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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by tensor on March 26, 2013, at 15:06:50
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
> I attempted to discontinue Lamictal in the hope that my cognition and memory would improve. They did. Unfortunately, I relapsed within a week of discontinuation. I have had to restart Lamictal and will return to a dosage of 200 mg/day. At some point, I might attempt to reduce the dosage to 150 mg/day, but for now, I am looking to reestablish a stable antidepressant response.
>
> I am left feeling demoralized and doomed. I am less optimistic about my future. I am too far from remission to return to work, and I am sick and tired of being so ill. I am losing my motivation to fight and push against my depression. It is ridiculous to be on 7 different drugs and not feel more than 50% well. What choice do I have? I have attempted to remove each drug except for the antidepressants (Parnate and nortriptyline). I relapsed with each attempt, demonstrating to me that I need all 7 drugs in order to receive any relief. My dependency on medication is upsetting.
>
>
> - ScottI'm sad to read this. Atleast, you will now know you were not taking it for nothing. I hope you get relief soon, Scott, you are greater than your suffering.
The most authentic thing about us is our capacity to create, to overcome, to endure, to transform, to love and to be greater than our suffering. Ben Okri/tensor
Posted by Roslynn on March 26, 2013, at 15:52:49
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Posted by joe schmoe on March 26, 2013, at 16:37:57
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Sorry to hear you are feeling down. It is quite understandable.
Have you ever had your testosterone levels checked?
Posted by Phillipa on March 26, 2013, at 20:26:12
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Scott after thinking about this some today. I recall you once saying I think that some doctor discontinued a med that was working for you and this is when you became a nonresponder. Is it possible this doc is responsible for what happened to you? Or is it possible after all this time that your diagnosis is wrong and not bipolar since didn't you post one manic reaction to a med? Seems that after all these years all the docs you have seen could find something that helps. I only question as I wonder at times if less is better after the neurotransmitters have time to return to their pre med state. I again am at a loss for words. Phillipa
Posted by alexcanada on March 26, 2013, at 20:41:49
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
I was losing my motivation this morning too during what I believe what a horrendous Anafranil + ritalin interaction. My mood was in a horribly negative state.
The cognition aspect is so difficult. Do you recall what your baseline is like? Such as when you are on very few meds or no meds? Or what is your personal diagnosis?
Lamictal I found to provide some very positive relief in terms of anxiety and some positive mood but unfortunately the cognitive side effects made me incapable of tolerating it. Though I have issues tolerating many meds and my deep melancholic symptoms are not a proper fit for lamictal anyway.
Have you attempted much in terms of alternatives such as supplements and herbals? I had some very positive benefit from Licorice root but it unfortunately interacts with SSRIs and likely SNRIs too. It provided me with some increased sense of peacefulness, positivity, and remarkably empathy. Though it increased anxiety.
> I attempted to discontinue Lamictal in the hope that my cognition and memory would improve. They did. Unfortunately, I relapsed within a week of discontinuation. I have had to restart Lamictal and will return to a dosage of 200 mg/day. At some point, I might attempt to reduce the dosage to 150 mg/day, but for now, I am looking to reestablish a stable antidepressant response.
>
> I am left feeling demoralized and doomed. I am less optimistic about my future. I am too far from remission to return to work, and I am sick and tired of being so ill. I am losing my motivation to fight and push against my depression. It is ridiculous to be on 7 different drugs and not feel more than 50% well. What choice do I have? I have attempted to remove each drug except for the antidepressants (Parnate and nortriptyline). I relapsed with each attempt, demonstrating to me that I need all 7 drugs in order to receive any relief. My dependency on medication is upsetting.
>
>
> - Scott
Posted by Beckett on March 26, 2013, at 20:48:20
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Posted by alchemy on March 26, 2013, at 22:47:00
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
You are a very helpful and smart guy. We are all rooting for you :-)
Posted by jono_in_adelaide on March 26, 2013, at 23:16:48
In reply to I'm sorry to hear this Scott (nm), posted by Beckett on March 26, 2013, at 20:48:20
Scott, I know 7 meds seems like a lot, but if you feel better on 7 meds than 6, then I say take them. The goal is to feel as good as you can, regardless how many pills a day that entails.
i think you have done realy well, you havent become self sorry, you have amazing insight into your condition, and you havent withdrawn from society.
be proud
Posted by Jeroen on March 27, 2013, at 4:34:00
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
lamictal destroyed my life
lamotrigine induced psychosis occurs in 1% of users
YES in me... and my cocky *ss doctor wont prescribe to me any Saphris
Posted by Emme_V2 on March 27, 2013, at 6:51:13
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
I hope you feel better soon. One day at a time. I'm hoping the minocycline will let me at least get away with a lower dose of Lamictal. Maybe you will have the same luck and have fewer cognitive effects with a stable lower dose even if you can't discontinue.
I know 7 drugs seems like a lot, but please do what you need to for relief. Depression's a terrible thing.
Posted by Velthir on March 27, 2013, at 8:54:56
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Have you tried folic acid supplementation, SLS? There's some evidence that Lamictal depletes it and that adding folic acid can help its effects on depression and lesson its effect on memory. I'll try to dig up some articles at some point.
I take 800 mcg/day and I *think* it helps a bit.
Posted by SLS on March 27, 2013, at 15:08:55
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by Velthir on March 27, 2013, at 8:54:56
> Have you tried folic acid supplementation, SLS? There's some evidence that Lamictal depletes it and that adding folic acid can help its effects on depression and lesson its effect on memory. I'll try to dig up some articles at some point.
>
> I take 800 mcg/day and I *think* it helps a bit.Hi.
Thank you for the suggestion. I tried taking Deplin L-methylfolate a number of years ago. I responded favorably to it at first, then felt somewhat worse. I wonder if taking a smaller dose would have helped. I'll keep it in mind.
- Scott
Posted by jono_in_adelaide on March 27, 2013, at 21:29:49
In reply to Re: My attempt to discontinue Lamictal = relapse. » Velthir, posted by SLS on March 27, 2013, at 15:08:55
I watched that video ad that Deplin has on its website, and i have to say, it was a bit of the stretch - if almost 50% of the population have difficulty converting dietary folate into its active form, why arent they suffering the symptoms of folate deficiency (sprue, anemia etc)
I'm sure Deplin greatly helps some people, but I think saying that half of the population are in need if it is a bit much
Posted by ChicagoKat on March 28, 2013, at 17:30:02
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
Scott, I am sorry to hear this news. Hoping that things improve for you.
Kat
Posted by SLS on March 29, 2013, at 6:31:19
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
I'm titrating Lamictal all over again. I am remaining flexible in order to establish the lowest effective dosage, even if that means increasing the dosage above 200 mg/day. Let's see where I end up. So far, my memory and cognition remain intact. Ataxia has not emerged.
The combination of depression and drug effects can be confusing and sometimes fool me. It is quite possible that my complaints regarding memory and cognitive impairments were actually the depression and not the Lamictal. One thing interesting about Lamictal is that one can experience a brief improvement in depression upon dosage reduction. I think that this is exactly what happened to me when I reported feeling better as I rapidly tapered the dose. If so, then I might be better off taking 300 mg/day than 200 mg/day.
Today, I am more hopeful.
I would like to thank everyone for your support and valuable suggestions.
- Scott
Posted by Tyrannosaur on March 30, 2013, at 12:33:56
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by Velthir on March 27, 2013, at 8:54:56
> Have you tried folic acid supplementation, SLS? There's some evidence that Lamictal depletes it and that adding folic acid can help its effects on depression and lesson its effect on memory. I'll try to dig up some articles at some point.
>
> I take 800 mcg/day and I *think* it helps a bit.If you're Velthir from depressionforums.org could you turn on your babblemail? I've got a few questions for you. Thanks
Posted by SLS on March 30, 2013, at 21:22:02
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by SLS on March 29, 2013, at 6:31:19
Hi all.
> I'm titrating Lamictal all over again. I am remaining flexible in order to establish the lowest effective dosage, even if that means increasing the dosage above 200 mg/day. Let's see where I end up. So far, my memory and cognition remain intact. Ataxia has not emerged.
> The combination of depression and drug effects can be confusing and sometimes fool me. It is quite possible that my complaints regarding memory and cognitive impairments were actually the depression and not the Lamictal. One thing interesting about Lamictal is that one can experience a brief improvement in depression upon dosage reduction. I think that this is exactly what happened to me when I reported feeling better as I rapidly tapered the dose. If so, then I might be better off taking 300 mg/day than 200 mg/day.
So far, so good. I have been taking Lamictal 300 mg/day for 5 days, and cognitive side effects have not emerged. I have been feeling significantly better over the last 3 days. It is hard for me not to be optimistic, but my brain is notorious for resisting the therapeutic response to treatment. I usually relapse after 3 days of improvement. Obviously, I am still within that 3-day window. I could relapse tomorrow.
The next few days will be critical.
- Scott
Posted by SLS on March 31, 2013, at 8:57:38
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by SLS on March 30, 2013, at 21:22:02
Woohoo!
Insomnia!
For me, insomnia is a great indicator that a treatment is working. Today is day 4 of my therapeutic response, and I am enjoying the improved state.
- Scott
Posted by Tomatheus on March 31, 2013, at 9:20:13
In reply to Insomnia! This is a good thing., posted by SLS on March 31, 2013, at 8:57:38
> Woohoo!
>
> Insomnia!
>
> For me, insomnia is a great indicator that a treatment is working. Today is day 4 of my therapeutic response, and I am enjoying the improved state.
>
>
> - ScottThis is good to hear, Scott. For those of us who tend to experience three-day therapeutic responses to some treatments, experiencing a fourth day of therapeutic benefits is certainly a good sign. I hope that Lamictal continues to treat you well at 300 mg/day.
Tomatheus
Posted by tensor on March 31, 2013, at 11:38:10
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by SLS on March 30, 2013, at 21:22:02
> Hi all.
>
> > I'm titrating Lamictal all over again. I am remaining flexible in order to establish the lowest effective dosage, even if that means increasing the dosage above 200 mg/day. Let's see where I end up. So far, my memory and cognition remain intact. Ataxia has not emerged.
>
> > The combination of depression and drug effects can be confusing and sometimes fool me. It is quite possible that my complaints regarding memory and cognitive impairments were actually the depression and not the Lamictal. One thing interesting about Lamictal is that one can experience a brief improvement in depression upon dosage reduction. I think that this is exactly what happened to me when I reported feeling better as I rapidly tapered the dose. If so, then I might be better off taking 300 mg/day than 200 mg/day.
>
> So far, so good. I have been taking Lamictal 300 mg/day for 5 days, and cognitive side effects have not emerged. I have been feeling significantly better over the last 3 days. It is hard for me not to be optimistic, but my brain is notorious for resisting the therapeutic response to treatment. I usually relapse after 3 days of improvement. Obviously, I am still within that 3-day window. I could relapse tomorrow.
>
> The next few days will be critical.
>
>
> - ScottGood news. How fast did you titrate? I'm thinking of restarting Lamictal after a few months hiatus. Wondering if I could go a little faster this time.
/tensor
Posted by SLS on March 31, 2013, at 12:53:57
In reply to Re: My attempt to discontinue Lamictal = relapse. » SLS, posted by tensor on March 31, 2013, at 11:38:10
Hi Tensor.
> > So far, so good. I have been taking Lamictal 300 mg/day for 5 days, and cognitive side effects have not emerged. I have been feeling significantly better over the last 3 days. It is hard for me not to be optimistic, but my brain is notorious for resisting the therapeutic response to treatment. I usually relapse after 3 days of improvement. Obviously, I am still within that 3-day window. I could relapse tomorrow.
> >
> > The next few days will be critical.> Good news. How fast did you titrate?
Be aware that I tapered Lamictal quickly and discontinued it completely for only two days before I relapsed. I don't think our situations are comparable. Even if you didn't develop a rash reaction during your first trial of Lamictal, does not guarantee that you will not have a reaction upon restarting it. For me, I know when I am titrating too quickly if my eyes start itching.
If you want to be somewhat conservative, what makes sense to me is the following schedule. It is a more rapid titration than what is recommended by the manufacturer.
25 mg/day for one week
50 mg/day for one week
100 mg/day for one week
200 mg/day for at least two weeksI know it is tempting to titrate Lamictal more rapidly, and you might be able to do so without adverse effects. If you decide to be more aggressive, and you do develop a rash, just know that you can discontinue taking it and restart at a more gradual pace.
- Scott
Posted by tensor on March 31, 2013, at 14:43:25
In reply to Re: My attempt to discontinue Lamictal = relapse. » tensor, posted by SLS on March 31, 2013, at 12:53:57
> Be aware that I tapered Lamictal quickly and discontinued it completely for only two days before I relapsed. I don't think our situations are comparable. Even if you didn't develop a rash reaction during your first trial of Lamictal, does not guarantee that you will not have a reaction upon restarting it. For me, I know when I am titrating too quickly if my eyes start itching.
>
> If you want to be somewhat conservative, what makes sense to me is the following schedule. It is a more rapid titration than what is recommended by the manufacturer.
>
> 25 mg/day for one week
> 50 mg/day for one week
> 100 mg/day for one week
> 200 mg/day for at least two weeks
>
> I know it is tempting to titrate Lamictal more rapidly, and you might be able to do so without adverse effects. If you decide to be more aggressive, and you do develop a rash, just know that you can discontinue taking it and restart at a more gradual pace.
>
>
> - ScottThat was the titration rate I was thinking of, I need to call my pdoc on tuesday before starting. The amitriptyline is helping with the physical fatigue but I'm mentally exhausted most of the time.
Thanks,
tensor
Posted by brynb on April 5, 2013, at 16:19:49
In reply to My attempt to discontinue Lamictal = relapse., posted by SLS on March 26, 2013, at 6:58:47
hi Scott,
sorry to hear :(. I was doing ok with ketamine for a while and had a recent relapse/setback too.
have you tried ketamine yet? or TMS? TMS and MAOIs are my next move.
hang in there--you always give great advice and have excellent insight. I so can relate to feeling demoralized and hopeless right now. I'm sure your efforts and knowledge will pay off in the long run. chin up.
-b
Posted by Englishman006! on April 9, 2013, at 8:38:58
In reply to Re: My attempt to discontinue Lamictal = relapse. » SLS, posted by tensor on March 31, 2013, at 14:43:25
Hi Scott, I think tapering off of certain meds can end in failure simply because we don't give ourselves enough time to heal. I beleive it can take the body a long time to recalibrate once a medication has been discontinued. It may feel as though you are relapsing when really all that is going on is withdrawal. I remember weaning off Nardil fairly rapidly and feeling intense anxiety to the point that it became unbearable, this resulted in me taking a dose out of shear panic and to my surprise it settled me immediately. But I again abstained as I wanted to get a clean SPECT scan with no meds on board. I couldn't cope doing the simplest of tasks and this went on for 2 weeks. Then it was time for the scan but something remarkable happened.. I began to feel centered, a feeling deep in my gut, a calmness I hadn't felt in many years. My social anxiety lifted! I was meant to begin some new meds but I resisted as I didn't want to disturb the peaceful feeling I was beginning to experience. However, despite the relief from anxiety a depression descended that probably only lasted a couple of weeks but felt like years during which I panicked thinking I had damaged my brain with all the years of taking antidepressants. But once that passed I felt better than I ever had on in all the years of taking medication.
It taught me a lesson.. That sometimes we second guess ourselves. We come off meds only to relapse and quickly go running back to them. I think maybe we give uo too early. Maybe we should discipline ourselves to give our bodies time to heal and get over any rebound depression or anxiety that stopping the meds may have caused.
Just something to think about perhaps!
Posted by SLS on April 9, 2013, at 15:44:31
In reply to Re: My attempt to discontinue Lamictal = relapse., posted by Englishman006! on April 9, 2013, at 8:38:58
Hi.
> That sometimes we second guess ourselves. We come off meds only to relapse and quickly go running back to them. I think maybe we give uo too early. Maybe we should discipline ourselves to give our bodies time to heal and get over any rebound depression or anxiety that stopping the meds may have caused.
>
> Just something to think about perhaps!Excellent point. It surely is a guessing game.
After more than a week of suffering with depression without taking Lamictal, I decided to restart it and play out a hunch. Instead of returning to 200 mg/day, I continued to titrate up to 300 mg/day. For now, I feel better at the higher dosage, and am not suffering a dramatic worsening of cognitive side effects. Sometimes, it is hard to discern the difference between the cognitive impairments produced by the illness and those produced by the drug.
I hope that my treatment is finally optimized. I don't like being in a position of constantly needing to change drugs and dosages.
So...
The bottom line for today is that I have been feeling significantly better since increasing the dosage of Lamictal to 300 mg/day. I am not in remission, but I have been responding quite well for almost two weeks. This response pattern is atypical for me. Usually, I feel better for only 3 days before relapsing.
Currently:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 300 mg/day
lithium 450 mg/day
Abilify 10 mg/day
prazosin 10 mg/day
minocycline 200 mg/day
- Scott
This is the end of the thread.
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