![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Sulpicia on January 28, 2001, at 15:42:36
Sorry in advance to anyone who's read this b4; I posted this earlier on the kiddie forum.
Hi Folks --
I have one horribly depressed 15 y/o with bipolar II dx. She was doing really well on wellbutrin and lamictal. Alas:
a week or so after we moved to 150mgs during a nice slow and by the books increase, she developed an actinic
rash and mouth ulcers. We took her off for nine frantic days while I tracked down and read *everything* written
about lamictal, lamictal and wellbutrin, SJS, TENS, actinic rashes, restarts, you name it. Rash went away w/in 24
hrs of starting prednisone. No biopsy [I read the derm stuff last like an idiot] so no confirmation other than
hypersensitivity. In view of the facts that: she didn't respond to depakote at all [8 wks therapeutic level] and was
rendered unconscious after 36 hrs by starting dose of lithium, had 4 p-hospitalizations and nearly died, we
decided to restart the lamictal. There is virtually no data here for us to work with. I know the rule: start low and go
slow. So far so good and up to 25mgs w/out problems. Am checking temp, lymph nodes, and skin. *Frequently*
Her severe depression returned w/in 24 hrs of stopping lamictal and has not shown any signs of letting up. Terrible
hypersomnia, 22 hrs per day, sadness, apathy, hunger, unable to eat, bathe or do anything. Once last week she
was able to stay awake for 24 hrs straight and made it to school. For one day out of the last 2 wks. Not a bad
strategy to use sleep deprivation to combat depression. Anyway, at the safe rate of increase she will be at the
level were she got relief in about 6 wks. She'll never make it. Pdoc tried provigil to no effect. This morning we
were down to 2 choices: try adding adderall [tricky at best w/ BP II and recent substance abuse remission] , or
exceed the traditional increase rate and pray. Started adderall 20mgs this AM; couldn't get up until severely
harrassed and threatened, and only managed 4 hrs awake. No mania tho or drug cravings. Thank god for AA.So, here's the question: I need experiential, or best guess, or even ethical calculus input here -- how fast can we
increase the lamictal?And yes, just in case you're wondering, I *do* realize that we're playing with fire but the situation is dire. Pdoc is
fabulous, highly experienced but there is simply no available data on which to make a decision. We're reluctant to
do a faster increase but also horrified of relapse. Between a rock and hard place indeed.Any and all input appreciated.
Posted by Ron Hill on January 29, 2001, at 11:08:05
In reply to Lamictal restart dosage help, posted by Sulpicia on January 28, 2001, at 15:42:36
Hi Sulpicia,
Boy you have been doing your homework, huh? Your daughter is fortunate to have such a caring and intelligent mom. I'm not going to be able to tell you anything you don't already know, but I'll add my two cents worth since your daughters situation hits close to home.
I am BP II currently taking Lithobid (600 mg/day), Prozac (20 mg/day), and Wellbutrin (100 mg/day). My meds are currently working extremely well (PTL). However, I was initially misdiagnosed as ADHD and prescribed Ritalin. The Ritalin pushed me into mania big time. But the mania felt so good that I could not be convinced by the people around me that something was wrong. And my ex-pdoc did not recognize my mania but instead kept writing scripts for Ritalin (can you say malpractice?).
I mention this only to say that I have a BIG CONCERN about putting a BP patient on a stimulant (Adderall in this case) without first having a mood stabilizer fully in place. Yes, I know you have this concern also.
At the same time, as a parent you want to "fix" the depression ASAP. However, as you know, a switch into mania could (maybe) result in a more treatment resistant BP disorder. So I can see how its been hard for you to decide in this case.
Here is what I would do (beware, however, I am no expert, so take my advice with that in mind):
1) Ditch the Adderall, keep the Wellbutrin, and slowly titrate the Lamictal up to a therapeutic level. Carry the kid through the short-term depression by taking special care of her until the Lamictal kicks in. In particular, talk with the kid a lot and help her fully understand what is happening in her brain and that the depression will be short lived. This too shall pass. Repeatedly fill her with hope and positive thoughts.
Encourage her to spend some time outside during sunlight hours and, if at all possible, have her exercise daily. Encourage her to have visitors and invite her friends over, provided your daughter is willing to be vulnerable enough to let her friends know that she is going through a short-term depression. I wouldn't spoil the kid, but I would be very understanding and cut the kid more slack than would otherwise be allowed.
After the full dose of lamictal is in place, if the kid is coming out of the depression but is still lethargic, unmotivated, with lack of energy and enthusiasm, then add an SSRI to the mix keeping the Wellbutrin and mood stabilizer in place. However, do not add an SSRI without a mood stabilizer fully in place.
2) Talk to the pdoc about the efficacy of adding Neurontin, Tegretol, or another AED (but not Depokote) as an adjunct mood stabilizer until the Lamictal can be fully ramped up.
Well that's my two cents. Solicit responses from SLS, Cam W, and JohnL.
I took Lamictal at one time and I liked it. However, I developed a rash and decided to quit. Fortunately, Lithobid works well for me. At some time in the future I may try adding a small amount of Lamictal to my Lithobid because I really liked Lamictal. As I later learned, I ramped up the lamictal way too fast in my first trial.
Best Wishes!
-- Ron
-------------------------------------
> Sorry in advance to anyone who's read this b4; I posted this earlier on the kiddie forum.
>
> Hi Folks --
> I have one horribly depressed 15 y/o with bipolar II dx. She was doing really well on wellbutrin and lamictal. Alas:
> a week or so after we moved to 150mgs during a nice slow and by the books increase, she developed an actinic
> rash and mouth ulcers. We took her off for nine frantic days while I tracked down and read *everything* written
> about lamictal, lamictal and wellbutrin, SJS, TENS, actinic rashes, restarts, you name it. Rash went away w/in 24
> hrs of starting prednisone. No biopsy [I read the derm stuff last like an idiot] so no confirmation other than
> hypersensitivity. In view of the facts that: she didn't respond to depakote at all [8 wks therapeutic level] and was
> rendered unconscious after 36 hrs by starting dose of lithium, had 4 p-hospitalizations and nearly died, we
> decided to restart the lamictal. There is virtually no data here for us to work with. I know the rule: start low and go
> slow. So far so good and up to 25mgs w/out problems. Am checking temp, lymph nodes, and skin. *Frequently*
> Her severe depression returned w/in 24 hrs of stopping lamictal and has not shown any signs of letting up. Terrible
> hypersomnia, 22 hrs per day, sadness, apathy, hunger, unable to eat, bathe or do anything. Once last week she
> was able to stay awake for 24 hrs straight and made it to school. For one day out of the last 2 wks. Not a bad
> strategy to use sleep deprivation to combat depression. Anyway, at the safe rate of increase she will be at the
> level were she got relief in about 6 wks. She'll never make it. Pdoc tried provigil to no effect. This morning we
> were down to 2 choices: try adding adderall [tricky at best w/ BP II and recent substance abuse remission] , or
> exceed the traditional increase rate and pray. Started adderall 20mgs this AM; couldn't get up until severely
> harrassed and threatened, and only managed 4 hrs awake. No mania tho or drug cravings. Thank god for AA.
>
> So, here's the question: I need experiential, or best guess, or even ethical calculus input here -- how fast can we
> increase the lamictal?
>
> And yes, just in case you're wondering, I *do* realize that we're playing with fire but the situation is dire. Pdoc is
> fabulous, highly experienced but there is simply no available data on which to make a decision. We're reluctant to
> do a faster increase but also horrified of relapse. Between a rock and hard place indeed.
>
> Any and all input appreciated.
Posted by Sulpicia on January 29, 2001, at 11:19:12
In reply to Re: Lamictal Restart - Attn SLS, Cam, JohnL » Sulpicia, posted by Ron Hill on January 29, 2001, at 11:08:05
>Thank you so much Ron -- I really felt like I was out of options. Your post made me realize that part of my response is panic, and so untrustworthy.
And on top of this huge mess, I'm stuck in my office grading %&^*ing exams. With 5 pm deadlline.
Will be back soonest.
I introduced myself to this board on a separate thread this am.Liz [actually] :)
Posted by SLS on January 29, 2001, at 15:34:38
In reply to Lamictal restart dosage help, posted by Sulpicia on January 28, 2001, at 15:42:36
I would be surprised if you had trouble with the following schedule
25mg x 2 weeks
50mg x 2 weeks
100 x 1-2 weeks
150 x 1 week
etc.
This schedule is recommended when Lamictal is used without any other anticonvulant. The only recognized use of Lamictal by the FDA is as an add-on to things like Depakote, phenytoin, and phenobarbital. Therefore, the only schedule recommended in the drug label is for this approved drug combination use. Each of these drugs interact with the others to produce different blood levels.Oh, by the way HI.
- Scott
> Sorry in advance to anyone who's read this b4; I posted this earlier on the kiddie forum.
>
> Hi Folks --
> I have one horribly depressed 15 y/o with bipolar II dx. She was doing really well on wellbutrin and lamictal. Alas:
> a week or so after we moved to 150mgs during a nice slow and by the books increase, she developed an actinic
> rash and mouth ulcers. We took her off for nine frantic days while I tracked down and read *everything* written
> about lamictal, lamictal and wellbutrin, SJS, TENS, actinic rashes, restarts, you name it. Rash went away w/in 24
> hrs of starting prednisone. No biopsy [I read the derm stuff last like an idiot] so no confirmation other than
> hypersensitivity. In view of the facts that: she didn't respond to depakote at all [8 wks therapeutic level] and was
> rendered unconscious after 36 hrs by starting dose of lithium, had 4 p-hospitalizations and nearly died, we
> decided to restart the lamictal. There is virtually no data here for us to work with. I know the rule: start low and go
> slow. So far so good and up to 25mgs w/out problems. Am checking temp, lymph nodes, and skin. *Frequently*
> Her severe depression returned w/in 24 hrs of stopping lamictal and has not shown any signs of letting up. Terrible
> hypersomnia, 22 hrs per day, sadness, apathy, hunger, unable to eat, bathe or do anything. Once last week she
> was able to stay awake for 24 hrs straight and made it to school. For one day out of the last 2 wks. Not a bad
> strategy to use sleep deprivation to combat depression. Anyway, at the safe rate of increase she will be at the
> level were she got relief in about 6 wks. She'll never make it. Pdoc tried provigil to no effect. This morning we
> were down to 2 choices: try adding adderall [tricky at best w/ BP II and recent substance abuse remission] , or
> exceed the traditional increase rate and pray. Started adderall 20mgs this AM; couldn't get up until severely
> harrassed and threatened, and only managed 4 hrs awake. No mania tho or drug cravings. Thank god for AA.
>
> So, here's the question: I need experiential, or best guess, or even ethical calculus input here -- how fast can we
> increase the lamictal?
>
> And yes, just in case you're wondering, I *do* realize that we're playing with fire but the situation is dire. Pdoc is
> fabulous, highly experienced but there is simply no available data on which to make a decision. We're reluctant to
> do a faster increase but also horrified of relapse. Between a rock and hard place indeed.
>
> Any and all input appreciated.
Posted by Sulpicia on January 30, 2001, at 17:36:51
In reply to Re: Lamictal restart dosage help, posted by SLS on January 29, 2001, at 15:34:38
> I would be surprised if you had trouble with the following schedule
>
> 25mg x 2 weeks
> 50mg x 2 weeks
> 100 x 1-2 weeks
> 150 x 1 week
> etc.
>
>
> This schedule is recommended when Lamictal is used without any other anticonvulant. The only recognized use of Lamictal by the FDA is as an add-on to things like Depakote, phenytoin, and phenobarbital. Therefore, the only schedule recommended in the drug label is for this approved drug combination use. Each of these drugs interact with the others to produce different blood levels.
>
> Oh, by the way HI.
>
>
> - Scott
>
>
> >HI Scott -- nice to meet you thanks for the input. It would be nice if the manufacturer's web site had anything *helpful* on aside from "not recommended for under 18 except for intractable seizures."
We've made the jump to 50mgs w/out incident. And may use the schedule you suggested [it's identical to her earlier start-up] but w/ 7 day interval between increases. Still doing risk/benefit calculation and being deeply scared.
The rash, if it appears and progresses, is a bona fide bitch. And I really want to get rid of the adderall -- a dangerous emergency measure.Will keep posting.
Liz
Posted by Sulpicia on January 30, 2001, at 17:57:00
In reply to Re: Lamictal Restart - Attn SLS, Cam, JohnL » Sulpicia, posted by Ron Hill on January 29, 2001, at 11:08:05
> Hi Ron -- now that I have a minute to catch my breath, I want to tell you how much I appreciate your long and helpful post.
You are wrong that you weren't telling me something I didn't know. I had not realized that mania/hypomania would make the BP more difficult to control. Is this only the case with drug-induced mania or does it also result from poor or ineffective mood stabilization. I'll have to read up on this. Clearly I've missed something important. Thanks for the heads up.
So for now: increasing lamictal with "standard" increments but accelerated schedule, i.e 5-7 day interval.
Will get rid of the adderall as soon as humanly possible. Certainly w/in 5 days.
I'm especially grateful for your psycho-social suggestions. In fact I printed them out.
I'll try to hire 2 shifts of pnurses and arrange to spend as much time as possible with her. Unfortunately leave from school is impossible at this time, but w/nurses I can manage it. I hope.
SSRIs -- am a bit gunshy here; paxil made her really irritable, tho this was w/out MS and pre BP dx.
Favorite alternatives for me to consider? Or perhaps once the MS is good, it won't matter.Thank you again -- I really appreciate the advice and support.
Liz
Posted by Ron Hill on January 30, 2001, at 20:34:27
In reply to Re: Lamictal Restart - Attn SLS, Cam, JohnL » Ron Hill, posted by Sulpicia on January 30, 2001, at 17:57:00
Liz,
I've read a few studies by various doctors contending that with each cycle into depression or mania the risk may increase for the bipolar patient to become more treatment resistant. I don't think it matters whether the switch is medication induced or just part of the "normal" bipolar cycling. I don't recall the link to this information. Further, as I understand it, not everyone buys into this theory.
Forget what I said about SSRIs. Please block and cut that part of my post from your memory banks. Here's the paragraph:
"After the full dose of lamictal is in place, if the kid is coming out of the depression but is still lethargic, unmotivated, with lack of energy and enthusiasm, then add an SSRI to the mix keeping the Wellbutrin and mood stabilizer in place. However, do not add an SSRI without a mood stabilizer fully in place." NOT
Okay, now block it and cut it. Thanks!
What I was thinking was vice versa of what I actually wrote. Let me explain. In my personal experience, I was on Lithobid and Prozac but was lethargic, unmotivated, with a total lack of energy and enthusiasm. Then I added a small amount Wellbutrin and was cured almost instantaneously. Sorry for the mix up. :-)
Best Wishes to You and Yours!
-- Ron
------------------------------------------------
> > Hi Ron -- now that I have a minute to catch my breath, I want to tell you how much I appreciate your long and helpful post.
> You are wrong that you weren't telling me something I didn't know. I had not realized that mania/hypomania would make the BP more difficult to control. Is this only the case with drug-induced mania or does it also result from poor or ineffective mood stabilization. I'll have to read up on this. Clearly I've missed something important. Thanks for the heads up.
> So for now: increasing lamictal with "standard" increments but accelerated schedule, i.e 5-7 day interval.
> Will get rid of the adderall as soon as humanly possible. Certainly w/in 5 days.
> I'm especially grateful for your psycho-social suggestions. In fact I printed them out.
> I'll try to hire 2 shifts of pnurses and arrange to spend as much time as possible with her. Unfortunately leave from school is impossible at this time, but w/nurses I can manage it. I hope.
> SSRIs -- am a bit gunshy here; paxil made her really irritable, tho this was w/out MS and pre BP dx.
> Favorite alternatives for me to consider? Or perhaps once the MS is good, it won't matter.
>
> Thank you again -- I really appreciate the advice and support.
> Liz
Posted by Sulpicia on February 5, 2001, at 12:06:33
In reply to Lamictal restart dosage help, posted by Sulpicia on January 28, 2001, at 15:42:36
> Sorry in advance to anyone who's read this b4; I posted this earlier on the kiddie forum.
>
> Hi Folks --
> I have one horribly depressed 15 y/o with bipolar II dx. She was doing really well on wellbutrin and lamictal. Alas:
> a week or so after we moved to 150mgs during a nice slow and by the books increase, she developed an actinic
> rash and mouth ulcers. We took her off for nine frantic days while I tracked down and read *everything* written
> about lamictal, lamictal and wellbutrin, SJS, TENS, actinic rashes, restarts, you name it. Rash went away w/in 24
> hrs of starting prednisone. No biopsy [I read the derm stuff last like an idiot] so no confirmation other than
> hypersensitivity. In view of the facts that: she didn't respond to depakote at all [8 wks therapeutic level] and was
> rendered unconscious after 36 hrs by starting dose of lithium, had 4 p-hospitalizations and nearly died, we
> decided to restart the lamictal. There is virtually no data here for us to work with. I know the rule: start low and go
> slow. So far so good and up to 25mgs w/out problems. Am checking temp, lymph nodes, and skin. *Frequently*
> Her severe depression returned w/in 24 hrs of stopping lamictal and has not shown any signs of letting up. Terrible
> hypersomnia, 22 hrs per day, sadness, apathy, hunger, unable to eat, bathe or do anything. Once last week she
> was able to stay awake for 24 hrs straight and made it to school. For one day out of the last 2 wks. Not a bad
> strategy to use sleep deprivation to combat depression. Anyway, at the safe rate of increase she will be at the
> level were she got relief in about 6 wks. She'll never make it. Pdoc tried provigil to no effect. This morning we
> were down to 2 choices: try adding adderall [tricky at best w/ BP II and recent substance abuse remission] , or
> exceed the traditional increase rate and pray. Started adderall 20mgs this AM; couldn't get up until severely
> harrassed and threatened, and only managed 4 hrs awake. No mania tho or drug cravings. Thank god for AA.
>
> So, here's the question: I need experiential, or best guess, or even ethical calculus input here -- how fast can we
> increase the lamictal?
>
> And yes, just in case you're wondering, I *do* realize that we're playing with fire but the situation is dire. Pdoc is
> fabulous, highly experienced but there is simply no available data on which to make a decision. We're reluctant to
> do a faster increase but also horrified of relapse. Between a rock and hard place indeed.
>
> Any and all input appreciated.Am reposting this -- adderall is making her nuts. SHE wants to get off it but can't get out of bed w/out it. Maxxed out on Wellbutrin; lamictal now up to 100mgs and no relief yet.
Any suggestions to discuss w/pdoc for a fast AD/stim add-on?
Aside to Ron: the psycho-social stuff you suggested worked up to a point. Now she's so irritable that she can't stand to be around anyone.All advice and suggestions appreciated. Things are grim here.
S.
Posted by JohnL on February 5, 2001, at 18:59:23
In reply to Re: Lamictal restart dosage help: attn:JohnL all, posted by Sulpicia on February 5, 2001, at 12:06:33
Hello,
I'm really sorry how tough things are right now. I can definitely relate. I don't think there's anything I can say that would help. You seem to be doing everything right.
My pdoc told me that Lamictal has considerable action on the brain chemical dopamine. And since there was a decent response to Lamictal, that could be a hint that dopamine drugs should be explored.You've already looked at Wellbutrin. And Adderall. Another drug though that I personally think should be at the very top of the list is Zyprexa, preferably combined with Prozac. Zyprexa+Prozac. And if Zyprexa doesn't work out either (I bet it would though), then replace it with Risperdal.
With either of these, I would look for a hint of a decent response within a week, a stronger hint by week 2. In clinical trials Zyprexa or Risperdal have been shown to speed antidepressant response often within one week. Best with Prozac. One clinical trial in particular showed how Zyprexa+Prozac has profound antidepressant action in treatment resistent cases. Based on my own excellent response to these meds, I agree.
Zyprexa is not only very powerful for treating depression, but it is also officially approved now to treat mania in bipolar. It can be tried as a replacement for mood stabilizers.
Zyprexa usually causes sedation. It is good for sleep, though its onset is kind of slow but steady. I take it with dinner. After the first couple days or maybe a week, any daytime sedation goes away.
In the meantime, you are monitoring the Lamictal situation very closely and deserve a lot of credit for that. I would stop the Adderall. She doesn't like it. A superior match of drugs will allow her to function and feel better.
Hang in there! Please keep us informed.
John
Posted by Sulpicia on February 7, 2001, at 18:34:24
In reply to Re: Lamictal restart dosage help: attn:JohnL all, posted by JohnL on February 5, 2001, at 18:59:23
> Hi Guys --
Well, this morning the adderall stopped working so my daughter is bedridden again, and very unhappy of course. Lamictal up to 100 mgs w/out trouble.
I guess in consultation w/pdoc the next step should be Zyprexa. Does this mean stopping or weaning her from the wellbutrin or could we do a simultaneous intro and withdrawal?
I'm terrified to think of her being *more* depressed. At least she'll see the pdoc on Saturday -- he has that wonderful gift of giving her hope. He acts like her situation is the most normal thing in the world and that the course of bipolar is always like this. LOL.
I'm also afraid I'm at the limit of how much I can support her; I can't take a leave from grad school and I'm in the midst of an AD switch myself. Not a good place to be when others are depending on me.Any thoughts?
Liz
Posted by Ron Hill on February 9, 2001, at 12:53:18
In reply to Re: Lamictal restart dosage help: attn:Ron » JohnL, posted by Sulpicia on February 7, 2001, at 18:34:24
Liz,
I wish I knew the best med combo for your daughter (and you), but I don't. Someday this branch of medicine may advance to the point of accurate medication diagnosis, but in the meantime "educated trial and error" is the best there is.
Based on the small amount I know about your daughter’s symptoms, I would guess that the depressive aspect of her BP is more frequent and more pronounced than the mania aspect. If this is true (and at the risk of stating the obvious), your daughter’s trial and error process likely has two components. First, what med (or med combo) works best as a mood stabilizer and, second, what med (or med combo) works best as an AD in your daughter’s case?
How long did the Lamictal/Wellbutrin combination work prior to the rash problem? For whatever reason, sometimes a restart of a med does not work the second time around.
If the Lamictal is currently functioning as a satisfactory MS, then perhaps it is time to focus on the AD trial and error portion of the equation. If the Lamictal is not satisfactory, then, if it were me, I would attack the MS trial and error first. For the MS, I would spend time on the Internet reading the studies done on the other AED’s (anti-epileptic meds) that you have not tried yet. It’s too bad that lithium doesn’t agree with her. I would also follow up on John’s recommendation and read the research studies on Zyprexa (I know nothing about this med).
Okay, now the AD trial and error. You mentioned that your daughter is suffering with irritability. As you know, this is a fairly common side effect of Wellbutrin. In fact, on one occasion when I temporarily increased my Wellbutrin from 100 to 150 mg/day, I became very irritable. My layman's overly simplistic hypothesis is that the irritability occurs when my norepinephrine (or maybe dopamine?) becomes high relative to my serotonin levels. In other words, my theory is Wellbutrin induced irritability might be overcome via addition of a medication that raises serotonin.
An increase in Serotonin makes me happy, carefree, and very "un-anal", but can also take away my drive, motivation, and enthusiasm. Increasing my norepinephrine (and/or dopamine?) restores a good amount of drive, motivation, and enthusiasm, but can make me grumpy and irritable. Therefore, Prozac and Wellbutrin together in the right proportions work for me (right now anyway).
Some people advocate short trial periods (2 weeks or so) of various medications until you hit on one that shows good results in the mini trial. Then give the med that shows initial promise a longer trial.
Liz, I don’t think I’ve helped you much with this post, but I did want to respond to your request. I wish I knew the recipe. Here’s my philosophy:
The cup is always have full, it is never half empty. Problems are merely solutions waiting to be found; I just have to be smart enough to uncover one of the already existing solutions.
Your are clearly an intelligent Lady. Good luck as you conduct your “educated trial and error” procedure to find one of the existing solutions applicable to your daughter's situation.
-- Ron
------------------------------------------------> > Hi Guys --
> Well, this morning the adderall stopped working so my daughter is bedridden again, and very unhappy of course. Lamictal up to 100 mgs w/out trouble.
> I guess in consultation w/pdoc the next step should be Zyprexa. Does this mean stopping or weaning her from the wellbutrin or could we do a simultaneous intro and withdrawal?
> I'm terrified to think of her being *more* depressed. At least she'll see the pdoc on Saturday -- he has that wonderful gift of giving her hope. He acts like her situation is the most normal thing in the world and that the course of bipolar is always like this. LOL.
> I'm also afraid I'm at the limit of how much I can support her; I can't take a leave from grad school and I'm in the midst of an AD switch myself. Not a good place to be when others are depending on me.
>
> Any thoughts?
>
> Liz
Posted by Sulpicia on February 11, 2001, at 19:05:33
In reply to Re: Lamictal restart dosage help: attn:Ron » Sulpicia, posted by Ron Hill on February 9, 2001, at 12:53:18
>Thank you Ron. I know there is no easy miracle here. I guess I've been really lucky in that every time I needed an AD, it worked.
And of course depression, from where I sit, seems like a walk in the park compared to bipolar disorders.
I've actually gotten the most mileage from your behavioral suggestions -- on Friday she got out of bed and off to school on 10 mgs of adderall.
Remarkable? No -- a date with her boyfriend after school. With this evidence of her ability to function [not entirely] I've become firmer
about my expectations. My silly mantra of the week is "privileges go with recovery" -- meaning that she can't do anything fun unless she
convinces me that she is recovering, i.e., getting up.
Up to 100 mgs on the lamictal and still no trouble. And certainly a bit of improvement, even if she won't admit it.Best,
Liz :)
Posted by Ron Hill on February 11, 2001, at 21:04:25
In reply to Re: Lamictal restart dosage help: attn:Ron » Ron Hill, posted by Sulpicia on February 11, 2001, at 19:05:33
Liz,
What did the pdoc say on Saturday?
-- Ron
------------------------------------------> >Thank you Ron. I know there is no easy miracle here. I guess I've been really lucky in that every time I needed an AD, it worked.
> And of course depression, from where I sit, seems like a walk in the park compared to bipolar disorders.
> I've actually gotten the most mileage from your behavioral suggestions -- on Friday she got out of bed and off to school on 10 mgs of adderall.
> Remarkable? No -- a date with her boyfriend after school. With this evidence of her ability to function [not entirely] I've become firmer
> about my expectations. My silly mantra of the week is "privileges go with recovery" -- meaning that she can't do anything fun unless she
> convinces me that she is recovering, i.e., getting up.
> Up to 100 mgs on the lamictal and still no trouble. And certainly a bit of improvement, even if she won't admit it.
>
> Best,
> Liz :)
This is the end of the thread.
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