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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 2 to 26 of 26. Go back in thread:
Posted by Dinah on June 25, 2005, at 11:05:28
In reply to Sleeping constantly. Strong suicidal ideation with, posted by Dinah on June 25, 2005, at 10:42:11
I'm just ignoring it, except for the sleepiness. I can't seem to combat that overwhelming sleepiness that is pitching me headfirst into sleep after a few hours of wakefulness.
And I just had to change that paragraph several times for word substitution problems. :(
I really can't see two small 25 mg doses over two days having that effect. So it must just be a sudden mood shift, right?
Posted by SLS on June 25, 2005, at 14:35:50
In reply to P.S., posted by Dinah on June 25, 2005, at 11:05:28
> I'm just ignoring it, except for the sleepiness. I can't seem to combat that overwhelming sleepiness that is pitching me headfirst into sleep after a few hours of wakefulness.
>
> And I just had to change that paragraph several times for word substitution problems. :(
>
> I really can't see two small 25 mg doses over two days having that effect. So it must just be a sudden mood shift, right?Lamictal often makes people sleepy early in treatment. However, I don't really know that it is depressogenic. We both know that these powerful psychotropic drugs can have varying effects in each individual. It is very possible that the initial exposure to Lamictal has temorarily destabilized your system. It is trying to act as an antidepressant and mood-stabilizer at the same time.
Hang in there. Give Lamictal a chance. You are bipolar. You gotta expect bipolar stuff to happen from time to time. It would be difficult to say for certain what's going on. The only thing I can say is that it is my belief that your mood-shift is biological and not situational.
Try to relax and go with the flow. Recognize your biological mood-shift as being just that - biological. Don't feed into it. Instead, use your coping tools to compensate for it.
With much love and respect.
- Scott
Posted by Dinah on June 25, 2005, at 16:53:49
In reply to Re: P.S. » Dinah, posted by SLS on June 25, 2005, at 14:35:50
Thanks Scott. I'll try to hang in there.
The sleepiness is tough, though. It's not as bad as Remeron, but bad enough. I'll try to gut it out. Not that sleeping is altogether unpleasant. :) I just didn't expect it.
I'll try to arrange not to drive, because it's a bit scary then.
The suicidal ideation does feel purely biological. I 'm not paying it too much attention other than to note it.
I was supposed to skip a day between pills, and got my days wrong and didn't. Maybe at every other day for two weeks it'll be acceptable.
You're a doll, you know.
Posted by Spriggy on June 25, 2005, at 16:55:13
In reply to Re: P.S. » Dinah, posted by SLS on June 25, 2005, at 14:35:50
First of all, I am sorry you are feeling this way. it's just miserable! I know..
I started Lamictal very slowly (at 12.5 mg's) and still noticed some effects (I had increased anxiety and swallowing problems). So I think it could possibly be the meds. I would give it at least 2-3 weeks, if this continues, tell your doctor.
Maybe you could start out slower.
I hope you feel better soon.
((((hugs))))
Posted by Dinah on June 25, 2005, at 17:07:00
In reply to Re: P.S., posted by Spriggy on June 25, 2005, at 16:55:13
Thanks Spriggy. I've been awake an entire two hours and feel like I'm ready to fall face down again.
I'm not sure I *have* two weeks to spare. I'm behind on my work so far, and I don't think my bosses will see this as an adequate excuse to sleep away my work time. :(
Posted by Ron Hill on June 25, 2005, at 18:59:15
In reply to Sleeping constantly. Strong suicidal ideation with, posted by Dinah on June 25, 2005, at 10:42:11
Dinah,
I'm so sorry you are having a hard time. I've always admired your passion and your giving spirit. You like to cheer for the underdog, don't you? Dinah, I want to help you if I can.
I've read so many of your posts over the years, that I feel like I know you fairly well. As an aside, do you have pictures in your mind of certain people on the boards? My picture of you has always been of an attractive lady in her late twenties, about 5'4'' and 125 lb, full of energy and passion, working at a computer in her cubicle at her job where she is an energizer bunny getting lots done and keeping harmony within the office with her fun loving spirit of encouragement.
When I see your posts it’s usually over on admin. I don't see you here on the med board very often. Therefore, I know very little about your dx and meds. From Scott's post on this thread, it appears that you are bipolar. Do you mind telling me your full dx (i.e.; BP II plus what else)? Also, please list your current meds and dosages. Are you satisfied with your current pdoc?
Symptoms of atypical depression can include low motivation, anergy (i.e.; low physical and mental energy), anhedonia, mood reactivity (i.e.; situational changes can temporarily alter the severity of the depression), hypersomnia, hyperphagia, leaden paralysis, and rejection sensitivity. Would you characterize your depression as the atypical variety? Which aspect of your bipolar disorder is more problematic, depression or hypomania?
I don't want to wear you out with my questions, but if you can, I'd also like to know how long you have been taking p-meds and what meds you have tried in the past. If you don't have the energy to answer all my questions, I understand.
Lastly, is your tiredness a “sleepy-tiredness” or is it also a lethargy that makes it very difficult to do anything? Does your energy return after you take a nap?
I’m going out of town, so it will likely be a few days before I get back to you.
Be well my friend.
-- Ron
BP II and OCPD
600 mg/day Lithobid
900 mg/day Trileptal
50 mg/day Lamictal
5 mg/day Deprenyl (as tx for atypical depression)
Posted by Jen Star on June 25, 2005, at 19:01:10
In reply to Sleeping constantly. Strong suicidal ideation with, posted by Dinah on June 25, 2005, at 10:42:11
hi Dinah,
I'm sorry you're feeling this way! I hope it gets better soon.It COULD be the meds...right? I know it was only 2 days (2 pills) but some meds can be very powerful.
Is the ideation just thoughts or do you feel compelled to act on it? Please let us know if you need help. I really care about you & don't want you to hurt yourself!
take care,
JenStar
Posted by Phillipa on June 25, 2005, at 19:13:35
In reply to Re: Sleeping constantly. Strong suicidal ideation with » Dinah, posted by Jen Star on June 25, 2005, at 19:01:10
Even I know it's unusual to see you hear. Try and rest this weekend, and don't hesitate to call the doctor. As Bob to let you have some time off. You do a wonderful job. Fondly, Phillipa
Posted by emme on June 25, 2005, at 23:02:38
In reply to Sleeping constantly. Strong suicidal ideation with, posted by Dinah on June 25, 2005, at 10:42:11
Hi Dinah,
> feelings of impending doom, nonspecific. For a couple of days now. I was feeling pretty good, looking forward to going to school before that. Now the idea of school seems both uninteresting and stupid.
>
> I just started 25 mg of Lamictal, two days in a row.
>
> That can't be the cause, can it?
>
> There are no life circumstances that can be causing it either, as far as I can see.
>
> Is this just one of those things? Just a sudden mood crash?About whether Lamictal is making you more depressed - anything is *possible*. But you may be having a mood shift unrelated to your starting Lamictal. I agree with Scott that it sounds awfully biological.
If you think the Lamictal is making you tired, you might consider a lower starting dose and slower titration. Has your pdoc given you any options to offset the sleepiness? Provigil?
I'm sorry you are feeling so bad. I do hope the cloud lifts soon.
em
Posted by gardenergirl on June 26, 2005, at 0:23:13
In reply to Re: P.S. » Dinah, posted by SLS on June 25, 2005, at 14:35:50
>
> Lamictal often makes people sleepy early in treatment. However, I don't really know that it is depressogenic.I've been on Lamictal for just over four weeks now. I've been much sleepier during the day, even taking naps in my office. (drooled on a pillow!) Right now I take 25 mg in a.m. and 50 mg at night. Any way to effect the sleepiness by changing how I take it?
I was attributing my increased need for sleep to my thyroid possibly being off. I think my doc cut thyroid med too much when my last labs came back with a very high T3. sigh But it could be the lamictal.
gg
Posted by gardenergirl on June 26, 2005, at 0:25:16
In reply to Sleeping constantly. Strong suicidal ideation with, posted by Dinah on June 25, 2005, at 10:42:11
Dinah,
I did not have such a strong reaction to 25 mg Lamictal, but as Scott said, meds can affect everyone so differently.Sleep can be such a wonderful coping mechanism. I'm glad you can take advantage of it, and I hope it's not interfering with work too much.
And I'm glad you are able to look at your ideation from an observer's standpoint (i.e. "it feels biological.") That is a very positive sign.
Hang in there, sweetie.
gg
Posted by iforgotmypassword on June 26, 2005, at 3:55:54
In reply to Re: Sleeping constantly. Strong suicidal ideation with » Dinah, posted by Ron Hill on June 25, 2005, at 18:59:15
there don't appear to be many doctors that actually believe atypical depression is a real illness and worth treating. i live in ottawa, ontario. i hope that she does not live anywhere near here. but maybe with obvious bipolar symptomology... i don't know what i'm talking about.
Posted by SLS on June 26, 2005, at 7:18:13
In reply to Lamictal and sleepiness » SLS, posted by gardenergirl on June 26, 2005, at 0:23:13
Hi there, GardenGirl.
> > Lamictal often makes people sleepy early in treatment. However, I don't really know that it is depressogenic.
> I've been on Lamictal for just over four weeks now. I've been much sleepier during the day, even taking naps in my office. (drooled on a pillow!) Right now I take 25 mg in a.m. and 50 mg at night. Any way to effect the sleepiness by changing how I take it?Although I have been somewhat surprised to see this, people are beginning to take Lamictal only once a day in the evening.
> I was attributing my increased need for sleep to my thyroid possibly being off. I think my doc cut thyroid med too much when my last labs came back with a very high T3. sigh But it could be the lamictal.
Ah. Difficult to guess which is which. When did you make the dosage change? Did you experience heart palpitations, increased heart rate, heat intolerance, or anxiety before lowering the T3? How about now? Fatigue and cold intolerance? Muscle aches?
I would guess that it would be the Lamictal that is causing the sleepiness, perhaps aggravated by a loss of T3 that the body has yet to fully compensate for.
I hope you are able to complete your titration of Lamictal to fully explore its potential therapeutic value to you.
- Scott
Posted by Dinah on June 26, 2005, at 8:55:45
In reply to Re: Sleeping constantly. Strong suicidal ideation with » Dinah, posted by Ron Hill on June 25, 2005, at 18:59:15
> Dinah,
>
> I'm so sorry you are having a hard time. I've always admired your passion and your giving spirit. You like to cheer for the underdog, don't you? Dinah, I want to help you if I can.Thanks, Ron. That means a lot coming from you.
>
> I've read so many of your posts over the years, that I feel like I know you fairly well. As an aside, do you have pictures in your mind of certain people on the boards? My picture of you has always been of an attractive lady in her late twenties, about 5'4'' and 125 lb, full of energy and passion, working at a computer in her cubicle at her job where she is an energizer bunny getting lots done and keeping harmony within the office with her fun loving spirit of encouragement.Chuckle. I hate to disillusion you, but...
5"7" nearly 200 lb, with as little energy as anyone could possibly have and live, working on a computer from home and avoiding anyone from work like the plague because I'm so far behind. Truth be told, I used to be a great employee, eight years ago, and I keep longing for my days of glory.
>
> When I see your posts it’s usually over on admin. I don't see you here on the med board very often. Therefore, I know very little about your dx and meds. From Scott's post on this thread, it appears that you are bipolar. Do you mind telling me your full dx (i.e.; BP II plus what else)? Also, please list your current meds and dosages. Are you satisfied with your current pdoc?He's ok. He doesn't scare me, and he doesn't push drugs at me. After previous pdocs that's enough.
Ok, more than you ever wanted to know about Dinah:
He's formally diagnosed me as cyclothymic and OCD. I have been hypomanic, almost always in response to medication changes or sleep deprivation. In general, my highs are below hypomanic, and take the form of "enthusiasms" about this or that.
I've also got health conditions that affect or are affected by stress and mental health concerns. Diabetes (controlled by Glucophage), migraines, and IBS. Oh, and the neurologist is sure I have narcolepsy, but I don't necessarily agree. I'm not sure my "involuntary naps" or "forgetting sleeps" aren't psychological.
After a nasty postpartum depression, I was put on Luvox for OCD and depression. I don't do overly well on antidepressants, and while I got better some ways I got worse others (started self injury etc.). The response was more and different AD's until I was in agitated hypomanic h*ll on Wellbutrin and maximum Luvox, to the point I was suicidal. The pdoc blew up, blaming me. I had enough self respect to give him the boot. I found my current pdoc, who immediately put me on a mood stabilizer. I had stopped the Wellbutrin on my own. Eventually I quit the Luvox, leaving me just on Depakote (very low dose) and Klonopin (1 mg). There were some short trials of other AD's. Remeron put me out for a weekend. Nortriptyline and Effexor sent me into hypomania like Wellbutrin. I discovered that the occasional Risperdal was very good for my anxiety.
My migraine doctor upped the Depakote to unacceptable levels, side effect wise (too sleepy), and took me off it mid to late May to start me on Topomax. But since I've had kidney stones she said I couldn't have that and used Lamictal instead.
Off the Depakote, I pretty much returned to my unmedicated state, which at present I think is vastly superior to medicated. I felt fine during the day, and had trouble with waking up at 4 am (daylight savings time, 3 am regular) with anxiety. I'd be up ten minutes sometimes, two hours others, then back to sleep. My migraines were no different than on Depakote. Sounds pretty good to me right now.
> Symptoms of atypical depression can include low motivation, anergy (i.e.; low physical and mental energy), anhedonia, mood reactivity (i.e.; situational changes can temporarily alter the severity of the depression), hypersomnia, hyperphagia, leaden paralysis, and rejection sensitivity. Would you characterize your depression as the atypical variety? Which aspect of your bipolar disorder is more problematic, depression or hypomania?
>
I always think of my main problem as being more anxiety than depression, though I've had bouts of major depression. I do have mood instability. Including despair and suicidal ideation at times, and "enthusiasms" at other times. I'm not sure about atypical. My downs are not the same from one time to the next. Sometimes they're more agitated, sometimes more apathy and leadenness. Always there is rejection sensitivity, but I'm guessing that's psychological in cause.Oh, and this is purely speculative, but so much of what's wrong with me, including some very silly minor things that are nonetheless interesting, can be traced to the cholinergic/adrenergic system. What possible treatment value that can have, I'm not sure.
> I don't want to wear you out with my questions, but if you can, I'd also like to know how long you have been taking p-meds and what meds you have tried in the past. If you don't have the energy to answer all my questions, I understand.
>
You caught me when I was first up. :) Plus I didn't take any Lamictal yesterday. I'm supposed to be taking it every other day.> Lastly, is your tiredness a “sleepy-tiredness” or is it also a lethargy that makes it very difficult to do anything? Does your energy return after you take a nap?
The last two day's it's been a fall on your face, sleepy tiredness, that makes driving downright dangerous if it hits then. When I'm awake I feel all right. But then, wham. I've been sleeping hours at a time, then up for a couple of hours, then out again.
>
> I’m going out of town, so it will likely be a few days before I get back to you.
>
> Be well my friend.Thanks for your interest Ron. I think you know all there is to know about me now. :)
Hmmm... Except that I am "exquisitely sensitive" as my pdoc puts it, to medications. I think that may be his word for a big ole hypochondriac about side effects. lol.
Posted by Dinah on June 26, 2005, at 9:02:46
In reply to unfortunately, where i live... » Ron Hill, posted by iforgotmypassword on June 26, 2005, at 3:55:54
I'll be ok. I'm just ignoring the thoughts, although they can be a bit annoying.
The sleepiness was despite Provigil (which I take as needed, and boy, was it needed). Without that, I wonder if I would have been up at all yesterday?
It's partly my fault. I was supposed to start at 25 mg every other day, but when I wrote down the first day I took it, on Thursday, I was positive I had taken it the day before. I am a positive idiot about time. I had actually taken it for the first time Thursday, then again on Friday. So I'll go back to every other day for the first two weeks.
But it did surprise me. I hadn't read that Lamictal was known for sleepiness and wasn't expecting it. So I wasn't altogether sure whether or not to blame the Lamictal for keeling over off and on for two days and counting. I feel like testing it by going off it until I feel normal again, then starting it and see if the sleepiness comes back.
But I really like my migraine doctor and have this uncharacteristic desire to be compliant, so I suppose I'll take it again today like I'm supposed to. :(
Posted by SLS on June 26, 2005, at 9:58:24
In reply to Re: Sleeping constantly. Strong suicidal ideation » Ron Hill, posted by Dinah on June 26, 2005, at 8:55:45
Is verapamil still used for migraines? It is a calcium channel blocker antihypertensive with some mild mood-stabilizing qualities and migraine prophylaxis.
- Scott
Posted by gardenergirl on June 26, 2005, at 10:11:07
In reply to Re: Lamictal and sleepiness, posted by SLS on June 26, 2005, at 7:18:13
>>
> Although I have been somewhat surprised to see this, people are beginning to take Lamictal only once a day in the evening.Now that you mention this, I think my pdoc said to take it all at night if it made me sleepy.
>
>
> Ah. Difficult to guess which is which. When did you make the dosage change? Did you experience heart palpitations, increased heart rate, heat intolerance, or anxiety before lowering the T3? How about now? Fatigue and cold intolerance? Muscle aches?I initially took myself to 100 mg Synthroid for about a week before he called in a prescription for 75 mg after (FINALLY!) reading and reacting to my lab results. I actually had to call them, even though the T3 and TSH numbers were way out of line. Imagine! I was having a lot of heat intolerance, but I didn't really notice any other symptoms, which was surprising. Now I feel sluggish, I bounce back and forth between being overly warm and being cold but then again it's 90+ outside, and air conditioner can feel chilly to me at times. Some muscle aches, but I can attribute them to overuse and/or I think I also developed plantar fasciitis in the same foot I broke my toe in. :(
>
Thanks for your input. I am hoping Lamictal works well for me, too. I'm not quite ready to drop to 45 mg Nardil, but hopefully in a couple of weeks.gg
Posted by Dinah on June 26, 2005, at 11:13:16
In reply to Re: Sleeping constantly. Strong suicidal ideation » Dinah, posted by SLS on June 26, 2005, at 9:58:24
I haven't mentioned it to my neurologist.
I suggested it years ago to my psychiatrist when Mouse was having such good results from it. He said no, that it would not be good for me in my job. He didn't elaborate much on that, but I got the idea that he thought it would dull my cognitive abilities?
Posted by Dinah on June 26, 2005, at 12:03:06
In reply to Re: Sleeping constantly. Strong suicidal ideation » SLS, posted by Dinah on June 26, 2005, at 11:13:16
Now I've read the prescribing info, I think I'm nuts to even try it.
I think maybe I shouldn't read about medications. :(
Posted by SLS on June 26, 2005, at 15:03:54
In reply to Good grief, posted by Dinah on June 26, 2005, at 12:03:06
> Now I've read the prescribing info, I think I'm nuts to even try it.
>
> I think maybe I shouldn't read about medications. :(
I really am not that familiar with verapamil. You know that every drug monograph describes a plethora of side effects, many of them having nothing to do with the drug itself. However, it is always reassuring to speak to someone who actually uses the stuff: either the clinician or the patient.What is it about verapamil that you find disturbing?
- Scott
Posted by Dinah on June 26, 2005, at 18:32:34
In reply to Re: Good grief » Dinah, posted by SLS on June 26, 2005, at 15:03:54
It was Lamictal I was reading about. :)
But...
I'm coming down with a cold or flu, so maybe that accounts for some of the feeling awful.
Posted by Maxime on June 26, 2005, at 22:37:42
In reply to Sleeping constantly. Strong suicidal ideation with, posted by Dinah on June 25, 2005, at 10:42:11
Hi there. I haven't read through the responses, so I am sorry if I am being redundant. But Lamictal made me VERY depressed. At fist I couldn't believe it was the med because I had heard so many positive things about thing about it. But when I stopped it, it went away and I switched to Trileptal. No problems. :)
Maxime
> feelings of impending doom, nonspecific. For a couple of days now. I was feeling pretty good, looking forward to going to school before that. Now the idea of school seems both uninteresting and stupid.
>
> I just started 25 mg of Lamictal, two days in a row.
>
> That can't be the cause, can it?
>
> There are no life circumstances that can be causing it either, as far as I can see.
>
> Is this just one of those things? Just a sudden mood crash?
Posted by Racer on June 26, 2005, at 23:23:24
In reply to Re: Good grief » SLS, posted by Dinah on June 26, 2005, at 18:32:34
Dinah, did you read Larry Hoover's description of when he was in a drug trial? He had just stopped taking anti-depressants, and as a result, the study showed that the drug involved could be associated with increased depression. Not because that drug actually affected his mood, but because he wasn't taking the AD anymore. Stats showed that one participant experienced depressed mood.
That's a story I keep in mind when I read side effects. It helps me. I hope it helps you, too.
Since we're partners in that fatigue thing, I wish you the very best in getting it fixed.
Posted by Dinah on June 27, 2005, at 18:55:16
In reply to Re: Sleeping constantly. Strong suicidal ideation » Dinah, posted by Maxime on June 26, 2005, at 22:37:42
That's good to know, Maxime. That my reaction isn't unheard of.
I didn't take the latest dose, because I really can't afford to be down for the count until after payday. Maybe this weekend I'll give it another try.
The suicidal thoughts are gone, or seem to be. But I'm still feeling tearful and a bit irritable. Not really like me at all. Who knows the cause. But I'll have a better idea if I stop the medication then start again next weekend.
Posted by Dinah on June 27, 2005, at 18:57:47
In reply to Re: Good grief » Dinah, posted by Racer on June 26, 2005, at 23:23:24
I know the drug can't be as bad as the prescribing information would indicate. No one would ever take it! :)
The fatigue is a big problem for me. I generally blame diabetes or my migraines or emotional upset. But this was like being hit over the head with a frying pan, even with taking provigil.
I so want to be the employee I used to be. I so want to be the me I used to be. Believe me, I'm not reaching all that high. (smile)
This is the end of the thread.
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