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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 worrier on January 18, 2004, at 19:24:57
Question for anyone out there...I won't go through the whole long 2 year saga, if you are interested I'm sure you can find lots of my old posts. Here's the new one and I'm at the end of my rope. Panic attacks for 20 years...looking back those were the easiest, best years of my life. No treatment..just rode them out. When they got more frequent about 2 years ago my GP tried me on numerous antidepressants all of which made things much worse. To make a long story a bit shorter, had a serotonin storm with paxil (on a low dose) and have had generalized anxiety since, plus the occasional panic attack. Xanax helps the anxiety a fair bit . but drpression has loomed its ugly head. We've tried remeron,gabitril,serzone and most recently Lamactil for a few day it seemed great then on day 6 (25mg) the raging panic hit....this time at work had to leave early 3 days last week. Emeergency call to the pdoc said it was undoutable the lamactil. Anyone had a reaction like this? Its been 2 days since my last dose and I'm still pretty freaked despite extra xanax. What's next, my pdoc thinks I may be mildly bipolar (no real highs only really low lows)...any suggestions, help .etc. I'm hanging on by my fingernails now. Hope someone has some clues. Worrier
Posted by metalflipflop on January 18, 2004, at 21:06:22
In reply to Anxiety and Lamactil, posted by worrier on January 18, 2004, at 19:24:57
hi worrier,
i am one too. =/ zoloft has been really agitating for me, so my doc and i decided to add lamictal. in order to get to a therapeutic level, i had to take klonopin every day... the lamictal (especially a couple days after i up the dose) gives me this feeling of panic, out of nowhere, and i have had huge struggles with depression but only a couple of panic attacks, ever. my doc says that at this higher dose (i am up to 300mg), it should provide better action against depression AND anxiety. i dunno. i have my doubts. i'll let you know. my depression is definitely well-treated though, which is a relief i never dreamed of. i haven't found a balancing point yet though.
good luck! you are definitely not alone in these kind of symptoms.
liz
Posted by Alex2 on January 18, 2004, at 23:27:23
In reply to Re: Anxiety and Lamactil » worrier, posted by metalflipflop on January 18, 2004, at 21:06:22
Hi worrier,
About 1 year ago my pdoc added Lamictal to my dose of Paxil CR 25mg for my treatment resistant depression (I have also suffered from panic attacks and subsequent depression on and off for over 20 years). We started out low and increased very slowly. After about 1 month, I noticed an improvement in my mood and it steadily got better. However, I did notice that the lamictal was a bit more activating, even at times anxiety provocing. I kept taking it for 6 month, at which time I had to stop it due to another side effect.
It got me out of a 2 1/2 year run with depression. I was truly grateful. I am still doing great, even after I had to stop the Lamictal.
It was a great drug for me as an adjunct; though, I don't think it is particullarly helpful with PD and anxiety.
Hope this helps.
Alex
Posted by HenryO on January 19, 2004, at 1:18:26
In reply to Re: Anxiety and Lamactil, posted by Alex2 on January 18, 2004, at 23:27:23
You asked for suggestions. I would build up the Lamictal much slower and in the meantime take a lot of Klonopin. That would be my plan. Lamictal is good stuff once it gets going, but I think it is mostly for depression. I went off everything else I was taking when I started Lamictal.
My life was hell for two months, but it wasn't because the Lamictal was doing anything to me. It was because all my other meds were leaching out of me and the Lamictal hadn't yet reached a theraputic window. I like it more than anything else I've tried. But It takes a good long time to get going. I was hurting for weeks till I found Klonopin.
Finding Klonopin saved me a great dea of pain. But I found it a bit later for than I'd have liked to. I still take it. Lamictal 200mg and Klonopin 5-10mg. You might require more Klonopin judging from the severity of your anxiety. Good luck.
Posted by Basia on January 19, 2004, at 12:17:05
In reply to Anxiety and Lamactil, posted by worrier on January 18, 2004, at 19:24:57
I have been on Lamictal (with Sulpiride and Carbamazepine) for seven weeks and ,as I have been titrating , have found that the first few days of an increase caused massive activation and panic, particularly in the early days. Now I've increased up to 200mg and most of the irritability and agitation have gone. It is an activating drug, I have found,and it really has got rid of most symptoms of my depression (at last!) but I reckon it takes a while to get over the panicky effects. I found the worst was when I went from 25mg to 50mg - felt like killing people!
I also find it less panic-inducing than SSRIs, which are killers as far as my illness is concerned (bipolar with psychosis when high but mostly depressed). Hang in there if you can bear it - maybe add a benzo.
Good luck anyway - I hope you find the right med combination soon..
Lyn
Posted by HenryO on January 19, 2004, at 19:31:37
In reply to Re: Anxiety and Lamactil, posted by Basia on January 19, 2004, at 12:17:05
Basia, have you ever tried Klonopin when you have that anxiety?
Posted by Tony P on January 20, 2004, at 6:29:34
In reply to Re: Anxiety and Lamactil, posted by HenryO on January 19, 2004, at 19:31:37
Thanks for this post - I thought I was the only one having severe anxiety attacks on Lamictal. My pdoc said "Funny, I haven't heard of that, it should help with anxiety/GAD; especially once you're up to 200 mg/day".
I have now been up to 200 mg/day for 4 days and am experiencing more peculiar effects - see below.
Since the first anxiety attack (6 weeks ago at Lamictal 100 mg/day) I am taking 4mg clonazepam per day as well, which is not that much for me but raises the danger of increasing tolerance/withdrawal.
I am now getting insomnia, occasional depression, rumination esp. at night (anxiety & pointless revolving thoughts about what I'll do in future about...), some hypomania and angry/resentful thoughts which my hypomania is leading me to act on when perhaps I should let sleeping dogs lie....
Additional clonazepam helps, but I'm already probably taking more than I should be. I missed my pdoc and MD appointments last week as I was a)in a depression b) couldn't find my 2003 datebook and didn't care to phone.
Anyone else been there, especially the insomnia and rumination?
Tony P
Posted by AnneL on January 20, 2004, at 9:54:27
In reply to Re: Anxiety and Lamactil + Rumination, posted by Tony P on January 20, 2004, at 6:29:34
Anne here. . .
I am new to Lamictal and am currently at 150 mg.
along with Effexor and Klonopin. The plan is to titrate up to 200 to 300 mg. depending on response. When I initially started Lam at 25 mg. I felt anxious and that went away within a few days. Each subsequent dose increase brings its own unique sensations, the worst was jumping from 100 mg. to 200 mg. The agitation was continuous at this dose and I was miserable 24/7. The anxiety stopped immediately once I reduced the dose to 150 mg. I, too, am experiencing some early morning insomnia and ruminating thoughts. In the past, 1 mg. of Klonopin kept me sleeping throughout the night. I would guess that the culprit is the Lam. I'll address this with my Pdoc. Perhaps a little extra Klon at night will
help me sleep through the night again. Keep us posted as to how you are doing and if you find anything that helps with your sleep! Best, Anne!
Posted by jtevers on January 20, 2004, at 17:37:19
In reply to Anxiety and Lamactil, posted by worrier on January 18, 2004, at 19:24:57
hello all...
i have been on seroquel ( an antipsychotic ) and neurontin / gabapentin ( a mood stabilizer ) since a bipolar diagnosis in 2000
i have consequently gained 60 lbs. in two winters due primarily to my medication.... this gain has not responded to exercise or diet.
i am currently investigating alternatives to my current regimen and a local doctor had advised that lamictal ( a viable mood stabilizer and enhancer? ) is weight neutral.... has anyone remained on a course of lamictal and can share their insight about its propensity to cause weight increase?
Posted by worrier on January 20, 2004, at 20:51:06
In reply to Re: Anxiety and Lamactil, posted by Basia on January 19, 2004, at 12:17:05
> I have been on Lamictal (with Sulpiride and Carbamazepine) for seven weeks and ,as I have been titrating , have found that the first few days of an increase caused massive activation and panic, particularly in the early days. Now I've increased up to 200mg and most of the irritability and agitation have gone. It is an activating drug, I have found,and it really has got rid of most symptoms of my depression (at last!) but I reckon it takes a while to get over the panicky effects. I found the worst was when I went from 25mg to 50mg - felt like killing people!
>
> I also find it less panic-inducing than SSRIs, which are killers as far as my illness is concerned (bipolar with psychosis when high but mostly depressed). Hang in there if you can bear it - maybe add a benzo.
>
> Good luck anyway - I hope you find the right med combination soon..
>
> Lyn> After much discussion with my pdoc....frantic "oh my god what am I going to do?" type calls we've decided to stop the lamactil for a couple of weeks and then start with a really small dose (12.5mg) and work slowly up from there, since it did seem to help with the depression more than anything else I've tried. I do take xanax, the extended release suplemented with the regular stuff, but its taking alot to keep the anxiety the lam. caused at bay. He thinks due to my extreme sensitivity to virtually all drugs(with the exception of benzos which I seem to metabolize at the speed of light) I need at least 2 weeks off the lam. to make sure its really all cycled out before we try again. I really appreciate everyones' input and am GREATLY RELIEVED to know I am not the only one who has had this happen. Gives me a bit more hope. Thanks again to everyone. Luck to all. Worrier.
Posted by Basia on January 21, 2004, at 4:26:54
In reply to Re: Anxiety and Lamactil, posted by HenryO on January 19, 2004, at 19:31:37
Hi Henry,
I don't think I've tried Klonopin, but have been taking a mixture of Nitrazepam and Temazepam (on different nights)-v. groggy in the morning but at least it gives me a bit of a rest from chronic insomnia..
Take care,Lyn
Posted by HenryO on January 22, 2004, at 2:32:25
In reply to Re: Anxiety and Lamactil-HenryO, posted by Basia on January 21, 2004, at 4:26:54
I have never heard of Nitrazepam and Temazepam. I was taking Trazadone for a year. I've been thinking of going back to it. Anyway, when I told my doctor that it left me feeling groggy, he said to cut the pills up and find a dose that let me sleep but didn't knock me out all the next day. Good luck.
Did you know there is no such thing as depression without sleep disturbance or sleep disturbance without depression. Weird ain't it?
Posted by Sad Panda on January 22, 2004, at 6:00:40
In reply to Re: Anxiety and Lamactil + Rumination, posted by Tony P on January 20, 2004, at 6:29:34
> I am now getting insomnia, occasional depression, rumination esp. at night (anxiety & pointless revolving thoughts about what I'll do in future about...), some hypomania and angry/resentful thoughts which my hypomania is leading me to act on when perhaps I should let sleeping dogs lie....
>
> Additional clonazepam helps, but I'm already probably taking more than I should be. I missed my pdoc and MD appointments last week as I was a)in a depression b) couldn't find my 2003 datebook and didn't care to phone.
>
> Anyone else been there, especially the insomnia and rumination?
>
> Tony PI'm not on Lamicital, but for most of my life I have been troubled by ruminations/revolving thoughts before trying to get to sleep. I have taken up to 60mg of Temazepam or 40mg of Valium without them giving me sleep. It use to take me roughly 2 hours of tossing & turning & thinking before getting to sleep before I discovered Remeron. 15mg of Remeron turns off my mind & gives me the best sleep I have ever had in my life & my bed no longer looks like an animal has slept in it. Remeron sleep is mostly induced by it being a powerful anti-histamine, all the tertiary tricyclics are anti-histamines, the strongest of them would be Doxepin.
Cheers,
Panda.
Posted by Sad Panda on January 22, 2004, at 6:10:51
In reply to Re: Anxiety and Lamactil-HenryO, posted by HenryO on January 22, 2004, at 2:32:25
> I have never heard of Nitrazepam and Temazepam.
They are short acting Benzos intended for sleep, Nitrazepam is know as Mogodon, Temazepam is known as Restoril. Temazepam is a minor metabolite of Diazepam (Valium)
Posted by Basia on January 22, 2004, at 7:35:54
In reply to Re: Anxiety and Lamactil-HenryO, posted by HenryO on January 22, 2004, at 2:32:25
Thanks, I'll try cutting up the pills - the real killer is alcohol with any of these drugs (am also on Lamictal, Sulpiride and Carbamazepine)- even 2 or 3 glasses of wine brings on major depression the next day.
I really didn't know about sleep and depression being so linked, although I knew there was some connection. Makes sense to me due to having severely curtailed and interrupted sleep during my three year depression epic!
Wishing you all the best,Lyn
Posted by Tiss on January 22, 2004, at 15:08:21
In reply to Re: Anxiety and Lamactil-HenryO, posted by Basia on January 22, 2004, at 7:35:54
My 3 months experience with lamictal is this:
I felt GREAT with that 1st dose, like a shot of speed! I was busy, busy, busy and boy did I have some conversations going on in my head (especially with my ex-hub :). Then 'the crash' about 4 hours later with extreme edginess, anger (I felt MEAN), irritability and not sleeping. This was on only 25 mg. I tried this for 4 days and had to keep increasing my klonopin. So I started messing with the doses-very small doses spaced throughout the day. But, I couldn't take any after 4pm because then I couldn't sleep. And then I would crash about 7pm just about the time my husband gets home. The worse parts for me were-constant and obsessive ruminating over anything and everthing that popped into my head, irritability, anger, hostility. I think it really made my a bit manic. My dr. didn't believe me and said he'd never heard of this reaction. I told him to find some message boards about lamictal and read how REAL people are having different reactions. Now I'm on Xanax XR (.5mg low dose) during the day. I'm doing OK but get sleepy in the afternoon. I'd rather have this than those other awful reactions.Glad to know I'm not alone. I think I'll give my dr this website address to read! I thought about trying a teeny bit of Lamictal for the 'boost' of energy since I'm taking the Xanax but do not want to take the chance of having those other reactions again.
Posted by HenryO on January 27, 2004, at 3:47:10
In reply to Re: Anxiety and Lamactil-HenryO, posted by Basia on January 22, 2004, at 7:35:54
Alcohol and meds is one thing I have no experience with. I've been in sober for 20 years.
Excessive sleep makes depression worse. If you keep a depressed person up all night you will se a huge improvement by 5AM. But we all have to sleep sometime.
This is the end of the thread.
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