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Re: Lamictal and Pre-emptive Strikes colin wallace

Posted by Ron Hill on February 24, 2003, at 15:10:52

In reply to Lamictal and Pre-emptive Strikes , posted by colin wallace on February 24, 2003, at 13:40:48


Have you read the most recent (Spring 2002) edition of the American Psychiatric Association's "Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)"? If not, here is a link to the document:

May I give you my opinion? If yes, keep reading. If no, STOP HERE!

This is just my two cents and as such it could be completely incorrect. If I were in your situation, I'd leave the Lamictal in place and add a time-release lithium product (e.g.; Lithobid) at a low dose, shooting for a Li blood level of about 0.4 micromol/l (I think Ive got the units correct).

My second choice would be to add-on Trileptal to your existing Lamictal. As you probably know, Trileptal is Tegretol with an extra oxygen molecule tagged on. Trileptal works similarly to Tegretol but with fewer side effects.

As you likely know, using Depakote and Lamictal concurrently can be a little risky because Depakote influences the blood levels of Lamictal and, therefore, the patient can be put at higher risk of rash and/or Steven's Johnson Syndrome.

Once you have enough mood stabilization on board, if you still struggle with depressive episodes, then add-on a MAOI like Parnate, Nadil, or (maybe) Selegiline.

That's my opinion, but you know what they say? Opinions are like butt-holes; everybody has one!

Quick questions: Do you think the nine cans of beer contributed to your current "eternal pessimist" mind set? Could alcohol be destabilizing you? Do you think that your brief sampling of Enada NADH was destabilizing for you?

I care about you as a friend.

-- Ron

> Hi guys,
> I need some innovative ideas here. I have my (BP11 type) depression pretty much under control right now, with Lamictal at 225mg.My experience with Lamictal has surpassed my most optimistic expectations, but its been a bit of a cat n mouse affair all along- excellent results within three months or so and a complete normalizing of mood and temperament. Then, very suddenly the cracks start to appear, and the AD effect just cuts-out.When this happens, I immediately start to relapse into a dysphoric hypomania(angry, bitter, helter-skelter runaway depressive thoughts- reckless actions etc.).
> What cures this very quickly is raising the Lamictal dose by 25mg or so, although this too tends to wane over time. I had hoped(prayed) that I would reach an optimum dose where the mood stabilization and depression would be taken care of- at least for some considerable period of time. This may yet happen. However, my track record and the experiences of others suggest that at some point (possibly sooner than Id anticipated)my underlying illness will finally outpace any viable Lamictal dosage.I say this because I am now forced to rely on an uniformed, overcautious GP. who just wont raise my dose high enough or quickly enough .Im only supposed to be taking 150mg as it is.
> If I start to slide again, Id like to be prepared. I intend to pre-empt this by choosing a suitable mood stabilizer to fortify the Lamictal(I only ever experience dysphoric hypomania-never euphoric, sadly).At that point, Ill also need to aggressively tackle my depression, with a serious AD, where all else has failed.
> My current thoughts are along the lines of Topomax or Carbemazapine for stabilization, with a last attempt at Prozac, before trying. Selegiline or another MAOI as a last resort.A lithium or Valproate re-trial are possibilities although I hated both without an AD first time around).
> If my Lamictal does finally poopout(God forbid), I know Ill very quickly become badly unstable and depressed, and I want to be prepared should it happen.
> Any ideas would be appreciated here, so I can bounce them around with a psych.(assuming I can find/afford one).
> Col. The eternal pessimist.




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