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Low Maintenance Mood Stabilizer?


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I have a doctor's appointment coming up soon. I'm planning on asking to try a mood stabilizer. I notice Lithium requires blood tests and I believe Lamictal requires frequent appointments at first because of some rare skin thing it could potentially cause. So what mood stabilizer can I take for bipolar II that won't require tests or special appointments? 

 

I know this sounds silly, but the first time I got on an anti-depressant, the doctor had me get a seemingly arbitrary blood test and the hospital that ran it rewarded me with a bill that resulted in a $250 co-pay for my good results. If I had known that the charge would've been that, I would have looked into engineering my own blood test at home, despite my crippling fear of needles and blood. And of course, (in the US, at least), regular doctor appointments aren't free, so I would like to limit them as much as possible.

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Lamictal was fairly low maintenance for me. I didn't have frequent appointments, the doc just said to call straight away if I got a rash. And although lithium does require blood tests, I'm pretty sure I've only had two or three in the year I've taken it. I think those two are your best options to try first. I think you should choose what is most likely to be effective for your symptoms without causing too many side-effects. It's no use having a low-maintenance med if it doesn't work or makes you sick.

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Any pdoc worth seeing will start you off with a routine blood panel to check your baseline health and then follow up with another every six months to a year. Almost all meds can be hard on liver and/or kidneys, so they monitor to spot any problems quickly.

 

Lamictal is a low maintenance med after the first month or two. It has a low side effect profile. It helps with depression more than many other stabilizers. I would seriously consider it.

 

A number of atypical antipsychotics are good stabilizers. Sedation, weight gain, and akathisia are more common side effects than usually experienced on Lamictal. Many people don't get these! Just stating rough odds.

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Any pdoc worth seeing will start you off with a routine blood panel to check your baseline health and then follow up with another every six months to a year. Almost all meds can be hard on liver and/or kidneys, so they monitor to spot any problems quickly.

I've never had a pdoc monitor my blood work.

I like Lamictal a lot, and have had blood work for other things, and the Lamictal hasn't affected me. It takes several weeks to get up to the full strength, but it's well worth it in my opinion. The pdoc wanted me to advise him if I started getting a rash, but otherwise, the follow-up was once after one month (or earlier if requested by me), and once stable, I see him every three months for a short visit (no blood tests).

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My pdoc orders routine lab work if my mdoc didn't already order it.  He also checks my blood pressure and weight on every visit. He even had me get an EKG because my mdoc started me on Metropolol and it effects the heart the same way Geodon. Now that I think about it, he also had me get a lamictal blood level.

 

I feel glad to have found him.

Edited by Savannah
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Generic Depakote here. My pdoc has never sent me for blood tests himself - my gdoc does that. And I've only been sent for one, about a year after starting. Other than that, the only time I've had bloodwork done in relation to my meds is when I've been hospitalized. Do assume that you are, at some point, going to have to have bloodwork done however.

 

Admit up front to your pdoc that you can't afford to have frequent bloodwork done. Tell them your concerns - they should be able to work with you on that issue (but do assume that you will need to provide blood at least once every year), and if they won't then find yourself a pdoc who will.

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Thanks for the advice, guys. I got on Lamictal. The doc didn't require a blood test for the initial prescription, but when I told him my financial concerns he said I might need bloodwork every 3 months. I doubt I'll be able to afford that, but I thought the hell with it and got the script. Now I'm not sure if I want it to work.

 

One other thing, the doc told me Lamictal makes people susceptible to diabetes. This is the first time I've ever been afraid of a side-effect.

Edited by arr
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Thanks for the advice, guys. I got on Lamictal. The doc didn't require a blood test for the initial prescription, but when I told him my financial concerns he said I might need bloodwork every 3 months. I doubt I'll be able to afford that, but I thought the hell with it and got the script. Now I'm not sure if I want it to work.

 

One other thing, the doc told me Lamictal makes people susceptible to diabetes. This is the first time I've ever been afraid of a side-effect.

 

 

I have never heard of any link between Lamictal and diabetes.  Here is the prescribing information, and it doesn't mention it, either.  I'd be interested if you have any information about it. 

 

As purely anecdotal information, I have been monitoring my blood sugar for other reasons and have not noticed any increase; I've been on Lamictal for over four years.  I have a family history that increases my likelihood of developing diabetes.

 

http://www.crazymeds.us/Lamictalpi.pdf

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Thanks for the advice, guys. I got on Lamictal. The doc didn't require a blood test for the initial prescription, but when I told him my financial concerns he said I might need bloodwork every 3 months. I doubt I'll be able to afford that, but I thought the hell with it and got the script. Now I'm not sure if I want it to work.

 

One other thing, the doc told me Lamictal makes people susceptible to diabetes. This is the first time I've ever been afraid of a side-effect.

It strikes me as odd that your doc says you may need blood tests, especially as you have expressed a difficulty paying for them and as they aren't really necessary on Lamictal.

 

I've also never heard or read that Lamictal can make people susceptible to diabetes. I don't know why they are worrying you about something that must be very rare because it isn't in the prescribing information and doesn't come up with a Google search.

 

Is your doc a psychiatrist or general practitioner? They don't sound like they know what they're doing.

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One other thing, the doc told me Lamictal makes people susceptible to diabetes. This is the first time I've ever been afraid of a side-effect.

 

Like Catnapper, I've also never heard of this before.  I also am surprised about the lamictal blood levels needed.  The only reason I can think of is that he wants to make sure you stay in the therapeutic range.  My pdoc does them on me but not on a regular basis.  Maybe 2 or 3 times a year, at the most.

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Thanks for the advice, guys. I got on Lamictal. The doc didn't require a blood test for the initial prescription, but when I told him my financial concerns he said I might need bloodwork every 3 months. I doubt I'll be able to afford that, but I thought the hell with it and got the script. Now I'm not sure if I want it to work.

 

One other thing, the doc told me Lamictal makes people susceptible to diabetes. This is the first time I've ever been afraid of a side-effect.

It strikes me as odd that your doc says you may need blood tests, especially as you have expressed a difficulty paying for them and as they aren't really necessary on Lamictal.

 

I've also never heard or read that Lamictal can make people susceptible to diabetes. I don't know why they are worrying you about something that must be very rare because it isn't in the prescribing information and doesn't come up with a Google search.

 

Is your doc a psychiatrist or general practitioner? They don't sound like they know what they're doing.

 

 

My doc is a GP. He's actually my childhood doctor and I think he's a very smart, likable guy. But yeah, he doesn't seem to have lots of experience with psych meds as his specialty is geriatrics. I'm just really grateful for being able to try a mood stabilizer. I went to some random doc my therapist suggested for the first time I tried an AD (the one who had me take a blood test). I had the hunch that a mood stabilizer would help and asked for one, she seemed taken aback as if I asked for cocaine and referred me to a pdoc.

 

I'm also on Adderall, so possibly that was what he was talking about when it comes to diabetes. I thought he was talking about the Lamictal, but I only had 3 hours of sleep, so I suppose I was a little off.

Edited by arr
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Neither Lamictal nor Adderall have warnings about causing diabetes. Google "Lamictal Prescribing Information" and "Adderall Prescribing Information". Choose the PDF files. That's the insert that comes with your meds. It is more for physicians than patients. It includes all known problems a med can cause. Do a Find for "diabetes." Nothing comes up for either. I think you doc is confusing a common side effect of antipsychotics with those of anticonvulsants.

 

Pdocs are the experts in psych meds. You owe it to yourself to see one.

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Well, good news, I quit the Lamictal already anyway. Made me feel like a piece of shit, just like the SSRIs I've tried. I know it's unwise to not give psych meds a good trial, but the Lamictal was bringing me down in a severe way (I feel it was the Lamictal because I quit Adderall while I was on it). Adderall is the only med that's ever helped me with depression and it's not even an on the label use (that I know of.) I don't even think I'm bipolar now, after reading more and more accounts that don't relate to me, I conclude that I'm just a unipolar depressed guy who's way too emotionally sensitive. I'm an expert at self-diagnosis, someone should give me an honorary doctorate. Now I have all this extra Lamictal, unfortunately I'm guessing Lamictal is a lousy party drug. Not really an upper or downer and can potentially give you a rash. Sounds a lot like seeing a prostitute. http://www.youtube.com/watch?v=obKLdou0LH0

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I feel it was the Lamictal because I quit Adderall while I was on it). Adderall is the only med that's ever helped me with depression

 

Maybe the way you felt was because you quit the Adderall, not the lamictal.  Or did you take adderall with the lamictal and find it to not be a good match for  you?

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I feel it was the Lamictal because I quit Adderall while I was on it). Adderall is the only med that's ever helped me with depression

 

Maybe the way you felt was because you quit the Adderall, not the lamictal.  Or did you take adderall with the lamictal and find it to not be a good match for  you?

 

I agree that this could be the true reason you felt shitty. Quitting stims suddenly, especially if they relieve your depression, will make you feel pretty lousy. Either way, making more than one med change at a time always confuses things and you can't truly know what has done what. 

 

If you are doubting your bipolar diagnosis, consider seeing a psychiatrist for a thorough assessment. 

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I second the recommendation to see a pdoc. Your GP may be the best GP in the world, but he's not an expert in psychiatry, and that's what I think you need. Self-diagnosis isn't going to help you, although many of us here have also studied enough on mental illness and treatment that we are almost as knowledgeable as doctors.

Even if you only go for an assessment and possible diagnosis, an initial visit with a pdoc is well worth your while. It will last from 45 to 90 minutes, depending on the doctor, and they will have a much better idea of what is causing you trouble. Good luck to you.

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You need a real evaluation by a formally trained pdoc or psychologist qualified to diagnose mental illnesses, not self diagnosis and a GP willing to prescribe what you want.

 

Lamictal can be a hard med to start, but after one reaches 100mg or so, it usually evens out and starts to become effective. A lot of psych meds require patience and time for the body to adjust. Immediate side effects often go away with a little time. From the sounds of it, you bailed on a very good med way too soon.

 

That you decided that you don't have bipolar because you don't like the way a med made you feel sounds so sketch. Really, see a professional. You are neither objective nor qualified to diagnose yourself one way or the other.

Edited by AnneMarie
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