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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 Beckett on May 12, 2014, at 14:38:30
(Sorry for taking up too much bandwidth by posting twice.)
I am experiencing a word recall problem on lamictal. And I'm not convinced it is doing much for me. Maybe it is. Not sure. Difficulty with words is discouraging. It adds to the feeling of being weighed down.
I guess lamictal is the worst offender. Do anticonvulsants as a category tend to have this effect? I'm not sure if I should see about discontinuing and trying another.
Posted by Phillipa on May 12, 2014, at 15:21:34
In reply to Anticonvulsants and the dumb factor, posted by Beckett on May 12, 2014, at 14:38:30
Are you on a high dose? As if low trileptal at 150mg was fine for me. No side effects at all. Phillipa
Posted by Beckett on May 12, 2014, at 15:32:22
In reply to Re: Anticonvulsants and the dumb factor » Beckett, posted by Phillipa on May 12, 2014, at 15:21:34
You used trileptal? Was that for anxiety? I have heard of it used here. What is it for?
Sorry so many questions!
Posted by phidippus on May 12, 2014, at 18:08:06
In reply to Anticonvulsants and the dumb factor, posted by Beckett on May 12, 2014, at 14:38:30
>Do anticonvulsants as a category tend to have this effect?
Topomax is the worst offendor, especially when it comes to problems such as word finding. Hence the nickname Dopomax.
Not ALL anticonvulsants effect cognitive processes in such a manner-some are very clean, such as Keppra(which can be used as a mood stabilizer). In any case, cognitive slowing is a side effect that usually resolves after a few weeks of treatment with the drug.
Eric
Posted by Phillipa on May 12, 2014, at 18:32:22
In reply to Re: Anticonvulsants and the dumb factor » Phillipa, posted by Beckett on May 12, 2014, at 15:32:22
In my case was to help an ad work. It's used as a mood stablizer. Most take a lot higher doses. Similar to tegretol. Phillipa
Posted by Beckett on May 12, 2014, at 19:17:38
In reply to Re: Anticonvulsants and the dumb factor » Phillipa, posted by Beckett on May 12, 2014, at 15:32:22
Thanks for weighing in Eric. I'll look at Keppra. Not familiar with it. Nor trileptal.
Posted by LouisianaSportsman on May 12, 2014, at 21:50:11
In reply to Re: Anticonvulsants and the dumb factor, posted by Beckett on May 12, 2014, at 19:17:38
> Thanks for weighing in Eric. I'll look at Keppra. Not familiar with it. Nor trileptal.
Eric is correct, Topamax (topiramate), colloquially Dopamax, is one of the worst offender along with its carbonic anhydrase pal, Zonegran (zonisamide).
Eric and I have atypical reactions with both of our respective anticonvulsants. Like myself with Topamax XR, he gets mood stabilization effects from Keppra 3,000mg. daily which is not proven clinically as a mood stabilizer and is not a first-line anticonvulsant for mood stabilization just like Topamax which also has little credibility for mood stabilization. I do not have any cognitive issues from 400mg. max dosage topiramate.
With Keppra, if anything, your cognition might be enhanced as it is a piracetam, a cognitive enhancer. Just don't use these more experimental anticonvulsants until you've also exhausted two of three first-line, a Depakote, a Lithium and a (es, ox) Carbamazepine [trileptal] anticonvulsants first after Lamictal.
With the exception of Keppra, anything will have that "dumb factor", particularly Depakote of the ones aforementioned since it has the most GABA relevancy.
I believe that Keppra has a better side effect profile than Topamax and I only suggest Topamax as a last resort to people looking to lose weight already stabilized as it typically doesn't work out for patients. It generally produces unreal side effects for patients, but I am medication tolerant.
Posted by Beckett on May 12, 2014, at 22:33:43
In reply to Re: Anticonvulsants and the dumb factor, posted by LouisianaSportsman on May 12, 2014, at 21:50:11
Hi LS,
I think lithium works o.k. Lamical is onboard for an antidepressant effect and to see about keeping mood variability low. It might help towards that end, but maybe not enough given how difficult it is to concentrate. I was hoping maybe another AC would work. Topamax didn't help (but did not cause cognitive diminishment). Depakote was too dulling and flattening. Thanks for sharing your knowledge. So it looks like trileptal would be next to discuss if I understand you correctly.
Posted by LouisianaSportsman on May 14, 2014, at 0:14:00
In reply to Re: Anticonvulsants and the dumb factor » LouisianaSportsman, posted by Beckett on May 12, 2014, at 22:33:43
Lamical is onboard for an antidepressant effect and to see about keeping mood variability low. It might help towards that end, but maybe not enough given how difficult it is to concentrate. I was hoping maybe another AC would work.
>
>How high do you think you can dose the Lamictal? Do you think you can reach 100mg.? That would be the target dosage if you were to augment another mood stabilizer to it. 200mg. for monotherapy. If you can handle 100mg. of lamotrigine, perhaps you can adjust to its effects and augment another mood stabilizing drug and a carbamazepine is a good idea.
>
So it looks like trileptal would be next to discuss if I understand you correctly.
>
>Correct. However, bring up the much underrated:
http://equetro.com/ basically it comes in a very complex extended-release form and it uses carbamazepine which is the only version that is proven to work in bipolar disorder-- it does have the epoxide unlike Trileptal so that may interfere with drug-drug interactions, but I'm not sure if it really applies to your case. I think the Equetro would be the best way to go followed by Aptiom (eslicarbazepine) which is a newer version of Trileptal in plain speak. Ask about Equetro (perhaps more side effects but comes with the chance of more improvement) and Aptiom (least side effects of all) as I think they are the best forms of carbamazepine, anything else would be just common and inferior.
I think Aptiom is clearly the best way to go as it the newest, most refined carbamazepine and the suggested maintenance dose is one 800mg. daily which would be perfect with one 100mg. Lamictal daily for optimal stabilization. You may see dramatic improvement.
Posted by Beckett on May 17, 2014, at 1:24:15
In reply to Re: Anticonvulsants and the dumb factor, posted by LouisianaSportsman on May 14, 2014, at 0:14:00
Hello Louisiana,
My lamictal dose is 200 mg, hence the dumb factor. But I am beginning to think it is kicking in along with lithium to good effect. A bit antidepressant, too. I think despite the word retrieval problem, I will stick with lamictal for now. Sometimes I post when I am casting about in my mind about meds. Despite the mood stabilizers, I'm moody with anxiety to boot. I much appreciate your generous sharing of your knowledge. I've been wondering how the simplification of your med regime is going.
Posted by Zyprexa on May 20, 2014, at 21:01:00
In reply to Anticonvulsants and the dumb factor, posted by Beckett on May 12, 2014, at 14:38:30
I don't know about other ACs, but lamictal made me feel dumb. And was not helping so I stoped it.
This is the end of the thread.
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