Posted by Ron Hill on February 26, 2003, at 20:52:51
In reply to Re: Lamictal and Pre-emptive Strikes » Ron Hill, posted by catmint on February 26, 2003, at 15:10:53
Amy,
Thanks for taking time to tell me some of your dx and Rx background.
May I be bold and tell you what I would do if I were in your shoes? What follows is merely my opinion. Please treat it as such. Obviously, I’m not a pdoc. I’m only a peer offering my opinion.
It seems clear to me that the first order of business should be to get an effective moodstabilizer on board ASAP. I would choose a first line moodstabilizer (see the APA document “PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH BIPOLAR DISORDER (Revision)), and since Depakote does not agree with you, that leaves lithium. Please beware; I have a personal bias in favor of lithium because it has worked well for me. However, it may or may not work well for you. If it were me, I'd choose a slow-release brand of lithium (I like Lithobid). Further, I'd start out in the low-to-mid dose range shooting for a blood level around 0.6 mEq/l. Side effects are less likely at the lower dose levels, but if it does not provide enough mood stabilization, the dosage may need to be increased.
If it were me, I'd keep the Lamictal in place and continue to ramp it up slowly. If your irritability is causing irreparable damage to your relationships, perhaps your pdoc would be willing to prescribe a benzo to get you by until the lithium and Lamictal get you stabilized. However, I’d try to avoid the benzo if you can get by without it. If you still have trouble with depression after the lithium is on board and the Lamictal is ramped up, then it might be time to investigate the feasibility of adding an MAOI. If it were me, I would not add an SSRI, SNRI, or TCA.
The material contained herein is provided for informational purposes only and should not be considered as medical advice or instruction. Consult your health care professional for advice relating to a medical problem or condition.
Best wishes, Amy, and let me know how it goes.
-- Ron
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> > What did the Neurontin feel like? Did it help your irritability? What was your highest dose?
>
> >The Nuerontin felt good at first, like a kind-of buzzed, ralaxed feeling, but it had no mood stabilizing effects whatsoever. I also was taking Wellbutrin and Prozac with it, and began to fall apart after a year. I ended up smoking a lot of pot to try to help with the irritability, but it only ended up messing me up even worse, I was in a perpetual mixed state, smoking cigarretes, not sleeping well, having those night terrors I told you about, and occasional auditory hallucinations. I quit my job right after 9/11, and in a manic state, went out and bought a bunch of batteries,and film, and packed my backpack. I was paranoid that my boyfriend was going to be drafted and I wanted to get ready to move to Canada. Needless to say, I was going bonkers. I then became severely depressed and agitated and literally began tearing my hair out in an attempt to end the pain I felt. At the time I was in an outpatient program for mentally ill people who were on sick leave from work, it did help somewhat, but I mostly was either hyper and agitated or lying on the floor crying. My pdoc and I talked about hospitalization, which she told my I did not want to do unless I felt that I needed someone to watch me in case I was suicidal. Well, I had my boyfriend to take care of me and my son, so I rode it out at home, I quit all meds, still smoked pot, which I later quit, and somehow stabilized. That didn't last long, I then became euphiorically manic, over the summer and thought I was cured! LOL. THe depression inevitably hit hard in the fall and I started Depkote, tried to add Wellbutrin (no go), then Prozac(terrible).I then had my first trial of Lam. which gave me a rash. I then quit all meds again, convinced that psychiatry was ruining my life and there was no hope for me. After more misery, I opted to give Lamictal a second chance which brings us up to date.
>
> I should add that I wasn't diagnosed until I was 32, after many years of illness. I knew I was depressed but not bipolar, the mania I had was mostly dysphoric, but occasionally I would freak out and think I was someone I wasn't, invite complete strangers into my home, spend lots of money I didn't have, drive recklessly, have delusions, and so on.
>
> Ron, thanks for your interest.
>
> ::Amy
poster:Ron Hill
thread:203376
URL: http://www.dr-bob.org/babble/20030224/msgs/204150.html