Psycho-Babble Medication Thread 511101

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Re: Trileptal 600mg » emme

Posted by SLS on June 15, 2005, at 19:26:42

In reply to Re: Trileptal 600mg » SLS, posted by emme on June 15, 2005, at 17:28:09

Hi Emme.

I'm glad that I am forgiven.

:-)

It is difficult to say whether I feel energized by Trileptal or not. Not really. However, I have more mental energy and motivation to do stuff. I know that sounds contradictory, but the balance between motivation and energy does not feel stimulating. I don't feel like I am taking a stimulating drug. It is more of a mitigation of the depression than it is an input of nervous energy.


- Scott

 

Re: Trileptal 600mg » Ron Hill

Posted by SLS on June 15, 2005, at 19:28:17

In reply to Re: Trileptal 600mg » SLS, posted by Ron Hill on June 15, 2005, at 17:00:56

> Scott,
>
> I hope it works. You deserve relief.
>
> -- Ron


Thanks, Ron. It is always nice to see your name appear on the board. I hope we get to see more of you.

:-)

Be well.


- Scott

 

Re: Trileptal 600mg » SLS

Posted by EERRIICC on June 15, 2005, at 20:37:41

In reply to Trileptal 600mg, posted by SLS on June 11, 2005, at 15:58:46

Hey Scott, hope your current combination works out for you!

When you took Memantine, did you take it with Parnate? Parnate always works for me for a couple months and then quits, do you think Memantine could stop this and perhaps potentiate Parnate's effects?

Thanks,

Eric

 

Re: Trileptal 600mg » SLS

Posted by emme on June 15, 2005, at 22:14:49

In reply to Re: Trileptal 600mg » emme, posted by SLS on June 15, 2005, at 19:26:42

Hi Scott,

> It is difficult to say whether I feel energized by Trileptal or not. Not really. However, I have more mental energy and motivation to do stuff. I know that sounds contradictory, but the balance between motivation and energy does not feel stimulating.

Actuallly, that doesn't sound half bad.

> I don't feel like I am taking a stimulating drug. It is more of a mitigation of the depression than it is an input of nervous energy.

It seems like this is the most promising treatment you've reported in eons.

em

 

Re: Trileptal 600mg - How much higher can I go?

Posted by SLS on June 16, 2005, at 8:14:05

In reply to Re: Trileptal 600mg » SLS, posted by emme on June 15, 2005, at 22:14:49

How much higher do people go with Trileptal?

I know I can go higher on the Trileptal. I wish I knew how many people absolutely need higher dosages to glean a therapeutic effect, especially an antidepressant effect.


> It seems like this is the most promising treatment you've reported in eons.
>
> em

Yes. But...

It feels like I have plateaud already. I feel about as good this week as I did last week. It's hard to tell sometimes, but I would like to feel things that are indicative of an unequivocal trend in the direction of further improvement. The problem with my response to medication in drug trials is that improvements never persist beyond two weeks once they appear. Since I have not been feeling better for two weeks yet, I am still in that zone of uncertainty. If two weeks from now I am feeling better than I am today, I will then feel reassured that things are headed in the direction of a robust response. At this point, I would rate myself as a total of 20% improved over my unmedicated baseline state. Of that, Trileptal is responsible for 5%, so the degree of improvement is small. However, the rate of improvement I experienced the time I did respond well to medication was very gradual.

Today, I am feeling more pessimistic than optimistic.

I know I can go higher on the Trileptal. I wish I knew how many people absolutely need higher dosages to glean a therapeutic effect, especially and antidepressant effect.


- Scott

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by ed_uk on June 16, 2005, at 9:03:40

In reply to Re: Trileptal 600mg - How much higher can I go?, posted by SLS on June 16, 2005, at 8:14:05

Hi Scott,

>Trileptal 600mg - How much higher can I go?

You could go up to 2400mg if you can tolerate it! I very much doubt you'd need that much though. Perhaps you should wait until the cognitive side effects have worn off and then increase to 750mg or 900mg.

Kind regards,
Ed.

 

Lookin' like Cymbalta » SLS

Posted by emme on June 16, 2005, at 12:12:47

In reply to Re: Trileptal 600mg » emme, posted by SLS on June 15, 2005, at 19:26:42

Hi Scott,

Update. In case you were waiting with bated breath. We're keeping memantine where it is for now (don't want to risk losing any more AD effect). She wants me to try a little Cymbalta. She said her patients have been tolerating it pretty well. 15 mg...here we go...

Do you feel ready to raise the Trileptal? Maybe better to wait a few more days while the cognitive effects dissipate?

em

 

Re: Lookin' like Cymbalta » emme

Posted by SLS on June 17, 2005, at 3:23:15

In reply to Lookin' like Cymbalta » SLS, posted by emme on June 16, 2005, at 12:12:47

> Hi Scott,
>
> Update. In case you were waiting with bated breath. We're keeping memantine where it is for now (don't want to risk losing any more AD effect). She wants me to try a little Cymbalta. She said her patients have been tolerating it pretty well. 15 mg...here we go...
>
> Do you feel ready to raise the Trileptal? Maybe better to wait a few more days while the cognitive effects dissipate?
>
> em


Hi Emme.

I'm happy that you are taking yet another step. Let's hope your foot lands on the first step of the stairway to recovery. I look forward to watching you smile.

:-)

Good luck.


- Scott

 

Re: Trileptal 600mg - How much higher can I go? » ed_uk

Posted by SLS on June 17, 2005, at 3:29:31

In reply to Re: Trileptal 600mg - How much higher can I go? » SLS, posted by ed_uk on June 16, 2005, at 9:03:40

> >Trileptal 600mg - How much higher can I go?

> You could go up to 2400mg if you can tolerate it! I very much doubt you'd need that much though. Perhaps you should wait until the cognitive side effects have worn off and then increase to 750mg or 900mg.
>
> Kind regards,
> Ed.


Thanks, Ed.

Today was not a good day. I got hit by two waves of depression. I seem to have plateaud, if not moved backwards. Your advice is great. It's what I would tell anyone else in my position. But I am extremely impatient and tend to judge drugs perhaps too quickly. I am tempted to increase the dosage now, but I'll try to hold out until I see the doctor a week from today.


- Scott

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by ed_uk on June 17, 2005, at 7:44:15

In reply to Re: Trileptal 600mg - How much higher can I go? » ed_uk, posted by SLS on June 17, 2005, at 3:29:31

Hi Scott,

>Today was not a good day. I got hit by two waves of depression.

I'm sorry to hear that.

>I am tempted to increase the dosage now, but I'll try to hold out until I see the doctor a week from today.

Well.....perhaps you could try taking 750mg for a few days. You could 'play it by ear' and return to 600mg if the higher dose causes cognitive side effects.

Kind regards,
Ed.

 

Re: Lookin' like Cymbalta » SLS

Posted by emme on June 17, 2005, at 10:29:00

In reply to Re: Lookin' like Cymbalta » emme, posted by SLS on June 17, 2005, at 3:23:15

Hi Scott,
>
> I'm happy that you are taking yet another step. Let's hope your foot lands on the first step of the stairway to recovery. I look forward to watching you smile.

Thanks for the good wishes. I don't know why, but I was a little surprised she suggested Cymbalta when I talked about antidepressants. Maybe it's that "It's new so I'm gonna start prescribing it a lot" thing. Or maybe she's just happy with what it's doing for some of her patients. Even though I was envisioning trying an older drug, I have no reason to not be open-minded about it. I used to feel hopeful when trying new medication. Now I just dread it. Will report back in a week or so.

I am sorry you're backsliding. I really hope it's temporary. If this persists another day or two, then yeah, maybe you're ready to try an increase and see if you can avoid going too far down.

Feel better,

em

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by Ron Hill on June 17, 2005, at 14:04:30

In reply to Re: Trileptal 600mg - How much higher can I go?, posted by SLS on June 16, 2005, at 8:14:05

> How much higher do people go with Trileptal?

> I know I can go higher on the Trileptal. I wish I knew how many people absolutely need higher dosages to glean a therapeutic effect, especially an antidepressant effect.

> - Scott
---------------------

Scott,

FWIW, I've been on Trileptal for one year. I use it as a moodstabilizer and I currently take 900 mg/day. I've been as high as 1200 mg/day for a couple of weeks, and once I bumped up to 1600 mg/day for a day or two. The side effects were worse at 1200 and 1600 and, for me, the benefits did not increase at the higher dosages. So early on in the trial, I backed down the dosage and ended up setting in at 900 mg/day.

Sometimes I toy with the idea of reducing to 600 to see if I have more energy and to see if I spend less time in the depressive (atypical) phase of my BP II cycling. But for now, I need the moodstablizing power of 900 mg/day to prevent hypomania during my current (3 week old) Selegiline trial.

I had some trouble with side effects (including cognitive blunting, among others) during Trileptal startup. To minimize these startup effects, I ramped up slowly (i.e.; 300, 450, 600, 750, 900, 1200, 1600 mg/day) with at least a couple weeks between incremental increases.

The startup side effects have long since subsided, but for me, any of the moodstabilizers (including Trileptal) cause some amount of ongoing cognitive blunting. It just seems to come with the MS territory (in my case).

I really like Trileptal (as a moodstabilizer). It is the best med I've found for the tx of hypomania. Further, it reduces (but does not eliminate) my dysphoric irritability, and it is an absolutely excellent sleep agent. However, in my case, I have never attributed any antidepressant action to Trileptal. To the contrary, in a manner reminiscent of Depakote (but much less severe), I sometimes think that Trileptal "holds me in" the depressive phase of my BP II cycling longer than I would reside there otherwise. Are there research data that indicate Trileptal may have antidepressant qualities in certain cases?

Your situation is different than mine, so my anecdotal report is likely of little value to you. None-the-less, just thought I'd relay my experience FWIW.

I hope Trileptal helps you Scotty. You're a good man and I have a ton of respect for you.

-- Ron

BP II and OCPD

600 mg/day Lithobid

900 mg/day Trileptal

50 mg/day Lamictal (level limited by rash)

5 mg/day Deprenyl (as tx for atypical depression)

 

Re: Trileptal 600mg - How much higher can I go? » Ron Hill

Posted by SLS on June 17, 2005, at 15:49:15

In reply to Re: Trileptal 600mg - How much higher can I go? » SLS, posted by Ron Hill on June 17, 2005, at 14:04:30

Hi Ron.

Thanks for the feedback. I just spoke to my doctor on the phone. He'll let me go from 600mg to 750mg to 900mg. I'm torn apart here. I see him in one week. I don't know whether to remain at 600mg for another week or begin to increase the dosage now. The goal is to use the minimum amount necessary that will extract 100% of the drug's therapeutic potential. I wish I had a better idea as to what is the average dosage used by people with bipolar disorder.

I am gleaning an antidepressant effect from Trileptal at 600mg. However, it is episodic and of inadequate magnitude. I expect that my improvement with the right drugs will be extremely slow because of the severity and chronicity of my depression. Therefore, it is possible that I wouldn't improve any quicker than this anyway. I am just concerned that I have already reached a plateau and will be experiencing diminished returns.

Bipolar Depression; drug-induced manias:

Lamictal 150mg
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Trileptal 600mg

I am so damned impatient!


- Scott

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by Ron Hill on June 17, 2005, at 18:40:41

In reply to Re: Trileptal 600mg - How much higher can I go? » Ron Hill, posted by SLS on June 17, 2005, at 15:49:15

> I wish I had a better idea as to what is the average dosage used by people with bipolar disorder.

Scott,

I think that a dosage of 1200 mg/day for adults (or 1800 mg/day for kids) is about average for BP. This is consistent with woolav’s post further down on this PB page at http://www.dr-bob.org/babble/20050617/msgs/514305.html . But it’s like any other p-med, the correct dosage (if any) is the one that works for you personally. So you know the drill (much better that I do); trial-and-error experimentation while keeping a symptom tracking diary and then analyze the data collected.

I’m sure you’ve already reviewed the Prescribing Information document for Trileptal ( http://www.crazymeds.org/trileptalpi.pdf ). The Dosage and Administration section begins on page 33 for its use as an antiepileptic. Since the use of Trileptal for BP is off label, I’ve not seen any BP dosage recommendations from the manufacturer. But the AED dosage and administration guidelines do serve to define the safe dosage range. I wouldn’t take more than 2400 mg/day.

I’d say it’s safe to use the Trileptal dosage guidleines as if you were on a monotherapy treatment. I say this because the only other AED you have on board is Lamictal and there is very little drug-drug interaction between Trileptal and Lamictal (and vise versa). See the applicable drug-drug interaction information (e.g.; pg 42 and other related pages) in the Lamictal Prescribing Information document ( http://us.gsk.com/products/assets/us_lamictal.pdf ). However, I have no idea of the interactions of Trileptal and the other meds that you take.

> Lamictal 150mg
> Parnate 80mg
> nortriptyline 100mg
> Abilify 10mg
> Trileptal 600mg

Wow, you’ve got some big guns onboard.

> I am so damned impatient!

That’s understandable. You’ve been battling a long long time, so who wouldn’t be eager if even a glimmer of hope appears.

-- Ron

 

Re: Trileptal 600mg - How much higher can I go? » Ron Hill

Posted by SLS on June 18, 2005, at 10:01:08

In reply to Re: Trileptal 600mg - How much higher can I go? » SLS, posted by Ron Hill on June 17, 2005, at 18:40:41

Hi Ron.

I am leaning in the direction of staying on 600mg until I see my doctor a week from now. It seems like the logical thing to do. It just requires a little more patience, which, unfortunately, I don't seem to have a lot of.

By the way, it is really cool to have you around again. You are always a good source of information, sensibility, and positive energy. Glad you're back...


- Scott

 

Re: Trileptal 600mg - How much higher can I go?

Posted by SLS on June 19, 2005, at 11:04:19

In reply to Re: Trileptal 600mg - How much higher can I go? » Ron Hill, posted by SLS on June 18, 2005, at 10:01:08


> I am leaning in the direction of staying on 600mg until I see my doctor a week from now. It seems like the logical thing to do. It just requires a little more patience, which, unfortunately, I don't seem to have a lot of.

I went ahead and popped 900mg. It just felt like the right thing to do. I see my doctor in a week. I'd like to see how I react to the higher dosage so that I can bring in more information with me to make decisions upon. I didn't want to waste another week at the same dosage I had been at for many weeks. I increased my dosage yesterday evening. I feel more stable today. So far, I haven't been hit by the waves of depression that I experienced at 600mg. Whether or not I actually improve is another story.

Still a believer.


- Scott

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by ed_uk on June 19, 2005, at 12:05:36

In reply to Re: Trileptal 600mg - How much higher can I go?, posted by SLS on June 19, 2005, at 11:04:19

Looks like 900mg is going to work out :-)

Keep on believing!

~Ed

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by 4WD on June 19, 2005, at 23:18:34

In reply to Re: Trileptal 600mg - How much higher can I go?, posted by SLS on June 19, 2005, at 11:04:19

>
> > I am leaning in the direction of staying on 600mg until I see my doctor a week from now. It seems like the logical thing to do. It just requires a little more patience, which, unfortunately, I don't seem to have a lot of.
>
> I went ahead and popped 900mg. It just felt like the right thing to do. I see my doctor in a week. I'd like to see how I react to the higher dosage so that I can bring in more information with me to make decisions upon. I didn't want to waste another week at the same dosage I had been at for many weeks. I increased my dosage yesterday evening. I feel more stable today. So far, I haven't been hit by the waves of depression that I experienced at 600mg. Whether or not I actually improve is another story.
>
> Still a believer.
>
>
> - Scott


Scott,

I think that's a good idea. This way you'll have more of an idea what an increased dosage will do. If you'd stayed at 600 til your visit, he'd just tell you to increase it and then you'd have to wait for your next appt. to tell him how that's going.

I'd go ahead and ask for a backup plan while you're there, though. I mean, ask about raising it further if necessary. And/or what to do if the improvement isn't (perish the thought) sustained.

I hate it when I go to an appt. and my doc makes some very minor change and then I have to wait another month for another very minor change. I want a plan and a backup plan and a second backup plan.

Marsha

 

Re: Trileptal 600mg - How much higher can I go? » SLS

Posted by Ron Hill on June 20, 2005, at 11:23:50

In reply to Re: Trileptal 600mg - How much higher can I go? » Ron Hill, posted by SLS on June 18, 2005, at 10:01:08

SLS,

> By the way, it is really cool to have you around again. You are always a good source of information, sensibility, and positive energy. Glad you're back...

Thank you very much for your kind words. When it comes to tx of p-disorders with p-meds and/or supplements, I'm just a monkey-see-monkey-do trial-and-error kind of a guy. On the other hand, you and many other learned individuals on this site actually understand the pharmacological actions of p-meds and the associated brain functioning.

It's like you smart guys and gals are the horticulturists who determine the best genetics, optimal seed germinating requirements, soil conditioners and nutrients, optimal watering amounts and frequency, optimal quantity and intensity and wavelength of light, etc. All I do is stop by the garden, pick and sample a particular variety of the produce, and see if it gives me a boost or if it's a dud.

When I first found this site in 1999, I knew virtually nothing about p-meds and p-disorders. All I knew was that my brain was all screwed up from a p-doc giving me the wrong meds. But over the years I've read the posts of you horticulturists and now I have a lot better idea of which type of produce would have the best chance of giving me a boost and which would likely be a dud. Scott, thank you for sharing your knowledge over the years!

Hey with regard to your current Trileptal trial, do you think it might be worthwhile to keep the Trileptal on board even if the antidepressant action turns out to be merely a startup phenomenon? I say this because for several years I've thought there might be a bipolar component to your dx. In fact, I think I may have shared this opinion with you in the past. My only point is that if you do have some BP in your dx (as you currently believe to be the case), then it would seem prudent to have more mood stabilization on board than what the Lamictal and Abilify bring to the table. Just my 2 cents, FWIW.

-- Ron

 

Re: Trileptal Long-term Side Effects » SLS

Posted by Ron Hill on June 21, 2005, at 21:20:18

In reply to Re: Trileptal 600mg - How much higher can I go?, posted by SLS on June 19, 2005, at 11:04:19

Scott,

FYI: The only ongoing long-term adverse side effect that I experience with Trileptal is a very noticeable short-term memory problem. I forget things s lot! I use various aids and coping mechanisms to compensate for the memory deficit.

-- Ron

 

Re: Trileptal Long-term Side Effects » Ron Hill

Posted by SLS on June 22, 2005, at 19:28:12

In reply to Re: Trileptal Long-term Side Effects » SLS, posted by Ron Hill on June 21, 2005, at 21:20:18

Thanks, Ron.

This helps me to understand what's going on with Trileptal and the memory changes I have noticed.

> FYI: The only ongoing long-term adverse side effect that I experience with Trileptal is a very noticeable short-term memory problem. I forget things s lot! I use various aids and coping mechanisms to compensate for the memory deficit.


Yes. I have already noticed increased difficulties in short-term memory. I also seem to be having trouble with word-finding. Gosh, I hate having to compromise cognitive function for mental health. :-( I hate having to compromise anything. After suffering and waiting for a remission from depression from age 17, I feel I deserve to live the second half of my life firing on all cylinders. It's only fair.

What sorts of coping mechanisms have you employed?


- Scott


 

Re: Trileptal Long-term Side Effects » SLS

Posted by Ron Hill on June 24, 2005, at 0:05:32

In reply to Re: Trileptal Long-term Side Effects » Ron Hill, posted by SLS on June 22, 2005, at 19:28:12

> Yes. I have already noticed increased difficulties in short-term memory. I also seem to be having trouble with word-finding. Gosh, I hate having to compromise cognitive function for mental health.

For me, the cognitive side effects were much worse during start-up (i.e.; they have greatly eased during long-term use). Are you still experiencing some antidepressant effects from the Trileptal?

> I feel I deserve to live the second half of my life firing on all cylinders. It's only fair.

You deserve it (IMHO), but unfortunately life isn't always fair. Scott, like you, I want your brainchemistry to operate like a finely tuned Indy racing car; fast, nimble, and incredibly powerful.

> What sorts of coping mechanisms have you employed?

1) Lists and more lists. For me, the hard part is keeping the lists in a functionally ordered and retrievable fashion.

2) My favorite short-term memory aid is to create a picture in my mind that reminds me of the item or task that I need to remember. If more things come up that I also need to remember (before I can get to a place where I can write them down), then for each thing I need to remember, I add one new feature to the already existing picture in my mind. I also keep track of the total number of things that I have incorporated into the picture. Then when I get somewhere that has paper and pen, I pull up the picture in my brain and I recall each feature until I reach the total number of things that I needed to remember. This method works well for me up to a total of about seven things to remember.

-- Ron

 

Re: Trileptal Long-term Side Effects

Posted by SLS on June 24, 2005, at 6:24:44

In reply to Re: Trileptal Long-term Side Effects » SLS, posted by Ron Hill on June 24, 2005, at 0:05:32

Dear Ron,

Thanks for the lesson in mental gymnastics.

> For me, the cognitive side effects were much worse during start-up (i.e.; they have greatly eased during long-term use).

Phew. That's good news.

> Are you still experiencing some antidepressant effects from the Trileptal?

:-)

Strange, but true.

Things seem to be happening in such a way as to lead me to believe that I am moving in the direction of a robust response. The improvement is now mild, but significant. I feel as if Trileptal is renewing my sensitivity to the Panate + nortriptyline. I'm becoming a virgin again. Woohoo!

Thanks, Ron.


- Scott

 

Re: Trileptal Antidepressant Effects » SLS

Posted by Ron Hill on June 24, 2005, at 13:19:38

In reply to Re: Trileptal Long-term Side Effects, posted by SLS on June 24, 2005, at 6:24:44

Scott,

> Thanks for the lesson in mental gymnastics.

You bet. One thing I forgot to mention is that my short-term memory problems are much much worse if I don't get a full night's sleep.

> Things seem to be happening in such a way as to lead me to believe that I am moving in the direction of a robust response.

That makes me VERY happy; surprised perhaps, but happy! I wouldn't have thought that Trileptal would produce the AD effects that you are experiencing. For course, it's too early in the trial to start doing the victory lap quite yet. But none-the-less, I'm in the grandstands cheering for you as you're on the track putting down some good lap times.

-- Ron

BP II and OCPD

600 mg/day Lithobid

900 mg/day Trileptal

50 mg/day Lamictal

5 mg/day Deprenyl (as tx for atypical depression)

 

Re: Lookin' like Cymbalta » emme

Posted by katia on June 24, 2005, at 15:13:02

In reply to Re: Lookin' like Cymbalta » SLS, posted by emme on June 17, 2005, at 10:29:00

Hi Em,
I just recently tried Cymbalta at about 5mg (I took individual pellets about 50). I started to become more agitated and anxious. I'm on 450mg of Trileptal and 25mg of Seroquel (BP II) and am in a mild/mod depression with anxiety. I had to stop it after about three weeks. Looks like I'll have to go back to Paxil as that did work for me, I just hate the w/drawals.
How's it working for you?
Katia

> Hi Scott,
> >
> > I'm happy that you are taking yet another step. Let's hope your foot lands on the first step of the stairway to recovery. I look forward to watching you smile.
>
> Thanks for the good wishes. I don't know why, but I was a little surprised she suggested Cymbalta when I talked about antidepressants. Maybe it's that "It's new so I'm gonna start prescribing it a lot" thing. Or maybe she's just happy with what it's doing for some of her patients. Even though I was envisioning trying an older drug, I have no reason to not be open-minded about it. I used to feel hopeful when trying new medication. Now I just dread it. Will report back in a week or so.
>
> I am sorry you're backsliding. I really hope it's temporary. If this persists another day or two, then yeah, maybe you're ready to try an increase and see if you can avoid going too far down.
>
> Feel better,
>
> em
>
>


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