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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by AMD on June 1, 2004, at 19:43:49
I was on Trileptal for about two weeks, quickly titrating up from 300 mg daily to 600 mg bid. After three days at 1200 mg I began to feel zonked, and then quickly started dropping the dose, 300 mg per day, until I was off it for two days. By yesterday I felt so jittery that this morning I took a 300 mg to take the edge off, so to speak.
I had read that you can induce a seizure by quitting Trileptal too abruptly, but my understand was this would happen only after having taken it for several months. But was my jitteriness a sign of seizure? Can Trileptal /give/ you epilepsy or a permanent seizure disorder on its own? Or cause permanent disfunctioning of the temporal lobe?
I plan to take 150 mg tomorrow, and prehaps for a few days, and then finally quit.
I'd appreciate some opinions on this.
Thanks,
Posted by Chairman_MAO on June 1, 2004, at 20:57:37
In reply to Quitting Trileptal, posted by AMD on June 1, 2004, at 19:43:49
I quit Trileptal 900mg/day "cold turkey" after six months of use with no adverse effects except slight, pleasant hypomania as it wore off and perhaps some agitation for about 24 hours. I am not a neurologist nor even a degree-holder, but I suspect you'd have to have an underlying seizure disorder for withdrawl convulsions to occur.
That said, the brain usually takes at least four weeks to become dependent on a drug. One could quit, for example, high-dose pentobarbital (this statement comes with no warranty) "cold turkey" after only two weeks of use with no convulsions. Are you sure what you're experiencing isn't related to the illness for which the Trileptal was prescribed?
Posted by psychosage on June 1, 2004, at 23:57:18
In reply to Quitting Trileptal, posted by AMD on June 1, 2004, at 19:43:49
> I was on Trileptal for about two weeks, quickly titrating up from 300 mg daily to 600 mg bid. After three days at 1200 mg I began to feel zonked, and then quickly started dropping the dose, 300 mg per day, until I was off it for two days. By yesterday I felt so jittery that this morning I took a 300 mg to take the edge off, so to speak.
>
> I had read that you can induce a seizure by quitting Trileptal too abruptly, but my understand was this would happen only after having taken it for several months. But was my jitteriness a sign of seizure? Can Trileptal /give/ you epilepsy or a permanent seizure disorder on its own? Or cause permanent disfunctioning of the temporal lobe?
>
> I plan to take 150 mg tomorrow, and prehaps for a few days, and then finally quit.
>
> I'd appreciate some opinions on this.
>
> Thanks,Are you bipolar or epileptic? Is this all you are taking for bipolar {monotherapy}?
I ask because I wonder if there are prescribing differences depending on the reason you are taking it or your past experience with anticonvulsants.
I wonder if you moved up way too fast.
In some cases I think it is reasonable and normal to move up slowly.
I think moving from the first 150mg pill to 300mg bid could have been done over an entire month. That was my situation, so I assume I was moving slowly but surely. I eventually hit 1200mg/day, and the move was pretty easy since my mind and body knew what to expect.
If you kept increasing over a mere 14 days you would have had virtually no break from the dizzy drunken feeling. Having that many screwed up days in a rwo where you have to take naps and wonder if your brain just turned into jello can be discouraging.
If I am not mistaken i think I took a mere 150mg for 4 days or a week before I even hit 300mg/day, and my target dose before I took a single pill was 600mg a day. I wasn't allowed to reach that though for a full month according to my pdoc.
Trileptal has a great side effect profile relatively speaking, and the only thing to be concerned about thus far {trying not to be presumptuous in light of serzone} is the sodium issue. So blood work should be drawn for that {regular metabolic panel I think}.
Good luck if you decide to ever go back on it or on your next med.
Posted by AMD on June 2, 2004, at 14:37:05
In reply to Re: Quitting Trileptal » AMD, posted by psychosage on June 1, 2004, at 23:57:18
Bipolar I, although the main symptom causing me to get the I v. the II diagnosis is some psychosis re: my health: freaking out about, say, bumping my head, and actually feeling "out of it" (depressed) because of that.
I would like a medicine that actually made me thinking clearer, instead of making it harder to concentrate. Is this possible with ANY anticonvulsant? I certainly believe at this point that some low dose mood stablizer would help, but I am starting to feel like I've lost my capacity to learn, and it's really freaking me out. Is this a side-effect of the Trileptal, this spaced-out, no-concentration feeling? I was on Lamictal before, and I had some good days on that, but it really agitated me and caused the obsessions I mention above.
I've always taken Celexa and I wonder if any of these medicines have actually lessened its effect or increased its metabolic half-life, perhaps making it less effective.
a
Posted by saralyn on June 2, 2004, at 19:29:01
In reply to Re: Quitting Trileptal » psychosage, posted by AMD on June 2, 2004, at 14:37:05
Yes, that's exactly what i want, a mood stabilizer that helps me think rather than make me feel like a zombie. Trileptal made me dull and suicidally depressed after taking it for 2 months, i decided to quit it one day against my doctor's advice because I just wanted to feel like myself again, (yes, I spiraled immediately into mania). Another one that will make you dumb is zonegran, but to be fair i probably didn't give it a fair trial but watch out for some dulling at first with that one, probably have to do with the 63-hour elimination half-life.
One that sounds promising at the moment is Keppra, very low side-effect profile with a short half-life(about 7 hours), supposed to be the only one that helps you think clearer. Anyone have experience with that care to share about its side-effects? What of its effect on weight? Thanks!
Posted by Chairman_MAO on June 2, 2004, at 19:36:14
In reply to Re: Quitting Trileptal, posted by saralyn on June 2, 2004, at 19:29:01
Posted by AMD on June 2, 2004, at 19:47:54
In reply to Re: Quitting Trileptal, posted by saralyn on June 2, 2004, at 19:29:01
How long did it take you after stopping the Trileptal to get your cognition back?
I've stopped mine (last 300 m.g. dose was yesterday) and I've got my fingers crossed my brain will recover. It's so scary to suddenly feel like I went from top of the class to the bottom -- I wonder if I've done some permanent brain damage. My head is all over the place -- on the drug, too spaced out to concentrate; and now, a little racy (either from the withdrawal, or a bit of mania coming in).
Posted by saralyn on June 2, 2004, at 23:29:16
In reply to Re: Quitting Trileptal » saralyn, posted by AMD on June 2, 2004, at 19:47:54
> How long did it take you after stopping the Trileptal to get your cognition back?
>
> I've stopped mine (last 300 m.g. dose was yesterday) and I've got my fingers crossed my brain will recover. It's so scary to suddenly feel like I went from top of the class to the bottom -- I wonder if I've done some permanent brain damage. My head is all over the place -- on the drug, too spaced out to concentrate; and now, a little racy (either from the withdrawal, or a bit of mania coming in).
>
>
Couple of days, i think. I started feeling racy and happy on day one with a minor headache and photo sensitivity (i quit cold turkey, did not taper) that went away by day 3. By then I had already started cycling.Trileptal has a 9-hour half life, for most people it should be out of the system in 2-3 days
Posted by saralyn on June 2, 2004, at 23:34:57
In reply to Abilify is a MS that does not impair cognition (nm), posted by Chairman_MAO on June 2, 2004, at 19:36:14
I would prefer to avoid the AP route. Diabetes runs in my family so can't risk weight gain.
Posted by Chairman_MAO on June 3, 2004, at 13:04:07
In reply to Re: Abilify is a MS that does not impair cognition, posted by saralyn on June 2, 2004, at 23:34:57
This is definitely in the realm of the experimental, but I think there's a lot of promise here. Cholinesterase inhibitors ENHANCE cognitive function and SUPRESS appetite. Try Aricept (mentioned here) or Reminyl + Wellbutrin, which is a good AD to use in bipolars. Alternatives for sparing cognitive function on the AD side abound, such as Parnate, desipramine, Strattera, etc.
Biol Psychiatry. 1999 Apr 15;45(8):959-64. Related Articles, Links
Donepezil in treatment-resistant bipolar disorder.Burt T, Sachs GS, Demopulos C.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
BACKGROUND: A considerable percentage of patients with bipolar disorder do not respond or do not tolerate conventional treatment. Cholinesterase (ChE) inhibitors have been suggested to possess depressogenic and antimanic properties. METHODS: We report a case series of treatment-resistant bipolar patients (n = 11) to whom we administered the ChE inhibitor donepezil. Four patients met criteria for current manic episode, 5 for mixed episode, 1 for hypomanic episode, and 1 for major depressive episode. Donepezil was added to current medication on an openlabel basis. Ratings were based on a retrospective chart review. RESULTS: Of the 11 patients, 6 (54.5%) demonstrated marked improvement (improvement in CGI-S > or = 2), 3 (27.2%) demonstrated slight improvement, 1 did not respond, and 1 did not tolerate the medication. Among those patients who had marked improvement (i.e., responders, n = 6), improvement was observed within 2 weeks or less in 5 of them (83%). Patients experienced only minor side effects. CONCLUSIONS: These pilot data suggest the efficacy and safety of donepezil in the treatment of bipolar disorder. To our knowledge this is the first published report on the use of donepezil in the treatment of mood disorders. Controlled, randomized, double-blind studies are necessary to validate these preliminary observations.
Posted by AMD on June 3, 2004, at 14:08:19
In reply to Re: Quitting Trileptal, posted by saralyn on June 2, 2004, at 19:29:01
I'm a bit freaked out I've done permanent damage to my memory. I've been off Trileptal for a couple of days now, and I'm still having a hard time remembering things as quickly and clearly as I was able to even two weeks ago.
For example, someone today needed an old address of mine, somewhere I lived for over a year, and I totally blanked on it for several seconds, and really only remembered it a few minutes later. WHAT THE F***!?!
I have quit ALL anticonvulsants and mood stablizers for now, until they give me one that doesn't ruin my head. Now I've lost the strength of my memory, and if it doens't come back, I don't think there's a pill they could give me to make me not depressed.
Is this effect going to be permanent? When will I feel my ability to concentrate and remember return. UGH!
:-( :-( :-(
Posted by AMD on June 3, 2004, at 14:10:53
In reply to Re: OK, try a cholinesterase inhibitor + AD » saralyn, posted by Chairman_MAO on June 3, 2004, at 13:04:07
I will look into this, but at this point I have ZERO trust of my psychiatrists or mood stablizing medicines in general. My experience thus far as been
mood stablizers == stupid pills
Yeah, you're not depressed or manic because you don't have the freakin' brain cells any more.
Dammit! Can you tell I'm frustrated? I want this to END! Starting mood stablizers was the worst decision in my life. My life has been up and down hell since I first started them in October. I thought these were supposed to HELP!?!?!
>
> This is definitely in the realm of the experimental, but I think there's a lot of promise here. Cholinesterase inhibitors ENHANCE cognitive function and SUPRESS appetite. Try Aricept (mentioned here) or Reminyl + Wellbutrin, which is a good AD to use in bipolars. Alternatives for sparing cognitive function on the AD side abound, such as Parnate, desipramine, Strattera, etc.
>
>
> Biol Psychiatry. 1999 Apr 15;45(8):959-64. Related Articles, Links
>
>
> Donepezil in treatment-resistant bipolar disorder.
>
> Burt T, Sachs GS, Demopulos C.
>
> Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
>
> BACKGROUND: A considerable percentage of patients with bipolar disorder do not respond or do not tolerate conventional treatment. Cholinesterase (ChE) inhibitors have been suggested to possess depressogenic and antimanic properties. METHODS: We report a case series of treatment-resistant bipolar patients (n = 11) to whom we administered the ChE inhibitor donepezil. Four patients met criteria for current manic episode, 5 for mixed episode, 1 for hypomanic episode, and 1 for major depressive episode. Donepezil was added to current medication on an openlabel basis. Ratings were based on a retrospective chart review. RESULTS: Of the 11 patients, 6 (54.5%) demonstrated marked improvement (improvement in CGI-S > or = 2), 3 (27.2%) demonstrated slight improvement, 1 did not respond, and 1 did not tolerate the medication. Among those patients who had marked improvement (i.e., responders, n = 6), improvement was observed within 2 weeks or less in 5 of them (83%). Patients experienced only minor side effects. CONCLUSIONS: These pilot data suggest the efficacy and safety of donepezil in the treatment of bipolar disorder. To our knowledge this is the first published report on the use of donepezil in the treatment of mood disorders. Controlled, randomized, double-blind studies are necessary to validate these preliminary observations.
>
Posted by saralyn on June 3, 2004, at 15:11:32
In reply to Re: OK, try a cholinesterase inhibitor + AD » Chairman_MAO, posted by AMD on June 3, 2004, at 14:10:53
> I will look into this, but at this point I have ZERO trust of my psychiatrists or mood stablizing medicines in general. My experience thus far as been
>
> mood stablizers == stupid pills
>
> Yeah, you're not depressed or manic because you don't have the freakin' brain cells any more.
>
Yea, I felt that way too, that's why I've kinda taken myself off all meds just to feel alive for now.
Tell me what else you have taken, AMD. Though most mood stabilizers/anti-epileptics are cognitive dulling, they *shouldn't* cause any permanent damage. Unless I'm mistaken, they work to suppress hyperactivity and misfirings in the brain (hence their use in epilepsy and bipolar), thereby exhibiting a neuroprotective action, albeit an extremely intrusive one.
If it's taking you this long to get over the side effects from Trileptal after having stopped it for this long I'm wondering if perhaps there was a problem with the way you were metabolizing trileptal, perhaps with other drug combinations? It is enzyme-inducing so there are potential drug-drug interactions.As for trying a cholinesterase inhibitor, it sounds interesting (increased cognition, you say? wow. Wonder why I was never told about this :-(
) and a consideration in the future if I ever decide to go back on meds. Right now I'm feeling good and *clean* without anything to mask my feelings/thoughts.
Posted by AMD on June 3, 2004, at 15:25:25
In reply to Re: OK, try a cholinesterase inhibitor + AD, posted by saralyn on June 3, 2004, at 15:11:32
I'm only taking Celexa, 40 mg, which worked before but now I fear it has pooped out on me. I just wish I had my confidence and concentration back. That's been the most damaging part of this entire endeavor.
I do take a bunch of vitamin supplements: C, E, B and fish oil (~3g day).
What are you taking these days? Anything at all?
amd
Posted by saralyn on June 3, 2004, at 15:37:46
In reply to Re: OK, try a cholinesterase inhibitor + AD » saralyn, posted by AMD on June 3, 2004, at 15:25:25
I was taking 300 mg wellbutrin, 5 mg ambien, 900 mg trileptal, and most recently just 100 mg zonegran.
But nope, as of this moment i am taking NOTHING, not even ambien and i feel (dare I say??) happy!
Posted by AMD on June 3, 2004, at 16:35:48
In reply to Re: OK, try a cholinesterase inhibitor + AD, posted by saralyn on June 3, 2004, at 15:37:46
Excellent. How long have you been off your medication?
a
Posted by saralyn on June 4, 2004, at 1:54:27
In reply to Re: OK, try a cholinesterase inhibitor + AD » saralyn, posted by AMD on June 3, 2004, at 16:35:48
> Excellent. How long have you been off your medication?
>
> a
Just 3 days. Actually I'm not feeling so good at the moment..i'm wondering if I'm still going through withdrawal...just feeling kinda foggy and dizzy...maybe there's some permanent damage from using mood stabilizers afterall, grr!
Posted by SLS on June 7, 2004, at 8:52:32
In reply to Re: OK, try a cholinesterase inhibitor + AD » saralyn, posted by Chairman_MAO on June 3, 2004, at 13:04:07
Pro-cholinergic drugs can sometimes precipitate or exacerbate depression. I have bipolar depression. Donepezil (Aricept) made me feel significantly worse.
- Scott
Posted by Chairman_MAO on June 8, 2004, at 9:22:42
In reply to Re: OK, try a cholinesterase inhibitor + AD, posted by SLS on June 7, 2004, at 8:52:32
Yeah, I should've mentioned that instead of simply hinting that it should be combined with an AD. I surmise that for BP1 folks who spend a lot of time at the manic end of the spectrum, cholinesterase inhibitors could be especially useful.
I found that while on lexapro and Strattera, I could use galantamine (Reminyl, Nivalin) in moderate doses without exacerbating my depression. Fine titration is a requirement, however. If I took just a little too much, I fell into an an agitated, thought-frenzied, depressive state.
Posted by chemist on June 13, 2004, at 22:05:42
In reply to Re: OK, try a cholinesterase inhibitor + AD » SLS, posted by Chairman_MAO on June 8, 2004, at 9:22:42
hello, chemist here. a little problem with galantamine: it is not a cholinesterase inhibitor, rather acetylcholinesterase. as you should be aware, there is quite a difference. you will excarebate transmission at neuromuscular junction ACh, enhancing smooth-muscle function. you ought to try a true nootropic. all the best, chemist p.s. or at least a real cholinesterase inhibitor, not an ACh-I.
> Yeah, I should've mentioned that instead of simply hinting that it should be combined with an AD. I surmise that for BP1 folks who spend a lot of time at the manic end of the spectrum, cholinesterase inhibitors could be especially useful.
>
> I found that while on lexapro and Strattera, I could use galantamine (Reminyl, Nivalin) in moderate doses without exacerbating my depression. Fine titration is a requirement, however. If I took just a little too much, I fell into an an agitated, thought-frenzied, depressive state.
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