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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Kingfish on February 21, 2001, at 9:58:38
Hi all. I posted about Topamax awhile back. I take 40 mg of Celexa and 75 mg of Topamax - am diagnosed BPII. After several months of playing with the Topamax, I've found that I cannot get above 75 mg, without severe sedation, although when I was up to 200 mg for a few days, I definitely felt better when awake.
I also had a major depressive episode last fall for about a month while on the Celexa alone.
I'm going to be switching pdocs due to a location change and was wondering if anyone has any other suggestions for a mix. I want to avoid the (usual) side effects:
weight gain
sedationand especially another major depressive episode.
Do you think if I switched to a more stimulating AD, I might be able to tolerate higher doses of the Topamax?
Thanks much ahead of time for your help!
- Kingfish
Posted by SalArmy4me on February 21, 2001, at 10:24:53
In reply to Solutions to Sedation?, posted by Kingfish on February 21, 2001, at 9:58:38
Perhaps you could take Lamictal and Celexa. Lamictal has very few people complaining about weight gain or sedation.
Other good choices would be Celexa + Neurontin or Tegretol.
My experience has been this: whenever you combine a stimulating medicine with a drowsiness medicine, the drowsiness always wins. I've tried Wellbutrin to get rid of drowsiness on several different drugs, and it has never worked. Neither has dextroamphetamine or methylphenidate!
Posted by Kingfish on February 21, 2001, at 11:14:47
In reply to Re: Solutions to Sedation?, posted by SalArmy4me on February 21, 2001, at 10:24:53
Thanks so much for the super quick reply.
What's your thought re: the rash associated with Lamictal? Is it common?
Posted by SalArmy4me on February 21, 2001, at 14:04:44
In reply to Re: Solutions to Sedation? » SalArmy4me, posted by Kingfish on February 21, 2001, at 11:14:47
Here is the truth about Lamictal:
The fears over Lamictal (lamotrigine) rashes are unfounded. The chance of having a mild to moderate rash are 3%--according to clinical trials. But clinical trials done years ago do not necessarily predict the incidence of side-effects now. Besides, most of these rashes were due to taking a combination of Valproate and Lamictal, and they resolve without hospital stays. I believe that the chance of a seizure from Wellbutrin is much higher, and the chance of a hypertensive crisis with phenelzine is a little higher.
The chance of having a severe rash leading to hospitalization is reported as 0.3%. With those odds, it is easier to get hit by
lightening than it is to have a Lamictal rash. Point in case: You never hear in the paper about someone severely harmed
by Lamictal.
I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects. I believe that Lamictal will replace Lithium as the drug of choice in bipolar disorder in 10 years, due to its prominent antidepressant effect and benign side-effect profile.
Posted by Kingfish on February 21, 2001, at 14:58:00
In reply to Lamictal » Kingfish, posted by SalArmy4me on February 21, 2001, at 14:04:44
Thank you for the info - sounds like a distinct possibility.
Posted by Cece on February 23, 2001, at 0:00:49
In reply to Re: Lamictal » SalArmy4me, posted by Kingfish on February 21, 2001, at 14:58:00
Hi-
I have also taken Lamictal with good results, mood improvement and stabilization.
People's sensitivity to all meds vary a lot. I'm really sensitive to them, so begin at low doses and progress conservatively. My doctor has seen cases of "the rash", so is conservative in dosing Lamictal with all his patients.
I began at 6.25mg and increased by that amount every 1-2 weeks to my present dose of 125mg. Even at those small increases, I got flushing (a rash precurser), GI upset, and fatigue the second or third day after each increase. It wasn't bad- I knew to expect it and would plan for the fatigue. I expect from the postings I've read that some people would consider this absurdly conservative, but for me it was just right. I'm sure that if I had followed the regular dosing schedule I would have gotten unacceptable side effects (if not "the rash"), and would have missed out on the help of a very good med.
So remember, 'mileages may vary'.
Good luck,
Cece
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