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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by lymom3 on October 27, 2006, at 10:14:37
I had a great month when Lamictal and Topamax were wonderful for me. I didn't want to cry or yell at people but the mental clarity was the absolute best part. I can't remember when I haven't been fuzzy in the head. I used to have a mind like a steel trap and remember everything. Even though I was disorganized as hell, I got things done. I am on meds for ADD that do help somewhat but nothing like that the month or so that Topamax and Lamictal worked. Every antidepressant that's been tried makes the "fog" worse. I had forgotten what it was like to be "on the ball" because it's been so long.
However, me and meds just don't seem to get along. Topamax started tearing me up. Hair falling out, stomach problems that doc says is gall bladder issues, exhausted, HUGE weight gain, swollen feet. After spending half the national debt in testing, there is nothing wrong with me. I have quit the Topamax and most of that has gone away. Still swelling in the feet but that may be due to the amount of weight that I packed on so I get to try to work that off now.
But...I'm back in my brain fog. I have to find a new pdoc as the one I have won't try any more med combo's. He is not comfortable with doing anything else. I can't go past 50mg of Lamictal or I have s/e's from that but it does help somewhat even at that small dose. I have been on AD's with Lithium and then with Depakote before and that never seemed to help. I'm wondering what other med or type of med to try with Lamictal. My main problem now is still that I'm so tired and can't get motivated or get going (going for a sleep study next week to see if there is any help there) and the glazed, dazed feeling and the incredible irritation. I don't think that anyone could turn the light off without it pissing me off. I'm really trying not to make everyone around me suffer; I realize I am hell to be around right now but that doesn't always keep my mouth shut and it sure doesn't help the pissed off agitation going on in my head.
Guess I'm looking for similar experiences or success stories. I would like to have a plan in mind when I do find a new pdoc. Having somewhat normal energy levels and a brain that was functioning on all cyliinders at the same time was a tease. It made me realize what I'm supposed to be able to feel like and I want it back somehow....
Posted by ronaldo on October 28, 2006, at 12:08:11
In reply to Low dose Lamictal...need something else., posted by lymom3 on October 27, 2006, at 10:14:37
> I had a great month when Lamictal and Topamax were wonderful for me. I didn't want to cry or yell at people but the mental clarity was the absolute best part. I can't remember when I haven't been fuzzy in the head. I used to have a mind like a steel trap and remember everything. Even though I was disorganized as hell, I got things done. I am on meds for ADD that do help somewhat but nothing like that the month or so that Topamax and Lamictal worked. Every antidepressant that's been tried makes the "fog" worse. I had forgotten what it was like to be "on the ball" because it's been so long.
>
> However, me and meds just don't seem to get along. Topamax started tearing me up. Hair falling out, stomach problems that doc says is gall bladder issues, exhausted, HUGE weight gain, swollen feet. After spending half the national debt in testing, there is nothing wrong with me. I have quit the Topamax and most of that has gone away. Still swelling in the feet but that may be due to the amount of weight that I packed on so I get to try to work that off now.
>
> But...I'm back in my brain fog. I have to find a new pdoc as the one I have won't try any more med combo's. He is not comfortable with doing anything else. I can't go past 50mg of Lamictal or I have s/e's from that but it does help somewhat even at that small dose. I have been on AD's with Lithium and then with Depakote before and that never seemed to help. I'm wondering what other med or type of med to try with Lamictal. My main problem now is still that I'm so tired and can't get motivated or get going (going for a sleep study next week to see if there is any help there) and the glazed, dazed feeling and the incredible irritation. I don't think that anyone could turn the light off without it pissing me off. I'm really trying not to make everyone around me suffer; I realize I am hell to be around right now but that doesn't always keep my mouth shut and it sure doesn't help the pissed off agitation going on in my head.
>
> Guess I'm looking for similar experiences or success stories. I would like to have a plan in mind when I do find a new pdoc. Having somewhat normal energy levels and a brain that was functioning on all cyliinders at the same time was a tease. It made me realize what I'm supposed to be able to feel like and I want it back somehow....
Hi lymom3I can sympathise with what you are going through. I also have the brain fog and the irritability. I am on 900 mg of Lithium and 10 mg of Olanzapine. I am bipolar/schizo-affective. I used to be on 5 mg of Olanzapine which I tapered off to zero, substituted with Seroquel 50 mg which didn't do anything for me. In order to get some sleep I went back onto the Olanzapine at 10 mg. Been on it now for 2 weeks.
I equate brain fog with flat affect, ie feeling 'passive without motivation or creativity, a feeling almost like depression'. I don't think I am this way naturally. ie If I wasn't taking any psychotropic drugs I don't think I would be in this fog. That is why I tapered off the 5 mg Olanzapine. I held the Olanzapine responsible. I would have stayed off the Olanzapine if it were not for the insomnia. The Seroquel was supposed to address that but it didn't.
I want to talk my pdoc into prescribing me some Lamictal. How has Lamictal been for you? Do you ascribe the lifting of the fog to the Lamictal or the Topamax or to a combination of the two?
What is your Dx? and Rx? Have you ever tried Lithium and Lamictal together?
Sorry I cannot be of any help to you. I can only offer commiseration. I hope you find a cure. If you do please let me know.
Posted by lymom3 on October 28, 2006, at 13:04:23
In reply to Re: Low dose Lamictal...need something else. » lymom3, posted by ronaldo on October 28, 2006, at 12:08:11
Flat, unmotivated, all of that. I gained 20 lbs in 2 months on Topamax...supposed to lose weight on that. Lithium made me a zombie when I took it before but that was in conjunction with an anti depressant that zonked me out too (Zoloft) and I gained weight. Depakote made my hair fall out horribly.
It's the times that I'm clear, focused and getting stuff done that make me keep looking for the "right stuff" so to speak. I was dx'd for years with depression, atypical depression, dythsmia. Finally they decided BPII and I have done much better with the mood stabilzer class of meds. I just have to find the right ones, I guess.
I felt benefits from the Lamictal but can't take a 100mg dose as I get chest pains and horrible bruising. At first the Topamax and the Lamictal were great so I"d say the combination together worked but then the Topamax started really kicking my butt. I want to see about going up to 75mg of Lamictal and see if I can tolerate that.
I am pretty tired all the time so it's hard for me to know what part of my mood issues are from being exhausted and what is med related (or lack of). I don't really feel depressed, just worn out. Here's to hoping the next doc can help me find the right combo.
Posted by SLS on October 28, 2006, at 13:19:15
In reply to Re: Low dose Lamictal...need something else. » ronaldo, posted by lymom3 on October 28, 2006, at 13:04:23
Trileptal (oxcarbazepine) might be worth taking a look at if you want to stay with the anticonvulsants. It should help with aggressive impulses if that is part of what's going on. Of course, irritability by itself can be part of depression, even in the absence of bipolar disorder.
I was actually going to mention Zyprexa, but I guess the weight-gain would be a turn-off. People often report that it helps clear-up their thinking when brain-fog is a problem. I found it helpful in this way. Abilify might offer an alternative here.
- Scott
Posted by lymom3 on October 28, 2006, at 14:03:46
In reply to Re: Low dose Lamictal...need something else., posted by SLS on October 28, 2006, at 13:19:15
I had wondered about Abilify. My psychologist had thought it's worth a shot since I've been hard to medicate and have odd reactions to most meds. Too much Topamax in the morning knocked me out; too much at night gave me insomnia. Any meds that I've tried to help sleeping have given me such a "hangover" that the insomnia was less of a problem than the fix for it was.
The irritability coupled with the racing thoughts make me think more the BP needs to be addressed because the mind is still going a million miles an hour even if the body is in a coma, but you're right on that irritable can be from the lack of sleep; it could be depression, although I don't feel depressed.
I do wish I could string together a few decent nights sleep and assess the situation then. Maybe the sleep study can give me some help there. I never have felt very rested in the mornings. I just wish that everything in the world didn't piss me off. Because I'm physically worn out my mouth is driving everyone nuts. I am not getting up and doing stuff to keep me busy I'm just babbling like an idiot when I'm not asleep.
I am somewhat amusing to my family though when they try to talk to me. I jump from one thing to something totally different. They have no clue how I got there...I've had an entire conversation in my head before I open my mouth but it's a game for them to figure out how I got from one statement to the next. I would like to fix that problem and be able to have a whole conversation again. Like one where I actually listen to what the other person is saying and talk to them.
Posted by theo on October 29, 2006, at 15:20:00
In reply to Re: Low dose Lamictal...need something else. » ronaldo, posted by lymom3 on October 28, 2006, at 13:04:23
When do you take Lamictal, morning or bedtime?
Posted by theo on October 29, 2006, at 15:29:42
In reply to Re: Low dose Lamictal...need something else., posted by SLS on October 28, 2006, at 13:19:15
How have you been? I haven't been here in a while, been busy and off meds. Unfortunatly, I'm feeling like I'm in a permanent rut and my brain is on hold, like a robot doing daily tasks but nothing seems enjoyable, nothing.
How's the Abilify working. That seemed to be the only thing that got me off my butt and doing things, but I kept obssessing about tardive dyskensia and stopped it.
Now, I'm wondering, do I start an SSRI, Lamictal, Abilify or Emsam, ain't mental illness grand! I'm the worst at starting something only to think something else may work better and switching!
Does Abilify cause TD as much as the old AP's?
Thanks,
Ted
Posted by SLS on October 29, 2006, at 18:37:26
In reply to Re: Low dose Lamictal...need something else. » SLS, posted by theo on October 29, 2006, at 15:29:42
> How have you been?
Pretty crummy. Things have not been going my way, but I'm still kicking.
> How's the Abilify working.
I think it still helps take the edge off of the suicidal ideation and catastrophic anxiety. It probably isn't as effective as Zyprexa in this regard, but it has been sufficient.
> That seemed to be the only thing that got me off my butt and doing things, but I kept obssessing about tardive dyskensia and stopped it.
Abilify doesn't seem to bind to the dopamine receptors located in those regions of the brain responsible for movement and TD.
> Now, I'm wondering, do I start an SSRI, Lamictal, Abilify or Emsam, ain't mental illness grand!What are your primary symptoms? What have you responded to in the past? What was your response to Wellbutrin? Wellbutrin + Lamictal can be a very energizing combination.
> I'm the worst at starting something only to think something else may work better and switching!
I can totally relate.
- Scott
Posted by SLS on October 29, 2006, at 18:40:23
In reply to Re: Low dose Lamictal...need something else. » theo, posted by SLS on October 29, 2006, at 18:37:26
Sorry.
> Abilify doesn't seem to bind to the dopamine receptors located in those regions of the brain responsible for movement and TD.
That's wrong.
What I meant to say is that Abilify doesn't seem to produce an upregulation of dopamine receptors located in those regions of the brain responsible for movement and TD.
- Scott
Posted by theo on October 29, 2006, at 19:49:45
In reply to Correction..., posted by SLS on October 29, 2006, at 18:40:23
So is Abilify least likely to cause tardive dyskensia than other AP's?
Posted by lymom3 on October 29, 2006, at 21:07:09
In reply to Re: Low dose Lamictal...need something else. » lymom3, posted by theo on October 29, 2006, at 15:20:00
I split it. 25mg in the morning and 25mg at night. I can't do 100mg because of s/e's. I might see about trying 75mg and see how that goes. I'm still hoping to find a new pdoc that can see me before January. That seems like a long time when your meds aren't right and you're feeling miserable.
Posted by lymom3 on October 29, 2006, at 21:12:18
In reply to Re: Low dose Lamictal...need something else., posted by SLS on October 28, 2006, at 13:19:15
What does Abilify do for you? I have been trying to do my research. Trileptal is something that I thought might be worth a shot. Prior pdoc refused to do anything besides the anti convulsants; wouldn't even try anti psychotics. Not sure why. I don't mind being a guinea pig too much. At least I still have hope; something more to try. Just have to hang in there until I can get in to see a new pdoc. Looking like January unless I get a call that he had a cancellation. So...I hope every day I wake up that I might feel a little better or at least not feel worse...
Posted by SLS on October 29, 2006, at 23:18:59
In reply to Re: Correction... » SLS, posted by theo on October 29, 2006, at 19:49:45
> So is Abilify least likely to cause tardive dyskensia than other AP's?
I'm not sure. Despite its high binding affinity at D2 receptors, I think theoretical arguments can be made in the affirmative based on its partial agonist properties. However, I would hesitate to make any recommendations. The drug hasn't been around long enough to be certain.
At this point, there may only be one reported incident on Medline:
1: CNS Spectr. 2006 Jun;11(6):435-9.
Aripiprazole-related tardive dyskinesia.
* Maytal G,
* Ostacher M,
* Stern TA.Psychiatric Consultation Service, Massachusetts General Hospital, Boston, MA 02114, USA. [email protected]
The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade. Aripiprazole, the newest medication in this class, has been associated with extrapyramidal symptoms (eg, akathisia) and with improvement of tardive dyskinesia (TD), but to date it has not been associated with the development of TD. We report a case of TD associated with the use of aripiprazole 15 mg/day for 18 months for refractory depression. Symptoms of TD resolved within several weeks of discontinuation of aripiprazole.
PMID: 16816781 [PubMed - indexed for MEDLINE]
- Scott
Posted by SLS on October 30, 2006, at 8:05:37
In reply to Re: Low dose Lamictal...need something else. » SLS, posted by lymom3 on October 29, 2006, at 21:12:18
> What does Abilify do for you?
When I first started taking it, I noticed an increase in mental energy and motivation. I think it also helps prevent or mitigate the anxious catastrophic thinking that leads to suicidality. Some people experience a true antidepressant effect. A few actually become manic. Be aware, though, that it can produce anxiety and insomnia during the first one or two weeks. It can even produce an akathisia-like reaction. These things usually disappear. I have seen it suggested to use a beta-blocker or benzodiazepine to help get through this period. I didn't need one, but I did experience a sort of restlessness at first.
> I have been trying to do my research. Trileptal is something that I thought might be worth a shot. Prior pdoc refused to do anything besides the anti convulsants; wouldn't even try anti psychotics. Not sure why. I don't mind being a guinea pig too much. At least I still have hope; something more to try. Just have to hang in there until I can get in to see a new pdoc. Looking like January unless I get a call that he had a cancellation. So...I hope every day I wake up that I might feel a little better or at least not feel worse...
One morning at a time.
Sometimes, it ends up being one hour at a time.
I'm sure your new doctor will provides you with a fresh set of ideas. Hopefully, it will only take one to hit the target.
Good luck.
- Scott
This is the end of the thread.
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