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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by MB on January 2, 2002, at 17:22:32
I'm taking Trileptal 300mg/day and will be working up to 450mg day. I'm tolorating it a lot better than the Gabitril that I tried a couple of weeks ago, but I'm noticing that the Trileptal is making me sleepy and sometimes spacy. Can anyone with experience with this drug tell me how long these side effects take to go away (if they do go away)?
MB
Posted by Elizabeth on January 5, 2002, at 3:56:20
In reply to How long until Trileptal sleepiness goes away?, posted by MB on January 2, 2002, at 17:22:32
> I'm taking Trileptal 300mg/day and will be working up to 450mg day. I'm tolorating it a lot better than the Gabitril that I tried a couple of weeks ago, but I'm noticing that the Trileptal is making me sleepy and sometimes spacy. Can anyone with experience with this drug tell me how long these side effects take to go away (if they do go away)?
You're feeling tired on Trileptal? Jeez, I'd say you're lucky -- I'd love it if this stuff helped me sleep. What are you taking it for, and do you find it helpful?
Unfortunately, I can't answer your question. I'm taking 600 mg of Trileptal and haven't noticed any side effects. I wonder if you could take it just once a day (at bedtime) and if so, whether that would help with the drowsiness. When are you taking it, and how much? (I take 300 in the morning and 300 at bedtime.)
Good luck to you.
-elizabeth
Posted by CalvaryHill on January 6, 2002, at 1:22:52
In reply to Re: How long until Trileptal sleepiness goes away? » MB, posted by Elizabeth on January 5, 2002, at 3:56:20
Keep in mind that recommendations for dosage for bipolar may be higher or lower than the dosage in the PDR for epilepsy.
Posted by MB on January 6, 2002, at 9:44:45
In reply to Re: How long until Trileptal sleepiness goes away? » MB, posted by Elizabeth on January 5, 2002, at 3:56:20
> > I'm taking Trileptal 300mg/day and will be working up to 450mg day. I'm tolorating it a lot better than the Gabitril that I tried a couple of weeks ago, but I'm noticing that the Trileptal is making me sleepy and sometimes spacy. Can anyone with experience with this drug tell me how long these side effects take to go away (if they do go away)?
>
> You're feeling tired on Trileptal? Jeez, I'd say you're lucky -- I'd love it if this stuff helped me sleep. What are you taking it for, and do you find it helpful?
Well, things have changed since I've been on it a while. It seems that about two hours after a dose, I get really agitated and restless. For a while there, I was only sleeping 4-5 hrs a night. It seems that the sleepiness hits as my blood levels of the Trileptal start to go *down*. This is all I can figure since the sleepiness hits right before my next dose, and the anxiety and agitation return if I take more.
> Unfortunately, I can't answer your question. I'm taking 600 mg of Trileptal and haven't noticed any side effects.
I find this stuff hard to tolorate. My pdoc wanted me to work up to 450mg/day (which I did, yuck) but it looks like I'm going to have to drop down to 300mg/day, and maybe to 225mg/day if I can't get used to the 300mg.
> I wonder if you could take it just once a day (at bedtime) and if so, whether that would help with the drowsiness. When are you taking it, and how much? (I take 300 in the morning and 300 at bedtime.)
He wants me to take it later at night because it makes me fatigued (flu-like symptoms) but I don't think he really heard me when I said that along with the fatigue is insomnia...
I'm taking it for rage attacks. I'm supposed to start Prozac for OCD and Adderall for ADD. Unfortunately, SSRIs make my anxiety and rage worse, and stimulants make my thoughts race so fast I "lose it" (and the anxiety on stims is absolutely, maddeningly unbearable). The Trileptal is supposed to help with these side effects. So far, the Trileptal has made the anxiety worse and I am scared to add an SSRI (and DEATHLY afraid to add a pstim!). One good thing about the Trileptal is that my rage attacks have gotten better. Also, I can no longer tolorate caffeine on the Trileptal, and I an willing to give it up (where before I wasn't)...sort of aversion therapy for my caffeine addiction which undoubtedly contributes to my anxiety. So, in the long run, in a round about way, the Trileptal might help my anxiety by forcing me off caffeine.
> Good luck to you.
>
> -elizabeth
Thanks, I'll need it...LOLMB
Posted by Elizabeth on January 6, 2002, at 22:34:56
In reply to Re: How long until Trileptal sleepiness goes away? » Elizabeth, posted by CalvaryHill on January 6, 2002, at 1:22:52
> Keep in mind that recommendations for dosage for bipolar may be higher or lower than the dosage in the PDR for epilepsy.
I wasn't comparing recommended doses; I was comparing the dose I take (600 mg/day) to the dose that MB takes (300 mg/day).
-e
Posted by Elizabeth on January 6, 2002, at 22:47:30
In reply to Re: How long until Trileptal sleepiness goes away? » Elizabeth, posted by MB on January 6, 2002, at 9:44:45
> Well, things have changed since I've been on it a while. It seems that about two hours after a dose, I get really agitated and restless.
Hmm. I wonder if it's contributing to my sleep problems (I'm a long-time insomniac).
> For a while there, I was only sleeping 4-5 hrs a night.
I'd be grateful for that much!
> It seems that the sleepiness hits as my blood levels of the Trileptal start to go *down*.
I haven't read up on the pharmacokinetics of Trileptal -- when does the serum level start dropping again? (Also remember that things like this may not be the same with steady-state levels as with a single dose.)
> This is all I can figure since the sleepiness hits right before my next dose, and the anxiety and agitation return if I take more.
Sounds like maybe an in-between dose is what you need. Maybe you could divide the doses up more (e.g., taking it three times a day instead of two)?
> I'm taking it for rage attacks. I'm supposed to start Prozac for OCD and Adderall for ADD.
Jeez. Honestly, I think that the chances are that your symptoms are all due to one underlying disorder. Have you ever tried benzos (Klonopin maybe?), and if so, what effect did they have?
> Unfortunately, SSRIs make my anxiety and rage worse, and stimulants make my thoughts race so fast I "lose it" (and the anxiety on stims is absolutely, maddeningly unbearable).
Yeah, I'm not so impressed by the recommendation of SSRIs and stimulants for you! How do you feel about it? Do you think it will be okay? It seems like Trileptal isn't the answer, but maybe there's something else that will help (that's why I asked about benzos -- I'm thinking Klonopin maybe). Also, have you tried other anticonvulsants like Depakote, Lamictal, etc. for the rage attacks? And is there anything else you've taken that's helped with the rages?
> > Good luck to you.
>
> Thanks, I'll need it...LOLYeah, I know what you mean! I hope things work out sooner or later (preferably sooner)!
-elizabeth
Posted by MB on January 7, 2002, at 0:18:50
In reply to Re: How long until Trileptal sleepiness goes away? » MB, posted by Elizabeth on January 6, 2002, at 22:47:30
> I haven't read up on the pharmacokinetics of Trileptal -- when does the serum level start dropping again? (Also remember that things like this may not be the same with steady-state levels as with a single dose.)
I don't know what the pharmacokinetics are but what I know is that it's making my depression worse. I was dysthymic before starting, now I don't care if I live, really. Just when I feel like I'm starting to pull myself out of the depressed pit (to the relatively high place of dysthymia), it's time for my next dose, and within two hours after I take it, all ability to have any positive feeling whatsoever is erased. Plus, it makes my body feel like absolute crap. I worked up to 450mg, then back down to 150mg...all I know is that its all bad and no good for me. I flushed that crap down the f*cking toilet tonight. I started the SSRI this morning, and around 7 tonight I could feel the Trileptal wearing off and I was actually feeling positive and even excited about starting school tomorrow. Then I took my evening dose of Trileptal, and I've crashed into another depression...totally hopeless. It only took two hours for the grey miasma of dread and hopelessness to overtake me. I'm not taking that crap anymore.
> > This is all I can figure since the sleepiness hits right before my next dose, and the anxiety and agitation return if I take more.
>
> Sounds like maybe an in-between dose is what you need. Maybe you could divide the doses up more (e.g., taking it three times a day instead of two)?
>
> > I'm taking it for rage attacks. I'm supposed to start Prozac for OCD and Adderall for ADD.
>
> Jeez. Honestly, I think that the chances are that your symptoms are all due to one underlying disorder. Have you ever tried benzos (Klonopin maybe?), and if so, what effect did they have?
They relax me with no side effects (unless I drink with them, then I dissociate). When I take them as prescribed they're great. Unfortunately, I'm in alcohol recovery (sober 2 years) so I'll have to try everything on the market before I'll be allowed to try a benzo. You know how it is.
> > Unfortunately, SSRIs make my anxiety and rage worse, and stimulants make my thoughts race so fast I "lose it" (and the anxiety on stims is absolutely, maddeningly unbearable).
>
> Yeah, I'm not so impressed by the recommendation of SSRIs and stimulants for you! How do you feel about it? Do you think it will be okay? It seems like Trileptal isn't the answer, but maybe there's something else that will help (that's why I asked about benzos -- I'm thinking Klonopin maybe). Also, have you tried other anticonvulsants like Depakote, Lamictal, etc. for the rage attacks? And is there anything else you've taken that's helped with the rages?
When I heard that the doc wanted to try SSRIs (*again*) I was mortified (I hate them) but he assured me the AE would mitigate the agitation/rage/anxiety induced by the SSRI (which Im supposed to start after getting on the AE). Then once I'm on the SSRI, I'm supposed to be able to tolorate the Adderall without anxiety. All I know is that I have OCD symptoms and I'm told SSRIs are the only way to go with OCD. My experience with SSRIs is that after I'm on them about a year, I go into a state where I'd sleep 24 hrs a day if someone would let me. I figured the Adderall would help with that, also.So, I took Gabitril for two weeks, but it made my fingers numb, and I couldn't think or remember what was real or not, what day it was, where I was, etc. It was like a waking, depressed dream. The Trileptal was better, but the depression got so much worse on that stuff, and now, even at a lower dose, the finger numbness is comming back. I think I hate antiepileptics. The past month has been like a dream...memories hazy like a dream you had three nights ago...pieces missing, anachronistic sequencing...bla bla bla
> > > Good luck to you.
> >
> > Thanks, I'll need it...LOL
>
> Yeah, I know what you mean! I hope things work out sooner or later (preferably sooner)!
>
> -elizabeth
Posted by Elizabeth on January 10, 2002, at 21:33:49
In reply to Re: How long until Trileptal sleepiness goes away? » Elizabeth, posted by MB on January 7, 2002, at 0:18:50
> I don't know what the pharmacokinetics are but what I know is that it's making my depression worse.
Uh-oh. It sounds like it's pretty bad. I think that if you're pretty sure that the Trileptal is to blame, getting off it makes sense (although it's important not to stop anticonvulsants abruptly -- you should really talk to your doctor about that). Anhedonia is a big part of my (major) depression, and it's really hard to treat -- buprenorphine is the only thing I've found that helps. A lot of people do feel more depressed on mood stabilizers, although they can have antidepressant effects on others.
> > Have you ever tried benzos (Klonopin maybe?), and if so, what effect did they have?
>
> They relax me with no side effects (unless I drink with them, then I dissociate). When I take them as prescribed they're great. Unfortunately, I'm in alcohol recovery (sober 2 years) so I'll have to try everything on the market before I'll be allowed to try a benzo. You know how it is.Yeah. *sigh* If you ask me, a history of alcoholism is a reason to consider a benzo, not a reason to rule them out. I think a lot of people who get in trouble with drugs are self-medicating, and what they need is a drug that acts similarly but that they can take under a doctor's supervision.
> When I heard that the doc wanted to try SSRIs (*again*) I was mortified (I hate them) but he assured me the AE would mitigate the agitation/rage/anxiety induced by the SSRI (which Im supposed to start after getting on the AE).
Wait -- do SSRIs have any positive effect on you that justifies exacerbating the anger/agitation symptoms?
> All I know is that I have OCD symptoms and I'm told SSRIs are the only way to go with OCD.
Well, sometimes the atypical antipsychotics, benzos, and Buspar are used. Also, I think that other things may often resemble OCD. What kind of symptoms do you have that are supposed to be indicative of OCD?
Best of luck to you. It looks like you're in a twisted situation that needs to get untangled!
-elizabeth
Posted by MB on January 11, 2002, at 16:44:56
In reply to Re: How long until Trileptal sleepiness goes away? » MB, posted by Elizabeth on January 10, 2002, at 21:33:49
> > I don't know what the pharmacokinetics are but what I know is that it's making my depression worse.
>
> Uh-oh. It sounds like it's pretty bad. I think that if you're pretty sure that the Trileptal is to blame, getting off it makes sense (although it's important not to stop anticonvulsants abruptly -- you should really talk to your doctor about that). Anhedonia is a big part of my (major) depression, and it's really hard to treat -- buprenorphine is the only thing I've found that helps. A lot of people do feel more depressed on mood stabilizers, although they can have antidepressant effects on others.
I'm off of the Trileptal and feeling better. By itself, it made me more depressed, but mixed with Prozac (which I started) it made me absolutely miserable. I felt stimulated and mildly euphoric from the Prozac, and then the Trileptal would kick in (approx. 2 hrs after dose) and I would sink into this horrible dysphoria that was like a mixture of euphoria and depression combined. Prozac by itself seems to cause anxiety, but not dysphoria in me. The doc wants me to try Neurontin next. I've taken it before for RLS and found it really tolorable.
> > > Have you ever tried benzos (Klonopin maybe?), and if so, what effect did they have?> > They relax me with no side effects (unless I drink with them, then I dissociate). When I take them as prescribed they're great. Unfortunately, I'm in alcohol recovery (sober 2 years) so I'll have to try everything on the market before I'll be allowed to try a benzo. You know how it is.
>
> Yeah. *sigh* If you ask me, a history of alcoholism is a reason to consider a benzo, not a reason to rule them out. I think a lot of people who get in trouble with drugs are self-medicating, and what they need is a drug that acts similarly but that they can take under a doctor's supervision.
I've had a few episodes of really *severe* anxiety since I started the Prozac. I find that Kava extract really helps. That's scary that some people are turning up with liver damage from the stuff.
> > When I heard that the doc wanted to try SSRIs (*again*) I was mortified (I hate them) but he assured me the AE would mitigate the agitation/rage/anxiety induced by the SSRI (which Im supposed to start after getting on the AE).
>
> Wait -- do SSRIs have any positive effect on you that justifies exacerbating the anger/agitation symptoms?
I think I got mixed up...it was *Wellbutrin* that made the anger worse, not SSRIs...they just give me anxiety and make my thoughts kind of racey. Well, they do relieve the depression for the first week or so that I'm on them, but then they poop out. I'd have to say that with the Prozac, the *anger* is better, but *anxiety* is worse. I'm supposed to try a higher dose this time of the Prozac (60mg instead of 20mg) so it might be different. Then, I'm supposed to add Adderall. I'm scared...I can't even drink a cup of green tea without severe, hand-ringing, hyperventilating anxiety (moreso now than ever since I started the Prozac). Amphetamine will send me to the moon. This is another reason for the antiepileptic; to help with the anxiety. Neither Trileptal nor Gabitril did anything for the anxiety. I don't know if Neurontin will help...the first time I was on it, I was also taking .25mg Xanax tid, so anxiety was not a problem
> > All I know is that I have OCD symptoms and I'm told SSRIs are the only way to go with OCD.
>
> Well, sometimes the atypical antipsychotics, benzos, and Buspar are used. Also, I think that other things may often resemble OCD. What kind of symptoms do you have that are supposed to be indicative of OCD?
Recurrent thoughts that are disturbing...thoughts of killing myself even when I'm not suicidal, thoughts of horrible things happening to people (people I love), etc. Anxiety when things are not in their place. Weird rituals like...my feet have to be on carpet when the clock chimes or when the toilet stops refilling. Also I repeat words over and over in my head and spell them out with my forefinger on my thumb. I think these last two are more *tics* than *obsessions* because stimulants (and SSRIs) make them worse and faster.
> Best of luck to you. It looks like you're in a twisted situation that needs to get untangled!
>
> -elizabeth
Well, thanks for the luck...I'm hoping the Neurontin smoothes things out without making me derealize (Gabitril) or sending me into a mixed state (Trileptal).MB
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