Posted by Ron Hill on March 10, 2003, at 11:09:10
In reply to Re: Lamical and Lithium-Does it work for you? » Ron Hill, posted by catmint on March 9, 2003, at 16:42:13
Hey Amy,
> I'm up to 75 mg, but backed off today to 50. I am realizing that I cannot be on Lamictal as monotherapy. I am getting so irritable and have had a horrible 4 days, making me think I am in a very dysphoric manic episode.
> So... it's one of 4 things next:
> 1)Depakote and NADH
Maybe, but Depakote worsened your depression when you tried it last fall. Also (as you probably know) if you choose to take Depakote, your pdoc may want to wash-out the Lamictal to avoid the possible Depakote/Lamictal interaction.
> 2)Trileptal and "
Does the quotation mark mean ditto what is above in Option 1 (i.e.; NADH)? I've never tried Trileptal but I've read good things about it. The APA does not currently view it as a "first-line" moodstabilizer in the treatment of bipolar disorder. But that, in and of itself, does not necessarily mean that it would not work as the mood stabilization backbone in your particular rx. It is a second-line or third-line moodstabilizer, however.
> 3)Lithium and Lamictal
IMHO, this is an option worthy of discussing with your pdoc. I am, however, becoming somewhat concerned by the number of people that experience an erratic effectiveness with Lamictal. Will the erratic antidepressant effectiveness continue even after a first-line moodstabilizer is put in place? Or, on the other hand, is Lamictal mono-therapy functioning erratically in some BP II patients precisely because it does not provide enough mood stabilization power (in and of its self) to corral and contain its own antidepressant qualities? In other words, unchecked by adequate mood stabilization, perhaps the antidepressant qualities of Lamictal cause the BP II patient to periodically cycle into dysphoric (or euphoric) hypomania . If my latter speculation is correct (and I’m not suggesting that it is), then perhaps the co-administration of a first-line moodstabilizer with Lamictal would smooth out its otherwise erratic effectiveness.
I did a short trial with Lamictal a few years ago and I really liked the way it felt in my brain, but unfortunately, I am highly susceptible to rash and Lamictal gave me a bad one.
> 4)no meds
You’ve tried this one before and it didn’t work. I see no reason to think it would work this time.
May I add two more possible options?
5) Lithium and an MAOI
6) Lithium and Enada NADH
As you know, the sixth option is what is working for me. It might work for you or it might not.
I have sooo many questions, mainly about Lithium. I'm scared to take that cause of side effects.
What side effects? Are you still concerned about possible weight gain? In the low-to-mid dosage range, lithium does not typically cause a lot of side effects (but, as always, YMMV). I am VERY sensitive to side effects and yet I have no problems at all with 600 mg/day of Lithobid. My lithium blood level is in the lower part of the therapeutic range at 0.4 mEq/l. The more typical maintenance dose range is 0.6 – 0.8 mEq/l. As I’ve said before, 0.6 mEq/l might be a good initial target blood level for you.
Stay in touch Amy.
-- Ron
poster:Ron Hill
thread:207324
URL: http://www.dr-bob.org/babble/20030310/msgs/207723.html