Need advice as I go for another ride

[dangergirl]

Ok, for the short time I've been here, for those who've followed my posts know that I don't do well with med changes and know that I've been feeling that one has been due for a little while...and lo and behold, the new pdoc agreed and decided to lower my Topamax from 100mg to 50mg (to get rid of the brain fog) and add Lamictal (to titrate up to 100mg eventually...starting slowly at 25mg every other day, first week, then, 1 per day, second week and 2 per day if that has no affect by the third week and then we meet again to discuss). He confirmed my dx of BP (didn't say whether it was 1 or 2) - he didn't confirm nor deny the ADD dx but said that we needed to get my BP under control before we even considered working on treating any other dx's.

Anyway, the Lexapro will remain constant at 10mg. Of course I'm nervous about the Lamictal and worried that I'll think myself into some of the SE's (how do you keep yourselves from doing that???) and I want to make sure that I have the smoothest transition possible. He was cool about it and said that he handles these things gently, which was very reassuring. My question for you guys is this: Do you think that I should take some time at the decreased Topa dosage and stabilize there before I start adding the Lamictal in to the mix? If so, how much time should I hang out there? I will be starting the decreased dosage tomorrow (and can start the Lamictal then too, so am anxious for replies). (oh, the doc kinda gave me leeway here, so that's why I'm asking you guys - mostly for what you're experiences were like).

I do have high hopes for the Lamictal, even though I'm pretty scared of the side affects and from my research, understand that I may suffer some initial anxiety and possible hypo mania (which, if I'm understanding correctly, should go away after about a week, although everyone's mileage does vary). Thoughts and comments would greatly be appreciated. Thanks!

[r.mcmurphy]

danger, i can only speak from my experience with lamictal. it's a really gentle chemical compared to most that i have taken. i don't currently have a seriously dinged up brain so i can not speak to it's side effects in those that are way ill.

the rash, i believe, is the threat.

i take lamictal when ever i feel my moods getting frisky. i have had no problem letting days or weeks go by and just tossing back a 100mg.

if i were in your shoes i would begin tomorrow but then we are all the same but different.

[scatty]

Start tomorrow like your pdoc told you. Don't be a bad girl! Just be stubborn and don't accept any side effects. They will go away soon enough if you do get any, so don't bother worrying. Lamictal is a good drug for a lot of people, I hope it works out well for you.

[MiaB]

I completely understand the fear of thinking yourself into side effects - I'm one of those people who scours the PI sheet, then reads the crazymeds write-up, then analyses every little thing that happens from the minute I pop the pill.. etc

Obviously everyone's mileage varies and so on, but I can say that lamictal is honestly the easiest med that I've ever been on. I've never had a single issue with it, including in the early days when I was looking at every red mark as if The Rash had arrived.

Do you think that I should take some time at the decreased Topa dosage and stabilize there before I start adding the Lamictal in to the mix? If so, how much time should I hang out there?

It's great that your pdoc is taking things slowly and easily and the schedule he has planned out looks good. I'd say follow the suggestion of starting the lamictal on Monday. The lamictal might also help with any slight withdrawal effects that you go through from beginning to drop the topamax.

Try to take some deep breaths - you're obviously in good hands - and know that this can be a really good med for the kinds of issues that you're dealing with.

best wishes

M

PS I forgot to say - don't scour the PI sheet, don't analyse the crazymeds write-up, try not to analyse every little thing that happens from the minute you pop the pill...

[mel1]

DG, I do the same thing with meds. I am always thinking the worst will happen. With Lamictal, the only se's i had were headaches. Not migraines, just headaches. And that only lasted a few weeks. I don't know anything about topa, so i can't speak to you about it, but lamictal seems to be a very well=liked med. around these parts. I would call it my "staple" med.

Oh, it never made me foggy or tired. i take 100 in the am and 200 at night. Most people don't take that high of a dosage for bp. I just need that dose. I think. who knows? Your pdoc sounds trustworthy so just go for it. If you have se's they probably will be minimal and there is a good chance that this med. will be good for you . And the rash is rare, if you are worried about that. take care, love, mel.

[DustyJr]

I do have high hopes for the Lamictal, even though I'm pretty scared of the side affects and from my research, understand that I may suffer some initial anxiety and possible hypo mania (which, if I'm understanding correctly, should go away after about a week, although everyone's mileage does vary). Thoughts and comments would greatly be appreciated. Thanks!

[resonance]

Lamictal is dangerous to just occasionally take; you need to titrate up slowly because raising the dose suddenly makes it more likely that you can get a potentially fatal SJS rash, and dropping the dose carries a risk of seizures even if you've never had them before.

It takes a damn long time to titrate up to an effective dose, so starting earlier has some advantages.

[dangergirl]

Thanks everyone for your replies - I have one more 100mg Topa, so I'll start everything (lowering the Topa, adding the Lamictal) tomorrow and let you know how it goes. One of the other reasons I was concerned was bc my glands were swollen from the pneumonia and he said me that's one of the symptoms of SJS (swollen glands, fever, rash), which was one of the reasons that he said I could wait on the Lamictal. My glands are down considerably - not quite normal, but much better. I'm gonna go for it anyway and not stress too much about it.

I tried signing up for one of the mood charting tools online but my ADD got in the way of that, so I'll have to research some better tools - that will help me not stress too much about SE's and what the med is or is not doing TO me but rather, how my moods are affected....if that makes sense...

Also - he didn't tell me take the Lamictal willy-nilly, but to take one every other day for the first week bc they are 25 mg tabs and to see how that affects me and to stay there for at least a week before moving to one a day - he also said to stay at a dosage for at least a week before bumping up to more than the next dosage (he's pretty smart too, he has a pad and pen near his "patient" chair so you can write stuff down which he encouraged me to do and I listened). Sorry if that wasn't clear in my first post. He also didn't recommend more than 2 pills a day, which I think will only be up to 50mg before I see him again (beginning of Jan).

Dusty - the Topamax is an anticonvulsant - none of the other meds that I've taken have been

Miab - TOO LATE! I've already scoured everything about Lamictal that I could find and I don't even have the drug in my hands yet....lol...it's at the pharmacist waiting for me to pick it up (along with my refill of Lexi and my new dosage of Topa -- yay for me! Between that and my pneumonia meds, I feel like I single handedly made Riteaid's quotas for this month...lol).

[YorkshireRose]

Honey I cant comment on the Lamictal as Ive only ever had lexapro and prozac,I do understand the concerns with the side effects though,I too tend to read up every scary comment I can find until Im in a worse state of panic!!!

I take a betablocker and was stupid enough to google its side effects,it said to not miss a dose or stop taking unless supervised by my doctor because of DANGER OF DEATH!!!!!

WHAT THE FUUUUUUUUCK!!!!!!

Needless to say I try not to read up too much on stuff now,I take them with the attitude of fuck it!!!!!!

Funny I use that alot in my life.....

I shouldnt have that glass of wine..........fuck it!!!!

I really shouldnt have pizza for tea AGAIN .........fuck it

You can see where Im going here,

Yes its good to be educated and informed but try keep a little perspective too,those side effect have to be listed ,most of the time they come and go without too much hassle!!!

I hope it turns out to be the perfect fit for you hun xxx

[zenbean]

hey danger,

as you know, i loved lamictal and it absolutely broke my heart to have to stop it. smoothed out my moods - kicked depression's ass - with none of the soul-crushing, zombie-fying, libido-smothering effects of other meds.

but...in the interest of full disclosure...

i'm one of those people who gets really squirrely and irritable when i'm titrating up. even irate. even enraged, when under extreme pressure. it tends to last for about a week after an increase, then go away, but if it happens to you, it's a good thing to be aware of. i try to say and do as little as possible during that time, keeping in mind that my impulses can't be trusted.

as always, ymmv - just a heads up that this happens to some people.

i hope you love lamictal as much as you love your lexi.

bean

[Ashdene]

Hey!

I have to admitt, i'm not that worldly wise when it comes to all the meds, but do my own fair share of researching, got a cool copy of my Med student friends not on psych notes and all the meds! Its pretty handy.

I was taking topamax and it was like eating candy for me! I thought it may have been helping untill i started taking lamictal this year, and realised that it certainly was not. I have had no problems with side effects that i have noticed, and no difficulty switching from one to the other.

But i must add, take my advice with a pinch of salt, as i have been having a bad spat of late. But i do really like the lamictal, and think it made a world of difference in my life!

Just want to say, good luck!!!

Hope it works out for you!

Luvies Ashdene

[dangergirl]

I didn't properly thank everyone for their input here and wanted to let you all know how much I appreciate it . Just wanted to report in to say that the Lamictal seems to be helping, with one minor glitch...the little break-thrus of psychosis...I know some people have suggested adding an ap for this (my Topa was managing it before - no problems but was pretty brain-foggy on it - down to 50mg on that now and the brain fog has lifted but lots of other bad symptoms poked through as I was titrating up, most have subsided except for this one). Anyway, I was wondering if anyone noticed their psychotic symptoms tapering off as their Lamictal dosage increased?

I'm currently up to 75mg now, will be hitting 100mg Tuesday night and pdoc said to jump to 150mg the week after that. I'm asking bc if these little episodes don't get under control, I fear he'll put me on the dreaded Depakote (he brought it up today and I immediately freaked out, so he dropped it). Don't get me wrong, I'll do whatever he tells me (within reason, I mean, if he asks me to take my clothes off and dance around nekkid, he's pretty much fired)...but I'd really like to try to avoid the Dep if I can. Thanks again for your input!!

[Anelize]

I experienced switching into mania on every SSRI I tried. Is this a concern for you, and do your episodes feel like mania type psychosis? Back in the day, I loved the topa, and took a ton of it (600mg a day). I wasn't on an AP, but damn the side effects....anyhoo, Lamictal has been a good drug for me. No rash or any other problems with it. Best

[mel1]

DG, I don't know aboaut psychosis, but I too am increasing my lamictal,and have been a little manic since. But not bad. Of course i've been taking my other dose for a few years. Have you considered adding an AP? That could help a lot. I hope you will get this straightened out and feel better. love, melissa

[YorkshireRose]

*Grabs camera to take blackmailing evidence of DG dancing around naked in front of her therapist!!!!!

Babes youre so funny!!!!!!

I cant comment too much on the old lamictal and its effects as Im just on shitty prozac!!!!

The only thing I will say and I may be wrong here but I seem to remember you was really freaked about going onto Lamictal,scared of the side effects ect...........what Im saying is you seem to have had the same knee jerk reaction the the depakote,which looks like a red indian name to me...dep-a-ko-tay!!!!

Anyway just hoping that everything gets tweaked and pulled with in an inch of its life until you feel well,sorry if I seem insensative Im in a right cheeky mood!!!

[dangergirl]

Is this a concern for you, and do your episodes feel like mania type psychosis?

I really don't know, to be honest....I know that sounds bizarre...I have no desire to spend money and don't feel oversexual, but do have the aggresiveness and aggravation...I'm still trying to figure out what mania, hypomania and a plain ole good mood feels like for me. I'd say that I spent the last 6 years of my life in a borderline hypomanic state. I'm also having some sleep agitation as well...which is always a concern for me - that's usually my red light flag. So I'm gonna go with a yes there. Again, a lot of this is pretty new to me - I always assumed (which is just silly) that everyone had the experiences I had, so never worried about it. edited to add: my psychosis aren't serious...just minor annoyances like hearing people saying things when they don't and seeing things move or be there when they're not...so a little embarrassing sometimes, but a simple, "oh, I thought I heard you say something, or thought I saw something" usually does the trick without too much harm...nothing like believing aliens are speaking to me through the tv or anything like that (not that I believe it's outside the realm of possibilities - ha!)

My pdoc did ask me about adding the Seroquel back to my cocktail, but it zombified me - I'm not talking about being tired, I'm talking about stumbling around, not remembering things that people said to me 2 seconds ago, not being able to string two words together to form a sentence - not to mention the dry mouth, which caused me to drink gallons of water, which caused me to spend more time in the bathroom than a narcissist in the mirror (it even woke me up at night), the weight gain (which I still haven't lost), the tiredness, etc. So I pertty much told him - um, not really a good choice for me...which is how he thought about Depakote...weird sequitor if you ask me...

I'll have to research some other ap's and see what I come up. Thanks everyone for the replies again - it's been really helpful!

And Rosie, you're not being insensitive - you're cracking me up about the Indian Depakote...thanks for the laugh

[zenbean]

do have the aggresiveness and aggravation...just minor annoyances like hearing people saying things when they don't and seeing things move or be there when they're not...

hey danger, sorry to hear you're having a hard time. i wouldn't consider these psychotic sx...is that what your pdoc calls them? i mean, i guess they may be depending on the level of what you're seeing or hearing, but when you elaborated a little more, it didn't sound like it rose to the level of hallucinations exactly. anyway, the reason i'm trying to draw a finer line, is a SE many of us have noticed on lamictal is a sharp increase in feelings of irritation/aggressiveness at the time of dose increase, that usually goes away within a few days to a week. is it possible this is what you're experiencing? it sounds like you're titrating up pretty rapidly, and it might be easy to confuse this SE effect with sx breakthrough if you're not allowing enough time in between dose increases to see if things settle down. might wanna ask your pdoc about it, esp if it might mean avoiding the dreaded (cue dramatic music here) depakote. (why are you dreading it, btw? does it have scary SEs? i don't know much about it.)

anyway, good luck, and hang in there - you're gonna get this figured out! (after all, you're dangergirl - you're scarier than any damn med.)

bean

[YorkshireRose]

*Rosie does her hmmmmmmmmmmmmmmmmm

look.....as she has very little else to do!!!!!!

I have cheese and champers

I also have olives and humous and when you really piss me off............pate'...........but thats mine and I gotta be in the mood to share!!!!!!

*hides the crusty bread...............

[dangergirl]

****tackles Rosie, steals her pate and eats it with her own nice crackers....heh .

No, they are definitely hallucinations, but like I said, not too bothersome...and definitely not in relation to the aggressiveness and aggravation - those two are typical behaviors for me, which is prolly the decrease in Topa (I hadn't realized how whacked out the stuff was making me, actually) and the Lamictal titration - it's actually been getting better the more Lamictal I take. I hadn't realized that the 25 mg per week was a fast titration (week 1 = 12.5, week 2 = 25, week 3 = 50, week 4 = 75)...I did question him about jumping from 100 to 150 in one week though since I'd been doing the 25 mg week to week (that's what's meant to happen next week (5) and then on week 6).

I'm not stressing too much...just want to get nice and smooth and feel as well as I can. I'm a lot better than I was, that's for sure...the depakote has a nasty SE profile - weight gain, bone aches, hair loss, bloating, fatigue, stupidity...basically it sounds like how I was on Seroquel...the biggest complaints were the weight gain, the stupidity and the fatigue...people had to take naps, which, if I go back to my traditional corporate lifestyle, would not be in the least bit feasible...and well, who likes being fat and stupid? I mean, one or the other, I could take, but BOTH??? NO WAY!!!

[CER]

Anyway, I was wondering if anyone noticed their psychotic symptoms tapering off as their Lamictal dosage increased?

Heh. Feel free to check out my sig.

Have you had these before you started on Lamictal? A very few [link=http://www.ncbi.nlm.nih.gov/pubmed/17485241?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" target="_blank]have been known to develop psychosis from Lamictal.[/link]

Not to alarm you or anything.

If you're hearing voices and seeing things (as minor as it may seem) then that's never a good sign. Chances are the Lamical is not the culprit, but if you are dead against Depakote then you should probably consider either Lithium or adding an AAP if they don't go away or get any worse. If you had a bad experience with Seroquel you could try Risperdal or Invega to get rid of those little hallucinations.

[dangergirl]

Thanks CER - I'll look into those both...and yeah, I can totally relate to your sig...lol. The hallucinations have been pretty much all my life...just never realized there was anything wrong with me until they went away at the higher dosages of Topamax. I noticed that you have ADD too but don't see anything in your cocktail that would specifically treat it...can I ask how you handle your ADD? I'm struggling with that right now as well, but my pdoc wants to get the moods in order before he starts tinkering with my attention span...LOL. He's such a patient man with my pea brain .

[zenbean]

oops...you're right danger...you're not doing a terribly fast titration, was the just the 100 to 150 jump that threw me off. yeah, the depakote sounds like potentially nasty stuff...but remember not everyone gets every SE...maybe you'd be one of the lucky ones? (oh well, you can dream about it, right?)

rosie...what are champers? something edible i take it? are we gonna hafta fly you here to ny to find out what all this stuff is?

bean

[CER]

Thanks CER - I'll look into those both...and yeah, I can totally relate to your sig...lol. The hallucinations have been pretty much all my life...just never realized there was anything wrong with me until they went away at the higher dosages of Topamax. I noticed that you have ADD too but don't see anything in your cocktail that would specifically treat it...can I ask how you handle your ADD? I'm struggling with that right now as well, but my pdoc wants to get the moods in order before he starts tinkering with my attention span...LOL. He's such a patient man with my pea brain .

I've been taking some left over Provigil since Strattera failed me last month. It doesn't really do a whole lot other than keep me awake, but it's better than nothing.

I actually have an appointment with my pdoc tomorrow. We're supposed to come up with a new med for me to try.

[dangergirl]

CER - if you wouldn't mind keeping me posted, I'd appreciate it...I'm a little anxious to get a handle on the ADD - believe it or not, the hallucinations are nothing in comparison to my short attention span .

Bean - champers is short for champagne. I learned that from my Aussie friends...lol.

[CER]

I noticed that you have ADD too but don't see anything in your cocktail that would specifically treat it...can I ask how you handle your ADD?

My doc is starting me on Adderall.

[mel1]

DG, how goes it on the Lamictal? I have been at my increase from 300

to 350 for about 3 wks and i have def. noticed an improvement. i'm not cycling like crazy and i'm not at all depressed. i can really see the diff. when looking at my mood chart. it's funny how those things can actually work. I started working and am not too anxious and no depression or agitation or irritabiltiy./ ok, a little irritability here and there, but no ones perfect. I can't wait to show my tdoc and pdoc my mood chart. even my bf has noticed my mood change. i guess it was the right thing. finally. i really want to know how you are doing , so check in and let us know! melissa

[dangergirl]

CER - keep me posted on the Adderall front, if you don't mind...that's what my tdoc wanted me to start with but the old pdoc had it in her head that Strattera was the way to go (duh, no it wasn't).

Mel, thanks for checking in...I've been so sick this week (physically ill, not mentally), I don't know how it's going....I've been a little "up" as in I can't sleep, but I'm not feeling hypo or manic (although, I wanted to shop like a mad woman yesterday)...and my paranoia is raging. I think I'm gonna sit at the 100mg for an extra week if this doesn't level off by Tuesday (that's my jump day). Rage issues have been good though. I will definitely keep you posted.

I am so happy to hear that you are feelin better. You are right, it's been a tough couple of months for you and seriously, it's about time you get some relief!! I'm very excited for you .

[betcsu]

okay so im way late in replying here but i wanted to touch base on the scouring for SEs with the lamictal. as you read in my blog entry last week, i did that with a vengence. BAD idea.

i did have a LOT of SEs as you read, but most of them have subsided, thankfully. im taking my titration slower than the pdoc suggested. he wanted me to increase by 25 every 2 weeks but im only increasing by 25 every 3 weeks cuz i want to be suuuuuure! im still at 50 mg and wont titrate up to 75 for 11 more days.

and looking at my mood chart, ive actually had 2 days in a row where not only have a felt stable, but i havent felt any anxiety or irritabilty ('cept for that caused my my kids not listening to me, but thats normal, right?)

now today, i do feel a little anxiety creeping in but the days just beginning and im hoping itll wear off as i get busy doing stuff.