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Dr. Bob is Robert Hsiung, MD,
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Posted by Barbara Cat on April 17, 2003, at 11:29:23
In reply to Re: Mom, and my vacation » Barbara Cat, posted by wcfrench on April 3, 2003, at 0:13:19
Hi All,
Just got back from the second leg of Mom's death journey. This time it was hard WORK, schlepping furniture around, estate sale of her things (actually fun!), little sleep, walking out of our family home for the last time, saying goodbye forever to the places of my childhood. I was not on the euphoric high of the first trip which was due no doubt to endorphins saving my sanity from the shock. This was pure adrenaline pushing through it. My poor adrenals!So glad to be back home and so are our 8 kitties who missed us. Life has been on hold for months and now it's time to begin a new stage of life. I'm ready - I think.
Charlie, thanks for your words of comfort. I am SO GLAD I've been working with Power of Now during this time. I saw my sister-in-law go more nuts during it and recognized the spin caused by ego and time identification. It was very difficult not to get sucked into it and those times I was sucked in were the most difficult. I will get "Meditation as Medicine". I recommend "Breathwalk" by Khalsa as well. Dance on, bro'. Have you been to Burning Man?
Day/Night cycles: I seem to be opposite of you all in this regard. I feel a sense of dread shortly after waking and begin to feel much better as evening comes on. I love the cozy glow of lights. I get a burst of energy around 8:00pm. My circadian cycles are definitely screwed. When I'm depressed I feel better in cloudy gray weather than sunny chipper days. I come alive in storms and blustery weather.
There is a certain time in the afternoon that I feel the worst. Emily Dickenson wrote a poem about 'that certain slant of light' describing her own depressions and the late afternoon light. I noticed it very strongly while back on the East Coast recently. Perhaps it was triggering my less than happy childhood, but it was also an almost physical reaction to the different play of light and shadow that caused dread and claustrophobia. William Styron talks of this phenomenon as well.
I've heard that cortisol cycling can be the reason for these mood changes during the day. I'm taking melatonin to try regulating this weird sleep cycle but I've always been like this. Becoming a night shift worker is out. Too many weirdos going about their business. - Barbara
Posted by wcfrench on April 19, 2003, at 1:28:45
In reply to Mom, Vacation Part II (and day/night cycles), posted by Barbara Cat on April 17, 2003, at 11:29:23
I take 200mg around noon and it seems like later on at work (around 6 or 7) it starts to wear off. Not the high the Lamictal gives you, I don't experience that anymore, but just the effects. I start to feel "bipolar" again and become paranoid and sensitive. Does anyone else have to take it twice a day in as little as 6-7 hour increments to keep it going? The only other thing I take in the morning is Zoloft, and I think that wouldn't wear off during the day. Any suggestions? My nights are really struggling...
Thanks all,
Take care,
CharliePS welcome back BCat!
Posted by SpreadDaALoha on April 19, 2003, at 3:41:49
In reply to Re: Lamictal - how long does it last for you?, posted by wcfrench on April 19, 2003, at 1:28:45
I take 150mg Lamictal in morning and 150mg at night. I don't really notice any particular part of day when it works....
Posted by Ponder on April 19, 2003, at 12:25:23
In reply to Re: Lamictal - how long does it last for you?, posted by SpreadDaALoha on April 19, 2003, at 3:41:49
I take Lamictal 75mg in the morning and 75mg at night and do not notice much variation during the day. Well, actually, I have a lot of variation during the day, but never thought to attribute it to meds wearing off.
Question for you guys: seems most people have found Lamictal to be pretty good overall as an antidepressant. What do you think of it's stabilizing properties? My p-doc wants to add lithium. I have not had anything but trouble with lithium in the past, but he thinks it has synergy with Lamictal and wants to do another trial. I'm remembering the 45 bad drug pounds that I blessedly am no longer carrying, the awful tremor lithium gives me, etc. Arrgh. Anyway, isn't Lamictal a stabilizer? I'm already on Topa low dose (75 mg/day) for some synergy. Your thoughts?
Posted by Barbara Cat on April 19, 2003, at 12:54:54
In reply to Rate Lamictal as stabilizer, posted by Ponder on April 19, 2003, at 12:25:23
Hi Ponder,
I recommend lithium with lamictal because of my own experience. I've run out of lithium (on purpose I think) on a few occassions and started feeling scattered and irritable within 2 days, even while on lamictal. There does seem to be a synnergy with the two and I find I have to use less of each. I was on lithium without lamictal for awhile and was not getting good antidepressant response. Adding lamictal gave me a very nice burst of energy (at first) and helped with the depression. But I've learned that for me it doesn't work without lithium which tends to smooth things out.Of course, it's hard to say what's responsible for my overall improvement since I've had many different mixes of meds. The current one which seems to be successful is lamital 75mg, lithium 600mg, nortriptyline 75mg. The next test will be to decrease lamictal to see if I really need it since the nortriptyline made such a huge difference and along with lithium might be all I really need. We'll see.
I'm also taking thyroid since lithium can cause hypothyroidism. This is a very important and serious factor to consider. If you do go on lithium, INSIST that your thyroid levels are checked every few months. - Barbara
p.s. I had bad tremors, especially when starting nortriptyline. They went away in 2 months, thank God. I'm keeping weight down using a rebounder mini-trampoline and dancing (whether I feel like it or not!).
> Question for you guys: seems most people have found Lamictal to be pretty good overall as an antidepressant. What do you think of it's stabilizing properties? My p-doc wants to add lithium. I have not had anything but trouble with lithium in the past, but he thinks it has synergy with Lamictal and wants to do another trial. I'm remembering the 45 bad drug pounds that I blessedly am no longer carrying, the awful tremor lithium gives me, etc. Arrgh. Anyway, isn't Lamictal a stabilizer? I'm already on Topa low dose (75 mg/day) for some synergy. Your thoughts?
Posted by wcfrench on April 19, 2003, at 13:17:27
In reply to Rate Lamictal as stabilizer, posted by Ponder on April 19, 2003, at 12:25:23
It seems to be working OK for me as a stabilizer, but not as well as Depakote did. I feel a little brighter on it, but the overall effect doesn't seem as "stabilizing" as Depakote did, but I might still have to increase the dosage, or add another mood stabilizer to reach maximum effectiveness. I am moving to Las Vegas next week and my damn doctor won't get me an appointment and won't call in a higher dosage after I keep telling him I need to go up on the Lamictal. He thinks 250mg is in the "dangerous zone" and that 400mg is only for patients with epilepsy. Damnit Jim, I'm a doctor, not a pool man. Get with it dude, I took as much as 3600mg Neurontin, I'm a high responder. I feel good after 200mg for some time, but I need more.
I know it was only recently approved (a few years back?) as a mood stabilizer, as is the trend with a few other epilepsy medications. It wasn't designed specifically for that task though, so to say that you would need an adjunct such as Lithium or Depakote to achieve maximum effectiveness would make perfect sense. It definitely gives me an antidepressant response though, in comparison with Depakote. With Depakote, I was in a stable, though negative disposition. Maybe I should try Lithium as adjunctive therapy, but I don't want my pee to smell like salt again. :-D And the days go by...
Once I reached the state of "OKness" and not total despair, books have proven to be my greatest therapy, no holds barred. "Meditation as Medicine", "The Power of Now", "Present Moment Awareness", and currently, "Emotional Longevity" (a really good one) have all taught me so much, in so many different ways. Very highly recommended. Drugs can only get you so far, and my lofty aspirations lead me to one day being able to function without medication, though I won't be upset if it doesn't happen. If you can read and it doesn't bother you, do it. Amazon has lots of good recommendations in these categories, and the reviews are always pretty accurate. See you guys.
-Charlie
Posted by wcfrench on April 19, 2003, at 13:20:44
In reply to Re: Rate Lamictal as stabilizer » Ponder, posted by wcfrench on April 19, 2003, at 13:17:27
This is the correct link:
If that doesn't work, here is a direct one:
http://www.amazon.com/exec/obidos/ASIN/0670031852/drbobsvirte00-20
-Charlie
Posted by Barbara Cat on April 19, 2003, at 14:17:00
In reply to Re: Rate Lamictal as stabilizer » Ponder, posted by wcfrench on April 19, 2003, at 13:17:27
A very hearty second on the books Charlie recommends. I've read a few on his list and they've changed my life. One other thing, Charlie, you've answered why my pee smells so weird. I also pee like a racehorse (why like a racehorse, I wonder?) since taking lithium. - BCat
> Once I reached the state of "OKness" and not total despair, books have proven to be my greatest therapy, no holds barred. "Meditation as Medicine", "The Power of Now", "Present Moment Awareness", and currently, "Emotional Longevity" (a really good one) have all taught me so much, in so many different ways. Very highly recommended. Drugs can only get you so far, and my lofty aspirations lead me to one day being able to function without medication, though I won't be upset if it doesn't happen. If you can read and it doesn't bother you, do it. Amazon has lots of good recommendations in these categories, and the reviews are always pretty accurate. See you guys.
>
> -Charlie
Posted by sac on January 9, 2004, at 12:38:23
In reply to Lamictil is NOT a mood stabilizer » Krissy P, posted by BarbaraCat on March 18, 2003, at 15:33:44
This is quite an old post but I am intrigued with this one because I have been having problems with Lamictal. I am Bipolar II and have been on Lamictal on and off (Love/Hate relationship) for the last 2 years. Sometimes, I feel good especially in the beginning of treatment, However this eventually goes away and I am left feeling depressed, apathetic, irritable, and anxious. I keep going back to lamictal because it is supposed to have a good reputation for mood stabilization with good anti-depressant action (which is my main problem.)
So why then, am I feeling so DEPRESSED? Maybe I should give up the lamictal and go for the Lithium. Any suggestions/advice would be greatly appreciated.> Krissy,
> I have to agree with Ron and Maximus here. You are not, I repeat not, on a mood stabilizer. Lamictal is tossed into that category because of it's anti-epileptic profile but it doesn't work well enough if you need something different. I know this well because I've been in a very similar place to you. I'm fine at 50mg lamictal and if I start increasing I get depressed. I'm on a tricyclic after being on all the SSRI's and SNRI's in the book. The only thing that makes everything else tie together and work is lithium. Without lithium, NOTHING works. Lithium alone does not work but it is a necessary part of my brew.
>
> I HATE taking it because it's caused my hypothyroid condition to worsen and I'm concerned about kidney problems. But I'm only taking 600mg which seems to be the magic number for me. If you have the kind of bipolar syndrome that responds best to lithium, believe me, nothing else is going to work as well. You'll continue to futz around with this med and that. They'll work for a while and then you'll get in that weird mixed hypomanic depressed place again. I can only say to give lithium a try. For what is does, nothing else does it better. After many off/on attempts I am now a greatful believer that sometimes those old fashioned meds work the best - at least for me. As far as the weight, I now feel so much better (since starting nortriptyline) that I'm inspired to exercise like mad and am getting in better shape than ever.
Posted by eugenia on January 10, 2004, at 7:31:46
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
Hi:
I had the same experience with Lamictal. Initial buzz, then depression, fatigue and PANIC. I don't think a lot of doctors know that the stuff can make a person panic. I was really disappointed, because I heard such great things about lamictal, I thought it might be my magic bullet. Oh well. Just remember to take your side effects seriously, even if they are not the norm.
Posted by Sooshi on January 10, 2004, at 9:46:05
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
Lamictal did not work for me either. Nada. Nothing.
Posted by SLS on January 10, 2004, at 9:57:31
In reply to Re: Lamictil is NOT a mood stabilizer, posted by Sooshi on January 10, 2004, at 9:46:05
If there is one thing that Lamictal is not, it is an acute anti-manic agent. It did not prevent me from having a manic reaction to changes made in my medication. However, I have read things that indicate it helps reduce rapid-cycling. When combined with lithium, it seems to. Lamictal definitely acts as a prophylactic against future depressive episodes according to the most recent studies I have read.
- Scott
Posted by wcfrench on January 10, 2004, at 11:36:44
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
What else are you taking? I'm still on Lamictal since I wrote in that post (although I don't feel as good) and I have also noticed that Lamictal without another mood stabilizer doesn't quite keep me completely stable. Tell me what else you are taking and I'll write back as soon as ya do.
Take care,
Charlie
Posted by Maxime on January 10, 2004, at 16:24:07
In reply to Re: Lamictil is NOT a mood stabilizer » BarbaraCat, posted by sac on January 9, 2004, at 12:38:23
It is a mood stabiliser if you look at the chemical properties of the med. It's similar to tegretol which is used as a stabiliser. It's also been approved by the FDA as a stabiliser.
Um, having said that it made me more depressed when I was on it (BP 1).
Maxime
LAMICTAL
Na+ channel inhibition
GLU decreased
Ca2+(N) channel inhibition
Ca2+(P) channel inhibition
Posted by Flipsactown on January 10, 2004, at 16:27:15
In reply to Re: Lamictil is NOT a mood stabilizer, posted by SLS on January 10, 2004, at 9:57:31
Scott,
I know this is off the mark, but it appears you have been around this forum a long time, so I value your opinion. Recently my pdoc gave me an rx for 300mg daily of lithium to add to my cocktail of prozac, remeron and lamictal. Although this combo does an excellent job in relieving my depression, I do notice that my depression comes back big time around 3PM-5PM. So, I am depressed until I take my remeron at bedtime. Consequently, I have been taking my remeron earlier and earlier to get some relief. Do you think that adding lithium will get me through the late afternoon? What are your thoughts?
FST
> If there is one thing that Lamictal is not, it is an acute anti-manic agent. It did not prevent me from having a manic reaction to changes made in my medication. However, I have read things that indicate it helps reduce rapid-cycling. When combined with lithium, it seems to. Lamictal definitely acts as a prophylactic against future depressive episodes according to the most recent studies I have read.
>
>
> - Scott
Posted by brussell on January 10, 2004, at 17:22:16
In reply to Re: Lamictil is NOT a mood stabilizer » SLS, posted by Flipsactown on January 10, 2004, at 16:27:15
I agree that Lamictal's effect is subtle, and I doubt it would be enough for anyone with BPI.
I have "cyclical depression" (like BPII without hypomania--cycles from dysthemia down through the seven levels of hell and back).
For me, Lamictal tends to prevent depressive episodes from spiraling out of control, and it seems to have mild AD properties. I added 25mg/day of it to the 50mg/day of Parnate I take, and it seems to improve my mood and prevent evening crashes when the Parnate wears off.
Parnate's really interesting in that respect. For me it "kicks in" soon after I take it and then the AD effect wears off until the next dose--completely unlike most ADs.
Posted by sac on January 10, 2004, at 17:24:30
In reply to Re: Lamictil is NOT a mood stabilizer » sac, posted by wcfrench on January 10, 2004, at 11:36:44
I am only taking Prozac 20mgs. now. I quit Lamictal 3 days ago but am still undecided as to what I should do. I was on Lamictal in the past for about 18 months straight and while it did keep the major depressive episodes as bay, it did so by keeping me in a low grade depressive,apathetic state. The trouble is, I only really was bothered by this feeling in the evening. In the mornings, I felt OK. I was wondering whether this had to do with the way the med is metabolized. I am very frustrated. I have been on Depakote and did great for about two months until a nasty depression (side effect I believe) made me quit that. I don't know if I gave Lithium a fair chance. I only tried it for about 1 week back in August. First of all, I was scared to go on it because of the risk with toxicity and the reputation for being hard on the kidneys, thyroid, etc. Maybe this influenced my decision to quit too soon. I just remember telling my doctor that I felt more depressed on it (300mgs) he reluctantly said OK, stop it but he is not convinced that the Lithium made me feel depressed. I see him on Monday, and I am agonizing over how I am going to explain to him that I quit my medication...Again.
> What else are you taking? I'm still on Lamictal since I wrote in that post (although I don't feel as good) and I have also noticed that Lamictal without another mood stabilizer doesn't quite keep me completely stable. Tell me what else you are taking and I'll write back as soon as ya do.
> Take care,
> Charlie
Posted by Maxime on January 10, 2004, at 19:56:04
In reply to Re: For many people, it does have MS properties., posted by brussell on January 10, 2004, at 17:22:16
Brusell - I know isn't it interesting. It has a very short half life so I suspect that is part of the reason. What I like about Parnate is that because I am bipolar, if I feel a manic episode coming on I can decrease the Parnate and I know that the decrease will have an immediate effect. It has stopped me from going into full blown mania on two occasions by doing this. No other AD will do this.
Maxime
> Parnate's really interesting in that respect. For me it "kicks in" soon after I take it and then the AD effect wears off until the next dose--completely unlike most ADs.
Posted by brussell on January 10, 2004, at 20:27:40
In reply to Re: For many people ... Parnate}} Brusell, posted by Maxime on January 10, 2004, at 19:56:04
> Brusell - I know isn't it interesting. It has a very short half life so I suspect that is part of the reason. What I like about Parnate is that because I am bipolar, if I feel a manic episode coming on I can decrease the Parnate and I know that the decrease will have an immediate effect. It has stopped me from going into full blown mania on two occasions by doing this. No other AD will do this.
>
> Maxime
>
>Wow! That's VERY interesting. I don't have any experience dealing with manic phases.
I always thought the idea with mood-stabilizers was to keep bipolar people around the "center" of their mood spectrum, which hopefully was more or less normal mood.
In my case, lamictal alone just stabilized me in a dysthemic state. I really needed a strong AD, and setting off mania was never an issue.
Do mood stabilizers work as antidepressants for people with BPI and II? What do people with Bipolar Disorder do when deeply depressed? Are lithium and Depakote the only options?
Thanks a lot for any answers you can give me.
Posted by Patient on January 11, 2004, at 10:23:18
In reply to Re: Lamictil is NOT a mood stabilizer » SLS, posted by Flipsactown on January 10, 2004, at 16:27:15
The mood stabilising agents are lithium, valporic acid, and carbamzepine. Newer drugs are actually anticonvulsants used to treat epilepsy. Okay, we know all that.
The newer drugs used for treating bipolar illness "include the three mood stabilisers listed above, seem to stimulate the transmitter 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 catagory include valporic acid, as well as gabapentin (Neurontin), tiagibine (Gabitril), vigabatrin (Sabril), and several others. The anticonvulsants that inhibit glutamate tend to cause stimulation and anxiety. Medications in this catagory include felbamate (Felbatol), lamotrigine (Lamictal), topirimate (Topamax), and several others." Quote from "Feeling Good"
I would think that if Lamictil wasn't helping, then try something from the other catagory that stimulates GABA.
Posted by Maxime on January 11, 2004, at 10:59:23
In reply to Re: Question about Bipolar disorder » Maxime, posted by brussell on January 10, 2004, at 20:27:40
> > Brusell - I know isn't it interesting. It has a very short half life so I suspect that is part of the reason. What I like about Parnate is that because I am bipolar, if I feel a manic episode coming on I can decrease the Parnate and I know that the decrease will have an immediate effect. It has stopped me from going into full blown mania on two occasions by doing this. No other AD will do this.
> >
> > Maxime
> >
> >
>
> Wow! That's VERY interesting. I don't have any experience dealing with manic phases.
>
> I always thought the idea with mood-stabilizers was to keep bipolar people around the "center" of their mood spectrum, which hopefully was more or less normal mood.
>
> In my case, lamictal alone just stabilized me in a dysthemic state. I really needed a strong AD, and setting off mania was never an issue.
>
> Do mood stabilizers work as antidepressants for people with BPI and II? What do people with Bipolar Disorder do when deeply depressed? Are lithium and Depakote the only options?
>
> Thanks a lot for any answers you can give me.
>
Hi there.You are right about mood stabilisers ... they are suppose to keep one more level. The reason I go hypomanic/manic is because I haven't found the right stabiliser yet. Right now I am increasing my trileptal slowly so hopefully it will work. It doesn't seem to be that the Parnate is making me manic (which happened with so many other meds).
I think lithium is the best for BP. It wards off deep depression and mania. I don't know if Depakote is as good for depression. I am allergic to depakote and I go toxic on any amount of lithium.
I know some people with BP who only take an anti-depressant when depression hits. I have to take one all the time otherwise I slide into a deep depression. Wellbutrin seems to a common AD for people with BP (but it made me psychotic).
The only mood stabilisers I have heard working as anti-depressants are lithium and lamictal. Zyprexa is used as a mood stabiliser for people with BP and some have claimed it keeps depression at bay.
Maxime
Posted by wcfrench on January 12, 2004, at 0:54:15
In reply to Re: Question about Bipolar disorder}}Brusell, posted by Maxime on January 11, 2004, at 10:59:23
Lamictal never helped me stabilize my mood from the highs or deep lows (the scary suicidal lows). Depakote is the only thing that has worked for me, Lithium didn't do much at all.
Lamictal helped me with bipolar depression only, and was one of the only adjuncts that really fit the spot, although I have never tried MAOI. Depakote is a life-saver.
Sac I know for a fact that too much Lamictal combined with an AD can have adverse effects. It has such definite AD properties that it would cause me to be more depressed if I took too much of it. (which is what happens with SSRIs for me)
Someone else wrote that they feel worse at night... I was writing that on here a while back, and the Lamictal was always the cause for me. It wears off in 5-6 hours for me, without fail.
Any BPII on Nardil/Parnate have better response than with TCA or SSRI/NRI? I tried both of the latter and TCAs did not work out- too strong or something, just didn't click. Anyway I think I need something else, or I need therapy.
Posted by Flipsactown on January 19, 2004, at 11:36:15
In reply to Re: Lamictil is NOT a mood stabilizer » SLS, posted by Flipsactown on January 10, 2004, at 16:27:15
Scott,
Attached is the earlier post I was referring to.
Regarding your current questions, my pdoc is not much of a help to me as it appears that I am doing all the research. He pretty much goes along with my suggestions which I pick up mostly from this board. My pdoc did suggest taking the lamictal 3 times daily versus 2 times which help some but the biggest concern I have is that when my depression returns like from 3PM to 6PM, it returns big time until I take the remeron which I have been taking earlier and earlier. And the lithium? Yes, it was my idea and so was the rest of my meds. This is the same pdoc who required me to sign a liability waiver if I were to die taking lamictal. My pdoc stated that it would take a couple of weeks before the lithium would kick in and possibly longer until we got the blood levels worked out. How would the stimulant, Adderal, help with my depression? And yes, I would consider taking it if it will rid me of the depression.
Flipsactown
> Scott,
>
> I know this is off the mark, but it appears you have been around this forum a long time, so I value your opinion. Recently my pdoc gave me an rx for 300mg daily of lithium to add to my cocktail of prozac, remeron and lamictal. Although this combo does an excellent job in relieving my depression, I do notice that my depression comes back big time around 3PM-5PM. So, I am depressed until I take my remeron at bedtime. Consequently, I have been taking my remeron earlier and earlier to get some relief. Do you think that adding lithium will get me through the late afternoon? What are your thoughts?
>
> FST
>
>
>
> > If there is one thing that Lamictal is not, it is an acute anti-manic agent. It did not prevent me from having a manic reaction to changes made in my medication. However, I have read things that indicate it helps reduce rapid-cycling. When combined with lithium, it seems to. Lamictal definitely acts as a prophylactic against future depressive episodes according to the most recent studies I have read.
> >
> >
> > - Scott
>
>
Posted by terrics on January 19, 2004, at 17:09:11
In reply to Re: Lamictil is NOT a mood stabilizer, posted by SLS on January 10, 2004, at 9:57:31
Yes, lamictal is a mood stabilizer. But its first use is for seizures. My pdoc wanted me to be in a study on lamictal because it had a severe skin side effect that is supposedly being worked out. I said no to the study because I would have to come off lithium and the lithium helps me alot. terrics
Posted by HenryO on January 19, 2004, at 19:52:09
In reply to Re: Lamictil is NOT a mood stabilizer, posted by terrics on January 19, 2004, at 17:09:11
Yeah, what he said. Yes, lamictal is a mood stabilizer.
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