Posted by JohnX2 on January 21, 2002, at 15:17:44
In reply to Re: Mood-reactivity in atypical depression. » JohnX2, posted by SLS on January 21, 2002, at 14:12:53
Hi Scott,Here is what is amazing about my reaction
to the cognitive side effects to Topamax:
ALMOST NONE!The 1st day the doctor gave it to me I took 25 mg.
He gave me another 25 mg but was afraid it may
make me drowsy. It didn't make me drowsy. It did
immediately fix any residual myofacial pain in a
manner identical to klonopin.We quickly bumped the dose to 200 mg. No dizziness,
blurred vision, stupor, etc. Just typical benzo
like side effects. I can't explain this phenomina.
Topamax works on glutamate at the AMPA receptor
and GABA at the GABA(A) receptor. But I seemed to
be getting side effects consistent only with
increased conductance at the GabaA receptor and
not goofing with the glutamate (which is where the
major cognitive crap comes in, I believe). So for
me Topamax acts more like a benzo than a
bad anti-convulsant. My doctor was really shocked
too, and we pumped up the dose really fast with
no difficulty.I asked people on this group if they tried Topamax
as an ADD-ON to Lamictal, and it seems as though
I am a guinea pig. So I know that Topamax is mediating
the AMPA glutamate receptors and these cascade intot
the NMDA glutamate receptors that Lamictal work
on and I'm wondering if the Lamictal sitting there
"banding" the NMDA receptors was some how preventing
the AMPA effects from causing cognitive side effects,
etc. I just don't know. That's why I think the
duo is an interesting combo.I was thinking that adding Acamprosate,
a GabaB agonist and mild NMDA antagonist would
make a trio bipolar knockout punch for me.
Just a muse.Good Luck.
John> Thanks so much for your post, John.
> I will definitely keep Topomax in mind, then. My doctor brought up its use early in my treatment with him, but I don't know if he meant to use it as a supplement. I'm sure he would have kept the Lamictal on-board anyway, as it is one of the only drugs that makes a dent in an otherwise inpenetrable wall. That Topomax has enhanced your response to stimulants is exciting. I think I'll make sure to try it before giving up on Effexor.
>
> What side effects do you notice with Topomax? In particular, what cognitive effects do you experience? Have they mitigated with time. The current posture on this issue is that a gradual titration can almost prevent the emergence of cognitive side effects and increase the chances of their eventual disappearance. How did you go about starting Topomax?
>
> In re: Zyprexa. I seem to suffer a zombie-like cognitive blunting after reaching 5.0mg for several days. Risperdal and Geodon too. Do you have any thoughts on this? The thing that confuses me is that I tolerated Zyprexa 10mg well for a week or so a few years ago. At the time, it was used to put out a manic brush-fire. Maybe there is some sort of time-dependency involved in the emergence of this effect. Any thoughts? Otherwise, these atypical neuroleptics show signs of being particularly beneficial to me.
>
> Currently:
>
> Lamictal - 300mg
> Effexor - 300mg
> imipramine - initially, titrating to 200mg
> (It is likely that IMI blood levels will be increased due to the interaction of Effexor with CYP450. Otherwise, 300mg will be the eventual target)
>
>
> BTW, What are your thoughts on Gabitril?
>
> I am SO glad that things are progressing splendidly for you. I was concerned for awhile when your name on PB was appearing less frequently.
>
> HAVE FUN!!! Enjoy every moment of it.
>
> Thanks again for your input.
>
>
> Sincerely,
> Scott
>
>
>
> > Hi Scott,
> >
> > Sorry you feel crummy.
> >
> > Did you every get to try the Topamax + Lamictal
> > experiment?
> >
> > Mine is going very well.
> >
> > I am taking:
> >
> > 400 mg Topamax
> > 150 mg Lamictal
> > 2.5 mg Klonopin
> > 5 mg Zyprexa
> >
> > The Topamax addition FIXED my myofacial pain.
> > Plus it seems to have MOPPED UP any residual
> > depression. Plus I seem to have noticed that I
> > DON'T HAVE stimulant tolerance issues. Plus
> > I can take meds that would cause myofacial pain
> > in the past (Wellbutrin), etc.....worth a try.
> > I think the Topamax works well as an adjunct
> > to Lamictal, but I'm not so sure how I would
> > do on it stand alone.
> >
> >
poster:JohnX2
thread:90736
URL: http://www.dr-bob.org/babble/20020116/msgs/91013.html