![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 47. Go back in thread:
Posted by banga on January 13, 2005, at 9:29:24
In reply to Re: Lamictal dose range? poop-out? » banga, posted by ace on January 12, 2005, at 22:41:19
Thanks. I have enviously been reading posts about people's success with Nardil and Parnate. I don't know my pdoc well enough yet to know what her reaction would be. My guess is that she would feel we haven't exhausted all other possibilities yet...
I will have to sit down today and think this through.
Posted by catmint on January 14, 2005, at 14:38:32
In reply to Re: Lamictal dose range? poop-out? » ace, posted by banga on January 13, 2005, at 9:29:24
Hello All,
Please read. I need some advice or just someone to listen and some support.
I take 100 mg. twice a day which I have gradually increased over 2 years ago.
This past summer I had a manic episode due to some cocaine that my wonderful(sarcastic)friend brought around. I can't say that is exactly what triggered it; I had started smoking pot months before that for what reason I don't know. I was in art school at the time and I guess I felt that I needed to reach some kind of high in order to tap into my creativity. It was b*llshit, I became really messed up. We increased the Lamictal to 300 mg. and it was way to much. I'm back to 200. I am really depressed, edgy and irritable, and sad.Lately I have been getting in some really wierd states. I get delusional and have a thought disorder. My thoughts are consantly racing. I'm having headaches and insomnia. When I get triggered by a fight with my boyfriend, I have these really long, gut wretching crying spells and suicidal ideation. And I'm always irritable and sad.
The Lamictal doesn't work any more.
I'm pissed because I thought it was the answer to my depression. Of course I know there is a lot more I can do, like exersise.I've tried every med and combination.
I'm thinking of adding Depakote. I know it will raise Lamictal levels, so I will take less. Depakote was the only med that helped with my constant irritabiliy.
Thanks for reading. I have been on this board for 3 years and I love all of you.
Amy
Posted by CareBear04 on January 14, 2005, at 17:16:12
In reply to Re: Lamictal doesn't work anymore, posted by catmint on January 14, 2005, at 14:38:32
hi all,
i'm currently on lamictal 200mg, which i take in the morning. i was under the impression that this way a small dose; that most people take at least 300mg, but no one on this thread mentioned taking more than 200.
my pdoc says that the effects of lamictal aren't usually correlated to dose. i feel like lamictal is not doing much for me, especically compared to the lithium that i'm used to. i would feel more comfortable on a higher dose.
different doctors have a different schedule for increasing the dose, though all are concerned about steven johnsons. one said that we can double the dose every two weeks while another increased me from 100 to 150 for two weeks before taking me up to 200.
good luck to you all!
Posted by johnnystats on January 15, 2005, at 11:47:15
In reply to Re: Lamictal doesn't work anymore, posted by catmint on January 14, 2005, at 14:38:32
I'm sorry to hear about your troubles lately. I know the rollercoaster ride that can happen with mental illness and it can be really tough. I had to see a therapist to get through it.
I was on Depakote for three years, and boy was it effective at controlling mood swings and irritability. But eventually i gave it up because of the side effects it caused me. I lost some of my hair, gained weight, and felt tired all the time. As far as combining the lamictal with the depakote, i wouldn't recommend it. How would you know which med was working? Best to just be patient and make the switch.
Best of luck,
Johnnystats
Posted by Ritch on January 15, 2005, at 14:21:15
In reply to Re: Lamictal doesn't work anymore, posted by catmint on January 14, 2005, at 14:38:32
> Hello All,
>
> Please read. I need some advice or just someone to listen and some support.
>
> I take 100 mg. twice a day which I have gradually increased over 2 years ago.
>
> This past summer I had a manic episode due to some cocaine that my wonderful(sarcastic)friend brought around. I can't say that is exactly what triggered it; I had started smoking pot months before that for what reason I don't know. I was in art school at the time and I guess I felt that I needed to reach some kind of high in order to tap into my creativity. It was b*llshit, I became really messed up. We increased the Lamictal to 300 mg. and it was way to much. I'm back to 200. I am really depressed, edgy and irritable, and sad.
>
> Lately I have been getting in some really wierd states. I get delusional and have a thought disorder. My thoughts are consantly racing. I'm having headaches and insomnia. When I get triggered by a fight with my boyfriend, I have these really long, gut wretching crying spells and suicidal ideation. And I'm always irritable and sad.
>
> The Lamictal doesn't work any more.
> I'm pissed because I thought it was the answer to my depression. Of course I know there is a lot more I can do, like exersise.
>
> I've tried every med and combination.
> I'm thinking of adding Depakote. I know it will raise Lamictal levels, so I will take less. Depakote was the only med that helped with my constant irritabiliy.
> Thanks for reading. I have been on this board for 3 years and I love all of you.
> AmyI think adding Depakote to the Lamictal might make a good combo. You would be supervised by a doctor? I wouldn't do it on my own. It might be best to start titrating the Lamictal down before you add the Depakote.. maybe reduce the Lamictal by half over a couple of weeks, then hold at 100mg/day, then maybe add Dep. 250mg/day for a couple of weeks and see how you do? Lithium would be a safer add.. have you considered that or done that before?
Posted by catmint on January 15, 2005, at 14:27:59
In reply to Depakote works, but be wary of side effects » catmint, posted by johnnystats on January 15, 2005, at 11:47:15
Thanks a lot for your post.
I spent some time yesterday researching the Lamictal/Depakote combo and have decided against it.
I was on just Depakote before the Lamictal and it is true what you said. I was tired all the time, my depression worsened and I had a huge apppetite.
I am now considering going off all meds for a while. I've done it before and can't say it was that much better but I don't know what else to try at this point.
What meds do you take now?
Posted by catmint on January 15, 2005, at 14:32:25
In reply to Re: Lamictal doesn't work anymore » catmint, posted by Ritch on January 15, 2005, at 14:21:15
Hi Ritch,
I have tried Li with the Lamictal and it just made me constipated, tired and depressed.I'm not sure what to do at this point.
Thanks, hope you are doing well.
Amy
Posted by catmint on January 15, 2005, at 14:55:02
In reply to Re: Lamictal doesn't work anymore » catmint, posted by Ritch on January 15, 2005, at 14:21:15
Hi Ritch,
By the way, have you heard from Colin lately?
Posted by Ritch on January 15, 2005, at 15:46:25
In reply to Re: Lamictal doesn't work anymore » Ritch, posted by catmint on January 15, 2005, at 14:55:02
> Hi Ritch,
>
> By the way, have you heard from Colin lately?Yes, last time I posted to him he was looking for advice on adding a psychostim for bipolar depression, I think that was just about a week or two ago. Haven't heard back on it yet. Oh, while the server was being switched I done some researching and there is derivative of Trileptal that is in clinical trials for bipolar.. it is licarbazapine. You may have read a few days ago about the approval of a unique extended-release form of carbamazepine for bipolar (can't remember the brand name now). Anyhow, here's some links related to licarbazapine.. I think they are still looking for volunteers for the trials..:
http://www.clinicaltrials.gov/ct/gui/show/NCT00099229
http://www.jclinpharm.org/cgi/content/abstract/44/8/906
http://www.ingentaconnect.com/content/sage/j377/2004/00000044/00000008/art00010Here's a text clip related to licarb. :
Novartis appear to have revived
licarbazepine, the monohydroxy
analog of oxcarbazepine, develop-
ment of which was suspended in
1999 as part of a pipeline reorgani-
zation process. Applications this year
have expanded the indications from
epilepsy to include tinnitus
(WO2004014391)
and
pain
(WO2004035041) and two applica-
tions this week claim anxiety, bipolar
disorder and neuropathic pain.Hmmm... it's interesting that they are pursuing an anxiety indication.... from what I read the side effect profile was supposed to be better than carbamazepine and oxcarbazepine. I'll be watching this one with interest for sure.
Oh yeah! Felbamate is also in clinical trials now for Bipolar. Hope you get to feeling better! Do you think that the Lamictal is *causing* your agitation and irritability?
Posted by catmint on January 16, 2005, at 0:31:02
In reply to Re: Lamictal doesn't work anymore » catmint, posted by Ritch on January 15, 2005, at 15:46:25
>>>>>Oh yeah! Felbamate is also in clinical trials now for Bipolar. Hope you get to feeling better! Do you think that the Lamictal is *causing* your agitation and irritability?
Good quesion. I guess I've always had problems with irritablity and the Lamictal makes it worse. I'm really not liking the fact that I'm an angry person. When I get really agitated I could smash things but I never do. Usually I end up crying for a long time.
Could go off coffee but won't.
I see my pdoc in a week. I want to talk about going off the Lamictal.
Hope you are doing well.
Amy
P.S. thanks for the info about those new meds. Please keep me posted when you know more.
Posted by Ron Hill on January 18, 2005, at 13:30:01
In reply to Re: Lamictal doesn't work anymore » catmint, posted by Ritch on January 15, 2005, at 15:46:25
Mitch,
> > By the way, have you heard from Colin lately?
> Yes, last time I posted to him he was looking for advice on adding a psychostim for bipolar depression, I think that was just about a week or two ago. Haven't heard back on it yet.
Mitch, did you really hear from Colin recently, or do you have me confused with my good buddy Colin? The most recent post I've seen from Colin was back in October:
http://www.dr-bob.org/babble/20041007/msgs/401578.html
Do you know of a more recent post?
It's no big deal if you've got us mixed up; we can write off the name recall glitch to the Depakote.
I feel bad that I didn't get back to thank you for your response to my former post regarding Adderall. I've had a very "interesting" response to the addition of 5 mg of Adderall. At some point I'll tell you all about it. My one-year protest is over sometime in February.
Thank you Mitch!
Hey in reference to your posts in a thread above, have you ever tried ginger on a prn basis to treat Trileptal induced nausa? I buy crystallized ginger at the grocery store in the bulk food section. It's a little spendie (about $7 per lb) but it does the trick on my rare bouts of nausa. YMMV.
I love two things about Trileptal; it reels in my hypomania within minutes of taking a dose and I sleep like a baby on it. As you are well aware, good sound sleep is an excellent bipolar "medication".
Unfortunately, Trileptal does not help my BPII atypical depression. In fact, it almost feels like it hinders me from cycling out of the depressive phase of my cycle. In other words, it kinda holds me in the depressive phase longer than I would have been without it. I notice this particularly at higher dosages. As a side note, I'm absolutely convinced that Depokote caused depression when I was on it years ago.
-- Ron
Bipolar II and Obsessive Compulsive Personality Traits
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal
5 mg/day Adderall PRN for very short intervals (i.e.; about five days or so) as needed to chase away the bipolar atypical depression demons. The Adderall is discontinued as soon as the depression abates in order to avoid pstim induced burnout. (Note: the Adderall experiment is early in the trial, so time will tell.)
-------------------------------------------------
> > Hi Ritch,
> >
> > By the way, have you heard from Colin lately?
>
> Yes, last time I posted to him he was looking for advice on adding a psychostim for bipolar depression, I think that was just about a week or two ago. Haven't heard back on it yet. Oh, while the server was being switched I done some researching and there is derivative of Trileptal that is in clinical trials for bipolar.. it is licarbazapine. You may have read a few days ago about the approval of a unique extended-release form of carbamazepine for bipolar (can't remember the brand name now). Anyhow, here's some links related to licarbazapine.. I think they are still looking for volunteers for the trials..:
> http://www.clinicaltrials.gov/ct/gui/show/NCT00099229
> http://www.jclinpharm.org/cgi/content/abstract/44/8/906
> http://www.ingentaconnect.com/content/sage/j377/2004/00000044/00000008/art00010
>
> Here's a text clip related to licarb. :
> Novartis appear to have revived
> licarbazepine, the monohydroxy
> analog of oxcarbazepine, develop-
> ment of which was suspended in
> 1999 as part of a pipeline reorgani-
> zation process. Applications this year
> have expanded the indications from
> epilepsy to include tinnitus
> (WO2004014391)
> and
> pain
> (WO2004035041) and two applica-
> tions this week claim anxiety, bipolar
> disorder and neuropathic pain.
>
> Hmmm... it's interesting that they are pursuing an anxiety indication.... from what I read the side effect profile was supposed to be better than carbamazepine and oxcarbazepine. I'll be watching this one with interest for sure.
>
> Oh yeah! Felbamate is also in clinical trials now for Bipolar. Hope you get to feeling better! Do you think that the Lamictal is *causing* your agitation and irritability?
>
Posted by Ron Hill on January 18, 2005, at 14:32:56
In reply to Re: Depakote works, but be wary of side effects » johnnystats, posted by catmint on January 15, 2005, at 14:27:59
Amy,
So sorry to hear of your difficulty. I can totally relate to the symptoms you've listed in this thread. I’ve been there, done that, and I pray that I don't have to do it again. The dysphoric mood state is the worst. At least when I'm depressed (atypical type) I can sleep 24/7. But there is no escaping the dysphoric mixed-state hell. And I pity my poor wife!!
My sympathy goes out to you Amy. You're such a sweetie. I wish you didn't have to suffer this way. (And for goodness sakes, STAY AWAY from the recreational drugs!! But you know that.)
Refresh my memory; have you ever tried Trileptal. It seems like you did a couple years ago, but my memory fails me. Based on the Prescribing Information document for Lamictal -- http://us.gsk.com/products/assets/us_lamictal.pdf --, Trileptal and Lamictal do not interfere with each other very much. Adding Trileptal might be worth a trial for you Amy. You know best, of course; just a thought.
As I was telling Mitch above, I love two things about Trileptal; it reels in my hypomania within minutes of taking a dose and I sleep like a baby on it. As you are well aware, good sound sleep is an excellent bipolar "medication".
Unfortunately, Trileptal does not help my BPII atypical depression. In fact, it almost feels like it hinders me from cycling out of the depressive phase of my cycle. In other words, it kinda holds me in the depressive phase longer than I would have been without it. I notice this particularly at higher dosages. As a side note, I'm absolutely convinced that Depokote caused depression when I was on it years ago.
Based on the most recent post that I know of from Colin, it appears that he is taking Trileptal (as of 10/04).
http://www.dr-bob.org/babble/20041007/msgs/401578.html
Amy, I’m not supposed to be posting until late February ’05, but I just wanted to drop you a quick note of empathy and encouragement. There is a solution out there for you and you’re a smart gal; so keep looking. (At the risk of being reduntant and overly opinionated, please allow me to say it again: You and I both know that the solution is NOT recreational drugs).
-- Ron
Bipolar II and Obsessive Compulsive Personality Traits
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal
5 mg/day Adderall PRN for very short intervals (i.e.; about five days or so) as needed to chase away the bipolar atypical depression demons. The Adderall is discontinued as soon as the depression abates in order to avoid pstim induced burnout. (Note: the Adderall experiment is early in the trial, so time will tell.)
-----------------------------
> Thanks a lot for your post.
> I spent some time yesterday researching the Lamictal/Depakote combo and have decided against it.
> I was on just Depakote before the Lamictal and it is true what you said. I was tired all the time, my depression worsened and I had a huge apppetite.
> I am now considering going off all meds for a while. I've done it before and can't say it was that much better but I don't know what else to try at this point.
> What meds do you take now?
>
Posted by johnnystats on January 18, 2005, at 16:02:50
In reply to Re: Depakote works, but be wary of side effects » johnnystats, posted by catmint on January 15, 2005, at 14:27:59
> Thanks a lot for your post.
> I spent some time yesterday researching the Lamictal/Depakote combo and have decided against it.
> I was on just Depakote before the Lamictal and it is true what you said. I was tired all the time, my depression worsened and I had a huge apppetite.
> I am now considering going off all meds for a while. I've done it before and can't say it was that much better but I don't know what else to try at this point.
> What meds do you take now?
>I'm currently taking nardil, xanax xr, and switching from depakote to lamictal. It's the best combo i've tried so far for anxiety/depression.
Posted by catmint on January 18, 2005, at 16:32:17
In reply to Re: Amy, have you ever tried Trileptal? » catmint, posted by Ron Hill on January 18, 2005, at 14:32:56
Hi Ron,
Thank you so much for your post. It was good to see your name again.
I have stayed off recreational drugs since August. I had a close call a month ago. I smoked some cigarrettes for a couple days and had that euphoric recall thing. I have too much at stake to ever go down that road again. The depression that followed was too much. I don't want to want to die ever again.
I have cut back the Lamictal from 200 to 100 a day and am feeling a lot better. Of course, I am entering the better part of the month for me, so I don't know if the dose reduction is the answer.
Yes, Ron I have tried Trileptal for a brief period before I started Lamictal. I probably stopped taking it because I was really in need of an effective antidepressant other than an ssri, you know why.
Once on Lamictal, I never looked back until now.
Ron, sorry to hear you don't or can't post until February. Great to hear from you. Let's all keep in contact. Another person I'm interested in talking to is BarbaraCat. I haven't seen her in a while. I think she and I have a lot in common.
Hopefully Colin will chime in soon.
Bye Ron, take care, talk to you soon.
Amy
Posted by SLS on January 18, 2005, at 21:26:44
In reply to Re: Colin Wallace » Ritch, posted by Ron Hill on January 18, 2005, at 13:30:01
Hi Ron!
:-)
Glad to see you back.
- Scott
Posted by Ron Hill on January 18, 2005, at 22:50:42
In reply to Re: Colin Wallace » Ron Hill, posted by SLS on January 18, 2005, at 21:26:44
Posted by Ritch on January 19, 2005, at 0:08:33
In reply to Re: Colin Wallace » Ritch, posted by Ron Hill on January 18, 2005, at 13:30:01
> Mitch, did you really hear from Colin recently, or do you have me confused with my good buddy Colin? The most recent post I've seen from Colin was back in October:
> It's no big deal if you've got us mixed up; we can write off the name recall glitch to the Depakote.
YEP, got your post mixed up with Colin's!
>
> I feel bad that I didn't get back to thank you for your response to my former post regarding Adderall. I've had a very "interesting" response to the addition of 5 mg of Adderall. At some point I'll tell you all about it. My one-year protest is over sometime in February.
>
> Thank you Mitch!
You're welcome. Stims DO have good utility with bipolar for the ADD/depressive dimensions, but watch out for panic.. that was my case. If you don't have comorbid panic troubles and you can respond to low dosages for limited periods....
>
> Hey in reference to your posts in a thread above, have you ever tried ginger on a prn basis to treat Trileptal induced nausa? I buy crystallized ginger at the grocery store in the bulk food section. It's a little spendie (about $7 per lb) but it does the trick on my rare bouts of nausa. YMMV.
I've heard about the ginger "trick" for Depakote nausea. Thanks for reminding me about that. It just seems weird that 300mg Trileptal gives me such nausea and 500mg Depakote doesn't. The PDR numbers for nausea are actually worse for Depakote! You see, that makes me worried that Trileptal and its associates being not such a nice fit for my particular chemistry. I didn't get serum sodium checked.. and if it was seriously dipping serum sodium that led to the nausea symptoms--I don't want to take it--BUT if *Tegretol* WOULDN'T do that AND give me better or as good benefits as Trileptal for the manic-mixed symptoms I would rather take the Tegretol than the Depakote that I take now BECAUSE I think my sleep quality would be better and it would be *less* depressogenic than the Dep. Just a theory now.
>
> I love two things about Trileptal; it reels in my hypomania within minutes of taking a dose and I sleep like a baby on it. As you are well aware, good sound sleep is an excellent bipolar "medication".Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. If I take a dose at bedtime it seems that it activates me and wakes me up just a few hours later and then I can't go back to sleep.. and then I DO go back to sleep right before I need to wake up- really irritating! This leaves me all foggy headed and tired all next day. SOOO I have tried taking it earlier in the evening and it has helped some but not enough. It is like a triphasic response... first I get sedated and might nap or nod off.. then there is an *activation* that happens 4-6 hrs in (while I am trying to sleep), then several hours of somnolence after that (the next morning-midday). I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
>
> Unfortunately, Trileptal does not help my BPII atypical depression. In fact, it almost feels like it hinders me from cycling out of the depressive phase of my cycle. In other words, it kinda holds me in the depressive phase longer than I would have been without it. I notice this particularly at higher dosages. As a side note, I'm absolutely convinced that Depokote caused depression when I was on it years ago.
>
>----- RonI get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
Posted by Ron Hill on January 19, 2005, at 10:55:55
In reply to Re: Colin Wallace » Ron Hill, posted by Ritch on January 19, 2005, at 0:08:33
Mitch,
> You're welcome. Stims DO have good utility with bipolar for the ADD/depressive dimensions, but watch out for panic.. that was my case. If you don't have comorbid panic troubles and you can respond to low dosages for limited periods....
10 mg/day of Adderall completely resolved my atypical depression within hours of taking the first dose. I believe it is the dopamine reuptake inhibitor action, but the norapinphrine reuptake inhibitor action of Adderall might play a role as well.
Unfortunately, the Adderall caused severe insomnia (2 hr sleep per night)immediately, and within four days I was in a full-blown mania. The cause of the mania was two fold: 1) the Adderall induced insomnia and; 2) The amphetamine directly.
When the insomnia started I immediately knew that I was at great risk of going manic, but I felt sure that I could control it my increasing my Trileptal dosage. My pdoc has been ragging on me for "self-medicating" by adjusting the dosages of my meds on my own. So I called the good doc's office (which I never do) and left a v-mail on the nurse's phone to ask the doc for his permission to increase my dosage of Trileptal to reel in the Adderall induced hypomania and insomnia because I was at risk of becoming manic.
Based solely on the brief v-mail that I left for the nurse, he instructed the nurse to call me and tell me not to change the dosage of
my meds at least until the following Monday (four days later). He made this edict without even calling me to fully hear my rationale.Well sure enough, I went manic the next day (which was New Year's Eve) while the good doc was enjoying a well deserved long weekend. Initailly my wife encourged me to strictly follow the doctor's orders, but when I woke up, after my usual two hours of sleep, at 1 am on Sunday morning (1/2/05) in a full-blown manic state, my wife changed her tune and was pleading with me to take some extra Trileptal to reduce the severity of the mania. But I responded that I had told my pdoc in my last appointment that I would strictly adhere to his instructions and, by golly, I fully intend to keep my word.
Needless to say, I was on the phone Monday morning letting the nurse know my displeasure and instructing her to convey to the good doc the consequences of his poor decision. He responded by telling the nurse to call me back and grant my request to increase my Trileptal, and to grant my new added request to reduce the Adderall to 5 mg/day (which required a new script).
Don't get me wrong, I have a very good pdoc. He just made a couple bad calls. The other bad call was to start me out on 10 mg/day when we should have started with 5 mg/day. We all make mistakes, and I can forgive. I just wish that these pdoc's would listen to us patients a little better.
To bring you up to date with regard to my Adderall trial, two weeks into the trial the pstim caused burnout. My symptoms of burnout are physically drained, increasing amounts of sleep required to recover physically, aches and pains (flue-like without the runny nose and/or cough), etc.
These symptoms are distinctly different from the atypical depression symptoms of increased sleep, low energy, etc. I'm not able to articulate the symptoms of burnout very well, but trust me it's very different from the simillar words that I use to describe atypical depression.
I recognized the burnout symptoms right away because I experienced a very simillar effect with Ritalin when in 1996 a bad pdoc (my first) misdiagnosed my bipolar hypomania as ADHD and fed me Ritalin without having a moodstabilizer on-board. But that's a whole 'nother pdoc from hell story, and I'll not bore you with it here (besides, you've probably already read some of my previous rants on this topic that I've posted on PB in years past).
So back to the story at hand. One week ago I discontinued the 5 mg/day of Adderall and I left a v-mail for the nurse asking her to tell (not ask) the pdoc that I had to discontinue the Adderall trial due to burnout. I didn't hear back from his office, but I'll talk to him at my next appointment next week.
I was deeply regreting that I had to discontinue the Adderall because it had helped me so much initially and because I expected a huge rebound depression from the discontinuation. But to my suprise, the antidepressive effects are continuing even still, one week later. No hint of depression. Some hypomania, but I can chase it down with extra Trileptal.
From a pyschopharmacological standpoint, it makes no sense at all to me that the antidepressant effect continues for me after discontinuation. The half-life of Adderall is 13 hours, so it's gone by now! So my plan at this point is to use Adderall on a prn basis and to take it as infrequently as possible and for short durations. Time will tell.
> Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. If I take a dose at bedtime it seems that it activates me and wakes me up just a few hours later and then I can't go back to sleep.. and then I DO go back to sleep right before I need to wake up- really irritating! This leaves me all foggy headed and tired all next day. SOOO I have tried taking it earlier in the evening and it has helped some but not enough. It is like a triphasic response... first I get sedated and might nap or nod off.. then there is an *activation* that happens 4-6 hrs in (while I am trying to sleep), then several hours of somnolence after that (the next morning-midday). I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
Mitch, do you take magnesium at bedtime? I take 750 mg of magnesium malate every night at bedtime. It really helps my sleep (going to sleep, staying asleep, and sleeping sound. Along with it, I also take 10 mg of P-5-P (co-enzyme B6) to help the magnesium do its thing, and I take 1/2 tablet of a B-100 (B-complex) so that the Bee's don't get out of balance by taking the P-5-P. The Bee's can get angry if they get outta balance. :-)
> I get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
Exactly!! I don't know about the mechanism, but that's why I like to decrease my Lithobid and Trileptal dosages when I cycle into a depressed phase because I'm convinced that these moodstabilizers make the depression worse. Of course, when the depression abates, I have to increase these dosages to keep my hypomania in check. But this dosage adjustment is what my pdoc is complaining about. Go figure.
Posted by Ritch on January 19, 2005, at 13:44:51
In reply to Re: Adderall tx for Atypical Depression » Ritch, posted by Ron Hill on January 19, 2005, at 10:55:55
> Mitch,
...
> Unfortunately, the Adderall caused severe insomnia (2 hr sleep per night)immediately, and within four days I was in a full-blown mania. The cause of the mania was two fold: 1) the Adderall induced insomnia and; 2) The amphetamine directly.Wow! you really had a serious spinout there! Yeah, 10mg is too high too start off with a potentially serious risk of inducing mania from the getgo. It is tough to tell what that stuff will do (at least you can find out relatively quickly!).
I started at 5mg first thing in the AM and I was only taking some Neurontin with it.. that's it. No Depakote, lithium, anything that is supposed to be an "antimanic" med. I *was* beginning the usual seasonal depressive thing, so I wasn't taking it at a time where manic sx tend to predominate anyhow. I slept like a ROCK.
When I was taking Ritalin (10mg/day) or Dexedrine (5mg/day) I never had any sleep trouble. To me stims seemed to work out my brain and tire it and when bedtime came I SLEPT. When I took dexedrine I actaully felt somewhat tired and drowsy feeling and my forehead seemed as hot as an iron.
When I want to get "high" on something, all I have to do is take an extra pinch of an SSRI! That's the stuff that sets *me* off. Just like weed.
The negative effects that I got from pstims were: 1) sometimes overfocused and aloof, cold personality, 2) occasionally an exaggerated sense of interest in something... REALLY!, that's INTERESTING!, 3) A worsening anxiety scene over time (without a pinch of SSRI/Eff. +a little clon). I kinda think that I truly have a comorbid ADHD condition. I felt just a slight bit of euphoria a day or two starting up any stim, but very quickly there was zero euphoria from them. I could get "excitable" on them, but NOT euphoric... OK that's the distinction with me. It is difficult to explain, I was *interested* in stuff and worked one thing at a time, but wasn't HIGH. Very strange.
...
> Don't get me wrong, I have a very good pdoc. He just made a couple bad calls. The other bad call was to start me out on 10 mg/day when we should have started with 5 mg/day. We all make mistakes, and I can forgive. I just wish that these pdoc's would listen to us patients a little better.
>
> To bring you up to date with regard to my Adderall trial, two weeks into the trial the pstim caused burnout. My symptoms of burnout are physically drained, increasing amounts of sleep required to recover physically, aches and pains (flue-like without the runny nose and/or cough), etc.
IMO, I think you should have just just halved the Adderall on the second day and checked what happened. If you had trouble after a couple of days on the lower dosage I would have dx'ed it. I've been hounded for self-discontinuing as well. But, I can TELL when something is going seriously awry.. especially if it is immediately triggering hostile/mixed/manic symptoms.
>
> These symptoms are distinctly different from the atypical depression symptoms of increased sleep, low energy, etc. I'm not able to articulate the symptoms of burnout very well, but trust me it's very different from the simillar words that I use to describe atypical depression.I think it triggered a mixed state. Or what many folks would call an agitated depression. I have two different "flavors" of depression.. the 'atypical' one where I sleep and eat too much and the other where the anxiety is like an air-raid and I have sleep disruption and am agitated/angry as hell, no appetite.
> So back to the story at hand. One week ago I discontinued the 5 mg/day of Adderall and I left a v-mail for the nurse asking her to tell (not ask) the pdoc that I had to discontinue the Adderall trial due to burnout. I didn't hear back from his office, but I'll talk to him at my next appointment next week.
>
> I was deeply regreting that I had to discontinue the Adderall because it had helped me so much initially and because I expected a huge rebound depression from the discontinuation. But to my suprise, the antidepressive effects are continuing even still, one week later. No hint of depression. Some hypomania, but I can chase it down with extra Trileptal.If something is irritating or agitating you and you stop it you can get an antidepressive effect by stopping the offending substance. Your reaction to stopping Adderall is the reaction I've gotten (for a few days or so) after stopping Wellbutrin when it gets too agitating.
>
> From a pyschopharmacological standpoint, it makes no sense at all to me that the antidepressant effect continues for me after discontinuation. The half-life of Adderall is 13 hours, so it's gone by now! So my plan at this point is to use Adderall on a prn basis and to take it as infrequently as possible and for short durations. Time will tell.Yep, it's gone by now, but your receptors are re-regulating from stopping it.. I'm wondering whether ever using Adderall might be a good thing for you. I would suggest trying 5mg dexedrine (cut it in half take it twice a day) instead if you want to pursue stims again. That way you can get a definite crash after six hours or so.. you shouldn't be staying up on that one... if you do.. WARNING.
>
> > Yes, there is something weird about Depakote that I don't like regards sleep. It seems to *aggravate* sleep maintenance troubles I have. ... I liked Trileptal or lithium because I could take a dose at bedtime and it would put me out right.
> Mitch, do you take magnesium at bedtime? I take 750 mg of magnesium malate every night at bedtime. It really helps my sleep (going to sleep, staying asleep, and sleeping sound. Along with it, I also take 10 mg of P-5-P (co-enzyme B6) to help the magnesium do its thing, and I take 1/2 tablet of a B-100 (B-complex) so that the Bee's don't get out of balance by taking the P-5-P. The Bee's can get angry if they get outta balance. :-)Ron, I've been down the B'vits, etc. route and did try magnesium and it simply upset my stomach. It seems that MEDS are causing a circadian sleep disruption of some kind.. I'm trying to mitigate the source of the disruption instead of trying to treat it as much.. haven't found much that really helps to treat it. The only supps I've found to be helpful is folic acid (I stopped losing hair on Depakote!), a little fish oil (and I'm even a little doubtful on that one).
>
> > I get clearly depressed on Depakote if I take it during a depressive episode in doses exceeding 250mg/day. You know, here's something I've been wondering about a little: Effective antimanics are associated with effective PKC inhibition, but I think brain norepinephrine levels are reduced as some downstream consequence of this...and if they aren't corrected during a BP depression an antimanic might actually worsen it.. SO I've found that a low dose of a stim or a little Strattera or nortript. whatever seems to be the right thing to counteract the antimanic's depressogenic tendencies.. just thinking out loud a little.... Mitch
>
> Exactly!! I don't know about the mechanism, but that's why I like to decrease my Lithobid and Trileptal dosages when I cycle into a depressed phase because I'm convinced that these moodstabilizers make the depression worse. Of course, when the depression abates, I have to increase these dosages to keep my hypomania in check. But this dosage adjustment is what my pdoc is complaining about. Go figure.
Yeah the conventional wisdom with antimanics is to maintain the dose all the time at the level that is effective for the worst manic sx and then just toss plenty of antidepressants onto the smoldering bonfire when the flames are about to go completely out :) I understand the reasoning, I just don't think all the truth is known just yet about how they effect the depressive phases.... Mitch
Posted by CareBear04 on January 19, 2005, at 19:27:45
In reply to Re: Adderall tx for Atypical Depression » Ron Hill, posted by Ritch on January 19, 2005, at 13:44:51
i've heard of this being done, but i've certainly never met a pdoc who would do this for me. then again, i tend not to have atypical depression nor purely melacholic depression, but rather, jittery and agitated depressions.
10mg of adderall doesn't seem like too much to me. i take 30mg of xr and 10mg of immediate release. but then again, when i started at about 20-30mg a day, i was on lithium for my mmood stabilizer, which is as strong as they come for me.
i have the tendency to self-medicate or adjust my doses myself, too. it doesn't help that my pdoc gives me scripts for a handful of prns that i can take at my discretion. at least she's pretty cool about taking more or less meds depending on how i feel, which is more than what it sounds like your pdoc is like.
i think if my pdoc put stringent restrictions on what i can and can't do, i'd be more apt to disobey. my last pdoc kinda joked that if i were any younger, he would diagnose me with oppositional defiant disorder. maybe knowing this, the drs would rather help me do things safely than take the chance that i could hurt myself by disobeying their orders.
i don't remember much anymore about what the last couple of posts were about, but i hope this relates at least minimally.
Posted by Ritch on January 20, 2005, at 0:05:14
In reply to do many drs prescribe stims for depression?, posted by CareBear04 on January 19, 2005, at 19:27:45
> i've heard of this being done, but i've certainly never met a pdoc who would do this for me. then again, i tend not to have atypical depression nor purely melacholic depression, but rather, jittery and agitated depressions.
>
> 10mg of adderall doesn't seem like too much to me. i take 30mg of xr and 10mg of immediate release. but then again, when i started at about 20-30mg a day, i was on lithium for my mmood stabilizer, which is as strong as they come for me.
>
> i have the tendency to self-medicate or adjust my doses myself, too. it doesn't help that my pdoc gives me scripts for a handful of prns that i can take at my discretion. at least she's pretty cool about taking more or less meds depending on how i feel, which is more than what it sounds like your pdoc is like.
>
> i think if my pdoc put stringent restrictions on what i can and can't do, i'd be more apt to disobey. my last pdoc kinda joked that if i were any younger, he would diagnose me with oppositional defiant disorder. maybe knowing this, the drs would rather help me do things safely than take the chance that i could hurt myself by disobeying their orders.
>
> i don't remember much anymore about what the last couple of posts were about, but i hope this relates at least minimally.
The real theme that Ron is talking about is self-discontinuation of a *new* medication (add or change) that is prescribed at one visit and then soon after the add or change, the patient experiences what they sincerely believe (with good evidence) of *worsening* of their condition (an immediate manic reaction). It is generally understood that it takes a classic unipolar depressive at least a two week trial (i.e) with an antidepressant to experience much positive benefit. So one might expect a doctor to poohpooh adverse effects of the AD and push the patient to comply and wait it out. With bipolar things get a lot more complicated... there are a lot of substances that can worsen the condition immediately (and potentially very dangerously) and not just fail to work and give "side effects". I just think Ron's pdoc was a little asleep at the wheel and didn't pay proper attention. I took a 4-day course of high dose prednisone once (for hives) and nearly flipped out so bad that I almost lost my job. It was kind of like putting salt on a slug. This is where pdocs have to watch things closely... When the communication loop isn't the best sometimes the patient needs to make the call.
Posted by Ron Hill on January 22, 2005, at 16:25:07
In reply to do many drs prescribe stims for depression?, posted by CareBear04 on January 19, 2005, at 19:27:45
Posted by smith562 on January 23, 2005, at 7:59:04
In reply to Re: Thanks Care Bear. I'll talk to ya in February (nm), posted by Ron Hill on January 22, 2005, at 16:25:07
Hey Ron,
I have a feeling I am BPII ... father is BP II and I have this tough atypical depression with panic that low dose lithium helps. I keep playing with lamictal ... seem to work great for 3 days then nothing. How is lamictal working for you?
Thank a million ...
Smith
PS I had read Colin's troubles with lamictal in the past
Posted by smith562 on January 23, 2005, at 8:01:51
Hey Ron,
the post is above
http://www.dr-bob.org/babble/20050119/msgs/446121.html
Thanks
Smith
Posted by Ron Hill on January 24, 2005, at 23:13:18
In reply to Ron: Quick Question about Lamictal, Thank You » Ron Hill, posted by smith562 on January 23, 2005, at 7:59:04
Smith,
I'm not the best person to ask about Lamictal because my pdoc and I added it to my cocktail only two months ago. I tend to get rashes from any of the moodstabilizers (AED's and Lithobid) so it's no suprize that I get a rash from Lamictal. I've ramped up VERY slowly (I'm up to 50 mg/day after two months) and yet I have developed a pronounced rash problem from Lamictal. My pdoc wants to hold at 50 mg/day until we see if the rash will go away.
Therefore, as you can see, I'm not the best person to ask, because I'm not even up to a theraputic dose level. Others on this board are much better qualified to answer your questions. However, I have noticed that your experience of obtaining early but short-lived benefit from Lamictal seems to be a common complaint with this particular medication. Further, short-term benefit is often reported after each small increase.
I like Lamictal (except for the rash). I like the way it feels in my brain. But I'm not on a high enough dose to make any conclusions yet. I also tried Lamictal several years ago (1998) but I had to discontinue due to rash. I started at way too high of a dosage back then.
-- Ron
Bipolar II and Obsessive Compulsive Personality Traits
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal
5 mg/day Adderall XR for just one day when needed to chase away the bipolar atypical depression demons. If I take Adderall XR for more than one day at a time, it induces "pstim burnout" symptoms.
-------------------------------------------------> Hey Ron,
>
> I have a feeling I am BPII ... father is BP II and I have this tough atypical depression with panic that low dose lithium helps. I keep playing with lamictal ... seem to work great for 3 days then nothing. How is lamictal working for you?
>
> Thank a million ...
>
> Smith
>
> PS I had read Colin's troubles with lamictal in the past
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