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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 31. Go back in thread:
Posted by SLS on March 26, 2013, at 12:29:03
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by Twinleaf on March 26, 2013, at 11:44:31
Hi Twinleaf.
> I have a couple of thoughts: because you have an element of PTSD which has responded well to Prazosin, would it be worthwhile to find out your cortisol levels,
My cortisol levels have historically been high, and I am a dexamethasone non-suppressor.
> and,if it is high, and if you don't suppress normally, do the things which are known to lower it - such as meditation, physical touch
Physical touch is tremendously soothing to me, depending on the person doing the touching. :-)
> such as massages, and even trying a spray of nasal oxytocin?
Interesting. Where would I find this?
> TMS definitely lowers cortisol, and can also reverse non-suppression, but only temporarily.
I didn't know that. Thanks.
> It does this for me. You do have to keep on doing it, and the cost gets very high. I have one treatment every four months.
I thought to use TMS as an adjunct to medication. I have not checked recently with Medicare to find out whether they have started to cover it yet. What do you know about deep TMS?
> Lastly, and probably most important, what about another trial of therapy, with emphasis on the cortisol- lowering aspects - a very good fit where you feel truly safe, and where the relationship is of primary importance?
I think about returning to psychotherapy every now and then, but I haven't decided upon what issues I need help with. I'll give it more thought.
> I feel that this has been the most important thing I have done, and the one thing that has helped the most. I know those really good therapy relationships are not easy to find, but they can be invaluable.
I need someone who is committed to the fact that my that depressive disorder is predominantly biological in nature, and to design a treatment plan taking that into consideration. My last psychotherapist didn't do this, although I profited a great deal from my interactions with her. I simply filtered out her biases against biological psychiatry. It was a source of tension, though.
Thank you for offering such kindness and insightful suggestions.
- Scott
Posted by Twinleaf on March 26, 2013, at 13:19:28
In reply to Re: My attempt to discontinue Lamictal = relapse. » Twinleaf, posted by SLS on March 26, 2013, at 12:29:03
I also have high cortisol levels, and, at times, am a non-suppressor. I do use meditation, exercise, loving touch ( and massages) and oxytocin nasal spray, which I get from International Anti-aging Systems. The effect is mild, but I definitely notice a calming effect. The same is true of TMS. As far as I know, it is not yet paid for by Medicare or any insurance. I would think deep TMS would be even more effective, but haven't had any experience with it.
As to the therapy, I kind of think the best therapy occurs when one stops having an agenda!
I have focused as much as possible on cortisol in my own treatment, because of my own background of childhood trauma and because of its known deleterious effects on the hippocampus (lack of new cells forming daily, damage to CA3 cells, loss of volume) which are thought to be the main reasons for the development of reactive depression. My psychoanalyst is very up-to-date on all these things, so there is no stress between us on that score.
Posted by tensor on March 26, 2013, at 15:06:50
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
> I attempted to discontinue Lamictal in the hope that my cognition and memory would improve. They did. Unfortunately, I relapsed within a week of discontinuation. I have had to restart Lamictal and will return to a dosage of 200 mg/day. At some point, I might attempt to reduce the dosage to 150 mg/day, but for now, I am looking to reestablish a stable antidepressant response.
>
> I am left feeling demoralized and doomed. I am less optimistic about my future. I am too far from remission to return to work, and I am sick and tired of being so ill. I am losing my motivation to fight and push against my depression. It is ridiculous to be on 7 different drugs and not feel more than 50% well. What choice do I have? I have attempted to remove each drug except for the antidepressants (Parnate and nortriptyline). I relapsed with each attempt, demonstrating to me that I need all 7 drugs in order to receive any relief. My dependency on medication is upsetting.
>
>
> - ScottI'm sad to read this. Atleast, you will now know you were not taking it for nothing. I hope you get relief soon, Scott, you are greater than your suffering.
The most authentic thing about us is our capacity to create, to overcome, to endure, to transform, to love and to be greater than our suffering. Ben Okri/tensor
Posted by Roslynn on March 26, 2013, at 15:52:49
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Posted by joe schmoe on March 26, 2013, at 16:37:57
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Sorry to hear you are feeling down. It is quite understandable.
Have you ever had your testosterone levels checked?
Posted by Phillipa on March 26, 2013, at 20:26:12
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Scott after thinking about this some today. I recall you once saying I think that some doctor discontinued a med that was working for you and this is when you became a nonresponder. Is it possible this doc is responsible for what happened to you? Or is it possible after all this time that your diagnosis is wrong and not bipolar since didn't you post one manic reaction to a med? Seems that after all these years all the docs you have seen could find something that helps. I only question as I wonder at times if less is better after the neurotransmitters have time to return to their pre med state. I again am at a loss for words. Phillipa
Posted by alexcanada on March 26, 2013, at 20:41:49
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
I was losing my motivation this morning too during what I believe what a horrendous Anafranil + ritalin interaction. My mood was in a horribly negative state.
The cognition aspect is so difficult. Do you recall what your baseline is like? Such as when you are on very few meds or no meds? Or what is your personal diagnosis?
Lamictal I found to provide some very positive relief in terms of anxiety and some positive mood but unfortunately the cognitive side effects made me incapable of tolerating it. Though I have issues tolerating many meds and my deep melancholic symptoms are not a proper fit for lamictal anyway.
Have you attempted much in terms of alternatives such as supplements and herbals? I had some very positive benefit from Licorice root but it unfortunately interacts with SSRIs and likely SNRIs too. It provided me with some increased sense of peacefulness, positivity, and remarkably empathy. Though it increased anxiety.
> I attempted to discontinue Lamictal in the hope that my cognition and memory would improve. They did. Unfortunately, I relapsed within a week of discontinuation. I have had to restart Lamictal and will return to a dosage of 200 mg/day. At some point, I might attempt to reduce the dosage to 150 mg/day, but for now, I am looking to reestablish a stable antidepressant response.
>
> I am left feeling demoralized and doomed. I am less optimistic about my future. I am too far from remission to return to work, and I am sick and tired of being so ill. I am losing my motivation to fight and push against my depression. It is ridiculous to be on 7 different drugs and not feel more than 50% well. What choice do I have? I have attempted to remove each drug except for the antidepressants (Parnate and nortriptyline). I relapsed with each attempt, demonstrating to me that I need all 7 drugs in order to receive any relief. My dependency on medication is upsetting.
>
>
> - Scott
Posted by Beckett on March 26, 2013, at 20:48:20
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Posted by alchemy on March 26, 2013, at 22:47:00
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
You are a very helpful and smart guy. We are all rooting for you :-)
Posted by jono_in_adelaide on March 26, 2013, at 23:16:48
In reply to I'm sorry to hear this Scott (nm), posted by Beckett on March 26, 2013, at 20:48:20
Scott, I know 7 meds seems like a lot, but if you feel better on 7 meds than 6, then I say take them. The goal is to feel as good as you can, regardless how many pills a day that entails.
i think you have done realy well, you havent become self sorry, you have amazing insight into your condition, and you havent withdrawn from society.
be proud
Posted by Jeroen on March 27, 2013, at 4:34:00
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
lamictal destroyed my life
lamotrigine induced psychosis occurs in 1% of users
YES in me... and my cocky *ss doctor wont prescribe to me any Saphris
Posted by Emme_V2 on March 27, 2013, at 6:51:13
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
I hope you feel better soon. One day at a time. I'm hoping the minocycline will let me at least get away with a lower dose of Lamictal. Maybe you will have the same luck and have fewer cognitive effects with a stable lower dose even if you can't discontinue.
I know 7 drugs seems like a lot, but please do what you need to for relief. Depression's a terrible thing.
Posted by Velthir on March 27, 2013, at 8:54:56
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Have you tried folic acid supplementation, SLS? There's some evidence that Lamictal depletes it and that adding folic acid can help its effects on depression and lesson its effect on memory. I'll try to dig up some articles at some point.
I take 800 mcg/day and I *think* it helps a bit.
Posted by SLS on March 27, 2013, at 15:08:55
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by Velthir on March 27, 2013, at 8:54:56
> Have you tried folic acid supplementation, SLS? There's some evidence that Lamictal depletes it and that adding folic acid can help its effects on depression and lesson its effect on memory. I'll try to dig up some articles at some point.
>
> I take 800 mcg/day and I *think* it helps a bit.Hi.
Thank you for the suggestion. I tried taking Deplin L-methylfolate a number of years ago. I responded favorably to it at first, then felt somewhat worse. I wonder if taking a smaller dose would have helped. I'll keep it in mind.
- Scott
Posted by jono_in_adelaide on March 27, 2013, at 21:29:49
In reply to Re: My attempt to discontinue Lamictal = relapse. » Velthir, posted by SLS on March 27, 2013, at 15:08:55
I watched that video ad that Deplin has on its website, and i have to say, it was a bit of the stretch - if almost 50% of the population have difficulty converting dietary folate into its active form, why arent they suffering the symptoms of folate deficiency (sprue, anemia etc)
I'm sure Deplin greatly helps some people, but I think saying that half of the population are in need if it is a bit much
Posted by ChicagoKat on March 28, 2013, at 17:30:02
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Scott, I am sorry to hear this news. Hoping that things improve for you.
Kat
Posted by SLS on March 29, 2013, at 6:31:19
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
I'm titrating Lamictal all over again. I am remaining flexible in order to establish the lowest effective dosage, even if that means increasing the dosage above 200 mg/day. Let's see where I end up. So far, my memory and cognition remain intact. Ataxia has not emerged.
The combination of depression and drug effects can be confusing and sometimes fool me. It is quite possible that my complaints regarding memory and cognitive impairments were actually the depression and not the Lamictal. One thing interesting about Lamictal is that one can experience a brief improvement in depression upon dosage reduction. I think that this is exactly what happened to me when I reported feeling better as I rapidly tapered the dose. If so, then I might be better off taking 300 mg/day than 200 mg/day.
Today, I am more hopeful.
I would like to thank everyone for your support and valuable suggestions.
- Scott
Posted by Tyrannosaur on March 30, 2013, at 12:33:56
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by Velthir on March 27, 2013, at 8:54:56
> Have you tried folic acid supplementation, SLS? There's some evidence that Lamictal depletes it and that adding folic acid can help its effects on depression and lesson its effect on memory. I'll try to dig up some articles at some point.
>
> I take 800 mcg/day and I *think* it helps a bit.If you're Velthir from depressionforums.org could you turn on your babblemail? I've got a few questions for you. Thanks
Posted by SLS on March 30, 2013, at 21:22:02
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by SLS on March 29, 2013, at 6:31:19
Hi all.
> I'm titrating Lamictal all over again. I am remaining flexible in order to establish the lowest effective dosage, even if that means increasing the dosage above 200 mg/day. Let's see where I end up. So far, my memory and cognition remain intact. Ataxia has not emerged.
> The combination of depression and drug effects can be confusing and sometimes fool me. It is quite possible that my complaints regarding memory and cognitive impairments were actually the depression and not the Lamictal. One thing interesting about Lamictal is that one can experience a brief improvement in depression upon dosage reduction. I think that this is exactly what happened to me when I reported feeling better as I rapidly tapered the dose. If so, then I might be better off taking 300 mg/day than 200 mg/day.
So far, so good. I have been taking Lamictal 300 mg/day for 5 days, and cognitive side effects have not emerged. I have been feeling significantly better over the last 3 days. It is hard for me not to be optimistic, but my brain is notorious for resisting the therapeutic response to treatment. I usually relapse after 3 days of improvement. Obviously, I am still within that 3-day window. I could relapse tomorrow.
The next few days will be critical.
- Scott
Posted by SLS on March 31, 2013, at 8:57:38
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by SLS on March 30, 2013, at 21:22:02
Woohoo!
Insomnia!
For me, insomnia is a great indicator that a treatment is working. Today is day 4 of my therapeutic response, and I am enjoying the improved state.
- Scott
Posted by Tomatheus on March 31, 2013, at 9:20:13
In reply to Insomnia! This is a good thing., posted by SLS on March 31, 2013, at 8:57:38
> Woohoo!
>
> Insomnia!
>
> For me, insomnia is a great indicator that a treatment is working. Today is day 4 of my therapeutic response, and I am enjoying the improved state.
>
>
> - ScottThis is good to hear, Scott. For those of us who tend to experience three-day therapeutic responses to some treatments, experiencing a fourth day of therapeutic benefits is certainly a good sign. I hope that Lamictal continues to treat you well at 300 mg/day.
Tomatheus
Posted by tensor on March 31, 2013, at 11:38:10
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by SLS on March 30, 2013, at 21:22:02
> Hi all.
>
> > I'm titrating Lamictal all over again. I am remaining flexible in order to establish the lowest effective dosage, even if that means increasing the dosage above 200 mg/day. Let's see where I end up. So far, my memory and cognition remain intact. Ataxia has not emerged.
>
> > The combination of depression and drug effects can be confusing and sometimes fool me. It is quite possible that my complaints regarding memory and cognitive impairments were actually the depression and not the Lamictal. One thing interesting about Lamictal is that one can experience a brief improvement in depression upon dosage reduction. I think that this is exactly what happened to me when I reported feeling better as I rapidly tapered the dose. If so, then I might be better off taking 300 mg/day than 200 mg/day.
>
> So far, so good. I have been taking Lamictal 300 mg/day for 5 days, and cognitive side effects have not emerged. I have been feeling significantly better over the last 3 days. It is hard for me not to be optimistic, but my brain is notorious for resisting the therapeutic response to treatment. I usually relapse after 3 days of improvement. Obviously, I am still within that 3-day window. I could relapse tomorrow.
>
> The next few days will be critical.
>
>
> - ScottGood news. How fast did you titrate? I'm thinking of restarting Lamictal after a few months hiatus. Wondering if I could go a little faster this time.
/tensor
Posted by SLS on March 31, 2013, at 12:53:57
In reply to Re: My attempt to discontinue Lamictal = relapse. » SLS, posted by tensor on March 31, 2013, at 11:38:10
Hi Tensor.
> > So far, so good. I have been taking Lamictal 300 mg/day for 5 days, and cognitive side effects have not emerged. I have been feeling significantly better over the last 3 days. It is hard for me not to be optimistic, but my brain is notorious for resisting the therapeutic response to treatment. I usually relapse after 3 days of improvement. Obviously, I am still within that 3-day window. I could relapse tomorrow.
> >
> > The next few days will be critical.> Good news. How fast did you titrate?
Be aware that I tapered Lamictal quickly and discontinued it completely for only two days before I relapsed. I don't think our situations are comparable. Even if you didn't develop a rash reaction during your first trial of Lamictal, does not guarantee that you will not have a reaction upon restarting it. For me, I know when I am titrating too quickly if my eyes start itching.
If you want to be somewhat conservative, what makes sense to me is the following schedule. It is a more rapid titration than what is recommended by the manufacturer.
25 mg/day for one week
50 mg/day for one week
100 mg/day for one week
200 mg/day for at least two weeksI know it is tempting to titrate Lamictal more rapidly, and you might be able to do so without adverse effects. If you decide to be more aggressive, and you do develop a rash, just know that you can discontinue taking it and restart at a more gradual pace.
- Scott
Posted by tensor on March 31, 2013, at 14:43:25
In reply to Re: My attempt to discontinue Lamictal = relapse. » tensor, posted by SLS on March 31, 2013, at 12:53:57
> Be aware that I tapered Lamictal quickly and discontinued it completely for only two days before I relapsed. I don't think our situations are comparable. Even if you didn't develop a rash reaction during your first trial of Lamictal, does not guarantee that you will not have a reaction upon restarting it. For me, I know when I am titrating too quickly if my eyes start itching.
>
> If you want to be somewhat conservative, what makes sense to me is the following schedule. It is a more rapid titration than what is recommended by the manufacturer.
>
> 25 mg/day for one week
> 50 mg/day for one week
> 100 mg/day for one week
> 200 mg/day for at least two weeks
>
> I know it is tempting to titrate Lamictal more rapidly, and you might be able to do so without adverse effects. If you decide to be more aggressive, and you do develop a rash, just know that you can discontinue taking it and restart at a more gradual pace.
>
>
> - ScottThat was the titration rate I was thinking of, I need to call my pdoc on tuesday before starting. The amitriptyline is helping with the physical fatigue but I'm mentally exhausted most of the time.
Thanks,
tensor
Posted by brynb on April 5, 2013, at 16:19:49
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
hi Scott,
sorry to hear :(. I was doing ok with ketamine for a while and had a recent relapse/setback too.
have you tried ketamine yet? or TMS? TMS and MAOIs are my next move.
hang in there--you always give great advice and have excellent insight. I so can relate to feeling demoralized and hopeless right now. I'm sure your efforts and knowledge will pay off in the long run. chin up.
-b
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