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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Peter on December 27, 2002, at 3:51:44
Hello:
Here's the deal: for a few weeks I've been experiencing consistent mixed mood states of dysphoria/agitation/depression/irritation, and just hopelesness. I can't leave my apartment. I can't smile or laugh. I feel the worst I've ever felt.
After being diagnosed with cyclothymia/SP/ 'depressive-anxiety'/ADD in the years since 1997, I've been placed on every anticonvulsant and non-anticonvulsant mood-stabilizer (including lithium), a variety of benzos (I still take klonopin and restoril), every SSRI, stimulants, beta-blockers, moclobemide, effexor, dopamine agonists, naltrexone, you name it. I've gone to 3 different doctors for consultations (other than the one I've been going to for 7 years).
I'm SO sick of all this. I attempted weaning off of everything numerous times, but symptoms came back. Different pdocs have given me different diagnoses. My steady one thinks everything centers around the Bipolar spectrum, while the last pdoc I went to for consultation said there's nothing suggesting that I've ever been manic or hypomanic and that's it's important to target my MAIN symptoms-anxiety and depression, rather than bog me down with all these mood-stabilizers. But all the SSRI's helped for a time but then heightened my impulsivity & alcohol cravings. So this last consultation doc suggested TCA's for me, which I've never tried. She then spoke with my current doctor and now she respects his opinion and he respects her opinion-BUT WHAT ABOUT ME?!
Right now, I've been taking lamictal since the beginning of October, slowly titrating to my current dose of 50mg, while decreasing zoloft (now down to 37.5mg) and decreasing depakote (down from 750mg to 375mg). Aside from klonopin and restoril, I also take adderall 40mg and ambien 10mg.
After telling my normal pdoc of my recent moods, he said something that makes NO SENSE to me: he said these bad feelings CAN be due to the lamictal, but they also CAN be due to my recent REDUCTION of zoloft and depakote (I reduced both of them a bit within the last week or two). Fine. But then he tells me to 'therefore' start tapering off the zoloft and depakote completely!! WHAT!?%&^@* I mean, if the reduction of zoloft & depakote is causing this, then wouldn't FURTHER reducing them HEIGHTEN rather than alleviate these bad feelings? Likewise, if the lamictal itself is the culprit, taking the time to taper off of aoloft and depakote would be redundant and possibly detrimental.
I don't know what to do. I can't meet with my pdoc again until JAN. 14. He told me all this over the email. I'm the guinea pig ingesting all this stuff-and he's just sitting back and thinking about 'possible', 'reasonable' steps for me to take. I'm sick of it all. Please, any comment or consolence of any kind? I need human interaction. Thanks,
Peter
Posted by noelle on December 27, 2002, at 6:03:49
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
Hello Peter,
I too as well as many others wish psychopharmacology was more of an exact science. We all feel like lab rat sometime and for me it seem the people that should know the most, know the least. It seems that the only places to get real truth about medication is from sites such as these. I know how it feels to wonder who you really are under all those medications and whats worse the depression or the side effects. You are living with a disability and i think the worst kind because it effects the very essense of who you are and your feeling of wellbeing. Don't give up just try to live in the moment and give yourself little goals. I have found that information can lesson the anxiety,(i,e, research old posts about the meds your are on) try really had to document every feeling you have.
Good luck to you
Posted by jimmygold70 on December 27, 2002, at 7:22:46
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
Take the Lamictal up to therhaputeic doses (i.e 300-500mg). Do not use adderal since it can worsen everything. I would add Zyprexa of Seroquel for additional mood stabilization, and can also make you more relaxed. It also augments any AD. Until you reach therapuetic doses of Lamictal, do NOT take the Depakote dose down!
Why do you get off Zoloft ? It is effective. You can add Edronax if you don't feel completeky fine with it. Switching to high dose Effexor will do as well.
Jimmy
Posted by Ritch on December 27, 2002, at 10:20:28
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
> Hello:
> Here's the deal: for a few weeks I've been experiencing consistent mixed mood states of dysphoria/agitation/depression/irritation, and just hopelesness. I can't leave my apartment. I can't smile or laugh. I feel the worst I've ever felt.
> After being diagnosed with cyclothymia/SP/ 'depressive-anxiety'/ADD in the years since 1997, I've been placed on every anticonvulsant and non-anticonvulsant mood-stabilizer (including lithium), a variety of benzos (I still take klonopin and restoril), every SSRI, stimulants, beta-blockers, moclobemide, effexor, dopamine agonists, naltrexone, you name it. I've gone to 3 different doctors for consultations (other than the one I've been going to for 7 years).
> I'm SO sick of all this. I attempted weaning off of everything numerous times, but symptoms came back. Different pdocs have given me different diagnoses. My steady one thinks everything centers around the Bipolar spectrum, while the last pdoc I went to for consultation said there's nothing suggesting that I've ever been manic or hypomanic and that's it's important to target my MAIN symptoms-anxiety and depression, rather than bog me down with all these mood-stabilizers. But all the SSRI's helped for a time but then heightened my impulsivity & alcohol cravings. So this last consultation doc suggested TCA's for me, which I've never tried. She then spoke with my current doctor and now she respects his opinion and he respects her opinion-BUT WHAT ABOUT ME?!
> Right now, I've been taking lamictal since the beginning of October, slowly titrating to my current dose of 50mg, while decreasing zoloft (now down to 37.5mg) and decreasing depakote (down from 750mg to 375mg). Aside from klonopin and restoril, I also take adderall 40mg and ambien 10mg.
> After telling my normal pdoc of my recent moods, he said something that makes NO SENSE to me: he said these bad feelings CAN be due to the lamictal, but they also CAN be due to my recent REDUCTION of zoloft and depakote (I reduced both of them a bit within the last week or two). Fine. But then he tells me to 'therefore' start tapering off the zoloft and depakote completely!! WHAT!?%&^@* I mean, if the reduction of zoloft & depakote is causing this, then wouldn't FURTHER reducing them HEIGHTEN rather than alleviate these bad feelings? Likewise, if the lamictal itself is the culprit, taking the time to taper off of aoloft and depakote would be redundant and possibly detrimental.
> I don't know what to do. I can't meet with my pdoc again until JAN. 14. He told me all this over the email. I'm the guinea pig ingesting all this stuff-and he's just sitting back and thinking about 'possible', 'reasonable' steps for me to take. I'm sick of it all. Please, any comment or consolence of any kind? I need human interaction. Thanks,
> PeterPeter, I haven't tried any Lamictal, but I have read some posts here about agitation from it. Also, FWIW, I have had two or three episodes over the last few years with Depakote withdrawal reactions. Those have been extremely nasty and sound precisely like the symptoms you describe. I had a stomach flu a while back and had to stop my Depakote for a couple of days, and WHEWW!, I felt totally electrified and agitated. That is interesting that your pdoc wants to lower the Depakote even further. Depakote and Lamictal interact in an unusual way, they BOTH tend to increase each other's blood levels. If you do nothing but reduce the Depakote, the Lamictal blood level should drop as well. That could be the angle that he is looking at (to get the Lamictal level lower). He probably thinks the Lamictal is what is setting you off. The trouble is that any withdrawal reaction from the reduced Depakote could "mask" the benefits from the Lamictal level falling as a result. Could you ask him about leaving everything the same and just reducing the Lamictal instead and see what he says? Also, do you think the Adderall could be contributing to your agitation? I hope you get better soon, that is a not a fun place to be at all...
Posted by Peter S. on December 27, 2002, at 15:35:28
In reply to Re: LAMICTAL-END OF MY ROPE-PLEASE HELP » Peter, posted by Ritch on December 27, 2002, at 10:20:28
Peter,
I've had success with Lamictal- it was truly a wonder drug when I started taking it but the effect didn't last. What it does for me now is give me a good kick of energy about an hour after I take it. I imagine for some people this stimulating effect may translate into anxiety.
Currently I'm taking 200mg in am and 200 in afternoon.It's really hard to say what's going on since your taking all those meds. I know how difficult it is and what a pain in the ass! I've been on the psychopharmacology train myself for years and still looking to get off. Currently trying Lexapro.
All the best of luck!
Peter S.
Posted by polarbear206 on December 28, 2002, at 8:56:09
In reply to Re: LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter S. on December 27, 2002, at 15:35:28
Peter,
Lamictal has been a wonder drug for my cyclothymia. It got better the higher the dose and backing off of the a/d's. I did however have some short lived mixed states as I titrated higher doses. This does subside. You have to be very patient with this drug!! It's been worth the wait for me.
Laura
Posted by Lawrence S. on December 28, 2002, at 10:42:18
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
Peter, I really can relate to your experiences. Here's what happened to me on lamictal.. I had a good reduction in anxiety from it initially but when reaching 50mg. I started feeling really screwed up. Extreme mood swings, rage, deppresion. I've lost faith in the mood stabilizers. All mood stabilisers I have been on have been an unpleasant experience for me, only making me more unstable. The bipolar theory does'nt hold water for me. I know when I'm feeling good. And it's not when I'm on mood stabilizers. I watched my Mom on lithium for ten years and have concluded that it did'nt help her. She got a new Dr. and he took her off of Li and commented "what the heck was she taking this stuff for"? It all depends on what on the psychiatrist beleives! I really hope you get feeling better! I wish I had more time to comment. I am pressed for time. You are not alone! Please keep posting!
Lawrence
Posted by chad_3 on December 28, 2002, at 11:53:05
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
Sounds like you have no psychosis or hallucinations - so his idea to slowly taper off the dopamine blocker sounds good.
You have a Dr. who likes to prescribe many drugs.
Question: Have you ever tried an MAOI? These are the most powerful antidepressants overall - and Nardil is the most powerful mediciation for mixed anxiety / depression with features of fear, avoidance, phobia, shyness, neurosis, etc.
With all the chaotic combos of meds he is playing around with hoping for some miracle - why not just try proven effective medications for your condition?
That is - if you have not tried the MAOI's which it sounds like you have not.
Ask him about it at your next visit - his current advice sounds reasonable as though he were preparing you slowly for a new strategy.
Chad
http://www.socialfear.com/
> Hello:
> Here's the deal: for a few weeks I've been experiencing consistent mixed mood states of dysphoria/agitation/depression/irritation, and just hopelesness. I can't leave my apartment. I can't smile or laugh. I feel the worst I've ever felt.
> After being diagnosed with cyclothymia/SP/ 'depressive-anxiety'/ADD in the years since 1997, I've been placed on every anticonvulsant and non-anticonvulsant mood-stabilizer (including lithium), a variety of benzos (I still take klonopin and restoril), every SSRI, stimulants, beta-blockers, moclobemide, effexor, dopamine agonists, naltrexone, you name it. I've gone to 3 different doctors for consultations (other than the one I've been going to for 7 years).
> I'm SO sick of all this. I attempted weaning off of everything numerous times, but symptoms came back. Different pdocs have given me different diagnoses. My steady one thinks everything centers around the Bipolar spectrum, while the last pdoc I went to for consultation said there's nothing suggesting that I've ever been manic or hypomanic and that's it's important to target my MAIN symptoms-anxiety and depression, rather than bog me down with all these mood-stabilizers. But all the SSRI's helped for a time but then heightened my impulsivity & alcohol cravings. So this last consultation doc suggested TCA's for me, which I've never tried. She then spoke with my current doctor and now she respects his opinion and he respects her opinion-BUT WHAT ABOUT ME?!
> Right now, I've been taking lamictal since the beginning of October, slowly titrating to my current dose of 50mg, while decreasing zoloft (now down to 37.5mg) and decreasing depakote (down from 750mg to 375mg). Aside from klonopin and restoril, I also take adderall 40mg and ambien 10mg.
> After telling my normal pdoc of my recent moods, he said something that makes NO SENSE to me: he said these bad feelings CAN be due to the lamictal, but they also CAN be due to my recent REDUCTION of zoloft and depakote (I reduced both of them a bit within the last week or two). Fine. But then he tells me to 'therefore' start tapering off the zoloft and depakote completely!! WHAT!?%&^@* I mean, if the reduction of zoloft & depakote is causing this, then wouldn't FURTHER reducing them HEIGHTEN rather than alleviate these bad feelings? Likewise, if the lamictal itself is the culprit, taking the time to taper off of aoloft and depakote would be redundant and possibly detrimental.
> I don't know what to do. I can't meet with my pdoc again until JAN. 14. He told me all this over the email. I'm the guinea pig ingesting all this stuff-and he's just sitting back and thinking about 'possible', 'reasonable' steps for me to take. I'm sick of it all. Please, any comment or consolence of any kind? I need human interaction. Thanks,
> Peter
Posted by Remi on December 28, 2002, at 12:14:47
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
Klonopin can worsen depression in some. It did for me. Instead, try another long acting benzo. I also vote for Zyprexa or Seroquel ,short term, to give you some stability while you sort things out. They ARE outstanding in this situation.
Posted by Peter on December 28, 2002, at 13:53:02
In reply to Re: LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by polarbear206 on December 28, 2002, at 8:56:09
> Peter,
>
> Lamictal has been a wonder drug for my cyclothymia. It got better the higher the dose and backing off of the a/d's. I did however have some short lived mixed states as I titrated higher doses. This does subside. You have to be very patient with this drug!! It's been worth the wait for me.
>
> Laura
>But these mixed states are very extreme, and what makes them worse is the heightened social phobia I'm experiencing. I can't leave my apartement; my girlfriend is returning with her dad and brother and I'm so nervous I feel like throwing up! I've been going out with her for almost 4 years! It's completely irrational, but, hey, I feel it anyway. My levels of antisocialness and dysphoria are intense. I'm down to 25mg zoloft, decreasing from now every 4 days by 12.5 until I'm off of it. But pdoc told me to stay on 50mg lamictal, which I've been taking for weeks-and it's taken me over 3 months to get up to 50mg! I realize you have to be patient, but how patient?
Does the lamictal have any benefits for social phobia to the levels that an SSRI does? Is lamictal seratonergic? Does it deal with dopamine? I just have no improvement at all in any of my target symptom areas from this med.
Peter
Posted by Peter on December 28, 2002, at 14:02:31
In reply to Re: LAMICTAL-END OF MY ROPE- TRIED AN MAOI??, posted by chad_3 on December 28, 2002, at 11:53:05
> Sounds like you have no psychosis or hallucinations - so his idea to slowly taper off the dopamine blocker sounds good.
> I'm not taking a dopamine blocker-which drug are you referring to?>
> Question: Have you ever tried an MAOI? These are the most powerful antidepressants overall - and Nardil is the most powerful mediciation for mixed anxiety / depression with features of fear, avoidance, phobia, shyness, neurosis, etc.
> I only tried moclobemide when it came out, and it wasn't good. But I realize it's a reversible MAOI, not like the real thing. The only major problem I have with the MAOI's is my fear of eating the wrong foods without knowing and having an MAOI attack. Is this common?
> With all the chaotic combos of meds he is playing around with hoping for some miracle - why not just try proven effective medications for your condition?
> I ABSOLUTELY AGREE. THIS IS WHAT I'VE BEEN TELLING HIM; it's also what the last doctor said who I went to for a consultation (she recommended a TCA). Next thing I know, she calls him and mysteriously ends up agreeing with him! Completely confusing!
Posted by polarbear206 on December 28, 2002, at 17:53:15
In reply to Re: LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 28, 2002, at 13:53:02
> > Peter,
> >
> > Lamictal has been a wonder drug for my cyclothymia. It got better the higher the dose and backing off of the a/d's. I did however have some short lived mixed states as I titrated higher doses. This does subside. You have to be very patient with this drug!! It's been worth the wait for me.
> >
> > Laura
> >But these mixed states are very extreme, and what makes them worse is the heightened social phobia I'm experiencing. I can't leave my apartement; my girlfriend is returning with her dad and brother and I'm so nervous I feel like throwing up! I've been going out with her for almost 4 years! It's completely irrational, but, hey, I feel it anyway. My levels of antisocialness and dysphoria are intense. I'm down to 25mg zoloft, decreasing from now every 4 days by 12.5 until I'm off of it. But pdoc told me to stay on 50mg lamictal, which I've been taking for weeks-and it's taken me over 3 months to get up to 50mg! I realize you have to be patient, but how patient?
> Does the lamictal have any benefits for social phobia to the levels that an SSRI does? Is lamictal seratonergic? Does it deal with dopamine? I just have no improvement at all in any of my target symptom areas from this med.
> Peter
>
>
Peter,You just weined down on the zoloft and depakote rather fast. You are most likely having withdrawal. I got the same way. I think that your dose of Lamictal is so low that it isn't even at a therapeutic level to help you out with the symptoms you are having. MAOI's and tricylics are superior over all other a/d's. Esp in your current situation, I would consider giving them a trial with the Lamictal. Imipramine has been very faithful for me. I was taking a low dose SSRI with the imipramine. I used to take 100mg with 10mg of paxil. I only take 25mg and 10mg of both now. Lamictal has been excellent for anxiety and my social phobia. I'm going up to 200mg of Lamictal tomarrow. My pdoc wants me up at the 200 range. I have learned finally after all these years (14) that mood stablizers need to be the MAIN med for me with a low dose of an antidepressant. Please read this book. "Why Your Depression Isn't Getting Better"
Laura
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