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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Slinky on March 15, 2005, at 22:02:57
Hello
I was supposed to start a week ago but I'm scared tegretol will flip my mood into deeper depression like depakote and lithium did.
I've been feeling ok-ish for a week.
I'm usually not so scared to pop pills
I take neurontin & paxil.
I suppose I want my mood to elevate a little before the taming teggy ..I've been a l o n g time down.
~~~~~~~~~~~~~~~~~~~
Mitchie babe..hello darling..youre looking good to me .Hope you're feeling fizzy.
I've discovered Sonic Youth ye old American band
Posted by cache-monkey on March 15, 2005, at 23:11:24
In reply to Scared to pop tegretol, posted by Slinky on March 15, 2005, at 22:02:57
Out of curiousity, how come your doctor prescribed Tegetrol? My understanding is that Trileptal (a modified version of Tegetrol) works almost as well, but with fewer troublesome side effects.
I've been ramping up on Lithium for the last few weeks and feel a little worse for the wear. I have a couple of questions if you don't mind... It made you more depressed? Did you notice that you felt better when you went off it? Also, were you also on an AD at the time?
Anyway, good luck with the Tegetrol. I hope that it ends up working out alright for you. Oh, it just occured to me that I didn't see Lamictal on the list of MSs that you've tried. That's supposed to have some nice AD properties in addition to mood stabilization... (I didn't have much luck with it -- too agitating, but others on this board have benefited from it.)
Best,
cache-monkey> Hello
> I was supposed to start a week ago but I'm scared tegretol will flip my mood into deeper depression like depakote and lithium did.
> I've been feeling ok-ish for a week.
> I'm usually not so scared to pop pills
> I take neurontin & paxil.
> I suppose I want my mood to elevate a little before the taming teggy ..I've been a l o n g time down.
> ~~~~~~~~~~~~~~~~~~~
> Mitchie babe..hello darling..youre looking good to me .Hope you're feeling fizzy.
> I've discovered Sonic Youth ye old American band
Posted by Phillipa on March 16, 2005, at 0:15:20
In reply to Re: Scared to pop tegretol » Slinky, posted by cache-monkey on March 15, 2005, at 23:11:24
Posted by Ritch on March 16, 2005, at 0:38:43
In reply to Scared to pop tegretol, posted by Slinky on March 15, 2005, at 22:02:57
> Hello
> I was supposed to start a week ago but I'm scared tegretol will flip my mood into deeper depression like depakote and lithium did.
> I've been feeling ok-ish for a week.
> I'm usually not so scared to pop pills
> I take neurontin & paxil.
> I suppose I want my mood to elevate a little before the taming teggy ..I've been a l o n g time down.
> ~~~~~~~~~~~~~~~~~~~
> Mitchie babe..hello darling..youre looking good to me .Hope you're feeling fizzy.
> I've discovered Sonic Youth ye old American band
You are beginning to feel a little GUILTY that you haven't started the Teg. yet, and your doctor WANTS you to! :) Weren't you prescribed 400mg/day to start? Did the doctor write for the plain Tegretol (carbamazepine)? Hmmm. if so, you COULD take just 1/4 the dose.. 50mg twice a day-get out thou pill chopper! Quarter them things and just test the water a bit, no need to dive in 100%. Compromise, you know, politics!
^^^^ fizzy-Mitchie
Posted by ed_uk on March 16, 2005, at 10:02:50
In reply to Re: Scared to pop tegretol » Slinky, posted by cache-monkey on March 15, 2005, at 23:11:24
Hello!
I think slinky lives in the UK. When I worked in a pharmacy, I never once saw a prescription for Trileptal, it's available here but it's not used much. We went through *tonnes* of Tegretol and Epilim (similar to Depakote). So much so that each had their own shelf!
Best regards,
Ed.
Posted by Slinky on March 17, 2005, at 16:46:49
In reply to Re: Scared to pop tegretol » cache-monkey, posted by ed_uk on March 16, 2005, at 10:02:50
..Yes..Ed's correct..I gave my pdoc some info on Trileptal.
Anyway I 've started the tegretol ..I felt the DREADS coming. I awoke more angry than usuall...and seems to increase the neurontin effect..I feel stupid but calm.
I did take paxil during the lithium trial.
Lamactal also made me agitated and I started to develop an allergy.
I forgot to mention about 2 years ago I took 800mg a day of tegretol for a week (I aquired them from another patient ) because I was having a little crisis...just spaced me out for a bit.
I'm hoping the tegretol will just smooth out the switches and not push me further into hopelessness.
Posted by Maxime on March 17, 2005, at 19:06:06
In reply to Re: popped tegretol, posted by Slinky on March 17, 2005, at 16:46:49
Hi, I had a lot of side effect with Tegretol and now I am on Trileptal. I am bipolar Type 2 and I find the Trileptal help with the irritability. I don't get "happy" hypomania, I get the irritability and the "everyone in the world is an idiot but me" syndrome. I had a few side effects from the Trileptal at first (a little sleepy and some diziness) but that went away after 2 weeks.
Trileptal is expensive though, but worth it.
Maxime
Posted by slinky on March 17, 2005, at 21:11:45
In reply to Scared to pop tegretol, posted by Slinky on March 15, 2005, at 22:02:57
Me again..
I asked pdoc about the teg affecting the paxil.
He opened his little book and said teg affects the paxil plasma level.
I took this as the amount of paxil absorbed in the system is less.
Now whether or not my mind is playing tricks..but I'm slightly getting a withdrawal feeling..the brain bounce thing.
Am I imagining this?
Posted by Ritch on March 18, 2005, at 12:54:17
In reply to Re: what does paxil plasma level mean?, posted by slinky on March 17, 2005, at 21:11:45
> Me again..
> I asked pdoc about the teg affecting the paxil.
> He opened his little book and said teg affects the paxil plasma level.
> I took this as the amount of paxil absorbed in the system is less.
> Now whether or not my mind is playing tricks..but I'm slightly getting a withdrawal feeling..the brain bounce thing.
> Am I imagining this?
>Hi, I couldn't find anything about *Paxil* and Tegretol, but I did find info about interaction between Prozac and Tegretol. Prozac inhibits liver enzymes similar to Paxil, so you might be able to draw the same conclusion. Anyhow, co-admininstration of Prozac will *increase* Tegretol blood levels, possibly doubling them. So... probably some of the "brain bounce" your getting is likely the Tegretol--not to say that the Teg might *also* actually be *lowering* the Paxil level. So.. your 400mg/day of Tegretol might be yielding a Teg blood level that is what you might find if you were taking 800mg/day of Tegretol *without* the Paxil. Hopefully, somebody else can chime in with more specific knowledge about Paxil and Teg. (Larry Hoover, i.e.). Hope this helps-- Mitch
Posted by Slinky on March 18, 2005, at 13:32:31
In reply to Re: Teg-Paxil interaction question L. Hoover help? » slinky, posted by Ritch on March 18, 2005, at 12:54:17
Hello Mitchie babes..
I'm feeling good..probably because I feel a little intoxicated.
Also my legs ain't so restless..and my little mind's conflict performance has quietend
So far so good-ish.
I'm off to buy you a fizzy mineral water to celebrate.
Posted by Slinky on March 19, 2005, at 21:50:25
In reply to Re: Teg-Paxil interaction question L. Hoover help? » Ritch, posted by Slinky on March 18, 2005, at 13:32:31
..these physical sensations are exactly like I experienced with effexor withdrawal.
Posted by Larry Hoover on March 19, 2005, at 22:16:54
In reply to Re: what does paxil plasma level mean?, posted by slinky on March 17, 2005, at 21:11:45
> Me again..
> I asked pdoc about the teg affecting the paxil.
> He opened his little book and said teg affects the paxil plasma level.
> I took this as the amount of paxil absorbed in the system is less.
> Now whether or not my mind is playing tricks..but I'm slightly getting a withdrawal feeling..the brain bounce thing.
> Am I imagining this?Sorry, didn't catch my name being added to this thread.....
Carbamazepine induces enzyme 3A4, which increases the rate at which paroxetine is destroyed. The net effect is a lower blood plasma level, and a shorter half-life for the Paxil.
Lar
Posted by Slinky on March 19, 2005, at 23:38:27
In reply to Re: what does paxil plasma level mean? » slinky, posted by Larry Hoover on March 19, 2005, at 22:16:54
Thanks Larry
Hmm..In your opinion is it wise to keep taking the paroxetine in the future..I mean do I have to go through withdrawal every evening or will my brain get to acclimatized to it.
Posted by Larry Hoover on March 20, 2005, at 11:10:10
In reply to Re: what does paxil plasma level mean? » Larry Hoover, posted by Slinky on March 19, 2005, at 23:38:27
> Thanks Larry
> Hmm..In your opinion is it wise to keep taking the paroxetine in the future..I mean do I have to go through withdrawal every evening or will my brain get to acclimatized to it.It's hard to say. If you liked or benefited from the effects of the paroxetine, then you may have to retitrate the dose. I'll give a hypothetical example.
Let's say you were taking 20 mg once a day, but now that you've added carbamazapine, you get the withdrawal effect (due to enhanced clearance). It might be possible to maintain the paroxetine effect, without withdrawal, by going to a 15 mg twice a day schedule, yielding 30 mg per day, thus accomodating both the lower plasma peak and the shorter half-life.
It's hard to put numbers to it, because you still have to "do the experiment" to find the new balance that works for you. Only you can say whether it's worth the trouble to do so, or not. Just figuring out how to get 15 mg per dose might be a problem, eh? Would going to 20 mg twice a day be a more pragmatic solution?
These are issues I'd take right back to the prescribing physician, as soon as it possible for you to get back there.
Lar
Posted by Slinky on March 20, 2005, at 13:29:22
In reply to Re: what does paxil plasma level mean? » Slinky, posted by Larry Hoover on March 20, 2005, at 11:10:10
Posted by Slinky on March 20, 2005, at 22:25:13
In reply to Re: Thanks (nm) » Larry Hoover, posted by Slinky on March 20, 2005, at 13:29:22
..I just awoke sweating like cheese in the sun with my brain swishing round my scull like formula 1 race...causing the initial start up tegretol nausea worse.
I think I'll quit the paroxetine gradually in a couple of weeks..it's used for anxiety/pre menstrul stuff some minor OCD.
If needed something with a longer half life if there is one I haven't tried.
Meanwhile I may try 5htp in the evenings..I think it has about 8 hour half life.
Posted by gardenergirl on March 21, 2005, at 0:00:24
In reply to Re: I know I'm whining, posted by Slinky on March 20, 2005, at 22:25:13
You're entitled. Sounds like things feel pretty lousy. Great description, though.
Aside, do you like F1? I'm a big Indy car fan. I would probably like F1, but it's not on much here. Well, it is, but I'm too cheap to pay for the digital tier on cable.
Hope you are feeling better soon.
gg
Posted by Ritch on March 21, 2005, at 10:30:40
In reply to Re: I know I'm whining, posted by Slinky on March 20, 2005, at 22:25:13
> ..I just awoke sweating like cheese in the sun with my brain swishing round my scull like formula 1 race...causing the initial start up tegretol nausea worse.
> I think I'll quit the paroxetine gradually in a couple of weeks..it's used for anxiety/pre menstrul stuff some minor OCD.
> If needed something with a longer half life if there is one I haven't tried.
> Meanwhile I may try 5htp in the evenings..I think it has about 8 hour half life.
>
Slinky, you might give Celexa a try.. you might get enough coverage with its longer half-life and from what I remember doesn't interact quite as strongly with meds like Teg. What about Larry's idea of just taking a little more Paxil and take it twice a day? -- Mitch
Posted by Slinky on March 21, 2005, at 17:08:49
In reply to Whining's okay » Slinky, posted by gardenergirl on March 21, 2005, at 0:00:24
..I like the rallys
Thanks gg
Posted by Slinky on March 21, 2005, at 17:23:01
In reply to Re: I know I'm whining » Slinky, posted by Ritch on March 21, 2005, at 10:30:40
..I don't know what to do..I've been surfing the net trying to find something.
I think Larry's idea is best..but I don't see the doc for 3 weeks...actually I may phone him cause i feel so poo.
He's mentioned I'm a patient so sensitive to meds..hope he doesn't think I'm imaging it all .
I'm anxious .
I think I'll start to take half of 30mg tab in morning..at least maybe the dip won't be so harsh
I have tried Celexa..I couldn't tolerate the side effects. Not sure if Lexepro is prescribed here yet.
I've popped 50mg of 5htp to see if that helps.
~~~slinky
Posted by ed_uk on March 21, 2005, at 17:30:17
In reply to Re: I know I'm whining » Ritch, posted by Slinky on March 21, 2005, at 17:23:01
Hi Slinky! (Cool name, I love slinkies)
>Not sure if Lexepro is prescribed here yet.
It's called Cipralex here, it's very similar to citalopram (Cipramil, Celexa).
Regards,
Ed.
Posted by Larry Hoover on March 21, 2005, at 19:15:49
In reply to Re: I know I'm whining » Ritch, posted by Slinky on March 21, 2005, at 17:23:01
> ..I don't know what to do..I've been surfing the net trying to find something.
> I think Larry's idea is best..but I don't see the doc for 3 weeks...actually I may phone him cause i feel so poo.
> He's mentioned I'm a patient so sensitive to meds..hope he doesn't think I'm imaging it all .
> I'm anxious .
> I think I'll start to take half of 30mg tab in morning..at least maybe the dip won't be so harsh
> I have tried Celexa..I couldn't tolerate the side effects. Not sure if Lexepro is prescribed here yet.
> I've popped 50mg of 5htp to see if that helps.
> ~~~slinkyEven just splitting your regular dose (i.e one half of whatever you used to take, twice a day) will reduce the amount of the fluctuation of the paroxetine concentration in your blood.
The other alternative would be to back off on the carbamazepine until you get to see your doctor again. Clearly, you need to manage this medication change differently than the way he left it.
Best,
Lar
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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