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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 porkpiehat on July 19, 2016, at 23:22:42
visited a new pdoc yesterday after ending SSRIs in feb. I have been extremely dysthymic, unmotivated and socially anxious/ruminous since feb. Interestingly I have felt very nice and "still" inside, as well as emotionally vulnerable instead of blocked, which is a relief after 15 years on SSRI and lamictal.
She insisted I go up to 200mg of lamictal from 150mg even though I said it gives me headaches, flu symptoms, sleep problems and possibly mixed symptoms.
This morning I took my full 150 dose instead of splitting and BAM. Hyper and racy. Lots of sex drive but also agitated and irritable. The aggitation got worse as the day continued, even after food. The flueyness is totally gone, but it took a little bit of klonopin and two beers to not feel like I wanted to jump out of my skin and dropkick my cat across the room.
Certainly not depressed, however, and I focused on homework I have been constantly dropping in favor of TV. I feel a little like I'm back on track, and I have felt like this before.
I emailed the doctor, who said I should push through it unless I felt suicidal or dangerous.
Can lamictal cause this kind of aggitation without it being a mixed state? We know they exist. This reaction is definitely more likely with the brand name or Teva pill, whereas the others are more likely to leave me more still and depressed.
I dunno this feels good but not right, and I'm not committing to her as a doctor yet.
Posted by PeterMartin on July 20, 2016, at 2:32:48
In reply to lamictal aggitation vs. mixed mania?, posted by porkpiehat on July 19, 2016, at 23:22:42
I get irritable for 2 or 3 days after increasing Lamictal. After I usually feel a lot better though. I actually just increased from 200 to 250 today and I've been a bit grumpy. I'm not worried though.
I'd give it a few days and see if it goes away. I've read about it here as well and it almost always does. The bigger issue to look out for is cognitive stuff...like I start to type a lot of emails with words missing once I got to 200mg. For me though the mood benefits outweigh some minor issues like that....
Posted by Horse on July 20, 2016, at 13:45:11
In reply to lamictal aggitation vs. mixed mania?, posted by porkpiehat on July 19, 2016, at 23:22:42
I felt that way the first time I took it. Really awful. I discontinued, and a few years later restarted, and now I'm fine, eventually at 250 mg.
So does the 150 mg split feel okay, and may I ask when you started lamictal?
But I'm not saying push through this way. Feels awful!
Posted by Porkpiehat on July 20, 2016, at 14:03:44
In reply to Re: lamictal aggitation vs. mixed mania? » porkpiehat, posted by Horse on July 20, 2016, at 13:45:11
My god it was awful this morning too. Actually felt a little better as the dose kicked in. I also took an amount of klonopin which would normally put me on my *ss and I'm able to keep it together.
I don't have a proper BP II diagnosis so it's shocking to me to feel like my old, motivated, friendly self and realize that state of being might be manic. For the last 5 months I've been avoiding, shamed, living on tv, and directionless, plus having some serious "weird episodes" that may be depersonalizations or panic attacks but I felt like I was losing touch with reality. APs made it worse.
I'm willing to up the klonopin if this is transitory but not if it is simply putting me in a constant hypo mania
Posted by baseball55 on July 20, 2016, at 20:02:53
In reply to Re: lamictal aggitation vs. mixed mania? » Horse, posted by Porkpiehat on July 20, 2016, at 14:03:44
Why do you think feeling motivated and friendly is hypomania, rather than just a normal feeling state that most non-depressed people feel all the time?
> I don't have a proper BP II diagnosis so it's shocking to me to feel like my old, motivated, friendly self and realize that state of being might be manic. For the last 5 months I've been avoiding, shamed, living on tv, and directionless, plus having some serious "weird episodes" that may be depersonalizations or panic attacks but I felt like I was losing touch with reality. APs made it worse.
>
> I'm willing to up the klonopin if this is transitory but not if it is simply putting me in a constant hypo mania
Posted by porkpiehat on July 21, 2016, at 13:22:24
In reply to Re: lamictal aggitation vs. mixed mania? » Horse, posted by Porkpiehat on July 20, 2016, at 14:03:44
baseball I think that is an oversimplification. I feel there is a difference between envisioning a future, having motivation and deriving satisfaction from accomplishments (good) and having these ramped up to 15 on a scale of 10; and having an uncontrollable feeling of hyperactivity and anger under your skin. That is what I am feeling now.
Previously on just the generic lamictal in split doses I felt calm and started to experience emotional openness, but with no drive or desire to visit people, take care of myself, or advance my career or pursue hobbies. Boy was the stillness good though
Posted by porkpiehat on July 21, 2016, at 13:55:17
In reply to Re: lamictal aggitation vs. mixed mania? » Porkpiehat, posted by porkpiehat on July 21, 2016, at 13:22:24
I am on day four of 150mgs brand lamictal formulation and I have accomplished more than I have in four weeks but I am also crawling out of my skin and trying to control my rage. the Klonopin isn't really helping.
I took 25mgs of my generic lamictal last night and it restored calm and I could sleep. Doctor isn't returning calls. If another pdoc tells me this isn't or shouldn't be happening someone is going to get hurt.
Posted by Horse on July 22, 2016, at 10:53:17
In reply to THIS FEELS SO GOOD/AWFUL NO ONE CAN HELP!, posted by porkpiehat on July 21, 2016, at 13:55:17
Stop the brand Lamictal. Return to generic. Feel better.
Posted by porkpiehat on July 22, 2016, at 11:26:51
In reply to THIS FEELS SO GOOD/AWFUL NO ONE CAN HELP!, posted by porkpiehat on July 21, 2016, at 13:55:17
Doc said hypomania add lithium at a low dose. Going back to the generic lamictal would leave my depression unaddressed.
Posted by SLS on July 22, 2016, at 16:02:54
In reply to lithium » porkpiehat, posted by porkpiehat on July 22, 2016, at 11:26:51
> Doc said hypomania add lithium at a low dose. Going back to the generic lamictal would leave my depression unaddressed.
1. Low-dosage lithium (300 mg/day) might not be enough to control mania. My guess is that it will take 900 mg/day to do it. So, that lithium doesn't help control mania at low dosages does not mean that it will not work at high dosages.
2. I happen to like the combination of Lamictal and Trileptal (oxcarbazine) in your situation based upon things I have read and having seen a few people do well on it for its anti-manic and mood-stabilization properties. I have tried Trileptal. It is a very clean drug with respect to side effects. It didn't help my depression, but I wouldn't pass this drug over for treating your hypomania. The only side effect that should be monitored for is the development of hyponatremia - low blood sodium. If Trileptal works well to address your mania, then any reduction in the sodium levels in your body can be corrected using water restriction, increased salt intake, or low dosages of diuretics.
3. There's Depakote, but you would have to reduce your dosage of Lamictal by 50% to compensate for the interaction between the two drugs. Depakote hinders the body's ability to eliminate Lamictal. I think glucuronidation is involved here. Depakote can cause weight-gain and minor depression. I have no statistics to characterize the incidence of these things happening. Personally, I find that Depakote takes care of my mania within hours. Lithium does not reduce my mania, regardless of dosage. The key to getting an immediate response to Depakote is to begin treatment using loading-doses. However, it doesn't sound like there is enough urgency in your condition to do this. My guess is that the average dosage necessary to treat mania or hypomania is 1000-1500 mg/day. There is great variability, with people doing well at dosages of 750-2000 mg/day. I'm pretty sure that there are blood tests that can be used as guidelines.
4. Zyprexa (olanzapine) can be used acutely if immediate relief is necessary. You might not ever need to use it, but it is good to know that this antipsychotic drug can squash mania in 12 hours at a dosage of 5 mg/day.
I hope you find an answer soon.
- Scott
Posted by porkpiehat on July 23, 2016, at 9:09:43
In reply to Re: lithium » porkpiehat, posted by SLS on July 22, 2016, at 16:02:54
Thanks Scott:
I'm on day two of 150mgs. Yesterday waking up was easy and my morning hyperactive state from the lamictal seemed blunted. I felt a little blunted in general but not awful.
Felt pretty tired but functional. The irritabilty crept through in the afternoon but not as explosively as prior days. I also didn't feel my typical avoidant tendancies for responsibility and willfully worked out in between clients and groomed myself properly!I'm hoping the hypomanic reaction abates over time. I really wonder about an allergic reaction to this lamictal brand. Other side effects include headache, flu/headcold symptoms/sore throat, and heart palpitations.
Posted by SLS on July 23, 2016, at 9:43:17
In reply to Re: lithium » SLS, posted by porkpiehat on July 23, 2016, at 9:09:43
> Thanks Scott:
>
> I'm on day two of 150mgs. Yesterday waking up was easy and my morning hyperactive state from the lamictal seemed blunted. I felt a little blunted in general but not awful.
> Felt pretty tired but functional. The irritabilty crept through in the afternoon but not as explosively as prior days. I also didn't feel my typical avoidant tendancies for responsibility and willfully worked out in between clients and groomed myself properly!That is very encouraging.
- Scott
Posted by porkpiehat on July 23, 2016, at 9:59:36
In reply to Re: lithium » porkpiehat, posted by SLS on July 23, 2016, at 9:43:17
If last week's symptoms were truly a mixed state, wouldn't the state continue instead of building up every morning and then exploding in the afternoon?
Posted by SLS on July 23, 2016, at 11:00:27
In reply to Re: lithium » SLS, posted by porkpiehat on July 23, 2016, at 9:09:43
I forgot to ask you more about why you were diagnosed as having hypomania. It is possible that you were simply agitated by Lamictal rather than your being in a mixed-state state hypomania. The reason differenting the two is important is that you might not need higher dosages of lithium as I suggested. You might do very well at 300 mg/day for the depressive symptoms of unipolar depression. Many clinical researchers seem to like the lamotrigine + lithium combination for bipolar depression.
If depression persists with your current treatment regime, you can try adding Wellbutrin, perhaps at low dosages. Wellbutrin shouldn't blunt your emotions, and can help with mood and energy. Some people do experience agitation, anxiety, and anger with Wellbutrin, though. Low-dose buspirone might also be helpful. Besides acting as an augmenter in treating bipolar depression, it can also reduce anxiety and perhaps agitation as well.
Good luck.
:-)
- Scott
Posted by SLS on July 23, 2016, at 11:03:44
In reply to Re: lithium » SLS, posted by porkpiehat on July 23, 2016, at 9:59:36
> If last week's symptoms were truly a mixed state, wouldn't the state continue instead of building up every morning and then exploding in the afternoon?
That is a great question. I don't know. Perhaps this is an indication that taking melatonin would help.
Is it possible that you were experiencing withdrawal effects from discontinuing the SRI?
- Scott
Posted by porkpiehat on July 23, 2016, at 11:22:54
In reply to Re: lithium » porkpiehat, posted by SLS on July 23, 2016, at 11:00:27
I pretty much told them I was feeling manic and my doc agreed based upon description of symptoms. The teva lamictal seems to be handling the depression and social symptoms.
Before switching Lamictal brands I was taking WB also. It gave me some motivation but was ramping up irritability. When I increased the lamictal to control the irritability it knocked me out cognitively and energy wise for hours. Couldn't really eek out a proper thought.
Day two of teva lamictal/ 150 mgs lithium mood and social is good, but I am a little sedated. Keep forgetting things like phone keys, food at take out window.
Buspar actually works well for about a week and then I'm filled with seething anger. Worst I've had.
My theory is that this is all trauma based and that I start to feel better or my anxiety is stripped away, leaving whatever part of my personality that is angry/defensive.
This is the end of the thread.
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