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Dr. Bob is Robert Hsiung, MD,
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Posted by tensor on November 12, 2006, at 15:28:12
In reply to Re: Depression is getting worse » tensor, posted by ronaldo on November 12, 2006, at 15:03:23
>Do you think a more gradual increase to 200 mg might be better?
Hard to say, if there were any improvement in energy, I could stay at 200mg and use benzos(high dose) to combat the anxiety attacks for a period. As I said I'm going to take 100mg tonight. The pdoc I'm going to see tomorrow is a very experienced old school guy i think, he's retired but jumps in now and then for other pdocs. He's really calming and seems to be a nice type of person. If he says "don't worry, it'll be okay" it calms you down more than 2mg of clon.
I've never met him in person but I've spoke to him over phone a few times.Thanks for your input.
/Mattias
Posted by ronaldo on November 12, 2006, at 15:31:28
In reply to Re: Depression is getting worse, posted by ronaldo on November 12, 2006, at 15:19:11
here it is, Dr Ivan Goldberg:
9. How is treatment with lamotrigine initiated?
In people not taking carbamazepine or valproate, lamotrigine is usually initially prescribed at an initial dose of 12.5 or 25 mg a day and the dose increased by 12.5 or 25 mg every week or two.
In people taking valproate the initial dose of lamotrigine is often 12.5 mg/day and the drug is increased by 12.5 mg every ten days or two weeks.
In people taking carbamazepine somewhat larger initial doses and more rapid increases in dose are possible.
http://www.psycom.net/depression.central.lamotrigine.html
I hope this helps. I know I posted it before; please don't think I am rubbing salt in the wound.
...ronaldo
Posted by tensor on November 12, 2006, at 15:48:04
In reply to Re: Depression is getting worse - sorry wrong link, posted by ronaldo on November 12, 2006, at 15:31:28
>Dr Ivan Goldberg:
9. How is treatment with lamotrigine initiated?But isn't the slow titration a way of minimizing the risk of rash rather than avoiding anxiety and depression? TCA's for example, has more s/e than Lamictal and the titration rate for them is often a doubling of dose every third day.
/Mattias
Posted by ronaldo on November 12, 2006, at 16:36:58
In reply to Re: Depression is getting worse - sorry wrong link » ronaldo, posted by tensor on November 12, 2006, at 15:48:04
> >Dr Ivan Goldberg:
> 9. How is treatment with lamotrigine initiated?
>
> But isn't the slow titration a way of minimizing the risk of rash rather than avoiding anxiety and depression? TCA's for example, has more s/e than Lamictal and the titration rate for them is often a doubling of dose every third day.
>
> /MattiasPsychotropic drugs are powerful but not all people react to them in the same way. You need to find the right dosage for you which is not the same thing as the right dosage for anyone else. You can only find the right dose if you try all of them, slowly, one by one, until you hit on the one that is right for you. IOW you have to be careful and patient and you have to monitor your reactions and note them down if necessary...
Good luck, Lamictal might still have good things in store for you. I hope so. I may be taking the Lamictal route myself in the near future. I hope to take my own advice when the time comes...after I have tried it out on someone else, lol.
...ronaldo
Posted by BryanII on November 12, 2006, at 16:39:55
In reply to Re: Depression is getting worse » tensor, posted by blueberry on November 12, 2006, at 10:01:37
> I keep daily notes in a depression diary. I looked back through my notes of when I tried lamictal back in 2005. I had the same things happen to me. It gave me an immediate boost of good mood on the first day, followed by a worsening of mood from the second day on, actually quite a bit worse than where I had started. Lamictal was abandoned in a week.
>
> I guess if someone had the time to just sit around and wait it out and give it a real long trial and they were able to endure the worsening of conditions to see if they eventually got better, that might be one thing. But I have a daily job to perform at and a family to support financially, so somehow my medication trials have to fit into that. Lamictal was not able to do that. I worsened very quickly with lamictal.
I also kept a daily diary. After increasing to 100 mg my mood deteriorated. Depression, negative ruminations, low focus and energy. This passed after 5-7 days. Ultimately I ended up at 200.I'm not saying this will be the case for you, just offering my experience. Lamictal may not be for you. Best to monitor closely, work with Pdoc, and wean off it if it's really not good.
Good luck
Posted by tensor on November 12, 2006, at 16:47:17
In reply to Re: Depression is getting worse, posted by BryanII on November 12, 2006, at 16:39:55
> I also kept a daily diary. After increasing to 100 mg my mood deteriorated. Depression, negative ruminations, low focus and energy. This passed after 5-7 days. Ultimately I ended up at 200.
This is very interesting, maybe I went up to 200mg too quickly, as ronaldo also suggests. Will tell my pdoc about your experience.
> I'm not saying this will be the case for you, just offering my experience. Lamictal may not be for you. Best to monitor closely, work with Pdoc, and wean off it if it's really not good.It could be the case for me and thanks for sharing.
> Good luck
Thank you, I will keep you updated.
/Mattias
Posted by rovers95 on November 12, 2006, at 20:11:49
In reply to Re: Depression is getting worse » BryanII, posted by tensor on November 12, 2006, at 16:47:17
Are you supplementing with folic acid??
Its just iv read in numerous places that lamictal results in folate loss, and seen as low folic aid is implemented in lots of depressions anyway........this could lead to a further worsening of the folic acid deficiency and therefore the depression!
"Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed"
Obviously i am not a medical expert and everyone reacts differently to meds......this is just a suggestion!!
mark
Posted by Phillipa on November 12, 2006, at 21:32:31
In reply to lamictal - folic acid?, posted by rovers95 on November 12, 2006, at 20:11:49
Would an MVI take care of the folate? Love Phillipa
Posted by stargazer on November 12, 2006, at 22:52:11
In reply to Re: lamictal - folic acid? » rovers95, posted by Phillipa on November 12, 2006, at 21:32:31
Last visit to my pdoc, he rec. taking 800 mcg of folic acid, most MVI has 400 mcg. He also rec taking fish oil, but can't remember amount he rec.
I've got too many things to think about right now, I just want a med to work, don't psychiatrists know what they're doing? Don't they get any training to know how to determine what meds will work for one person and not for another? And with every new med developed the process gets trickier and trickier.
Is anybody getting better for longer than a brief time on these meds? Perhaps they do only work briefly and that is why we are live on Psychobabble. Except Psychobabble is wearing me out, Good night......................SG.
Posted by tensor on November 13, 2006, at 5:22:34
In reply to lamictal - folic acid?, posted by rovers95 on November 12, 2006, at 20:11:49
Yes I do take folic acid, 200microg/day as supps.
Do you know if it's enough?/Mattias
Posted by rovers95 on November 13, 2006, at 8:50:49
In reply to Re: lamictal - folic acid? » rovers95, posted by tensor on November 13, 2006, at 5:22:34
> Yes I do take folic acid, 200microg/day as supps.
> Do you know if it's enough?
>
> /MattiasThink crazymeds recommends 800mcg, so i take 2 x solgar 400mcg capsules along with my multivitamin.
mark
Posted by rovers95 on November 13, 2006, at 8:56:06
In reply to Re: lamictal - folic acid?, posted by stargazer on November 12, 2006, at 22:52:11
> Last visit to my pdoc, he rec. taking 800 mcg of folic acid, most MVI has 400 mcg. He also rec taking fish oil, but can't remember amount he rec.
>
> I've got too many things to think about right now, I just want a med to work, don't psychiatrists know what they're doing? Don't they get any training to know how to determine what meds will work for one person and not for another? And with every new med developed the process gets trickier and trickier.
>
> Is anybody getting better for longer than a brief time on these meds? Perhaps they do only work briefly and that is why we are live on Psychobabble. Except Psychobabble is wearing me out, Good night......................SG.
I prefer to think that the people who have got better from these meds have deserted us on psychobabble as they now live a "normal" life again!!i agree about the meds thing, its ridiculous - sometimes it seems whatever your symptoms, a med that a doc has succesfully prescribed for others before will be prescribed to u!! it seems to be to much of a trail and error thing.............with way too much error!!!
mark
Posted by tensor on November 13, 2006, at 9:35:58
In reply to Depression is getting worse, posted by tensor on November 12, 2006, at 9:28:11
I just came back from the pdoc, he's not my regular pdoc. My regular pdoc is away till next week. I will stay at 100mg Lamictal. We also talked about experts in psycho-pharmacology and to do a spinal tap at a university hospital and examine metabolites in the fluid. He will tell my pdoc that we had this conversation and it will be interesting to hear what he has to say about this on the next appointment next wednesday.
So it's just waiting, waiting and more waiting.
/Mattias
Posted by stargazer on November 13, 2006, at 10:54:47
In reply to Recently met pdoc » tensor, posted by tensor on November 13, 2006, at 9:35:58
Tensor,
Well that's a new approach,doing a spinal tap for depression. I haven't heard of this being done although it makes sense to try and quantify the chemical composition of the spinal fluid. Does that pdoc work directly with your pdoc? That seems a good thing to have two heads to determine an approach to treating depression. I wish my pdoc was part of a larger group so that there would be additional feedback or specialists in one condition, i.e. depression, one in ADHD, etc.The worst side effect of a spinal tap are the severe headaches from fluid leaking out. Make sure they do a "patch" afterwards to eliminate this side effect. Keepus posted on that suggestion.
SG
Posted by tensor on November 13, 2006, at 11:58:16
In reply to Re: Recently met pdoc/tensor, posted by stargazer on November 13, 2006, at 10:54:47
Hi SG,
>I haven't heard of this being done...
It's sometimes used if the patient has a TRD. That pdoc is retired but he substitues my regular pdoc when he's away, so they work directly with each other. He also said it would be possible for me to meet a specialist in psycho-pharmacology.
>That seems a good thing to have two heads to determine an approach to treating depression
The funny thing is that there's three pdocs currently involved in my treatment. First there's a female private pdoc who takes care about the talk therepy and the "normal" AD's, she in turn consulted a pdoc at the hospital for treatment with Lamictal, she felt insecure about this type of meds. Now when he's away I have talked to his substitute. So I have plenty of support!!
>Keepus posted on that suggestion.
Absolutely, hopefully Lamictal will work soon, that would be best.
/Mattias
Posted by stargazer on November 13, 2006, at 17:05:02
In reply to Re: Recently met pdoc/tensor » stargazer, posted by tensor on November 13, 2006, at 11:58:16
Tensor,
I am jealous of your situation where 3 docs are involved in your case. I only have one and I'm losing hope, although today we decided that if our new plan (try Emsam first, Nardil second) doesn't work he will refer me for a second opinion. I just don't know to whom. I want to find a pdoc on my own with help from my psychobabblers, but haven't been bombarded with feedback yet. There's got to be some experts on TRD in New England or NY, else no wonder no one is feeling better. Too many generalists who can't make heads or tails over what to prescribe next. Thank God I can give some direction to my pdoc but I don't know very much and he usually agrees with what I think we should do. I want to find a doctor that can sort through this sh*t today..it's been 30 years of up and down, never really getting more than a marginal response.
Also, what university (US or other country) is dong this spinal tap procedure for TRD since I also have TRD. I asked my pdoc if he heard of a spinal tap to evaluate the chemistry of the fluid for depression diagnosis and treatment and he hadn't (no surprise). Is there any literature that describes what the procedure is looking for and how the test is interpreted?
You may want to start a thread to get others feedback on this procedure since others may know more about it and it could really help alot of us, although I am afraid of spinal taps myself, but I wouldn't rule it out.
SG
Posted by Phillipa on November 13, 2006, at 17:54:07
In reply to Re: Recently met pdoc/tensor...SPINAL TAP for TRD, posted by stargazer on November 13, 2006, at 17:05:02
Stargazer the only reason I know of for a spinal tap would be to rule out other diseases. I've had two as I have chronic lyme's disease. I know you know about lymes. That shows in spinal fluid. Unless the country Mattias is from has some new technique it can only check say for spinal menangitis too. Tensor can you comment on this please. Need to know what your doc says. You know lymes is all over the world. In different varieties. And it was years before they found mine as I never had the classic bullseye rash or the tic is so small not visible. So I'm very curious. And my fluid was clear a good thing. Love Phillipa
Posted by tensor on November 13, 2006, at 18:25:21
In reply to Re: Recently met pdoc/tensor...SPINAL TAP for TRD » stargazer, posted by Phillipa on November 13, 2006, at 17:54:07
Tensor can you comment on this please. Need to know what your doc says.
There's a method for examining Cerebrospinal Fluid(CSF) for transmitter precursors, transmitters and their metabolites. It's probably expensive and can be used for very TRD. The pdoc have had patients in the past who he had sent to a large uni hsopital for this test. It's probably still difficult knowing how to treat a patient accordingly to their spinal fluid content.
Here are some links:
http://cat.inist.fr/?aModele=afficheN&cpsidt=16115865
http://www.nature.com/npp/journal/v30/n11/full/1300746a.html
http://www.eje-online.org/cgi/reprint/139/5/493.pdf/Mattias
Posted by stargazer on November 13, 2006, at 18:29:52
In reply to Re: Recently met pdoc/tensor...SPINAL TAP for TRD » stargazer, posted by Phillipa on November 13, 2006, at 17:54:07
Phillipa,
What Tensor's post said was that the spinal tap was being done to examine the fluid for metabolites for TRD, so the procedure is specific for depression, I don't think it is for any other reason as you suggest, i.e. Lymes.
So it seems to be a new approach to diagnosing and/or treating TRD. Very interesting since it may have to do with evaluating deficiencies of certain brain chmeicals.
Is Europe ahead of us in depression, perhaps so. I don't care who finds the answer, as long as we can all benefit from "the discovery" of something that can be quantified and treated.
SG
Posted by BryanII on November 13, 2006, at 19:04:38
In reply to Re: lamictal - folic acid?, posted by stargazer on November 12, 2006, at 22:52:11
> Last visit to my pdoc, he rec. taking 800 mcg of folic acid, most MVI has 400 mcg. He also rec taking fish oil, but can't remember amount he rec.
>
> I've got too many things to think about right now, I just want a med to work, don't psychiatrists know what they're doing? Don't they get any training to know how to determine what meds will work for one person and not for another? And with every new med developed the process gets trickier and trickier.
>
> Is anybody getting better for longer than a brief time on these meds? Perhaps they do only work briefly and that is why we are live on Psychobabble. Except Psychobabble is wearing me out, Good night......................SG.Folic acid is also common in B-Complex vit's, so a multivit and a B-Complex may give you 800 mcg.
I've seen from 1000-4000 units of fish oil, or a combo of fish oil caps and cod liver oil caps to get vit A and D.
My meds are working well for several months now. I worry a lot about having them go south on me (this is not just a psychobabble side effect:)).
Bryan
Posted by Phillipa on November 13, 2006, at 20:09:57
In reply to Re: Recently met pdoc/.SPINAL TAP for TRD/Phillipa, posted by stargazer on November 13, 2006, at 18:29:52
I agree with you. I've never heard of this. Tensor would you please start a thread on this? Love Phillipa or is it only being tested? It mentioned VNS in one and in another Vanderbuilt University isn't this in the USA? Love Phillipa
Posted by tensor on November 14, 2006, at 5:40:08
In reply to Re: Recently met pdoc/.SPINAL TAP for TRD/Phillipa » stargazer, posted by Phillipa on November 13, 2006, at 20:09:57
>or is it only being tested? It mentioned VNS in one and in another Vanderbuilt University isn't this in the USA?
This kind of tests have been around for a long time, they can most certainly be done at any larger uni hospital or specialist clinics all over Europe and USA. E.g. it's done to confirm Alzheimer's disease and other neurological diseases. My pdoc informed me I could have it done if I'm non-respondant to many meds, he also said that just because you know the content of the spinal fluid it's still not easy to pick a med that works, that's probably why it's so uncommon, it's still trial and error, but you may know if you need a SSRI and not a NARI(ad hoc)?. Read through the docs linked to in my previous post.
Maybe Dr. BOB could clarify this or atleast tell us the extent of usage?
/Mattias
Posted by Phillipa on November 14, 2006, at 19:18:46
In reply to Re: Recently met pdoc/.SPINAL TAP for TRD/Phillipa » stargazer, posted by Phillipa on November 13, 2006, at 20:09:57
Tensor don't get angry I've just never heard of a way through spinal tap to let you know what type of antidepressant would work? Love Phillipa That's why a thread would bring more people in to read.
Posted by tensor on November 15, 2006, at 1:34:35
In reply to Re: Recently met pdoc/.SPINAL TAP for TRD/Phillipa » Phillipa, posted by Phillipa on November 14, 2006, at 19:18:46
> Tensor don't get angry
No, no, i'm not angry.
> I've just never heard of a way through spinal tap to let you know what type of antidepressant would work? Love Phillipa That's why a thread would bring more people in to read.
I'll see my (regular)pdoc next Wednesday, he maybe has more information on this, i'm gonna ask him, I will tell you then what I know.
/Mattias
Posted by Phillipa on November 15, 2006, at 18:58:49
In reply to Re: Recently met pdoc/.SPINAL TAP for TRD/Phillipa » Phillipa, posted by tensor on November 15, 2006, at 1:34:35
Thanks Tensor it's a deal!!!!!!Love Phillipa
This is the end of the thread.
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