![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by gardenergirl on October 8, 2006, at 21:06:59
Current meds:
200 mg Provigil for ADHD (modestly effective for ADHD, but helps me with sleep cycle)52.5 mg Nardil for atypical depression
125 mg Lamictal to augment Nardil since I can't tolerate doses higher than 67.5 mg. And I'm not thrilled with side effects even at 60 mg.
When I went from 100 mg Lamictal to 125 mg, I was extremely irritable for about 2 weeks. It's smoothed out a lot, but I still feel more on the irritable side than my normal. I'm not sure if I'm in one of those in-between doses where I don't have enough to help, but I have too much to feel "okay" as it is, or if maybe Lamictal is not for me afterall.
Pdoc 1 said to increase to 150 mg, and if I get irritable again, to taper back down to 100 mg. Considering I see new pdoc in 10 days, I wonder if it's worth trying that.
Given that I'm seeing new doc in 10 days, should I try 150 mg, stay at 125 mg, or go back down to 100 mg (a dose that did not increase irritability, but may not have helped depression enough)?
I'm inclined to leave it alone, but anyone have suggestions?
Thanks
gg
Posted by Phillipa on October 8, 2006, at 21:32:17
In reply to fired pdoc 1, see new 10-20. Advice til then?, posted by gardenergirl on October 8, 2006, at 21:06:59
GG if you said you felt better at l00mg why not that? Love Phillipa
Posted by gardenergirl on October 8, 2006, at 22:00:14
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » gardenergirl, posted by Phillipa on October 8, 2006, at 21:32:17
I don't consistently feel better. I recently put all my CEDS scores into a spreadsheet and graphed the totals. There is a clear pattern of times when I appear to be less depressed and times when I seem much worse. I know that with recurrent depression there will always be depressive episodes. But I don't think I'm getting the relief and stability I had in the past. Or maybe I never did have enough. I also feel that it's been so long since I've been on Nardil that I don't remember well enough what it was like before. I can't tell anymore that it's making a difference. And I think that's significant.
gg
Posted by Phillipa on October 8, 2006, at 22:05:03
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » Phillipa, posted by gardenergirl on October 8, 2006, at 22:00:14
GG yes you're so right. Get that pdoc appointment ASAP. And I know you will find the right solution for you. Love Phillipa
Posted by willyee on October 8, 2006, at 23:26:32
In reply to fired pdoc 1, see new 10-20. Advice til then?, posted by gardenergirl on October 8, 2006, at 21:06:59
I am generaly surprised at the success of the drug,i resonded to it in nothing but a negative way.
I remeber it darkened my mood,made my ocd seem worse,and overall made me feel horrable.
I keep quiet and in awe as i see how many people use it,but i know for a fact it wasnt for me.
Then again i find a high dose of Nuerontion soooo soothing when my mind simply runs rampid.
I have built a new respect for the drug,and definatly appreciate it.
I say this because so many call it the sugar pill etc,well i know it sure aint a sugar pill for me,not at all.
Id stick to where i am and see the new doc.
Posted by Racer on October 9, 2006, at 1:16:56
In reply to fired pdoc 1, see new 10-20. Advice til then?, posted by gardenergirl on October 8, 2006, at 21:06:59
>
>
> Pdoc 1 said to increase to 150 mg, and if I get irritable again, to taper back down to 100 mg. Considering I see new pdoc in 10 days, I wonder if it's worth trying that.
>
> Given that I'm seeing new doc in 10 days, should I try 150 mg, stay at 125 mg, or go back down to 100 mgActually, I'd suggest trying the 150mg for those ten days. That way, you'll have a pretty good idea of whether or not Lamictal is your friend at 150mg, and you'll save that experiment. Does that make sense?
For what it's worth, although Lamictal ultimately wasn't for me, the few days after I hit 150 were great. Even if it's not for you long term, at least you might get a few really good days out of it!
Hope that helps.
Posted by SLS on October 9, 2006, at 5:38:21
In reply to fired pdoc 1, see new 10-20. Advice til then?, posted by gardenergirl on October 8, 2006, at 21:06:59
Racer's idea is an interesting one. Lamictal clears the body pretty quick. Divide your doses into 50mg t.i.d. If you react REALLY badly to it, you can simply skip the next two doses and return to 50mg b.i.d. I actually think Lamictal should be taken in divided doses. If you are not doing that already, give it a try. It might smooth things out. I take 150mg as 75mg b.i.d.
Have you tried Parnate, Marplan, or Effexor? Those are the drugs one would naturally ask about given your partial response to Nardil.Lyrica is an interesting drug. It is anxiolytic, antidepressant, and pro-social. We just don't know how persistent these benefits are yet. Despite my ultimate failure to respond continuously to it, I did have a positive reaction to it at 225mg. I am dubious that it is necessary to go up to the 600mg that others have claimed. It is probably a very safe drug in the same family as Neurontin. It is a drug that can produce some sleepiness or sedation, or even feelings of mild intoxication in the beginning (thus its status as a C IV substance), but this wears off. For me, some mild constipation and slight weight gain have been the only side effects I have encountered otherwise. You might want to keep your eye on this one.
- Scott
Posted by Meri-Tuuli on October 9, 2006, at 8:48:14
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » Phillipa, posted by gardenergirl on October 8, 2006, at 22:00:14
Hey GG!
> I don't consistently feel better. I recently put all my CEDS scores into a spreadsheet and graphed the totals.
Wow, thats organised!! I wish I could be like that - I have a really hard time trying to objectify my feelings, in terms of better/worse....
>I can't tell anymore that it's making a difference. And I think that's significant.
IMHO, I wouldn't change the nardil (or whatever it was that you can't remember what it was like before) as long as the s/e are bearable....I have made the mistake in the past where I thought a med wasn't working, or it wasn't working enough... and dropped it, quickly to rebound into depression again...and ending up wishing I hadn't changed it!
I think it shows that the drug is working.
Kind regards
Meri
Posted by SLS on October 9, 2006, at 9:06:38
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » gardenergirl, posted by Meri-Tuuli on October 9, 2006, at 8:48:14
> Hey GG!
>
> > I don't consistently feel better. I recently put all my CEDS scores into a spreadsheet and graphed the totals.
>
> Wow, thats organised!! I wish I could be like that - I have a really hard time trying to objectify my feelings, in terms of better/worse....
>
> >I can't tell anymore that it's making a difference. And I think that's significant.
>
> IMHO, I wouldn't change the nardil (or whatever it was that you can't remember what it was like before) as long as the s/e are bearable....I have made the mistake in the past where I thought a med wasn't working, or it wasn't working enough... and dropped it, quickly to rebound into depression again...and ending up wishing I hadn't changed it!
I think the problem is that the Nardil is working, but only partially. GG appears to be undermedicated. When she attempts to increase to a dosage that would produce a robust antidepressant response, side-effects preclude its continuation. So, the choice is to either continue a life being chronically undermedicated or to explore other treatments, understanding that there will be most assuredly a period of an increase in the severity of depressive symptoms. Hopefully, the Lamictal will allow her to feel better at her current dosage of Nardil, or perhaps even allow for a reduction. I guess it is possible. There is always Lyrica to add. There should be no contraindications with simply adding it. Provigil either. I guess I am just frustrated to hear that anyone should have to settle for something substantially less than remission. I should talk, though. I'd be happy with 50%. At least I could return to work.GG, is it edema that prevents you from going higher with the Nardil?
- Scott
Posted by gardenergirl on October 11, 2006, at 15:18:20
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » gardenergirl, posted by Phillipa on October 8, 2006, at 22:05:03
Posted by gardenergirl on October 11, 2006, at 15:20:10
In reply to Re: fired pdoc 1, see new 10-20. Advice til then?, posted by willyee on October 8, 2006, at 23:26:32
Thanks, willyee. I'm glad you found good results in neurontin. So many different folks, so many different responses. It would be nice if we could predict better and not have to go through the trials of meds that don't help or even make us worse.
take care,
gg
Posted by gardenergirl on October 11, 2006, at 15:25:46
In reply to Re: fired pdoc 1, see new 10-20. Advice til then?, posted by Racer on October 9, 2006, at 1:16:56
> Actually, I'd suggest trying the 150mg for those ten days. That way, you'll have a pretty good idea of whether or not Lamictal is your friend at 150mg, and you'll save that experiment. Does that make sense?Yep, that makes a lot of sense. Still, I'm torn. So far, I've left things as they are (125 mg). I hate decisions like this. It seems so simple. Bah.
>
> For what it's worth, although Lamictal ultimately wasn't for me, the few days after I hit 150 were great. Even if it's not for you long term, at least you might get a few really good days out of it!Could be. Funny thing is, I've been feeling pretty good for the last couple of days. It's hard to sort out why that might be. I had my Indy ride last weekend (total blast!) and a good session in therapy Monday. Both could be contributing to me feeling better, especially therapy. Though in a couple more weeks, I'll have to factor in how ending therapy might be affecting my mood. (EEK!)
So I think what you say makes sense. I'm scared to rock the boat, though.
>
> Hope that helps.thanks,
gg
Posted by gardenergirl on October 11, 2006, at 15:37:20
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » gardenergirl, posted by SLS on October 9, 2006, at 5:38:21
> Racer's idea is an interesting one. Lamictal clears the body pretty quick. Divide your doses into 50mg t.i.d. If you react REALLY badly to it, you can simply skip the next two doses and return to 50mg b.i.d.
I never thought of taking it tid. At the moment, I take 75 mg in the a.m. and 50 mg in the p.m. I already take Nardil tid, so rearranging the Lamictal schedule would be pretty easy. Although I take the last Nardil at about 10:00 p.m. Would taking Lamictal that late disrupt sleep? Or I could try 75 bid as you do.
>
>
> Have you tried Parnate, Marplan, or Effexor? Those are the drugs one would naturally ask about given your partial response to Nardil.I haven't tried any of these. Old pdoc and I discussed Parnate, but at the time it was not a good idea to go through the stuff associated with washing out Nardil and switching to Parnate. It still feels risky, since I'm hittin major crunch time with a very important deadline (that which shall not be named, lol). I'd hate to lose any more ground on that. But then, if I had a good response, I might be zooming away on it in no time. Ack! What to do, what to do? Marplan and Effexor are worth looking into, too. I'm looking forward to having a fresh set of eyes (and ears and brain, etc) to assess and treat me.
>I'll check out Lyrica as well. I don't know much at all about that med.
Thanks,
gg
Posted by gardenergirl on October 11, 2006, at 15:46:07
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » gardenergirl, posted by Meri-Tuuli on October 9, 2006, at 8:48:14
> Hey GG!
>
> > I don't consistently feel better. I recently put all my CEDS scores into a spreadsheet and graphed the totals.
>
> Wow, thats organised!! I wish I could be like that - I have a really hard time trying to objectify my feelings, in terms of better/worse....I think it helped, though I think it might be useful for me to track things weekly for a bit. It's pretty easy to get that data into Excel. I just copied it into Word, used the convert feature to make it a table, and then exported that to Excel. I've had to become pretty good with tables and spreadsheets because I really need info very structured in order to be able to process it with my ADHD brain.
> >I can't tell anymore that it's making a difference. And I think that's significant.
>
> IMHO, I wouldn't change the nardil (or whatever it was that you can't remember what it was like before) as long as the s/e are bearable....I have made the mistake in the past where I thought a med wasn't working, or it wasn't working enough... and dropped it, quickly to rebound into depression again...and ending up wishing I hadn't changed it!That's true. And whenever I decrease Nardil, I do get more depressed. I don't know quite if that's because the med really is working or if it's some other withdrawal effect. I tend to suspect it's because it actually is working to some extent. Side effects only get annoying at 60mg, although I have excessive sweating at pretty much any dose. That is getting very very old, and of course was a bigger problem this summer. But I really hate dripping with even the smallest exertion.
Thanks for thinking through this with me. Still in the process of deciding. Of course that could wind up a decision all by itself if I'm still deciding by the time the 20th rolls around.
gg
Posted by gardenergirl on October 11, 2006, at 16:02:32
In reply to Re: fired pdoc 1, see new 10-20. Advice til then?, posted by SLS on October 9, 2006, at 9:06:38
Hi again,
> I think the problem is that the Nardil is working, but only partially. GG appears to be undermedicated.
I think you're right.
> So, the choice is to either continue a life being chronically undermedicated or to explore other treatments, understanding that there will be most assuredly a period of an increase in the severity of depressive symptoms.
That's the part that scares me. And now that I think about it, I wonder how wise it would be to make a change like that at the same time I'm ending therapy after 3 and a half years. Although I'm sort of in a change/transition mood recently. I know this is sort of silly, but I just changed from dark auburn hair to nearly strawberry blonde, and also to cut my hair short again versus growing it out. I'm not all that attached to my hair, and pretty much anything I'd do to it can be fixed, but it feels sort of symbolic or meaningful in some way. (shrugs ..., or I'm just putting way too much meaning on hair)
> Hopefully, the Lamictal will allow her to feel better at her current dosage of Nardil, or perhaps even allow for a reduction.
That's always been the purpose of Lamictal for me.
> I guess I am just frustrated to hear that anyone should have to settle for something substantially less than remission. I should talk, though. I'd be happy with 50%. At least I could return to work.
It IS frustrating. With recurrent depression, it's very likely that I will have more depressive episodes in the future. That in and of itself is depressing. But episodes seem shorter in duration than they did before Nardil. And I can see it coming on better now, and I at least know some things to do or not do that can help. Doesn't necessarily mean I do them, but recognition is the first step.
> GG, is it edema that prevents you from going higher with the Nardil?
Edema is a biggie. I have taken a low dose of Lasix as needed, when it was the worst. I don't like doing that, though. I don't like how it feels, and I worry about edema and my heart.
Excessive sweating is really getting on my nerves this year, and that one is much less dose-dependent. I would say that's my current biggest complaint. Anorgasmia, which lasts about 4 months after a dose increase is no fun, either. ;)
And at the highest dose I tried (75mg), I had akathisia. It's hard to say if that would have smoothed out, or if there was something that could augment or treat the akathisia. I just couldn't stand it long at all.
In thinking about Lamictal, though. I'm worried it's starting to have cognitive effects. I've noticed more word substitution and word finding problems in the few weeks. It's very very frustrating, and I feel stupid when it happens. Kind of scary, too. I can't rule out the effects of increased depression on cognition, though.
Bah. Wouldn't it be nice if we could rule stuff out easier? So much is involved. So hard to figure out, sometimes.
gg
Posted by Meri-Tuuli on October 11, 2006, at 16:38:11
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » Meri-Tuuli, posted by gardenergirl on October 11, 2006, at 15:46:07
Hello again
>I've had to become pretty good with tables and spreadsheets because I really need info very structured in order to be able to process it with my ADHD brain...
I know the feeling-I sometimes wonder if I have ADD. Well certainly when I'm depressed, concentration is the first thing to go..... well even then its patchy at the best of times. Sadly here in Europe its pretty underdiagnosed particulary in adults, or perhaps in American its overdiagnosed? Its hard to tell. Somewhere between the two probably!
I'm far too unorganised to chart my feelings.... perhaps I don't think they're important enough!
Anyway, I understand your frustration with the 'glowing' thing (ladies glow - mean sweat!!!) but, this has happened to me before - you get used to a drug and then get annoyed with the s/e....which aren't *that* bothersome in comparison with the actual depression itself... so its worthwhile bearing that in mind.
Kind regards
Meri
Posted by Phillipa on October 11, 2006, at 20:19:35
In reply to Re: fired pdoc 1, see new 10-20. Advice til then? » gardenergirl, posted by Meri-Tuuli on October 11, 2006, at 16:38:11
GG it's the decision making that's so hard. And people tell you(not babblers) to just not worry about it and wait. Ha Ha. I wish I could do that. Love Phillipa
Posted by gardenergirl on October 11, 2006, at 20:45:37
In reply to Re: fired pdoc 1, see new 10-20. Advice til then?, posted by Phillipa on October 11, 2006, at 20:19:35
Well, I took 150 mg of Lamictal today (75 bid). I'm sure it's way too soon, but I about bit my husband's head off tonight when he got home. Irritable again.
It's not PMS. Although it's also gray and rainy today. And the power keeps going off on the UPS my computer is plugged into. That's enough to make anyone grumpy.
gg
Posted by gardenergirl on October 12, 2006, at 23:36:47
In reply to Re: fired pdoc 1, see new 10-20. Advice til then?, posted by gardenergirl on October 11, 2006, at 20:45:37
It occurs to me that some folks get irritable from light therapy. I wonder if maybe I'm having that reaction this year. I know it's not PMS.
Another day or two at 150 mg Lamictal, and if it doesn't get better, I'm tapering back down to 100 mg.
gg
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.