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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by simcha on August 25, 2010, at 17:58:27
OK, so I had a rash that stopped my experiment with Lamictal.
Currently here is the mix I'm taking:
Cymbalta 60mg a.m.
BuproprionXL 450mg p.m.
Trazodone 25mg p.m. (Insomnia)
Clonazepam 0.5mg p.m. (Restless Legs)
Sotalol 180mg 2 times per day (Tachycardia)
Slo-Niacin 500mg 2 times per day (Borderline high cholesterol)Those are my prescribed meds. I take vitamins c & e. Also I take fish oil 1200mg. And I take milk thistle because it's helped balance my liver enzymes. Also I take 10mg of Claritin at night for allergies.
I started to take Caltrate (600mg calcium + 400iu vitamin d) 2 times per day with starting the Lamictal because I read somewhere that Lamictal could reduce Calcium and Vitamin D in the blood.
The problem is that I started both the Caltrate and the Lamictal (25mg) last Thursday. Yesterday (Wednesday) I broke out in hives. Now I'm fine. I have no hives. My pdoc wants me to go back on the Caltrate to see if I break out in hives. If I do then I'm cleared to start Lamictal again without taking the Caltrate. If however, I don't break out in hives, we have to try something else.
I'd like to get off of the Cymbalta 60mg. I'm not sure it's doing much good for me. I know it's making me sweat uncontrollably and it messes up my sex life. Also I suspect that it elevates my heart rate a little (something I don't need).
The other medications he suggested are Abilify, Remeron, Tegretal or Trileptal (I think).
I'm already overweight so whatever I take, I don't want it to make me gain more. I know that there are issues with weight gain for both Abilify and Remeron. Also I'm tired of the reduced libido and anorgasmia that the Cymbalta causes so I want something that doesn't do that.
I don't know much about Tegretal or Trileptal.
So I have no clue what to suggest I try next to my pdoc if I can't go back on the Lamictal.
I hate being depressed and I hate these darn side effects. I feel like no matter what I pick, it won't work and I'll have terrible side effects.
Posted by Maxime on August 25, 2010, at 19:00:49
In reply to Need Help - What to do next?, posted by simcha on August 25, 2010, at 17:58:27
I take Trileptal as a mood stabiliser and it works well and it is weight neutral.
I guess you will just have to wait it out a bit to see what is causing the hives. Hang in there.
Posted by bk2va23 on August 25, 2010, at 19:51:17
In reply to Need Help - What to do next?, posted by simcha on August 25, 2010, at 17:58:27
Great you found out about Lamictal when you did.Sounds like a sulphur reaction,meds like xonegran,lamictal,and even depakote have this issue,even internal.
As far as repalcing it,lamictal is a mood stablizer not a anti depressant,most dont do well on a mood stablizer alone.
If i were a doc,and im not,id try s good ned antidepressant like PRIQITQ which most here do fair on,replace your mood stablizer with Nuerontion a med alone useless but with a antidepressant seems to help a lot,its extremly safe,and id add a low dose benzo like ativan.
Heres a paste of course,and the source,
"Predictive risk factors associated with lamotrigine-induced rash and liver dysfunction include
rapid dose titration, previously reported rash with other medications, age, and concurrent interacting
medications. More serious adverse effects, such as StevensJohnson syndrome and fulminant hepatic failure,
have also been associated with lamotrigine treatment. If rash appears at any time during treatment,
lamotrigine must be discontinued"source
Source is from google scholar
Posted by simcha on August 25, 2010, at 21:35:07
In reply to Re: Need Help - PLEASE READ, posted by bk2va23 on August 25, 2010, at 19:51:17
OK, I guess I should have specified my diagnosis. I don't have Bipolar Disorder. I have Major Depressive Disorder with Recurrence and I'm currently moderately to severely depressed. My pdoc has a hypothesis that I might do well with something that people who suffer from Bipolar Disorder do well with since there are many people in my family who have Bipolar Disorder. He talked about something about if you have Bipolar in your family and you have Unipolar depression and have tried a few things out in the anti-depressant category, atypical anti-psychotics and/or anti-convulsants may work as an adjunct to an anti-depressant.
So, I don't need a mood stabilizer to prevent me from going manic. I've never even been hypomanic in my life. I may need it to boost the main anti-depressant that works, BuproprionXL. I've maxed out on 450mg and I'm still somewhat depressed but going from 300-450 did give me some improvement.
Posted by simcha on August 25, 2010, at 21:35:54
In reply to Re: Need Help - What to do next? » simcha, posted by Maxime on August 25, 2010, at 19:00:49
Thanks for the encouragement and the information Maxime. I appreciate it.
Posted by Phillipa on August 25, 2010, at 23:06:49
In reply to Re: Need Help - What to do next? » Maxime, posted by simcha on August 25, 2010, at 21:35:54
Hi Simcha just home. Tegrotol and Trileptal are almost the same but trileptal has an extra oxygen molecule. I've taken low doses of it and as Maxime stated weight neutral and although my dose was low no side effects I feel I'd pick that again. Hoping the mystery is soon solved. Phillipa
Posted by sigismund on August 25, 2010, at 23:33:34
In reply to Need Help - What to do next?, posted by simcha on August 25, 2010, at 17:58:27
If and when agomelatine comes out in the US and you can afford it, consider replacing Cymbalta, bupropion, and Trazadone with it.
Posted by simcha on August 26, 2010, at 14:05:34
In reply to Re: Need Help - What to do next? » simcha, posted by sigismund on August 25, 2010, at 23:33:34
Thanks Phillipa and Sigismund for your responses. I appreciate it.
Posted by ed_uk2010 on August 26, 2010, at 14:36:19
In reply to Re: Need Help - What to do next?, posted by simcha on August 26, 2010, at 14:05:34
Hi Simcha,
How about reducing your Cymbalta dose to 30mg? This should help you to decide whether you're actually obtaining any benefit from it, whilst also reducing the adverse effects and acting as a stepping stone to coming off Cymbalta - if indeed that's what you decide to do.
Posted by Phillipa on August 26, 2010, at 20:25:32
In reply to Re: Need Help - What to do next?, posted by ed_uk2010 on August 26, 2010, at 14:36:19
Good idea. Phillipa
Posted by angels78 on August 27, 2010, at 5:14:27
In reply to Re: Need Help - PLEASE READ » bk2va23, posted by simcha on August 25, 2010, at 21:35:07
Why not try an MAOI?
Posted by simcha on August 27, 2010, at 16:56:25
In reply to Re: Need Help - PLEASE READ » simcha, posted by angels78 on August 27, 2010, at 5:14:27
Thanks for the suggestion.
I don't want to try an MAOI because of the side effects and the many medicines and foods that react with them. I don't know if I can even take an MAOI while on my heart medication, Sotalol, which I can't change because it works and if I were to need to switch heart medications, I would have to be in a hospital for almost a week because of possible danger while quitting Sotalol.
Posted by bleauberry on August 27, 2010, at 17:50:03
In reply to Need Help - What to do next?, posted by simcha on August 25, 2010, at 17:58:27
You might try a cross taper of cymbalta to milnacipran.
Or a cross taper from cymbalta to zoloft+nortriptyline.
Or something that impacts the opioid system in a positive way, such as LDN, DLP, DLPA.
Of all the meds your doctor suggested, I know I said before, I disagree with all of them except maybe low dose abilify. The others, forget it. There are a lot better things than those.
But I'm not the doctor, so take it in a casual friendly manner. Just sharing what I believe to be true based on my own experiences and observations of others over the years.
And I realize you are sensitive to a lot of things due to other confounding health problems. With that in mind, I would not allow that to rule in or rule out any med choice, but instead to direct the initiation of any chosen med at a low dose. Don't go shoorting for "supposed" target doses (that's clinical trial stuff, not real world stuff) in any hurry. Cut starting doses in half and stay there a while before changing anything. You were worried about heart problems with ritalin. Understandable. But not if done responsibly by starting at 2.5mg and going gently from there. Or even 1.25mg. You might not need much. Don't automatically assume that you will need the dose on the bottle or that you will get the side effects you expect.
I dunno, the whole depression game is a tough one. Who knows. I just don't see the doctor suggested meds as being very helpful for the simple reason we don't see that happen with those meds here very often. Abilify has some success stories and that's why it would be the only one in that bunch I would consider.
Posted by simcha on August 31, 2010, at 18:46:30
In reply to Re: Need Help - What to do next?, posted by bleauberry on August 27, 2010, at 17:50:03
OK, so I just found out I wasn't allergic to Caltrate (d'uh!). And my pdoc judged that my hives may not be an allergic reacion to Lamictal because the rash disappeared in just 12 hours or so and apparently the bad rash doesn't just disappear that fast.
Also I have very sensitive skin and stress can sometimes make me break out in hives.
So, I'm going to try Lamictal again and pray that I don't break out in hives again or a rash. I thought I was just beginning to notice a difference when I broke out in hives after being on just the 25mg for 6 days. It could have been placebo effect, but maybe not.
From what I've been reading, Lamictal just might work. I know I have some reservations and others have expressed their reservations about the possible success of this med for me, but I'm feeling a little hopeful since I've read more about it.
Thanks.
Posted by Phillipa on August 31, 2010, at 21:59:15
In reply to Re: Need Help - Lamictal Again, posted by simcha on August 31, 2010, at 18:46:30
Hey that's great. Glad not the dreaded Stevens Johnsons rash. Stress does cause rashes. I feel that lamictal could of really been good for me also. Darn spitting constantly is what caused me to have to stop a rare side effect. Phillipa
Posted by ed_uk2010 on September 1, 2010, at 6:24:56
In reply to Re: Need Help - Lamictal Again, posted by simcha on August 31, 2010, at 18:46:30
Hi Simcha,
I guess you'll be increasing the dose quite slowly? This decreases the risk of rash. Although mild rashes are common with lamotrigine (and without it), severe rashes are rare. In the absence of other symptoms, urticaria (hives) is not normally suggestive of a severe reaction.
Signs that a rash could become severe include:
Discomfort, ulceration and blistering inside the mouth or on the lips
Soreness and redness of the eyes or inside the nostrils
Rash affecting the genitals - can cause pain on urination
Skin blistering or peeling
Rash + systemic symptoms such as fever, sore throat, enlarged and tender lymph nodes and feeling generally flu-like and unwell.If any of these symptoms occur, lamotrigine should be stopped and not restarted.
To reduce the risk of rash occuring when starting lamotrigine:
Do not start other new medications or supplements at the same time
Do not start eating new foods
Do not use new cosmetics, conditioners, deodorants, detergents or fabric softeners
If appropriate, wear a suitable sunscreen to avoid sunburn
Take precautions to avoid Poison Oak/Poison Ivy exposure
Do not start lamotrigine within 2 weeks of having a rash, viral syndrome or vaccination.Hope this is useful.
Posted by simcha on September 1, 2010, at 13:34:10
In reply to Re: Need Help - Lamictal Again » simcha, posted by ed_uk2010 on September 1, 2010, at 6:24:56
Phillipa, thanks for the encouragement.
Ed_uk2010, thanks for the information. Yes, it's helpful. I'm trying to hold out some hope here. I'm feeling hopeless at the moment since I'm horribly behind at work due to the depression with the motivation and focus issues. Now I may not be able to take time off next week if I can't get things done by Friday.
This just adds to my stress and I hope that Lamictal will help.
Posted by Phillipa on September 1, 2010, at 20:21:17
In reply to Re: Need Help - Lamictal Again » ed_uk2010, posted by simcha on September 1, 2010, at 13:34:10
So do I and you will keep us posted? Phillipa
Posted by ed_uk2010 on September 2, 2010, at 12:24:10
In reply to Re: Need Help - Lamictal Again » ed_uk2010, posted by simcha on September 1, 2010, at 13:34:10
>I hope that Lamictal will help
Me too :)
Posted by simcha on September 3, 2010, at 13:03:46
In reply to Re: Need Help - Lamictal Again » simcha, posted by ed_uk2010 on September 2, 2010, at 12:24:10
Thanks everyone. So far no hives or rash. It's day 3 at 25mg.
Posted by ed_uk2010 on September 3, 2010, at 15:05:56
In reply to Re: Need Help - Lamictal Again, posted by simcha on September 3, 2010, at 13:03:46
> Thanks everyone. So far no hives or rash. It's day 3 at 25mg.
Good news :) Could you put your babble on by the way?
Posted by Phillipa on September 3, 2010, at 20:15:45
In reply to Re: Need Help - Lamictal Again » simcha, posted by ed_uk2010 on September 3, 2010, at 15:05:56
Congrats that is definitely good news. Phillipa
Posted by simcha on September 8, 2010, at 14:30:35
In reply to Re: Need Help - Lamictal Again, posted by Phillipa on September 3, 2010, at 20:15:45
Today marks one week at 25mg Lamictal. No rash. Yay!
Posted by Phillipa on September 8, 2010, at 20:29:08
In reply to Re: Need Help - Lamictal Again, posted by simcha on September 8, 2010, at 14:30:35
Yeah for Simcha that is super news!!!! Phillipa
Posted by simcha on September 15, 2010, at 16:36:40
In reply to Re: Need Help - Lamictal Again » simcha, posted by Phillipa on September 8, 2010, at 20:29:08
I just went up to 50mg last night. When should I start feeling a difference?
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