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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by qbsbrown on February 27, 2009, at 8:14:41
Since I've started the med, I go from hypomanic in the morning, depressed from noon to 6pm, then feel normal the rest of the night.
I'm only staying on it because of the feeling normal part. During the day, I pray that it will be 6pm faster.
I hope that this will go away with higher doses.
Lamictal was sort of the same, it actually induced severe anxiety, hypomania, and mixed mood episodes.
depakote works, but my cognitive functioning goes out the window, and i become zombified.
Any advice is appreciated.
My doc says trileptal can be taken once daily, but all the literature I read says twice daily.
Regards,
Brian
Posted by SLS on February 27, 2009, at 9:50:57
In reply to Can Trileptal induce rapid cycling?, posted by qbsbrown on February 27, 2009, at 8:14:41
> Since I've started the med, I go from hypomanic in the morning, depressed from noon to 6pm, then feel normal the rest of the night.
Another way of looking at this is that perhaps the Trileptal is only partially effective and is now producing very variable results, probably revolving around peaks and troughs in blood levels. I would take it twice a day. If you get stuck in depression, you can add back the Lamictal, now that you have a more anti-manic mood stabilizer on board. Keep working. I think you are getting close.
You didn't add Depakote to Lamictal, did you?
- Scott
Posted by Ron Hill on March 1, 2009, at 14:23:35
In reply to Can Trileptal induce rapid cycling?, posted by qbsbrown on February 27, 2009, at 8:14:41
Brian,
> Since I've started the med, I go from hypomanic in the morning, depressed from noon to 6pm, then feel normal the rest of the night.
For me, Trileptal always has an anti-manic effect. I usually take 300 mg on a daily basis, but if I become hypomanic, I take 900 mg/day or 1200 mg/day and my hypomania subsides.
> My doc says trileptal can be taken once daily, but all the literature I read says twice daily.
Perhaps it "can" be taken once a day, but the Prescribing Information document says to take it twice a day (BID). See bottom of page 28, continuing on the top of page 29:
http://www.pharma.us.novartis.com/product/pi/pdf/trileptal.pdf
You might find it worthwhile to scan the entire document.
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild OCPD
300 mg/day Trileptal
200 mg/day Lamictal
250 mg/day Keppra
60 mg/day Nardil
Posted by qbsbrown on March 2, 2009, at 7:56:46
In reply to Re: Can Trileptal induce rapid cycling? » qbsbrown, posted by SLS on February 27, 2009, at 9:50:57
Hey Scott. So with the Trileptal, I wake up in a pleasurable hypomania that lasts til 1200. So I'm taking my largest dose in the morning (1200).
Then I crash at noon, but depression. So I'm trying to pick myself up with a 300-600 mg dose. Then I take another 600mg at about 6pm, and a calm normalcy takes over.
I've tried to give it up, but the pleasurable parts almost outweight the depression i experience everyday.
But needless to say, I shouldn't have to be bed bound depressed for 6 hours a day.
I also take provigil, which usually helps my depression.
I have been taking lexapro, which I know can induce my "mixed moods", so I'm discontinuing that.
Lamictal induces derealization, so any med that does that is not worth it to me.
Depakote makes me apathetic, flat, and dead. Not worth it.
I don't do well on anti-psychotics.
Any other ideas?
I wonder if a low dose of lithium (600 mgs) would help.
Thanks for your help.
Brian
Posted by qbsbrown on March 27, 2010, at 20:46:27
In reply to Re: Can Trileptal induce rapid cycling? » qbsbrown, posted by SLS on February 27, 2009, at 9:50:57
> > Since I've started the med, I go from hypomanic in the morning, depressed from noon to 6pm, then feel normal the rest of the night.
>
> Another way of looking at this is that perhaps the Trileptal is only partially effective and is now producing very variable results, probably revolving around peaks and troughs in blood levels. I would take it twice a day. If you get stuck in depression, you can add back the Lamictal, now that you have a more anti-manic mood stabilizer on board. Keep working. I think you are getting close.
>
> You didn't add Depakote to Lamictal, did you?
>
>
> - ScottHey Scott, so if taking the Trileptal 2 times a day, still yields the quite bad daily depression. I think I may be on to something, to spread it out to 3 doses per day, and I've added in Provigil, which seems to greatly lessen the depression. Sound prudent?
My only other idea is to go back on 900mgs of lyrica and just have a false sense of well being the rest of my life:)
Oh, and Lamictal was terrible for me!
Brian
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