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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by linnette on October 15, 2003, at 0:15:54
This is my first post to this board. I have learned that you folks have loads of knowledge and hopefully I can get some feedback as to what is happening. Here goes: I have been diagnosed with bipolarII that my pdoc says is AD induced. My first major depressive episode as an adult happened at age 23. I have been on many, many meds and combos of meds. I don't think my depression is AD induced, because I remember having hypomanic episodes as a child, and my 1st major depression at age 8, but my doc hasn't questioned me at length about any of this. She also had indicated that I may just be treatment resistant.
My current meds are lamictal, (I'm on 75 mg/day on day 30)m 2 mg xanax, 35 nortiptyline, 50 mg zoloft. We added the lamictal because I just don't feel that life is worth the trouble anymore. I'm not suicidal, but just just don't care about much anymore. Waking up thinking about every wrong I've ever done, guilt ridden. Just hard to face each day. I also may mention that contrary to many opinions about benzos, xanax has been a lifesaver for me, and I have been on the same dose for many years, and am really religious about my dose timing, so as not to experience rebound effects.
At first the lamictal was stimulating, and I was hopeful. Then it levelled off, and although I find that I can now follow through on many things much better, such as work, I am going from feeling very depressed and teary, to just plain irritable to the point that I could just scream. Last week, for 1 or 2 days, my ears were ringing and I had some depersonalization, confusion, that seemed to be alleviated by dropping the zol by 25 mg.. I've also had to all but eliminate my caffeine consumption.
My question is, could the lamictal be making me feel worse before I feel better? I know some AD's have worked that way for me. Is this just part of the adjustment process with lamictal or should I give up on it? My doc wanted me up to 100 mg, but I haven't been able to get to 100 yet. I really want off the zoloft, since I have experienced more cycling when on it. I really am hoping that lamictal can be my main medication, but at this point I doubt it. Any feedback is appreciated.. I am really impressed with the knowledge on this board, and sorry about the lengthy post.
Posted by HenryO on October 15, 2003, at 1:32:09
In reply to lamictal questions , posted by linnette on October 15, 2003, at 0:15:54
I am not going to claim to have any special knowledge. I am just going to surmise based on my experience.
Your doctor thinks the bipolar II meds made you depressed?
I want to make sure I understand your terms, AD, anit-depresant medication?
I'd persevere with the Lamictal. For me there was a long period of waiting to get up to a therapeutic dose. I take 200mg daily and it has been the best AD/mood stabilizer I've ever taken.
At 225 I don't sleep that well and at 175 it doesn't work as well. I see people here taking twice that though. And of course you need to be so patient moving up the dose.
I like your idea of lowering the Zoloft dose slowly and prudently but I'd try to taper off it eventually. I don't know about interactions but I have learned to trust my gut. Certain meds made me feel truly strange. Some people like Zoloft.
I would also keep the Xanax handy and use it to tide you over while you dial in the Lamictal dose. I went through hell (emotional pain) for weeks after my cocktail washed out of my system and the Lamictal wasn't working yet. These multi med cocktails just make me a bit nervous. I took one for several years but I feel more secure on a single med with one or two on the shelf for when (or if) the bottoms drops out.
This whole process takes way to long. I want to encourage you to be hopeful about the Lamictal. I have seen people post here about Lamictal poop-out, but that has not been my experience. I have had great success with it.
Posted by linnette on October 15, 2003, at 11:00:44
In reply to Re: lamictal questions , posted by HenryO on October 15, 2003, at 1:32:09
thanks for the feedback henry.. I really appreciate it and it is good to hear positive feedback on the lamictal.
Yes, my pdoc did seem to think my bpII was antidepressant induced. Perhaps my doc just meant that the cycling was made worse by the many ADs I have been on.. Not real sure.
I will keep cautiously increasing the dose and see what happens. I will just grin and bear the irritability thing. The xanax does seem to help with that somewhat.
I know that the lamictal does, at least for me, provide some AD benefits, more so than any other mood stabilizers that I have been on. Thanks again for the feedback and I will keep you posted.
Posted by fluffy on October 16, 2003, at 12:01:14
In reply to Re: lamictal questions , posted by linnette on October 15, 2003, at 11:00:44
Hi Linnette--
Welcome to the bipolar II, AD induced agitation club!! I don't know exactly what your experiences have been--what AD's (I'm guessing SSRI's?) or what mood stabilizers you have tried.
I'll tell you what--I also had a really bad spin out from AD's--SSRI's anyway. I was first put on Lamictal by my pdoc after a nightmarish mixed state on SSRI's. At first, I did find Lamictal to be a bit activating and I had some agitation, but it was nothing like the SSRI's (where I wanted to peel my own skin off, and was grinding my teeth, practically hallucinating about suicide, couldn't sleep a wink for DAYS, etc.).
I put up with the Lamictal agitation for awhile, and found that it went away *a little* over time. Unfortunately, it just wasn't enough to quell my irritable hypomania bouts. And I had a lot of sleep problems on Lamictal alone.
So now I'm trying Trileptal (600mg) with the Lamictal, and it seems to quell the hypomania scatterbrain stuff. I am also giving Wellbutrin a try (along with 200mg Lamictal, 600mg Trileptal and 7.5mg of Restoril for sleep). I started feeling very depressed again, so I need a little boost on the AD side.
For me (and I can ONLY speak for myself) the Lamictal did SOMETHING, but I still needed to augment over time. If you feel agitated still over time, you should maybe talk to your doc about adding another mood stabilizer on top of the Lamictal. Feel comforted that maybe an augmentation or fine tuning on your dosing could really help if Lamictal doesn't do it alone. (it may work alone, and if it does--YIPPY!)
I'm very happy for what Lamictal did for me compared to the nightmare of SSRI's.
Best of luck and take care--
Katyp.s. Just so you know, most people on this board are feeling FRUSTRATED with their current regimine, and they may not be full of success stories. So I qualify my advice and warn that not all people here are offering support. Sometimes they are just pooped out with drug trials.
Posted by fluffy on October 16, 2003, at 12:15:10
In reply to Re: lamictal questions , posted by fluffy on October 16, 2003, at 12:01:14
Hi again Linnette--
Again-- I need to qualify that I'm no doc, but I just want you to know that I'm supporting you. I also need some support, as over the past month or so, I've had a minor depression creeping into a major one--also waking up and wondering why I'm alive, etc. I'm keeping my fingers crossed that wellbutrin works on the depression without spinning me into another mixed state (hope! hope!)
Could you give a brief run-down of your med history? Have you ever tried a mood stabilizer ALONE without anti-depressants?
take care,
Katy
Posted by linnette on October 17, 2003, at 1:05:13
In reply to Re: lamictal questions , posted by fluffy on October 16, 2003, at 12:01:14
Hi Katy,
It was really difficult gettomg on here tonight, there must be lots of activity with posts.
Thanks for the sharing and the encouragement, and the welcome! I should feel right at home here!:-)
I'm glad to be of help and encourage you any way I can, and I hope you feel better real soon.
That feeling of "maybe I will never feel better" is terrible, and makes one feel real helpless I know.As far as my drug trials go, way back when I was placed on imipramine. My main issue has been the mixed states that my pdoc thinks may have been bipolar all along, but diagnosed as just major depressive illness. That was my first real severe bout, and the imipramine did wonders, but only after about a month. I was sooo agitated for the first few weeks, the imipramine made it worse, I know it did.
I was put on maprotiline 2 years later, along with xanax. I was tried on on lithium, with an AD, (nortriptyline), but after a month, couldn't tolerate the lithium. At that time, they were just beginning to learn about mood stabilizers other than lithium. Much later, I was given tegretol, which made me feel real strange.
Then after a long bout of depression that just wouldn't remit, a doc put me on Nardil. Honestly, it was the best thing that I ever took. I really felt alive, and for the first time I was happy, truly happy, and motivated to do things other than worry, sleep/not sleep, pace cry. At that time, again, still not yet diagnosed with BP illness, within a year of starting the Nardil I was hypomanic, hardly sleeping, and it lasted a long, long time interrupted by really bad depressive crashes, where I couldn't get out of bed for days. I was truly addicted to the high mood, but in looking back I was a mess, although the first few months were wonderful.
A new pdoc pulled me of Nardil to try Wellbutrin, and for me it was a disaster, due to extreme agitation. BUT--KEEP IN MIND, that I wasn't on a mood stabilizer, I was coming off of Nardil and that may be the reason I couldn't tolerate it. I liked the fact that I could wake up easily in the morning. I was then put on prozac which totally freaked me out, and probably others, and ended up on nortriptyline and xanax, which have been my mainstays. Zoloft at low doses has been ok, but I really want off of it, and would be happy with just the lamictal and nortriptyline, or maybe just lamictal. My experience with high doses of zoloft has been that I just want to crawl out of my skin..
Again, I would have went back on Nardil, but have never been able to tolerate a mood stabilizer, until Lamictal, and that is a little shakey right now, but I think I will be ok. This week has been better than last, so I have my fingers crossed. The mixed states are the worst part of the illness for me, and if I can just get stable, I think there may be hope. That is what I am hoping the lamictal will curb.
I'm not a doc, but I think that you should stick with the wellbutrin, to see if it pulls you out of the pits. I have heard good things about it, and my pdoc had mentioned trying again for augmenting my other meds. And AGAIN, I often think that had I been able to tolerate a mood stabilizer that I would have avoided all of the trials, and probably been able to tolerate many of the meds I was tried on. I'm assuming that trileptal is a mood stabilizer? Is it similar to any of the other mood stabilizers, or does it have other benefits?
Boy, I've written a book here. Let's keep each other posted on our progress. Also thanks for the encouragement and sharing your experiences..
take care,
linnette
Posted by fluffy on October 19, 2003, at 11:39:10
In reply to Re: lamictal questions , posted by linnette on October 17, 2003, at 1:05:13
Hi Linnette--
I also just posted a "book" to you, and damnit, it got erased. SH*T!! Anyway-- I'll try this again.
To answer some of your questions, first--Yes, Trileptal is a "mood stabilizer". It is basically Tegretol w/ an oxygen molecule attached to it.
So your med history and misdiagnosis problems sound similar to mine. I was also diagnosed with recurrent depressions, not bipolar, until last year. I was on Paxil for a year and a half, and it never made me feel mixed, but the minute I went off of it, I had my first "clear cut" hypomanic episode. When I think about how I was feeling, it was just like everything was falling into place for me, and I'd conquered my life. But sure enough, I came crashing down into a horrible agitated depression. Then we tried Lexapro, and I became horribly and terrifyingly mixed. Then came the Zoloft plus Neurontin (for anxiety), and I just felt mixed and spaced out.
Wellbutrin has made me feel jittery. It's almost welcome, as I've been suffering from "leaden paralysis" (DSM language). So it's been good to get moving again.
Yesterday, though, I had to entertain a friend from out of town, and I felt agitated as HELL!! Poor friend! I went to a fabric store, and I wanted to yell at people for no reason--I thought I might explode!! There were too many colors, lights and sound in there. There was a woman who was talking in a heavy southern accent, and I just thought I'd crawl out of my skin, or yell at her to stop talking.
I called my doctor to see if he thought I might be getting mixed again, but he said he couldn't discuss it over the phone (is this some kind of law?? He's a resident, not a full specialist yet). I see him tomorrow.
But I feel like I had similar irritable bouts without the wellbutrin. My friend who is bipolar, and takes WB said that at first, she had the jitters, and also felt agitated, but wasn't sure it was just her depression, or the WB. In any case, it did pull her out of a jam, and she's still on it.
So I'm going to keep trying it unless I get the really bad mixed, suicidal urges. Sometimes it's easy to blame a drug for symptoms of the mood disorder that just haven't been resolved. It's very confusing and frustrating.
I really hope you're doing better. I definitely need to be "fixed" right now. I'll keep in touch, and you do the same, okay??
take lots of care,
Katy
Posted by fluffy on October 19, 2003, at 11:55:03
In reply to what is your drug trial history?, posted by fluffy on October 16, 2003, at 12:15:10
Hey Linnette--
p.s. Lithium was a nightmare for me, too. I couldn't remember a thing!! One day, I couldn't even find my house. I persisted with the hopes that it would get better, but it only got worse--so bye-bye Lithium. Like my others drug trials, I wanted it to work so badly. But it also ended in disappointment and dashed hopes.
Posted by JohnR on October 19, 2003, at 22:40:30
In reply to lamictal questions , posted by linnette on October 15, 2003, at 0:15:54
Hi Linnette,
I've been taking Lamictal for a few years now for seizures. I take 250mg twice a day. I can't say that it's affected my mood in any manner good or bad. In combination with Dilatin it's got my seizure problem totally controlled though.
I never associated any side effects with it. The only bad thing I can say about it is that it costs a fortune. Thank goodness for health insurance.John
Posted by msanjelpie on October 20, 2003, at 3:01:10
In reply to Re: lamictal questions » linnette, posted by JohnR on October 19, 2003, at 22:40:30
I started on Lamictal in 1999. The prozac just wasn't quite fixing everything... I upped the dose every week until I was at 200mg per day. I had the same side effects during each dose increase... muscles in my eyes hurt, blurred vision, leg cramps, spaciness etc...
Once I got to 200mg it seemed like the world was absolutely perfect. The problem with this was, of course it's not perfect, but my perception that it was made me very unwilling to change anything even if it needed changing...
Another problem is that it is very motivational and wants to make you do every little thing that pops into your head... So I'd have a pot on the stove cooking and all of a sudden I'd want to fold laundry while the pot is overflowing, and in the process of fixing the food with the laundry half done, then I decide that the fridge needs to be scrubbed etc... Hard to get anything done at first... Now that I've been on it 4 years, those problems have pretty much evened out as I 'force' myself to complete a task before starting a new one...
Somehow in my lamictal induced happy haze, I convinced myself that I should have another baby. I actually took the lamictal during the pregnancy up until the 5th month when I went off of it cold turkey.
When ever I skip a dose I get neck muscle tightening and a bad headache... That was multiplied during the withdrawal...
After the baby was born, and the resulting post partum suicidal depression, I started back on the same cocktail, 40mg prozac and 200mg lamictal.
Everything was the same.. Felt like doing those things that I didn't care about before, it's a very motivating drug, I don't want to sit still for a minute...
I wouldn't want to be off of either drug. I think they work great in combination. Definitely need the Prozac for the serotonin and the lamictal for the mood stabilizer... Also take Ativan for the anxiety associated with the Prozac...
I've probably never felt more 'normal' in my life on this cocktail...
Posted by fluffy on October 22, 2003, at 11:23:39
In reply to Re: lamictal questions, posted by msanjelpie on October 20, 2003, at 3:01:10
Hi to anyone that is reading...
I've been on 200mg Lamictal for 6 months, and recently augmented with 600mg of Trileptal to quell an oncoming depressive episode. It didn't quite work, and I ended up feeling suicidal and unable function socially, wake up, or eat.
So we added Wellbutrin to pull me out of it. Well--it really worked yesterday. I woke up with a feeling of anxiety and panic in my gut. I started to work on a class lecture for my teaching job. I whirled through the preparations, then I couldn't sit still. When I got to class, I sped through the whole presentation, and I could feel myself talking really fast, but I just wanted to finish. I ended up finishing my lecture 20 minutes early. The sound of my own voice was really bothering me--like it was grating really loudly in my own head. And I felt like I might panic, so I just went as fast as I could.
When I got home, I was hungry, but I felt like I didn't have time to eat. I started looking at my schedule, and mistakenly thought that Halloween was this weekend. So I began frantically sewing an intricate halloween costume, just whirling through it--digging through all of my fabrics, running around the house trying to find all of the materials, etc.
After I finished my costume (in like an hour), I decided to clean my house--MY ENTIRE HOUSE plus my studio (we're talking 2000 sq. feet). After I finished that, I couldn't sit still, so I took a restoril, and I fell asleep. I slept for 5 hours, and woke up with an edgy feeling, but couldn't go back to sleep. I called my doc today, and bye bye Wellbutrin. I don't know what I'll do now. My options are getting fewer.
Can anyone just give me some support right now? I'm feeling kind of helpless, but i'm still riding my manic crest.Thanks to anyone,
Katy
Posted by linnette on October 23, 2003, at 0:06:31
In reply to what is your drug trial history?, posted by fluffy on October 16, 2003, at 12:15:10
> Hi again Linnette--
>
> Again-- I need to qualify that I'm no doc, but I just want you to know that I'm supporting you. I also need some support, as over the past month or so, I've had a minor depression creeping into a major one--also waking up and wondering why I'm alive, etc. I'm keeping my fingers crossed that wellbutrin works on the depression without spinning me into another mixed state (hope! hope!)
>
> Could you give a brief run-down of your med history? Have you ever tried a mood stabilizer ALONE without anti-depressants?
>
> take care,
> Katy
>>
Hi Katy,
To answer your question about being on a mood stabilizer alone, no I haven't, but hoping that I will with the lamictal. I have been better this week, until today. Today I have been just in a hole, but am hoping it is transient, as I have tapered off the zoloft. I know it won't be a party getting off of that. But I do have more energy.. Maybe a good night's sleep will work
Take care..
I am trying to keep up on posts and just saw another one from you that I will reply to ..
Linnette
Posted by linnette on October 23, 2003, at 0:15:48
In reply to Re: lamictal questions, posted by msanjelpie on October 20, 2003, at 3:01:10
> I started on Lamictal in 1999. The prozac just wasn't quite fixing everything... I upped the dose every week until I was at 200mg per day. I had the same side effects during each dose increase... muscles in my eyes hurt, blurred vision, leg cramps, spaciness etc...
>
> Once I got to 200mg it seemed like the world was absolutely perfect. The problem with this was, of course it's not perfect, but my perception that it was made me very unwilling to change anything even if it needed changing...
>
> Another problem is that it is very motivational and wants to make you do every little thing that pops into your head... So I'd have a pot on the stove cooking and all of a sudden I'd want to fold laundry while the pot is overflowing, and in the process of fixing the food with the laundry half done, then I decide that the fridge needs to be scrubbed etc... Hard to get anything done at first... Now that I've been on it 4 years, those problems have pretty much evened out as I 'force' myself to complete a task before starting a new one...
>
> Somehow in my lamictal induced happy haze, I convinced myself that I should have another baby. I actually took the lamictal during the pregnancy up until the 5th month when I went off of it cold turkey.
>
> When ever I skip a dose I get neck muscle tightening and a bad headache... That was multiplied during the withdrawal...
>
> After the baby was born, and the resulting post partum suicidal depression, I started back on the same cocktail, 40mg prozac and 200mg lamictal.
>
> Everything was the same.. Felt like doing those things that I didn't care about before, it's a very motivating drug, I don't want to sit still for a minute...
>
> I wouldn't want to be off of either drug. I think they work great in combination. Definitely need the Prozac for the serotonin and the lamictal for the mood stabilizer... Also take Ativan for the anxiety associated with the Prozac...
>
> I've probably never felt more 'normal' in my life on this cocktail...I just wanted to say that I too find the lamictal very stimulating, but I am not complaining either. I find it much easier to get going on things..Your post was very encouraging , and informative. It enforces for me that it still has promise for depression, even severe depression.
And also, my legs are huring, blurred vision, some spaciness, but it does subside toward the end of week after a dose increase. I am now at 100 mg..and tolerating it ok..
As far as thinking everything is all better, I find myself really analyzing my anger instead of thinking that I shouldn't be angry. Maybe that is a good thing.. time will tell.
Linnette
Posted by linnette on October 23, 2003, at 0:26:44
In reply to Linnette?? Anyone? I got manic last night., posted by fluffy on October 22, 2003, at 11:23:39
> Hi to anyone that is reading...
>
> I've been on 200mg Lamictal for 6 months, and recently augmented with 600mg of Trileptal to quell an oncoming depressive episode. It didn't quite work, and I ended up feeling suicidal and unable function socially, wake up, or eat.
>
> So we added Wellbutrin to pull me out of it. Well--it really worked yesterday. I woke up with a feeling of anxiety and panic in my gut. I started to work on a class lecture for my teaching job. I whirled through the preparations, then I couldn't sit still. When I got to class, I sped through the whole presentation, and I could feel myself talking really fast, but I just wanted to finish. I ended up finishing my lecture 20 minutes early. The sound of my own voice was really bothering me--like it was grating really loudly in my own head. And I felt like I might panic, so I just went as fast as I could.
>
> When I got home, I was hungry, but I felt like I didn't have time to eat. I started looking at my schedule, and mistakenly thought that Halloween was this weekend. So I began frantically sewing an intricate halloween costume, just whirling through it--digging through all of my fabrics, running around the house trying to find all of the materials, etc.
>
> After I finished my costume (in like an hour), I decided to clean my house--MY ENTIRE HOUSE plus my studio (we're talking 2000 sq. feet). After I finished that, I couldn't sit still, so I took a restoril, and I fell asleep. I slept for 5 hours, and woke up with an edgy feeling, but couldn't go back to sleep. I called my doc today, and bye bye Wellbutrin. I don't know what I'll do now. My options are getting fewer.
> Can anyone just give me some support right now? I'm feeling kind of helpless, but i'm still riding my manic crest.
>
> Thanks to anyone,
> KatyHi Katy,
Linnette here again. Does it help slow you down when you take the trileptal, or is there anything else in your med past that could slow the mania down to get you through this? I hope things settle down soon for you. Does your pdoc just tell you to ride it out?
I know that Sunday, I also was whizzing around like I was on speed, and it was sort of spookey, but the xanax helps with that, and it hasn't happened since. I actually turned my top floor bedroom into a workout area all by myself. I thin my boyfriend thought I'd flipped!
How are you doing today? Any better? Keep me posted.. Today for me was a real drag. I was so down in the dumps, but I increased my lamictal to 100 mgs last Saturday, so hoping it levels out.
I wonder if decreasing the lamictal just a little would be a good move? Maybe the combo of all 3 just put you over the edge into the manic phase..Of course, as always check with doc..
Take care..
linnette
Posted by fluffy on October 23, 2003, at 11:15:55
In reply to Re: Linnette?? Anyone? I got manic last night., posted by linnette on October 23, 2003, at 0:26:44
Hi Linnette--
I'm having a very hard time right now. I totally crashed from my little high. I felt ok yesterday, but I had nightmares, bad sleep, and woke up crying this morning. I'm staying at my folk's house until I get through this little pinch of mine. It's worked before to get support from them, but they have never acknowledged the biological basis of my illness.
This morning, when I was crying and feeling scared about my doctor's appt. (I actually called yesterday morning to tell him I got manic, and that I might flip my lid if I took WB that morning). My dad and I got into an argument about my depressions, and he said that I should just pray more and read my bible and go to church. Incidentally, I did all of those things when I was religious, but it didn't work to stave off these relentless depressions. Needless to say, his advice only made me more upset, and he felt that he wasn't being heard.
He's very frightened of psychiatrists, as his mom went through shock treatments, but never got better, and eventually just went psychotic (who knows what she has now...the 1950's weren't the most enlightened years of psychiatry!!). Even though my dad has had really bad mood swings and depression, he is too frightened to see ANY doctor, let alone a psychiatrist. Anyway, I almost wouldn't mind trying ECT at this point. I'm feeling really helpless. It's really scary when you feel that the ones who are part of your "core circle" start to doubt you. I broke up with my boyfriend a month ago, who was one of the only ones who knew that it wasn't my wish to get severely depressed on a yearly basis. But unfortunately, I couldn't deal with some of the other issues going on in the relationship, so I had to let it go.
I also think I might join a support group and try to get some heavy duty counseling from the mood disorders clinic I go to. It's free, and I don't have to worry about religion or judgements coming into it.
I'm sorry to only talk about myself right now, but my brain is too muddled with sadness to think about meds.
I do hope you are feeling better, Linnette. It sounds like the Lamictal is working a bit, but if you want to go more slowly to avoid the agitation, then you could run it by your pdoc. I think the "target dose" is 200mg. If you get a therapeutic effect from lower doses, then I would way the side effects with the benefits. I wouldn't mind upping my dose to 250mg right now. It might not give my bad side effects since my body has adjusted to it for awhile.
Anything would beat what I've felt with other AD's.Keep in touch and take care,
Katy
Posted by poop'd-out on October 24, 2003, at 0:39:30
In reply to Re: lamictal questions, posted by msanjelpie on October 20, 2003, at 3:01:10
Did you experience any mood swings, irritability, depression until you reached the right dose?
Posted by sean7 on October 24, 2003, at 2:25:47
In reply to Linnette?? Anyone? I got manic last night., posted by fluffy on October 22, 2003, at 11:23:39
have you ever tried zyprexa?mabye that's an option
This is the end of the thread.
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