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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by tebasmm on February 12, 2010, at 20:27:19
Recently diagnosed with bipolar II after years of depression. Therapist says I have dysthymia. Was taking Topamax and Welbutrin xl. Was taken off Welbutrin (quickly) and put on Lamictal. Have been having severe sudden fits of rage for no apparent reason. They have only been getting worse. Now they want to add Celexa to the mix. I go from crying to fine to confused to angry all within 15 minutes, Then all three at the same time (this is fun )this repeats all day long. I can't get my Psych to really listen to me. My therapist is away for two weeks. I feel paranoid as well. I really don't want to take THREE drugs. I also take a lot of NSAIDS for an injury and it says celexa and nsaids should not be taken together. I don't know what to do. I feel like no one cares and I'm lost.
Posted by Phillipa on February 12, 2010, at 21:09:01
In reply to rapid cycling caused by lamictal?, posted by tebasmm on February 12, 2010, at 20:27:19
First I didn't know about the NSAIDS and celexa what type of injury and you sound so miserable. Hope some replies soon. Welcome. Phillipa
Posted by Phillipa on February 12, 2010, at 21:18:41
In reply to rapid cycling caused by lamictal?, posted by tebasmm on February 12, 2010, at 20:27:19
Could be the as you put quick change of meds? Phillipa
Posted by obsidian on February 12, 2010, at 22:26:30
In reply to rapid cycling caused by lamictal?, posted by tebasmm on February 12, 2010, at 20:27:19
I have had anger and irritability I associate with lamictal...pdocs seem surprised by that, but I think it's pretty common
Posted by tebasmm on February 13, 2010, at 8:38:21
In reply to Re: rapid cycling caused by lamictal? » tebasmm, posted by Phillipa on February 12, 2010, at 21:09:01
I believe it's mostly aspirin. And it's probably not a common problem. It can cause clotting problems. I am paranoid. I always read the cvs pamphlets thouroughly. I do take a lot of aleve or motrin(daily). I hurt my neck and shoulder at work 10 mo ago. I have lost faith in Drs. My mother has been getting nasty bruises on her arms not remembering banging them. She is on celexa,Aspirin 325mg daily (suppose to be 81mg her dr knows but she bought the wrong size so he told her to go ahead and take it until finished.???) And fish oil capsules. Mix these together and gee I wonder why she's bruising easily. I'm not saying she doesnt need them but maybe an adjustment is in order. I also had a cousin who's liver enzymes were elevated while on depakote his weight doubled. They still increased his dose. Acute liver failure. I feel the dr should have never increased the meds if his enzymes were up.(isnt that why they check the blood anyway) Or they could have switched him to something else. They just arent paying attention anymore. sorry for the venting I know this isnt the page for that.
Posted by mommyron on February 13, 2010, at 10:49:55
In reply to rapid cycling caused by lamictal?, posted by tebasmm on February 12, 2010, at 20:27:19
I am so sorry you are in this crappy space...I have been too. Hang in there. Lamictal was very helpful for me, and even more so with the addition of Seroquel... it took the edge off. In the meantime, the only thing I can suggest is to avoid sugar like the plague. Blessings.
Posted by bleauberry on February 13, 2010, at 17:31:39
In reply to rapid cycling caused by lamictal?, posted by tebasmm on February 12, 2010, at 20:27:19
In the short-run probably the best thing you could do would be to reintroduce some wellbutrin and reduce the lamictal. Maybe not get back to exactly where you started, but at least make a compromise and get halfway there. I think the doctor took you too far too fast by stopping wellbutrin and starting lamictal the way it was done, and compounding the whole mess by adding another new med on top of it all. Geez.
Ya know, I don't put much faith in the names we give this stuff...such as "bipolar"...but ok, let's assume there is enough hint that someone would label you bipolar. With that in mind, that absolute worst thing to do would be to change anything too fast or in large steps. For example, going from 100mg wellbutrin to 0mg is a huge massive step. Going from 0mg lamictal to 25mg lamictal is a huge step. Better...wellbutrin 100mg to 75mg; lamictal 0mg to 12.5mg. Very little moves...so as to avoid the risk of destabilizing anything too much. Stuff is going to get destabilized no matter what, even in someone without any bipolar, and even in a perfectly healthy person doing what was done with your doses...but to keep the destablizing at a bare minimum is crucial. I think too much was done in too short of a time frame.
Lamictal is popular, but lots of people do very poorly on it and deteriorate instead of improve.
Is it possible a med that will "supposedly" benefit you actually do the opposite, create new symptoms that never existed before, create extreme uncomfortableness? The answer is definitely yes, any med can do that.
Some would brush it off as start-up side effects. I know what those look like. In your case, I see other stuff going on that trumps any start-up side effects. Wellbutrin withdrawal is probably the biggest player here, with the introduction of lamictal at the same time making it a double whammy.
In situations like yours I personally feel the best thing to do is get back to the starting line and re-assess. And then, whatever decision is made, do it much more carefully in much smaller steps over a much longer period of time.
Ok, all the above comments are for the short term outlook. For the longterm outlook, but beginning Monday morning, start asking around for another doctor. You don't necessarily need to fire yours outright, but a second opinion is usually a good thing. That said, if you feel your doctor isn't listening and doesn't care, then yes, you should fire him. Be sure to let him know why you are firing him, because he needs some accountability.
I'm not suggesting you do anything I've mentioned. Only that if I were in your shoes, and I have been several times, those are the things I did, and the outcomes had more promising journeys than the one I had been stuck on.
Posted by linkadge on February 13, 2010, at 19:19:14
In reply to Re: rapid cycling caused by lamictal?, posted by bleauberry on February 13, 2010, at 17:31:39
I agree about lamotrigine. What GSK doesn't want you to know is that their clincal trial registry contains ~10 failed trials for lamotrigine in various mood disorders. I believe there are one or two positive trials.
Do a med washout. Whenever I am rapid cycling, fasting really helps. When your body is starving it goes into a survival mode and stops all the nonsense. Of course you can't fast forever but one day can do wonders.
Linkadge
Posted by morganator on February 14, 2010, at 3:22:12
In reply to Re: rapid cycling caused by lamictal?, posted by linkadge on February 13, 2010, at 19:19:14
Fasting also may help the brain heal:
Posted by linkadge on February 14, 2010, at 6:59:20
In reply to Re: rapid cycling caused by lamictal?, posted by morganator on February 14, 2010, at 3:22:12
Thanks for the links. The third link sites some decent research on the ability of fasting to prevent damage after a stresful event. Fasting has powerful effects on neurotransmission, reducing glutamate release like other mood stabilizers.
I think that anorexics get addicted to fasting just because of the emotional stability that it provides.
A quote from the link:
"Some, for the first time, will experience emotional stability."
Linkadge
Posted by linkadge on February 14, 2010, at 7:01:07
In reply to Re: rapid cycling caused by lamictal?, posted by morganator on February 14, 2010, at 3:22:12
I remember reading too that fasting induces a subsensitivity of the 5-ht1b autoreceptors. This is common effect to antidepressant medications, rTMS and ECT.
Linkadge
Posted by willey on February 14, 2010, at 7:12:47
In reply to Re: rapid cycling caused by lamictal?, posted by morganator on February 14, 2010, at 3:22:12
http://www.fasting.ws/juice-fasting/fasting-research/50-ways-to-kill-a-brain-cellWow this link has me in total awe.First most of the things he says suchs as excersise are pretty much common sense.
Worse of common sense are the incidents he points out as nuerotoxic.......
- concussion?
- Shaking your head
- Stress and anxiety,
Um is this in the book of bad things for ur brain for dummies?
Also the sleep depravation,i heard it can cause mania to worsen,as well as it was once a theory of being a therputic tool.
What id like to know as i honestly might have missed it,is where are this gus refrences?
Anway i cant believe he could fill a page with some of the silliest things and present it as important info.Dont have a contusion? lol.
What i will say to the orignal poster is lamictal is a cns depressant,and sometimes in some people they provoke the opposite of calm and can induce rage and worsen depression,prob because again they are strong cns DEPRESSANTS.
I personaly wouldent have a maniac person go on a fasting spree,you need to food and nutrients now more then ever.But i dont have a whole page of these kinds of deepy technical facts,so i cant assure you to PLEASE NOT FAST,TRY TO GET REST AND EAT HEALTHY AND CONTACT YOUR DOC.
Posted by tebasmm on February 14, 2010, at 10:32:15
In reply to Re: rapid cycling caused by lamictal?, posted by bleauberry on February 13, 2010, at 17:31:39
Thanks for your reply. My intuition was telling me not to go off of the welbutrin so fast but the Nurse at the day program I am going to said it was fine "it won't cause any side effects". I always do as I am told. Rediculous I know. I am in a day program the nurse their dx me with bipolar II after a 2 hr session. (My therapist disagrees). She took me off Welbutrin 300mg within 1week. My reg Pdoc has the mentality that someone else is treating me he doesnt have to do anything. I have tried to ask questions and get help now no one will talk to me. Therapist away. Nrs no longer "allowed to treat" me because of insurance and Pdoc is useless. So I guess I've know for awhile I need to go out on my own and fix this. Find a new doc but I'm not sure where to look. I'm afraid I'll get more of the same and waist my time and sanity. Plus it's extra difficult when dealing with the depression and confusion and hopelessness. But there are glimmers of light here and there maybe I'll find someone during that time. Thanks again for your time.
Posted by linkadge on February 14, 2010, at 11:15:44
In reply to Re: rapid cycling caused by lamictal?, posted by willey on February 14, 2010, at 7:12:47
Well, I stand behind my fasting recomendation. Not for prolonged periods of time. Even skipping a meal can help stabilize moods. The ketone bodies that are released during fasting bind to gaba-b receptors like GHB.
Linkadge
Posted by polarbear206 on February 14, 2010, at 14:16:03
In reply to Re: rapid cycling caused by lamictal?, posted by bleauberry on February 13, 2010, at 17:31:39
> Lamictal is popular, but lots of people do very poorly on it and deteriorate instead of improve.
>
Lamictal is popular, and many people do very well on it and improve.
Posted by polarbear206 on February 14, 2010, at 14:28:51
In reply to rapid cycling caused by lamictal?, posted by tebasmm on February 12, 2010, at 20:27:19
From my experience, Wellbutrin caused me to also have fits of rage and increased anxiety. It did nothing for my depression. You should never be taken off an AD too soon. This will only contribute to mood destabilization. Lamictal is usually combined with an AD for best results. It does very well for those who are depression dominated. You will know unless you give it a try. Good luck. Do your own research on the drug and come to your own conclusion. Revolutionhealth web site has many positive ratings for Lamictal from people who are actually taking the drug, along with an AD. I've been on it for 10 years now with Effexor and works like a charm.
Posted by polarbear206 on February 14, 2010, at 14:32:01
In reply to Re: rapid cycling caused by lamictal?, posted by polarbear206 on February 14, 2010, at 14:28:51
Posted by linkadge on February 14, 2010, at 15:27:08
In reply to Re: rapid cycling caused by lamictal?)) Blueberry, posted by polarbear206 on February 14, 2010, at 14:16:03
>Lamictal is popular, and many people do very >well on it and improve.
Says who?
Linkadge
Posted by linkadge on February 14, 2010, at 15:37:38
In reply to Re: rapid cycling caused by lamictal?)) Blueberry, posted by linkadge on February 14, 2010, at 15:27:08
Lamotrigine is not approved to treat either depression or mania in bipolar. It failed clinical trials for these indications. It is only approved for the reduction of further episodes of depression and mania in bipolar. I.e. in patients who are already stabilized, lamotrigine appeared to prolong the period until a future episode. (There was some cherry picking with trial results obviously.)
In other words, if you are destabilized or rapid cycling don't expect lamotrigine to stabilize you (oh sure I know yadi-yada lamotrigine did wonders for me case reports will come up - but it is not backed by large scale trial data). If a doctor is using it for this purpose they are not in touch with the research. I would switch to depakote or olanzapine as these have a well documented antirapid cycling effect.
If, after stabilization, you decide to go back on lamotrigine, this might be ok....so long as it actually works for you.
Linkadge
Posted by polarbear206 on February 14, 2010, at 21:20:39
In reply to Re: rapid cycling caused by lamictal?)) Blueberry, posted by linkadge on February 14, 2010, at 15:27:08
> >Lamictal is popular, and many people do very >well on it and improve.
>
> Says who?
>
> LinkadgeOf course Lamictal is NOT approved for rapid cycling and mania. I never said it was. Abruptly stopping an AD can cause the rapid shifts in mood. This doesn't neccessarily mean that this person is a "rapid cycler." We don't have all the facts here.
Posted by obsidian on February 14, 2010, at 22:01:04
In reply to Re: rapid cycling caused by lamictal?, posted by polarbear206 on February 14, 2010, at 14:28:51
hey,
you had responded to my post about increased irritability after a lamictal increase. You said it would pass. Thankfully, it seems to have subsided. It was quite unpleasant to be sure. Thanks for the response.
-sid
Posted by linkadge on February 15, 2010, at 7:11:17
In reply to Re: rapid cycling caused by lamictal?)) Blueberry, posted by polarbear206 on February 14, 2010, at 21:20:39
>This doesn't neccessarily mean that this person >is a "rapid cycler." We don't have all the facts >here.
No, but drug induced rapid cycling generally responds to the same theraputic strategies as does bipolar rapid cycling.
Linkadge
Posted by linkadge on February 15, 2010, at 7:12:57
In reply to Re: rapid cycling caused by lamictal? » polarbear206, posted by obsidian on February 14, 2010, at 22:01:04
Rapid cycling is nothing to f with. It can pass with time (for some), but mixed states and rapid cylcing can be a major risk for suicide.
Linkadge
Posted by willey on February 15, 2010, at 15:53:54
In reply to Re: rapid cycling caused by lamictal?, posted by linkadge on February 15, 2010, at 7:12:57
Yess it is,i meet the criteria,and am still building my small cocktail to meet its treatment,but as i read by some great docs its new to the industry and many local docs dont know how to treat it,showing studies on his page first off that with a anti depressant removed,or with the mood stablizer neither made a signigicant differance.
There are some meds,i can post what i use and read,but first let me say from going into it head on at a turn of age i noticed to end a rage for of mania,even if it seems to have calmed,a deep sleep should be sought with gaba meds to wake up with alsmost to say the DEMOND gone period.
I was mentioned this is hard to treat,very hard,and the two most common found working meds in small studies were lithuim but much more then i believe any simple old depakote.
I personaly use a strong dose of klonopin/gabententin to put me down,where as i normaly have these two in my daily combo at miniscure amounts,in the midst of a rage attackt i immediatly grab them for since i lift im over 250 pds and whether i am violent which im not,my size alone with rage has quickly gotten me in fast trouble worst maced before arrested.But to the cops dismay,which shocked me,i hold no criminal record,and i learn and still learn how to step in on a high swing and take charge my self,something other people,hopefully a supportive family can help u with untul you learn the signs and can most times notice it alone.
Link is right,self induced mania,which can be from over use of meds,recreational meds,staying up to late,for too many days,among others can very easly push that button of overdrive,so learn where it is,learn how to press stop,and try to learn how to shut it down.
Some people ,and mostly police have their set limitations on how they treat rage,some will be very accepting and supportive,some unfortantly will pay a blind eye to it,and prepare to take to you somewhere calm,somewhere you dont wanna be over your nice warm bed.
Posted by polarbear206 on February 15, 2010, at 18:30:28
In reply to Re: rapid cycling caused by lamictal? » polarbear206, posted by obsidian on February 14, 2010, at 22:01:04
> hey,
>
> you had responded to my post about increased irritability after a lamictal increase. You said it would pass. Thankfully, it seems to have subsided. It was quite unpleasant to be sure. Thanks for the response.
> -sidI'm glad you hung in there. Good Luck. :)
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