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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 50. Go back in thread:
Posted by SLS on May 3, 2010, at 13:53:02
In reply to Re: Frustration » SLS, posted by conundrum on May 3, 2010, at 11:55:51
> I might call her and see what she thinks about adding the prozac. I think I'd be able to discriminate the effects of prozac from the effects of lamictal but I'm not sure.
How does Wellbutrin affect you?
- Scott
Posted by ed_uk2010 on May 3, 2010, at 16:51:53
In reply to Re: Just took hydrocodone(percocet)..., posted by bulldog2 on May 2, 2010, at 17:52:00
>Well we do know that heroin addicts are maintained on methadone for years. Apparently it sustains their mood enough to keep them off heroin.
I don't think it sustains their mood but it does prevent withdrawal symptoms. Depression is very common during methadone maintenance therapy, but there are of course multiple reasons for this.
Posted by ed_uk2010 on May 3, 2010, at 16:56:25
In reply to Re: Just took hydrocodone(percocet)... » ed_uk2010, posted by floatingbridge on May 2, 2010, at 21:00:08
>Ed, is there any antidepressant treatment that creates sustainable improvement? I don't understand....
Most commonly prescribed antidepressants have the potential to produce sustained improvement (although not after they have been stopped). They don't always poop out, you know :) Still have good days and bad days of course.
Posted by conundrum on May 3, 2010, at 17:59:15
In reply to Re: Just took hydrocodone(percocet)... » conundrum, posted by bulldog2 on May 3, 2010, at 12:16:26
Thanks for the tip. I thought number 6 was pretty funny. I think you are right. I was feeling good until I read too much. I looked at askapatient.com and lamictal has pretty high ratings. So I'll try to be hopeful. Did you ultimately find things that help at all? Do you just post here for support?
Posted by conundrum on May 3, 2010, at 17:59:51
In reply to Re: Just took hydrocodone(percocet)... » conundrum, posted by bulldog2 on May 3, 2010, at 12:16:26
I think my pdoc is good but its hard to trust when I know a lot of what they do is guess work.
Posted by sigismund on May 3, 2010, at 18:40:36
In reply to Re: Just took hydrocodone(percocet)... » bulldog2, posted by ed_uk2010 on May 3, 2010, at 16:51:53
>I don't think it sustains their mood but it does prevent withdrawal symptoms. Depression is very common during methadone maintenance therapy, but there are of course multiple reasons for this.
That's right.
Most people on methadone maintenance suffer low grade depression, probably related to methadone toxicity.
Posted by conundrum on May 3, 2010, at 19:07:42
In reply to Re: Frustration » conundrum, posted by SLS on May 3, 2010, at 13:53:02
Doesn't have any positive effect. It gave me tremors and tinnitus. I had to stop taking it at 300mgs before giving it a long enough time because of the tinnitus. I could handle the tremors but thought of hearing loss is too scary. This was the SR generic.
Posted by SLS on May 4, 2010, at 5:48:45
In reply to Re: Frustration » SLS, posted by conundrum on May 3, 2010, at 19:07:42
> Doesn't have any positive effect. It gave me tremors and tinnitus. I had to stop taking it at 300mgs before giving it a long enough time because of the tinnitus. I could handle the tremors but thought of hearing loss is too scary. This was the SR generic.
It was just a thought. My doctor has had good results combining Wellbutrin with Lamictal. Theoretically, both drugs might have pro-dopaminergic effects - Wellbutrin via dopamine reuptake inhibition and Lamictal through disinhibition of dopamine release. In real life, who knows? For me, Wellbutrin makes my depression moderately worse.
- Scott
Posted by SLS on May 4, 2010, at 5:52:13
In reply to Re: Just took hydrocodone(percocet)... » bulldog2, posted by conundrum on May 3, 2010, at 17:59:15
> Thanks for the tip. I thought number 6 was pretty funny. I think you are right. I was feeling good until I read too much. I looked at askapatient.com and lamictal has pretty high ratings. So I'll try to be hopeful. Did you ultimately find things that help at all? Do you just post here for support?
You might consider that Lamictal is probably better as an adjunct than it is as monotherapy. So, if you feel somewhat better with Lamictal monotherapy, you could leave it in place as you try other drugs.
- Scott
Posted by bulldog2 on May 4, 2010, at 7:56:06
In reply to Re: Just took hydrocodone(percocet)... » bulldog2, posted by conundrum on May 3, 2010, at 17:59:51
> I think my pdoc is good but its hard to trust when I know a lot of what they do is guess work.
parnate and clomipramine for depression. High dose neurontin for anxiety and depression.
I like askapatient, because of the ratings you get more balance. But that also may be somewhat skewed towards the negative for reasons mentioned before. But better than other forums.
If you and your doctor have discussed a med and decided to use it don't go all over the internet looking for more info.If you looked up toothpaste,milk,cheese,etc on the internet you would find horrow stories about some disasterous side effect.
If you trust your doc and think he is good than discuss all your issues with him. Make a decision and follow through. If it doesn't work out than stop. He must have had some good results to be prescribing it.
Posted by conundrum on May 4, 2010, at 11:14:18
In reply to Re: Just took hydrocodone(percocet)... » conundrum, posted by bulldog2 on May 4, 2010, at 7:56:06
I see what you mean even on askapatient there is probably a disproportionate number of negative reviews, claiming the drug almost killed them, but there are also people that have tried a lot of things and finally find something that works they post reviews on sites like that. I think the thing that attracted me to this forum was that I wanted to know about how the drugs worked and what could help my specific symptoms. This is one of the few med forums where people don't say "ask your doctor" for better or for worse.
Well when I started seeing my pdoc I thought she had 38 years experience but its really only 18 years! So she isn't as comfortable with the older drugs although she said she has a patient on atleast one of each of the TCA drugs. Not sure about MAOIs. I think I would try them last after seeing how crazy my grandmom's blood pressure was in surgery. The surgeon believed it dropped because of the Nardil. If I exhaust all other options before trying APs I would consider parnate. I know she prescribes neurotonin, but I don't think I have an anxiety problem.
I think its important to talk to your doc about what kind of side effects would bother you most. Many people hate weight gain but I could handle that. I gained a lot of weight on prozac the first time and it never bothered me. Movement disorders, memory problems, and tinnitus are much more scarey to me.
Anyway, I really appriciate your posts, Bulldog, I feel much more relaxed now about just taking the lamictal and waiting it out. Maybe she'll add something too it like you said and it if it doesn't work you move on. Its like Tom Petty said, "The waiting is the hardest part."
Posted by floatingbridge on May 4, 2010, at 11:33:52
In reply to Re: Just took hydrocodone(percocet)... » bulldog2, posted by conundrum on May 4, 2010, at 11:14:18
By way of encouragement, I know people who have done quite well on lamictal. Good luck!
Posted by conundrum on May 4, 2010, at 11:42:06
In reply to Re: Just took hydrocodone(percocet)... » conundrum, posted by SLS on May 4, 2010, at 5:52:13
Hmm that could be good, I think my pdoc might have that in mind as she wanted to make sure my mood was stable, for some reason.
Posted by conundrum on May 4, 2010, at 11:46:44
In reply to Re: Frustration » conundrum, posted by SLS on May 4, 2010, at 5:48:45
Yeh I was thinking the brand might be better but then I remember tinnitus was listed as a side effect in the original brand trials, so I'm not sure about that. I didn't even know lamictal increased DA release, thats odd since too much DA causes psychosis doesn't it and its often used as a mood stabilizer for BP. Most drugs for BP like antipsychotics block DA. Thats interesting.
Posted by bulldog2 on May 4, 2010, at 12:16:29
In reply to Re: Just took hydrocodone(percocet)... » bulldog2, posted by conundrum on May 4, 2010, at 11:14:18
For a while I could never pull the trigger on taking meds. So many opinions on wether to take or not to take. Finally realized part of getting better was trusting my judgement on a drug. So I discuss the pros and cons on a particular drug with my p-doc. But now I tend to trust his recommendations.
I'm on 75 mg of clomipramine and the sides are fine. I heard comments like I'd rather be with cobras than take this med or something like that.
People read things on the internet.Once you learn to trust your judgement and a p-doc you trust you have taken a first step in getting better. One day you wake up and say enough. I'm a smart person and can make good judgements. Why am I asking other people about these things. I still enjoy reading the technical aspects of meds.
Posted by conundrum on May 4, 2010, at 12:26:58
In reply to Re: Just took hydrocodone(percocet)... » conundrum, posted by bulldog2 on May 4, 2010, at 12:16:29
Yeh I've had the same problem about making a decision about what drugs to take and worrying about sides. Ever since I tried pristiq and survived taking it and the withdrawal I put a lot less stock on what I read online since many people claimed it was a horrid experience.
I'm trying not to read too much about lamictal but now I'm curious about how it works. Not sure if I'll look it up or not.
Yes trusting yourself and your p-doc is very important.
Posted by SLS on May 4, 2010, at 15:28:32
In reply to Re: Frustration » SLS, posted by conundrum on May 4, 2010, at 11:46:44
> Yeh I was thinking the brand might be better but then I remember tinnitus was listed as a side effect in the original brand trials, so I'm not sure about that. I didn't even know lamictal increased DA release, thats odd since too much DA causes psychosis doesn't it and its often used as a mood stabilizer for BP. Most drugs for BP like antipsychotics block DA. Thats interesting.
As best as I can recall, glutamatergic circuits efferent from the PFC project into the nucleus accumbens and inhibit dopamine release there. Lamotrigine inhibits glutamate release in the PFC and thus disinhibits (allows) the release of dopamine. Glutamate antagonists can be psychotogenic. I have heard of people having manic reactions to lamotrigine.
- Scott------------------------------------------
Psychopharmacology (Berl). 2008 Dec;201(3):325-38. Epub 2008 Aug 28.
Blockade of NMDA receptors in the prefrontal cortex increases dopamine and acetylcholine release in the nucleus accumbens and motor activity.
Posted by SLS on May 4, 2010, at 15:35:24
In reply to Re: Just took hydrocodone(percocet)... » bulldog2, posted by conundrum on May 4, 2010, at 12:26:58
> I'm trying not to read too much about lamictal but now I'm curious about how it works. Not sure if I'll look it up or not.
I'm not sure that anyone can claim understanding as to how Lamictal works to treat depression. My guess is that it has more to do with its activity at glutamate nerve terminals than at sodium channels. I could be wrong, though.
- Scott
Posted by floatingbridge on May 4, 2010, at 16:25:03
In reply to Re: Just took hydrocodone(percocet)... » conundrum, posted by SLS on May 4, 2010, at 15:35:24
So Lamictal could be someone's main ad? Not just for BP...?
(Excuse the intrusion, conundrum.)
Posted by SLS on May 4, 2010, at 17:54:54
In reply to Re: Just took hydrocodone(percocet)... » SLS, posted by floatingbridge on May 4, 2010, at 16:25:03
> So Lamictal could be someone's main ad? Not just for BP...?
>
> (Excuse the intrusion, conundrum.)
I haven't heard too many stories describing Lamictal monotherapy as being particularly effective in treating unipolar depression. However, some researchers look at unipolar and bipolar disorders as being endpoints along a continuum. Some people who have demonstrated only depression may in fact have a bipolar diathesis. Perhaps these seemingly unipolar people would be responsive to Lamictal. I don't think it is entirely clear what place Lamictal has in the treatmtent of mood disorders. Under what circumstances does it produce long-term robust antidepressant effects?
- Scott
Posted by floatingbridge on May 5, 2010, at 9:07:08
In reply to Re: Just took hydrocodone(percocet)..., posted by SLS on May 4, 2010, at 17:54:54
Scott, you're asking me? I just know a couple of folks (one BP II w/ Lyme's complications), who did not feel well until they finally added lamictal. They're taking other meds, and as I think about it, are dx'd BPll. I don't know anyone on lamictal as monotherapy--didn't mean to give that impression. But after knowing some folks who had that 'ahhh' experience w/it, I thought, maybe.... So no one on monotherapy?
I'm always interested in the minimal. At least in theory.
My pdoc had mentioned it before the Stanford non-event as a possibility....
Posted by SLS on May 5, 2010, at 11:18:47
In reply to Re: Just took hydrocodone(percocet)... » SLS, posted by floatingbridge on May 5, 2010, at 9:07:08
> Scott, you're asking me?
I guess it was more of a statement than a question.
> So no one on monotherapy?
I really don't know what has been the clinical experience of the average practicioner with Lamictal monotherapy. I'll try to remember to ask my doctor the next time I see him.
> My pdoc had mentioned it before the Stanford non-event as a possibility....
What is the Stanford non-event?
- Scott
Posted by conundrum on May 5, 2010, at 11:55:00
In reply to Re: Just took hydrocodone(percocet)... » floatingbridge, posted by SLS on May 5, 2010, at 11:18:47
Well the reason I was prescribed lamictal is because my pdoc thinks I may have a mood stability problem and she didn't want to prescribe a TCA cause she thought it could make me manic. This was based on the fact that prozac worked really well the first time and that I was kinda weird during the 2 years after. I don't think I have a mood problem but I will see what this does. Maybe she plans on adding an AD to it later but wants to be sure I won't become manic? idk..
> > Scott, you're asking me?
>
> I guess it was more of a statement than a question.
>
> > So no one on monotherapy?
>
> I really don't know what has been the clinical experience of the average practicioner with Lamictal monotherapy. I'll try to remember to ask my doctor the next time I see him.
>
> > My pdoc had mentioned it before the Stanford non-event as a possibility....
>
> What is the Stanford non-event?
>
>
> - Scott
>
>
Posted by floatingbridge on May 5, 2010, at 12:36:40
In reply to Re: Just took hydrocodone(percocet)... » floatingbridge, posted by SLS on May 5, 2010, at 11:18:47
> > Scott, you're asking me?
>
> I guess it was more of a statement than a question.
Good. I figured you'd know more than I would:)> > My pdoc had mentioned it before the Stanford non-event as a possibility....
>> What is the Stanford non-event?
Oh, I had a relatively unenlightening Stanford consult. I posted so much about it that I'm a little embarrassed now.
fb
> - Scott
>
>
Posted by floatingbridge on May 5, 2010, at 12:38:17
In reply to Re: Lamictal monotherapy, posted by conundrum on May 5, 2010, at 11:55:00
Best to you...!
This is the end of the thread.
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