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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by SLS on May 13, 2005, at 9:30:58
I am being treated for bipolar depression. I recently added Trileptal to my drug cocktail to see if it would act to promote an antidepressant response. I do not experience mania or mixed states or rapid cycling.
I have been taking Trileptal for just over two weeks at 600mg. I didn't like the way I was feeling on it, but I thought it was tolerable if the stuff would actually work. I experienced a flattening of affect and amotivation. I also experienced fatigue and weakness. I became cognitively slowed. I felt pretty yucky. It was a sort of malaise.
Yesterday, my doctor asked that I reduce the dosage of Trileptal back down to between 300-450mg in an attempt to "clean it up". He probably would have had me discontinue it if I weren't determined to give it a full trial. Overall, Trileptal seems to have made things worse, not better.
Any comments?
- Scott
Posted by Ritch on May 13, 2005, at 10:06:51
In reply to Trileptal trial for bipolar depression..., posted by SLS on May 13, 2005, at 9:30:58
> I am being treated for bipolar depression. I recently added Trileptal to my drug cocktail to see if it would act to promote an antidepressant response. I do not experience mania or mixed states or rapid cycling.
>
> I have been taking Trileptal for just over two weeks at 600mg. I didn't like the way I was feeling on it, but I thought it was tolerable if the stuff would actually work. I experienced a flattening of affect and amotivation. I also experienced fatigue and weakness. I became cognitively slowed. I felt pretty yucky. It was a sort of malaise.
>
> Yesterday, my doctor asked that I reduce the dosage of Trileptal back down to between 300-450mg in an attempt to "clean it up". He probably would have had me discontinue it if I weren't determined to give it a full trial. Overall, Trileptal seems to have made things worse, not better.
>
> Any comments?
>
>
>
> - Scott
>
>
>
>
>The cognitive blunting and flattening that Trileptal (and others) can cause is really annoying. I had some serious blunting even at 225mg/day. If I ever add Tegretol again (i.e.), I would only want to take it at night for sleep. Sometimes the "blunting" effect gets mistaken as a pseudo-depression while other symptoms of depression get better. When I was off all meds and in a serious depressive episode and restarted lithium.. yeah the cognition worsened, but I definitely felt a sense of relief when the other symptoms began to lift and go away--- especially the negative ruminations--- those can get really bad.
Posted by Nickengland on May 13, 2005, at 11:00:36
In reply to Re: Trileptal trial for bipolar depression... » SLS, posted by Ritch on May 13, 2005, at 10:06:51
I have actually switched back today from Trileptal to Tegretol Retard (slow release) because of the kidney pains I was getting from the Trileptal.
Its pretty frustrating as during this week the kidney pains started to get better..but by that time I went and saw my doctor and got a blood test and the new prescription for Tegretol Retard.
I must add that today I after taking the Tegretol I can feel that this medication has zonked me out i.e 2 hours after taking one 200mg tablet I had to lay down for 30mins because of the sedation - I never had that sedation from Trileptal.
I find the 2 medications very similar, but Tegretol sure does seem like it has more of a kick to it with regards to anti-manic effects.
I know what your saying about the flattering effect and it maybe making your depression worse, I get this far more from Tegretol, but still I got flattering from Trileptal, albeit less so.. I would suggest from experience that if you find the Trileptal no help, don't bother with Tegretol as that will cause those depressing effects 10x more.
I would suggest going down the dose with Trileptal to 300mg in 2 divided doses, best taken in the evening I found...It sounds like the 600mg was alittle high for you, I hope the lower dose improves things.
If it wasn't for the kidney thing id still be on it now...and if this sedation continues i'm going back to trileptal and will ride through the kidney pains.
I do have one question myself about Trileptal...I have found I got more sexual side effects from Trileptal than I do Tegretol??..this seems odd to me??
Posted by Ritch on May 13, 2005, at 12:23:37
In reply to Re: Trileptal trial for bipolar depression..., posted by Nickengland on May 13, 2005, at 11:00:36
>...I must add that today I after taking the Tegretol I can feel that this medication has zonked me out i.e 2 hours after taking one 200mg tablet I had to lay down for 30mins because of the sedation - I never had that sedation from Trileptal.
Nick, hope you don't mind me asking a question about the sedative differences between Teg and Trileptal.. So, it was really that pronounced? The only time I tried Teg was 100mg twice daily back in the late '80's for a week or two and I can't remember much about it. I didn't notice much sedation from Trileptal either, no sexual sfx, but MAJOR blurry vision. Anyhow, I wonder if Tegretol at bedtime (only) would make a good sleep med for me... Hmmm. --- Mitch
Posted by Nickengland on May 13, 2005, at 12:59:53
In reply to Re: Trileptal trial for bipolar depression... » Nickengland, posted by Ritch on May 13, 2005, at 12:23:37
Hi Ritch,
Thanks for the input about the sexual sideffects..Its mistery why i get more side effects with triletpal in that area compared with Teg.
With your question about sleeping..I have found both drugs to be effect for getting a good nights sleep.
Between the two - Tegretol definately has more sedative effects, (the type of sedative effect is very similar to trileptal, the same more or less) but the actual strength of sedation is more so with Teg I have found.
Taking it at night to help with sleep?....Excellent choice of mood stabilier in my opinion, espeacially as your be able to keep it at low doses.
I only take one medication (teg/tri) and i have low doses, I actually only take 200mg and find that helps me sleep very well...
Kind regards
Nick
Ps Scott, hope its ok discussing tegretol/trileptal related matters on your thread..
Posted by SLS on May 13, 2005, at 15:51:46
In reply to Re: Trileptal trial for bipolar depression..., posted by Nickengland on May 13, 2005, at 11:00:36
Hi.
> I do have one question myself about Trileptal...I have found I got more sexual side effects from Trileptal than I do Tegretol??..this seems odd to me??
I seem to have a bit more trouble reaching orgasm with Trileptal, but it is not really too troublesome at 600mg.
- Scott
Posted by SLS on May 13, 2005, at 15:54:07
In reply to Re: Trileptal trial for bipolar depression...Ritch, posted by Nickengland on May 13, 2005, at 12:59:53
> Ps Scott, hope its ok discussing tegretol/trileptal related matters on your thread..No prob.
You are wonderfully considerate.
:-)
- Scott
Posted by Nickengland on May 13, 2005, at 16:31:08
In reply to Re: Trileptal trial for bipolar depression...Ritch, posted by SLS on May 13, 2005, at 15:54:07
Hi Scott : )
Yeah the sexual effetcs are quite mild..feels kinda numb without going into too much detail lol
How much are you going to reduce your dose?..do you think your use it long-term?
Am I right in thinking you not bipolar?..if so, I was going to ask if you've tried lamotrigine before?
Whoa - thats alot of questions! lol
kind regards,
Nick
Posted by tygereyes on May 13, 2005, at 18:24:42
In reply to Re: Trileptal trial for bipolar depression...Scott, posted by Nickengland on May 13, 2005, at 16:31:08
Wow ... that is totally NOT the experience I have had! Trileptal has been a miracle drug for me (I am borderline and possibly bipolar II). I'm sorry you didn't have the same positive experience I did.
Posted by Phillipa on May 13, 2005, at 18:34:18
In reply to Re: Trileptal trial for bipolar depression...Scott, posted by tygereyes on May 13, 2005, at 18:24:42
I tried l50mg of trileptal for a while. It was supposed to help with mood and sleep. When i changed pdocs he discontinued it. But I didn't have any side effects from it. Fondly, Phillipa
Posted by woolav on May 13, 2005, at 19:02:45
In reply to Re: Trileptal trial for bipolar depression...Scott, posted by Phillipa on May 13, 2005, at 18:34:18
what is bipolar depression?
is it just another name for bp?
or what?
as always,
confused.
Posted by Phillipa on May 13, 2005, at 20:49:59
In reply to Re: sorry off topic slightly, posted by woolav on May 13, 2005, at 19:02:45
Woolav, This question has come up before and it is very confusing as there are many types. Please start a Thread with that topic. If you really want to get confused wait til you see the answers. I was taught that if you were bipolar you had ups and downs and a period of normalcy inbetween. Not so anymore. Ask SLS, Link, maybe Ed to respond. This topic deserves it's own Thread. I'll get on it just to read what others Post. Fondly, Phillipa
Posted by SLS on May 13, 2005, at 20:52:47
In reply to Re: sorry off topic slightly, posted by woolav on May 13, 2005, at 19:02:45
> what is bipolar depression?
> is it just another name for bp?
> or what?Bipolar depression is simply the depressive phase of bipolar disorder. For many people, it is the depressive phase that is the most prominent and difficult to treat.
- Scott
Posted by Maxime on May 17, 2005, at 16:53:03
In reply to Trileptal trial for bipolar depression..., posted by SLS on May 13, 2005, at 9:30:58
Hi Scott, how is the Trileptal trial going? Are you feeling any better or do you think it is still making you depressed?
Maxime
Posted by SLS on May 17, 2005, at 19:19:17
In reply to Re: Trileptal trial for bipolar depression... » SLS, posted by Maxime on May 17, 2005, at 16:53:03
Hi Maxime.
> Hi Scott, how is the Trileptal trial going? Are you feeling any better or do you think it is still making you depressed?
After reducing my dosage from 600mg to 450mg, much of the "yuckiness" has dissipated, although not completely. It is tolerable. I'm still waiting for the magic to happen.
Thanks for your concern.
- Scott
Posted by katia on May 19, 2005, at 16:09:46
In reply to Re: Trileptal trial for bipolar depression... » Maxime, posted by SLS on May 17, 2005, at 19:19:17
What is the lowest dose anyone has been on Trileptal and still got results? I want to go to 300 from 450 and add Li. Orotate nasal spray. I'm feeling blunted and tired/depressed. Not sure if it's the Tril. or depression. (I've been on Trileptal about 15 months now.
Posted by SLS on May 19, 2005, at 16:36:58
In reply to Re: Trileptal trial for bipolar depression..., posted by katia on May 19, 2005, at 16:09:46
Hi.
> What is the lowest dose anyone has been on Trileptal and still got results? I want to go to 300 from 450 and add Li. Orotate nasal spray. I'm feeling blunted and tired/depressed. Not sure if it's the Tril. or depression. (I've been on Trileptal about 15 months now.
I decided to reduce my Trileptal from 450mg to 300mg today for exactly the same issue you are struggling with. It sure is difficult sometimes to separate out the original depression from the depression-like side effects that some medications can produce.
Because Trileptal and its active metabolite have such short half-lives, you should know within a day or two if your head clears at 300mg. Perhaps the easiest way to determine what Trileptal is and isn't doing for you would be for you to temporarily discontinue it for a day or two and observe the results. Unless you are at high risk for seizures, I wouldn't worry about any withdrawal reactions emerging.
- Scott
Posted by katia on May 19, 2005, at 16:45:33
In reply to Re: Trileptal trial for bipolar depression... » katia, posted by SLS on May 19, 2005, at 16:36:58
How long have you been on it?
What else are you on?
What is your current mental health like now?
Posted by Nickengland on May 19, 2005, at 16:52:34
In reply to Re: Trileptal trial for bipolar depression... » SLS, posted by katia on May 19, 2005, at 16:45:33
300mg seems like a good idea Scott..hows it treating you?..any benefit?
Kind regards
Nick
Posted by Minnie-Haha on May 19, 2005, at 18:45:56
In reply to Re: Trileptal trial for bipolar depression..., posted by katia on May 19, 2005, at 16:09:46
> What is the lowest dose anyone has been on Trileptal and still got results? I want to go to 300 from 450...
I went to 300 for a while, but went back up to 450 when I started augmenting my 40mg Cymbalta with Wellbutrin.
Posted by katia on May 19, 2005, at 22:04:39
In reply to Re: Trileptal trial for bipolar depression..., posted by Minnie-Haha on May 19, 2005, at 18:45:56
Did you go back up because you added ADs? (to prevent mania)?
> What is the lowest dose anyone has been on Trileptal and still got results? I want to go to 300 from 450...
>
> I went to 300 for a while, but went back up to 450 when I started augmenting my 40mg Cymbalta with Wellbutrin.
>
>
>
Posted by SLS on May 20, 2005, at 6:51:01
In reply to Re: Trileptal trial for bipolar depression... » SLS, posted by katia on May 19, 2005, at 16:45:33
Hi.
I have reduced my dosage of Trileptal from 600mg to 450mg to 300mg. It does not seem to be helping with depression. I have been reducing the dosage in an effort to rid myself of the negative effects it has on mood and cognition at the higher dosages. When I first began taking Trileptal, I thought that I might have been gleaning a small improvement in mental energy and perhaps even mood. That was during the first week. I am now in week 4. Although it is probably too soon to pass judgment on this drug, I suspect my doctor is not going to want to invest too much time in it if there isn't a clear trend towards improvement. Keppra is next on the list. I'm not sure if he is going to want to add it to the Trileptal or substitute for it. I think he is leaning in favor of a substitution now and adding back the Trileptal if no improvement is seen.
I am currently taking:
Lamictal 150mg
nortriptyline 100mg
Parnate 80mg
Abilify 10mg
Trileptal 300mgThis regime helps with depression only slightly - perhaps 15%. Otherwise, I am still very anergic and cognitively impaired in addition to the anhedonia. Dysphoria is not so much of a problem for me right now.
- Scott
Posted by SLS on May 20, 2005, at 6:55:13
In reply to Re: Trileptal trial for bipolar depression..., posted by Nickengland on May 19, 2005, at 16:52:34
Hi Nick.
I greatly appreciate your concern.
I'm you glad suggested to me to lower the dosage to 300mg. It helped to affirm my decision to do so. There seemed to be no real trend towards improvement at 600mg or 450mg. I'll let you know how the negative side effects respond to the dosage change.
- Scott
Posted by SLS on May 20, 2005, at 6:57:04
In reply to Re: Trileptal trial for bipolar depression..., posted by Minnie-Haha on May 19, 2005, at 18:45:56
> > What is the lowest dose anyone has been on Trileptal and still got results? I want to go to 300 from 450...
>
> I went to 300 for a while, but went back up to 450 when I started augmenting my 40mg Cymbalta with Wellbutrin.What were your reasons for increasing the dosage of Trileptal? Did 300mg have any positive effect?
Thanks.
- Scott
Posted by Minnie-Haha on May 20, 2005, at 14:27:46
In reply to Re: Trileptal trial for bipolar depression... » Minnie-Haha, posted by katia on May 19, 2005, at 22:04:39
> Did you go back up because you added ADs? (to prevent mania)?
Yes. After I augmented my Cymbalta with the Wellbutrin, I felt a little more agitated than I liked.
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