Posted by Ron Hill on December 10, 2003, at 12:00:13
In reply to Re: The Joys of Being Bipolar » Ron Hill, posted by SLS on December 10, 2003, at 9:00:22
My friend Scott,
> Thanks for the info on l-theonine. Great bibliography.
Please post your results if you decide to give it a trial. For me, the effects are subtle but very worthwhile (so far). Might help you, or might not, but probably worth a trial. For the benefit of others reading this post, the correct spelling is l-theanine.
> To start Lamictal at a dosage of 200mg is silly. It violates the instructions printed on the package insert by the manufacturer. Almost anyone would react badly to that.I totally agree with you. However, in defense of my initial pdoc, I think that much less was known about Lamictal dosing for BP patients back in 1997 when he prescribed it to me. I remember him telling me at the time that much higher doses of Lamictal have been used safely in the treatment of epilepsy.
> There are plenty of examples of people titrating Lamictal too rapidly for whom discontinuation followed by reintroduction using the prescribed dosing schedule was successful. I would DEFINITELY consider adding it back to your regimen.
Scott, thanks for giving me your opinion on this matter. I value your informed opinion. As a result, I’m going to bump this option up to a higher level on my “might-try” list. Having said that, however, I have three main reasons for my reluctance to adding Lamictal.
First and foremost, I’m reluctant to take any synthetic medication (I do not consider lithium to be a synthetic medication, but instead, I view it as a naturally occurring mineral). Given my history of leading a relatively normal productive life and then getting my brainchemistry so completely screwed up by allowing a pdoc to convince me to take Ritalin and Paxil (synthetic medications), it is little wonder that I am a little gun shy. Screw me up once, shame on you, Mr. pdoc. Screw me up twice, shame on me for not doing my homework. Further, we quite frankly do not know the long-term health consequences of these synthetic drugs.
Second, I don’t have health insurance, so I would have to pay for the Lamictal out of our family budget. Third, I truly doubt that I can avoid the rash, but only a properly conducted trial will answer this question.
Rigorous exercise served me well as an antidepressant for more than twenty years prior taking p-meds. Now that my brainchemistry has recovered from the insults of previous p-meds, I want to see if I can treat the depressive phase of my disorder using intense exercise (and vitamins/supplements). If I become convinced that a fully ramped up exercise program (in conjunction with a healthy diet, vitamins/supplements, and good lifestyle choices) is not enough to keep the enemy of depression at bay, then I’ll probably try some type of an add-on medication. And, Lamictal is high on the list.
> I haven't been able to come up with the citation I referred to in my previous post. It was very specific in its descripton of Lamictal increasing the time between depressive episodes and lithium extending the period between manic episodes. When used together, the time to relapse into any episode was extended significantly.If I recall correctly, Charles L. Bowden, MD mentioned something about this in his Grand Rounds presentation last spring (Maintenance Treatment of Bipolar Disorders):
http://psychiatry.uchicago.edu/grounds/030303/
> > For me, Depakote... seemed to make my depression worse.
>
> Me too. What dosage did you work up to?I think my initial pdoc made yet another mistake with regard to the methods he used when he switched me from Lamictal to Depakote. He made this switch after I repeatedly complained about the rash problems I was having with Lamictal. Without a wash out period, he switched me directly from 300 mg/day of Lamictal to 1000 mg/day of Depakote. I had rash problems with Depakote and I wonder if the Depakote rash could have been avoided with a Lamictal wash out period. Maybe not, I don’t know. At any rate, I reduced my Depakote dosage down to 500 mg/day to reduce (but not eliminate) the rash.
Scott, perhaps I’ve rambled a bit here. Sometimes typing (and/or talking) out my thoughts can help get things straight in my mind. “Over the lips and through the fingertips, thoughts disentangle themselves”.
I truly hope you find an answer to your treatment resistant depression. I send you my very best wishes my friend.
-- Ron
poster:Ron Hill
thread:287370
URL: http://www.dr-bob.org/babble/20031208/msgs/288388.html