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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 40. Go back in thread:
Posted by Doo on March 12, 2001, at 22:35:26
In reply to Neurontin as a mood stabilizer, posted by Chaston on March 12, 2001, at 10:47:29
Hi Chaston,
I take Neurontin 1200mg, in 4 separate doses of 300mg. Like SalArmy4me, I don't believe it is of any use to take it all at once, considering it's short-term effect. Once, I took 2 at a time (I forgot I had taken the first one, and took the second one a couple of minutes later) and I, too, felt... let's say not "stupid" but in a kind of very cloudy mood. So I understand you felt that way in the morning!
Take care,
Doo.
> Has anyone had any success over a period of time using Neurontin as the sole mood stabilizer, in conjunction with an SSRI, to treat recurrent depression and Bipolar II (?? the one with periodic depressions, mild ups exacerbated by anti-depressants)?
> My P-doc put me on Neurontin almost a year ago. It had a calming effect. I ramped up to 1200 mg (all at bedtime, his recommendation), but felt too stupid (literally) in the morning to go up more. I have not had hypomania since then, but my P-doc put me on Depakote last December (now at 1250 mg/day).
> He says that the consensus seems to be that Depakote is better at mood stabilization. Since I would like to eliminate at least one of these drugs, my P-doc is having me taper off the Neurontin. I wondered if I am elimanting the wrong med.
> Thanks for your input!
Posted by Kingfish on March 13, 2001, at 8:03:59
In reply to Neurontin as a mood stabilizer, posted by Chaston on March 12, 2001, at 10:47:29
Hi! I'm currently adding Neurontin to my "mix" to see how it works. I had used it last year with just Celexa and had not noticed much effect, but it now "seems" to be helping quite a bit. I am taking the following:
Celexa: 40mg
Topamax (another mood stabilizer): 50 mg
Neurontin: 1800 mg (600 mg, 3x a day)I am BPII. The topamax is what really seemed to work for me but I could not tolerate it above 75 mg because of the sedation. For some reason, Neurontin does not have the affect on me.
Hope this helps.
Good luck.
Posted by vince on March 13, 2001, at 11:12:28
In reply to Neurontin as a mood stabilizer, posted by Chaston on March 12, 2001, at 10:47:29
> Has anyone had any success over a period of time using Neurontin as the sole mood stabilizer, in conjunction with an SSRI, to treat recurrent depression and Bipolar II (?? the one with periodic depressions, mild ups exacerbated by anti-depressants)?
> My P-doc put me on Neurontin almost a year ago. It had a calming effect. I ramped up to 1200 mg (all at bedtime, his recommendation), but felt too stupid (literally) in the morning to go up more. I have not had hypomania since then, but my P-doc put me on Depakote last December (now at 1250 mg/day).
> He says that the consensus seems to be that Depakote is better at mood stabilization. Since I would like to eliminate at least one of these drugs, my P-doc is having me taper off the Neurontin. I wondered if I am elimanting the wrong med.
> Thanks for your input!Chaston,
There is a neurontin thread here where it is claimed that the body cannot metabolize more than 600mg of neurontin at one time.http://www.dr-bob.org/babble/20010111/msgs/51776.html
Also, the half life of neurontin is very short, as SalArmy4me points out.
So, since you have done well with neurontin, maybe you should try deviding the single nightime dose into three or four smaller doses through out the day before you decide to discontinue it.
Vince
Posted by allisonm on March 13, 2001, at 17:52:15
In reply to Re: Neurontin as a mood stabilizer, posted by vince on March 13, 2001, at 11:12:28
> > There is a neurontin thread here where it is claimed that the body cannot metabolize more than 600mg of neurontin at one time.< <
>From what I have read from a pdf file on Neurontin supplied by Parke-Davis < http://www.pfizer.com/hml/pi%27s/neurontinpi.pdf > bioavailability is not dose proportional but when you get up to 300-600mg t.i.d., there isn't a lot of decrease in bioavailability -- it is about 60%. If the body could only process 600mg at a time and bioavailability decreases markedly in higher doses (which they don't say it does, nor do they say that it doesn't), then I wonder why they make and why I am taking 800mg tablets.
Posted by Chaston on March 15, 2001, at 8:33:41
In reply to Re: Neurontin as a mood stabilizer, posted by allisonm on March 13, 2001, at 17:52:15
First, **thanks** to everyone who has contributed to this thread for all of the helpful information on Neurontin. There are some bright, well-informed, and helpful, people here! It appears that many people, including some docs, are not well informed about the newer uses for this med (I'm certainly not). If I continue using it in the future, it will be in more divided doses.
I too wonder why they make the 800's, when 600 tid seems to be the max you can use. The stuff is really expensive, too (in all strengths--the cost per mg drops a little but not drastically in higher strengths), so maybe this is part of Pfizer/Parke-Davis's marketing strategy.
My personal experience with 1200-1600 mg at bedtime, and ocassional use during the day, has been:
1) helps with sleep
2) reduces anxiety
3) reduces iritability and emotional reactiveness
(sensitivity), but did not prevent depression after I tapered off Celexa last November.It seems to put a dampening layer between me and the world that can be beneficial and calming. It is very different from benzos, though--no sense of well-being or goofiness, just insulation and less reactivity. At higher doses, I literally felt "stupid"--not unpleasant, but just slow-witted and unresponsive to external stimuli. Overall, though, I agree that its side-effect profile is unusually benign.
I am not convinced, though, that it is the right drug for me to use as a long-term mood stabilizer, which is why I am tapering down. For me, it might be better used on an as-needed basis to deal with anxiety.
Interestingly, I have noticed that after reducing the dosage to 800 mg at bedtime, in addition to an increase in anxiety (temporary rebound, I hope), I had a heightened sense of smell.
> > > There is a neurontin thread here where it is claimed that the body cannot metabolize more than 600mg of neurontin at one time.< <
> >
>
> From what I have read from a pdf file on Neurontin supplied by Parke-Davis < http://www.pfizer.com/hml/pi%27s/neurontinpi.pdf > bioavailability is not dose proportional but when you get up to 300-600mg t.i.d., there isn't a lot of decrease in bioavailability -- it is about 60%. If the body could only process 600mg at a time and bioavailability decreases markedly in higher doses (which they don't say it does, nor do they say that it doesn't), then I wonder why they make and why I am taking 800mg tablets.
Posted by Wendy B. on October 17, 2001, at 10:46:01
In reply to Neurontin as a mood stabilizer, posted by Chaston on March 12, 2001, at 10:47:29
Hello:
Bringing back a thread from March '01...
My scrip for neurontin has been upped to 4200 mg or more, because of an apparent incident of hypomania last week. This was exacerbated by several nights of very little sleep.
When first prescribed, I was on 2400 mg (four X 600 mg spaced evenly through the day). I asked for a reduction of the amount (I felt better, I wasn't able to remember dreams, which I wanted to work on in therapy...), and with the pdoc's permission, went down to about 1800.
At the same time, I was becoming less compliant with the dosing, since you have to take so many pills through the day. I would go out of the house and not remember to take the pills with me, etc. So, the pdoc thinks the reduction in dose was a mistake, because of the hypomanic incident I mentioned.
I asked the pdoc if I needed a bigger gun, such as depakote or lithium, and she was adamant that if I upped the dose to 4200 or more, the neurontin would take care of the cycling. It seems she is very reluctant to add something like topamax as an adjunct mood stabilizer...
My dx is Bipolar I (one manic episode), and I suffer from typical bipolar symptoms, such as hypomania, anger and irritability, and depression. After the single episode, I went down, into a major depression.
Adjunct AD is Wellbutrin, to keep me from going down, 300 mg per day (I take 2 in am, 1 in early evening). The pdoc says it is the best anti-depressant for someone like me, because it doesn't produce mania for the bipolar sufferer. So far, after about 10 months of use, it has been working. I do get depressed, but the episodes last hours, not days.
My main questions are:
** What is the max dose of neurontin anyone is taking out there in babble-land?
** Are you taking neurontin as sole mood-stabilizer?** If not, what are your adjunct meds?
** What will I feel like on 4200 mg per day? I may have to go up higher than that. Already on 3600, I'm feeling woozy, a little removed, a little tired, non-reactive, calm.
** Would anyone recommend depakote or lithium over the constant pill-popping on the neurontin? (It looks like I'm going to have to get a new watch that I can set to beep an alarm every 3 hours...)
Anybody with info, or responses, or ideas?? I would appreciate hearing about anyone's experience with this topic...Thank you very much for input, in advance,
Wendy
> Has anyone had any success over a period of time using Neurontin as the sole mood stabilizer, in conjunction with an SSRI, to treat recurrent depression and Bipolar II (?? the one with periodic depressions, mild ups exacerbated by anti-depressants)?
> My P-doc put me on Neurontin almost a year ago. It had a calming effect. I ramped up to 1200 mg (all at bedtime, his recommendation), but felt too stupid (literally) in the morning to go up more. I have not had hypomania since then, but my P-doc put me on Depakote last December (now at 1250 mg/day).
> He says that the consensus seems to be that Depakote is better at mood stabilization. Since I would like to eliminate at least one of these drugs, my P-doc is having me taper off the Neurontin. I wondered if I am elimanting the wrong med.
> Thanks for your input!
Posted by Mitch on October 17, 2001, at 11:43:17
In reply to Re: Neurontin as a mood stabilizer-max. dose? » Chaston, posted by Wendy B. on October 17, 2001, at 10:46:01
> ** Would anyone recommend depakote or lithium over the constant pill-popping on the neurontin? (It looks like I'm going to have to get a new watch that I can set to beep an alarm every 3 hours...)
> Anybody with info, or responses, or ideas?? I would appreciate hearing about anyone's experience with this topic...
>
> Thank you very much for input, in advance,
>
> WendyHi Wendy,
I don't know if any of my experience is that applicable: I am BPII rapid cycling with atypical depression, etc. However, I have got a couple of ideas. I am on Neurontin as a sole mood stabilizer at just 400mg/day. The highest I went to was 1800mg/day. I understand what you mean about having to cart meds around with you all the time. I have found either Depakote or Lithium works well as an adjunct to the Neurontin. I don't understand why your pdoc doesn't want to allow the Depakote (i.e.) to be added on(?) Especially if it makes it easier for you to comply with your Neurontin dosage regimen (say 2x or 3x a day instead of 4+!) FWIW, I responded well in the past to 900mg Neurontin + 500mg Depakote per day in that ratio.
Mitch
Posted by Wendy B. on October 17, 2001, at 23:22:40
In reply to Re: Neurontin as a mood stabilizer-max. dose? » Wendy B., posted by Mitch on October 17, 2001, at 11:43:17
> > ** Would anyone recommend depakote or lithium over the constant pill-popping on the neurontin? (It looks like I'm going to have to get a new watch that I can set to beep an alarm every 3 hours...)
> > Anybody with info, or responses, or ideas?? I would appreciate hearing about anyone's experience with this topic...
> >
> > Thank you very much for input, in advance,
> >
> > Wendy
>
> Hi Wendy,
>
> I don't know if any of my experience is that applicable: I am BPII rapid cycling with atypical depression, etc. However, I have got a couple of ideas. I am on Neurontin as a sole mood stabilizer at just 400mg/day. The highest I went to was 1800mg/day. I understand what you mean about having to cart meds around with you all the time. I have found either Depakote or Lithium works well as an adjunct to the Neurontin. I don't understand why your pdoc doesn't want to allow the Depakote (i.e.) to be added on(?) Especially if it makes it easier for you to comply with your Neurontin dosage regimen (say 2x or 3x a day instead of 4+!) FWIW, I responded well in the past to 900mg Neurontin + 500mg Depakote per day in that ratio.
>
> Mitch
Thank you for responding, Mitch:I will keep on doing what the pdoc says, I guess, for a while. I wonder if she has ever popped 7 pills a day of the same med... Having to do it every 3 hours, means I took it today at 7am, 10am, 1pm, 4pm, 7pm, 10 pm, and I'll take 1 more at bedtime. God, it's weird. It may even have to be upped from the 4200.
I really feel like an invalid, sort of connected to this drug like it should be hooked up in an IV in a pouch on my hip! I wonder if the pdoc wants me to feel this? Like, it's part of the therapy, to admit that I *am* limited in what I can do? Or that I am really sick. (The pdoc is also the therapist).
I don't know, I feel so frustrated I want to cry. I envy you, that you only ever had to take it 2 or 3 times a day. I thought the pdoc would give me a positive response when I asked about depakote or Li. I hear Li isn't as hard on the body as it's made out to be. I take it you were never on it, Mitch?
I suppose she doesn't want me to have to suffer from the depakote side-effects, or the lithium blood tests... What else would it be? I have an appointment Friday, so I'll be sure to ask. I'm afraid I'm going to get angry with her.
I also wonder why Parke-Davis doesn't figure out how to pack an extended release into 1 or 2 pills a day. It makes me upset, why don't they care what the patient is going through?
Arrgh. You are a sweetie to talk to me about this. I hope others respond, too, so I can bounce some ideas off them, too, get the reality check.
Many many thanks,
Wendy
Posted by Mitch on October 17, 2001, at 23:59:42
In reply to Re: Neurontin as a mood stabilizer-max. dose? » Mitch, posted by Wendy B. on October 17, 2001, at 23:22:40
> > > ** Would anyone recommend depakote or lithium over the constant pill-popping on the neurontin? (It looks like I'm going to have to get a new watch that I can set to beep an alarm every 3 hours...)
> > > Anybody with info, or responses, or ideas?? I would appreciate hearing about anyone's experience with this topic...
> > >
> > > Thank you very much for input, in advance,
> > >
> > > Wendy
> >
> > Hi Wendy,
> >
> > I don't know if any of my experience is that applicable: I am BPII rapid cycling with atypical depression, etc. However, I have got a couple of ideas. I am on Neurontin as a sole mood stabilizer at just 400mg/day. The highest I went to was 1800mg/day. I understand what you mean about having to cart meds around with you all the time. I have found either Depakote or Lithium works well as an adjunct to the Neurontin. I don't understand why your pdoc doesn't want to allow the Depakote (i.e.) to be added on(?) Especially if it makes it easier for you to comply with your Neurontin dosage regimen (say 2x or 3x a day instead of 4+!) FWIW, I responded well in the past to 900mg Neurontin + 500mg Depakote per day in that ratio.
> >
> > Mitch
>
>
> Thank you for responding, Mitch:
>
> I will keep on doing what the pdoc says, I guess, for a while. I wonder if she has ever popped 7 pills a day of the same med... Having to do it every 3 hours, means I took it today at 7am, 10am, 1pm, 4pm, 7pm, 10 pm, and I'll take 1 more at bedtime. God, it's weird. It may even have to be upped from the 4200.
>Wendy, that is just absurd to be expected to maintain that type of drug regimen! Most statistical studies on med compliance that have ever been done show at BEST 75% compliance with taking medications twice daily! And that percentage falls off rapidly with increased dosage timings. Geez, you are a human being not a lab rat!
> I really feel like an invalid, sort of connected to this drug like it should be hooked up in an IV in a pouch on my hip! I wonder if the pdoc wants me to feel this? Like, it's part of the therapy, to admit that I *am* limited in what I can do? Or that I am really sick. (The pdoc is also the therapist).
>
> I don't know, I feel so frustrated I want to cry. I envy you, that you only ever had to take it 2 or 3 times a day. I thought the pdoc would give me a positive response when I asked about depakote or Li. I hear Li isn't as hard on the body as it's made out to be. I take it you were never on it, Mitch?Oh, no I have been all sorts of mood stabilizers over decades including Lithium for probably 18 years or so. When I was in my mid-twenties I had my lithium dose pushed to 1800mg/day in combination with 150mg of Sinequan, 25mg of Thorazine, and 10mg of Valium every day!
>
> I suppose she doesn't want me to have to suffer from the depakote side-effects, or the lithium blood tests... What else would it be? I have an appointment Friday, so I'll be sure to ask. I'm afraid I'm going to get angry with her.Well, one thing you have to think about is have I taken this med before? If not, then you don't know if you are going to suffer all those horrible things, right?
>
> I also wonder why Parke-Davis doesn't figure out how to pack an extended release into 1 or 2 pills a day. It makes me upset, why don't they care what the patient is going through?I understand they are working on a refined version of gabapentin (pregabilin) which may be able to be taken less frequently, etc.
>
> Arrgh. You are a sweetie to talk to me about this. I hope others respond, too, so I can bounce some ideas off them, too, get the reality check.
>
> Many many thanks,
>
> WendyNo problem, there are MANY others here that can tell you that Neurontin doesn't work that well by itself for most people as a mood stabilizer. Also, there reaches a dose level in some where Neurontin can either quit working or it begins to *lose* some of its effectiveness (a therapeutic "window" of sorts-if you will). In fact I felt I needed to take 125mg of Depakote today with my Neurontin because I can tell I am getting too high and agitated.
I would just tell your pdoc something like this: 1) The frequency of the dosing is too strenuous to comply with (Neurontin).
2) I need an adjunct to it that will allow me to take the Neurontin a *reasonable* number of times during the day.hope this helps,
Mitch
Posted by Wendy B. on October 19, 2001, at 9:37:57
In reply to Re: Neurontin as a mood stabilizer-max. dose? » Wendy B., posted by Mitch on October 17, 2001, at 23:59:42
(comments interspersed...)
> > Hi Wendy,
> > >
> > > I don't know if any of my experience is that applicable: I am BPII rapid cycling with atypical depression, etc. However, I have got a couple of ideas. I am on Neurontin as a sole mood stabilizer at just 400mg/day. The highest I went to was 1800mg/day. I understand what you mean about having to cart meds around with you all the time. I have found either Depakote or Lithium works well as an adjunct to the Neurontin. I don't understand why your pdoc doesn't want to allow the Depakote (i.e.) to be added on(?) Especially if it makes it easier for you to comply with your Neurontin dosage regimen (say 2x or 3x a day instead of 4+!) FWIW, I responded well in the past to 900mg Neurontin + 500mg Depakote per day in that ratio.
> > >
> > > Mitch
> >
> >
> > Thank you for responding, Mitch:
> >
> > I will keep on doing what the pdoc says, I guess, for a while. I wonder if she has ever popped 7 pills a day of the same med... Having to do it every 3 hours, means I took it today at 7am, 10am, 1pm, 4pm, 7pm, 10 pm, and I'll take 1 more at bedtime. God, it's weird. It may even have to be upped from the 4200.
> >
>
> Wendy, that is just absurd to be expected to maintain that type of drug regimen! Most statistical studies on med compliance that have ever been done show at BEST 75% compliance with taking medications twice daily! And that percentage falls off rapidly with increased dosage timings. Geez, you are a human being not a lab rat!
Thank you! I *have* been feeling that way. The first day, Wed., that I was on the 4200 dose, I was all woozy and couldn't concentrate. Even yesterday, I was driving on a normal route I take out to the place I work, out of town a ways, and I kept thinking I didn't know where I was, like I'd never even driven on that road, quite disorienting. But the dizzy feeling was gone yesterday, and I still felt 'up' like a few days before.
> > I really feel like an invalid, sort of connected to this drug like it should be hooked up in an IV in a pouch on my hip! I wonder if the pdoc wants me to feel this? Like, it's part of the therapy, to admit that I *am* limited in what I can do? Or that I am really sick. (The pdoc is also the therapist).
> >
> > I don't know, I feel so frustrated I want to cry. I envy you, that you only ever had to take it 2 or 3 times a day. I thought the pdoc would give me a positive response when I asked about depakote or Li. I hear Li isn't as hard on the body as it's made out to be. I take it you were never on it, Mitch?
>
> Oh, no I have been all sorts of mood stabilizers over decades including Lithium for probably 18 years or so. When I was in my mid-twenties I had my lithium dose pushed to 1800mg/day in combination with 150mg of Sinequan, 25mg of Thorazine, and 10mg of Valium every day!
Wow, that sounds like a cocktail! what condition was it for? I know about the other drugs, but haven't ever heard of Sinequan. You don't have to talk about it if you don't want to...
Also, another personal question you can ignore if you want: how old are you now?
> > I suppose she doesn't want me to have to suffer from the depakote side-effects, or the lithium blood tests... What else would it be? I have an appointment Friday, so I'll be sure to ask. I'm afraid I'm going to get angry with her.
>
> Well, one thing you have to think about is have I taken this med before? If not, then you don't know if you are going to suffer all those horrible things, right?
Well, that makes a lot of good sense. I will say that to her.> > I also wonder why Parke-Davis doesn't figure out how to pack an extended release into 1 or 2 pills a day. It makes me upset, why don't they care what the patient is going through?
>
> I understand they are working on a refined version of gabapentin (pregabilin) which may be able to be taken less frequently, etc.
Any links I should know about? I'd like to read about it.
> > Arrgh. You are a sweetie to talk to me about this. I hope others respond, too, so I can bounce some ideas off them, too, get the reality check.
> No problem, there are MANY others here that can tell you that Neurontin doesn't work that well by itself for most people as a mood stabilizer. Also, there reaches a dose level in some where Neurontin can either quit working or it begins to *lose* some of its effectiveness (a therapeutic "window" of sorts-if you will). In fact I felt I needed to take 125mg of Depakote today with my Neurontin because I can tell I am getting too high and agitated.
How will I be able to tell if the neurontin is working at the higher dose? or if I've reached the therapeutic window? Do you think keeping a journal would help?
> I would just tell your pdoc something like this: 1) The frequency of the dosing is too strenuous to comply with (Neurontin).Amen.
> 2) I need an adjunct to it that will allow me to take the Neurontin a *reasonable* number of times during the day.
She can be quite stubborn, but, then again so can I. :-]
So I go today at 3:00. I'll rush home right after, and write back, if you don't mind. I hope it's ok to lean on you for the reality-check, Mitch. You've been a peach.
> hope this helps,
I has helped, very much.
> MitchWendy
Posted by Mitch on October 19, 2001, at 22:07:13
In reply to Re: Neurontin as a mood stabilizer-max. dose? » Mitch, posted by Wendy B. on October 19, 2001, at 9:37:57
Wendy,
The med combo I mentioned is one from 20 years ago for bipolar (I am 41). The pregabalin is supposed to be a more *refined* version of Neurontin. It is in several clinical trials right now for bipolar, anxiety disorders, and chronic pain, etc. I don't think it will be available in the US to be prescribed for at least several months if not a year or so. I don't have any "web-sites" available to help you with (perhaps someone else can help?). You probably won't be able to "tell" whether or not the Neurontin "quits" working at a very high dose-from what my pdoc says it is really more like the "dose-response" curve flattens out. That is, as you increase the dose above a certain level the benefits you get tend to diminish. So, the idea here is basically find the highest dose that clearly helps and don't bother trying to take more if it you really can't tell if it is helping any more or not.
Mitch
Posted by Wendy B. on October 19, 2001, at 22:22:21
In reply to Re: Neurontin as a mood stabilizer-max. dose? » Wendy B., posted by Mitch on October 17, 2001, at 23:59:42
Hi Mitch,
I went to therapy today, we had a good talk. She understands my need to not feel like a lab rat. Of course, as a good therapist, she wants me to feel the opposite - well enough, *because* of the meds, that I will go out into the world now with a little more bravery. Since last spring's major manic/depressive episode I have been a little reclusive, underachieving as usual, don't have a good, secure job. My bills pile up and I can't pay them. I dread it, but I have to bring up the issue of appropriate child support money with my ex-husband, and I'm avoiding filling out the paperwork on it. I can't seem to even fill out the insurance papers to get my refund back for therapy sessions. The therp said she'd help me out with that. She is out-of-network, so it's partly her job to do this. Anyway, the point is, I feel limited and insecure...
About the 4200 mg dose: I think we're doing a little dance around a 'Who's-In-Control-of-the-Meds' situation. I told her what the last few days have been like: just reciting the number of times I've had to dose the Neurontin per day is exhausting: 7am, 10am, 1pm, 4pm, 7pm, 10pm, & 1 at bedtime. She did wince a little when I performed this recitation.
I made a 'freudian' slip at one point during the session, and called the Neurontin 'lithium.' She smiled and said she'd been thinking about lithium for me. I had mentioned it to her Monday night after group, I reminded her. She just told me that I would have to have blood levels taken on a regular basis on lithium. I asked her if/when my dose stabilized, couldn't the blood tests eventually stop? And she was adamant that blood levels would have to be taken regularly, the entire time I might be on lithium. So I guess if I feel like an invalid now with the pill-popping, I might feel just as much, or more, of one when going in for tests and blood-letting. She said it's expensive, and it's a pain in the ass.
We didn't talk about depakote or about using it as adjunct to the Neurontin, I'll mention it next week.
Thanks again for listening, Mitch.
Wendy
Posted by Mitch on October 20, 2001, at 11:05:59
In reply to Re: Neurontin -max. dose? -- update » Mitch, posted by Wendy B. on October 19, 2001, at 22:22:21
> I made a 'freudian' slip at one point during the session, and called the Neurontin 'lithium.' She smiled and said she'd been thinking about lithium for me. I had mentioned it to her Monday night after group, I reminded her. She just told me that I would have to have blood levels taken on a regular basis on lithium. I asked her if/when my dose stabilized, couldn't the blood tests eventually stop? And she was adamant that blood levels would have to be taken regularly, the entire time I might be on lithium. So I guess if I feel like an invalid now with the pill-popping, I might feel just as much, or more, of one when going in for tests and blood-letting. She said it's expensive, and it's a pain in the ass.
>
> We didn't talk about depakote or about using it as adjunct to the Neurontin, I'll mention it next week.
>
> Thanks again for listening, Mitch.
>
> WendyWendy,
I would ask about adding Depakote (and then reduction of Neurontin to a 3x daily dosage!) before the lithium. Lithium has to be monitored because of its potential toxicity (the therapeutic doses for many people get close to toxic ones). My pdoc doesn't want to use it because of that reason. The blood tests (lithium levels) are important when treatment is being initiated and after dosage changes, but beyond that I think it is basically CYA for the pdoc. The symptoms of lithium toxicity are fairly easy to recognize.
Mitch
Posted by Wendy B. on October 21, 2001, at 8:20:44
In reply to Re: Neurontin -max. dose? -- update » Wendy B., posted by Mitch on October 20, 2001, at 11:05:59
> Wendy,
>
> I would ask about adding Depakote (and then reduction of Neurontin to a 3x daily dosage!) before the lithium. Lithium has to be monitored because of its potential toxicity (the therapeutic doses for many people get close to toxic ones). My pdoc doesn't want to use it because of that reason. The blood tests (lithium levels) are important when treatment is being initiated and after dosage changes, but beyond that I think it is basically CYA for the pdoc. The symptoms of lithium toxicity are fairly easy to recognize.
>
> Mitch
I will arm myself with more info on the depakote, then, before I see her next week. I don't know much about it, except the horror stories about hair loss...Will update you then, and thank you!
Wendy
Posted by susan C on October 21, 2001, at 11:13:51
In reply to Re: Neurontin -max. dose with depakote » Mitch, posted by Wendy B. on October 21, 2001, at 8:20:44
Hi Wendy and Mitch,
Ah, here we are again, Mitch, crossing paths...you can see my up date on Keppra soon, still wozzy this am, just to let you know I am reading and will post something about depakote/neurton
Regards from a wozzy mouze
susan C
Posted by Krazy Kat on October 21, 2001, at 12:15:14
In reply to Re: Neurontin -max. dose with depakote, posted by susan C on October 21, 2001, at 11:13:51
> Hi Wendy and Mitch and Susan:
>
Sorry, I didn't see this post until today.Mitch, your comments are always So helpful!
Wendy, I started with Neurontin alone and it didn't do much for me. It was a little calming at first, but didn't really help until Topamax was added. Then I could tell a difference if I didn't take a Neurontin dose.
Topamax has been too sedating so now I'm taking Depakote which has helped me quite a bit. Hadn't thought about keeping the Neurontin up - might be helpful. The Depakote really is stronger for me.
No hair loss, no weight gain yet. But it feels more like a heavy med - Neurontin is so gentle (at least it was for me).
I am having a difficult time coming to terms with being dependent on meds right now, myself. Going in for lab tests. Worrying about side effects. But I know I have to at some point... The mania sneaks back in, so does the depression. It's not going to go away.
I could never take the doses of Neurontin you're being asked to take - it's just ludicrous. MHO.
Is any other info helpful?
- K.
P.S. I was wondering if Lithium or Depakote was the better choice re: side effects - from what Mitch says, it sounds like Depakote.
Posted by Mitch on October 21, 2001, at 15:27:04
In reply to Re: Neurontin -max. dose with depakote, posted by Krazy Kat on October 21, 2001, at 12:15:14
> > Hi Wendy and Mitch and Susan:
> >
> Sorry, I didn't see this post until today.
>
> Mitch, your comments are always So helpful!
>
> Wendy, I started with Neurontin alone and it didn't do much for me. It was a little calming at first, but didn't really help until Topamax was added. Then I could tell a difference if I didn't take a Neurontin dose.
>
> Topamax has been too sedating so now I'm taking Depakote which has helped me quite a bit. Hadn't thought about keeping the Neurontin up - might be helpful. The Depakote really is stronger for me.
>
> No hair loss, no weight gain yet. But it feels more like a heavy med - Neurontin is so gentle (at least it was for me).
>
> I am having a difficult time coming to terms with being dependent on meds right now, myself. Going in for lab tests. Worrying about side effects. But I know I have to at some point... The mania sneaks back in, so does the depression. It's not going to go away.
>
> I could never take the doses of Neurontin you're being asked to take - it's just ludicrous. MHO.
>
> Is any other info helpful?
>
> - K.
>
> P.S. I was wondering if Lithium or Depakote was the better choice re: side effects - from what Mitch says, it sounds like Depakote.
Hi Krazy Kat,As far as Depakote versus Lithium goes that is soooo person specific. My experience has been that Depakote has the edge as far as antimanic effects, however I found lithium to be clearly better for depression. IF I didn't get so much cognitive dulling and diarrhea from the lithium I would prefer it over Depakote. However, some people find Depakote has a good antidepressant effect for them. As far as the hair loss I didn't notice any on Depakote (at 500mg/day). I DID however gain about 20 lbs., but I didn't *continue* to gain the weight (thank God!). All in all I think most people would find Depakote easier to *tolerate*, but many people will get a better positive response to lithium (esp. antidepressant). Also, I found Neurontin to have a clear antidepressant effect. If Depakote was a little more tolerable than lithium and the Neurontin has a mild AD effect, the combo of Depakote/Neurontin might work well for many.
Mitch
Posted by Krazy Kat on October 21, 2001, at 15:57:51
In reply to Re: Neurontin -max. dose with depakote » Krazy Kat , posted by Mitch on October 21, 2001, at 15:27:04
Posted by susan C on October 21, 2001, at 20:01:43
In reply to Re: Neurontin -max. dose? -- update » Mitch, posted by Wendy B. on October 19, 2001, at 22:22:21
OHHHHkayyy,
since we are talking aboot all these wonderful meds...I would like your opinions on these questions...
Why I didnt try neurotin (pdoc said, we had already tried big guns, so 'gentle' med like neurotin wouldn't help)?
Depakote (1000mg) works a little, if I add lithium or neurontin or both, which one first, how much...which second?
I took lithium a long time ago and it didn't really help much, but that was by itself and it upset my stomach......what if all three were together?
Mulling Mouse
susan C
Posted by Mitch on October 21, 2001, at 23:39:52
In reply to Neurontin+Depakote+lithium+Mitch and anyone else, posted by susan C on October 21, 2001, at 20:01:43
> OHHHHkayyy,
>
> since we are talking aboot all these wonderful meds...I would like your opinions on these questions...
>
> Why I didnt try neurotin (pdoc said, we had already tried big guns, so 'gentle' med like neurotin wouldn't help)?
>
> Depakote (1000mg) works a little, if I add lithium or neurontin or both, which one first, how much...which second?
>
> I took lithium a long time ago and it didn't really help much, but that was by itself and it upset my stomach......what if all three were together?
>
> Mulling Mouse
> susan CHi Susan,
I think you should try adding the Neurontin. I once saw a pdoc a few years ago that didn't like *retrials* of stuff that you either got no response to or got bad side effects (that was readily attributable to the med in queston). I was skeptical at the time thinking that different combos could turn up different results (sudden tolerability of the previous med or sudden unexpected efficacy in combo with something new). Well.... I am inclined to agree with him (not entirely, but much more so now)after all the crap I have been through over the past several years. So, I suggest adding the Neurontin to your Depakote (because you haven't tried it yet!). I think it would be reasonable to add the NEW med BEFORE you consider retrial in combination of a previous agent that produced either a partial response and/or nasty side effects. I would like to find some form of closure to this circus myself and I have been somewhat dissapointed with retrials of agents.
Mitch
Posted by Wendy B. on October 22, 2001, at 15:59:13
In reply to Re: Neurontin+Depakote+lithium+Mitch and anyone else » susan C, posted by Mitch on October 21, 2001, at 23:39:52
> > OHHHHkayyy,
> >
> > since we are talking aboot all these wonderful meds...I would like your opinions on these questions...
> >
> > Why I didnt try neurotin (pdoc said, we had already tried big guns, so 'gentle' med like neurotin wouldn't help)?
> >
> > Depakote (1000mg) works a little, if I add lithium or neurontin or both, which one first, how much...which second?
> >
> > I took lithium a long time ago and it didn't really help much, but that was by itself and it upset my stomach......what if all three were together?
> >
> > Mulling Mouse
> > susan C
>
> Hi Susan,
>
> I think you should try adding the Neurontin. I once saw a pdoc a few years ago that didn't like *retrials* of stuff that you either got no response to or got bad side effects (that was readily attributable to the med in queston). I was skeptical at the time thinking that different combos could turn up different results (sudden tolerability of the previous med or sudden unexpected efficacy in combo with something new). Well.... I am inclined to agree with him (not entirely, but much more so now)after all the crap I have been through over the past several years. So, I suggest adding the Neurontin to your Depakote (because you haven't tried it yet!). I think it would be reasonable to add the NEW med BEFORE you consider retrial in combination of a previous agent that produced either a partial response and/or nasty side effects. I would like to find some form of closure to this circus myself and I have been somewhat dissapointed with retrials of agents.
>
> Mitch
Arrrgghhh. Mitch, I know what you mean about the circus aspect of all this. I feel the lab rat thing happening... as if I'm slowly poisoning myself to death, just so the therapist can make a point. Not good...I am so NOT INTO doing this neurontin regimen. I am taking 600 mg every 3 hours. My therp/pdoc says: tell the schoolchildren that you're on medicine for a mental illness and educate them about the issue, don't hide in the closet when you have to dose at 10:00 and 1:00 while you're teaching... Is this a reasonable answer to my question: how do I do this while teaching? I mean, what if it gets to the principal? Then I won't get called to substitute, I don't have a union position like the tenured teachers...
Thank you Kelly (KK) and Susan, as always. Mitch has been exceedingly kind.
Kelly, can you read the other posts above, and give me a response to the therp? She has been great, but won't budge on the neurontin thing, upping the dose as much as possible to eliminate the hypomanic episodes... When I told her I was doing 4200 mgs, even she raised her eyebrows, like 'that's a lot,' but she asked me to do this... I don't know what to do, I've been on the higher dose (raised from 2400 mg per day) for a week now. Today I've felt the cognitive dulling that Mitch mentions, and also some apathy. I just feel >blechy< , slept 3 hours this morning, could not go in to teach, was too sick. Maybe pre-menstrual stuff, maybe pre-mens PLUS being on so much neurontin. And the fact that I was on my feet all weekend at the winery pouring tastes for customers. I couldn't walk when I got home last night...
But I'm veering from the meds issues. Susan, I would try the neurontin as Mitch suggests. It is so easy to take, in lower doses than the one I'm on anyway. Are you totally off the Keppra withdrawal? I would wait till that's done...
love to all,
Wendy
Posted by sar on October 22, 2001, at 17:35:41
In reply to Re: Neurontin+Depakote+lithium+Mitch and anyone else, posted by Wendy B. on October 22, 2001, at 15:59:13
Wendy,
thanks for tipping me off to this thread.
as far as the lab-rat thing goes...personally, i love taking my pills, i think oh yum yum this is making me better...but i've never had to dose every few hour like you. can you afford consultation with a really hot-shot pdoc?
does neurontin make you tired? it makes me crawl back into bed even after tea every morning.
explaining to students--these are middle schoolers, right? i'd equate that to a 5 year-old asking about where babies come from. they don't want the lurid details, just a simple explanation. i would say to the students (if they even asked) "i take these to maintain my health"--end of subject. i don't think i'd venture to educate middle-schoolers on mental illness in the classroom as a sub. if it was in the textbooks (which it should be, like in health class) fine, but--
i don't have the experience of the other posters, but my pdoc said to me, "Some people go as high as 2400 mg on neurontin"--so nearly double that kinda makes my eyebrows jump up...
love,
sar
Posted by Mitch on October 22, 2001, at 22:59:10
In reply to Re: Neurontin+Depakote+lithium+Mitch and anyone else, posted by Wendy B. on October 22, 2001, at 15:59:13
> I am so NOT INTO doing this neurontin regimen. I am taking 600 mg every 3 hours. My therp/pdoc says: tell the schoolchildren that you're on medicine for a mental illness and educate them about the issue, don't hide in the closet when you have to dose at 10:00 and 1:00 while you're teaching... Is this a reasonable answer to my question: how do I do this while teaching? I mean, what if it gets to the principal? Then I won't get called to substitute, I don't have a union position like the tenured teachers...
Wendy,
I would go and get a 2nd opinion from another psychiatrist. Don't tell your current one this, however-wait till you have had a chance to talk to one or two others first. Just go and do it. I mean, geez, just how *bad* are the "hypomanic episodes" anyways?? Do they significantly interfere with you being able to teach-OR does taking a ton of Neurontin interfere with your day to day activities just as much?? You have got to weigh this all in. If your current pdoc can't see this, then maybe you should be checking out a different one. I am starting to see a pattern based on what you and some others have said about Neurontin. I think it is very useful and *often* needs to be supplemented by other meds to be effective for many people. It seems like pdocs give you some Neurontin and YES, they see some improvement and they think that MORE, MORE, could just do the trick! Monotherapy mecca! Well...I doubt that somehow.
Mitch
Posted by Chloe on October 23, 2001, at 9:44:28
In reply to Re: Neurontin+Depakote+lithium+Mitch and anyone else, posted by Wendy B. on October 22, 2001, at 15:59:13
>I don't know what to do, I've been on the higher dose (raised from 2400 mg per day) for a week now. Today I've felt the cognitive dulling that Mitch mentions, and also some apathy. I just feel >blechy<
Hi Wendy
I just wanted to jump in, because I can relate to some of what you are saying. But not at the doses you are taking, I am extremely med sensitive. I was taking 400 mgs of Neurontin with a dab of Celexa for my depression and cycling. It was absolutely no help with the cycling and irritability. So 600mg of Li was adding. Wow, the Li has a nice AD effect and really smoothed things out. Neurontin alone is useless IMHO!
Things seemed to be fine for a while, but I have had a return of cycling and depression. So pdoc said why not try to get the N up to 600 mgs since that has the least amount of side effects. Well, I did it 100/week and I didn't really have any side effects except added dry skin and sore hair (I really hate that one, it hurts, and I fear I am going to shed all my hair). BUT, after at least 1 week at 600 mgs N, I just started feeling >blechy< . No energy, can't focus, tired all the time, but unable to nap, irritable (I think because I feel so crappy) and just unhappy.So, I am not sure N should be hailed as this side effect free medication. It's powerful in a very subtle way, but not necessary in a good way for emotions. I think if you go beyond your own "therapeutic" window, you can get nasty side effects, that increase emotional INstability.
If I were brave enough to go through the withdrawal and change, I might consider a dab of depakote instead of the N. But I am so tired...I think from the Neurontin!
Anyway, good luck sorting this issue out. I hope you can get a second opinion on this
Chloe
Posted by Krazy Kat on October 24, 2001, at 10:06:04
In reply to Re: Neurontin+Depakote+lithium+Mitch and anyone else, posted by Wendy B. on October 22, 2001, at 15:59:13
Wendy:
Your therp: By all accounts I've seen, Neurontin just doesn't work on its own as a stabilizer. It seems to me your therp. is being a tad condescending, but that's just my opinion. Especially if you are BPI, this just doesn't make sense to me. My pdoc, for what it's worth, considers Neurontin more of an anti-anxiety med.
You're in a different situation b/c you're doing therapy. I'm not. So if you're comfortable with her, it would be difficult to switch.
You may just have to keep insisting, which I know you can do. :) My pdoc has had me on Topamax since last December. It worked well, but was too sedating. I kept telling him that. He just wasn't concerned and didn't see how much that was interferring with my life. It took until August for him to recognize it and switch my, mostly to Depakote, and I kind of had to throw a fit. I shouldn't have put up with it that long.
I think Mitch has the right idea - a second opinion.
Is that what you wanted?
- K., eatin' a bagel and feelin' better today
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