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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by laurenjb on October 8, 2005, at 0:13:05
I saw a psychopharmacologist today who was of the opinion that I fit more into the "soft bipolar spectrum" than treatment resistant major depression. He is an incredibly smart man and I trust him but he wants me to go off Parnate, which has stopped working, and onto both Lithium and Lamictal, which kind of seems like overkill, given that he thinks I have experiences of mild hypomania. I have been on Lithium before -- don't remember what happened but it obviously didn't work because I went off it and have also been on Lamictal before in combo with other meds. After doing a fair amount of research, I feel more comfortable trying the Lamictal as monotherapy, esp. with the thyroid/kidney problems Lithium can cause and, I admit it, because of the weight gain. I finally lost the Remeron weight and it definitely adds to my depression to gain weight. I saw some posts here from a few years ago on the subject but am wondering what anyone else has to say, especially those with a "soft" diagnosis, which I'm still kind of trying to get my mind around. As always, your insights are appreciated. Lauren
Posted by blueberry on October 8, 2005, at 8:02:24
In reply to Lamictal + Lithium for soft bipolar, posted by laurenjb on October 8, 2005, at 0:13:05
Lamictal, lithium low to medium dose, and depakote low to medium dose are all good for bipolar stuff. From what I have read, it often takes a combination of any two of them. Since you've already tried lithium and lamictal, you might want to sample depakote for a week. Then you could choose your favorite two and see how that goes. Just a thought.
But if there is any hint of bipolar, I think you are definitely on the right track. Just an opinion though.
Posted by Phillipa on October 8, 2005, at 18:19:14
In reply to Re: Lamictal + Lithium for soft bipolar, posted by blueberry on October 8, 2005, at 8:02:24
okay, I know there's biplar l, ll, lll. But what is soft biplar? Fondly, Phillipa
Posted by laurenjb on October 8, 2005, at 18:38:28
In reply to Re: Lamictal + Lithium for soft bipolar, posted by Phillipa on October 8, 2005, at 18:19:14
> okay, I know there's biplar l, ll, lll. But what is soft biplar? Fondly, Phillipa
Sorry -- I'm just getting used to the terminology myself. I guess it's also called bipolar spectrum disorder and basically means that you're Bipolar II but your hypomania doesn't tend to last as long as the DSM definition. Apparently, there is a growing contingent of researchers who believe that many diagnosed with treatment resistant depression (like me -- about 30 meds tried and ect) actually have some form of bipolar disorder that might not quite fit into the accepted definitions. I don't have its web location, but the actual cite for an article the psychopharmacologist gave me is:
Journal of Affective Disorders 84 (2005) 251-257.
By the way, I have started tapering down on the Parnate (down to 30mg from 60) and started the Lamictal at 25mg, but have decided not to start the lithium until I talk to either my own doctor or the psychopharm. because I feel so resistant to it. I feel really overwhelmed by the change in diagnosis and by the idea of going on lithium so I decided that trusting my instincts and not being a good, compliant little patient wouldn't hurt me this time. I'm already pretty low so I figure I'll just stay here without the lithium side effects for now. Take care, Lauren
Posted by rasberry on October 12, 2005, at 6:49:41
In reply to Re: Lamictal + Lithium for soft bipolar » Phillipa, posted by laurenjb on October 8, 2005, at 18:38:28
Your doctor might have a good suggestion. There has been some research showing that a low dose of Lithium + Lamictal can be effective. It has been for me. I am bipolar II but tend to lean towards severe depression. I didn't like Lithium alone. I didn't like Lamictal with other drugs. The combination of these two is a charm. It is the only thing that has ever worked for me. I take 600MG Lithium and 350MG Lamictal. The lithium dose is low enough not to cause weight gain. It is slow to get started but.....it works for some people.
Good Luck.
Posted by laurenjb on October 12, 2005, at 14:03:00
In reply to Re: Lamictal + Lithium for soft bipolar, posted by rasberry on October 12, 2005, at 6:49:41
Hi rasberry: Your post really eased my mind -- thank you. I think I will probably start the lithium in a few weeks.
When you say that the combination is the only thing that ever worked for you, do you mean that it is the only thing that has worked long-term? How long have you been taking the combo? I have been on so many ADs and combinations of ADs that have worked for awhile (usually with pretty frequent upward dosing adjustments needed) but stopped working and left me back where I was or worse. I guess I am still so depressed that it is hard to believe that anything might actually REALLY work.
Also, what brand of lithium are you taking? It seems to make a difference in terms of side effects. You said you take 600mg so you're obviously not taking Eskalith CR, since it only comes in 450mg pills, but I was going to ask my doctor about that one since I've read it might have fewer side effects. Are you have any side effects at all?
Thanks again. Take care, Lauren
> Your doctor might have a good suggestion. There has been some research showing that a low dose of Lithium + Lamictal can be effective. It has been for me. I am bipolar II but tend to lean towards severe depression. I didn't like Lithium alone. I didn't like Lamictal with other drugs. The combination of these two is a charm. It is the only thing that has ever worked for me. I take 600MG Lithium and 350MG Lamictal. The lithium dose is low enough not to cause weight gain. It is slow to get started but.....it works for some people.
> Good Luck.
Posted by SLS on October 12, 2005, at 17:22:20
In reply to Re: Lamictal + Lithium for soft bipolar, posted by rasberry on October 12, 2005, at 6:49:41
> I am bipolar II but tend to lean towards severe depression.
Are you a rapid cycler?
Were you in a depressed state when you started the lithium + Lamictal combination?
> It is slow to get started but.....it works for some people.
How long did it take to feel the antidepressant effects?
Between the time you began treatment and the time you began to respond, were there any intervening periods of mania or euthymia?
Thanks.
- Scott
Posted by SLS on October 12, 2005, at 17:24:52
In reply to Re: Lamictal + Lithium for soft bipolar, posted by rasberry on October 12, 2005, at 6:49:41
Posted by SLS on October 12, 2005, at 17:29:47
In reply to Re: Lamictal + Lithium for soft bipolar, posted by blueberry on October 8, 2005, at 8:02:24
Hi.
> Lamictal, lithium low to medium dose, and depakote low to medium dose are all good for bipolar stuff. From what I have read, it often takes a combination of any two of them. Since you've already tried lithium and lamictal, you might want to sample depakote for a week. Then you could choose your favorite two and see how that goes. Just a thought.
The only major precaution when combining Depakote + Lamictal is that there is an interaction that results in the blood level of Lamictal to increase by about 200%. If you add Depakote to Lamictal, you need to cut the dosage of Lamictal in half to obtain the same blood level. If you are adding Lamictal to Depakote, you must begin at half the starting dose and titrate upwards more gradually. The suggested schedule of titration for this situation is printed in the Lamictal package insert or PDR entry.
- Scott
This is the end of the thread.
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