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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Cindylou on April 9, 2002, at 7:57:29
Hi all,
Just an update that I decided to go off of the Lamictal for now. I was on too low of a dose for it to do any good (75 mg), and every time I tried to increase I got severe bloating, and things actually seemed to be worse. But the main reason I'm going off of it is to try to get pregnant, eventually!My pdoc gave me a prescription for Nortriptyline (I think that's the one ... the tricyclic.) She said it's been proven safe in pregnancy -- I'm not sure if I'll be able to tolerate it or not, but it's worth a shot.
I'm also going to try vitamins and that Omega 3 fatty acid stuff.
We'll see what happens!
Any experiences with Nortriptyline and/or Omega 3 are appreciated!
take care,
cindy
Posted by SLS on April 9, 2002, at 10:18:42
In reply to Going off Lamictal. Sigh..., posted by Cindylou on April 9, 2002, at 7:57:29
> My pdoc gave me a prescription for Nortriptyline (I think that's the one ... the tricyclic.) She said it's been proven safe in pregnancy -- I'm not sure if I'll be able to tolerate it or not, but it's worth a shot.> Any experiences with Nortriptyline and/or Omega 3 are appreciated!
Hi Cindy.
The only thing that I would want comment on is that nortriptyline can be temperamental in terms of what dosage works best. Unlike most of the other drugs, you can actually lose a positive response by taking too much. Doctors usually make 75mg the target. Here is a thread that appeared a few weeks ago.
http://www.dr-bob.org/babble/20020322/msgs/99639.html
I find that the side effects of nortriptyline are very tolerable. However, at first, you might feel sedated and have dry-mouth. These things have disappeared entirely for me, although I have been on TCAs so many time, I have probably grown tolerant of them. Nortriptyline is generally a safe ,effective, and well-tolerated drug. Since nortriptyline has been around for 40 years as compared to the 15 years of oldest SSRI drug, Prozac, doctors can place much greater confidence in its historical lack of birth-defects and other complications of pregnancy (along with the TCAs as a group). Up until now, though, Prozac has a good track record.
The only thing that appears in the literature concerning gestation is that Prozac is associated with a small increase in the rate of premature births. However, I think it has been overlooked that the baby will experience the same sort of SSRI-withdrawal effects that any adult would from the sudden disappearance of Prozac from the blood stream. It does pass through the placenta. It also shows up in breast milk, although I don't know to what degree this is significant.
> I'm also going to try vitamins and that Omega 3 fatty acid stuff.Are you bipolar? Is Omega-3 effective for unipolar depression?
I like to take plenty of B-vitamins along with a multiple vitamin containing zinc. I also take 1000mg of vitamin-C and 800 IU of vitamin-E.
Good luck and congratulations!
- Scott
Posted by Cindylou on April 9, 2002, at 12:11:35
In reply to Re: Going off Lamictal. Sigh..., posted by SLS on April 9, 2002, at 10:18:42
Thanks so much, Scott, for the informative post, and positive feedback! It gives me hope.
Last night I decreased the Lamictal from 75 mg to 50, and I have to tell ya, I feel better now than I have in weeks! I wonder if the Lamictal was backfiring on me (other drugs have done that after they have run their course.)
I'm not sure about Omega 3 being effective for unipolar depression or not -- I have been diagnosed as bipolar II, and my pdoc says it's good for stabilizing moods. Jury's still out on whether I'll try it or not ...
Thanks again, Scott!
cindy>
> > My pdoc gave me a prescription for Nortriptyline (I think that's the one ... the tricyclic.) She said it's been proven safe in pregnancy -- I'm not sure if I'll be able to tolerate it or not, but it's worth a shot.
>
> > Any experiences with Nortriptyline and/or Omega 3 are appreciated!
>
> Hi Cindy.
>
> The only thing that I would want comment on is that nortriptyline can be temperamental in terms of what dosage works best. Unlike most of the other drugs, you can actually lose a positive response by taking too much. Doctors usually make 75mg the target. Here is a thread that appeared a few weeks ago.
>
> http://www.dr-bob.org/babble/20020322/msgs/99639.html
>
> I find that the side effects of nortriptyline are very tolerable. However, at first, you might feel sedated and have dry-mouth. These things have disappeared entirely for me, although I have been on TCAs so many time, I have probably grown tolerant of them. Nortriptyline is generally a safe ,effective, and well-tolerated drug. Since nortriptyline has been around for 40 years as compared to the 15 years of oldest SSRI drug, Prozac, doctors can place much greater confidence in its historical lack of birth-defects and other complications of pregnancy (along with the TCAs as a group). Up until now, though, Prozac has a good track record.
>
> The only thing that appears in the literature concerning gestation is that Prozac is associated with a small increase in the rate of premature births. However, I think it has been overlooked that the baby will experience the same sort of SSRI-withdrawal effects that any adult would from the sudden disappearance of Prozac from the blood stream. It does pass through the placenta. It also shows up in breast milk, although I don't know to what degree this is significant.
>
>
> > I'm also going to try vitamins and that Omega 3 fatty acid stuff.
>
> Are you bipolar? Is Omega-3 effective for unipolar depression?
>
> I like to take plenty of B-vitamins along with a multiple vitamin containing zinc. I also take 1000mg of vitamin-C and 800 IU of vitamin-E.
>
> Good luck and congratulations!
>
>
> - Scott
Posted by SLS on April 9, 2002, at 17:59:10
In reply to Re: Going off Lamictal. Sigh... » SLS, posted by Cindylou on April 9, 2002, at 12:11:35
Ř Last night I decreased the Lamictal from 75 mg to 50, and I have to tell ya, I feel better now than I have in weeks! I wonder if the Lamictal was backfiring on me (other drugs have done that after they have run their course.)
I have seen quite a few people describe feeling better upon decreasing the dosage of Lamictal. I don’t think it is anything more than a temporary “blip” mood-lift due simply to the change, and that it is not a prognosticator of a stable improvement at the new dosage. If you have not done well on Lamictal at dosages of between 200-300mg, I don’t think you will do any better at lower ones. A few people have claimed a therapeutic window from time to time, but the assertions never seem to last for very long. Hopefully, my impressions are just plain wrong.How high a dosage have of Lamictal have you tried? Were cognitive side-effects getting in the way of reaching 300mg? How long were you at your highest dosage?
I must say that your “blip” improvement sounds like Lamictal might still have a place in your drug treatment. It could play a critical role in the effective combination you will surely come up with. For me, I don’t get any benefit from a tricyclic unless I am also taking Lamictal 300mg. Conversely, I receive no benefit from Lamictal unless I am also taking a tricyclic.
Keep thinking and hoping. Two things have kept me going for all of these years:
1. I know what it is like to live a life without depression. I experienced it once for about six months, and I have thus far deemed it worth the painful wait.
2. I am always thinking. If I can come up with a treatment alternative that I have not yet tried, I can’t exclude the possibility that I will enjoy the life I alluded to in #1.
- Scott
Posted by speck on April 9, 2002, at 20:27:52
In reply to Re: Going off Lamictal. Sigh..., posted by SLS on April 9, 2002, at 17:59:10
It was good for me to read your "two things". It reminded me that a little hope can go a long way. Thanks.
Posted by petters on April 10, 2002, at 1:31:04
In reply to Re: Going off Lamictal. Sigh..., posted by SLS on April 9, 2002, at 17:59:10
Dear Scott.
Why are you going off Lamictal? I thougt that you had mucth benifit from it. Are you going to have a trial on Litium?
On of my problem: I got tearfullnes from Effexor. This often happen when talking of painfull things ( not about me) I am not clinical depressed. I didn´t have this symptom on ssri, despit my depression was worser then. Strang, but when I am depressed I am not experienced this thearfullnes. I am quite sure that Effexor is the culprit.
I was adding Nefazodon 600 mg for two month ago. After 3-5 days I expected hypertemia ( hypomania? Now has the effect wean off AGAIN. I dont´t understand this damed poop out that occure, when tried new medications.
My current medication:
T. Effexor 300 mg
T. Serzone 600 mg
T. Lamictal 100mg
T. Litium ( 0,5 mmol/l)What do you think, best friend?
Sincerely...Petters
Posted by petters on April 10, 2002, at 3:12:35
In reply to Re: Going off Lamictal. Sigh..., posted by petters on April 10, 2002, at 1:31:04
Dear Scott.
Why are you going off Lamictal? I thougt that you had mucth benifit from it. Are you going to have a trial on Litium?
On of my problem: I got tearfullnes from Effexor. This often happen when talking of painfull things ( not about me) I am not clinical depressed. I didn´t have this symptom on ssri, despit my depression was worser then. Strang, but when I am depressed I am not experienced this thearfullnes. I am quite sure that Effexor is the culprit.
I was adding Nefazodon 600 mg for two month ago. After 3-5 days I expected hypertemia ( hypomania? Now has the effect wean off AGAIN. I dont´t understand this damed poop out that occure, when tried new medications.
My current medication:
T. Effexor 300 mg
T. Serzone 600 mg
T. Lamictal 100mg
T. Litium ( 0,5 mmol/l)What do you think, best friend?
Sincerely...Petters
Posted by Cindylou on April 10, 2002, at 6:42:19
In reply to Re: Going off Lamictal. Sigh..., posted by SLS on April 9, 2002, at 17:59:10
Hi Scott,
I hear ya, as far as the "temporary blip" this improvement I feel must be ... I suspect the same thing, since it has happened many times before. And you are probably right, that Lamictal could have a place in my treatment somewhere down the line. I never got higher than 125 mg because of the bloating and worse agitation/fatigue. Those side effects may have gone away given time, but I didn't have the gumption to stick it out.SO, I'm just going to wait it out and see what happens without the Lamictal, then what happens with Omega 3 and possibly Nortriptyline ... if I fall apart (which is a strong possibility), I will get on some more aggressive treatment and forget about trying to have another baby. I'm not sure if we can adopt, though, since I've been treated with these meds -- I don't know what adoption agency policies are on that. (We were thinking of adopting from overseas ... ) But that's a whole other topic!!
Thanks so much for your kind words and encouragement. Your last two points made my day!
cindy
> Ř Last night I decreased the Lamictal from 75 mg to 50, and I have to tell ya, I feel better now than I have in weeks! I wonder if the Lamictal was backfiring on me (other drugs have done that after they have run their course.)
>
>
> I have seen quite a few people describe feeling better upon decreasing the dosage of Lamictal. I don’t think it is anything more than a temporary “blip” mood-lift due simply to the change, and that it is not a prognosticator of a stable improvement at the new dosage. If you have not done well on Lamictal at dosages of between 200-300mg, I don’t think you will do any better at lower ones. A few people have claimed a therapeutic window from time to time, but the assertions never seem to last for very long. Hopefully, my impressions are just plain wrong.
>
> How high a dosage have of Lamictal have you tried? Were cognitive side-effects getting in the way of reaching 300mg? How long were you at your highest dosage?
>
> I must say that your “blip” improvement sounds like Lamictal might still have a place in your drug treatment. It could play a critical role in the effective combination you will surely come up with. For me, I don’t get any benefit from a tricyclic unless I am also taking Lamictal 300mg. Conversely, I receive no benefit from Lamictal unless I am also taking a tricyclic.
>
> Keep thinking and hoping. Two things have kept me going for all of these years:
>
> 1. I know what it is like to live a life without depression. I experienced it once for about six months, and I have thus far deemed it worth the painful wait.
> 2. I am always thinking. If I can come up with a treatment alternative that I have not yet tried, I can’t exclude the possibility that I will enjoy the life I alluded to in #1.
>
>
> - Scott
Posted by SLS on April 10, 2002, at 13:08:42
In reply to Re: Going off Lamictal. Sigh.....(((SLS))), posted by petters on April 10, 2002, at 3:12:35
Hi Anders.
> Why are you going off Lamictal? I thougt that you had mucth benifit from it.
I will continue with Lamictal at 300mg or higher. It does help when I combine it with antidepressants.
> Are you going to have a trial on Litium?
I think that I will try lithium, but at lower dosages. More than 600mg makes me feel worse. Dr. Husseini Manji and others have demonstrated that low dosages have neuroprotective and neurotrophic effects.
Neuroprotective = prevent further deterioration of hippocampus and prefrontal cortex.
Neurotrophic = restore and promote brain tissue in hippocampus, prefrontal cortex, and cerebral cortex.
> On of my problem: I got tearfullnes from Effexor. This often happen when talking of painfull things ( not about me) I am not clinical depressed. I didn´t have this symptom on ssri, despit my depression was worser then. Strang, but when I am depressed I am not experienced this thearfullnes. I am quite sure that Effexor is the culprit.
>
> I was adding Nefazodon 600 mg for two month ago. After 3-5 days I expected hypertemia ( hypomania? Now has the effect wean off AGAIN. I dont´t understand this damed poop out that occure, when tried new medications.
>
> My current medication:
>
> T. Effexor 300 mg
> T. Serzone 600 mg
> T. Lamictal 100mg
> T. Litium ( 0,5 mmol/l)
I’m sorry to hear that you still haven’t found complete remission yet. I was so hopeful for you when you last wrote of the improvement you were experiencing. These illnesses can be demons of deception and disappointment.Sometimes, tearfulness can be a good sign. I think that as a severe and mind-numbing depression begins to lift, the reemergence of mental activity and emotions can allow for tearful reactions to things that previously had no impact. I know that when I have experienced this, I cry while watching movies, seeing children play, and walking on the beach immersed in deep and profound thought – none of these being depressing. On the other hand, I think this same tearfulness occurs more often when one is moving in the opposite direction, while descends through the early stages of depression. Perhaps you are caught somewhere in the middle. My emotional experiences when remembering painful or tragic moments or aspects of my life become amplified and more intense during these “transitional” states.
I am sure that you know that your Lamictal dosage is at the lowest part of therapeutic range. 200mg seems to be the average optimal dosage, with 300mg being necessary occasionally. Also, you might want to try bringing up your lithium blood-level to 0.6 – 0.8. I am curious, what is your current lithium *dosage*? I wish I knew what to do for you. Some of the things that I am considering me are Nardil, S-AMe, modafinil, and low-dosage lithium (300-600mg).
Obviously, I have been feeling a little better these past few days. Unfortunately, things are beginning to deteriorate again. Reducing my dosage of nortriptyline from 100mg to 75mg produced a sort of temporary rebound improvement that is now fading. I am having trouble deciding whether to switch to imipramine 300mg or continue to hope that my system will somehow respond again to nortriptyline. When I am responding to it, I like better the way nortriptyline feels than imipramine. However, imipramine produces a more stable improvement. Also:
1. I need 300mg of imipramine to see an improvement.
2. Imipramine makes me feel numb to my surroundings; nortriptyline makes me feel more connected.
3. At 300mg, imipramine causes disturbances in my memory and cognition (anticholinergic).
4. When I add Nardil, the side-effects resulting from its synergy with imipramine will be worse than with nortriptyline. Last time I tried adding Nardil to imipramine, I could not walk without fainting because of hypotension, and I could not initiate urination.This is why I have been so stubborn and not discontinue nortriptyline. Unfortunately, I don’t think there is a therapeutic window for me. I hate therapeutic windows. They never seem to open up for me.
I will continue to pray for you. I think you are getting close.
- Scott
This is the end of the thread.
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