Posted by Sulpicia on February 5, 2001, at 12:06:33
In reply to Lamictal restart dosage help, posted by Sulpicia on January 28, 2001, at 15:42:36
> Sorry in advance to anyone who's read this b4; I posted this earlier on the kiddie forum.
>
> Hi Folks --
> I have one horribly depressed 15 y/o with bipolar II dx. She was doing really well on wellbutrin and lamictal. Alas:
> a week or so after we moved to 150mgs during a nice slow and by the books increase, she developed an actinic
> rash and mouth ulcers. We took her off for nine frantic days while I tracked down and read *everything* written
> about lamictal, lamictal and wellbutrin, SJS, TENS, actinic rashes, restarts, you name it. Rash went away w/in 24
> hrs of starting prednisone. No biopsy [I read the derm stuff last like an idiot] so no confirmation other than
> hypersensitivity. In view of the facts that: she didn't respond to depakote at all [8 wks therapeutic level] and was
> rendered unconscious after 36 hrs by starting dose of lithium, had 4 p-hospitalizations and nearly died, we
> decided to restart the lamictal. There is virtually no data here for us to work with. I know the rule: start low and go
> slow. So far so good and up to 25mgs w/out problems. Am checking temp, lymph nodes, and skin. *Frequently*
> Her severe depression returned w/in 24 hrs of stopping lamictal and has not shown any signs of letting up. Terrible
> hypersomnia, 22 hrs per day, sadness, apathy, hunger, unable to eat, bathe or do anything. Once last week she
> was able to stay awake for 24 hrs straight and made it to school. For one day out of the last 2 wks. Not a bad
> strategy to use sleep deprivation to combat depression. Anyway, at the safe rate of increase she will be at the
> level were she got relief in about 6 wks. She'll never make it. Pdoc tried provigil to no effect. This morning we
> were down to 2 choices: try adding adderall [tricky at best w/ BP II and recent substance abuse remission] , or
> exceed the traditional increase rate and pray. Started adderall 20mgs this AM; couldn't get up until severely
> harrassed and threatened, and only managed 4 hrs awake. No mania tho or drug cravings. Thank god for AA.
>
> So, here's the question: I need experiential, or best guess, or even ethical calculus input here -- how fast can we
> increase the lamictal?
>
> And yes, just in case you're wondering, I *do* realize that we're playing with fire but the situation is dire. Pdoc is
> fabulous, highly experienced but there is simply no available data on which to make a decision. We're reluctant to
> do a faster increase but also horrified of relapse. Between a rock and hard place indeed.
>
> Any and all input appreciated.Am reposting this -- adderall is making her nuts. SHE wants to get off it but can't get out of bed w/out it. Maxxed out on Wellbutrin; lamictal now up to 100mgs and no relief yet.
Any suggestions to discuss w/pdoc for a fast AD/stim add-on?
Aside to Ron: the psycho-social stuff you suggested worked up to a point. Now she's so irritable that she can't stand to be around anyone.All advice and suggestions appreciated. Things are grim here.
S.
poster:Sulpicia
thread:52762
URL: http://www.dr-bob.org/babble/20010131/msgs/53351.html