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Dr. Bob is Robert Hsiung, MD,
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Posted by sac on January 9, 2004, at 12:38:23
In reply to Lamictil is NOT a mood stabilizer » Krissy P, posted by BarbaraCat on March 18, 2003, at 15:33:44
This is quite an old post but I am intrigued with this one because I have been having problems with Lamictal. I am Bipolar II and have been on Lamictal on and off (Love/Hate relationship) for the last 2 years. Sometimes, I feel good especially in the beginning of treatment, However this eventually goes away and I am left feeling depressed, apathetic, irritable, and anxious. I keep going back to lamictal because it is supposed to have a good reputation for mood stabilization with good anti-depressant action (which is my main problem.)
So why then, am I feeling so DEPRESSED? Maybe I should give up the lamictal and go for the Lithium. Any suggestions/advice would be greatly appreciated.> Krissy,
> I have to agree with Ron and Maximus here. You are not, I repeat not, on a mood stabilizer. Lamictal is tossed into that category because of it's anti-epileptic profile but it doesn't work well enough if you need something different. I know this well because I've been in a very similar place to you. I'm fine at 50mg lamictal and if I start increasing I get depressed. I'm on a tricyclic after being on all the SSRI's and SNRI's in the book. The only thing that makes everything else tie together and work is lithium. Without lithium, NOTHING works. Lithium alone does not work but it is a necessary part of my brew.
>
> I HATE taking it because it's caused my hypothyroid condition to worsen and I'm concerned about kidney problems. But I'm only taking 600mg which seems to be the magic number for me. If you have the kind of bipolar syndrome that responds best to lithium, believe me, nothing else is going to work as well. You'll continue to futz around with this med and that. They'll work for a while and then you'll get in that weird mixed hypomanic depressed place again. I can only say to give lithium a try. For what is does, nothing else does it better. After many off/on attempts I am now a greatful believer that sometimes those old fashioned meds work the best - at least for me. As far as the weight, I now feel so much better (since starting nortriptyline) that I'm inspired to exercise like mad and am getting in better shape than ever.
Posted by eugenia on January 10, 2004, at 7:31:46
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
Hi:
I had the same experience with Lamictal. Initial buzz, then depression, fatigue and PANIC. I don't think a lot of doctors know that the stuff can make a person panic. I was really disappointed, because I heard such great things about lamictal, I thought it might be my magic bullet. Oh well. Just remember to take your side effects seriously, even if they are not the norm.
Posted by Sooshi on January 10, 2004, at 9:46:05
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
Lamictal did not work for me either. Nada. Nothing.
Posted by SLS on January 10, 2004, at 9:57:31
In reply to Re: Lamictil is NOT a mood stabilizer, posted by Sooshi on January 10, 2004, at 9:46:05
If there is one thing that Lamictal is not, it is an acute anti-manic agent. It did not prevent me from having a manic reaction to changes made in my medication. However, I have read things that indicate it helps reduce rapid-cycling. When combined with lithium, it seems to. Lamictal definitely acts as a prophylactic against future depressive episodes according to the most recent studies I have read.
- Scott
Posted by wcfrench on January 10, 2004, at 11:36:44
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
What else are you taking? I'm still on Lamictal since I wrote in that post (although I don't feel as good) and I have also noticed that Lamictal without another mood stabilizer doesn't quite keep me completely stable. Tell me what else you are taking and I'll write back as soon as ya do.
Take care,
Charlie
Posted by Maxime on January 10, 2004, at 16:24:07
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
It is a mood stabiliser if you look at the chemical properties of the med. It's similar to tegretol which is used as a stabiliser. It's also been approved by the FDA as a stabiliser.
Um, having said that it made me more depressed when I was on it (BP 1).
Maxime
LAMICTAL
Na+ channel inhibition
GLU decreased
Ca2+(N) channel inhibition
Ca2+(P) channel inhibition
Posted by Flipsactown on January 10, 2004, at 16:27:15
In reply to Re: Lamictil is NOT a mood stabilizer, posted by SLS on January 10, 2004, at 9:57:31
Scott,
I know this is off the mark, but it appears you have been around this forum a long time, so I value your opinion. Recently my pdoc gave me an rx for 300mg daily of lithium to add to my cocktail of prozac, remeron and lamictal. Although this combo does an excellent job in relieving my depression, I do notice that my depression comes back big time around 3PM-5PM. So, I am depressed until I take my remeron at bedtime. Consequently, I have been taking my remeron earlier and earlier to get some relief. Do you think that adding lithium will get me through the late afternoon? What are your thoughts?
FST
> If there is one thing that Lamictal is not, it is an acute anti-manic agent. It did not prevent me from having a manic reaction to changes made in my medication. However, I have read things that indicate it helps reduce rapid-cycling. When combined with lithium, it seems to. Lamictal definitely acts as a prophylactic against future depressive episodes according to the most recent studies I have read.
>
>
> - Scott
Posted by brussell on January 10, 2004, at 17:22:16
In reply to Re: Lamictil is NOT a mood stabilizer » SLS, posted by Flipsactown on January 10, 2004, at 16:27:15
I agree that Lamictal's effect is subtle, and I doubt it would be enough for anyone with BPI.
I have "cyclical depression" (like BPII without hypomania--cycles from dysthemia down through the seven levels of hell and back).
For me, Lamictal tends to prevent depressive episodes from spiraling out of control, and it seems to have mild AD properties. I added 25mg/day of it to the 50mg/day of Parnate I take, and it seems to improve my mood and prevent evening crashes when the Parnate wears off.
Parnate's really interesting in that respect. For me it "kicks in" soon after I take it and then the AD effect wears off until the next dose--completely unlike most ADs.
Posted by sac on January 10, 2004, at 17:24:30
In reply to Re: Lamictil is NOT a mood stabilizer » sac, posted by wcfrench on January 10, 2004, at 11:36:44
I am only taking Prozac 20mgs. now. I quit Lamictal 3 days ago but am still undecided as to what I should do. I was on Lamictal in the past for about 18 months straight and while it did keep the major depressive episodes as bay, it did so by keeping me in a low grade depressive,apathetic state. The trouble is, I only really was bothered by this feeling in the evening. In the mornings, I felt OK. I was wondering whether this had to do with the way the med is metabolized. I am very frustrated. I have been on Depakote and did great for about two months until a nasty depression (side effect I believe) made me quit that. I don't know if I gave Lithium a fair chance. I only tried it for about 1 week back in August. First of all, I was scared to go on it because of the risk with toxicity and the reputation for being hard on the kidneys, thyroid, etc. Maybe this influenced my decision to quit too soon. I just remember telling my doctor that I felt more depressed on it (300mgs) he reluctantly said OK, stop it but he is not convinced that the Lithium made me feel depressed. I see him on Monday, and I am agonizing over how I am going to explain to him that I quit my medication...Again.
> What else are you taking? I'm still on Lamictal since I wrote in that post (although I don't feel as good) and I have also noticed that Lamictal without another mood stabilizer doesn't quite keep me completely stable. Tell me what else you are taking and I'll write back as soon as ya do.
> Take care,
> Charlie
Posted by Maxime on January 10, 2004, at 19:56:04
In reply to Re: For many people, it does have MS properties., posted by brussell on January 10, 2004, at 17:22:16
Brusell - I know isn't it interesting. It has a very short half life so I suspect that is part of the reason. What I like about Parnate is that because I am bipolar, if I feel a manic episode coming on I can decrease the Parnate and I know that the decrease will have an immediate effect. It has stopped me from going into full blown mania on two occasions by doing this. No other AD will do this.
Maxime
> Parnate's really interesting in that respect. For me it "kicks in" soon after I take it and then the AD effect wears off until the next dose--completely unlike most ADs.
Posted by brussell on January 10, 2004, at 20:27:40
In reply to Re: For many people ... Parnate}} Brusell, posted by Maxime on January 10, 2004, at 19:56:04
> Brusell - I know isn't it interesting. It has a very short half life so I suspect that is part of the reason. What I like about Parnate is that because I am bipolar, if I feel a manic episode coming on I can decrease the Parnate and I know that the decrease will have an immediate effect. It has stopped me from going into full blown mania on two occasions by doing this. No other AD will do this.
>
> Maxime
>
>Wow! That's VERY interesting. I don't have any experience dealing with manic phases.
I always thought the idea with mood-stabilizers was to keep bipolar people around the "center" of their mood spectrum, which hopefully was more or less normal mood.
In my case, lamictal alone just stabilized me in a dysthemic state. I really needed a strong AD, and setting off mania was never an issue.
Do mood stabilizers work as antidepressants for people with BPI and II? What do people with Bipolar Disorder do when deeply depressed? Are lithium and Depakote the only options?
Thanks a lot for any answers you can give me.
Posted by Patient on January 11, 2004, at 10:23:18
In reply to Re: Lamictil is NOT a mood stabilizer » SLS, posted by Flipsactown on January 10, 2004, at 16:27:15
The mood stabilising agents are lithium, valporic acid, and carbamzepine. Newer drugs are actually anticonvulsants used to treat epilepsy. Okay, we know all that.
The newer drugs used for treating bipolar illness "include the three mood stabilisers listed above, seem to stimulate the transmitter called GABA (gamma-amino butyric acid) or inhibit a transmitter substance known as glutamate. GABA and glutamate are used by a large percentage of the nerves in the brain. The anticonvulsants that stimulate GABA tend to cause sleepiness. Medications in this catagory include valporic acid, as well as gabapentin (Neurontin), tiagibine (Gabitril), vigabatrin (Sabril), and several others. The anticonvulsants that inhibit glutamate tend to cause stimulation and anxiety. Medications in this catagory include felbamate (Felbatol), lamotrigine (Lamictal), topirimate (Topamax), and several others." Quote from "Feeling Good"
I would think that if Lamictil wasn't helping, then try something from the other catagory that stimulates GABA.
Posted by Maxime on January 11, 2004, at 10:59:23
In reply to Re: Question about Bipolar disorder » Maxime, posted by brussell on January 10, 2004, at 20:27:40
> > Brusell - I know isn't it interesting. It has a very short half life so I suspect that is part of the reason. What I like about Parnate is that because I am bipolar, if I feel a manic episode coming on I can decrease the Parnate and I know that the decrease will have an immediate effect. It has stopped me from going into full blown mania on two occasions by doing this. No other AD will do this.
> >
> > Maxime
> >
> >
>
> Wow! That's VERY interesting. I don't have any experience dealing with manic phases.
>
> I always thought the idea with mood-stabilizers was to keep bipolar people around the "center" of their mood spectrum, which hopefully was more or less normal mood.
>
> In my case, lamictal alone just stabilized me in a dysthemic state. I really needed a strong AD, and setting off mania was never an issue.
>
> Do mood stabilizers work as antidepressants for people with BPI and II? What do people with Bipolar Disorder do when deeply depressed? Are lithium and Depakote the only options?
>
> Thanks a lot for any answers you can give me.
>
Hi there.You are right about mood stabilisers ... they are suppose to keep one more level. The reason I go hypomanic/manic is because I haven't found the right stabiliser yet. Right now I am increasing my trileptal slowly so hopefully it will work. It doesn't seem to be that the Parnate is making me manic (which happened with so many other meds).
I think lithium is the best for BP. It wards off deep depression and mania. I don't know if Depakote is as good for depression. I am allergic to depakote and I go toxic on any amount of lithium.
I know some people with BP who only take an anti-depressant when depression hits. I have to take one all the time otherwise I slide into a deep depression. Wellbutrin seems to a common AD for people with BP (but it made me psychotic).
The only mood stabilisers I have heard working as anti-depressants are lithium and lamictal. Zyprexa is used as a mood stabiliser for people with BP and some have claimed it keeps depression at bay.
Maxime
Posted by wcfrench on January 12, 2004, at 0:54:15
In reply to Re: Question about Bipolar disorder}}Brusell, posted by Maxime on January 11, 2004, at 10:59:23
Lamictal never helped me stabilize my mood from the highs or deep lows (the scary suicidal lows). Depakote is the only thing that has worked for me, Lithium didn't do much at all.
Lamictal helped me with bipolar depression only, and was one of the only adjuncts that really fit the spot, although I have never tried MAOI. Depakote is a life-saver.
Sac I know for a fact that too much Lamictal combined with an AD can have adverse effects. It has such definite AD properties that it would cause me to be more depressed if I took too much of it. (which is what happens with SSRIs for me)
Someone else wrote that they feel worse at night... I was writing that on here a while back, and the Lamictal was always the cause for me. It wears off in 5-6 hours for me, without fail.
Any BPII on Nardil/Parnate have better response than with TCA or SSRI/NRI? I tried both of the latter and TCAs did not work out- too strong or something, just didn't click. Anyway I think I need something else, or I need therapy.
Posted by Flipsactown on January 19, 2004, at 11:36:15
In reply to Re: Lamictil is NOT a mood stabilizer » SLS, posted by Flipsactown on January 10, 2004, at 16:27:15
Scott,
Attached is the earlier post I was referring to.
Regarding your current questions, my pdoc is not much of a help to me as it appears that I am doing all the research. He pretty much goes along with my suggestions which I pick up mostly from this board. My pdoc did suggest taking the lamictal 3 times daily versus 2 times which help some but the biggest concern I have is that when my depression returns like from 3PM to 6PM, it returns big time until I take the remeron which I have been taking earlier and earlier. And the lithium? Yes, it was my idea and so was the rest of my meds. This is the same pdoc who required me to sign a liability waiver if I were to die taking lamictal. My pdoc stated that it would take a couple of weeks before the lithium would kick in and possibly longer until we got the blood levels worked out. How would the stimulant, Adderal, help with my depression? And yes, I would consider taking it if it will rid me of the depression.
Flipsactown
> Scott,
>
> I know this is off the mark, but it appears you have been around this forum a long time, so I value your opinion. Recently my pdoc gave me an rx for 300mg daily of lithium to add to my cocktail of prozac, remeron and lamictal. Although this combo does an excellent job in relieving my depression, I do notice that my depression comes back big time around 3PM-5PM. So, I am depressed until I take my remeron at bedtime. Consequently, I have been taking my remeron earlier and earlier to get some relief. Do you think that adding lithium will get me through the late afternoon? What are your thoughts?
>
> FST
>
>
>
> > If there is one thing that Lamictal is not, it is an acute anti-manic agent. It did not prevent me from having a manic reaction to changes made in my medication. However, I have read things that indicate it helps reduce rapid-cycling. When combined with lithium, it seems to. Lamictal definitely acts as a prophylactic against future depressive episodes according to the most recent studies I have read.
> >
> >
> > - Scott
>
>
Posted by terrics on January 19, 2004, at 17:09:11
In reply to Re: Lamictil is NOT a mood stabilizer, posted by SLS on January 10, 2004, at 9:57:31
Yes, lamictal is a mood stabilizer. But its first use is for seizures. My pdoc wanted me to be in a study on lamictal because it had a severe skin side effect that is supposedly being worked out. I said no to the study because I would have to come off lithium and the lithium helps me alot. terrics
Posted by HenryO on January 19, 2004, at 19:52:09
In reply to Re: Lamictil is NOT a mood stabilizer, posted by terrics on January 19, 2004, at 17:09:11
Yeah, what he said. Yes, lamictal is a mood stabilizer.
Posted by Emme on January 19, 2004, at 21:52:19
In reply to Re: Lamictil is NOT a mood stabilizer, posted by HenryO on January 19, 2004, at 19:52:09
> Yeah, what he said. Yes, lamictal is a mood stabilizer.
Stabilizing for me, yes. Personal and anecdotal I know, but it has me bobbing up and down less and more consistent.
Posted by wcfrench on January 19, 2004, at 23:24:21
In reply to Re: For many people ... Parnate}} Brusell, posted by Maxime on January 10, 2004, at 19:56:04
Are you BPII? Anyone had good results with Nardil or Parnate with bipolar? I have tried TCA and SSRI but not great results.
Thanks
Posted by Maxime on January 20, 2004, at 13:39:17
In reply to Re: For many people ... Parnate}} Brusell » Maxime, posted by wcfrench on January 19, 2004, at 23:24:21
I'm BP 1 actually. MAOIs are less likely to cause mania than SSRIs and TCAs.
Maxime
> Are you BPII? Anyone had good results with Nardil or Parnate with bipolar? I have tried TCA and SSRI but not great results.
>
> Thanks
Posted by GoodAnimal on January 20, 2004, at 13:54:10
In reply to Lamictil is NOT a mood stabilizer » Krissy P, posted by BarbaraCat on March 18, 2003, at 15:33:44
I was misdiagnosed as BiPolar in may of 2000, although I was not told about it until I actually started treatment in September of that year (my GP never bothered to tell me of the psychiatrist's letter.) When I was told of the diagnosis, it came with all sorts of advice generally stating that being bi-polar is a wonderful thing, and I was given books to read like one by some psychiatrist at UCLA who went out and purchased 27(?) emergency snake bite kits, or spent $35,000 on frivolous shopping. Needless to say, I exhibited none of these symptoms. I repeatedly insisted that I was not manic, I was just very depressed, and had very good situational reasons to be depressed (losing my home, grieving the death of both parents, among other things).
I struggled with my psychiatrist and her supervisor, a Dr. Z. from Toronto (BEWARE! BEWARE! ). It turned out that Z. was applying for, or had just received a grant to conduct research on the effectiveness of Cognitive Behavioral Therapy in BiPolar patients. He probably needed more people for his tests, and conveniently labelled me bipolar (I have since realized that characteristics which Z. chose to attribute to a bipolar condition are actually the markings of a lifelong struggle with ADHD. I would like to point out here that while "attention deficit" is labeled an abnormality and a disorder, I say we are just wired differently, not abnormally - I think of it as being a Mac person in a PC world.)
What ensued were two years of absoltue torture. Because of the misdiagnosis, I was not allowed to take SSRIs such as Prozac which had worked for me in the past for depression (although I can now see that I had made several bad choices while under the influence of this false high), but which, due to misuse, catapulted me into three sleepless nights which culminated in a brief, chemically-induced psychotic episode. (I had had the dosage increased - OVER THE PHONE - to 3x20mg of Prozac a day over the years. I was homeless and jobless and the drugs were so prohibitively expensive that I decided to take one one day, two the next, three the third, then two again on the fourth day, one on the fifth, two on the sixth and so on. Bad idea, though I at the time figured that the famous half-life would take care of the varying doses.)
I resisted their recommendations of Lithium, Serzone, Zyprexa, and several other drug cocktails; but by the time November rolled around, with that awful winter approaching, and me sinking deeper and deeper into depression, I finally said to my doctor, give me anything but give me something, I'm dying here. Their answer was Lamotrigine (Lamictal). BEWARE! I lost 25 lbs in a month, my skin became dry and my nails ridged and brittle, and I began losing my hair, with a plethora of other unpleasant symptoms (including a rash on the upper half of my body). Not only had I aged 10 years in 6 months, it has damaged my liver, and disrupted my sleep to the extent that to this day I wake up after only 3-4 hours of sleep, while in the past I was an 8-9 hour sleeper. As you may imagine, I am always tired, and my energy and focusing abilities are low with such extensive and long-lasting sleep deprivation. My doctor's answer to my lack of sleep was to prescribe clonazepam which, when I decided to stop taking it some weeks later, gave me a week of such bad shakes I couldn't even sign my name. I'm still bewildered by these doctors' arrogance in virtually taking a sledgehammer to our heads, while at the same time admitting that they have no clue as to what they're doing, they have no real tests to diagnose or determine treatment for chemical imbalances in the brain (which, in most cases, is another widespread fallacy). It's all just shots in the dark. Their ONLY agenda is their pocket, and their professional/political ambition. We are, indeed, no more than lab rats for them and their sponsors, the evil druglords of Eli Lilly and the likes.
I struggled to rectify the diagnosis, and for those of us who have been debilitatingly depressed, I'm sure you've encountered being invalidated in whatever you say. I finally had a session with Z.'s superior, who immediately concluded that I was not BP, I was just very, very depressed. Z's angry response to my cry for help was that I should "stop being a victim", and leaving the room in a huff. Very supportive, isn't it? Let me also mention here that the CBT workbook that they prescribed is an insult to anyone's intelligence.
I went back to taking prozac for a while, but stopped taking it again because I had come to detest PMeds and everything they involve, philosophical and practical. I figured, if I am sad then that's just who I am and I will not continue to damage my god-given health on the altar of their uncaring stupidity. I have been off any medication for over two-and-a-half years, and while withdrawal was as bad as the worst depression and took nearly two years, I am doing a little bit better every day. I moved and started working again, and can even withstand the abusive cycles of a boss who is truly BiPolar (and on Wellbutrin). (Don't worry, I'm out of there as soon as I'm able).
This is my story. While I acknowledge that there are a small number of people who may need to be on medication, perhaps paranoid schizophrenics, but most others would probably do better with constant support, particularly during the 1-2 years of withdrawal that all these medications entail.) Don't believe the old "side effects" line - a drug's effects are exactly that, and all of them - there's nothing "side" about it, they're all real and valid effects. These so called "mental health care" professionals will gladly damage you if it serves their purposes or their innate arrogance and stupidity. I still wake up crying in anger, thinking of what people that I trusted to help did instead.
My personal turning point came after reading Andrew Solomon's "The Noonday Demon". What first attracted me to the book was that it begins with stating that all the names in the book are real - what a refreshing change, particularly in contrast to the made-up character amalgams who populated the CBT workbook. While at the end of several hundred fascinating pages Solomon chose to continue with his 5-6 drug cocktails and I chose the opposite road, his book allowed me to feel that I was still a valid human being who is worthy of being treated as such, even if only by myself.
God Bless Us - Every One! (though please god, bestow no blessings on Z. and his cohorts)
Posted by catmint on January 20, 2004, at 15:27:47
In reply to Re: Lamictal is DANGEROUS and INEFFECTIVE, posted by GoodAnimal on January 20, 2004, at 13:54:10
Posted by wcfrench on January 20, 2004, at 16:03:20
In reply to Re:May be ineffec. 4 you, but IT IS NOT dangerous! (nm), posted by catmint on January 20, 2004, at 15:27:47
No. 1 rule in psychotropic drugs: everything affects everyone differently.
Posted by jtevers on January 20, 2004, at 17:23:27
In reply to Re: Lamictil is NOT a mood stabilizer » Flipsactown, posted by Flipsactown on January 19, 2004, at 11:36:15
hello all...
i have been on seroquel ( an antipsychotic ) and neurontin ( a mood stabilizer ) for several years since a diagnosis of bipolar in 2000.
i have consequently gained 60 lbs. over two winters due primarily to my meds. ... this weight has not responded to even the most vigorous exercise and diet.
i am currently investigating alternatives to my present treatment regimen and a local doctor has asked i switch from gabapentin / neurontin to lamictal / lamotrigine because the latter is weight neutral. i have read several testimonials of weight gain while on lamictal right here, but don't know who to trust....
does anyone have any insight about the propensity of lamictal to cause weight increase?
Posted by Flipsactown on January 20, 2004, at 17:56:55
In reply to Re:May be ineffec. 4 you, but IT IS NOT dangerous!, posted by wcfrench on January 20, 2004, at 16:03:20
I agree and I will continue taking 400mg lamictal. Almost anything is better than living with depression. Why be depressed when you don't have to?
Flipsactown
> No. 1 rule in psychotropic drugs: everything affects everyone differently.
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