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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by CK1 on March 31, 2005, at 22:25:00
I have been on Paxil 10mgs + Lamictal (37.5mg) for 3 weeks and am experiencing agitation/anxiety. Since I started both meds at the same time, I'm not sure which med is the culprit. I upped the dose of Lamictal to 50mg and got very tense (muscle aches in neck, crying like a baby for no reason) so I backed down.
I'm wondering if it's a good idea to drop the Paxil to 5mg and add Lithium (150-300mg) to this combo making it:
Paxil 5mg
Lamictal 37.5
Lithium 150-300mgDepression seems to have lifted, but anxiety is still not under control and, in my opinion, Lamictal is making it worse. Does anyone have any experiences with this combo or have any suggestions? I'm getting tired around 4pm for the past few days and need a nap so I'm wondering if Lithium will make me even more tired.
(I have two months to mess around with this stuff until my internship this summer!)
Posted by Ritch on April 1, 2005, at 0:41:47
In reply to Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on March 31, 2005, at 22:25:00
> I have been on Paxil 10mgs + Lamictal (37.5mg) for 3 weeks and am experiencing agitation/anxiety. Since I started both meds at the same time, I'm not sure which med is the culprit. I upped the dose of Lamictal to 50mg and got very tense (muscle aches in neck, crying like a baby for no reason) so I backed down.
> I'm wondering if it's a good idea to drop the Paxil to 5mg and add Lithium (150-300mg) to this combo making it:
> Paxil 5mg
> Lamictal 37.5
> Lithium 150-300mg
>
> Depression seems to have lifted, but anxiety is still not under control and, in my opinion, Lamictal is making it worse. Does anyone have any experiences with this combo or have any suggestions? I'm getting tired around 4pm for the past few days and need a nap so I'm wondering if Lithium will make me even more tired.
> (I have two months to mess around with this stuff until my internship this summer!)
Just an opinion, but before you tinker around with a lithium add.. I would determine which med is causing the anxiety first and dx, switch, or reduce that one. When do you take the Paxil, at bedtime or in the AM? When is the anxiety the worst?
Posted by CK1 on April 1, 2005, at 9:33:28
In reply to Re: Bipolar II - SSRI/Lamictal - anxious » CK1, posted by Ritch on April 1, 2005, at 0:41:47
Thanks Ritch. That's the problem..I don't know which med is causing the anxiety! That's why most people do better starting a mood stabilizer without an AD and THEN add the AD after a few weeks on the mood stabilizer. I don't know why my doctor started both at the same time. Also, I'd rather get by with only two meds, since 3 would complicate things even more. Ritch, you should get a Babblemail account! I wish I could email you privately since you seem to really know your stuff.
Posted by Ritch on April 1, 2005, at 10:11:57
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on April 1, 2005, at 9:33:28
> Thanks Ritch. That's the problem..I don't know which med is causing the anxiety! That's why most people do better starting a mood stabilizer without an AD and THEN add the AD after a few weeks on the mood stabilizer. I don't know why my doctor started both at the same time. Also, I'd rather get by with only two meds, since 3 would complicate things even more. Ritch, you should get a Babblemail account! I wish I could email you privately since you seem to really know your stuff.
All the stuff I talk about comes mostly from my personal anecdotal experiences which vary quite a bit from others.. so that needs to be taken with a grain of salt. As far as the mail thing goes.. I don't want to get *too* immersed in all of this-I'm obsessive enough with meds as it is :) As far as the anx. goes.. what does your pdoc say about it-that it will go away.. or just startup effects of Lam, i.e.?
Posted by BP2TreadingWater on April 1, 2005, at 10:17:29
In reply to Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on March 31, 2005, at 22:25:00
> I have been on Paxil 10mgs + Lamictal (37.5mg) for 3 weeks and am experiencing agitation/anxiety. Since I started both meds at the same time, I'm not sure which med is the culprit. I upped the dose of Lamictal to 50mg and got very tense (muscle aches in neck, crying like a baby for no reason) so I backed down.
> I'm wondering if it's a good idea to drop the Paxil to 5mg and add Lithium (150-300mg) to this combo making it:
> Paxil 5mg
> Lamictal 37.5
> Lithium 150-300mg
>
> Depression seems to have lifted, but anxiety is still not under control and, in my opinion, Lamictal is making it worse. Does anyone have any experiences with this combo or have any suggestions? I'm getting tired around 4pm for the past few days and need a nap so I'm wondering if Lithium will make me even more tired.
> (I have two months to mess around with this stuff until my internship this summer!)CK1,
I'm on Lamictal 100mg and it's working pretty well for me. I am a BP-II with rapid-cycling, or that is, I used to rapid-cycle before Lamictal. My depression is close to over, and my anxieties are more eveyday and don't grab me by the throat and make me impulsive.
Here's my take on your situation. First of all, Paxil is NOTORIOUS for producing anxiety (instead of alleviating it...go figure). My best guess is that you should taper off the Paxil and titrate your Lamictal up to 100mg and just hang out there for a while, see what happens.
Best of luck,
BP2TreadingWater
Posted by theo on April 1, 2005, at 12:01:19
In reply to Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on March 31, 2005, at 22:25:00
> I have been on Paxil 10mgs + Lamictal (37.5mg) for 3 weeks and am experiencing agitation/anxiety. Since I started both meds at the same time, I'm not sure which med is the culprit. I upped the dose of Lamictal to 50mg and got very tense (muscle aches in neck, crying like a baby for no reason) so I backed down.
> I'm wondering if it's a good idea to drop the Paxil to 5mg and add Lithium (150-300mg) to this combo making it:
> Paxil 5mg
> Lamictal 37.5
> Lithium 150-300mg
>
> Depression seems to have lifted, but anxiety is still not under control and, in my opinion, Lamictal is making it worse. Does anyone have any experiences with this combo or have any suggestions? I'm getting tired around 4pm for the past few days and need a nap so I'm wondering if Lithium will make me even more tired.
> (I have two months to mess around with this stuff until my internship this summer!)
I can almost guarantee you the side effects are coming from the Lamictal. I was on several meds at once, dropped them all except Lamictal and when I increased the dose on Lamictal, my anxiety/OCD went through the roof, had lower back ache and would cry for no reason. Lamictal wasn't for me.
Posted by ed_uk on April 1, 2005, at 12:09:26
In reply to Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on March 31, 2005, at 22:25:00
CK, did you have any anxiety during the first few weeks of Paxil treatment the last time you used Paxil??
Ed.
Posted by CK1 on April 1, 2005, at 12:11:23
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by theo on April 1, 2005, at 12:01:19
One person says it's the Paxil and to drop that and increase the Lamictal and another says it's the Lamictal! I only WISH I knew which med is causing this anxiety and muscle tension. Paxil dramatically lessened my anxiety for a few years and then stopped working leaving my anxious and tense and this is the same way I feel now. It worked so well for years and now could be making my anxiety worse?
Am I on two drugs that can provoke anxiety?! What are some good alternatives that have worked for some of you?? My aunt takes Depakote+Effexor and my cousin takes Lamictal+Paxil and they have been stable for years. It took them each about 6 months to get stable though!!!!!! ughh
Posted by Ritch on April 1, 2005, at 13:21:29
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on April 1, 2005, at 12:11:23
>...Paxil dramatically lessened my anxiety for a few years and then stopped working leaving my anxious and tense and this is the same way I feel now...
That's an important fact. That tells me restarting Paxil was probably a bad idea. I'd leave the Lamictal right where it is and substitute the Paxil for something else for the anx. (preferably not an SSRI). What about swapping it for some clonazepam or lorazepam?
Posted by CK1 on April 1, 2005, at 14:21:34
In reply to Re: Bipolar II - SSRI/Lamictal - anxious » CK1, posted by Ritch on April 1, 2005, at 13:21:29
Ritch,
I was on Paxil for 2 years and it worked very well. I stopped it because I wanted my libido back and I felt good enough to quit. 3 months later, my anxiety came back, but I wanted to try an SSRI without the sexual SE's. Tried Lexapro for 3 weeks and made my hands shake, dizzy, etc. Took Klonopin (.25 2x/day) for 3 weeks and started forgetting EVERYTHING -- AND it was hell getting off. (no way am I taking a benzo long term) After Klonopin, went back on Paxil and it worked again for 8 months before it stopped working. Since then, I have tried Effexor (caused SEVERE panic), Zoloft (insomnia, anxiety) and, at the moment, am taking Paxil and Lam to no avail. SSRI's seem to bring on the panic for me. My primary care doctor mentioned Nortriptyline saying it's known to be one of the best antidepressants for anxiety...........
Posted by qbsbrown on April 1, 2005, at 21:23:55
In reply to Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on March 31, 2005, at 22:25:00
If you are BP II, I would easily venture to guess that it is the Paxil. MANY people w/ BP are unable to tolerate any antidepressants, and are notorious for inducing mania/hypomania.
I had panic disorder for years, and paxil worked like a charm. That pooped out, and developed BP disorder. I am completely unable to take any SSRI's, the make me go through the roof, anxiety worse, racing thoughts, and everything else.
It is usually advisable that you get settled in on the mood stablizer (lamictal), and then to try an antidepressant if needed.
I think you had mentioned that you had tried a benzo, xanax?. How about klonopin? Usually the benzo of choice for BP people w/ anxiety.Regards,
Brian
Posted by Spriggy on April 1, 2005, at 21:59:12
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by qbsbrown on April 1, 2005, at 21:23:55
I saw an excellent pdoc over two hospitals in Washington state. He was emphatic about BP's not using any AD that messes with seratonin. He swore that if you give someone with Bipolar something that messes with seratonin, they will wig out.
I am BP 2- I took Lexapro and spent about 6 weeks in "a whole other world." I even hallucinated. But I mostly experienced dysphoric mania BIG TIME. Restless, agitated, suicidal, etc.
I would say if you are Bipolar to stay away, far, far, away from SSRI's.
I have read much research that agrees with that as well.
NOW, I am also on Lamictal but have noticed an increase in my anxiety so it COULD very well be the Lamictal as well. I am trying to give it a fair shot but even on a low dose, my anxiety seems worse (but have blood sugar problems right now too and thyroid so that could be the culprit).
ANyway, there's my 2 cents! I hope you find the solution soon.
Posted by Ritch on April 2, 2005, at 0:21:48
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by CK1 on April 1, 2005, at 14:21:34
> Ritch,
> I was on Paxil for 2 years and it worked very well. I stopped it because I wanted my libido back and I felt good enough to quit. 3 months later, my anxiety came back, but I wanted to try an SSRI without the sexual SE's. Tried Lexapro for 3 weeks and made my hands shake, dizzy, etc. Took Klonopin (.25 2x/day) for 3 weeks and started forgetting EVERYTHING -- AND it was hell getting off. (no way am I taking a benzo long term) After Klonopin, went back on Paxil and it worked again for 8 months before it stopped working. Since then, I have tried Effexor (caused SEVERE panic), Zoloft (insomnia, anxiety) and, at the moment, am taking Paxil and Lam to no avail. SSRI's seem to bring on the panic for me. My primary care doctor mentioned Nortriptyline saying it's known to be one of the best antidepressants for anxiety...........Hey, I would listen to your primary care doc! Nortriptyline can work wonders for panic anxiety and generalized anxiety. Maybe keep the Lam and switch the Paxil to Nortriptyline? Get your pdoc and primary care doc on conference call... :)
Posted by Lushkins on April 2, 2005, at 11:03:40
In reply to Re: Bipolar II - SSRI/Lamictal - anxious » CK1, posted by Ritch on April 2, 2005, at 0:21:48
Lamictal has caused anxiety for me, and is at the moment. It tends to occur after each increase. I am usually anxious person anyway, well I have the physical symptoms but I am generally not worried about anything if that makes sence. But after each increase the physical symptoms increase, but at the same time I am really really happy, then after a week the happiness fades, along with other symptoms like insomnia, but the anxiety persists for alot longer. I increased to 250mg 2 weeks ago and am very anxious at the moment, but not that depressed, I think the anxiety at the moment is holding my mood back into slightly depressed, at least I am not in despair.
But it could be the paxil, I got anxiety of SRRIs and I have read that its not uncomman at the start of the treatment. Its hard to say which is causing it, I think your Dr would struggle to, I am just mythed why he put you on 2 different drugs at the same time. Hope it gets better soon.
Posted by CK1 on April 2, 2005, at 12:22:23
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by Lushkins on April 2, 2005, at 11:03:40
Thanks for the insights everyone! Bipolar II is an extremely general term: My pdoc thinks I'm Bipolar II because when I got on Paxil last year (it worked then!!), I became almost too happy and every day was a new experience. I spent the summer interning in New York and was parting 5 nights/week, sleeping around 5 hours a night, and, overall, feeling "on top of the world." He thinks SSRI "poop out" can oftentimes signify underlying bipolar II, especially when you try other SSRI's and they cause overwhelming anxiety. That's why I "could" be Bipolar II. There are also many family members with bipolar which is very important to point out.
Anyway, Paxil was my "wonder drug" for so long, but I'm thinking it's not working anymore due to the fact that my "illness" has progressed and, NOW, as opposed to before, maybe all the SSRI's will make me worse, if I don't have a high enough dose of a mood stabilizer in place (for weeks) BEFORE I add an SSRI. 37.5mg of Lamictal ain't gonna stabilize me since the normal stabilizing dose is 100-400mg, so I'm thinking: drop Paxil (for now!) and reach the theraputic dose of Lamictal (if I can!) before re-introducing Paxil or Nortriptyline. If Lamictal starts causing too much anxiety, maybe a switch to Depakote is in question. Gosh....there sure are a lot of lot of "what if's" for mental illnesses. The more drugs that come to the market, the more complicated everything gets...so it seems!
This site is amazing since it brings so many people together who are going through the same experiences. I guess I consider it my form of "therapy"
Posted by Lushkins on April 3, 2005, at 10:28:04
In reply to Re: Bipolar II - SSRI/Lamictal - anxious » Lushkins, posted by CK1 on April 2, 2005, at 12:22:23
I had remeron poop out on me, I felt great for a month then rapidly felt depressed, I am still on this as when I try to get of it I get worse than before I first started it, sucks really. I have been on a number of SRRIs, cipramil made me VERY anxious, Zoloft made me go into a terrible state, cant really explain it suicidal, angry, violent to myself, hitting concrete walls smashing glass on myself, didn't sleep, bit of a blur, not good really. So I can probabily say that antidepressants don't work for me. I don't really know if I;m Bipolar or not, nither does my Dr, I have respnded well to lamictal but I take along time to adjust to each increase, it has some weird effects on me, I have been having intense anxiety lately, well at least for me, I'm sure alot of other people have worse here, I just hopoe it goes soon as its sticking around this time, I may have to go down a dose but I will stick with it for a while.
There is no history of Bipolar in my family, but I took too many drugs in the past, very stupid, but hindsight is beutiful thing. My uncle is schitzophrenic really badly, in hospital alot of the time, my other uncle suffers depression badly on the otherside of the family. So I geuss family history is there, I think thats what most Drs look for FIRST when making a diagnoses. Hopefully in the future there will be a new generation of drugs based on studies on the human genome, but your goverement (assuming your USA) have banned work on stem cells (I think), which considering your at the forfront of this, is kind of a setback. Sorry I will stop diverging.
Hope it goes well, it may take some time to get the the correct dose, and if your like me you will probabily expereince anxiety to start with but just stick with it, it may just be the med for you.
Posted by Lushkins on April 3, 2005, at 10:32:59
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by Lushkins on April 3, 2005, at 10:28:04
By the way, by the look of things your Dr knows what he/she is talking about,I would have to mention stuff like AD poop out as a sign of BP and would have to show him the studies. Don't get me wrong, hes good, and treatment is a 2 way process between us, but he is a little bit behind on the present studies.
Posted by CK1 on April 5, 2005, at 14:36:28
In reply to Re: Bipolar II - SSRI/Lamictal - anxious, posted by Lushkins on April 3, 2005, at 10:28:04
Thanks Lushkins. I'm getting off Lamictal. It's way too activating 4 me
This is the end of the thread.
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