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BP 2 with anxiety... Lamitrogine allergy, now what?


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If this is in the wrong spot, feel free to move.

I've been taking 25 mg of generic Seroquel nightly and it has helped immensely, but now I'm having trouble waking up in the morning, pdoc wants to try something new.

We were titrating up with lamitrogine but at 50 mg I got a rash. Not SJS, but suspicious, miserable and enough to d/c it.

Ugh. Back to square one.

He gave me a list of options. It's overwhelming. Anyone have a similar flavor of crazy and found something other than lamitrogine that works?

Just need to decide whe to start....

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Okay, I am basing this on having read the information I have picked up posting here for the last 7 years. I have never taken it. So I'm kind of pulling this out of my ass.

 

But I am under the impression that low doses cause sedation, but larger doses do not. Since you are at 25mg, that's a pretty low dose, and you could be sedated by it. I am almost certain a member who has used Seroquel will jump in to give you more info from the horse's mouth. But I thought I had seen doses between 600mg and 800mg, and the sedation was no longer a issue. Very low doses of 'quel' are actually used as a sleeping aid.

 

Anyway, a couple of ideas: Depakote, Tri-leptal (and it's precursor, Tegretol), Neurontin (for some people). I've seen some people here use Zonegran and Topamax, but they are not a first line treatment, and *technically* don't work for BP. I forget which AAPs are used for bipolar illness, but I think there are others that treat bipolar. But I am being lazy because my head hurts.

 

Oh! How could I forget the old standby, lithium. I use it as an adjunct for therapy with Lamictal. Lithium sounds scary but if it is right for you, it really is more of a pain in the ass than scary: Regular blood tests are required. I don't know how other pdocs compare, but I do it quarterly. Not a lot of side effects for me, but there are some common ones.

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Thanks. My pdoc is wonderful and doesn't want me to increase the dosage of the Seroquel because of metabolic syndrome, he would rather throw a different AAP into the mix.

He has me taking Neurontin right now, just for a week until this rash is out of my system, and then we will reconvene on what to try.

It sounds like maybe Trileptal. I will look into that.

I have to admit, anything that could cause weight gain is out.

I already have thyroid problems, so am freaked out by lithium, but that said I do know many people who love it with little side effects.

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Have you ever tried good ole' tegretol ?  It's out of fashion but for some with BP2 works well.   It's going to be trial and error with many meds.  Tegretol is touted by many pdocs as having both mood stabilization and antidepressant effects while not activating mania.  When it works it tends to work well though. 

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That's correct, tegretol is a precursor of Tri-leptal. Tri-leptal is supposed to be "better," but everyone's different, and some people respond better to tegretol. It did zip for me, but my husband uses Tri-leptal as an anti-seizure med.

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If you're worried about metabolic syndrome, I hear Abilify has a better profile than most AAPs when it comes to that. I don't have research to back this up though, just what I've read on CB and on various websites, like psycheducation.org. Also, in my experience, Abilify has not messed up my metabolism, my blood work all came back normal. I did gain 30 lbs, I'll be honest. Buuuuut we don't know if that's cause of the Abilify or cause I was stress eating like crazy during school and sitting on my ass studying every day. So, as always, YMMV.

 

Abilify has been really great to me though. It's a powerful anti-manic, it nuked my depression and anxiety and I've only had one breakthrough hypomania on it. No breakthrough depression to speak of. It's not proven to be effective for bipolar depression, but it's definitely effective for me. 

 

I really love Abilify, as you can tell. Hehe. 

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I can chime in with some AAPs. This is based on personal experience and also from reading on CB.

There's risperdal and Invega. Which I found weight neutral.

Zyprexa which I gained weight on. But is a great med.

Seroquel which you are on but in higher doses it is less sedating and I haven't gained weight from it. But YMMV.

Abilify which has worked wonders for me as well. No weight gain for me.

Saphris and fanapt which I have tried but do not know a whole lot about.

Geodon which was also weight neutral.

Not to mention the typical APs which I have no experience with.

Now I'm not saying you need to try another AP, because that is something that your pdoc will have to decide if it is right for you or not. Just giving you some options to discuss with your pdoc. It could very well be that you do fine with a mood stabilizer by itself.

Good luck!!!!

Edited by Wonderful.Cheese
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Topomax on top of my lamictal helped a lot with stabilizing my moods. They are NOT stable, but they are much more stable then before.  

 

As a added benefit I lost 18 pounds over 6 weeks I had gained due to Trazadone I struggled to lose the prior year .. Quite amazing. Pry a great drug to combat AP/AAP weight gain as well. My dosage is only 50 mg per day ... I am a leight weight though ... 200 mg lamictal, 1.5 mg clonazepam are all at this time. I desperately need the right AP though.

 

Sorry, saw you already take Topomax ... Lithium helped with my depression at the beginning of treatment. Not many others helped. Tegretol sucked for me but it was combined with Lamictal which REDUCES efficiacy of Lamictal. So adding Tegretol may be perfect for you ?

Edited by lanry78
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It sounds like we have very similar types of crazy. I haven't tried lamitrogine, but I'm currently having great sucess managing my moods and anxiety with a combination of Cymbalta and Geodon. I've found Geodon to be very weight neutral, and it really helps with my anxiety.

 

Before trying Geodon, I had great luck controling my anxiety with Abilify, but unfortunately, I experienced weight gain on it. It has a good reputation weight-wise, so it still might be worth giving a shot.

 

Good luck finding something that works for you!

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I no longer take Topamax, actually. It was prescribed for migraines before I knew I had bipolar and it worked wonderfully for migraines and had a mood stabilizing effect (mild) until the pharmacy switched my type of generic and I got really nasty mixed/agitated depression/whatever you want to call it. I haven't found a lot of luck reading about Topa as a monotherspy for bipolar disorder but would love to, as it definitely helped my migraines.

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I vote lithium. It has the most evidence behind it, so it makes sense to try it first. As well as evidence for being effective in the short term, it seems to be beneficial for the brain over the long-term. It's also the most natural option, if that's something that appeals to you. I had some mild nausea when I started it but absolutely no side-effects now. 

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ray_of_sunshine, did you ever ask your doctor to "over-ride" your insurance company's policy of automatically switching you from topamax to the generic? In some cases, the Dr indicates brand name only, and usually the insurance company does it. Only the brand name of Imitrex works for me, and my neurologist contacted my insurer, and now I get Imitrex instead sumatriptan.

 

I know Drs sometimes will do this, but it may depend on your insurance and/or your doctor.

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I am a stay at home mom (currently looking for a job though) and my husband just got laid off, so after this month our insurance will be new.  My neuro requested the pharmacy stick to only one type of generic with the topiramate.  I am leaning towards a brand name Topamax/Abilify combo but really I'm just pulling that out of my hat here... I'm not symptomatic right now, maybe a little hypomanic, so my desire to even go on meds is very small.

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