Chantho Posted November 2, 2017 Share Posted November 2, 2017 The way I see it, I have four options since my Lamictal never really did anything for me and Topomax messed with my vision: Tegretol, Trileptal,Depakote, and Lithium (I have read mixed reports on whether Neurontin is effective for bipolar disorder). I was on Depakote years ago and had bad side effects, so I want to avoid it. Lithium, of course, has all kinds of blood work required. Since I'm self-pay, full-cost, I highly doubt I'd be able to afford lithium in the end. That leaves Tegretol and Trileptal. Do any of you know whether either of those require more blood draws than say once a month (or at all)? I've read that one of them did require levels, but that was in the context of use for seizures. If they require a lot of blood work, it'll have to be Depakote. Link to comment Share on other sites More sharing options...
crtclms Posted November 2, 2017 Share Posted November 2, 2017 For lithium, there are only a lot of blood tests at the beginning when you are finding a level, and not an insane number. I only get blood tests every 6-8 months, now. Lithium is dirt cheap. I know Neurontin is considered iffy, but when I was on it, I actually went into remission for 8 years. We tried it again a few years ago, but I started putting on weight too fast. I don't remember needing tests on Tegretol, although it's been a long time. My husband takes Tri-leptal for seizures, and they check his sodium levels 4 times a year. I thought when using it for Bipolar illness, Depakote needed blood tests to check levels, too? I took it for migraine, which doesn't require blood tests, which is why I was surprised to hear people say that. This blog post says you need a blood test every few months, which is more than I get tests for lithium. I'm always confused when I see an article (like this one) saying Depakote has fewer side effects than lithium. I had many annoying to serious side effects on Depakote, and I have very few, pretty benign side effects on lithium. When I first started Depakote, I vomited every day for a couple of months, and I had a fine tremor the entire time I was on it. My libido was killed dead. And while I was one of the lucky few who didn't gain weight, weight gain is a serious issue. There are a lot of people who really benefit from Depakote, I just found it to be a much harsher med than lithium. Link to comment Share on other sites More sharing options...
Blahblah Posted November 2, 2017 Share Posted November 2, 2017 7 hours ago, Chantho said: The way I see it, I have four options since my Lamictal never really did anything for me and Topomax messed with my vision: Tegretol, Trileptal,Depakote, and Lithium (I have read mixed reports on whether Neurontin is effective for bipolar disorder). I was on Depakote years ago and had bad side effects, so I want to avoid it. Lithium, of course, has all kinds of blood work required. Since I'm self-pay, full-cost, I highly doubt I'd be able to afford lithium in the end. That leaves Tegretol and Trileptal. Do any of you know whether either of those require more blood draws than say once a month (or at all)? I've read that one of them did require levels, but that was in the context of use for seizures. If they require a lot of blood work, it'll have to be Depakote. Following this thread because I'm having the same issue. Lamictal doesn't seem to be doing much but I am afraid to change because other heavier meds give me intolerable side effects. I tried Lithium years ago, and I felt extremely flat & dissociated - it didn't help my depression (I don't have hypomania or any mania issues). Depakote made me a fat, exhausted zombie....Topamax (Dope-amax) really affected my cognition, did not help depression.. As far as Tegretol and Trileptal - I have previously mentioned these to my pdoc and she doesn't think these will be a fit since I struggle with depression (not bipolar)...she said they have much more side effects than Lamictal :-( Are there any other mood stabilizers that help more with depression, that do not cause fatigue, sedation, kidney issues or flatten all the "good moods" and natural brain endorphins?? 1 Link to comment Share on other sites More sharing options...
Chantho Posted November 2, 2017 Author Share Posted November 2, 2017 I remembered that Depakote required levels, but I was thinking it was a couple times a year. I could handle every few months, but that initial number with lithium worries me. We might be able to swing it, though. Link to comment Share on other sites More sharing options...
jt07 Posted November 2, 2017 Share Posted November 2, 2017 Tegretol is similar to Depakote with regard to blood tests. You need initial blood draws to determine the therapeutic level, and then blood tests every few months to check liver function. Link to comment Share on other sites More sharing options...
Iceberg Posted November 2, 2017 Share Posted November 2, 2017 @Blahblah that's more AAP territory unfortunately Link to comment Share on other sites More sharing options...
Chantho Posted November 2, 2017 Author Share Posted November 2, 2017 We've come to the conclusion that, unless blood tests are way more expensive than I am anticipating, we will go with lithium. Over the course of however long I'm on it (probably a long time if it does the trick), we'll end up saving as compared to others. It's just the short-term investment that we have to deal with. Link to comment Share on other sites More sharing options...
crtclms Posted November 2, 2017 Share Posted November 2, 2017 I hope you like it. I consider it the most effective med in my cocktail. You may feel nauseated at first, also push water as much as you can. Link to comment Share on other sites More sharing options...
Chantho Posted November 3, 2017 Author Share Posted November 3, 2017 pdoc changed his mind (or forgot what he initially said; I don't freaking know). He's increasing my Lamictal to 300 mg. If that doesn't work, I'll go up to 400 mg. If *that* doesn't work he wants me to add Rexulti, but how the shit am I supposed to afford that out of pocket until my deductible is met when I get insurance? Right now, I just want to give up. I had to tell him the same thing 4 times, and it was something he was already told. Why the shit wasn't it in the notes? Now, I'm trying to be understanding. He has a lot of patients. Also, given the fact that he's obsessed with ADHD/ADD (his "decor" is almost exclusively advertisements for meds) and he can't sit still and is obviously easily distracted, I'm bettin he has some sort of deficit in that area. But dammit. I do deserve to be listened to. He didn't even know why I was there. He checked in and asked if we were just leaving my meds alone. Anyway, this is off-topic. I'm just not doing great right now. Link to comment Share on other sites More sharing options...
Rabbit37 Posted November 3, 2017 Share Posted November 3, 2017 Chantho, samples samples samples. 1) my cousin and her husband were both pharma reps, they loved giving samples to docs, and docs should be able to ask for enough to keep you covered for a while. 2) I was able to get a year and a half's worth of seroquel xr's til I got insurance (and then went to ir, go figure). Please ask. Samples are free, they're there for patients who can't afford them. Don't be afraid/embarrassed to ask. And lithium is dirt cheap, $11 uninsured/mo. If you start low/go slow (as my kids' doc says), you shouldn't have to have too many blood tests. Link to comment Share on other sites More sharing options...
Chantho Posted November 3, 2017 Author Share Posted November 3, 2017 My pdoc gave me samples and said we could do samples until I get insurance. I don't know what my coverage will be like, because I'm partially waiting on my husband's open enrollment period, but I'm sure there will be a deductible. So, I will have to pay some chunk at first. I worry that it'll be more than we can afford. However, this is all moot if the higher Lamictal dose works. No use borrowing trouble, right? Link to comment Share on other sites More sharing options...
Iceberg Posted November 4, 2017 Share Posted November 4, 2017 2nd opinion maybe? It sounds like ur unhappy and feel ignored Link to comment Share on other sites More sharing options...
Chantho Posted November 4, 2017 Author Share Posted November 4, 2017 I'm less bugged now. Like I said, it makes no sense to borrow trouble. For all I know the increased dose will work. (The second opinion is rough because I go to a clinic, and I can't afford a pdoc outside of that clinic.) Link to comment Share on other sites More sharing options...
browri Posted November 4, 2017 Share Posted November 4, 2017 (edited) Depakote definitely needs levels in the beginning to make sure that you aren't at a toxic level. Between 50 and 100 mcg/ml is acceptable. You also need to test liver function. Once you get to a specific dose and stick with it, you can likely move to getting levels and checking liver function every 6 months. Same for lithium, testing until you get a stable level and checking kidney function instead of liver. Tegretol and Trileptal don't actually NEED blood levels done. But one thing that is important to check when you're taking them is your blood sodium. Especially with Trileptal, low blood sodium can result. So it is important to get those tested. When I was taking 1200mg of Trileptal (I was taking the Oxtellar XR brand of it) I had lower sodium levels but they were still within normal parameters. Definitely worth keeping an eye on. I can also say that Trileptal was good for anxiety. It was very calming. Probably not as calming as Tegretol, but it did have fewer side effects based on my experience and conversations with people who have taken both before. I switched from Oxtellar to Depakote though because Oxtellar wasn't calming enough. However, I know it was good for my mania because when I titrated across rapidly from Oxtellar to Depakote I became hypomanic for 2-3 days until my Depakote levels were high enough. Edited November 4, 2017 by browri Link to comment Share on other sites More sharing options...
jacques Posted November 29, 2017 Share Posted November 29, 2017 I don't think it requires a lot of blood work, but I've had blood taken to test my depakote level before so just a fair warning. It's only been once so far though (though I'm due to do it again since they upped my level). Link to comment Share on other sites More sharing options...
Chantho Posted November 30, 2017 Author Share Posted November 30, 2017 The new dose of Lamictal seems to be leveling me out. Link to comment Share on other sites More sharing options...
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