Posted by Ron Hill on November 16, 2007, at 22:18:57
In reply to Ran out of Provigil + stopped Lamictal = depressed, posted by gardenergirl on November 15, 2007, at 7:55:30
gg,
So sorry for your depressive episode.
FWIW, a year or so ago, I tried to very slowly titrate my Lamictal dosage down from 200 mg/day to 150. I wanted to see if I could reduce my Lamictal-induced forgetfulness and rashs.
I steadily titrated from 200 down to 167.5 very slowly over a four-week period. But, at 167.5 mg/day I fell into a huge depressive episode. I immediately increased back up to 200 mg/day and I recovered quickly.
I don't understand any reluctance on the part of your p-doc to combine Lamictal and Lithium. If Li works for you, and you historical have done well on Lamictal, combining the two is actually highly recommended.
Back in 2003, Calabrese et al were very happy with their large study results. Print this study and give it to your pdoc. I can't imagine that your pdoc is not aware of these study results:
http://archpsyc.ama-assn.org/cgi/content/full/60/4/392
If you have any trouble pulling up the study article, let me know.
I'd say ramp your Lamictal back up to 150 mg/day asap. But, you know yourself better than I, of course.
Get well soon gg. You are one of our leaders around here.
-- Ron
Currently in full remission.
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
4 pumps of Androgel testosterone on a prn basis during ultra rapid cycling depressive phases.--------------------
> I'm back into a full-blown depressive episode. I'm sure it's both biologically and psychologically/situational related. The bio part I can address fairly easily, I hope.
>
> Anyway, I ran out of Provigil a few weeks ago. I didnt' worry about it because I wasn't so sure it was doing that much anymore. But it must be, surely. I've been in such a cognitive fog since, and my sleep/wake cycle is back to the mess it was before I started getting better.
>
> Last time I saw my pdoc, about six weeks ago, we decided to try dropping Lamictal since I had such a positive response to Lithium. We wondered if the Lamictal was redundant. I went from 150mg to 75mg for about two weeks, and then I stopped. That was about a week ago. I don't know if feeling depressed is a withdrawal effect of Lamictal that will pass in time, or if I really did need Lamictal. I see pdoc again in about 2 weeks, though I'm tempted to call him. The Provigil shipped from my mail order pharmacy today. I probably won't get it before I leave for a weekend trip, but starting next week I can get back on it and see how I feel.
>
> It all stinks, though. Depression stinks. I hate feeling so debilitated and "useless". I hate that it affects my marriage. And my work. Hate it.
>
> Hate it hate it hate it.
>
> Any feedback, comments, support and/or suggestions welcome.
>
> Thanks,
>
> gg
poster:Ron Hill
thread:795259
URL: http://www.dr-bob.org/babble/20071115/msgs/795522.html