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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by dragonblack on August 4, 2010, at 1:06:06
Hi All! Been several years since I posted here. I'll spare you a retelling of the intervening drama.
Anyhoo, I am Dx'ed as BP2, co-morbid anxiety disorder.
Currently take Lamictal 200 mg, Wellbutrin XL 450 mg, and Klonopin .5-.75 mg.
Lamictal is the first and only mood stabilizer I have tried; it was supposed to be my magic bullet! At this point, I am forced to admit that it isn't working, at least enough, I still cycle, rapidly, still have rage/irritability, and am still not functional enough to work. Also have headaches nearly daily, enough that it's become a deal-breaker in it's own right. The plan is to try a new mood stabilizer asap (1st choice is Trileptal, 2nd is Depakote, 3rd is Tegretol...[tmi]).
BUT...researching antidepressants tonight (I've long wanted to try a 2nd as an adjunct, can't get a Dr., or now my PA, to Rx one (impersonal, statistic-based fear of manic switch), I'm now thinking that maybe I've failed to give Lamictal a fair trial merely by virtue of being on an antidepressant. Normally, I wouldn't consider going off Wellbutrin unless I desperately wanted to have a horrible crash, but since things aren't working, and I'm ready to give up on Lamictal, which was supposed to spare me years of trying mood stabilizers with awful side effects and weight gain, maybe it's worth a try? I don't think Wellbutrin is causing me to become hypomanic per se, but there's an excellent chance that it is involved in mood instability, insomnia, irritability, and maybe even the headaches (even though lamictal causes headaches, the combo of wellbutrin and lamictal also causes headaches, even when lamictal alone may not...this from some secret manual only ur Pdoc has).
Would love some feedback on this - am I just walking into a giant crash by going of Wellbutrin when I'm on a max dose and still having depression, or is this a good idea as a last ditch effort to give Lamictal a fair shake, as some would argue that I should have started on Lamictal alone before trying to add an AD?
sorry so long - thanks for reading!
P.S. Much love to everyone here : ) - forgot to mention, managed to quit drinking about 14 months ago, I was pretty much a raging alcoholic and used to post here when wasted, lol.
Posted by Phillipa on August 4, 2010, at 13:18:53
In reply to BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 4, 2010, at 1:06:06
You say your depressed so don't you require an ad? What's you do say on your theory or are you testing it here. Glad to see you back sober. Phillipa
Posted by polarbear206 on August 4, 2010, at 16:38:31
In reply to BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 4, 2010, at 1:06:06
> Hi All! Been several years since I posted here. I'll spare you a retelling of the intervening drama.
>
> Anyhoo, I am Dx'ed as BP2, co-morbid anxiety disorder.
>
> Currently take Lamictal 200 mg, Wellbutrin XL 450 mg, and Klonopin .5-.75 mg.
>
> Lamictal is the first and only mood stabilizer I have tried; it was supposed to be my magic bullet! At this point, I am forced to admit that it isn't working, at least enough, I still cycle, rapidly, still have rage/irritability, and am still not functional enough to work. Also have headaches nearly daily, enough that it's become a deal-breaker in it's own right. The plan is to try a new mood stabilizer asap (1st choice is Trileptal, 2nd is Depakote, 3rd is Tegretol...[tmi]).
>
> BUT...researching antidepressants tonight (I've long wanted to try a 2nd as an adjunct, can't get a Dr., or now my PA, to Rx one (impersonal, statistic-based fear of manic switch), I'm now thinking that maybe I've failed to give Lamictal a fair trial merely by virtue of being on an antidepressant. Normally, I wouldn't consider going off Wellbutrin unless I desperately wanted to have a horrible crash, but since things aren't working, and I'm ready to give up on Lamictal, which was supposed to spare me years of trying mood stabilizers with awful side effects and weight gain, maybe it's worth a try? I don't think Wellbutrin is causing me to become hypomanic per se, but there's an excellent chance that it is involved in mood instability, insomnia, irritability, and maybe even the headaches (even though lamictal causes headaches, the combo of wellbutrin and lamictal also causes headaches, even when lamictal alone may not...this from some secret manual only ur Pdoc has).
>
> Would love some feedback on this - am I just walking into a giant crash by going of Wellbutrin when I'm on a max dose and still having depression, or is this a good idea as a last ditch effort to give Lamictal a fair shake, as some would argue that I should have started on Lamictal alone before trying to add an AD?
>
> sorry so long - thanks for reading!
>
> P.S. Much love to everyone here : ) - forgot to mention, managed to quit drinking about 14 months ago, I was pretty much a raging alcoholic and used to post here when wasted, lol.
>Which drug were you on first. What were your syx like when on Wellbutrin without the Lamictal? How long have you been on the Lamictal and the wellbutrin together? Wellbutrin gave me intense anxiety and was very irritable on it. Did nothing for my depression. However, it works good for other people, but not for my mild bipolar. I take lamictal 200mg with Effexor 150 to 300mg, depending where I am in my monthly menstural cycle. It's very important to stablize your cycling with a mood stabilizer prior to initiating an AD.
Posted by dragonblack on August 4, 2010, at 17:33:27
In reply to Re: BPII: stop antidepressant to test mood stabilizer? » dragonblack, posted by Phillipa on August 4, 2010, at 13:18:53
> You say your depressed so don't you require an ad? What's you do say on your theory or are you testing it here. Glad to see you back sober. Phillipa
Haven't been able to get in to see anyone yet. The use of ADs in Bipolar is controversial, especially since I rapid cycle, so even though I have depressive episodes I maybe shouldn't be on an antidepressant. Not sure.
Thanks!
Posted by dragonblack on August 4, 2010, at 17:50:02
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by polarbear206 on August 4, 2010, at 16:38:31
I was originally diagnosed as unipolar forever ago, Zoloft was awful, switched to Wellbutrin, which was much better.
Went off all meds for several years (long story), then finally got back on in April '09. I started back on Wellbutrin and starter dose of Lamictal. Lamictal takes forever to get to a therapeutic dose, and I couldn't wait, I really did need an AD then. I saw improvements with each dose increase on Lamictal up to 200 mg, for the most part, but still didn't have any energy or motivation and wanted to add maybe a second AD as an adjunct, as I had to get back to work. Then my sister had a massive stroke and I had to move to help take care of her...convinced my Doc to let me go up to 450 mg on Wellbutrin (what I was on in law school, years ago), as I had fared well on it before and the problems I had stemmed from not addressing BP or anxiety back then, which in theory I am now doing. So, I had a period where this combo was working fairly well for me, at least in comparison to where I was, but I was still cycling. Tried to go up on Lamictal, to 300, and that was a huge mistake. I managed to stop cycling!...by settling into depression. Recently went back down to 200, now having the same thing, cycling, not up long enough to accomplish anything, lots of problems. The idea of taking away my AD seems kinda nuts to me, but it also seems strange to quit lamictal given that I've only taken it with an AD in place (though the headaches may justify quitting anyway). I really just don't know what to do. I probably need to wean off Wellbutrin slowly even if I were to take that route, and I need help NOW, so I think that I am going to have to try a different mood stabilizer now even if I try to wean off Wellbutrin. I've been reading that contrary to the 4-week taper they usually recommend, you really should give it 16 weeks to taper off an AD.
I'm so damn frustrated with my meds that I've often considered just quitting everything, though I imagine that can't be a good idea. But I'm constantly trying to treat side effects that I'm creating, treat anxiety, then treat somnolence, creating anxiety...and it aint working anyway. I don't know what to do, to sum up. Going off all meds and becoming completely nonfunctional just doesn't seem that far off. At least then I could evaluate my own chemistry and get rid of med induced sides.
Posted by MaybeSo on August 5, 2010, at 20:57:10
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 4, 2010, at 17:50:02
Over and over I have been told by my doctors that Lamictal over 200 gives no benefit. But I take an extra 1/2 every so often when I am feeling overstressed, sort of how people use a Xanax. Probably not supposed to do it, and could very well be placebo effect.
The Wellbutrin can make some people really irritable, you may want to try a different antidepressant.
Celexa maybe? It is generic and had a very calming effect on me--I had to add Wellbutrin to get up and go because I was so content sitting around--but not anxiety inducing at all.
Or another AD entirely.
Or no AD at all, although I have never made it for more than a few weeks without falling directly into the pit.
Posted by dragonblack on August 6, 2010, at 12:27:11
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by MaybeSo on August 5, 2010, at 20:57:10
Maybe so, MaybeSo. I've never heard that about Lamictal. It's weird, I have these deep psychological ties to these drugs, so it's hard for me to consider changing. Wellbutrin may have saved my life more than once - I can't let go! Re: your advice, I tried Lexapro in the past (the active enantiomer of which is identical to Celexa) and it was helpful for me at low dose (5 mg) but once I hit 10 mg I just emotionally flatlined. I sat and stared at the wall for an entire evening; I couldn't even summon the will to watch tv. Which is why I want to try a more stimulating SSRI (prozac), but that's the one they are least likely to let me try due to risk of manic switch (which is overestimated!!!). At the very least, I want to wean down on Wellbutrin. I'm interested in Remeron, too, I've heard cool stuff, though risk of weight gain seems to loom "large" there too. I've pretty much decided that even though I haven't managed to give Lamictal a fair trial, there's not much I can do about that now. I can't just go off of my AD, that's a long-term goal, especially since I want to try another mood stabilizer, as Lamictal is the only one that is basically also an AD, so my current plan is to ask for a new MS and low dose of a second AD, and then cut back on Wellbutrin slowly. I don't suspect they will give me a script for a second AD, (recently moved here, the PA I saw seems to think I am chasing hypomania by asking for one), but I will order it on my own if I have to. There can't be any harm in trying 10 mg a day of prozac and seeing if addressing the serotonin component isn't a glaring oversight of my current regimen. Every time I've gone off an AD in the past I have crashed, though I've never had a mood stabilizer in place. I'm too scared to try it, though. I'm always worried that maybe next time Wellbutrin won't work, which happens to some people.
> Over and over I have been told by my doctors that Lamictal over 200 gives no benefit. But I take an extra 1/2 every so often when I am feeling overstressed, sort of how people use a Xanax. Probably not supposed to do it, and could very well be placebo effect.
>
> The Wellbutrin can make some people really irritable, you may want to try a different antidepressant.
>
> Celexa maybe? It is generic and had a very calming effect on me--I had to add Wellbutrin to get up and go because I was so content sitting around--but not anxiety inducing at all.
>
> Or another AD entirely.
>
> Or no AD at all, although I have never made it for more than a few weeks without falling directly into the pit.
>
Posted by polarbear206 on August 6, 2010, at 17:29:44
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 6, 2010, at 12:27:11
> Maybe so, MaybeSo. I've never heard that about Lamictal. It's weird, I have these deep psychological ties to these drugs, so it's hard for me to consider changing. Wellbutrin may have saved my life more than once - I can't let go! Re: your advice, I tried Lexapro in the past (the active enantiomer of which is identical to Celexa) and it was helpful for me at low dose (5 mg) but once I hit 10 mg I just emotionally flatlined. I sat and stared at the wall for an entire evening; I couldn't even summon the will to watch tv. Which is why I want to try a more stimulating SSRI (prozac), but that's the one they are least likely to let me try due to risk of manic switch (which is overestimated!!!). At the very least, I want to wean down on Wellbutrin. I'm interested in Remeron, too, I've heard cool stuff, though risk of weight gain seems to loom "large" there too. I've pretty much decided that even though I haven't managed to give Lamictal a fair trial, there's not much I can do about that now. I can't just go off of my AD, that's a long-term goal, especially since I want to try another mood stabilizer, as Lamictal is the only one that is basically also an AD, so my current plan is to ask for a new MS and low dose of a second AD, and then cut back on Wellbutrin slowly. I don't suspect they will give me a script for a second AD, (recently moved here, the PA I saw seems to think I am chasing hypomania by asking for one), but I will order it on my own if I have to. There can't be any harm in trying 10 mg a day of prozac and seeing if addressing the serotonin component isn't a glaring oversight of my current regimen. Every time I've gone off an AD in the past I have crashed, though I've never had a mood stabilizer in place. I'm too scared to try it, though. I'm always worried that maybe next time Wellbutrin won't work, which happens to some people.
>
> > Over and over I have been told by my doctors that Lamictal over 200 gives no benefit. But I take an extra 1/2 every so often when I am feeling overstressed, sort of how people use a Xanax. Probably not supposed to do it, and could very well be placebo effect.
> >
> > The Wellbutrin can make some people really irritable, you may want to try a different antidepressant.
> >
> > Celexa maybe? It is generic and had a very calming effect on me--I had to add Wellbutrin to get up and go because I was so content sitting around--but not anxiety inducing at all.
> >
> > Or another AD entirely.
> >
> > Or no AD at all, although I have never made it for more than a few weeks without falling directly into the pit.
> >
>
>If an SSRI made you feel that apathetic, why don't you try an SNRI, like Effexor?
Posted by dragonblack on August 6, 2010, at 21:09:08
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by polarbear206 on August 6, 2010, at 17:29:44
> If an SSRI made you feel that apathetic, why don't you try an SNRI, like Effexor?
Good question. Well, I think each SSRI has it's own "personality," and that with any of these drugs, the only real way to know whether it will work for you is to trial it. I find prozac fascinating, and I've wanted to try it for years - it just has some properties that are very unique, and it has showed a lot of versatility that the other SSRIs haven't, IMO. It's also a popular combo with Wellbutrin ("Wellzac"). I am curious about the SNRIs, but, unlike Cymbalta, which hits serotonin and norepinephrine more or less equally, effexor is really just an ssri at low doses; it doesn't turn into an SNRI until you get to 150 mg or so, and I want to add just a low dose of something, hopefully. Also, Effexor has a 4-hour half-life, and thus is probably the worst culprit re SSRI discontinuation syndrome (though the XR version would alleviate some of this...). Prozac, on the other hand, has the longest half-life ever, and not only is this not a risk, prozac is prescribed to treat SSRI discontinuation syndrome caused by going off other SSRIs! I find this to be a distinct advantage when comparing drugs that are more or less equal in my eyes until I try them personally. Also, reading the book "Prozac Nation," and how it changed Elizabeth Wurtzel's life, is what originally convinced me to go on medication years ago. So, yeah, that's the story. Also, it will probably be cheaper for me.
Way more information that you wanted, right? Ha ha! Let it not be said that I don't over-analyze things!
Posted by Phillipa on August 6, 2010, at 21:38:08
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 6, 2010, at 21:09:08
Isn't it very stimulating? Was for me at 20mg. Should be or not used for anxiety? Phillipa
Posted by MaybeSo on August 7, 2010, at 8:33:04
In reply to Re: BPII: stop antidepressant to test mood stabilizer? » dragonblack, posted by Phillipa on August 6, 2010, at 21:38:08
I can't take SNRIs at all. They make me paranoid and negative to the extreme.
Something's really off with my norepinephrine circuits. I can't take any kind of epinephrine/pseudoeph (even a few days of OTC mucus relievers) without having a very marked personality change for the worse.
Another instance where the myriad individual chemical profiles that are involved in our 'conditions' make it so hard to find the right therapy. sigh.
Posted by polarbear206 on August 8, 2010, at 8:49:41
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 6, 2010, at 21:09:08
> > If an SSRI made you feel that apathetic, why don't you try an SNRI, like Effexor?
>
> Good question. Well, I think each SSRI has it's own "personality," and that with any of these drugs, the only real way to know whether it will work for you is to trial it. I find prozac fascinating, and I've wanted to try it for years - it just has some properties that are very unique, and it has showed a lot of versatility that the other SSRIs haven't, IMO. It's also a popular combo with Wellbutrin ("Wellzac"). I am curious about the SNRIs, but, unlike Cymbalta, which hits serotonin and norepinephrine more or less equally, effexor is really just an ssri at low doses; it doesn't turn into an SNRI until you get to 150 mg or so, and I want to add just a low dose of something, hopefully. Also, Effexor has a 4-hour half-life, and thus is probably the worst culprit re SSRI discontinuation syndrome (though the XR version would alleviate some of this...). Prozac, on the other hand, has the longest half-life ever, and not only is this not a risk, prozac is prescribed to treat SSRI discontinuation syndrome caused by going off other SSRIs! I find this to be a distinct advantage when comparing drugs that are more or less equal in my eyes until I try them personally. Also, reading the book "Prozac Nation," and how it changed Elizabeth Wurtzel's life, is what originally convinced me to go on medication years ago. So, yeah, that's the story. Also, it will probably be cheaper for me.
>
> Way more information that you wanted, right? Ha ha! Let it not be said that I don't over-analyze things!I take XR version. Just got the generic filled and paid only $10. Thought I'd never see the day that Lamictal and Effexor XR went generic. $20 a month with insurance, can't beat that.
Good luck and I hope Prozac works out for you. Keep us informed on your progress. :)
Posted by Dr. Bob on August 8, 2010, at 18:37:02
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by dragonblack on August 6, 2010, at 21:09:08
> reading the book "Prozac Nation," and how it changed Elizabeth Wurtzel's life, is what originally convinced me to go on medication years ago.
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, a movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though.
Thanks!
Bob
Posted by dragonblack on August 9, 2010, at 23:58:18
In reply to Re: BPII: stop antidepressant to test mood stabilizer?, posted by polarbear206 on August 8, 2010, at 8:49:41
> > > If an SSRI made you feel that apathetic, why don't you try an SNRI, like Effexor?
> >
> > Good question. Well, I think each SSRI has it's own "personality," and that with any of these drugs, the only real way to know whether it will work for you is to trial it. I find prozac fascinating, and I've wanted to try it for years - it just has some properties that are very unique, and it has showed a lot of versatility that the other SSRIs haven't, IMO. It's also a popular combo with Wellbutrin ("Wellzac"). I am curious about the SNRIs, but, unlike Cymbalta, which hits serotonin and norepinephrine more or less equally, effexor is really just an ssri at low doses; it doesn't turn into an SNRI until you get to 150 mg or so, and I want to add just a low dose of something, hopefully. Also, Effexor has a 4-hour half-life, and thus is probably the worst culprit re SSRI discontinuation syndrome (though the XR version would alleviate some of this...). Prozac, on the other hand, has the longest half-life ever, and not only is this not a risk, prozac is prescribed to treat SSRI discontinuation syndrome caused by going off other SSRIs! I find this to be a distinct advantage when comparing drugs that are more or less equal in my eyes until I try them personally. Also, reading the book "Prozac Nation," and how it changed Elizabeth Wurtzel's life, is what originally convinced me to go on medication years ago. So, yeah, that's the story. Also, it will probably be cheaper for me.
> >
> > Way more information that you wanted, right? Ha ha! Let it not be said that I don't over-analyze things!
>
> I take XR version. Just got the generic filled and paid only $10. Thought I'd never see the day that Lamictal and Effexor XR went generic. $20 a month with insurance, can't beat that.
> Good luck and I hope Prozac works out for you. Keep us informed on your progress. :)Thanks, I have my appointment this Thursday, so I am anxious to try to make some much needed changes. I can't wait to get off Lamictal! The thought of no more headaches.... Now the question is, which mood stabilizer? I think that they will want me to go with Depakote, but I am leaning toward pushing for Trileptal. I don't want blood tests and I fear weight gain like it's the apocalypse. But again, who knows how I will react. Sucks to have to move on to mood stabilizers that are really for mania when depression has always been what cripples me. Oh well. Lamictal, I hardly knew ye. Maybe in another life, when we are both cats.
This is the end of the thread.
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