![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 14 to 38 of 38. Go back in thread:
Posted by Fuscia on July 25, 2002, at 11:44:08
In reply to Re: Depakote, Lamictal Prozac??? » Geezer, posted by Ritch on July 22, 2002, at 21:53:25
Hi Mitch,
I was curious about the interaction as well and this is what I found at the rxlist monographs for valproate and lamotrigine.
"DEPAKOTE (Divalproex sodium) is a stable co-ordination compound comprised
of sodium valproate and valproic acid in a 1:1 molar relationship and formed
during the partial neutralization of valproic acid with 0.5 equivalent of sodium
hydroxide."Lamotrigine
http://www.rxlist.com/cgi/generic/lamotrigine_cp.htm"Valproic acid (VPA), however, actually decreases the clearance of
lamotrigine (i.e., more than doubles the elimination 11/2 of
lamotrigine),
whether given with or without EIAEDs.Accordingly, if lamotrigine is to
be
administered to a patient receiving VPA, lamotrigine must be given at a
reduced
dosage, less than half the dose used in patients not receiving VPA.""If taking Valproate concerning Lamactil (lamotrigine): In a steady-state study involving 10 healthy volunteers, the elimination half-life of lamotrigine increased from 26-70 hours with valproate co-administration (a 165% increase). The dose of lamotrigine should be reduced when co-administered with valproate.
Addition of Lamotrigine to a multi-drug regimen that includes VPA: dosage
reduction. Because VPA reduces the clearance of lamotrigine, the dosage of
lamotrigine in the presence of VPA is less than half of that required in its
absence."And other stuff of interest:
"CNS Effects: Sedative effects have occurred in patients receiving valproate
alone but occur most often in patients receiving combination therapy. Sedation
usually abates upon reduction of other antiepileptic medication."Geezer, I hope all goes well with you. As Mitch said, the worsening depression when attempting to lower Depakote could be just a withdrawal symptom as your brain tries to readjust, so hang in there. If you do try the Prozac again (assuming you have stopped taking it), and you still want to try it, then start out at a much lower dose than the recommended starting dose, which I believe is 20mg. Start out with 5mg or 10mg instead. This should help prevent the nausea and dizziness.
Take care, Fuscia
Posted by Ritch on July 25, 2002, at 19:17:21
In reply to Re: Depakote, Lamictal - Mitch and Geezer, posted by Fuscia on July 25, 2002, at 11:44:08
> Hi Mitch,
>
> I was curious about the interaction as well and this is what I found at the rxlist monographs for valproate and lamotrigine.
>
> "DEPAKOTE (Divalproex sodium) is a stable co-ordination compound comprised
> of sodium valproate and valproic acid in a 1:1 molar relationship and formed
> during the partial neutralization of valproic acid with 0.5 equivalent of sodium
> hydroxide."
>
> Lamotrigine
> http://www.rxlist.com/cgi/generic/lamotrigine_cp.htm
>
> "Valproic acid (VPA), however, actually decreases the clearance of
> lamotrigine (i.e., more than doubles the elimination 11/2 of
> lamotrigine),
> whether given with or without EIAEDs.Accordingly, if lamotrigine is to
> be
> administered to a patient receiving VPA, lamotrigine must be given at a
> reduced
> dosage, less than half the dose used in patients not receiving VPA."
>
> "If taking Valproate concerning Lamactil (lamotrigine): In a steady-state study involving 10 healthy volunteers, the elimination half-life of lamotrigine increased from 26-70 hours with valproate co-administration (a 165% increase). The dose of lamotrigine should be reduced when co-administered with valproate.
>
> Addition of Lamotrigine to a multi-drug regimen that includes VPA: dosage
> reduction. Because VPA reduces the clearance of lamotrigine, the dosage of
> lamotrigine in the presence of VPA is less than half of that required in its
> absence."
>
> And other stuff of interest:
>
> "CNS Effects: Sedative effects have occurred in patients receiving valproate
> alone but occur most often in patients receiving combination therapy. Sedation
> usually abates upon reduction of other antiepileptic medication."
>
> Geezer, I hope all goes well with you. As Mitch said, the worsening depression when attempting to lower Depakote could be just a withdrawal symptom as your brain tries to readjust, so hang in there. If you do try the Prozac again (assuming you have stopped taking it), and you still want to try it, then start out at a much lower dose than the recommended starting dose, which I believe is 20mg. Start out with 5mg or 10mg instead. This should help prevent the nausea and dizziness.
>
> Take care, Fuscia
>
Hi,Thanks for detailing that. That will be helpful information later on.
Mitch
Posted by Fuscia on July 26, 2002, at 20:42:18
In reply to Re: Depakote, Lamictal - Mitch and Geezer » Fuscia, posted by Ritch on July 25, 2002, at 19:17:21
Hi Ritch, not Mitch, and Hi Geezer,
Here is some more stuff on actions of Depakote and Lamictal
"Other Mood Stabilizing Agents
These new drugs (as well as the three mood stabilisers; lithium, valproic acid, and carbamazepine) are quite different from the antidepressants because they do not significantly increase levels of serotonin, dopamine, and norepinephrine in the brain. Instead, they seem to stimulate a transmitter substance called GABA (gamma-amino butyric acid) or inhibit a transmitter substance known as glutamate. GABA and glutamate are used by a large percentage of the nerves in the brain. The anticonvulsants that stimulate GABA tend to cause sleepiness. Medications in this category include valproic acid, as well as gabapentin (Neurontin), tiagabine (Gabitril), vigabatrin (Sabril), and several others. The anticonvulsants that inhibit glutamate tend to cause stimulation and anxiety. Medications in this category include felbamate (Felbatol), lamotrigine (Lamictal), topiramate (Topamax), and several others.
Although it is not known for certain why or how these drugs prevent epilepsy or stablize manic-depressive illness, it is known tha the GABA system and the glutamate system in the brain tend to compete with one another. This may be why drugs that stimulate GABA or inhibit glutamate are helful for epilepsy and for bipolar illness." From the book, Feeling Good, by David D. Burns, M.D.
GABA is one of the non-essential amino acids - that is, it can be made by the liver from other amino acids obtained from dietary sources. GABA acts as a neurotransmitter in the central nervous system. It is formed from another amino acid, glutamic acid. Its function is to decrease neuron activity and inhibit nerve cells from overfiring. Whereas the amino acid glutamic acid is an excitatory neurotransmitter that increases firing of neurons in the CNS." From the book, Prescription for Nutritional Healing, by Balch
This was informative for me for I didn't know that the different anticonvulsants used for mania in bi-polar disorder worked on either GABA or glutamate systems - I thought they all worked on the GABA system.
Take care, Fuscia
Posted by Geezer on July 26, 2002, at 21:11:15
In reply to Re: Depakote andLamictal actions- Ritch and Geezer, posted by Fuscia on July 26, 2002, at 20:42:18
Thanks Fuscia,
Maintained Lamictal at 100mg, D/Ced Prozac after 7 days (haven't been that sick for a long time). The big mistake was dropping Depakote to 500mg from 750mg. Took me out of the theraputic range and crashed very badly today. Your post is beginng to sink into my confused brain. I seem to need Lamictal and Depakote - if I could just overcome the terrable sedated feeling and bring the moderate depression under control.
I will answer your e-mail very soon.
Geezer
Posted by Ritch on July 27, 2002, at 8:55:41
In reply to Re: Depakote andLamictal actions- Ritch and Geezer, posted by Fuscia on July 26, 2002, at 20:42:18
> Hi Ritch, not Mitch, and Hi Geezer,
>
> Here is some more stuff on actions of Depakote and Lamictal
>
> "Other Mood Stabilizing Agents
>
> These new drugs (as well as the three mood stabilisers; lithium, valproic acid, and carbamazepine) are quite different from the antidepressants because they do not significantly increase levels of serotonin, dopamine, and norepinephrine in the brain. Instead, they seem to stimulate a transmitter substance called GABA (gamma-amino butyric acid) or inhibit a transmitter substance known as glutamate. GABA and glutamate are used by a large percentage of the nerves in the brain. The anticonvulsants that stimulate GABA tend to cause sleepiness. Medications in this category include valproic acid, as well as gabapentin (Neurontin), tiagabine (Gabitril), vigabatrin (Sabril), and several others. The anticonvulsants that inhibit glutamate tend to cause stimulation and anxiety. Medications in this category include felbamate (Felbatol), lamotrigine (Lamictal), topiramate (Topamax), and several others.
>
> Although it is not known for certain why or how these drugs prevent epilepsy or stablize manic-depressive illness, it is known tha the GABA system and the glutamate system in the brain tend to compete with one another. This may be why drugs that stimulate GABA or inhibit glutamate are helful for epilepsy and for bipolar illness." From the book, Feeling Good, by David D. Burns, M.D.
>
> GABA is one of the non-essential amino acids - that is, it can be made by the liver from other amino acids obtained from dietary sources. GABA acts as a neurotransmitter in the central nervous system. It is formed from another amino acid, glutamic acid. Its function is to decrease neuron activity and inhibit nerve cells from overfiring. Whereas the amino acid glutamic acid is an excitatory neurotransmitter that increases firing of neurons in the CNS." From the book, Prescription for Nutritional Healing, by Balch
>
> This was informative for me for I didn't know that the different anticonvulsants used for mania in bi-polar disorder worked on either GABA or glutamate systems - I thought they all worked on the GABA system.
>
> Take care, Fuscia
>
>
>Hi Fuscia,
That is the dilemma with most of the anticonvulsant antimanic agents-they make you generally calm, but tired and flat. I have got comorbid ADHD symptoms and higher doses of Depakote or Neurontin just "blank" me out cognitively. It is similar to taking a benzodiazepine at work and having to solve a complex problem. You need to be able to hold several things in your consciousness and to reason clearly and it is tough when you forget what you are doing every few minutes! If I try to take an "activating" antidepressant to compensate for it I sleep poorly and it worsens my cycling. If I take a stimulant I sleep OK, and I don't cycle, but I get panic! So, I can be attentive, but I am either more unstable or I am panicky. I think there is an underlying (more fundamental) mechanism to explain bipolar (other than it just like epilepsy, i.e.), which when "discovered" will bring more targeted medication without a lot of this hassle.
Mitch
Posted by cybercafe on July 27, 2002, at 11:23:20
In reply to Re: Depakote andLamictal actions- Ritch and Geezer » Fuscia, posted by Ritch on July 27, 2002, at 8:55:41
> That is the dilemma with most of the anticonvulsant antimanic agents-they make you generally calm, but tired and flat. I have got
hmm... have you tried lamotrigine? ... i heard it is supposed to be more antidepressant and less sedative like... though i havn't heard it being as good as gabapentin for anxiety
>comorbid ADHD symptoms and higher doses of Depakote or Neurontin just "blank" me out cognitively. It is similar to taking a benzodiazepine at work and having to solve a complex problem. You need to be able to hold several things in your consciousness and to
i'm curious as to whether you find gabapentin or depakote to be as bad as benzodiazepines in causing that stupor we all know and love
Posted by Ritch on July 27, 2002, at 11:55:55
In reply to Re: Depakote andLamictal actions- Ritch and Geezer, posted by cybercafe on July 27, 2002, at 11:23:20
> > That is the dilemma with most of the anticonvulsant antimanic agents-they make you generally calm, but tired and flat. I have got
>
> hmm... have you tried lamotrigine? ... i heard it is supposed to be more antidepressant and less sedative like... though i havn't heard it being as good as gabapentin for anxiety
>
> >comorbid ADHD symptoms and higher doses of Depakote or Neurontin just "blank" me out cognitively. It is similar to taking a benzodiazepine at work and having to solve a complex problem. You need to be able to hold several things in your consciousness and to
>
> i'm curious as to whether you find gabapentin or depakote to be as bad as benzodiazepines in causing that stupor we all know and love
>
>
Cyber,I haven't tried lamotrigine. The main reason is because I already have gotten skin reactions from other meds, and I already take allergy shots to prevent hives from dust and molds. Not only that, but if I got an even slight amount of itchiness or rash from it I would freak out and stop it (and it may have nothing to do with the drug). Also, I have heard stories about hypomania being induced by lamotrigine, and I definitely *need* a strong antimanic agent. That was why I went off gabapentin and back on depakote. Neurontin just wasn't controlling my temper and springtime hypomania, but just 250mg of depakote works like a charm---for that problem anyhow. I suppose I could add lamictal to my depakote, but that makes the rash thing more likely. Probably the best idea would be to add some lithium, but I can't tolerate the GI upset, and it causes *worse* cognitive problems than the depakote! Not to mention depressing thyroid function.. and I only have half a thyroid left. And my pdoc is afraid of T3/T4 augmentation.. and my TSH is about 1.4 anyways. I really wonder though if I could get my TSH down to about 1.0 if my cognitive symptoms would get better? Hmmm.
As far as cognitive sfx vis a vis Depakote, Neurontin, and benzos. Benzos are definitely the worst-oh yes! I can take just .25mg of Klonopin at work and I am just blitzed. Hey, I will tell you what: I'll list the meds that caused the most cognitive dysfunction with #1 being the worst:
1)Gabitril
2)Ativan + other higher dose benzos.
3)Remeron
4)Serzone (twice daily dosing)
5)Doxepin
6)Trazodone (just nighttime dosing)
7)Low-dose antipsychotics (any of them)
8)Lithium
9)Depakote
10) Gabapentin
Posted by cybercafe on July 28, 2002, at 1:18:07
In reply to Re: Depakote andLamictal actions- Ritch and Geezer » cybercafe, posted by Ritch on July 27, 2002, at 11:55:55
Thanks a lot for the info Ritch (Mitch?) ...I never realized antipsychotics caused less cognitive dysfunction (sedation?) than benzos or remeron
one thing i am really interested in following up on though -- where did you hear that lamotrigine can cause hypomania ?
cheers
cybercafe
Posted by colin wallace on July 28, 2002, at 4:54:14
In reply to Re: Depakote andLamictal actions- Ritch , posted by cybercafe on July 28, 2002, at 1:18:07
Cyber,
My psych. was unwilling to prescribe me lamotrigine due to its (supposed) capacity for causing hypomania.Was placed on depakote instead.
Personally, I believe the risks of becoming manic are much less with lamictal than with eg. prozac, but then again I'm not a psychiatrist.Col.
Posted by Ritch on July 28, 2002, at 10:17:06
In reply to Re: Depakote andLamictal actions- Ritch , posted by cybercafe on July 28, 2002, at 1:18:07
>
> Thanks a lot for the info Ritch (Mitch?) ...
>
> I never realized antipsychotics caused less cognitive dysfunction (sedation?) than benzos or remeron
>
> one thing i am really interested in following up on though -- where did you hear that lamotrigine can cause hypomania ?
>
> cheers
>
> cybercafe
>It's Mitch, but that is a long story! One thing to keep in mind about that "list" is it is based on my experiences, the doses vary a lot. IOW, If I could tolerate 100mg of Thorazine (i.e.), I would probably find it more than just a little difficult to do addition. However, it is easy for me to take a "standard" dose of a benzodiazepine, hence, it's position on the list. I heard about the lamotrigine induced mania here, so it is anecdotal of course. There may be some "formal" reporting of this in a medline abstract somewhere, but I don't know where it is. It is entirely possible that for some bipolar people, lamotrigine may not have a powerful enough of an antimanic effect to control a "natural" episode of mania or hypomania. It may not be "triggering" hypomania at all.
Mitch
Posted by Ron Hill on July 28, 2002, at 12:15:40
In reply to Re: Depakote andLamictal actions- Cybercafe, posted by colin wallace on July 28, 2002, at 4:54:14
> Personally, I believe the risks of becoming manic are much less with lamictal than with eg. prozac, but then again I'm not a psychiatrist.
You may not be a pdoc but IMHO you are correct.-- Ron
Posted by Fuscia on July 29, 2002, at 11:28:52
In reply to Re: Depakote andLamictal actions- Ritch and Geezer » Fuscia, posted by Ritch on July 27, 2002, at 8:55:41
I see and that is quite perplexing. Your name is Mitch from the post below, but I'm not sure if you go by Mitch or Ritch, but your input is "rich", Mitch .... ; )
I would think that if one were taking Depakote and Lamictal together, that dosing schedule might be important, such as taking Lamictal in morning and Depakote in the evening or bedtime. I'll have to read up more about these two drugs.
Since you are taking Depakote, have you ever thought about taking the amino acid tyrosine, which aids in mental alertness. Ask your doctor about this and try maybe a month's trial. L-Tyrosine should be taken on an empty stomach with 1,000mg of vitamin C and 50mg of vitamin B6 to help with absorption. Other suggestions would include L-glutamine, L-phenylalanine plus L-aspartic acid, taken as directed on an empty stomach. Take with water or juice. Do not take with milk. Addition of small amounts of vitamin C and vitamin B6 help with absorption. These amino acids are necessary for normal brain function, and also serve as fuel for the brain and prevent excess ammonia from damaging the brain. Caution: do not take phenylalanine if you suffer from panic attacks, diabetes, or high blood pressure. And another suggestion would be Dimethylaminoethanol (DMAE) as directed on label. Aids in memory and learning. Note: this supplement isn't intended for everyday use, but is best reserved for days when you need to be more focused and alert. Just some ideas.
I hope the best for you, Fuscia
Posted by Ritch on July 29, 2002, at 12:59:08
In reply to Re: Depakote and Lamictal actions- Ritch with an M, posted by Fuscia on July 29, 2002, at 11:28:52
> I see and that is quite perplexing. Your name is Mitch from the post below, but I'm not sure if you go by Mitch or Ritch, but your input is "rich", Mitch .... ; )
>
> I would think that if one were taking Depakote and Lamictal together, that dosing schedule might be important, such as taking Lamictal in morning and Depakote in the evening or bedtime. I'll have to read up more about these two drugs.
>
> Since you are taking Depakote, have you ever thought about taking the amino acid tyrosine, which aids in mental alertness. Ask your doctor about this and try maybe a month's trial. L-Tyrosine should be taken on an empty stomach with 1,000mg of vitamin C and 50mg of vitamin B6 to help with absorption. Other suggestions would include L-glutamine, L-phenylalanine plus L-aspartic acid, taken as directed on an empty stomach. Take with water or juice. Do not take with milk. Addition of small amounts of vitamin C and vitamin B6 help with absorption. These amino acids are necessary for normal brain function, and also serve as fuel for the brain and prevent excess ammonia from damaging the brain. Caution: do not take phenylalanine if you suffer from panic attacks, diabetes, or high blood pressure. And another suggestion would be Dimethylaminoethanol (DMAE) as directed on label. Aids in memory and learning. Note: this supplement isn't intended for everyday use, but is best reserved for days when you need to be more focused and alert. Just some ideas.
>
> I hope the best for you, Fuscia
Thanks for the ideas! I posted here a few months ago about craving Diet Coke (esp. when depressed), and we were wondering if it had to do with the aspartame and phenylalanine in the Diet Coke. The tyrosine sounds like a good try. I am already taking Flaxseed Oil and sublingual B-complex (which seems to help). I tried SAM-e for a while back in the spring and it seemed to make me a little too *wired*-especially in the mornings after I took it. So, that got stopped. Other things that seem to help: Eating smaller, more frequent meals (less carbs, more protein), intense cardiovascular exercise (more endorphins), midday sunlight exposure (whether it is summer or winter), and doing whatever it takes to get proper sleep (not too much or too little).As far as Lamictal and Depakote goes--I think that Lamictal can be dosed just once a day if the dose isn't too high (correct me anybody?), and I just take 250mg of Depakote at bedtime (no daytime dose). Your dosing idea sounds good (if both meds are at fairly low dosages). Perhaps 500mg of Depakote at bedtime + 100mg of Lamictal in the AM? Given that both being given together tend to elevate each other's blood levels that would probably put both of them in a "therapeutic range" for most bipolar folks.
Mitch
Posted by Ron Hill on July 29, 2002, at 16:11:04
In reply to Re: Depakote and Lamictal actions- Ritch with an M » Fuscia, posted by Ritch on July 29, 2002, at 12:59:08
Hi Mitch,
> ...I am already taking Flaxseed Oil and sublingual B-complex (which seems to help). I tried SAM-e for a while back in the spring and it seemed to make me a little too *wired*-especially in the mornings after I took it. So, that got stopped. Other things that seem to help: Eating smaller, more frequent meals (less carbs, more protein), intense cardiovascular exercise (more endorphins), midday sunlight exposure (whether it is summer or winter), and doing whatever it takes to get proper sleep (not too much or too little).
Everything you said in your paragraph above applies to me with one minor difference. For me, SAM-e worked wonderfully for five months, but then it began to induce episodes of flash rage. But everything else is exactly the same. A lot of us bipolar II folks travel common ground.
-- Ron
Posted by cybercafe on July 29, 2002, at 21:01:59
In reply to Re: Depakote and Lamictal actions- Ritch with an M » Fuscia, posted by Ritch on July 29, 2002, at 12:59:08
Hey Ritch, how much Flaxseed oil do you take?
Posted by Ritch on July 29, 2002, at 22:04:12
In reply to Re: Hey, me too! » Ritch, posted by Ron Hill on July 29, 2002, at 16:11:04
> Hi Mitch,
>
> > ...I am already taking Flaxseed Oil and sublingual B-complex (which seems to help). I tried SAM-e for a while back in the spring and it seemed to make me a little too *wired*-especially in the mornings after I took it. So, that got stopped. Other things that seem to help: Eating smaller, more frequent meals (less carbs, more protein), intense cardiovascular exercise (more endorphins), midday sunlight exposure (whether it is summer or winter), and doing whatever it takes to get proper sleep (not too much or too little).
>
> Everything you said in your paragraph above applies to me with one minor difference. For me, SAM-e worked wonderfully for five months, but then it began to induce episodes of flash rage. But everything else is exactly the same. A lot of us bipolar II folks travel common ground.
>
> -- RonRon,
The SAM-e seemed to really help for awhile. I had this whoosh of energy for a few hours after I took it and then it would die off later in the day. I never got really grouchy, but I was certainly restless and paced about quite a bit (did manage to get a lot done, however). I mainly quit it because it was costing a little much (400mg/day), and I was getting more hypomanic back in the spring and I was worried it was going to get *worse* (that's when I flipped from Neurontin back to Depakote).
Mitch
Posted by Ritch on July 29, 2002, at 22:04:59
In reply to Re: Depakote and Lamictal actions- Ritch with an M, posted by cybercafe on July 29, 2002, at 21:01:59
>
> Hey Ritch, how much Flaxseed oil do you take?Just two 1G caps-one with breakfast and the second at lunch.
Posted by cybercafe on July 30, 2002, at 0:16:16
In reply to Re: Depakote and Lamictal actions- Ritch with an M » cybercafe, posted by Ritch on July 29, 2002, at 22:04:59
> Just two 1G caps-one with breakfast and the second at lunch.damn... and you don't get... uhhhh... less-solid-than-desired-stool?
Posted by Ritch on July 30, 2002, at 7:48:35
In reply to Re: Depakote and Lamictal actions- Ritch with an M, posted by cybercafe on July 30, 2002, at 0:16:16
>
> > Just two 1G caps-one with breakfast and the second at lunch.
>
> damn... and you don't get... uhhhh... less-solid-than-desired-stool?Oh, that is a problem sometimes :) Some people take a lot more flax oil with no problems. One cap with two meals is about my limit, however. I would prefer the fish oil instead (because of the much higher level of EPA?), but the fishy burpy reflux is far worse than the flaxseed oil's occasional loose stools. I know they have soem enteric coated fish oil that eliminates that problem, but the main health food spots where I live don't carry it.
Mitch
Posted by Ron Hill on July 30, 2002, at 9:37:57
In reply to Re: Hey, me too! » Ron Hill, posted by Ritch on July 29, 2002, at 22:04:12
Mitch,
> ...that's when I flipped from Neurontin back to Depakote.
What prompted you to desire this change? Was the Neurontin causing some cognitive blunting and/or forgetfulness? What other side effects did you experience with Neurontin? The reason I ask is that for a couple of years I've been trying to decide whether or not to give gabapentin a trial as an add-on to my 600 mg/day Lithobid.
The supposed benign side effects profile of gabapentin is attractive to me because I am hypersensitive to medication side effects. Also it is purported to reduce irritability and, although the SAM-e rage thing disappeared shortly after discontinuation of the substance, I have always had some irritable mood problems associated with my BP II disorder.
I liked Lamictal when I tried it years ago, (but the rash side effect was intolerable). Therefore, I think my brain chemistry would benefit from an AED add-on if I could find one with tolerable side effects.
How long did you take gabapentin? Thanks much for you time, Mitch.
-- Ron
Posted by Ritch on July 30, 2002, at 11:01:53
In reply to Re: Neurontin vs Depakote » Ritch, posted by Ron Hill on July 30, 2002, at 9:37:57
> Mitch,
>
> > ...that's when I flipped from Neurontin back to Depakote.
>
> What prompted you to desire this change? Was the Neurontin causing some cognitive blunting and/or forgetfulness? What other side effects did you experience with Neurontin? The reason I ask is that for a couple of years I've been trying to decide whether or not to give gabapentin a trial as an add-on to my 600 mg/day Lithobid.
>
> The supposed benign side effects profile of gabapentin is attractive to me because I am hypersensitive to medication side effects. Also it is purported to reduce irritability and, although the SAM-e rage thing disappeared shortly after discontinuation of the substance, I have always had some irritable mood problems associated with my BP II disorder.
>
> I liked Lamictal when I tried it years ago, (but the rash side effect was intolerable). Therefore, I think my brain chemistry would benefit from an AED add-on if I could find one with tolerable side effects.
>
> How long did you take gabapentin? Thanks much for you time, Mitch.
>
>
> -- Ron
>Hi Ron,
It is a long story, but I will try to explain it as best I can. I was on lithium for probabably 20 years, but I could only tolerate 300-450mg/day because of GI upset. So, it wasn't really a high enough dose to really be effective at controlling my cycling. So, I flipped to Depakote back in 1997, my depression worsened, but there wasn't any hypomania. So, I spent a lot of time flipping between different low-dose AD's (and low-dose AD combos)with the Depakote to get the breakthrough depressions under control. I was on a combo of Depakote+Klonopin+Celexa when I added Neurontin in 1999. I immediately felt a *lot* better. It was during a major depression and it nearly lifted entirely. That was at 300mg tid of Neurontin. Well, I screwed up big time and stopped all of the other meds (because I thought I had found the *one* with Neurontin). Well, anxiety and panic started to return with a vengeance (possibly also a Depakote withdrawal, too), and I wound up on Neurontin+Celexa+Klonopin. My pdoc and I decided to try to bump up the Neurontin (since I was responding well to it). I went to 1800mg/day and got bad depersonalization and cognitive "blanking" from it (this has happened with Gabitril and Topamax, too at higher doses). I dropped the dose down to 1200mg/day for a while. Then I started getting all of these eustachian tube "thumps" in my ear canals. It was annoying as hell-kind of a myoclonus thing. So, I dropped the dose all the way down to 100mg 4x daily and stayed on that with Celexa+Klonopin for quite a while. Well, this spring I had some pronounced hypomanic situations and the gabapentin just wasn't a high enough dose to prevent it so we added some Depakote back in. It helped right away and my hostility level went way down. Then, when I started into my summertime depression this year I was just so TIRED. I knew the Depakote was keeping my anger under control and I didn't want to reduce that one so I could wake up. So, the Neurontin got axed so I wouldn't be so drowsy during the daytime. I was considering a stimulant this time around (with Neurontin+Depakote+Celexa+Klonopin), but geez! just *too* many meds! We tried a string of different stimulants back in the Spring and they helped, but I tend to get this "cascading" panic reaction to stimulants. They work OK for quite some time and then I slowly become more and more panicky. Yuck, didn't want to go there. So, I am on a med minimalism tack now. Three meds now: Depakote+Klonopin+Effexor. I found low-dose Effexor to be a little less tiring than low-dose Celexa. Whew! I hope that clarifies things. In short I think Neurontin is quite useful, but I can't tolerate higher doses of the stuff (or much of anything else either!),
Mitch
Posted by Ron Hill on July 30, 2002, at 12:33:10
In reply to Re: Neurontin vs Depakote » Ron Hill, posted by Ritch on July 30, 2002, at 11:01:53
Posted by Ritch on August 1, 2002, at 12:47:04
In reply to Re: Depakote and Lamictal actions- Ritch with an M, posted by Fuscia on July 29, 2002, at 11:28:52
> Since you are taking Depakote, have you ever thought about taking the amino acid tyrosine, which aids in mental alertness. Ask your doctor about this and try maybe a month's trial. L-Tyrosine should be taken on an empty stomach with 1,000mg of vitamin C and 50mg of vitamin B6 to help with absorption. Other suggestions would include L-glutamine, L-phenylalanine plus L-aspartic acid, taken as directed on an empty stomach. Take with water or juice. Do not take with milk. Addition of small amounts of vitamin C and vitamin B6 help with absorption. These amino acids are necessary for normal brain function, and also serve as fuel for the brain and prevent excess ammonia from damaging the brain. Caution: do not take phenylalanine if you suffer from panic attacks, diabetes, or high blood pressure. And another suggestion would be Dimethylaminoethanol (DMAE) as directed on label. Aids in memory and learning. Note: this supplement isn't intended for everyday use, but is best reserved for days when you need to be more focused and alert. Just some ideas.
>
> I hope the best for you, FusciaFuscia,
Hey, I started taking one capsule of L-tyrosine with C and sublinqual B when I get up in the morning all week this week (plus of course my usual meds) and there definitely is something happening that is positive. I am definitely feeling cheerful, almost hypomanic. I have noticed that it is easy to stay awake until bedtime without nodding off and I got a response from someone at work yesterday-"sounds like you are in a jolly mood". Hmmm. If it is just cycling it won't last more than a week or so, so that will be the "test". However, I *rarely* get much of any hypomania at this time of year. Thanks for the suggestion, I probably would never have thought of it.
Mitch
Posted by Fuscia on August 5, 2002, at 12:52:03
In reply to Re: L-Tyrosine suggestion-something's happening.. » Fuscia, posted by Ritch on August 1, 2002, at 12:47:04
Hi Mitch,
Wow, thanks for the feedback. I usually never hear from someone that has tried something I suggested. Maybe that is good, that they take my suggestions with a raised eye-brow for I don't have any studies showing it will help. I just know what some of the actions are of some of the nutrients, and figure if it does this and this, then maybe it will help in a certain situation. I really wish I could do this as research, with real patients under close supervision so they don't have negative effects.
I have taken L-tyrosine while taking an antidepressant and certainly notice the increased mental clarity and energy by afternoon. The only thing is that I have never taken it for more than one day at a time - so - I'll skip a day or a few days - usually because I simply forget to take it, or am reluctant to take it daily as to not over do it, especially while taking mood-altering drugs.
I don't know how much tryosine is in the product you are taking, but if it causes too much stimulation or you feel hypomania, then skip a day before taking it again, or find a product with a lower dosage. I have L-tyrosine 500mg by NOW brand.
This is highly interesting to me, so please keep me posted - especially if a downturn occurs. I hope not, but once again, amino acids are powerful substances, as well as certain of the vitamins, such as B6. I'm glad to hear the positive results thus far!
Take care, Fuscia
Posted by Ritch on August 5, 2002, at 23:50:43
In reply to Re: L-Tyrosine suggestion-something's happening.., posted by Fuscia on August 5, 2002, at 12:52:03
> Hi Mitch,
>
> Wow, thanks for the feedback. I usually never hear from someone that has tried something I suggested. Maybe that is good, that they take my suggestions with a raised eye-brow for I don't have any studies showing it will help. I just know what some of the actions are of some of the nutrients, and figure if it does this and this, then maybe it will help in a certain situation. I really wish I could do this as research, with real patients under close supervision so they don't have negative effects.
>
> I have taken L-tyrosine while taking an antidepressant and certainly notice the increased mental clarity and energy by afternoon. The only thing is that I have never taken it for more than one day at a time - so - I'll skip a day or a few days - usually because I simply forget to take it, or am reluctant to take it daily as to not over do it, especially while taking mood-altering drugs.
>
> I don't know how much tryosine is in the product you are taking, but if it causes too much stimulation or you feel hypomania, then skip a day before taking it again, or find a product with a lower dosage. I have L-tyrosine 500mg by NOW brand.
>
> This is highly interesting to me, so please keep me posted - especially if a downturn occurs. I hope not, but once again, amino acids are powerful substances, as well as certain of the vitamins, such as B6. I'm glad to hear the positive results thus far!
>
> Take care, FusciaHi,
Well... it looks like it may be helping some, but it looks like it could be explained by my "level 2" cycles (three week frequency). My mood chart shows an unusual elevation of mood, but it only lasted about four days. Interestingly, I was already "up" about a day or two before I tried the L-tryosine. The day I tried it and the next three days were definitely more "up" for sure, however. I did notice on the 2nd day I took it a marked ability to discern lyrics in music (my ADHD or CAPD probs improved noticeably). That was about four hours postdosing with the pinch of "Effexobutrin" kicking in with the sublingual B's. This is bizarre, but I feel the most "normal" when I can listen and understand musical lyrics AND I sleep about 7 hours straight through (unbroken), and wake feeling rested. Perfectamente! Oh, BTW, I am just taking a single 500mg cap of tyrosine. I increased the bupropion part of my morning venlafaxine+bupropion dose from 12.5+12.5mg to 12.5+18.75mg and got some mild hypomania this evening. But, it was very controllable, and I didn't have any of the "rocketing" experiences I get in the springtime.
Mitch
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