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Lithium, Topamax, and a short update


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I've been jumping between 900-1050 Li+ with a level of .6 for 6 months. and it's kept me somewhat stable (minor hypo breakthrough symptoms). It's also made me gain 25lbs and has affected my cognition in a major way. 2 weeks ago my Pdoc dropped me back down to 900mg of Li+ and brought Topamax onboard titrating at 25mg/week until we hit 100mg and see how I feel as a whole for a month.

So week one at 25mg I felt a bit calm yet nervous at the same time. Does this make any sense to anyone? It's like things slowed down a tiny bit which was nice but constant anxiety kicked in which we nuked with PRN Lorazepam. My appetite decreased slightly, my urge to smoke decreased slightly.

The only thing significant that I've noticed so far is that I've been more aggressive with people when under stress. A good example would be this past week. During the bad stint of weather we had problems with our generators at work and had to shut all of our equipment down. One of my employees disregarded orders and caused some major issues for the company. I was so mad I wanted to scream at him, firing him on the spot. I waited few hours to cool down and firmly told him if it ever happened again I would fire him without question, explaining why what he did was against policy. The point being I felt that aggression kicking up bad. Not sure if it was the medicine change, extreme stress, or both.

My Pdoc says it's going to take a few weeks to hit 100mg of Topamax and another month to see if I benefit from it, based on that we'll see about a different stabilizer or start playing with a mix of Lithium and Geodon or another Atypical.

All I know is it's been 2 years and this whole med game is getting tiring. Just wish I could find something that works consistently and well.

Thanks for listening...

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The only thing significant that I've noticed so far is that I've been more aggressive with people when under stress.

That's kind of interesting, because a lot of people notice the opposite effect from Topamax. 25 mg is an absolutely minuscule amount, though, so it'll take a bit longer to find out what it's actually going to do for you. Something worth noting is that there is an interaction between it and lithium. Topamax can raise your lithium levels by a non-trivial amount (something like 25%, depending on how much you're taking, I think), but generally not until you're at a higher dose. It may or may not be an issue if you stay at a fairly low dose of Topamax, but it's good to be aware of it, at least.

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The only thing significant that I've noticed so far is that I've been more aggressive with people when under stress.

That's kind of interesting, because a lot of people notice the opposite effect from Topamax. 25 mg is an absolutely minuscule amount, though, so it'll take a bit longer to find out what it's actually going to do for you. Something worth noting is that there is an interaction between it and lithium. Topamax can raise your lithium levels by a non-trivial amount (something like 25%, depending on how much you're taking, I think), but generally not until you're at a higher dose. It may or may not be an issue if you stay at a fairly low dose of Topamax, but it's good to be aware of it, at least.

Thanks for the feedback, I've heard the same. My Pdoc said the aggression is most likely stress mixed with the addition of a new med and lowering of Lithium. I've heard of the drug/drug interaction of the two so I'll continue getting readings as I move up. At 900-1050mg I barely push a .6 so maybe Topamax raising it won't necessarily be a bad thing. I think I'm just going to have to be patient while we see if it works.

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Fortunately it's not one of those ultra-slow starts like Lamictal. 25 mg every other week is the cautious route, but 50 mg every 7-10 days is also reasonable/common if you don't have side effect issues. For me, any side effects I had when raising or lowering the amount I was taking pretty much went away within a week, which was nice. It was great stuff during the time I was on it. First med I ever took that was unquestionably and overwhelmingly a positive experience, so I still kind of have a soft spot for it.

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Fortunately it's not one of those ultra-slow starts like Lamictal. 25 mg every other week is the cautious route, but 50 mg every 7-10 days is also reasonable/common if you don't have side effect issues. For me, any side effects I had when raising or lowering the amount I was taking pretty much went away within a week, which was nice. It was great stuff during the time I was on it. First med I ever took that was unquestionably and overwhelmingly a positive experience, so I still kind of have a soft spot for it.

Do you mind if I ask why you aren't on it any longer? Sounds like it was a good drug for you.

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titrating up on AEDs can be rough. when I hit 50mg of topamax I had bad anxiety and rapid cycling of mood. It freaked me out so bad I dropped back to 25mg the next day.

100mg is usually a stabilizing dose. Id stick it out if you can, and see if it helps you out.

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titrating up on AEDs can be rough. when I hit 50mg of topamax I had bad anxiety and rapid cycling of mood. It freaked me out so bad I dropped back to 25mg the next day.

100mg is usually a stabilizing dose. Id stick it out if you can, and see if it helps you out.

My anxiety hit as soon as I took 25mg.. It tapered off towards the end of the first week then came on again at 50mg. It's slow starting to calm a bit. Having had much rapid cycling (any more than usual that is). But I'm keeping my fingers crossed. Did you end up totally getting off of it? Having cyclomythia can make you swing fast as it is AEDs can cause people to cycle until they get to the target dose. Lamictal made me cycle in and out of hypomania from 50-125mg. After a while I couldn't take it so I tapered down and got off of it. The Topamax isn't that bad but the side effects are transient though I'm keeping it under control with PRN benzos and trying to keep stress in check.

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for me, the cyclothymia shows up as depressive and hyperaroused (PTSD) episodes. Maybe its there underneath and the topamax made it worse. I ended up on 12.5mg and at the time I thought it was helping me with rage issues and appetite that came from my SSRI. But this may have been depression creeping back in. 25mg gave me the stoopids pretty bad. and I was really anxious about being stoned and weirded out at work.

Usually a pdoc will give you some PRN benzos or something to control the anxiety and cycling until the AED is at the stabilizing dose. Theres no guarantees though =(

I wasnt able to take benzos because of the fear of takign these meds at work, so I decided to treat the PTSD with therapy and the depression with drugs for now. My doc took me off topamax because 'at that dose it doesnt do anything' which was BS.. it was helping a lot. Oh well..

My anxiety hit as soon as I took 25mg.. It tapered off towards the end of the first week then came on again at 50mg. It's slow starting to calm a bit. Having had much rapid cycling (any more than usual that is). But I'm keeping my fingers crossed. Did you end up totally getting off of it? Having cyclomythia can make you swing fast as it is AEDs can cause people to cycle until they get to the target dose. Lamictal made me cycle in and out of hypomania from 50-125mg. After a while I couldn't take it so I tapered down and got off of it. The Topamax isn't that bad but the side effects are transient though I'm keeping it under control with PRN benzos and trying to keep stress in check.

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Do you mind if I ask why you aren't on it any longer? Sounds like it was a good drug for you.

It was great while it lasted. My brain got along really well with it, and I had almost no side effects as high as 400 mg/day and only minor ones at 500. It just kind of crapped out on me after a while, and no amount of fiddling with the dosage raising or lowering it got it to work quite the same after that. Oh well. I found stuff to replace it eventually.

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Do you mind if I ask why you aren't on it any longer? Sounds like it was a good drug for you.

It was great while it lasted. My brain got along really well with it, and I had almost no side effects as high as 400 mg/day and only minor ones at 500. It just kind of crapped out on me after a while, and no amount of fiddling with the dosage raising or lowering it got it to work quite the same after that. Oh well. I found stuff to replace it eventually.

What did it help you with? Rapid cycling? Manic? Weight loss? Oddly enough it has really taken a stab at my appetite and I'm only at 50mg. I had read that it doesn't kick in until the higher doses.

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What did it help you with? Rapid cycling? Manic? Weight loss? Oddly enough it has really taken a stab at my appetite and I'm only at 50mg. I had read that it doesn't kick in until the higher doses.

Seizures, mostly, which is what I was taking it for in the first place, although it also improved my mood somewhat. I was a bit less "blah" on average while taking it. I lost a bunch of weight right before I started taking it (more than I wanted to, actually), but it stayed very stable within a five pound range or so the entire time I was on Topamax. It had no affect on my appetite at all (which only stims seem to do), and if I'm remembering right it only causes a significant amount of weight loss in about 10% of people. Didn't really do anything anxiety/irritability-related, either, positive or negative, just stopped seizures and raised my default mood state from "bleh" to "meh".

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100mg is usually a stabilizing dose. Id stick it out if you can, and see if it helps you out.

Wouldn't really say that, YMMV. I statred stabilizin on 50, better on 100, very good on 200. Currently on 400. Really really depends on your flavor.

The thing about topamax, see...it is on fucking picky med. If you're taking it for some sort of mood stabilization (usually a flavor of mania) it generally only hits just so and only for a certain subset, and it is that subset that can tolerate the SE's (and at least in my case, seems to have less of/less severe SE's).

Tiopamax is kind of a yes/no med. Either it works or it don't.

At any rate, I take topamax as my main stabilizer instead of lithium for one main reason--it squelches rage like nothing else. Like, wow, man. Just hits that part of my brain. Recently we added risperdal to take care of extra stressors that were poushing me over the edge but man topa shoves that raginess right down and I've heard that a lot.

Took both topa and lith together, didn't work, but the topa+lamictal+risperdal works great, don't blow up at all. So yeah, if you can pass the SE's. keep on it.

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100mg is usually a stabilizing dose. Id stick it out if you can, and see if it helps you out.

Wouldn't really say that, YMMV. I statred stabilizin on 50, better on 100, very good on 200. Currently on 400. Really really depends on your flavor.

The thing about topamax, see...it is on fucking picky med. If you're taking it for some sort of mood stabilization (usually a flavor of mania) it generally only hits just so and only for a certain subset, and it is that subset that can tolerate the SE's (and at least in my case, seems to have less of/less severe SE's).

Tiopamax is kind of a yes/no med. Either it works or it don't.

At any rate, I take topamax as my main stabilizer instead of lithium for one main reason--it squelches rage like nothing else. Like, wow, man. Just hits that part of my brain. Recently we added risperdal to take care of extra stressors that were poushing me over the edge but man topa shoves that raginess right down and I've heard that a lot.

Took both topa and lith together, didn't work, but the topa+lamictal+risperdal works great, don't blow up at all. So yeah, if you can pass the SE's. keep on it.

Somehow this post gives me some hope. Even if it targets my rage component or rapid cycling that'd be good enough for me to use it as an adjunct medication while I find a main mood stabilizer that works. I'm starting to feel a little bit better on 50 but still anxious/nervous/aggressive. We'll see what happens as I titrate up. As long as the "stupids" don't come on my Pdoc and I are willing to bring the dose up high. So far I can handle the side effects (loss of appetite and nervousness) so I'll just keep on trucking.

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As long as the "stupids" don't come on my Pdoc and I are willing to bring the dose up high.

I wouldn't let that be a major deterrent if it won't terribly affect your life--at one point in titration, I would forget my name, the road to turn off to get to my house, where I parked at Wal-Mart. It passed. I'm hoping you'll agree I'm fine now... (It only lasted a couple weeks)

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A quick update:

For the last 3-4 days at 50mg it seems that my impulsivity has been reduced quite a bit along with my rage. I still see it coming on but it seems to fade before it surfaces or gets me worked up. Plus I seem to be a bit more calm than usual and my appetite is starting to fade fast. Anxiety/nervousness seems to have reduced too. I move up to 75mg tomorrow so we'll see what happens. I have an appointment with the Pdoc next Friday so I'll also get a Lithium draw to see what my levels are at @ 900mg with Topamax. I'm usually at .5-.6 so I'm curious if it (or my change in eating habits) has changed my levels).

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topamax was awesome on my irritability and appetite issues. It also helps with pain.. I was having awful fibro pain before I started it.

Glad you can tolerate 50mg ok. I wussed out and went back to 25 after some issues with anxiety.

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2 days @ 75mg. Anxiety/nervousness is back with a vengeance but it quickly calms down with some Ativan. I seem calmer, less impulsive still, and appetite is under control. I know it's going to take a while to gauge the long-term effects but I'm pleased that I'm having some good days. It's nice not jumping the gun and getting so angry so quickly, I hope it lasts.

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Odd I didn't think anyone really took Topamax unless they were on something like Seroquel, Depakote or Zyprexa and if they were eating everything in their kitchen...

My doctor and I decided to add it to my medications because I was still struggling with alcohol and I have to say I believe it has really helped. Their are studies that show that Topamax helps reduce the chance that alcoholics will take that first drink and if they do it will cut down the amount they drink.

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Topamax is NOT a weight loss med.

I take it because it calms my mind. I don't know how to explain it any better than that. It just does. Oh yeah, and it helps with the migraines too.

I get what you're saying. I'm rx'd it as an adjunct to Lithium. Just hit 100mg today and things are a lot calmer. Less impulse, rage, racing thoughts. But I'm not going to complain that I don't crave tons of food or binge eat as I was on Lithium alone. Topamax is a serious AC/AED that should not be toyed with. Those taking it "casually" for weight loss should tread carefully.

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Lots and lots of people take topomax not as a weight loss med at all. It can help with that, but not always and if you are taking it JUST for that, be really destabilizing.

I would always recommend diet, exercise, metformin, and a whole bunch of other stuff before that....

Anna

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