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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by sac on April 27, 2004, at 20:21:21
I'm bipolar II and currently on Lamictal 200mgs. and Prozac 20 mgs. daily. The only trouble with the Lamictal is I tend to crash in the early evening. I feel very depressed and generally my mood worsens and anxiety increases. I do not feel this way in the morning. Currently I take 100 mgs. in the morning and 100 mgs. at bedtime. Does anyone else experience this "crashing" on Lamictal?
Posted by judy1 on April 27, 2004, at 23:47:46
In reply to LAMICTAL CRASH... ANYONE????, posted by sac on April 27, 2004, at 20:21:21
how long have you been on prozac? has your dose remained stable? a lot of people with bipolar disorder cannot take ADs (usually become more unstable). If you are certain it isn't the prozac, then I don't know- lamictal was very stimulating for me- maybe you can divide your dose tid instead of bid?
take care, judy
Posted by T_R_D on April 28, 2004, at 14:56:32
In reply to LAMICTAL CRASH... ANYONE????, posted by sac on April 27, 2004, at 20:21:21
So far I'm fine with the Big L... You might be able to up for better mood stabilization properties. And yes, SSRIs can really screw things up. They make me totally manic.
Posted by sac on April 28, 2004, at 19:50:33
In reply to Re: LAMICTAL CRASH... ANYONE???? » sac, posted by judy1 on April 27, 2004, at 23:47:46
I've been on Prozac off and on for about 10 years. However, I only recently (within 2 years) been re-diagnosed with bipolar II. Years ago I had no problem with Prozac and no instability or hypomania. That all changed with the birth of my second child. It has been a whole new ballgame now. I have been on different mood stabilizers and AD's. Yes, the Lamictal is stimulating for me and I can't go above 150mgs. or I am very agitated. It's just this "crash" that I experience every evening. Maybe the Prozac doesn't work well with the Lamictal. Perhaps, it's some sort of interaction??
> how long have you been on prozac? has your dose remained stable? a lot of people with bipolar disorder cannot take ADs (usually become more unstable). If you are certain it isn't the prozac, then I don't know- lamictal was very stimulating for me- maybe you can divide your dose tid instead of bid?
> take care, judy
Posted by Peter S. on April 28, 2004, at 22:19:08
In reply to Re: LAMICTAL CRASH... ANYONE???? » judy1, posted by sac on April 28, 2004, at 19:50:33
I know exactly what you mean by the crash. I've been on Lamictal for a couple of years now and have gone up to as much as 600mg- now I take 50mg/day. It gets me really energized in the morning only about an hour after I take it. It's a very positive effect. However generally the effect wears off in the afternoon. I've tried taking it twice a day but it really makes no difference. I'm combining it with Lexapro and Neurontin. I think the stimulating/anti-depressant effect is secondary to any mood stabilizing effects Lamictal may have. If anyone figures out how to sustain it I'd love to hear about it!
> I've been on Prozac off and on for about 10 years. However, I only recently (within 2 years) been re-diagnosed with bipolar II. Years ago I had no problem with Prozac and no instability or hypomania. That all changed with the birth of my second child. It has been a whole new ballgame now. I have been on different mood stabilizers and AD's. Yes, the Lamictal is stimulating for me and I can't go above 150mgs. or I am very agitated. It's just this "crash" that I experience every evening. Maybe the Prozac doesn't work well with the Lamictal. Perhaps, it's some sort of interaction??
>
>
>
>
> > how long have you been on prozac? has your dose remained stable? a lot of people with bipolar disorder cannot take ADs (usually become more unstable). If you are certain it isn't the prozac, then I don't know- lamictal was very stimulating for me- maybe you can divide your dose tid instead of bid?
> > take care, judy
>
>
Posted by colin wallace on April 29, 2004, at 12:14:40
In reply to Re: LAMICTAL CRASH... ANYONE????, posted by Peter S. on April 28, 2004, at 22:19:08
> I know exactly what you mean by the crash. I've been on Lamictal for a couple of years now and have gone up to as much as 600mg- now I take 50mg/day. It gets me really energized in the morning only about an hour after I take it. It's a very positive effect. However generally the effect wears off in the afternoon. I've tried taking it twice a day but it really makes no difference. I'm combining it with Lexapro and Neurontin. I think the stimulating/anti-depressant effect is secondary to any mood stabilizing effects Lamictal may have. If anyone figures out how to sustain it I'd love to hear about it!
Hi there Pete,
So you're still tinkering with the Lamictal/SSRI/neurontin combo. eh? :)
If I remember rightly, you and I were both experementing with virtually identical med. combinations for quite some time(over a year ago I think...)and puzzling over how to prolong the elusive Lamictal effect.
I went up to 600mg Lam. eventually, before I finally got exasperated with the stuff and binned it for good.I traded it for Trileptal and (along with the Prozac I was taking until recently)it has been excellent in many ways.
1)Great mood stabilizer and checked my rapid cycling (yup, I started to 'spin' again on Lamictal..)
2)Supressed my BP11 anger spells(as well as Valproate ever did), but without causing the mental dumbness.
3)Allowed me to discontinue Prozac completely, once it's(Trileptal's) antidepressant effect took hold-it's a subtle effect(unlike Lamictal)and seemed to happen after a month or two.
4)Quite stimulating also, provided you don't overshoot the dose or move too quickly.
The only side effects I've had have been sleepiness and headaches(watch these *******)if I raise the dose too quickly.Other than that, very unobtrusive.Have you tried this one at all yet?Hope you're doing well.
Col.
Posted by judy1 on April 29, 2004, at 13:06:14
In reply to Re: LAMICTAL CRASH... ANYONE???? » judy1, posted by sac on April 28, 2004, at 19:50:33
bummer, I just lost a long message I just typed to you. the essence was that I was concerned that prozac precipitated a hypomanic state following your pregnancy- post pregnancy can cause hormonal changes that directly affect mood states and in my case prozac caused a full blown psychotic manic state that despite the addition of mood stabilizers I continued to cycle. so in my case I basically went from bp 2 to bp 1 after prozac. how long has it been since the birth of your child? has anyone considered the possibility that you don't have bipolar disorder or if you do it's bp 3 (med induced)? Have you thought about gradually discontinuing your AD and if still depressed starting a different class like TCAs. Have you seen a psychopharmacologist? I wonder if you tried a trial of discontinuing your prozac if you would need a mood stabilizer? just some thoughts...
take care, judy
Posted by judy1 on April 29, 2004, at 13:10:11
In reply to Impressed with Trileptal » Peter S., posted by colin wallace on April 29, 2004, at 12:14:40
I'm glad you're doing so well with trileptal. I agree it's much more gentle than it's cousin (tegretol), but I still had too many side effects to continue it (mostly nausea and headaches). What dose have you settled on?
take care, judy
Posted by judy1 on April 29, 2004, at 13:13:19
In reply to Re: LAMICTAL CRASH... ANYONE????, posted by Peter S. on April 28, 2004, at 22:19:08
so when you took it bid did you have a crash after the second dose? or was it just after the initial dose? did you increase your dose by taking it bid?
take care, judy
Posted by colin wallace on April 29, 2004, at 19:29:11
In reply to Re: Impressed with Trileptal » colin wallace, posted by judy1 on April 29, 2004, at 13:10:11
> I'm glad you're doing so well with trileptal. I agree it's much more gentle than it's cousin (tegretol), but I still had too many side effects to continue it (mostly nausea and headaches). What dose have you settled on?
> take care, judy
Hi Judy,I have to say that I had a bit of a hard time with the headaches at first (in fact, in I hadn't have been laid up in bed anyway with a horrendous winter depression, I wonder whether I might have given up sooner too).
I was on 300mg for 2months or so (with zero side-effects)and did an instant switch from Lamictal, which had bottomed out completely after over 2yrs chasing my tail with the doses.
When I tried to go to 600mg, the headaches started, and they were quite nasty.I kept dropping back to 300mg, waiting a week or so, then taking 600mg on alternate days only for a while.The headaches lessened, and I reached 600mg daily(milder 'background' headaches now;in other words, I was able to function despite them).
I don't think I hit 900mg for three months(my current dosage), which I take as 300mg 3x daily.(it's the 600mg in one sitting that gives me headaches).
No side effects now whatsoever(I avoid the possibility of nausea by taking it with meals).
Basically, my long (sometimes bitter) experience with Lamictal has taught me to be patient and move slowly with these anticonvulsants!
Hope you're well yourself.Take care,
Col.
Posted by sac on April 29, 2004, at 21:06:08
In reply to Re: LAMICTAL CRASH... ANYONE???? » sac, posted by judy1 on April 29, 2004, at 13:06:14
Thank you Judy for your response. Yes I had a manic episode after my second child was born 3 years ago and I was on 40 mgs. Prozac and I think that is the reason. I've never been the same since. I'd love to get off the Prozac but when I try to discontinue I become depressed. I have been on imipramine in the past as well as Paxil, Zoloft, Wellbutrin, Serzone, Lexapro, Celexa, etc....
Maybe I will need to give up the prozac to stop the cycling. Thanks for your insight. -Stacey> bummer, I just lost a long message I just typed to you. the essence was that I was concerned that prozac precipitated a hypomanic state following your pregnancy- post pregnancy can cause hormonal changes that directly affect mood states and in my case prozac caused a full blown psychotic manic state that despite the addition of mood stabilizers I continued to cycle. so in my case I basically went from bp 2 to bp 1 after prozac. how long has it been since the birth of your child? has anyone considered the possibility that you don't have bipolar disorder or if you do it's bp 3 (med induced)? Have you thought about gradually discontinuing your AD and if still depressed starting a different class like TCAs. Have you seen a psychopharmacologist? I wonder if you tried a trial of discontinuing your prozac if you would need a mood stabilizer? just some thoughts...
> take care, judy
Posted by sac on April 29, 2004, at 21:26:09
In reply to Re: LAMICTAL CRASH... ANYONE????, posted by Peter S. on April 28, 2004, at 22:19:08
At least I know I am not imagining this. My doctor is totally unaware that this could possibly happen. However, the crashing effect is enough that I might just have to throw in the towel with Lamictal. It affects my quality of life. I mean, in the morning and afternoon I am basically feeling fine but every evening I crash badly no matter what times I take the Lamictal during the day. Doesn't really make sense but it's happening.
> I know exactly what you mean by the crash. I've been on Lamictal for a couple of years now and have gone up to as much as 600mg- now I take 50mg/day. It gets me really energized in the morning only about an hour after I take it. It's a very positive effect. However generally the effect wears off in the afternoon. I've tried taking it twice a day but it really makes no difference. I'm combining it with Lexapro and Neurontin. I think the stimulating/anti-depressant effect is secondary to any mood stabilizing effects Lamictal may have. If anyone figures out how to sustain it I'd love to hear about it!
>
>
> > I've been on Prozac off and on for about 10 years. However, I only recently (within 2 years) been re-diagnosed with bipolar II. Years ago I had no problem with Prozac and no instability or hypomania. That all changed with the birth of my second child. It has been a whole new ballgame now. I have been on different mood stabilizers and AD's. Yes, the Lamictal is stimulating for me and I can't go above 150mgs. or I am very agitated. It's just this "crash" that I experience every evening. Maybe the Prozac doesn't work well with the Lamictal. Perhaps, it's some sort of interaction??
> >
> >
> >
> >
> > > how long have you been on prozac? has your dose remained stable? a lot of people with bipolar disorder cannot take ADs (usually become more unstable). If you are certain it isn't the prozac, then I don't know- lamictal was very stimulating for me- maybe you can divide your dose tid instead of bid?
> > > take care, judy
> >
> >
>
>
Posted by Peter S. on April 29, 2004, at 23:23:35
In reply to Impressed with Trileptal » Peter S., posted by colin wallace on April 29, 2004, at 12:14:40
Hey Colin,
Good to hear from you and I'm glad you found something that works. I tried Trileptal and I think it made the depression worse- I stuck it out for a couple of weeks. The Lamictal is better than nothing- I've tried everything on the market and I've come to the conclusion that the state of the art science on depression is still in the stone age. I was hoping that there would be some breakthroughs on the horizon but I don't consider developing a new SSRI/SNRI a breakthrough.
Best,
Peter
>
> Hi there Pete,
>
> So you're still tinkering with the Lamictal/SSRI/neurontin combo. eh? :)
> If I remember rightly, you and I were both experementing with virtually identical med. combinations for quite some time(over a year ago I think...)and puzzling over how to prolong the elusive Lamictal effect.
> I went up to 600mg Lam. eventually, before I finally got exasperated with the stuff and binned it for good.I traded it for Trileptal and (along with the Prozac I was taking until recently)it has been excellent in many ways.
> 1)Great mood stabilizer and checked my rapid cycling (yup, I started to 'spin' again on Lamictal..)
> 2)Supressed my BP11 anger spells(as well as Valproate ever did), but without causing the mental dumbness.
> 3)Allowed me to discontinue Prozac completely, once it's(Trileptal's) antidepressant effect took hold-it's a subtle effect(unlike Lamictal)and seemed to happen after a month or two.
> 4)Quite stimulating also, provided you don't overshoot the dose or move too quickly.
> The only side effects I've had have been sleepiness and headaches(watch these *******)if I raise the dose too quickly.Other than that, very unobtrusive.Have you tried this one at all yet?
>
> Hope you're doing well.
>
> Col.
>
Posted by colin wallace on May 1, 2004, at 8:41:43
In reply to Re: Impressed with Trileptal » colin wallace, posted by Peter S. on April 29, 2004, at 23:23:35
> Hey Colin,
>
> Good to hear from you and I'm glad you found something that works. I tried Trileptal and I think it made the depression worse- I stuck it out for a couple of weeks. The Lamictal is better than nothing- I've tried everything on the market and I've come to the conclusion that the state of the art science on depression is still in the stone age. I was hoping that there would be some breakthroughs on the horizon but I don't consider developing a new SSRI/SNRI a breakthrough.
Pete,I meant to ask you how you're finding Lexapro?I tried it very recently, and it made me seriously hypo. within 2 days- at only 5mg.
Can't believe I was dumb enough to be persuaded to try yet another(yawn) re-branded SSRI.Same old story.
I've still only got one foot out of my own personal quagmire too- realistically, I know I'll never get by on Trileptal alone in the long term, and plan to jump straight back in there with either Nardil or Parnate in 3 weeks time, once my Prozac washout's done.Watch this space.Colin.
This is the end of the thread.
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