lamictal and zoloft actions would overlap in a bad way. I had been on zoloft for almost a year, and within my first 4 days of taper, I became almost suicidal. So I upped the dose from 50 to 75mg-I couldn't handle the taper. Now I don't know what to do. I've resumed 30mg restoril + 3mg klonopin + 5mg ambien + 3mg melatonin every night. In my opinion, the zoloft/adderall combo has helped my day-to-day symptoms (social phobia, depression) more than anything else I've tried. Yet, it's this overarching, bipolar tendency lurking in the background that leaps upon me sporadically and puts everything out of wack that's the main problem. Obviously the depakote is tolerable but not effective enough. Considering the situation with the lithium and the problems with starting lamictal, I did some research and came upon Trileptal. The APA seems like it's very supportive of the drug for bipolar mania/mixed/maintenance. It has a low side-effect profile (much lower than Tegratol, from which it was derived), no known drug interactions with antidepressants or depakote, no bloodtests required, and is considered by many at least as if not more effective than Tegratol. So, in this way, I can begin it immediately,and stay on zoloft+adderall, with a chance that it would help my bp better than depakote (or maybe use it in conjunction with depakote). Does anyone have any input for me about this idea (which I plan to introduce to my pdoc at tomorrow's session), or any positive experiences on Trileptal?
> Thanks in advance,
> Peter

Peter,

I don't understand why your pdoc won't let you start the Lamictal at the same time with tapering the Zoloft? You need to taper very slowly down on the Zoloft. A 50mg drop is too much. Try dropping to 75mg. I started to taper on my antidepressant after I went up to 25mg of Lamictal twice a day. I was on 100mg of Imipramine and 15mg of Paxil when I started the Lamictal. You have to be very patient also with titrating the Lamictal. This drug has done wonders for my "soft" bipolar. I've been on it since spring. I'm down to 50mg of Imipramine and 7.5mg of Paxil. I'm up to 100mg of Lamictal daily.

Laura


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poster:polarbear206 thread:123769
URL: http://www.dr-bob.org/babble/20021012/msgs/123818.html