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gb84

Need recommendation for something other than Gabapentin

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I've been on Gabapentin for about 5 years.  I'm supposed to take 600mg x 5 a day, but usually only take 3 when I wake up.  I really don't notice any effect from it anymore and it feels like I might as well be taking a sugar pill.  I'm kinda trying to ween myself off of it, even though this hasn't been approved by my doc.  Right now she is more concerned with finding the right antipsychotic and antidepressant for me.

Even though I recently switched to Viibryd 20mg, I am still in a pretty depressed state.  Although after about a week titrating on it I was much improved, maybe manic, but this has subsided somewhat.

Based on the Genetic test I took there are basically 4 options for me to try:  Tegretol, Lamictal, Trileptal, Depakote.

In the past my first mood stabilizer was Depakote, but I don't remember how it worked since it's been over 10 years.  I've also taken Lithium (didn't like) and Topamax, but the latter was more for weight loss and made me really anxious.  I've never tried Tegretol, Lamictal or Trileptal.

This is the cocktail I am taking at the moment: See signature, or (Viibryd 20mg x1, Klonopin 1mg x2, Zyprexa 10mg x1 / 2.5mg PRN, Ritalin 20mg x3, L-Methylfolate) and of course the Gabapentin.

What would you recommend trying?  I am tired of being in a constantly depressed state and I am hoping a good mood stabilizer can pull me out of my usual winter depression this year.  Honestly I would prefer being somewhat manic as opposed to depressed, at least I would feel somewhat alive.

Any feedback is really appreciated.

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I'd think lamictal would be best if your treating BP depression....takes a while to titrate and kick in tho 

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If gabapentin was good when it  worked, you can try pregabalin (lyrica).

Otherwise Lamictal could work.

Tegretol and Trileptol, are also options. However if you are of east or south asian descent, you'll want to ensure that you do not carry the HLA-B*1502 gene, which is strongly correlated to SJS/TENs in those populations with these two meds. If your gene test also took that into consideration..well rock and roll.

There's also depakote, however if you're doing lamitcal at the same time as depakote, note that it will almost double the amount of lamitcal in your system. 

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Is Lyrica approved as a mood stabilizer in the United States? 

I'm half German and half Russian. 

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some of these are actually used offlabel. Gabapentin might have shown promise early on, but per double blinded tests, it did no better than placebo. Same for topamax

http://tmedweb.tulane.edu/pharmwiki/doku.php/other_mood_stabilizers

Looks like only Lamitcal, Tegretol and Valproic acid (think it's similar to Depakote) are officially approved.

Here's basically that in PDF format along with drug interactions.

http://www.dbsalliance.org/pdfs/medication_charts/BPmedication_chart.pdf

 

 

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7 hours ago, gb84 said:

 

Based on the Genetic test I took there are basically 4 options for me to try:  Tegretol, Lamictal, Trileptal, Depakote.

In the past my first mood stabilizer was Depakote, but I don't remember how it worked since it's been over 10 years.  I've also taken Lithium (didn't like) and Topamax, but the latter was more for weight loss and made me really anxious.  I've never tried Tegretol, Lamictal or Trileptal.

 

Lamictal. The other are hard on you body while lamictal is more easy on your body.  

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3 hours ago, argh said:

some of these are actually used offlabel. Gabapentin might have shown promise early on, but per double blinded tests, it did no better than placebo. Same for topamax

http://tmedweb.tulane.edu/pharmwiki/doku.php/other_mood_stabilizers

Looks like only Lamitcal, Tegretol and Valproic acid (think it's similar to Depakote) are officially approved.

Here's basically that in PDF format along with drug interactions.

http://www.dbsalliance.org/pdfs/medication_charts/BPmedication_chart.pdf

 

 

Thanks for the pdf, very helpful. 

I guess I will ask about Lamictal instead of Gabapentin to try.  Going to have to switch away from Viibryd due to the stomach issues and Zyprexa because of the weight gain.. Why does this have to be so hard.  If I had a lot of money I bet I could have this problem licked in a few months of bi-weekly visits.  Having to wait 3 months is a bunch of crap.  

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11 hours ago, gb84 said:

 Having to wait 3 months is a bunch of crap.  

You have to wait 3 months between appointments?........Why so long?

Just curious.

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13 hours ago, notloki said:

Lamictal. The other are hard on you body while lamictal is more easy on your body.  

^^ this. I'm actually starting back up on lamotrigine (Lamictal) now myself because I'm having some minor spring/summer cycling from the Trintellix I was taking and I've been out of a depressive episode for a while. So it was time to come off of it. However, I will point out that lamotrigine has a lot of positive evidence indicating its abilities to prevent both depressive and hypomanic/manic episodes. However it's better for the depressive side of things overall. Additionally, it isn't good at treating depression or mania acutely because of how slow and long the titration is. Proper mood stabilization likely wouldn't be achieved until between 100mg and 200mg and you wouldn't even hit 100mg until Week 5 and 200mg until Week 9.

17 minutes ago, CrazyRedhead said:

You have to wait 3 months between appointments?........Why so long?

Just curious.

Curious as well. I sometimes have appointments every two weeks with my pdoc when I'm being treated acutely. Is it an issue with scheduling at the pdoc's office or because of your insurance?

My other question would be what your predominant symptoms are. I would think that if you're taking gabapentin at that dose, it's likely because you need something that's calming. In that regard, perhaps replacing the gabapentin with carbamazepine (Tegretol) or oxcarbazepine (Trileptal) makes more sense.

Carbamazepine definitely has a lot of compelling evidence when lithium and valproate (Depakote) aren't options. Although some people can't tolerate some of the side effects. And those patients typically find oxcarbazepine to be much more tolerable and have fewer issues. As you can see from their names, they are related. Carbamazepine came first. Oxcarbazepine was later developed to have a slight structural change by making alterations to the carbamazepine compound. The resulting compound relied less on the liver for metabolism. The positive effect there is that oxcarbazepine does not induce liver enzymes and impact the metabolism of other medications the way that carbamazepine does. With carbamazepine, you have to effectively double the doses of most of your other medications. Oxcarbazepine, not so much. Additionally, carbamazepine is broken down into a somewhat toxic epoxide metabolite that contributes mostly to its side effects as well as the MHD metabolite which contributes to its pharmacological action. Oxcarbazepine does not produce the epoxide metabolite when the body breaks it down, only the MHD metabolite. This significantly reduces the risk of anemia and agranulocytosis that, while rare, did happen to some patients treated with carbamazepine.

Upside to carbamazepine is the controlled release is now generic I believe. And there is a brand, Equetro, that is specifically approved to treat bipolar disorder. It has a combination of immediate and extended release beads. Otherwise, what you would have to do to accomplish the same thing is take both low dose immediate release and higher dose extended release of the generic tablets in the morning to achieve the same effect. Not sure if the distributed release mechanism makes it more tolerable or anything. Not sure if anyone on the boards here has tried Equetro specifically compared to the carbamazepine XR generic tablets. Unfortunately, with oxcarbazepine, the XR is brand only (Oxtellar XR). Not many insurance companies will cover it unless you've tried the generic oxcarbazepine immediate release first.

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I would love to go more often, but I can't afford the copay.  Every time I see a specialist it is $50.  I have 2 others I see monthly for other health problems. 

I'm just blowing off steam.. 

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Oh I see. That's really a shame. My copay for my pdoc now is $20 but it's going back up to $50 in July. <_<

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I could put my mental health in the care of my GP.  I would be there once a week for only $7 a pop :D

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11 minutes ago, gb84 said:

I could put my mental health in the care of my GP.  I would be there once a week for only $7 a pop :D

Yeah I know that isn't always ideal though because GPs are very wary of doing psych. It does depend on the GP though.

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Mine won't do it, he'll prescribe antidepressants but that's about it.  

I just need to find a job, then I would be able to go more often.. 

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I really liked lamictal and Trileptal. Unfortunately both made me itch and had to discontinue.

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Did you get sjs on the lamictal or was it a normal itch/rash?

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Can u get Lyrica? 

 

I found tgat ti erase erase my anxiety and give me a boost. 

 

Gavapentin In has always been good to me.

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