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Mood Disorder Community
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texblue2
Starting Member
6 Posts |
 Posted - 07/05/2005 : 12:04:18
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TextText
Howdy out there! I am SO glad to have found this board, would like your input on a med problem. Hope to be able to help one of you someday, too...been doing this BP s__t for a long time...but this is weird...
Last week I was taken off Cymbalta 25mg, and my Lamictal doubled from 100 mg to 200mg because doc thought too much effect on norepinephrine was causing my weepiness/suicidal thoughts alternating with anger/homicidal thoughts, all in a day.
Weird thing is, since then (thurs 6/30) have still had weepiness, vertigo, nausea, and the "eye/brain swoosh" I had long time ago with effexor withdrawal. Still homicidal, but that's another story....
I did not think it (symptoms like effexor withdrawal) was from stopping Cymbalta, thought it was from lamictal surge. So I called office friday. Dr's PA said take it in 2 doses, 100mg, 12 hrs apart. Since I was reluctant to take lamictal 100mg in morning over holiday weekend (am also on wellbutrin 200mg twice day 6 hrs apart, klonopin as needed, and metadate 30mg). So I decided to try 50mg this past weekend. And today.
But when I take lamictal 50mg in morning with wellbutrin and metadate, within an hour I'm nauseous, dizzy, unable to think, and cry myself to sleep. After a couple hrs nap I can function some.
I'm unloading here because unable to see Dr until 18th July. They don't like to discuss med problems without seeing you.
So, my vast unpaid research team, have ya'll been thru this with lamictal? cymbalta? Your comments will mean a lot to me. Gonna take a nap now.
Thanks!
I'm FRIED in Texas, and would
rather be truckin',
texblue2  |
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| humbleheart37
Starting Member
24 Posts |
Posted - 07/05/2005 : 20:50:10
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Hey Texblue:
Welcome! I am a new member myself. Idon't have a lot to help you with as far as information on meds. I'm actually newly diagnosed with BP. So I'm trying to take this all in. But I can tell you that I understand the difficulty you are experiencing with your meds. I have Obsessive-Compulsive Disorder, Dysthymia, and BP and I have several physical health issues, so I take a lot of different meds. And I know what it's like to feel s***** after taking some meds, then changing meds til finding the one that works. The side effects, watching for drug interactions, allergic reactions, etc. You get the idea. Sometimes I want to stop them all and see what happens. I know inside that's probably a bad idea.
Have you contacted the prescribing doctor? Are these effects something that goes away with continued use?
Best of luck!
You have a friend here who understands,
HH37 |
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| autumn2night
Full Member (100+ posts)
175 Posts
Gratitude: 4
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Posted - 07/06/2005 : 15:48:56
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Hi,
I lived in Texas forever it seems. I'm very familiar with their psychology/psychiatry websites. The local government has made it very easy for people like you and I to find information on all matters of mental health. The easiest website is www.texas.gov You can access a lot of agencies through this site. As far as asking questions in between appointments, I've come across this site that I think you can find someone who can help you locate a person who will better answer your questions also.
Go to www.dshs.state.tx.us/ Follow it down to "Learn more about mental health and where you can get help" Scroll down to "Where to seek help"
Then click Local mental help authorities.
The rest is self explanatory. Med changes can be tricky. I am on several medications and feel fine. Lamictal is one of the cleaner ones that I am on.
Good luck,
Duffy
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| Administrator
Administrator
14912 Posts
Gratitude: 593
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Posted - 07/07/2005 : 00:14:13
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Hi Texblue2,
I'm a little confused by your treatment. The usual treatment for an individual with Bipolar I Disorder consists of a mood-stabilizer (ie.g., lithium, valproate, or carbamazepine) +/- an antipsychotic medication. Half of all individuals with Bipolar I Disorder require both a mood-stabilizer and an antipsychotic medication before they get control of their mood disorder.
My question is why aren't you on a mood-stabilizer and/or antipsychotic medication?
The danger with your current medication treatment is that you are on two medications that can trigger mania, namely an antidepressant (bupropion = Wellbutrin) and a stimulant (Metadate = long-acting methylphenidate). Your anticonvulsant, lamotrigine (Lamictal) won't prevent mania. Lamotrigine only is effective in the prevention of depressive relapses.
Thus my concern is that there is nothing in your current treatment that will prevent the return of mania (which can present with anger and irritability).
I'm sure that there is a good reason why your psychiatrist is treating you with your current medications, but could you tell us a little more about your past response to mood-stabilizers and/or antipsychotic medications?
Phil Long M.D.
Administrator  |
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| texblue2
Starting Member
6 Posts |
Posted - 07/07/2005 : 07:42:46
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Thank you, I'll try to hit the highlights and answer your queries about my hx...currently I believe my prescribed mood stabilizer is lamictal 100mg bid, and as for anti-psychotic, it's my understanding I am to take clonazepam 1.5mg hs for sleep and prn agitation. I'd been doing fairly well until just recently, so I think that's why they've backed off my cymbalta and have me on lamictal to prevent relapse of depression.
I'm supposed to be taking wellbutrin 200mg Q am, but ran out and am waiting for Medco mail order. I planned to call Dr today and request a call-in to tide me over. I had a large supply wellbutrin from previous treatment and thought it would last until 90 day rx came via snail mail. I've been under care of this psychiatrist since emergency hospitalization back in Jan.
I have been on seroquel in the past, not sure why it was switched...I was on trileptal for quite awhile prior to hosp, but it was dc'd so they could try ECT...since then it's been lamictal, cymbalta, and clonazepam.
In the past I was on wellbutrin and effexor simultaneously, with trileptal and buspar. My hx goes back to 1997...I was on depakote, I think, for years, with bad weight gain and it made me feel "stupid" and unable to effectively do my job as a clinical research nurse.
A doc at the Baylor Mood Disorder center started me on strattera, and then my current doc put me on metadate to try to help me function, to stay out of bed and try to do something around the house. I just can't get my thoughts lined up....
I have a hx of pseudotumor cerebri, so they've stayed away from lithium. But I was on it for awhile, because I still have some...not sure why it was dc'd.
Recently I've been reading about seroquel more often on the I-net for bipolar.
The short story is I've done it all. I can no longer work, and inadequate does not describe how I feel.
thank you, hope that sheds some light...
texblue2 |
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| Administrator
Administrator
14912 Posts
Gratitude: 593
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Posted - 07/08/2005 : 23:21:20
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Hi Texblue2,
Thank you for the clarification. It still seems that you currently aren't on any medication that will prevent mania.
- You are not on a mood-stablizer than can prevent mania (like lithium, valproate, or carbamazepine). Your present anticonvulsant, lamotrigine, only prevents depressive relapses.
- You are not on an antipsychotic medication. Clonazepam is a benzodiazepine antianxiety + anticonvulsant medication (not an antipsychotic medication). Clonazepam is used to treat acute mania when sedation is required. However, clonazepam can disinhibit some individuals and trigger anger and aggression.
- You would have to check with a neurologist, but I think that individuals with Pseudotumor Cerebri could be treated with lithium if their serum lithium levels were closely monitored (especially if they were on diuretics). Interestingly, significant weight loss in conjunction with conventional therapy for Pseudotumor Cerebri leads to complete remission of this disorder in many instances.
- You mentioned coming off Cymbalta last week. Hopefully, you always take 1-2 months to slowly come off your antidepressants. A sudden withdrawal over 1-2 weeks from an antidepressant can trigger mood-instability +/- pronounced physiological withdrawal symptoms (especially for Paxil and Effexor). Your "eye/brain swoosh" that you experienced suggests that you may have come off Cymbalta too quickly
In summary texblue2, all I can say is that your current treatment for Bipolar I depression doesn't conform to the American Psychiatric Association's guidelines for the treatment of Bipolar I Disorder. Namely, you are not on an anti-manic mood-stabilizer or an antipsychotic medication.
In addition, you are on clonazepam which, in some Bipolar individuals, can trigger irritability and aggression. Likewise you are on 2 medications (an antidepressant and a stimulant) which can trigger mania if not "controlled" by the simultaneous use of a mood-stabilizer and/or antipsychotic medication.
I have printed two relevant research studies using lamotrigine (Lamictal) to treat Bipolar I depression. Notice that, in the first study, only 51% of the depressed Bipolar I Disorder patients responded. Thus lamotrigine, when used by itself, is effective only about half the time. Hence the importance of your being on another mood-stabilizer +/- antipsychotic medication in combination with your lamotrigine.
J Clin Psychiatry. 1999 Feb;60(2):79-88.
A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group.
Calabrese JR, Bowden CL, Sachs GS, Ascher JA, Monaghan E, Rudd GD.
Case Western Reserve University, Cleveland, Ohio, USA.
BACKGROUND: More treatment options for bipolar depression are needed. Currently available antidepressants may increase the risk of mania and rapid cycling, and mood stabilizers appear to be less effective in treating depression than mania. Preliminary data suggest that lamotrigine, an established antiepileptic drug, may be effective for both the depression and mania associated with bipolar disorder. This is the first controlled multicenter study evaluating lamotrigine monotherapy in the treatment of bipolar I depression.
METHODS: Outpatients with bipolar I disorder experiencing a major depressive episode (DSM-IV, N = 195) received lamotrigine (50 or 200 mg/day) or placebo as monotherapy for 7 weeks. Psychiatric evaluations, including the Hamilton Rating Scale for Depression (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), Mania Rating Scale, and the Clinical Global Impressions scale for Severity (CGI-S) and Improvement (CGI-I) were completed at each weekly visit.
RESULTS: Lamotrigine 200 mg/day demonstrated significant antidepressant efficacy on the 17-item HAM-D, HAM-D Item 1, MADRS, CGI-S, and CGI-I compared with placebo. Improvements were seen as early as week 3. Lamotrigine 50 mg/day also demonstrated efficacy compared with placebo on several measures. The proportions of patients exhibiting a response on CGI-I were 51%, 41%, and 26% for lamotrigine 200 mg/day, lamotrigine 50 mg/day, and placebo groups, respectively. Adverse events and other safety results were similar across treatment groups, except for a higher rate of headache in the lamotrigine groups.
CONCLUSION: Lamotrigine monotherapy is an effective and well-tolerated treatment for bipolar depression.
PMID: 10084633
J Clin Psychiatry. 2004 Feb;65(2):204-10.
A 52-week, open-label continuation study of lamotrigine in the treatment of bipolar depression.
McElroy SL, Zarate CA, Cookson J, Suppes T, Huffman RF, Greene P, Ascher J.
BACKGROUND: Lamotrigine has demonstrated efficacy for the acute treatment of depression in bipolar I patients in a placebo-controlled, monotherapy study. We describe the results of a 52-week, open-label continuation of that trial.
METHOD: Patients meeting DSM-IV criteria for bipolar I disorder with a current major depressive episode who completed a 7-week, double-blind study of bipolar depression were offered 1 year of open-label lamotrigine therapy (flexible doses of 100-500 mg/day) in a continuation study. To maintain the acute study blind, the first 3 weeks of the continuation study remained blinded while patients previously randomly assigned to placebo were titrated to a lamotrigine dose of 50 mg/day. Patients who had been randomly assigned to lamotrigine continued at their fixed doses. Beginning at week 4, all patients received open-label lamotrigine for up to 49 additional weeks. Concomitant psychotropic medications were permitted during the open-label phase. Effectiveness (Montgomery-Asberg Depression Rating Scale [MADRS], Clinical Global Impressions-Improvement scale) and safety assessments were administered at weeks 4, 12, 24, 36, and 52. The study was conducted from June 1996 to December 1998.
RESULTS: Of 135 patients completing the acute study, 124 (92%) entered the continuation study: 77 had received lamotrigine and 47 had received placebo in the acute study. The mean duration of lamotrigine exposure was 10.4 months, with a mean modal dose of 187 mg/day. Sixty-nine patients (56%) completed 1 year of treatment. Significant and sustained improvement from baseline was seen in mean observed MADRS scores (p <.05). The proportion of patients achieving remission (MADRS score < or = 11) by week 4 of the study was 81.4%, and episodes of mania/hypomania occurred less frequently than in the preceding year. Headache was the most common drug-related adverse event.
CONCLUSION: During 1 year of open-label therapy with lamotrigine as adjunctive therapy or monotherapy, bipolar I patients experienced sustained improvement in depressive symptoms without evidence of mood destabilization.
PMID: 15003074
Please discuss this with your psychiatrist.
Phil Long M.D.
Administrator |
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| texblue2
Starting Member
6 Posts |
Posted - 07/09/2005 : 21:16:46
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Dr Long,
that information is extremely helpful. My psydoc and I have a lot to talk about. I have not had s/s of BIH in many yrs, and recent (<2yrs) neuro-ophthalmology exam showed almost complete resolution of my scotoma and brain MRIs have normalized. have gained weight recently, but at age 53, BIH seems less of a threat than my insanity.
I'd like to stop the metadate, and don't think there will be a problem with that...
I'll ask about a mood stabilizer, but would that be in addition to lamictal?
so the klonopin could be exacerbating the anger and irritability?
seroquel or something like it might be needed? I already feel like a slug sometimes...would that help my tearfulness?
I just don't feel like I'm making progress toward being able to function in my profession again. that really makes me feel sad and hopeless.
Dr Long, I don't know how you have time to do this, but thank you very much...
rather be truckin',
texblue2 |
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| Ferengi (inactive)
Incredible Member (2000+ posts)
3264 Posts
Gratitude: 332
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Posted - 07/11/2005 : 09:02:44
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Klonopin didn't work for me but I'd be very concerned about the way your psychiatrist is treating you. You should not have come off the Cymbalta cold turkey, that can really destabilize you and you have no anti mania drugs in your *****tail. Does your pdoc know anything about bipolar?
Ferengi |
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| Administrator
Administrator
14912 Posts
Gratitude: 593
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Posted - 07/11/2005 : 09:58:29
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Hi Texblue2,
I will get back to you later today concerning the issues you raised in your last post.
First, I wanted to show you this research on lithium aggravating pseudotumor cerebri. I was unaware of this very rare complication of lithium therapy. It is so rare that I have never seen this in 30 years of clinical practice. Nevertheless, there are apparently 5 cases of this condition in the medical literature. You and your psychiatrist would have to decide if this extremely rare complication of lithium would be a contraindication for your trying lithium.
Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1989 Jul-Aug;17(4):251-3.
[Benign cranial hypertension secondary to treatment with lithium]
[Article in Spanish]
Moral Iglesias L, O'Neill of Tyrone A, Alvarez Cermeno JC, Fernandez JM, Saiz Ruiz J.
A 23 years old woman, diagnosed as having manic-depressive psychosis, in treatment with lithium carbonate for eight months, developed a benign cranial hypertension secondary to the lithium. Suppression of the lithium gave place to the normalization of the pressure of the cerebrospinal liquid which increased again with the reintroduction of the drug. This rare complication of the lithium salts, has only been described in five other cases, all women, with a relative short time of treatment, non-toxic lithium serum levels and without precipitating factors.
PMID: 2572150
Phil Long M.D.
Administrator |
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| texblue2
Starting Member
6 Posts |
Posted - 07/12/2005 : 11:03:38
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thank you dr lang, i've always been aware of lithium being contraindicated in BIH. for some reason I have an rx dated 12/26/01 from psydoc at BCM Mood Disorder Center. It was rx for 300mg #90, and there were still 82 in bottle. have no idea why we tried it. maybe i had not given them all hx, don't know...but I just flushed them. they're outta here.
rather be truckin',
texblue2 |
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| WilliPlate
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| warblaster
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| warblaster
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| warblaster
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Posted - 12/02/2021 : 00:49:47
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| warblaster
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newby here, anyone have probs with lamictal?
