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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Nickengland on June 3, 2005, at 7:04:21
Hello there :-)
Just wondered if anyone has used these 2 medications in a combo?
Any experiences on if it worked?
Would it work well?
Am I right in thinking that Tegretol would make Topamax half as efective: eg you would need 50mg of Topamax, to gain the benefits of a 25mg pill as Tegretol would break it down by 50%?
Thanks for any replies about this!
Posted by stresser on June 3, 2005, at 8:04:41
In reply to Tegretol/Topamax Combo Anyone been on this?, posted by Nickengland on June 3, 2005, at 7:04:21
Nick,
This may be helpful to you. I think Tegretol and Trileptal somewhat the same; Tegretol is just stronger. My daughter as you know, takes Trileptal with Topomax, and I THINK it is working quit well. We will know more today.
Here is a link, take a look:http://www.psycheducation.org/depression/meds/moodstabilizers.htm#symptoms
Posted by Nickengland on June 3, 2005, at 8:52:23
In reply to Re: Tegretol/Topamax Combo Anyone been on this?, posted by stresser on June 3, 2005, at 8:04:41
Thanks Lu!
I agree with you, Tegretol is definately stronger than Trileptal - I often think of them like Marlborough, and Marlborough Lights with Trielptal being the light version.
Your definately right they are somewhat the same carbamazepine (tegretol) & oxcarbazepine (Trielptal) the only difference being is that Trielptal has an oxygen atom added to the chemical structure of the drug, hence the "ox"-carbazepine.
I so wish I could continue to take Trielptal, but I got a rare kidney pain side efect from it.
I hope all goes well with the psychiatrist and your daughter today :-)
Kind regards
Nick
Ps Did you get my babblemail, about if the topamax helps with sleep and the decreasing sweating side effect? (i'm not sure if it worked when I sent it)
Posted by SLS on June 3, 2005, at 8:58:14
In reply to Tegretol/Topamax Combo Anyone been on this?, posted by Nickengland on June 3, 2005, at 7:04:21
Hi.
What do you hope adding Topamax will accomplish?
Thanks.
- Scott
Posted by Nickengland on June 3, 2005, at 10:18:26
In reply to Re: Tegretol/Topamax Combo Anyone been on this? » Nickengland, posted by SLS on June 3, 2005, at 8:58:14
Hello Scott :-)
Well as you know the Trielptal was great for my mood but had to be stopped because of kidney pains.
Now i'm back on Tegretol and its no way near as effective..I feel more depressed - my mood seems more heavy for want of a better word if you get what I mean. I'm also experiencing more head aches, something I didn't get from Trielptal and I have an increase in sweating which is uncomfortable. All in all though the Tegretol is still better for me than either lithium, sodium valproate or lamotrigine.
So I feel that I had a taste of "the good life" with Trileptal lol...and now I want that back. I really don't want to settle for a half measure if theres a possbilty of something better...
With Topamax if i'm successful getting it prescribed (my current psychiatrist didn't even know of Trileptal until i suggessed it) I hope to gain from it this:
It has a side-effect of decreasing sweating, which is very much a plus for me as I overly sweat anyway even without meds.
Its supposed to be good for preventing migraine head aches..again something good for me.
As I understand, Tegretol, Trileptal and Topamax are the 3 main meds that mainly work on the Temporal Lobes. I've responded best to these medications out of all the other mood stabilisers, so my logic seems to think that *perhaps* Topamax would help too, although its just guess work, I strongly believe Topamax would be worth considering taking into account as it works on the Temporal Lobes and teg and tri have helped so much.
It will either be a case of adding, or trying Topamax alone, I'd prefer it alone if possible. If push comes to shove maybe the 2 would work better..all guess work until I try lol maybe the Topamax will makes things worse?!
Are you thinking of trying Topamax and how is the Trileptal treating you?
Kind regards
Nick
Posted by SLS on June 3, 2005, at 11:08:20
In reply to Re: Tegretol/Topamax Combo Anyone been on this?, posted by Nickengland on June 3, 2005, at 10:18:26
Hi Nick.
> Well as you know the Trielptal was great for my mood but had to be stopped because of kidney pains.
I know. How weird is that?
> Now i'm back on Tegretol and its no way near as effective..I feel more depressed - my mood seems more heavy for want of a better word if you get what I mean.
In what ways did Trileptal improve your depression?
I sure do. Good word for it. Do you experience a feeling of general malaise with it? That's what I felt when I first started taking Trileptal. It still persists actually, but had not been as bad the longer I stayed on it. I discontinued it yesterday as it wasn't doing enough for me, and I wanted to see what would happen. Sometimes you don't realize how much a drug has been helping you until you stop taking it. My doctor asked that I keep the dosage down to 300mg. He also said that I could discontinue it to see what would happen. Well, I experienced a rebound worsening of depression that lasted for half a day and then subsided. I feel ok today. I might go back to it at 600mg just to compare, but I need to decide on a stable regimen within the next 4 weeks. If all goes well, I'll be trying mifepristone using the 7-day protocol in a month or two.
> I'm also experiencing more head aches, something I didn't get from Trielptal and I have an increase in sweating which is uncomfortable. All in all though the Tegretol is still better for me than either lithium, sodium valproate or lamotrigine.
You might want to look into Keppra. No reason in particular. It's just one more anticonvulsant available for consideration. A doctor Kenneth Kaufman published a case study of a woman whom was a rapid cycler and refractory to many polypharmaceutical treatments. She is now doing very well using Keppra as monotherapy. She tried to come off of it once, but relapsed.
> With Topamax if i'm successful getting it prescribed (my current psychiatrist didn't even know of Trileptal until i suggessed it) I hope to gain from it this:
>
> It has a side-effect of decreasing sweating, which is very much a plus for me as I overly sweat anyway even without meds.
>
> Its supposed to be good for preventing migraine head aches..again something good for me.
>
> As I understand, Tegretol, Trileptal and Topamax are the 3 main meds that mainly work on the Temporal Lobes. I've responded best to these medications out of all the other mood stabilisers, so my logic seems to think that *perhaps* Topamax would help too, although its just guess work, I strongly believe Topamax would be worth considering taking into account as it works on the Temporal Lobes and teg and tri have helped so much.
>
> It will either be a case of adding, or trying Topamax alone, I'd prefer it alone if possible. If push comes to shove maybe the 2 would work better..all guess work until I try lol maybe the Topamax will makes things worse?!
>
> Are you thinking of trying Topamax...?If I see enough people find it an effective antidepressant, I will probably move it higher on my list of things to try.
I'm sure you know this, but the more gradually you titrate Tompamax, the more likely you are to avoid completely the cognitive side effects. Once triggered, these negative effects tend to linger. I was just thinking about this yesterday. If two people begin taking Topamax on the same day; person #1 using a rapid titration and person #2 using a gradual titration; at the end of six months, person #1 will still be experiencing cognitive impairments while person #2 will not. It is worth the investment in time to go slowly. Unfortunately, I am not yet familiar enough with dosing of Topamax to suggest a titration schedule.
Get well.
- Scott
Posted by Nickengland on June 3, 2005, at 12:29:17
In reply to Re: Tegretol/Topamax Combo Anyone been on this? » Nickengland, posted by SLS on June 3, 2005, at 11:08:20
Hello Scott
Yes malaise sure is a word thats fits the description. I don't like taking something that makes me feel this way. There seems to be a fine line when a medicine actually makes you feel better and then when a medicine appears to make you feel worse. The Tegretol to me in some respects makes me better...but it also cross the line and makes me feel worse.
This is where I found Trileptal better (putting th kidney pain aside) I generally did not feel that it was making me feel worse. The "heavyness" of mood was completely gone, it seemed the balance was just right.
Thats great that you can play with the dose. For me personally I found 300mg to be just right. I can only add from my experience that I would think if you decide to stick with Trileptal, 300mg may well be the best dosage..saying that you may feel even better without it altogether...
I know how you feel about a stable regime, i'm getting close but still have abit of tweaking to do. I can't wait till I get it right. It will be nice when I can just take the pill everyday and not think about adding anything or taking away..when you reach that point its the best indicator you've got as far as you can go I think. I did reach that with Trileptal briefly and it was a great feeling.
Thanks for suggesting Keppra. Its always nice to know theres something else. I hate thinking I only have 1 more option left to try, and thats given me another one :-) Hey also Verapamil..have you tried or heard of this?
Glad you mention about Topamax tritation.. I will be going very slow indeed if I get it and will take a very small dose anyway. I really want to avoid those cognitive side effects..thats the one i'm worried about. Always though, my psychiatrist puts me on low doses and strangely enough never even speaks about raising the dose. Which sometimes I wonder if he's under-dosing me, you wouldn't believe the low doses he puts me on compared with others on here and its not like i'm a small guy or anything. I mean i'm on just 200mg of Tegretol. I would imagaine 25mg or 50mg would be the dose given and thats all he would give.
Mifepristone sounds interesting, be sure to let us know how that goes. Was that originally used for abortion? I do remember sometime last year reading about that and how it was very effective for psychotic depression..Don't quote me exactly on that, but if its abortion related then from what I read it was brillant for psychotic depression.
Hope you manage to get some peace from these drugs soon...
Kind regards
Nick
Posted by bipolarspectrum on June 4, 2005, at 22:23:32
In reply to Re: Tegretol/Topamax Combo Anyone been on this? » Nickengland, posted by SLS on June 3, 2005, at 11:08:20
If two people begin taking Topamax on the same day; person #1 using a rapid titration and person #2 using a gradual titration; at the end of six months, person #1 will still be experiencing cognitive impairments while person #2 will not.
SLS,
Can you substiante the above statement? Sorry, not to be mean, but that seems hard to believe... I'm currently on topamax and not titrating especially slowly, so you've got me worried!!
bps
Posted by SLS on June 5, 2005, at 0:11:27
In reply to WHOA - can u expand on one point SLS???, posted by bipolarspectrum on June 4, 2005, at 22:23:32
I really don't have anything that I could pull up on the Internet for you. However, these are the clinical impressions that several doctors of mine have regarding Topamax and cognitive side effects. I have no personal experience with the drug, although I guess it will remain on my list of things to try.
Perhaps I've overstated the issue.
- Scott
Posted by SLS on June 5, 2005, at 10:17:45
In reply to WHOA - can u expand on one point SLS???, posted by bipolarspectrum on June 4, 2005, at 22:23:32
Hi BPS.
How does your titration schedule compare to the one below?
http://www.postgradmed.com/issues/2002/01_02/beydoun.htm
"Topiramate has significant efficacy when used as adjunctive therapy (15). Because of potential adverse cognitive events, it should be started at a low dose, with gradual adjustment in dosage thereafter. A starting dose of 25 or 50 mg per day is appropriate, with weekly increments of 25 to 50 mg per day. The usual target dose for adjunctive therapy is 400 mg taken twice daily, with a dose range between 100 and 1,000 mg per day."
- Scott
Posted by stresser on June 7, 2005, at 19:27:18
In reply to Re: WHOA - can u expand on one point SLS??? » bipolarspectrum, posted by SLS on June 5, 2005, at 10:17:45
I would like to add my experience with topomax. I know that for me, titrating at a slower pace was the best way for me and my daughter to get to the dosage. She did try to titrate at a faster pace, (doctor wanted her to do it)and she started to forget some things at school. It really "freaked her out". I MADE her drop back, and titrate up slower, and the symptoms dissapeared. We have not had any problems with that, since that incident.
Nick- I don't think I recieved your babble mail?
The doctor did keep her on 75mg of Trileptal for the next month, and I assume he thinks it is working just fine with the 300mg of tompomax. He did say, that 400mg is the recommended dosage for BPII. I don't think she will be back up to that again. -L
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