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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jack623 on November 6, 2005, at 2:23:29
I just need some support right now from those of you who are in a better place. I am on Lamictal 125mg and am about to go up to 150mg. I also take topamax 200mg. My diagnosis was changed from Major depressive disorder to bipolar II about a month ago, and I was switched to Lamictal after having taken every SSRI, SNRI and wellbutrin. I have taken more than 10 drugs in as many years and I am only 24. I suffer from bulimia and depression and the eating and the moods just never seem to get any better. Most days I don't want to live. I want to believe that there is some med out there that will work for me but I am so hopeless right now. I just want to be relieved of my misery. I don't feel objective enough to judge if I am becoming more depressed on Lamictal, but I can't go back to an SSRI. Any words of wisdom?
Jack
Posted by fuchsia on November 6, 2005, at 19:36:04
In reply to Need some support on Lamictal, posted by jack623 on November 6, 2005, at 2:23:29
Hello Jack
Sorry you are feeling so crappy.
I'm probably not in a better place but I have a similar history with regards having had many many antidepressant (and other) treatments and ending up with the bipolar II diagnosis.
I'm on Lamictal now also; I just got up to 175mg. For me there has definitely been a positive effect so I'll probably stay on it and add something else as well if it's not enough. It took me 3 months to get up to this dose though and I've had some gradual improvement.
Do you think you haven't noticed anything much changing since you started Lamictal? Was it a month ago you started it?
If it and the topomax are your first mood stabilisers there must still be a lot of other options for you.
Posted by Phillipa on November 6, 2005, at 20:39:50
In reply to Re: Need some support on Lamictal, posted by fuchsia on November 6, 2005, at 19:36:04
Just don't go up on the lamictal too quickly. The dreaded rash. Slow titration is recommended. Fondly, Phillipa
Posted by jack623 on November 6, 2005, at 23:46:34
In reply to Re: Need some support on Lamictal, posted by fuchsia on November 6, 2005, at 19:36:04
> Hello Jack
>
> Sorry you are feeling so crappy.
>
> I'm probably not in a better place but I have a similar history with regards having had many many antidepressant (and other) treatments and ending up with the bipolar II diagnosis.
>
> I'm on Lamictal now also; I just got up to 175mg. For me there has definitely been a positive effect so I'll probably stay on it and add something else as well if it's not enough. It took me 3 months to get up to this dose though and I've had some gradual improvement.
>
> Do you think you haven't noticed anything much changing since you started Lamictal? Was it a month ago you started it?
>
> If it and the topomax are your first mood stabilisers there must still be a lot of other options for you.I've been titrating up to 125mg for about 1.5 months. At first, I really felt good, almost hypomanic. My sense of smell was really acute and I was excited about life, for about a week. But I was also tapering off of Effexor (induces hypomania in me). Now I am totally off of the Effexor and I have some really bad days. I get very irritable and sad. I am not used to the irritability. My hope is that with the higher doses of Lamictal, this will subside. How abut you?
Posted by fuchsia on November 7, 2005, at 4:43:22
In reply to Re: Need some support on Lamictal, posted by jack623 on November 6, 2005, at 23:46:34
> I've been titrating up to 125mg for about 1.5 months. At first, I really felt good, almost hypomanic. My sense of smell was really acute and I was excited about life, for about a week. But I was also tapering off of Effexor (induces hypomania in me).
Now I am totally off of the Effexor and I have some really bad days. I get very irritable and sad. I am not used to the irritability. My hope is that with the higher doses of Lamictal, this will subside.Maybe it will. I've been less irritable on Lamictal.
Hopefully some antidepressant effect will start up for you also. And/or you will come out of the trough from coming down off the Effexor; if that's what is happening. I see it must be hard to tell what the Lamictal is doing at this point.
How abut you?
>Most times I increase the dose I get a boost and feel good for a while, but it dies off. Not to as bad as it was before the Lamictal though.
I haven't had such a big boost on my last increase
although it could still come tomorrow. Today was a kind of lazy vegetable depression day.
Posted by Mandy on November 7, 2005, at 10:03:49
In reply to Need some support on Lamictal, posted by jack623 on November 6, 2005, at 2:23:29
I take Lamictal and have found it a "God send". it quiets my racing thoughts and really has stabilized my moods. I also take two antidepressants--Wellbutrin and Lexapro. I tried Topamax but it made me feel like a zombie, so could the topamax be your problem? Hope it all works out. By the way, it was scary but I have had to go up to 375mg of Lamictal--I thought that was a lot, but it is working.
Posted by Bill LL on November 7, 2005, at 10:09:46
In reply to Need some support on Lamictal, posted by jack623 on November 6, 2005, at 2:23:29
I have a few thoughts on this. First, ask your doctor what he thinks about taking seroquel in addition to, or instead of topomax, at least while you are titrating up on Lamictal. I believe that seroquel has a fast acting antidepressant effect.
Second, you are still on a low dose of Lamictal. You won't really know if it works for you until you get up to at least 200 mg, and maybe 500 mg or so.
Third, although you have tried the first line antidepressants, such as the SSRI's and so forth, you have taken them since you were 14 years old. Antidepressants almost always work better on adults than on young children. So you might want to re-try some of the drugs you took when you were younger.
Also, it would not be surprising if a given antidepressant did not work in the past, that it would work later if taken along with a drug like Lamictal.
> I just need some support right now from those of you who are in a better place. I am on Lamictal 125mg and am about to go up to 150mg. I also take topamax 200mg. My diagnosis was changed from Major depressive disorder to bipolar II about a month ago, and I was switched to Lamictal after having taken every SSRI, SNRI and wellbutrin. I have taken more than 10 drugs in as many years and I am only 24. I suffer from bulimia and depression and the eating and the moods just never seem to get any better. Most days I don't want to live. I want to believe that there is some med out there that will work for me but I am so hopeless right now. I just want to be relieved of my misery. I don't feel objective enough to judge if I am becoming more depressed on Lamictal, but I can't go back to an SSRI. Any words of wisdom?
>
> Jack
Posted by Phillipa on November 7, 2005, at 18:15:20
In reply to Re: Need some support on Lamictal, posted by Bill LL on November 7, 2005, at 10:09:46
Bill don't know how you can say seroquel acts as an antidepressant. It is atypical antipsycotic and all it did for me was make me feel drunk. Maybe I misinterpreted your message. Let me know if I did. Fondly, Phillipa
Posted by Bill LL on November 8, 2005, at 15:56:38
In reply to Re: Need some support on Lamictal » Bill LL, posted by Phillipa on November 7, 2005, at 18:15:20
Hi Phillipa - I agree with you. It's not really an antidepressant per se. But I have seen a couple of articles about it. If you read the stuff I pasted below, things are a bit murky. The first guy was apparently funded by the manufacturer of Seroquel. And the second guy was talking about Seroquel supplementation to other drugs. So I don't really know for sure.
http://www.psycheducation.org/depression/meds/quetiapine.htm1. New evidence has been presented showing quetiapine has antidepressant effects. These effects were quite substantial in this new study. In addition, the design of this study is more solid than some of the other medications studies out there, in that patients were not pre-selected for having "tolerated" quetiapine. Everyone who was randomized to get quetiapine had never been on it. That's different than some of the "long-term" data, meaning more than a few weeks, in other studies such as lamotrigine, where the patients who entered the study had already been on the medication, at least for a few weeks, thus selecting patients who could get on and stay on it. In the quetiapine study, this favorable bias was not present.
How much antidepressant effect? It looks like a lot, based on the reports from this study released so far. The main investigator, Dr. Calabrese, also headed the studies of lamotrigine which showed striking antidepressant effects for that drug. So, he is not new to this area of bipolar disorder, that's for sure. But, he exclaimed, (mind you, he has surely been funded handsomely for his work with this company):
"This is the first time that an antipsychotic has been shown to have clear antidepressant activity," senior investigator Joseph R. Calabrese, MD, told Medscape in a telephone interview. "Treatment separated from placebo on every outcome. I was surprised to see how large the effect was. It seems to me that this drug is not just an antipsychotic. It separated from placebo on nine of 10 items, compared to olanzapine, which separates from placebo in three items when assessed as a treatment for bipolar depression."Medscape
(For you skeptics, who wonder about Dr. Phelps and his possible funding by AstraZeneca -- good on 'ya for wondering! I just started receiving $ from them yet after working on it for almost a year, as their point of view may allow me to promote my point of view using their money. Here's my full explanation of how I handle that.)
UPDATE 7/05: Another "real world" research study, with a very long period of observation, was just published.Hardoy This was not "blinded", meaning that both the patients and the doctors knew that Seroquel was being used. However, this study looked at the course of illness when Seroquel was added to other medications, which is how we often end up using it. Although system used to evaluate results was rather crude, it is similar to what doctors like me do: we basically ask ourselves "Is the patient better? How much?" The results were strong, even though there weren't many patients in the study (21; usually a small sample like this makes it harder to find "statistically significant" results). Relapse rates into some kind of bipolar symptom, including depression, were three times lower with Seroquel compared to before it was added. If we were to find these kind of results in a long-term trial that was randomized to start, as we have for Zyprexa, then this kind of result would be very impressive. For now, however, it adds just a little more reliability to the impression we doctors who use the stuff have developed: it does indeed seem to work pretty well over time, not just at first. Remember, that's the "holy grail", for now, amongst mood stabilizers -- does it work long term?
2. The second feature of quetiapine that distinguishes it from some of the other "atypical antipsychotic" options is a possible lower risk of causing weight gain and diabetes, at least compared to Zyprexa. [Update October 2004: a recent direct study of this issue confirms this relative risk, consistent with the table belowLeslie; although another study does not.Citrome]
> Bill don't know how you can say seroquel acts as an antidepressant. It is atypical antipsycotic and all it did for me was make me feel drunk. Maybe I misinterpreted your message. Let me know if I did. Fondly, Phillipa
Posted by Phillipa on November 8, 2005, at 19:27:33
In reply to Re: Need some support on Lamictal- Phillipa, posted by Bill LL on November 8, 2005, at 15:56:38
Bill, so it only acts as an antidepressant in bipolar disease? Fondly, Phillipa
This is the end of the thread.
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