![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by gardenergirl on November 15, 2007, at 7:55:30
I'm back into a full-blown depressive episode. I'm sure it's both biologically and psychologically/situational related. The bio part I can address fairly easily, I hope.
Anyway, I ran out of Provigil a few weeks ago. I didnt' worry about it because I wasn't so sure it was doing that much anymore. But it must be, surely. I've been in such a cognitive fog since, and my sleep/wake cycle is back to the mess it was before I started getting better.
Last time I saw my pdoc, about six weeks ago, we decided to try dropping Lamictal since I had such a positive response to Lithium. We wondered if the Lamictal was redundant. I went from 150mg to 75mg for about two weeks, and then I stopped. That was about a week ago. I don't know if feeling depressed is a withdrawal effect of Lamictal that will pass in time, or if I really did need Lamictal. I see pdoc again in about 2 weeks, though I'm tempted to call him. The Provigil shipped from my mail order pharmacy today. I probably won't get it before I leave for a weekend trip, but starting next week I can get back on it and see how I feel.
It all stinks, though. Depression stinks. I hate feeling so debilitated and "useless". I hate that it affects my marriage. And my work. Hate it.
Hate it hate it hate it.
Any feedback, comments, support and/or suggestions welcome.
Thanks,
gg
Posted by Mishal on November 15, 2007, at 10:02:34
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
> Anyway, I ran out of Provigil a few weeks ago. I didnt' worry about it because I wasn't so sure it was doing that much anymore.You should have kept some Provigil handy. Even a slight reduction in my current dosage often reminds me how helpful Provigil has been. But don't get it wrong. It is not withdawal. I am simply slipping to my old lazy self. That's all.
Hang on there until you manage to get your hands on Provigil again.Meanwhile, which brand do you use? I am content on Indian generic Modalert. Recently I offered two to my buddy in exchange of Provigil 200mg tabs. Just to confirm I am taking the right medication. And yes. I am taking the right one.
Posted by Phil on November 15, 2007, at 10:46:14
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
gg, I take Lamictal and Lithium(and Clonazepam and Cymbalta). Not sure I understand your doctors reasoning on this. "This combo is working--let's drop something."
I understand not wanting to be on too many meds but if something is working, especially for those of us that have tried everything, it's no time to start tweaking and dropping meds.
I'm glad you're getting the Provigil back and I'd tell the doc to stay the course on Lamictal. You weren't on a high dose anyway.Phil
Posted by Phillipa on November 15, 2007, at 11:37:48
In reply to Re: Ran out of Provigil + stopped Lamictal = depre » gardenergirl, posted by Phil on November 15, 2007, at 10:46:14
GG I'm so sorry. What Phil said makes sense why change something that's working? Still on the nardil? Can you ask a pharmacist for a few providgil to hold you over with your pdocs's prescription of course. Gee I wish I could experience a remission. But if I did I wouldn't change a thing. If it ain't broken don't try to fix it. Love Phillipa ps have a good time on vacation try and let us know how you're doing
Posted by ClearSkies on November 15, 2007, at 15:23:15
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
I'm so sorry to hear that you're going through a depressive episode. Surely it must be related to the medication changes, don't you think? Lamictal did nothing for me, but I could never detect any improvement in my mood from taking it, so when I stopped I merely felt the relief from the side effects stopping. Lamictal helps so many others - it sounds like maybe it was working in concert with the lithium?
I hope that you're able to see your pdoc sooner rather than later. I would also concur that the Provigil was probably making a big difference in keeping you going (and perhaps masking the depression).
Good luck with your trip - I know how difficult it can be to slap on a happy face when you're really not feeling it.
ClearSkies
Posted by Jay_Bravest_Face on November 15, 2007, at 17:13:00
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
> I'm back into a full-blown depressive episode. I'm sure it's both biologically and psychologically/situational related. The bio part I can address fairly easily, I hope.
>
> Anyway, I ran out of Provigil a few weeks ago. I didnt' worry about it because I wasn't so sure it was doing that much anymore. But it must be, surely. I've been in such a cognitive fog since, and my sleep/wake cycle is back to the mess it was before I started getting better.
>
> Last time I saw my pdoc, about six weeks ago, we decided to try dropping Lamictal since I had such a positive response to Lithium. We wondered if the Lamictal was redundant. I went from 150mg to 75mg for about two weeks, and then I stopped. That was about a week ago. I don't know if feeling depressed is a withdrawal effect of Lamictal that will pass in time, or if I really did need Lamictal. I see pdoc again in about 2 weeks, though I'm tempted to call him. The Provigil shipped from my mail order pharmacy today. I probably won't get it before I leave for a weekend trip, but starting next week I can get back on it and see how I feel.
>
> It all stinks, though. Depression stinks. I hate feeling so debilitated and "useless". I hate that it affects my marriage. And my work. Hate it.
>
> Hate it hate it hate it.
>
> Any feedback, comments, support and/or suggestions welcome.
>
> Thanks,
>
> gg
Oh Gg..I am so sorry. It really feels like someone is pulling a 'fast one' on you when you know what meds you need, but can't get them. It almost feels cruel. If you are interested in saving money, meds from Canada are much less expensive. I wish the best for you...Hope and Light..
Jay
Posted by gardenergirl on November 15, 2007, at 22:12:45
In reply to Re: Ran out of Provigil + stopped Lamictal = depressed » gardenergirl, posted by Mishal on November 15, 2007, at 10:02:34
> You should have kept some Provigil handy. Even a slight reduction in my current dosage often reminds me how helpful Provigil has been. But don't get it wrong. It is not withdawal. I am simply slipping to my old lazy self. That's all.
I didn't realize I was running out until it was too late. And I somehow lost the first prescription he gave me, so I had to get new ones before I could send them into the mail order place my insurance pays for. I didn't know it was going to make so much difference. I'll have to make sure to always refill it as soon as they'll let me versus just before I'm running out.>
>
> Hang on there until you manage to get your hands on Provigil again.Thanks. Fortunately, it arrived today. :)
>
> Meanwhile, which brand do you use? I am content on Indian generic Modalert. Recently I offered two to my buddy in exchange of Provigil 200mg tabs. Just to confirm I am taking the right medication. And yes. I am taking the right one.I take Provigil. My insurance covers it, though I pay a higher co-pay for meds without a generic available.
Thanks. Glad it's working for you as well.
gg
Posted by gardenergirl on November 15, 2007, at 22:18:02
In reply to Re: Ran out of Provigil + stopped Lamictal = depre » gardenergirl, posted by Phil on November 15, 2007, at 10:46:14
> gg, I take Lamictal and Lithium(and Clonazepam and Cymbalta). Not sure I understand your doctors reasoning on this. "This combo is working--let's drop something."
I think it's because I never felt a really robust response to Lamictal while I did once I added Lithium. So we thought we'd see.
> I understand not wanting to be on too many meds but if something is working, especially for those of us that have tried everything, it's no time to start tweaking and dropping meds.
That's a very good point. I do sometimes fall into the stigma trap about the number of meds I'm on. I try to use self-talk to counter it, and it does help, but that stigma and stupid shame I feel is rather persistent at times.
And if I ever got pregnant, I'd have to do some serious rearranging, so I guess I thought that if I didn't need it, it would be best to go ahead and get off it, and he agreed. It's not looking like such a good idea at this point, though, sigh.
> I'm glad you're getting the Provigil back and I'd tell the doc to stay the course on Lamictal. You weren't on a high dose anyway.
True. The Provigil arrived this afternoon, so I'm back on that tomorrow a.m. If no significant improvement in a few days after that, I'll call him about the Lamictal.
Thanks Phil.
gg
Posted by gardenergirl on November 15, 2007, at 22:21:59
In reply to Re: Ran out of Provigil + stopped Lamictal = depre, posted by Phillipa on November 15, 2007, at 11:37:48
> GG I'm so sorry. What Phil said makes sense why change something that's working?
Thanks Phillipa. I guess I wondered just how much the Lamictal was contributing to the picture. I guess maybe more than I realized.
> Still on the nardil?
Yep. I always have tons of that, since my old pdoc used to write for the highest dose I'd taken, and I didn't stay at that dose.> Can you ask a pharmacist for a few providgil to hold you over with your pdocs's prescription of course.
I could, but I'd have to pay significantly more for the refill than getting it by mail order if I got it at the local pharmacy. Mail order it's a $90 copay for 90 days worth. One month worth, which is what the few to hold me over would come out of, would be $75 for 30. Fortunately, they arrived in today's mail.
> Gee I wish I could experience a remission.
I wish everyone could. And actually true and lasting relief.
Thanks for your support, Phillipa. :)
gg
Posted by Mathia on November 15, 2007, at 22:23:52
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
My sister just came from her psychiatrist because she was on lamictal and cyprexa and adderall and was still feeling depressed. The psychiatrist told her "YOU DONT WANT TO STOP THE LAMICTAL BECAUSE YOU"LL START FEELING WORSE THAN WHAT YOU ALREADY ARE"
Be careful with the lamictal because she didnt take her lamictal for a couple of days before and went into a major down episode.
Posted by gardenergirl on November 15, 2007, at 22:30:58
In reply to Re: Ran out of Provigil + stopped Lamictal = depre » gardenergirl, posted by ClearSkies on November 15, 2007, at 15:23:15
> I'm so sorry to hear that you're going through a depressive episode. Surely it must be related to the medication changes, don't you think? Lamictal did nothing for me, but I could never detect any improvement in my mood from taking it, so when I stopped I merely felt the relief from the side effects stopping. Lamictal helps so many others - it sounds like maybe it was working in concert with the lithium?
Thanks. Judging from your reaction when stopping it, it doesn't sound like what I'm experiencing is a withdrawal effect of Lamictal. Guess it was helping. To which my negative thinking brain adds, "darn it!" How stupid is that?
I do think it's a great deal medication related. But there's also recent termination to consider. It's brought up a lot of old grief. And of course I can't process that with him anymore, dang it. I procrastinated on the big feelings about termination too long, and now it's too late. And my mom is moving many miles away--hence the quick out of town this weekend to accompany her--and there's grief about that. Happiness for her and my sis and nephew, too. But grief.
It's so complicated, isn't it? Of course hindsight tells me that I should have been a bit more careful about making sure I had everything I needed in place, including meds, to cope with what was absolutely going to be emotionally difficult.
>
> I hope that you're able to see your pdoc sooner rather than later. I would also concur that the Provigil was probably making a big difference in keeping you going (and perhaps masking the depression).Hmm, I didn't think about it masking it. I kind of viewed it as being the thing that worked on the excessive sleepiness and ADHD-related problems. That's a good theory to bring up with my pdoc. Thanks!
>
> Good luck with your trip - I know how difficult it can be to slap on a happy face when you're really not feeling it.I wish you didn't know. And I found today it's actually literally true about putting on a happy face. I'm starting to feel a bit better today, and I was listening to music I love and always sing along to (Dixie Chicks) while driving up to Mom's. I found I literally felt like my "smile" muscles were almost paralyzed. I couldn't really smile even though I usually do with this music and sort of felt like it. Weird. Very weird. Because I usually smile pretty easily.
Thanks again,
gg
Posted by gardenergirl on November 15, 2007, at 22:33:47
In reply to Re: Ran out of Provigil + stopped Lamictal = depressed » gardenergirl, posted by Jay_Bravest_Face on November 15, 2007, at 17:13:00
Thank you for your caring words, Jay. It means a lot. You're sure right about the difference in the cost of meds between US and Canada. I'm lucky that my husband's job has really good prescription drug coverage in the health care benefits. Though of course the premiums keep going up, but still...
Thanks again. I can feel the hope and light, I'm grateful, and I'm sending it back stronger as I can.
gg
Posted by gardenergirl on November 15, 2007, at 22:36:08
In reply to Re: Ran out of Provigil + stopped Lamictal = depressed, posted by Mathia on November 15, 2007, at 22:23:52
Oy! That certainly sounds familiar here. Even more incentive to call my pdoc to talk about resuming it. He's good about calling in scrips when necessary.
Thanks for letting me know. I hope your sister feels better very soon.
gg
Posted by Phil on November 16, 2007, at 6:56:45
In reply to Re: Ran out of Provigil + stopped Lamictal = depre » Phil, posted by gardenergirl on November 15, 2007, at 22:18:02
Good luck gardenergirl. Sometimes I feel I come off a bit preachy--I don't mean to. I do wish the best for you!
Posted by gardenergirl on November 16, 2007, at 8:51:03
In reply to Re: Ran out of Provigil + stopped Lamictal = depre » gardenergirl, posted by Phil on November 16, 2007, at 6:56:45
I didn't think you were at all preachy. I'm grateful you took the time to share your reactions. Thanks!
I wish the same for you, Phil. And it's always good to see your name next to a post.
gg
Posted by Ron Hill on November 16, 2007, at 22:18:57
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
gg,
So sorry for your depressive episode.
FWIW, a year or so ago, I tried to very slowly titrate my Lamictal dosage down from 200 mg/day to 150. I wanted to see if I could reduce my Lamictal-induced forgetfulness and rashs.
I steadily titrated from 200 down to 167.5 very slowly over a four-week period. But, at 167.5 mg/day I fell into a huge depressive episode. I immediately increased back up to 200 mg/day and I recovered quickly.
I don't understand any reluctance on the part of your p-doc to combine Lamictal and Lithium. If Li works for you, and you historical have done well on Lamictal, combining the two is actually highly recommended.
Back in 2003, Calabrese et al were very happy with their large study results. Print this study and give it to your pdoc. I can't imagine that your pdoc is not aware of these study results:
http://archpsyc.ama-assn.org/cgi/content/full/60/4/392
If you have any trouble pulling up the study article, let me know.
I'd say ramp your Lamictal back up to 150 mg/day asap. But, you know yourself better than I, of course.
Get well soon gg. You are one of our leaders around here.
-- Ron
Currently in full remission.
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
4 pumps of Androgel testosterone on a prn basis during ultra rapid cycling depressive phases.--------------------
> I'm back into a full-blown depressive episode. I'm sure it's both biologically and psychologically/situational related. The bio part I can address fairly easily, I hope.
>
> Anyway, I ran out of Provigil a few weeks ago. I didnt' worry about it because I wasn't so sure it was doing that much anymore. But it must be, surely. I've been in such a cognitive fog since, and my sleep/wake cycle is back to the mess it was before I started getting better.
>
> Last time I saw my pdoc, about six weeks ago, we decided to try dropping Lamictal since I had such a positive response to Lithium. We wondered if the Lamictal was redundant. I went from 150mg to 75mg for about two weeks, and then I stopped. That was about a week ago. I don't know if feeling depressed is a withdrawal effect of Lamictal that will pass in time, or if I really did need Lamictal. I see pdoc again in about 2 weeks, though I'm tempted to call him. The Provigil shipped from my mail order pharmacy today. I probably won't get it before I leave for a weekend trip, but starting next week I can get back on it and see how I feel.
>
> It all stinks, though. Depression stinks. I hate feeling so debilitated and "useless". I hate that it affects my marriage. And my work. Hate it.
>
> Hate it hate it hate it.
>
> Any feedback, comments, support and/or suggestions welcome.
>
> Thanks,
>
> gg
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.