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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 116. Go back in thread:
Posted by SpreadDaALoha on March 16, 2003, at 21:23:20
In reply to Re: Lamictal-I am depressed and it's getting worse, posted by Lawrence S. on March 15, 2003, at 1:06:32
I take 300mg Lamictal (with 4 mg Folic Acid) and 1500mg of Keppra [The Keppra at night and the Lamictal twice per day]. I have had no rash issues.
My "diagnosis" is Bipolar II (primary challenges are irritability (with infrequent irrational outbursts), racing thoughts, depression, and social anxiety). [By the way, I often wonder if I have ADD+irritable depression+social anxiety instead of Bipolar II, but I am not an expert]
On these meds (Keppra and Lamictal) my irritability and racing thoughts seem to have decreased, and my mood seems to be a bit better. However, I feel slightly lethargic and unmotivated, but this is better than extreme irritablity. I have only been on these meds since maybe November or so.
[I had a short stint on 50mg Topamax, but I quit because it made me WAY tired and sad which is funny because I hear it helps some depressed people (good things were substantial decrease in irritability and some weight loss). Also used to take 400mg Neurontin 3x per day (I didn't like the short half life) which helped with social anxiety and made me less irritable...but my doc took me off it and I sort of miss the way it helped my social anxiety--he says he doesnt like what it does to gaba molecule or something similar to what alcohol does]
So any comments on my experiences would be cool. The Keppra/Lamictal seems to be sustaining me (lower irritablity/racing thoughts), but I wish I was less depressed. My doctor mentioned the next step being an addition of Selegilene (antidepressant med originally for Parkinsons disease I think). He said he would be cautious about Selegilene increasing my irritability, but he still thinks its the next step depending on his assessment at my next appointment.
Oh I also see a friendly psychologist once a week now (prescribed by my PDoc, which makes me nervous, but I suppose it can't hurt).
:) ???????????????
Posted by wcfrench on March 17, 2003, at 22:30:42
In reply to LAMICTAL/KEPPRA ( Topamax/Neurontin/Selegilene ), posted by SpreadDaALoha on March 16, 2003, at 21:23:20
I started Lamictal about 3 1/2 weeks ago and at first it seemed to be working well. I was able to live in the moment and not get so hung up about everything and overly emotionally obsess on my own ruminating thoughts. I have slowly increased dosage from 50mg/day to 125/day (I have a pretty high tolerance) with no problems but the effect has seem to left me. Do you think it's that I need a higher dose to be effective? I am dx as Bipolar II, and recently (last few days) I have been having mixed states (I think)... basically going between peace and severe anxiety, especially with girls in my life (potential relationships). I hate this. I'll be outgoing and confident one hour, and the next, I'll want to run like a baby because I feel like I am not liked. For God's sake will it stop?
I was on Depakote before Lamictal and it worked well after about a month (500mg 2x/day, from beginning to end) but I had a huge appetite and was still a little apathetic so I decided to try Lamictal for its antidepressing reputation. I have definitely noticed that it's better in this respect (At least initially) but I don't know where it's going now. I'm also on 100mg Zoloft and 100mg Wellbutrin, having come down a couple months ago from 150 Zoloft and 200 Wellbutrin. I use .5mg Klonopin in social situations.
I wasn't drinking much but then I had a week or so when I drank for a few nights, maybe 3-4 beers one night, at the most 5 or 6 one night, and on a couple of other nights like 2 beers. Over a week's time, do you think that would screw up my titration schedule? I have heard this, but I asked my pdoc and he said something along the lines of "alcohol doesn't affect as much the absorption of the medicine in the liver as it does have a depressing effect..".. But wouldn't you notice a depressing effect right away and not throughout the next week? I've heard people say that it [alcohol] can lag or slow your medicine intake and it will feel as if you aren't taking any. What do you all think? Too many possibilities!!! Increase dosage? I need stability. Thanks friends.
Sincerely,
Charlie
Posted by Ritch on March 17, 2003, at 23:25:20
In reply to Lamictal What the hell is going on, posted by wcfrench on March 17, 2003, at 22:30:42
> I started Lamictal about 3 1/2 weeks ago and at first it seemed to be working well. I was able to live in the moment and not get so hung up about everything and overly emotionally obsess on my own ruminating thoughts. I have slowly increased dosage from 50mg/day to 125/day (I have a pretty high tolerance) with no problems but the effect has seem to left me. Do you think it's that I need a higher dose to be effective? I am dx as Bipolar II, and recently (last few days) I have been having mixed states (I think)... basically going between peace and severe anxiety, especially with girls in my life (potential relationships). I hate this. I'll be outgoing and confident one hour, and the next, I'll want to run like a baby because I feel like I am not liked. For God's sake will it stop?
>
> I was on Depakote before Lamictal and it worked well after about a month (500mg 2x/day, from beginning to end) but I had a huge appetite and was still a little apathetic so I decided to try Lamictal for its antidepressing reputation. I have definitely noticed that it's better in this respect (At least initially) but I don't know where it's going now. I'm also on 100mg Zoloft and 100mg Wellbutrin, having come down a couple months ago from 150 Zoloft and 200 Wellbutrin. I use .5mg Klonopin in social situations.
>
> I wasn't drinking much but then I had a week or so when I drank for a few nights, maybe 3-4 beers one night, at the most 5 or 6 one night, and on a couple of other nights like 2 beers. Over a week's time, do you think that would screw up my titration schedule? I have heard this, but I asked my pdoc and he said something along the lines of "alcohol doesn't affect as much the absorption of the medicine in the liver as it does have a depressing effect..".. But wouldn't you notice a depressing effect right away and not throughout the next week? I've heard people say that it [alcohol] can lag or slow your medicine intake and it will feel as if you aren't taking any. What do you all think? Too many possibilities!!! Increase dosage? I need stability. Thanks friends.
>
> Sincerely,
> CharlieHi Charlie, I haven't tried Lamictal yet, but I figured I would respond anyhow because I am wondering if you are having a Depakote withdrawal reaction of sorts. Depakote DOES induce a metabolic slowing syndrome (which is responsible for the weight gain it can cause), and reversing that by discontinuing it might ramp up your energy level a little higher than you might be able to handle all at once. 1G is fairly high for BP-II. From what the others here that have tried Lamictal say it seems that you need to be in the 200-400mg range for bipolar. Given that you are on such higher doses of other meds-you probably aren't med sensitive and that might be the target you need to be aiming for. Hope others jump in with some thoughts---Mitch
Posted by Krissy P on March 17, 2003, at 23:27:09
In reply to Lamictal What the hell is going on, posted by wcfrench on March 17, 2003, at 22:30:42
Hi, I am experiencing this exact same thing:
I started Lamictal about 2 1/2 weeks ago and at first it seemed to be working well too. I was able to live in the moment and not get so hung up about everything and overly emotionally obsess on my own ruminating thoughts, basically going between peace and severe anxiety also with this one guy (a potential relationship).
I agree with your doc when he says "alcohol doesn't affect as much the absorption of the medicine in the liver as it does have a depressing effect.." but I'm not a doc.
>>>>>>But wouldn't you notice a depressing effect right away and not throughout the next week? NOT NECESSARILY.
I know that when I've drank more in the past while on meds, I have felt as if I wasn't taking any, but that was probably the alcohol effects.
Be honest with your doc about the drinking and I hope you wouldn't necassarily increase the dose because you want to drink more. Hang in there and best of luck.
Keep me posted k?!
:-)Kristen
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I have slowly increased dosage from 50mg/day to 125/day (I have a pretty high tolerance) with no problems but the effect has seem to left me. Do you think it's that I need a higher dose to be effective? I am dx as Bipolar II, and recently (last few days) I have been having mixed states (I think)... basically going between peace and severe anxiety, especially with girls in my life (potential relationships). I hate this. I'll be outgoing and confident one hour, and the next, I'll want to run like a baby because I feel like I am not liked. For God's sake will it stop?
>
> I was on Depakote before Lamictal and it worked well after about a month (500mg 2x/day, from beginning to end) but I had a huge appetite and was still a little apathetic so I decided to try Lamictal for its antidepressing reputation. I have definitely noticed that it's better in this respect (At least initially) but I don't know where it's going now. I'm also on 100mg Zoloft and 100mg Wellbutrin, having come down a couple months ago from 150 Zoloft and 200 Wellbutrin. I use .5mg Klonopin in social situations.
>
> I wasn't drinking much but then I had a week or so when I drank for a few nights, maybe 3-4 beers one night, at the most 5 or 6 one night, and on a couple of other nights like 2 beers. Over a week's time, do you think that would screw up my titration schedule? I have heard this, but I asked my pdoc and he said something along the lines of "alcohol doesn't affect as much the absorption of the medicine in the liver as it does have a depressing effect..".. But wouldn't you notice a depressing effect right away and not throughout the next week? I've heard people say that it [alcohol] can lag or slow your medicine intake and it will feel as if you aren't taking any. What do you all think? Too many possibilities!!! Increase dosage? I need stability. Thanks friends.
>
> Sincerely,
> Charlie
Posted by BarbaraCat on March 18, 2003, at 15:33:44
In reply to Lamictal-I am depressed and it's getting worse, posted by Krissy P on March 12, 2003, at 19:20:23
Krissy,
I have to agree with Ron and Maximus here. You are not, I repeat not, on a mood stabilizer. Lamictal is tossed into that category because of it's anti-epileptic profile but it doesn't work well enough if you need something different. I know this well because I've been in a very similar place to you. I'm fine at 50mg lamictal and if I start increasing I get depressed. I'm on a tricyclic after being on all the SSRI's and SNRI's in the book. The only thing that makes everything else tie together and work is lithium. Without lithium, NOTHING works. Lithium alone does not work but it is a necessary part of my brew.I HATE taking it because it's caused my hypothyroid condition to worsen and I'm concerned about kidney problems. But I'm only taking 600mg which seems to be the magic number for me. If you have the kind of bipolar syndrome that responds best to lithium, believe me, nothing else is going to work as well. You'll continue to futz around with this med and that. They'll work for a while and then you'll get in that weird mixed hypomanic depressed place again. I can only say to give lithium a try. For what is does, nothing else does it better. After many off/on attempts I am now a greatful believer that sometimes those old fashioned meds work the best - at least for me. As far as the weight, I now feel so much better (since starting nortriptyline) that I'm inspired to exercise like mad and am getting in better shape than ever.
Posted by Krissy P on March 18, 2003, at 18:34:13
In reply to Lamictil is NOT a mood stabilizer » Krissy P, posted by BarbaraCat on March 18, 2003, at 15:33:44
Wow-ok! I hear you here. I was just told it was a mood stabilizer. But I also have heard the same thing you say here,
Thanks for the clarification.
> Krissy,
> I have to agree with Ron and Maximus here. You are not, I repeat not, on a mood stabilizer. Lamictal is tossed into that category because of it's anti-epileptic profile but it doesn't work well enough if you need something different. I know this well because I've been in a very similar place to you. I'm fine at 50mg lamictal and if I start increasing I get depressed. I'm on a tricyclic after being on all the SSRI's and SNRI's in the book. The only thing that makes everything else tie together and work is lithium. Without lithium, NOTHING works. Lithium alone does not work but it is a necessary part of my brew.
>
> I HATE taking it because it's caused my hypothyroid condition to worsen and I'm concerned about kidney problems. But I'm only taking 600mg which seems to be the magic number for me. If you have the kind of bipolar syndrome that responds best to lithium, believe me, nothing else is going to work as well. You'll continue to futz around with this med and that. They'll work for a while and then you'll get in that weird mixed hypomanic depressed place again. I can only say to give lithium a try. For what is does, nothing else does it better. After many off/on attempts I am now a greatful believer that sometimes those old fashioned meds work the best - at least for me. As far as the weight, I now feel so much better (since starting nortriptyline) that I'm inspired to exercise like mad and am getting in better shape than ever.
Posted by wcfrench on March 19, 2003, at 14:49:39
In reply to Lamictal-Thanks for the clarification » BarbaraCat, posted by Krissy P on March 18, 2003, at 18:34:13
I have taken 150mg Zoloft, 1000 Depakote, 60mg Remeron, 160 Geodon, 600-700 Seroquel... not all at the same time of course. I found the most beneficial dosages to be around those dosages if not slightly lower. It seemed though, that all the increases helped. Should I ask my doc if I should increase past 100mg/2x ? Thanks for your help!
-Charlie
Posted by BarbaraCat on March 19, 2003, at 15:14:17
In reply to Re: Lamictal-What's high dosage??, posted by wcfrench on March 19, 2003, at 14:49:39
I don't know since I can't seem to go past 75mg on lamictal. It causes anxiety and that is my bane. This is unusual since I was at one time on 300mg zoloft, another time on 90mg of Remeron. Each increase helped for a while but then the antidepressant effect wore off and I was left with the body twitches. For me, the breakthrough came when I realized I was Bipolar 2 and no amount of SSRIs was going to work without adding lithium.
Why do you want to increase, are you not getting good antidepressant results from lamictal? I've heard of people going up to 400mg and above, but perhaps you need to add another class of med if you're not quite getting there.
> I have taken 150mg Zoloft, 1000 Depakote, 60mg Remeron, 160 Geodon, 600-700 Seroquel... not all at the same time of course. I found the most beneficial dosages to be around those dosages if not slightly lower. It seemed though, that all the increases helped. Should I ask my doc if I should increase past 100mg/2x ? Thanks for your help!
>
> -Charlie
Posted by SpreadDaALoha on March 19, 2003, at 16:09:35
In reply to Re: Lamictal-What's high dosage??, posted by BarbaraCat on March 19, 2003, at 15:14:17
I'm bipolar II. I take 300mg Lamictal and 1500mg Keppra. My irritability and racing thoughts have basically subsided, and these meds have had a mild/significant antidepressant effect (but not enough for me). My doc was deciding between Remeron and Selegilene--he decided Selegilene. I am starting with 2.5mg every other day, which is a very small dose...I'm to see him in two weeks.
He didn't opt to increase my Lamictal or Keppra (although he thought about increasing my Keppra). I'm hoping the Lamictal/Keppra/Selegilene combination will work for me. I wonder what dosage of Selegilene I will need...
Posted by SpreadDaALoha on March 19, 2003, at 16:14:12
In reply to Re: Lamictal-What's high dosage??, posted by SpreadDaALoha on March 19, 2003, at 16:09:35
Lamictal may not be a mood stabilizer for all, but it is for some. For some it has antidepressant properties. Although it hasn't been shown to work as an anti-manic by itself, studies have shown some mood stabilizing properties (not just antidepressant).
So lamictal aids in mood stabilization for some. I have rarely heard of it causing depression at higher doses. Just wanted to add my two cents...
Posted by BarbaraCat on March 19, 2003, at 16:47:21
In reply to Re: Lamictal-What's high dosage??, posted by SpreadDaALoha on March 19, 2003, at 16:09:35
What is Keppra? Are you in the US? Haven't heard of it here. Selegilene is mainly a dopamine enhancer, very little if any serotonin/NE affect and not generally used for antidepressant qualities. Deciding between it and Remeron is like apples and oranges so I wonder what his thoughts are. Very interesting combination. Have you ever been on lithium? It's been a life saver for me, even with the annoying side effects.
I was on Remeron up to 90mg and it started out great and then pooped in a big way. Nortriptyline has turned out to be the best AD I've been on which shocked the heck out of me, having been on all the newer esoteric stuff.
> I'm bipolar II. I take 300mg Lamictal and 1500mg Keppra. My irritability and racing thoughts have basically subsided, and these meds have had a mild/significant antidepressant effect (but not enough for me). My doc was deciding between Remeron and Selegilene--he decided Selegilene. I am starting with 2.5mg every other day, which is a very small dose...I'm to see him in two weeks.
>
> He didn't opt to increase my Lamictal or Keppra (although he thought about increasing my Keppra). I'm hoping the Lamictal/Keppra/Selegilene combination will work for me. I wonder what dosage of Selegilene I will need...
>
>
Posted by Krissy P on March 19, 2003, at 18:44:56
In reply to Re: Lamictal-What's high dosage?? » SpreadDaALoha, posted by BarbaraCat on March 19, 2003, at 16:47:21
Hi BarbaraCat, would you be willing to share the side effects you have experienced from Lithium? And what your dosage is? Any information would be appreciated.
I am going to talk to my pdoc about starting Lithium, but it seems my depression is worse than my mania.
Hope to hear back, and thanks:-)
Kristen
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Have you ever been on lithium? It's been a life saver for me, even with the annoying side effects.
>
> I was on Remeron up to 90mg and it started out great and then pooped in a big way. Nortriptyline has turned out to be the best AD I've been on which shocked the heck out of me, having been on all the newer esoteric stuff.
>
> > I'm bipolar II. I take 300mg Lamictal and 1500mg Keppra. My irritability and racing thoughts have basically subsided, and these meds have had a mild/significant antidepressant effect (but not enough for me). My doc was deciding between Remeron and Selegilene--he decided Selegilene. I am starting with 2.5mg every other day, which is a very small dose...I'm to see him in two weeks.
> >
> > He didn't opt to increase my Lamictal or Keppra (although he thought about increasing my Keppra). I'm hoping the Lamictal/Keppra/Selegilene combination will work for me. I wonder what dosage of Selegilene I will need...
> >
> >
>
>
Posted by SpreadDaALoha on March 19, 2003, at 18:45:10
In reply to Re: Lamictal-What's high dosage?? » SpreadDaALoha, posted by BarbaraCat on March 19, 2003, at 16:47:21
I am in Honolulu. Keppra is a newer anti-epileptic. There are NO studies that show it effective as far as I know. Some Pdocs are using it for bipolar as mood stabilizer and mood enhancer (maybe other things like sleep-not sure). So like Neurontin, soon they will figure out if it does any good or not. My Pdoc is pretty assured that it works. I think it is a good mood stabilizer...Keppra and Lamictal work for me...time will tell.
Hmmmm...I wonder if that tricyclic you mentioned would work for me. My Pdoc seems very smart and I think he really studies all the latest information. He knows I had problems with Wellbutrin (dopamine issues I suppose) and I liked Zoloft but after I started Wellbutrin I quit both (maybe Zoloft didn't poop out and the Wellbutrin is what messed me up--I got very aggressive). He knows Selegilene's effect on dopamine and other things (and knows how Wellbutrin affected me) so he must know what he is doing. I think he thinks it is a healthier drug than SSRI's or Tricylcics (in terms of what it does to brain...he said a study showed it made rats live longer...I think he knows I will appreciate that it is a "smart drug" whatever that means (he knows I have trouble concentrating and thinking clearly in addition to my depression).
Heheheheh. I hate having to take drugs. Oh well. I also hate to go to psychologist, but I am doing it anyway (he is nice--it is just hard for me to open up)...
Aloha ya'll! (I'm a southerner transplanted to Hawaii)
Posted by SpreadDaALoha on March 19, 2003, at 18:51:47
In reply to Re: Lamictal-What's high dosage??, posted by SpreadDaALoha on March 19, 2003, at 18:46:35
I have to add something funny...
I am in graduate school (how I am doing it I do not know). I went to the nutritionist because it is cheap at school and I was curious. I told her my diet and she said "well I would have bipolar disorder too if I ate like you do!" She was only kidding, but it made me think a lot about my diet better...
Posted by Krissy P on March 19, 2003, at 18:54:29
In reply to Re: Lamictal-What's high dosage??, posted by SpreadDaALoha on March 19, 2003, at 18:51:47
Hey-
what?????!!!! what role does diet play in BP? May I ask what your diet is? I want to compare mine lol I know we need to eat a lot and I know the Omega-3 Fatty acids in salmon, etc. are key to mood, but what did she mean by that? lol that is funny! Hope to hear back from ya!
Aloha:-)
Kristen
--------------------------------------------------------------------------------------------------> I have to add something funny...
> I am in graduate school (how I am doing it I do not know). I went to the nutritionist because it is cheap at school and I was curious. I told her my diet and she said "well I would have bipolar disorder too if I ate like you do!" She was only kidding, but it made me think a lot about my diet better...
Posted by JackD on March 19, 2003, at 19:23:53
In reply to Lamictil is NOT a mood stabilizer » Krissy P, posted by BarbaraCat on March 18, 2003, at 15:33:44
I've been lurking on this thread, and I remember you had a similar response as I did on Remeron (Good response and then poopout). I'm curious that perhaps since we seem to have that in common Nortriptyline may work for me too. What is your current cocktail? I'm on 1350mg Lithium, 400mg Lamictal, and 1mg Klonopin.
Posted by BarbaraCat on March 19, 2003, at 23:33:36
In reply to Re: Lamictil is NOT a mood stabilizer -BarbaraCat, posted by JackD on March 19, 2003, at 19:23:53
Dear Y'all,
Well, hope I can put some of my experience to good use. I'm probably BP-II rather than major depressive disorder as I thought for 25 years. Have had classic hypomanic symptoms that were a giveaway, but the clearest symptoms have been my non-responsiveness to SSRI's. There's a great book called "Why your depression isn't getting better" that clued me into why SSRI's made things worse for me and why I needed a mood stabilizer. Hence, lithium.It has been a very mild benign drug. I'm only taking 600mg vs the usual 1200mg 'therapeutic window dose'. The only noticeable side effects were some hand tremors at the beginning. More disturbing was the negative thyroid effects. I was already hypothyroid and that can cause depression, weight gain, muscle pain in it's own right. But lithium competes with thyroxin at the receptor site and can cause exacerbation of hypothyroidism. I've been taking more thyroid med and it's been helping, but I worry about long-term problems.
Even so, without lithium I start to disintegrate. I'm currently on 600mg lithium, 50mg lamictal, 75mg nortriptyline and occassional valium for stress and ambien for sleep. This seems to be the best cocktail I've been on in 20 years. The main side effect of nortriptyline is dry mouth, but it encourages me to drink more water. It also can cause weight gain, but I've been on so many porky drugs that I just gave in and realized that without exercise you just get fat, no matter what you're taking. So now I'm feeling better and exercising and getting buff in the process. For whatever reason, nortriptyline has worked better than any other SSRI I've been on. It feels more natural and seems to work on all levels instead of just serotonin.
Another thing to keep in mind is the role of reproductive hormones. Depending on what phase of life you're at, estrogen, progesterone, testosterone play a HUGE role in all this stuff. Not nearly enough attention is paid to this very crucial topic. Hormones seem to be the master key to so many health and mood issues and doctors just aren't paying attention. You have to do your own research and put the pieces together because docs are so specialized they don't see the connections between their specialized fields.
I also have to say that these past two years of being without work, my Mother dying rather tragically, being very sick physically and mentally, and coming to terms with Life in all it's grand design has caused me to wake up in so many ways and pay attention to Right Now and give up brooding about what may be. All that fretting takes energy away from positive action.
Meds keep my overactive imagination in line, but the rest is truly up to me and I believe I'm getting it at last. I need help, but it truly is up to me. And yes, diet is very important. What would make you think otherwise? You put shitty fuel in a car and it clogs up and breaks down. The only thing we really have any control over in this life is what we choose to put into our bodies. Garbage in, garbage out. Don't get me started on how that whole subject is totally ignored by the medical profession. - Barbara
Posted by Krissy P on March 19, 2003, at 23:54:26
In reply to Meds and all that jazz, posted by BarbaraCat on March 19, 2003, at 23:33:36
ah so much to say about this topic. My docs have always paid attention to diets. I learned a long time ago that if it's to be-it's up to me and when people relaize this-life is good. I took a lot of meds tonight-I hate them right now and wonder if I will ever be able to function without them-probably not-I tried-and that gets me down. Yeah, things could always be worse-but they can always be better too. Diet is important yes, but some people can't be perfect and to think otherwise, is ignorant. Sure, you can put shitty fuel in your car and it runs right? Put in a cookie instead of an apple in your body and yeah, you still run. Whatever we eat, we will die anyway. A lot of people have eaten terrible, smoked cigars or the like, and lived to be over 100-so what makes us any different????
Sometimes when a person does everyting in their power to live a happy, productive, so-called perfect life, it just doesn't happen-this isn't negativity-this is reality PERIOD. We don't have to brood about what may be, but we have to plan-if we don't, then we can choose or not, to suffer the consequences.
I am 32, my periods were always regular and just dandy-when I started these meds, I gained weight, and my periods went amuck-that pisses me off. Yes, female hormones have a TREMENDOUS amout of influence on us women and I am really getting sick of the docs out there that don't address that. Some of yours may-but I had 2 laparoscopies, endometriosis, and the doc hit an artery, and I almost died. Do any of you think that I had any control over that? Nope I don't feel I did.
Meds, controversy, some docs' ignorance, life, hormones, weight, fuel...........and all that jazz...............................................................................................................................................> Dear Y'all,
> Well, hope I can put some of my experience to good use. I'm probably BP-II rather than major depressive disorder as I thought for 25 years. Have had classic hypomanic symptoms that were a giveaway, but the clearest symptoms have been my non-responsiveness to SSRI's. There's a great book called "Why your depression isn't getting better" that clued me into why SSRI's made things worse for me and why I needed a mood stabilizer. Hence, lithium.
>
> It has been a very mild benign drug. I'm only taking 600mg vs the usual 1200mg 'therapeutic window dose'. The only noticeable side effects were some hand tremors at the beginning. More disturbing was the negative thyroid effects. I was already hypothyroid and that can cause depression, weight gain, muscle pain in it's own right. But lithium competes with thyroxin at the receptor site and can cause exacerbation of hypothyroidism. I've been taking more thyroid med and it's been helping, but I worry about long-term problems.
>
> Even so, without lithium I start to disintegrate. I'm currently on 600mg lithium, 50mg lamictal, 75mg nortriptyline and occassional valium for stress and ambien for sleep. This seems to be the best cocktail I've been on in 20 years. The main side effect of nortriptyline is dry mouth, but it encourages me to drink more water. It also can cause weight gain, but I've been on so many porky drugs that I just gave in and realized that without exercise you just get fat, no matter what you're taking. So now I'm feeling better and exercising and getting buff in the process. For whatever reason, nortriptyline has worked better than any other SSRI I've been on. It feels more natural and seems to work on all levels instead of just serotonin.
>
> Another thing to keep in mind is the role of reproductive hormones. Depending on what phase of life you're at, estrogen, progesterone, testosterone play a HUGE role in all this stuff. Not nearly enough attention is paid to this very crucial topic. Hormones seem to be the master key to so many health and mood issues and doctors just aren't paying attention. You have to do your own research and put the pieces together because docs are so specialized they don't see the connections between their specialized fields.
>
> I also have to say that these past two years of being without work, my Mother dying rather tragically, being very sick physically and mentally, and coming to terms with Life in all it's grand design has caused me to wake up in so many ways and pay attention to Right Now and give up brooding about what may be. All that fretting takes energy away from positive action.
>
> Meds keep my overactive imagination in line, but the rest is truly up to me and I believe I'm getting it at last. I need help, but it truly is up to me. And yes, diet is very important. What would make you think otherwise? You put shitty fuel in a car and it clogs up and breaks down. The only thing we really have any control over in this life is what we choose to put into our bodies. Garbage in, garbage out. Don't get me started on how that whole subject is totally ignored by the medical profession. - Barbara
Posted by Krissy P on March 20, 2003, at 0:41:39
In reply to Re: Lamictal-What's high dosage??, posted by BarbaraCat on March 19, 2003, at 15:14:17
Why does it always have to be add this, add that, to make a med work?? Adding so much is toxic. A med is solely used alone to supposedly work on the specific problem they manufacturer it for. Such poisons to our system, I'd rather die at the moment.
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Why do you want to increase, are you not getting good antidepressant results from lamictal? I've heard of people going up to 400mg and above, but perhaps you need to add another class of med if you're not quite getting there.
Posted by Tabitha on March 20, 2003, at 0:45:48
In reply to Meds and all that jazz, posted by BarbaraCat on March 19, 2003, at 23:33:36
BarbaraCat, thanks for sharing all that experience and wisdom. One question, what do you think the lamictal is doing for you? You've got the lithium which is your mood stabiliser, the nortryptiline which is your AD, and I understand the valium and ambien are for anxiety and sleep. What is left for the lamictal to do? I ask because I'm trying to understand how lamictal is used for bipolar II.
Posted by LUKA62 on March 20, 2003, at 1:16:14
In reply to Lamictil is NOT a mood stabilizer » Krissy P, posted by BarbaraCat on March 18, 2003, at 15:33:44
> Krissy,
> I have to agree with Ron and Maximus here. You are not, I repeat not, on a mood stabilizer. Lamictal is tossed into that category because of it's anti-epileptic profile but it doesn't work well enough if you need something different. I know this well because I've been in a very similar place to you. I'm fine at 50mg lamictal and if I start increasing I get depressed. I'm on a tricyclic after being on all the SSRI's and SNRI's in the book. The only thing that makes everything else tie together and work is lithium. Without lithium, NOTHING works. Lithium alone does not work but it is a necessary part of my brew.
>
>
LAMICTAL Is in fact For Me a very effective medication that has stabilized my moods for the first time in 20 years!! I've been on all the traditional mood stabilizers, newer meds when available and nothing was consistently effective.
Lithium was the first I was put on initially back in the mid-80's, and it was not helpful; tried others, Depakote, etc. and combinations; docs revisited some hoping it would be helpful. I was put on Lamictal 1 1/2yrs ago, staying on Neurontin. (I also take Nardil...which has been my best bet for depression.) I went off the Neurontin 9months ago. I have not been this stable ever before until the Lamictal. My therapist agrees.
I currently take 50mg 2x/day. Unfortunately, it seems to be the cause of some very troublesome GI problems that I never had before. I just had to put up with it because the trade-off seemed worth it. But 3 months ago when my doc increased the dose(doubling it) I immediately started having severe abdominal and chest pain, as well as terrible dental probs, we went back to previous dose. Since then though, I continued to have pain often, and severe; the past week I have had to have 4 diagnostic tests to see if there's something else going on. So far it just shows bad gastritis--doc did a biopsy of stomach...now awaiting results of abd.ultrasound and HIBA scan to check my gallbladder; I kinda hope that's what it has been; otherwise I may need to Stop the Lamictal afterall. I am SOO worried that may be case, because after all these years I just don't want to begin more trial and error games with meds. It's very distressing I am ready to quit; I don't think I can start trying other meds again.
I know Neurontin is also prescribed as a mood stabilizer, but not only did I believe it didn't help, I thought it was causing problems for me. I couldn't convince my old pdoc to take me off; I actually ended up taking myself off it, and now I see a new pdoc. It seems that quite a few of these meds, whether labeled as mood-stabilizers or prescribed as such, effect different people quite differently.
Posted by BarbaraCat on March 20, 2003, at 12:59:20
In reply to Re: Meds and all that jazz » BarbaraCat, posted by Tabitha on March 20, 2003, at 0:45:48
Tabitha,
I'm not really sure what Lamictal is doing for me right now. When I first started taking it about 6 months ago, it gave me a very nice surge of energy. I was taking it with only lithium and together they seemed to be keeping the depression and mixed states hell at bay. But then Lamictal seemed to stop working and when I increased all I got was anxiety. I could live with it OK, but then in December my Mom died very tragically and the whole shebang (funeral, legal matters, house sale) was very intense and unsettling for me and I went into a massive suicidal depression in Jan-Feb. That's when my pdoc put on nortriptyline 75mg. It brought me back to life, literally. Now the question remains, do I really need Lamictal since it seemed to stop working? Or is it a needed ingredient in my current brew? I tried stopping lithium when my thyroid began to fail and realized within 3 days that I require lithium otherwise I start to fragment.So, I'm going back in April to bury Mom's 'cremains' and complete the dissolution of the estate. I know it's going to be very difficult and I do not want to mess with anything. I'm currently feeling very strong, spiritually and biochemically and feel like 'OK, bring it on'. But I know I'll need some healing afterwards, at which point I'll start reducing Lamictal very very slowly. It may be that I need it, but if I don't, my liver will thank me. I'll keep you posted.
> BarbaraCat, thanks for sharing all that experience and wisdom. One question, what do you think the lamictal is doing for you? You've got the lithium which is your mood stabiliser, the nortryptiline which is your AD, and I understand the valium and ambien are for anxiety and sleep. What is left for the lamictal to do? I ask because I'm trying to understand how lamictal is used for bipolar II.
Posted by BarbaraCat on March 20, 2003, at 13:12:56
In reply to Add, Add, Add, posted by Krissy P on March 20, 2003, at 0:41:39
I know your frustration with this. No one seems to know why these meds work in the first place, only theories. Just as no one knows what depression, etc., is really caused by. So much of the medication merry go round is hit or miss. From what I read here on this board, it's rare that anyone finds the perfect med the first time, or if they do, the effect poops out. So add another to the pile of pills. Pdocs are frustrated with this as well. Seems the only happy campers are the pharmaceutical companies.
I was lamenting this with my pdoc and wondering why we can't do a SPECT scan or blood test and just zero in on the disfunction. He said that there's nothing so far that's dependable and it's too expensive and inaccurate for insurance companies to foot the bill. But, he said that we're learning so much with the DNA mapping project and the rumor is that in the next few years we'll probably see a DNA test that will be far more accurate. So until then it's like a crap shoot. BTW, milk thistle herb (silymarin) has gotten good press all around for liver support. It's regenerated livers that were being destroyed by mushroom poisoning. We need to consider the hits our livers are taking with all these meds and do what we can to take care of them.
> Why does it always have to be add this, add that, to make a med work?? Adding so much is toxic. A med is solely used alone to supposedly work on the specific problem they manufacturer it for. Such poisons to our system, I'd rather die at the moment.
> --------------------------------------------------------------------------------------------------
>
>
> Why do you want to increase, are you not getting good antidepressant results from lamictal? I've heard of people going up to 400mg and above, but perhaps you need to add another class of med if you're not quite getting there.
>
Posted by Tabitha on March 20, 2003, at 13:45:06
In reply to Re: Meds and all that jazz » Tabitha, posted by BarbaraCat on March 20, 2003, at 12:59:20
Thanks again. I had hopes for lamictal to replace my SSRIs, but it seems it poops out on everyone. I'll probably try it anyway. I can understand you not wanting to change anything right now. My mom died in '95-- I just passed that anniversary-- it's an enormous thing, coming to terms with that loss. I'll wish you strength for going thru the estate and cremation stuff.
Posted by wcfrench on March 20, 2003, at 14:02:41
In reply to Re: Add, Add, Add » Krissy P, posted by BarbaraCat on March 20, 2003, at 13:12:56
This has seemed to be the trend with my meds... Add because it's working, subtract because it's not (or it stops) working. The combo fails and we don't know who the culprit is.
I'm on 100mg/2x Lamictal now, having started it about a month ago, and I don't feel the same as when I started it... now I feel a little more depressed, and as if it doesn't work as well. I did stop Depakote a short time before that, do you think I could be suffering withdrawals? It doesn't seem likely... I think sometimes I have mixed states too.. I'll be peaceful, then really anxious/nervous, then OK again. It's very weird, but I'm trying to balance it. Is that mixed states? Thanks for your help to me the young "grasshoppa"
See ya
CharliePS I read "the power of now" and "present moment awareness" and both are really good books to read. Even if you're not in a great position to take them in (as we are at times), they could benefit anyone's current situation. They are also very relaxing, and unlike other books when I'm anxious, I find myself actually seeing these as reprieve.
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