Psycho-Babble Medication Thread 1095357

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Quick question on possible adjunct

Posted by beckett2 on October 9, 2017, at 16:52:50

I see my doctor tomorrow and want to take in treatment options for discussion. Would anyone suggest increasing lamotrigine? If so, how long would an increase take to be noticed?

Currently,

Trintellix 20 mg
lamotrigine 250 mg
lyrica 200-400 mg


I've been relatively well, but with the season change feel increased emotional lability, sadness and rumination. I'm treating BPll rapid cycling and GAD.

Thanks.

 

Re: Quick question on possible adjunct

Posted by linkadge on October 10, 2017, at 15:19:21

In reply to Quick question on possible adjunct, posted by beckett2 on October 9, 2017, at 16:52:50

>emotional lability, sadness and rumination.

I only have personal experience with lower doses of lamotrigine. Sadness and rumination sound like symptoms that would respond to more antidepressant. However, I think 20mg is the upper end of the dose for that medication.

Not sure what to suggest. Does the trintellix agree with you overall?

Omega 3 can be useful for bipolar II (if you're not already taking it).

Linkadge

 

Re: Quick question on possible adjunct linkadge

Posted by beckett2 on October 10, 2017, at 16:45:11

In reply to Re: Quick question on possible adjunct, posted by linkadge on October 10, 2017, at 15:19:21

Thanks Link, Rather than change any meds, my doc sent in a genetic test for me today. I agree an increase in Trintellix may be too much. It does agree with me-- best AD in years.

I haven't taken omega 3. Could you suggest a starting dose?

 

Re: Quick question on possible adjunct beckett2

Posted by SLS on October 10, 2017, at 20:04:24

In reply to Re: Quick question on possible adjunct linkadge, posted by beckett2 on October 10, 2017, at 16:45:11

Hi, Beckett2.

What are the details of the genetic testing? How will the results be used?

Do you find that Trintellix produces a noticeable improvement in clarity of thought?

Have you considered intranasal ketamine? It works very well for people who have the val66val allele of the BDNF gene.

Good luck!


- Scott

 

Re: Quick question on possible adjunct SLS

Posted by beckett2 on October 10, 2017, at 21:10:35

In reply to Re: Quick question on possible adjunct beckett2, posted by SLS on October 10, 2017, at 20:04:24

> Hi, Beckett2.
>
> What are the details of the genetic testing? How will the results be used?
>
> Do you find that Trintellix produces a noticeable improvement in clarity of thought?
>
> Have you considered intranasal ketamine? It works very well for people who have the val66val allele of the BDNF gene.
>
> Good luck!
>
>
> - Scott

This is above my pay grade. I think for MTHFR and psychiatric medications. My doctor is a real geek-- he can ramble on about chemistry, which I find a little endearing. I'll keep you posted.

Ketamine I've only read a little about here. Frankly, I cannot imagine not being depressed. The idea actually scares me which is kinda sad.

Regarding Trintellix, there was a near immediate positive effect when I transitioned from lexapro-- but I think lexapro has a baffling effect in general, so that might be some of it, idk.

 

Re: Quick question on possible adjunct beckett2

Posted by porkpiehat on October 10, 2017, at 21:17:48

In reply to Re: Quick question on possible adjunct SLS, posted by beckett2 on October 10, 2017, at 21:10:35

> > Hi, Beckett2.
> >
> > What are the details of the genetic testing? How will the results be used?
> >
> > Do you find that Trintellix produces a noticeable improvement in clarity of thought?
> >
> > Have you considered intranasal ketamine? It works very well for people who have the val66val allele of the BDNF gene.
> >
> > Good luck!
> >
> >
> > - Scott
>
> This is above my pay grade. I think for MTHFR and psychiatric medications. My doctor is a real geek-- he can ramble on about chemistry, which I find a little endearing. I'll keep you posted.
>
> Ketamine I've only read a little about here. Frankly, I cannot imagine not being depressed. The idea actually scares me which is kinda sad.
>
> Regarding Trintellix, there was a near immediate positive effect when I transitioned from lexapro-- but I think lexapro has a baffling effect in general, so that might be some of it, idk.
>
>
It's entirely possible that the depression is the tail end of the lexapro exiting your system. I felt great when I added Brintellix to celexa, but things dropped after I tapered on the celexa.

I have always found a fairly quick, robust reaction when I raised my lamictal...however, for me it responds very differently depending on what I'm taking with it...serotonergics and wellbutrin in particular. So the good news is you could increase your lamictal and know fairly soon if it is a good solution.

Hope that helps.

 

Re: Quick question on possible adjunct

Posted by Christ_empowered on October 11, 2017, at 8:47:16

In reply to Quick question on possible adjunct, posted by beckett2 on October 9, 2017, at 16:52:50

hi. sorry things are rough for you right now. on the plus side, it seems that you're responding well to the selected psych drugs, and you have a thoughtful doctor.

i think supplementation could be helpful, also. personally, i do (fairly high dose) Orthomolecular. Not for everyone, clearly, but since I'm stuck on an "atypical" tranquilizer, those high dose vitamins, minerals, etc. do seem to help me tolerate the psych drugs and "get more mileage" out of treatment.

can you tolerate any tranquilizers? Since you're already on Lyrica and lamictal, plus a full dose antidepressant, my first thought was a small(ish) dose of some sort of tranquilizer, perhaps just on an as-needed/PRN basis.

just...based on my own personal experiences w/ "atypical" tranquilizers, I'd think about a low-to-moderate dose of Abilify or a comparable dose of risperidone, possibly just as needed.

with abilify, you'd run a higher risk on akathisia, which...is.not.fun. On the other hand, if it works w/o akathisia, its one of the "cleaner" options.

risperidone is more sedating and (personally...) I found it more mind-numbing, but that was at a full dose (4mgs). very low doses have been used to boost antidepressants, with good results for many people.

with the older tranquilizers, I would think a (very) low dose of perphenazine or perhaps loxapine might "get the job done," too, w/ a different adverse effect profile.

hope this helps.

 

Re: Quick question on possible adjunct porkpiehat

Posted by beckett2 on October 11, 2017, at 16:13:02

In reply to Re: Quick question on possible adjunct beckett2, posted by porkpiehat on October 10, 2017, at 21:17:48

This is good to know, that you've felt a quick response to a bump in lamotrigine. That was what I had in my back pocket. Thanks.

 

Re: Quick question on possible adjunct Christ_empowered

Posted by beckett2 on October 11, 2017, at 16:26:21

In reply to Re: Quick question on possible adjunct, posted by Christ_empowered on October 11, 2017, at 8:47:16

> hi. sorry things are rough for you right now. on the plus side, it seems that you're responding well to the selected psych drugs, and you have a thoughtful doctor.
>
> i think supplementation could be helpful, also. personally, i do (fairly high dose) Orthomolecular. Not for everyone, clearly, but since I'm stuck on an "atypical" tranquilizer, those high dose vitamins, minerals, etc. do seem to help me tolerate the psych drugs and "get more mileage" out of treatment.
>
> can you tolerate any tranquilizers? Since you're already on Lyrica and lamictal, plus a full dose antidepressant, my first thought was a small(ish) dose of some sort of tranquilizer, perhaps just on an as-needed/PRN basis.
>
> just...based on my own personal experiences w/ "atypical" tranquilizers, I'd think about a low-to-moderate dose of Abilify or a comparable dose of risperidone, possibly just as needed.
>
> with abilify, you'd run a higher risk on akathisia, which...is.not.fun. On the other hand, if it works w/o akathisia, its one of the "cleaner" options.
>
> risperidone is more sedating and (personally...) I found it more mind-numbing, but that was at a full dose (4mgs). very low doses have been used to boost antidepressants, with good results for many people.
>
> with the older tranquilizers, I would think a (very) low dose of perphenazine or perhaps loxapine might "get the job done," too, w/ a different adverse effect profile.
>
> hope this helps.

Hi, nice to see you. I take a high vit D and a sublingual b12 atm. Then there is NAD that I've ordered but haven't tried yet. I don't know if that will help. And I've started drinking kefir again. I think you're right about exploring supplements. Thanks

 

Re: Quick question on possible adjunct

Posted by linkadge on October 11, 2017, at 19:41:08

In reply to Re: Quick question on possible adjunct linkadge, posted by beckett2 on October 10, 2017, at 16:45:11

Yeah, a dose of about 500mg of EPA and 500mg of DHA would be a good place to start.

Most products contain both EPA and DHA. EPA might have a slightly more antidepressant effect, whereas DHA is perhaps more stabilizing.

Many products contain slightly more EPA (EPA:DHA = 3:2).

However, something around 500mg + 500mg (EPA + DHA) of each would be a good place to start. It doesn't matter if you get a bit more of one or the other.

If you tolerate it well, you could easily triple this.

It mixes well with many psychiatric medications. It does have a slight blood thinning effect, so just watch your intake of other blood thinners like aspirin.

I find it very good at helping slow cycling, racing thoughts and anhedonia.

Linkadge

 

Re: Quick question on possible adjunct

Posted by linkadge on October 11, 2017, at 19:47:15

In reply to Re: Quick question on possible adjunct Christ_empowered, posted by beckett2 on October 11, 2017, at 16:26:21

I'm not sure if you're a coffee drinker, but my depression would be much worse without 1-2 cups of coffee a day.

I also drink pure organic cocoa powder (2-3 tsp a day). I find this great for anhedonia. However, you've got to watch this, if insomnia is an issue.

Some of my main adjuncts are...

coffee, cocoa, green tea, ginger root, omega-3, folic acid, magnesium + niacin

coffee, cocoa, and green tea have substances in them which act as MAOIs. Cocoa is more selective towards MAOb.


Linkadge

 

Re: Quick question on possible adjunct

Posted by Christ_empowered on October 12, 2017, at 8:33:51

In reply to Re: Quick question on possible adjunct Christ_empowered, posted by beckett2 on October 11, 2017, at 16:26:21

hi. l-theanine (I go for the Suntheanine brand, since they claim to do quality control...) has helped me with some of the things you've described. Of course, I'm on psych drugs and I've cobbled together a DIY Orthomolecular protocol.

Suntheanine should be taken on an empty stomach, for best results. Personally, I've found about 600mgs in an AM dose benefits my mood, lowers anxiety a bit, and just makes things "better," all around. If I remember correctly, the going "upper-limit" for l-theanine is 1200mgs/day.

taurine helps some people. there have been a couple very small studies using 4mgs/day w/ "atypical" tranquilizers, for psychosis. Good results, apparently. I think its works on GABA receptors and also has some "side benefits," such as potential cardiovascular benefits.

everyone is different, but personally...I've found that time release b complex tablets help me a good bit. The ones I get are either b-50 or b-100. I take a couple in the AM w/food, a couple more in the evening w/ food. the only thing I do not like about these tablets is that they clearly skimp on biotin :-( .

vitamin C is fairly standard for everyone, no matter the "issues" at work. I'm into Orthomolecular, so I'm now on what many would consider a "mega-dose" (30 grams daily). I use time release tablets and divide the dose into 1 AM dose and 1 PM dose, usually w/ food.

niacinamide has helped me, too. Some people go for good ole niacin, but I didn't want to deal with the flush and gradual dosage titration, so I've always taken the niacinamide version of B3. I take 3 grams (time release) in the AM, another 3 grams in the PM, plus what I get from the b-complex tablets.

a lot of people do not get sufficient vitamin E. I take an "atypical" tranquilizer, so I've decided to go for a somewhat high dose (1,000 IU) of the natural form vitamin E w/mixed tocopherols. Vitamin E is fat soluble, so its best to take it w/ a meal containing a good bit of fat.

Adding some minerals has helped me, too. I take a good bit of selenium and a capsule w/ "OptiZinc" and some copper in each pill. I have a liquid trace mineral supplement I'll soon start taking, just to make sure I'm covering all my bases.

NAC has been used to help people w/ diagnoses of Bipolar I and I think Schizophrenia who are on psych drugs. Its an amino acid, so its probably best to take it on an empty stomach. If I remember correctly, it can take months to see major improvements.

I hope this helps. :-)

 

Re: Quick question on possible adjunct

Posted by beckett2 on October 13, 2017, at 13:02:30

In reply to Quick question on possible adjunct, posted by beckett2 on October 9, 2017, at 16:52:50

Thanks everyone for your input. I really appreciate it. If something interesting comes of my genetic testing, I'll update.

 

Re: Quick question on possible adjunct

Posted by phidippus on October 15, 2017, at 8:48:23

In reply to Quick question on possible adjunct, posted by beckett2 on October 9, 2017, at 16:52:50

Honestly, you're pretty much at the highest dose most doctors recommend for lamotragine. I don't think 50 more mg is going to be noticeable. You can try raising the Lyrica as it is anti-glutamtergic. As you know, anti-glutamatergic drugs can decrease depression and anxiety.

I would max out all your drugs and see if that is effective. Trintellix to 30 mg, Lamotrogine to 300 mg and Lyrica to 600 mg.

Eric

 

Re: Quick question on possible adjunct phidippus

Posted by beckett2 on October 15, 2017, at 20:22:15

In reply to Re: Quick question on possible adjunct, posted by phidippus on October 15, 2017, at 8:48:23

Thanks Eric. 30 mgs might cause my head to explode-- or just feel like it. We'll see what the doc says in two weeks. Atm, walking, lightbox and reviewing supplements

Lyrica leaves me a doofus. Maybe there is another anti-glutamatergic.

> Honestly, you're pretty much at the highest dose most doctors recommend for lamotragine. I don't think 50 more mg is going to be noticeable. You can try raising the Lyrica as it is anti-glutamtergic. As you know, anti-glutamatergic drugs can decrease depression and anxiety.
>
> I would max out all your drugs and see if that is effective. Trintellix to 30 mg, Lamotrogine to 300 mg and Lyrica to 600 mg.
>
> Eric

 

Re: Quick question on possible adjunct linkadge

Posted by beckett2 on October 15, 2017, at 20:25:05

In reply to Re: Quick question on possible adjunct, posted by linkadge on October 11, 2017, at 19:47:15

> I'm not sure if you're a coffee drinker, but my depression would be much worse without 1-2 cups of coffee a day.
>
> I also drink pure organic cocoa powder (2-3 tsp a day). I find this great for anhedonia. However, you've got to watch this, if insomnia is an issue.
>
> Some of my main adjuncts are...
>
> coffee, cocoa, green tea, ginger root, omega-3, folic acid, magnesium + niacin
>
> coffee, cocoa, and green tea have substances in them which act as MAOIs. Cocoa is more selective towards MAOb.
>
>
> Linkadge
>
>

Agreed on coffee. One cup is a must. About cocoa, I didn't realize the effect on MAOIb. Maybe that's why I wasn't able to have chocolate on Emsam. That's not the issue now.

Matcha is delicious.

Thanks for all your help.

 

Re: Quick question on possible adjunct beckett2

Posted by phidippus on October 15, 2017, at 21:57:44

In reply to Re: Quick question on possible adjunct phidippus, posted by beckett2 on October 15, 2017, at 20:22:15

You can actually go up to 400 mg on the lamotrogine...

Topomax is anti-glutamatergic, so is Riluzole. I like Riluzole a lot.

Eric

 

Re: Quick question on possible adjunct phidippus

Posted by SLS on October 16, 2017, at 10:01:49

In reply to Re: Quick question on possible adjunct beckett2, posted by phidippus on October 15, 2017, at 21:57:44

> You can actually go up to 400 mg on the lamotrogine...
>
> Topomax is anti-glutamatergic, so is Riluzole. I like Riluzole a lot.
>
> Eric

I tried riluzole quite awhile ago. Unfortunately, it was inert.


- Scott


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