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At what point do you ask the doc for more meds?

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My pdoc seems reluctant to prescribe meds.  I'm on Lamictal 100mg, which wasn't doing crap for me when I requested to try Seroquel (75mg).  Seroquel made life better for awhile, but now I'm slipping back into depression.  I want to ask for more meds, but I don't know if I should do that or just wait until it either gets better or I get suicidal.

Oh, then there's this: last month I was hypomanic for about a week, which doesn't happen often.  So I don't know if this is a random depression or the depression that comes after the high.  And I usually can't sleep without some alcohol in me - bad, I know.  But pdoc refuses to prescribe sleep meds for some reason, so what am I to do?

I see pdoc in the morning.  I just need some advice.  Thank you.

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100 mg of lamictal is on the low end.

Not sleeping at night seems to be a problem for my hubby too.

Before adding another drug, what about upping the lamictal dose? Ask the doc.

As for sleep, there are over the counter options you might want to discuss with the doctor.

Melatonin seems to work (but in low doses...if you take too much it seems to do the opposite of what you want.)

:::not sure how to talk to someone who wants meds let alone more meds...hubby hates taking anything!!:::

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Beth, you really need to be firm with your pdoc. And tell him about the drinking-to-sleep thing. That's self-medicating, and a sure sign that your meds are not doing what they need to be doing.

I would say you need to talk to the doc soon after you notice you aren't doing well. My pdoc will change stuff for me even if I am going through a lot of situational stress.

I used to drink to sleep, too, but once I got up to 200mg of Lamictal, I didn't need to anymore.

For sure don't wait until you are suicidal. Not a good plan.

If he is still reluctant, ask him what his philosophy is as far as medication for BP patients. The whole point is to make our lives tolerable.

If he is still reluctant, I would see if I could find a new doc. You don't need to feel bad. It's not necessary.

I agree with WZ, upping the Lamictal would be a good place to start.

Gotta throw my opinions around, don'tcha know.


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100 mg of lamictal is on the low end.


Are you taking birth control pills or hormone replacement therapy? If so, then 100 mg is really on the low side. These hormones increases the clearance of Lamictal by up to 50%. Which means that women who are taking OCP or HRT often need twice as much Lamictal than they would if they were not on these hormones, in order to get the right amount of Lamictal in their systems.

If this applies to you, it's something else to talk about with your doc.

As for everything else, I agree with the other folks. You need to be honest with your doc about all of it. And try to be patient as you titrate up with the Lamictal.

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Are you taking birth control pills or hormone replacement therapy?

No.  I was on depo-provera when I started on Lamictal, but have been off the b/c for over a month now due to the problem of crappy sex.  That could have had an effect on why I was feeling better for awhile.  The lack of b/c, not the crappy sex.

And yes, I'm going to tell the doc about the drinking.  I think he doesn't want to give me sleep meds because I have a history of drug abuse/addiction, as if because I was addicted to an illegal substance in the past, I will get addicted to everything that's potentially addictive.

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well, everyone has given good advice.

i fought with my doc to get the med combo that i currently take now, after a lot of very scary, unstable periods. i also did a lot of research, and took that information with me to my appointments.  your doctor should be working with you...

do you fill out a mood chart?

what do you mean by 'more' meds?  upping the lamictal? or trying something different? 

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Well, he didn't up the dosage of my meds.  He said that if I get worse to call and then we'll talk about it.  I told him that I don't know when it's the right time to ask for more, and that I don't know if the Lamictal is doing any good at the current dosage.  I didn't tell him about the drinking, didn't get around to it.  I'm just going to quit and live with the consequences, otherwise I'll forever be dependent on the alcohol.  I'll see him again in a few weeks and I'll take a copy of the mood chart with me.

One of the problems I have with seeing docs is that I have a bubbly personality.  I like to make people smile and laugh, therefore I smile and laugh too.  Therefore it's hard to effectively show that I'm depressed, so people assume that things aren't as bad as I make them out to be.  Some people think that if you can smile and laugh, then you're really not all that depressed.  It's just how I am, it's just how I deal with things.

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Sorry you didn't come across as depressed (I never thought I'd write that!)

I am sometimes the same way.  I understand the confusion about how well the

meds are working.  I know my meds are working when I WANT to do things I

enjoy.  But it's different for everyone I guess.  Your current meds may work

better when you cut out the alcohol too.  I know all about drinking to get to sleep,

believe me.  Hop on over to the substance abuse board if you need support.

There are some meds that are used off label for sleep that aren't addicting.

You may want ask about those.  Be honest with pdoc and tell him that you use

humor as a coping mechanism.  It's not uncommon to present well, as my pdoc

calls it.  Good luck & be sure to call him if you do get worse.  Keep us posted.

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The mood chart will be your ticket to getting help. Try moodtracker.com and there's also a journal. You can write your thoughts/feelings/actions there, and really share, in real-time, what is going through your crazy head.

100mg of Lamictal is candy. I take 400mg. But I'm batshit. They just added Topamax for fortification of Lamictal.

You may want to ask if you can maximize the doseages of your current meds before trying to add more. Be careful with Seroquel. I used to take 800mg and believe me, it can fuck with you.

-- loon

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I lLOVE Moodtracker.com--its a great tool to print out and SHOW your doc whats up (LOL)

I go to another new pdoc tomorrow, and am taking my moodtracker info. If he doesn't want to read it, thats his deal--but it will give him MORE info than my "past records", I can tell you that for sure!

I have also learned about the docs who sdon't want to prescribe anything--I have been treated like a drug addict for the last 2 weeks because of my NEED for increasing doses of pain meds for my back.  Excuse me, can you KNOW how I am feeling?  A good medical person will rely on his/her skills in listening to you (or me) and PAYING ATTENTION.

Sigh--that is a long-lost quality in most docs, espc. pdocs!

Good luck, kiddo--and welcome to our world.

Love, china

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Heya Beth,

I like mood tracking too, so *much* easier to make myself do it than journaling.

Good for you quitting alcohol.  I did that when I started *real* medication.  It simplifies the whole mood thing, and the whole med thing also.

And heh.  Bubbly eh.  I come off professional -- hiya Dr. Psych, I'm a family doc with a little mood problem, a pain is all, howzabout a whiff of meds to make me better-than-well?

So yah, sane face sucks.  There's a thread around here somewhere about sane faces.

That's where mood tracking helps, b/c the paper can say things you can't say yourself.


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Don't know if this is the thread to which ncc refers, but here is one: http://www.crazyboards.org/index.php?showtopic=9132

Starts off about something else, but it gets to the "game face" issue. And really the original topic "You're the most reasonable 18 year old with bipolar I've ever seen" was about this issue, about not showing our docs who we are and how doing this works against us.

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