Psycho-Babble Medication Thread 1094452

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Re: Can meds cause a sense of dread/doom/fear?

Posted by pedr on August 21, 2017, at 16:45:55

In reply to Re: Can meds cause a sense of dread/doom/fear?, posted by SLS on August 20, 2017, at 14:08:12

> Reboxetine made me suicidal with a sense of doom and anxiety. It dissipated within 48 hours of discontinuation.
>
>
> - Scott

me too. I had obsessive (like every few seconds) suicidal ideation 24x7 for a week, it was astonishing. Went away after I stopped it. Not the nicest experience ever.

 

Re: Can meds cause a sense of dread/doom/fear? » SLS

Posted by MightyKondrian on August 21, 2017, at 17:02:16

In reply to Re: Can meds cause a sense of dread/doom/fear? » porkpiehat, posted by SLS on August 18, 2017, at 0:11:11

> Nardil feels very much different than Parnate. In my experience, it is more of a mood brightener and can be pro-social. However, mania or hypomania may be a greater risk with Nardil, especially early in treatment. You might need to establish some type of anti-manic coverage, hopefully one that doesn't aggravate depression. Depakote can be a great anti-manic drug, but sometimes leaves one mildly to moderately depressed. Abilify can be a good choice to prevent mania, too. It can also produce some remarkable antidepressant effects when combined with an antidepressant. I know someone who actually did well combining Abilify with Lamictal. I take both drugs in addition to Parnate.
>
> Let me know what your thought are on these things.
>
>
> - Scott

I have an idea I might be BPII as well. Asked my doc last time. He simply replied "maybe, but I'm more concerned with what works for YOU rather than that diagnosis." Fair enough, but I want the diagnosis. It can help me with certain life situations (esp housing). Also should I more than likely need to see a new doc in the future they will most likely treat BPII 'their way'

80% of add-ons often do appear to work initially or within a couple of weeks but they mostly poop out quick-time.

I'm doing surprisingly well on 5mg Abilify right now and for the previous month. Still good day bad day tho. I may well benefit from a mood stabilizer like lamotrigine but I would be interested in adding lithium back in (from 3yrs ago). I've taken lithium on Marplan but never on Nardil.

Its hard making decision when on an MAOI. There are many combinations, but where I would need an MAOI washout before hand. Thats a big step. Last time I did it myself. In future I will ask for a hospital bed. Its hard, I can never take my emotions along to the docs. Usually I've been waiting so long I'm happy the day I see my pdoc or even GP. I think my doc knows this. See him again this coming Thursday.
Hate the way they send you back him just coz u dont say ur suicidal. But saying so you are handing over your rights so it seems.

 

Re: Can meds cause a sense of dread/doom/fear?

Posted by MightyKondrian on August 21, 2017, at 17:14:28

In reply to Re: Can meds cause a sense of dread/doom/fear? » SLS, posted by MightyKondrian on August 21, 2017, at 17:02:16

A few non-MAOI combos I've read that especially caught my eye are:
fluoxetine & lofepramine
moclobemide and escitalopram
venlafaxine and mirtazepine (rocket fuel)

Another I'd be willing to try is an SSRI (Id favour sertraline) and a noradrenergic like lofepramine or bupropion

All the above taken with a mood stabilizer. Most probably lithium.

 

oops wrong thread (nm)

Posted by MightyKondrian on August 21, 2017, at 17:18:47

In reply to Re: Can meds cause a sense of dread/doom/fear?, posted by MightyKondrian on August 21, 2017, at 17:14:28

 

Re: Can meds cause a sense of dread/doom/fear? » SLS

Posted by porkpiehat on August 23, 2017, at 13:38:11

In reply to Re: Can meds cause a sense of dread/doom/fear?, posted by SLS on August 20, 2017, at 14:08:12

I was reading another post and it made me realize that in this state I'm extremely sensitive to noises, like squeaks and rattles in my boat.

For fun this weekend I held off on Lamictal and parnate as long as I could. No rage, no paranoia. I started finding it tough doing simple muscle memory tasks (ordering a pizza, unstrapping my boat, approaching the dock) but I remember this happening If I go all day without lamictal or drop too low.

Eventually for safety sake I took lamictal and started getting angry and resentful with my nephew. I was seething with anger at the incompetence of my buddy. Took the parnate and then in turned to the weird fear and almost psychotic feeling of doom driving home.

Could the lamictal be boosting the dopamine somewhere and causing quasi-psychotic symptoms?

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on August 23, 2017, at 17:55:05

In reply to Re: Can meds cause a sense of dread/doom/fear? » SLS, posted by porkpiehat on August 23, 2017, at 13:38:11

> I was reading another post and it made me realize that in this state I'm extremely sensitive to noises, like squeaks and rattles in my boat.
>
> For fun this weekend I held off on Lamictal and parnate as long as I could. No rage, no paranoia. I started finding it tough doing simple muscle memory tasks (ordering a pizza, unstrapping my boat, approaching the dock) but I remember this happening If I go all day without lamictal or drop too low.
>
> Eventually for safety sake I took lamictal and started getting angry and resentful with my nephew. I was seething with anger at the incompetence of my buddy. Took the parnate and then in turned to the weird fear and almost psychotic feeling of doom driving home.
>
> Could the Lamictal be boosting the dopamine somewhere and causing quasi-psychotic symptoms?

Sorry I have no med suggestions but dont you think its obvious that you need to ditch the Parnate? The Lamictal too. All you say is bad things about both. Are you with a competent Dr?

Mighty-Mouse

 

Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian

Posted by porkpiehat on August 24, 2017, at 14:10:43

In reply to Re: Can meds cause a sense of dread/doom/fear? » porkpiehat, posted by MightyKondrian on August 23, 2017, at 17:55:05


>
> Sorry I have no med suggestions but dont you think its obvious that you need to ditch the Parnate? The Lamictal too. All you say is bad things about both. Are you with a competent Dr?
>
> Mighty-Mouse

That's complicated I probably noted some of the positives in my other posts. Trying everything to make it work before giving up on parnate.

For example, I feel great for an hour after I take the parnate, then exhausted and irritable for the rest of the day.

When I wake up (thanks trazodone) I am still technically "on parnate" and in a fair mood, and can function cognitively. Not suicidal or prone to moments of "hysteria." Social anxiety is improved, I just don't enjoy being around people anymore.

I could live with this part. It's the exhaustion, apathy, irritability that comes after dosing that is untenable.

And unfortunately I don't have a doctor right now. Still looking.

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on August 24, 2017, at 15:07:57

In reply to Re: Can meds cause a sense of dread/doom/fear? » SLS, posted by porkpiehat on August 23, 2017, at 13:38:11


> For fun this weekend I held off on Lamictal and parnate as long as I could. No rage, no paranoia. I started finding it tough doing simple muscle memory tasks (ordering a pizza, unstrapping my boat, approaching the dock) but I remember this happening If I go all day without lamictal or drop too low.
>
> Eventually for safety sake I took lamictal and started getting angry and resentful with my nephew. I was seething with anger at the incompetence of my buddy. Took the parnate and then in turned to the weird fear and almost psychotic feeling of doom driving home.
>
> Could the lamictal be boosting the dopamine somewhere and causing quasi-psychotic symptoms?

You say above that you got angry and resentful at your Nephew!!
Don't u think that's enough to take deep thought into changing your meds?

 

Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian

Posted by porkpiehat on August 24, 2017, at 18:42:21

In reply to Re: Can meds cause a sense of dread/doom/fear? » porkpiehat, posted by MightyKondrian on August 24, 2017, at 15:07:57

>
> > For fun this weekend I held off on Lamictal and parnate as long as I could. No rage, no paranoia. I started finding it tough doing simple muscle memory tasks (ordering a pizza, unstrapping my boat, approaching the dock) but I remember this happening If I go all day without lamictal or drop too low.
> >
> > Eventually for safety sake I took lamictal and started getting angry and resentful with my nephew. I was seething with anger at the incompetence of my buddy. Took the parnate and then in turned to the weird fear and almost psychotic feeling of doom driving home.
> >
> > Could the lamictal be boosting the dopamine somewhere and causing quasi-psychotic symptoms?
>
> You say above that you got angry and resentful at your Nephew!!
> Don't u think that's enough to take deep thought into changing your meds?

Yes. That's why I am here. I think about little else. Maybe that wasn't clear. Ive already found some ways to improve the situation: Trazodone helps with the sleep and, with gabapentin, eases the detachment and apathy for the first part of the day; alpha and beta blockers can help with the anxiety and anger at times.

So maybe there's a way to address the fear, sedation, and irritability without stopping parnate altogether. I was hoping someone would have an idea because prescribers have no experience with the MAOIs


 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by SLS on August 24, 2017, at 19:12:36

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by porkpiehat on August 24, 2017, at 18:42:21

You must really go through hell when you are without an effective treatment. You are willing to expose yourself to very harsh negative effects of the drugs you are taking. I'm sorry that things are so difficult for you right now.

What were your symptoms before treatment?

I guess the first question is why you are so committed to Parnate?

Why MAOIs?

Have you tried Nardil yet? My guess is that it is more pro-serotonergic than Parnate is. Could your positive response to trazodone reveal a role for serotonin?

Bipolar? Mixed-state? Schizoaffective?

Lamictal (lamotrigine) is not much good for mania or psychosis. Have you ever tried combining Abilify with an antidepressant?

Don't give up.


- Scott

 

I see (nm) » porkpiehat

Posted by MightyKondrian on August 26, 2017, at 19:28:14

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by porkpiehat on August 24, 2017, at 18:42:21

 

Re: Can meds cause a sense of dread/doom/fear? » SLS

Posted by MightyKondrian on August 26, 2017, at 19:36:15

In reply to Re: Can meds cause a sense of dread/doom/fear? » porkpiehat, posted by SLS on August 24, 2017, at 19:12:36

> You must really go through hell when you are without an effective treatment. You are willing to expose yourself to very harsh negative effects of the drugs you are taking. I'm sorry that things are so difficult for you right now.
>
> What were your symptoms before treatment?
>
> I guess the first question is why you are so committed to Parnate?
>
> Why MAOIs?
>
> Have you tried Nardil yet? My guess is that it is more pro-serotonergic than Parnate is. Could your positive response to trazodone reveal a role for serotonin?
>
> Bipolar? Mixed-state? Schizoaffective?
>
> Lamictal (lamotrigine) is not much good for mania or psychosis. Have you ever tried combining Abilify with an antidepressant?
>
> Don't give up.
>
>
> - Scott

He could try Marplan. Was on it roughly 12yrs. Never any deep depression, well non much anyway. Easy to ad stuff too. You could even keep ur other meds except Parnat. But done very carefully you can cross-taper. I did that when I switched back from Marplan. Just please tell a doc 1st. Even if you are gonna do it without help just let a qualified dr of what you are doing. If you like i can give yo rough guidance on how i switch but remember I've yet to try Parnate. This was coming off isocarboxazid.

good luck

Mighty

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on August 26, 2017, at 19:56:07

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by porkpiehat on August 24, 2017, at 18:42:21

Sorry porkpiehat, my last post was more for you.
Few things about Marp

No sleep attacks like Ive had off Nardil, No drowsiness somewhat motivating.
10-60 is the dose range from the manufacturer. I ended up taking 150mg still along with 4-5 other meds. All at once am.
it a hydrazine derivative too, like Nardil. Hydrazine anologues have shown to been found, in the past to be good mood brighteners for schizophrenia. I think its currently being tested for Parkinson's too. Maybe coz is has a particularly strong dopaminergic effect? I'm not sure.

Bad dreams? Trimipramine can really help, Has dream enhancing quality too, even producing lucid dreaming in some. Tho for 20% of others it can cause nightmare

How about Mirtazepine for sleep? Chill u out too. Mianserin is an older med but similar in structure Mianserin technically a tetracyclic AD

 

Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian

Posted by SLS on August 27, 2017, at 7:12:00

In reply to Re: Can meds cause a sense of dread/doom/fear? » porkpiehat, posted by MightyKondrian on August 26, 2017, at 19:56:07

I didn't stay with Marplan for very long. I experienced a partial response to it before I once again returned to my baseline depression. However, I did not explore higher dosages, and certainly not with the other drugs that I am now on. I'll keep Marplan in mind. Thanks.

I found Nardil to be much more of a mood-brightener than Parnate. Marplan probably is, too.


- Scott

 

Re: Can meds cause a sense of dread/doom/fear?

Posted by porkpiehat on August 28, 2017, at 13:04:39

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by SLS on August 27, 2017, at 7:12:00

I don't think I can get Marplan here in the US.

In switching from MAOI to MAOI do you do a full washout? I've read about people taking just a few days off at a lower dose before doing the Parnate<-->nardil thing.

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on August 31, 2017, at 0:56:27

In reply to Re: Can meds cause a sense of dread/doom/fear? » SLS, posted by porkpiehat on August 23, 2017, at 13:38:11

> I was reading another post and it made me realize that in this state I'm extremely sensitive to noises, like squeaks and rattles in my boat.
>
> For fun this weekend I held off on Lamictal and parnate as long as I could. No rage, no paranoia. I started finding it tough doing simple muscle memory tasks (ordering a pizza, unstrapping my boat, approaching the dock) but I remember this happening If I go all day without lamictal or drop too low.
>
> Eventually for safety sake I took lamictal and started getting angry and resentful with my nephew. I was seething with anger at the incompetence of my buddy. Took the parnate and then in turned to the weird fear and almost psychotic feeling of doom driving home.
>
> Could the lamictal be boosting the dopamine somewhere and causing quasi-psychotic symptoms?

I have an easy answer, just depends if you are up for it! EXERCISE! Many of your symptoms sound stress related, especially the temper and anger effects. I rarely go now but trust me it will do a whole lot o0f good. I have exercised and its always been a stress reliever.
You are probably thinking "lol yeah f*ck that but if so you are procrastinating and it a great way the break the cycle. I've used it many somes for that reason

Gawd all MightyKondria ;)

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on August 31, 2017, at 2:29:08

In reply to Re: Can meds cause a sense of dread/doom/fear?, posted by porkpiehat on August 28, 2017, at 13:04:39

> I don't think I can get Marplan here in the US.
>
> In switching from MAOI to MAOI do you do a full washout? I've read about people taking just a few days off at a lower dose before doing the Parnate<-->nardil thing.

The washout is really the patients decision. But you can cross taper especially in Marplan and Nardil's case. Just by a BP monitor, ask for some nifedipine but you probably wont need it.
And yes, Marplan is available in the US. https://en.wikipedia.org/wiki/Isocarboxazid

ALL-MightyKondria

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on September 2, 2017, at 15:09:04

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by porkpiehat on August 24, 2017, at 18:42:21

> So maybe there's a way to address the fear, sedation, and irritability without stopping parnate altogether. I was hoping someone would have an idea because prescribers have no experience with the MAOIs
>
>
>
ANIRACETAM. An analogue of the 1st discovered racetam Piracetam. It's a powerful nootropic which has both a calming effect yet gives a clear head too.
I would take either CDP Choline (citicoline) or Alpha GPC as a choline precursor rather than Choline bitartrate or DMAE as the later 2 or week, plus DMAE can worsen depression. I read that from several sources about DMAE worsening depression in bipolar patients but I'd stay clear from it anyway if you suffer any kinda depression. Without an acetylcholine precursor many nootropics can give side effects like headaches.

Centrophenoxine is another acetylcholine precursor related to DMAE (dimethylaminoethanol aka dimethylethanolamine) but without the warning.
You may like to experiment with other Racetam nootropics. They are potent and useful in the right hands but beware, some are stimulating and may aggravate you condition. Other calming nootropics, other than Racetams are plentiful and you will find that the online stores that sell them provide excellent info, with references to help you choose. Why not give 'em a go. Save money by buying a cheap set of digi scales off eBay for accurate weighing.

My pdoc knows I take them. And I take 120mg Nardil plus over 5 meds so I consider them safe.

https://www.nootropics.com/product/aniracetam/

https://thoughtfoods.com/powder-line/aniracetam-powder.html

https://www.intellimeds.net/aniracetam

Perhaps look for a forum that talks about nootropics, as nobody seems to mention them here.

Personally I take citicoline & Oxiracetam daily. I occasionally take Phenypiracetam or Pramiracetam, two of the most potent noots. Only when I'm procrastinating too much. They are strong, perhaps due to the MAOI. Be especially careful with Phenylpiracetam. Its a real psycho-stim. Again, maybe coz of the MAOI. Comparable to amphetamine, like taking PEA with an MAOI (not recommended!). Feels good though and I'm sure less dangerous.

OK no more nootropic talk. Why nobody here talks about them I dont know.

Mighty

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by MightyKondrian on September 2, 2017, at 16:55:19

In reply to Re: Can meds cause a sense of dread/doom/fear?, posted by porkpiehat on August 28, 2017, at 13:04:39

And quit the caffeine!! (if you take it). Remember its in chocolate, green tea and cola. To wean yourself off you can use guarana, which contains caffeine but works more slowly making withdrawal easier. I found Siberian Ginseng helpful too. Caffeine takes up to 10 days to withdraw.
As far as pain killers go read the label! Many add caffeine - out of the pan into the fire! And forget aspirin. Best most potent OTC remedy is ONE 500mg paracetamol + ONE 200mg Ibuprofen. A trick given to me by a dentist lol. Take AFTER a meal and dont exceed 4 times daily.
Just wanted to throw that in.

A mildly 'motivating' noot might be worth a try. Oxiracetam (which I use) is mildly stimulating, and so are a number of noots. Stay away from the 2 I mentioned in the above post though. Switching from one stim to another aint the answer!
I swear caffeine cause Nardil poop-out last time. I ended up on night shifts and drank over 2 litres of red bull strength caffeine 5 day a week.
so if you are plunging heaps of caffeine down your neck to medicate the lethargy its only gonna get worse.

In 2003 I stopped caffeine and started Nardil. Thats when I felt my best ever. Even moods were the best part! Then I ruined it Switched to Marplan, an excellent med but could never kick the caffeine. And caffeine is a B*TCH! Anyone thinking its a benign drug, try quitting, and if you pull through watch you moods blow the roof! Yes I'm still addicted.

 

Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian

Posted by SLS on September 4, 2017, at 18:02:46

In reply to Re: Can meds cause a sense of dread/doom/fear? » porkpiehat, posted by MightyKondrian on September 2, 2017, at 15:09:04

Don't neglect the Alternative forum. You might consider reposting your information and recommendations there.


- Scott

> > So maybe there's a way to address the fear, sedation, and irritability without stopping parnate altogether. I was hoping someone would have an idea because prescribers have no experience with the MAOIs
> >
> >
> >
> ANIRACETAM. An analogue of the 1st discovered racetam Piracetam. It's a powerful nootropic which has both a calming effect yet gives a clear head too.
> I would take either CDP Choline (citicoline) or Alpha GPC as a choline precursor rather than Choline bitartrate or DMAE as the later 2 or week, plus DMAE can worsen depression. I read that from several sources about DMAE worsening depression in bipolar patients but I'd stay clear from it anyway if you suffer any kinda depression. Without an acetylcholine precursor many nootropics can give side effects like headaches.
>
> Centrophenoxine is another acetylcholine precursor related to DMAE (dimethylaminoethanol aka dimethylethanolamine) but without the warning.
> You may like to experiment with other Racetam nootropics. They are potent and useful in the right hands but beware, some are stimulating and may aggravate you condition. Other calming nootropics, other than Racetams are plentiful and you will find that the online stores that sell them provide excellent info, with references to help you choose. Why not give 'em a go. Save money by buying a cheap set of digi scales off eBay for accurate weighing.
>
> My pdoc knows I take them. And I take 120mg Nardil plus over 5 meds so I consider them safe.
>
> https://www.nootropics.com/product/aniracetam/
>
> https://thoughtfoods.com/powder-line/aniracetam-powder.html
>
> https://www.intellimeds.net/aniracetam
>
> Perhaps look for a forum that talks about nootropics, as nobody seems to mention them here.
>
> Personally I take citicoline & Oxiracetam daily. I occasionally take Phenypiracetam or Pramiracetam, two of the most potent noots. Only when I'm procrastinating too much. They are strong, perhaps due to the MAOI. Be especially careful with Phenylpiracetam. Its a real psycho-stim. Again, maybe coz of the MAOI. Comparable to amphetamine, like taking PEA with an MAOI (not recommended!). Feels good though and I'm sure less dangerous.
>
> OK no more nootropic talk. Why nobody here talks about them I dont know.
>
> Mighty

 

Re: Can meds cause a sense of dread/doom/fear? » SLS

Posted by MightyKondrian on September 8, 2017, at 16:23:17

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by SLS on September 4, 2017, at 18:02:46

> Don't neglect the Alternative forum. You might consider reposting your information and recommendations there.
>
>
> - Scott


Interesting what you say there. Many noots are indeed 'alternatives'. But many would definitely be be classed as drugs. Like nicotine, caffeine, NRIs, Modafinil, amphetamines & Racetams (most popular one being Piracetam used primarily for Alzheimer's and some of its analogues used in different countries to treat similar disorders. Many have be synthesized and used in Russia).
Kind of fits into both categories. Basically anything that increases memory ability, focus and speed of thought. Many via the neurotransmitter acetylcholine and sometimes GABA too.

 

Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian

Posted by Porkpiehat on October 11, 2017, at 14:04:24

In reply to Re: Can meds cause a sense of dread/doom/fear? » SLS, posted by MightyKondrian on September 8, 2017, at 16:23:17

Out of curiosity, what is wrong with caffeine and MAOI? If I'm sleeping ok with the trazodone and all

 

Re: Can meds cause a sense of dread/doom/fear? » Porkpiehat

Posted by MightyKondrian on October 11, 2017, at 16:47:43

In reply to Re: Can meds cause a sense of dread/doom/fear? » MightyKondrian, posted by Porkpiehat on October 11, 2017, at 14:04:24

> Out of curiosity, what is wrong with caffeine and MAOI? If I'm sleeping ok with the trazodone and all

LOL caffeine wrecks energy levels. Go one week without it. Then you will feel how it is not 'benign'. You will get headaches, lethargy & somnolence/hypersomnia. After a week off it drink a coffee. You will be buzzin'!
Its an energy stealer. And people drink it every day. Crazy! Should be used PRN IMHO.

Cod oh Mighty!

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by SLS on October 13, 2017, at 7:51:14

In reply to Can meds cause a sense of dread/doom/fear?, posted by porkpiehat on August 16, 2017, at 14:51:19

> Can meds cause a sense of dread/doom/fear?

I forgot to answer you initial question.

Yes. Medications do have the potential to cause the phenomena you listed. They can also pile on profound suicidality. Several drugs have done this to me. I think reboxetine was the worst. However, protriptyline wasn't much fun either. What hell to have to endure. I have had other drugs do more harm than good, but not with the dread/doom/fear you speak of. In my experience, no drug that caused a significant worsening of my condition early in treatment later went on to produce an improvement. That's just me.


- Scott

 

Re: Can meds cause a sense of dread/doom/fear? » porkpiehat

Posted by phidippus on November 25, 2017, at 12:02:41

In reply to Can meds cause a sense of dread/doom/fear?, posted by porkpiehat on August 16, 2017, at 14:51:19

Studies show that Lamictal can cause obessive anxiety in patients who are bipolar.

Eric


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