Posted by Bob on January 10, 2001, at 20:01:32
In reply to Re: The benefits of Topamax (more), posted by phillybob on January 10, 2001, at 16:23:55
> Hey, Bob. I'd like to hypothesize that our bodies' white cells go for these new drugs we put into our bodies which makes us more susceptible to things like sore throat, colds and hangovers ... heh, heh (that's my non-scientific theory :).
>
> Anyway, this article I found today I posted somewhere here was interesting and you will find it so, I believe: http://www.pshrink.com/wisdom/bipolar_disorder.html
>
> I am not familiar with T4, but I have played with Celexa before. Not so sure that at the small dose that you are at that it will do too much for a body (especially after reading the article linked above).
>
> Anyhow, since Topamax (I believe Cam supplied this info somewhere) has a 21 hour half-life or so), it can be taken in one dose, and I now prefer to take it in the evening. In this way, you might be able to bring yourself up in dosage a bit (assuming your rash problem has dissipated).
>
> I have definitely been feeling less depressed as the days go by/dosage goes up ... though am still thinking of some lamictal as an adjunct (after reading the article I linked I'm thinking of steering clear of other AD's for now).
>
> I'D LIKE TO HEAR OF OTHERS WHO'VE BEEN ON A LAMICTAL/TOPIRAMATE COMBO in a similar situation to me (and the one person who seemed to have been, Lexie, has, alas, seemed to disappear from the board :(.
>
> I'll update. Please do so yourself as well as others, please.
>
> *************phillybob's favorite research o'th'day ... the cut & paste method ***********************
>
> Edward S. Hume, M.D., J.D.
>
> Bipolar Disorder, the hidden epidemic.
> 1999/10/14
>
> At the 1998 meeting of the APA in Toronto, I put a question to a distinguished panel of clinicians gathered to present various methods of treating refractory depression. I asked, “When do you consider that you might be dealing with bipolar disorder and treat the patient with a mood stabilizer?”
>
> They had no answer. None of them did.
>
> I have an answer: you consider the diagnosis before you treat in the first place. Many patients who have depression have unrecognized bipolar disorder. Many people with bipolar disorder respond only partially or not at to antidepressants. They need mood stabilizers to get well.
>
> I grill every patient I see thoroughly for possible hypomanic and sub-hypomanic episodes. Even little ones, brief ones, mild ones will cause me to apply a diagnosis of bipolar disorder and treat the patient with a mood stabilizer. I get great results. In new-to-treatment cases of depression I have found where the depression was part of a bipolar disorder, patients do beautifully on a mood stabilizer.
>
> When you have a patient who has been referred to you because he/she has failed to respond to anti-depressants, think hard about bipolar disorder.
>
> When you have a patient who has been referred to you from an alcohol rehab or methadone treatment program, think hard about bipolar disorder.
>
> Pry carefully into the course of illness. Does the patient have “dysthymia”, never stably depressed? That is a pattern for anticonvulsant-responsive bipolar disorder. Dig for those micro-manic episodes.
>
> We have wonderful treatment options for bipolar disorder.
>
> I distinguish between the classic bipolar disorder, manic depressive illness, and the other forms of bipolar disorder. I still treat manic depressive illness with lithium. But the other forms of bipolar disorder I treat with anticonvulsants.
>
> Your choices for a complete treatment with an anticonvulsant:
>
> Divalproex sodium (Depakote in the US)
>
> Topiramate (Topamax in the US)
>
> Lamotrigine (Lamictal in the US)
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> Valproic acid (Depakene in the US; Epilim in some other countries) (In New Zealand—where divalproex was not available to ordinary patients—my patients often experienced full remission of symptoms with 200mg TID.)
>
> When a patient responds to a mood stabilizer, the patient may not need an antidepressant. A hypnotic might be the only other medication needed.
>
> To sum up, I believe that bipolar disorder should be a not be a diagnosis of exclusion. We should look hard for it. If we get the diagnosis right the first time, our patients will not suffer while their illness continues without effective treatment. If we get the diagnosis right the first time, our patients will be happy sooner. That’s where it’s at for us, isn’t it?
>
> [Note for prescribing physicians—Using lamotrigine requires starting low and going slow. I have found that starting with the pediatric dosing form of 5mg BID and moving up every two weeks can be a practical way to dodge the rash (in my experience psychiatric patients seem to have this side effect more often than neurologic patients seem to). If the rash occurs at 5mg or 10mg BID, patients have simply continued taking lamotrigine at that low dose. Unlike the experience of patients taking adult doses, these patients have had their rashes fade over the course of a month, not to recur. IF YOU ARE A PATIENT reading this, do NOT do ANYTHING without consulting closely with the doctor who prescribed your medication. This page has been published as a communication to doctors, and is not intended to be advice to patients. I do not treat patients over the Internet nor give advice to patients over the Internet. If you are a patient and want some advice aimed at you, look at Dr. Ivan Goldberg’s wonderful website.]
>
>
>
>
> E-mail: ehume@pshrink.com
>
> To Dr. Hume's home page
phillybob:Actually, I am at such a low level of Celexa because I tapered down from 20mg recently as I was tapering up on Topomax. It was a combination of the fact that I was sick of the "TMJD" effect (stiff jaw) it was having, while at the same time I'd also read about the ADs adding "fuel to the fire" so to speak when it comes to bipolar disorder in some cases.
In the case of your trying Lamotrigine with your topomax, it sounds interesting. I don't think that would be likely with me however, since I got a pretty nasty rash with that and my doc all but demanded that I stop. In the article you sent me though, they actually suggest levels of 5mg for awhile. Maybe it's worth another try at those levels if all signs of rash clear up. It seems risky though. I had originally started at 50mg dosages according to the recommended regimen as put forth by the manufacturer.
I think it's worth mentioning here exactly why the T4 is in my cocktail. Months back, I caught wind of the augmentation strategy going around to add T3 or T4, and sometimes both, to ADs in order to potentiate their response. I immediately jumped on this and started with T3 augmentation. The effects were not unlike stimulants, although slightly less straightforward. The benefits never lasted more than 3 or 4 days without hyperthyroid symptoms setting in. I tried T3, T3 and T4, and then finally just T4. At each change the benefits would come back for a few days and then take a back seat to the hyperthyroidism. The reason why I persisted though, was that the good feelings were so good, as to only have been approached by days BEFORE I was ill and had to be medicated. The side effects of the normally present ADs were almost imperceptible, my muscle tone was restored, I had energy, drive (both sex-drive, and goal-oriented drive), and I felt good physically: I wanted to be active and exercise. This brought back pre-illness memories. The only memories I have during period of illness that even remotely approaches this were my days on Effexor, but those I was to learn were numbered, as that medecine bogged down for me into hypersomnia and nonresponse, with significant weight gain. Oh did I mention that the thyroid augmentation also enabled me to begin losing some of the weight I had been accumulating from all of this drug treatment over the years? Well, anyway... it all faded away, as eventually the benefits of adding T3 and T4 seemed to become less and less, and the effects of an over-active thyroid became more and more troublesome: sweating, intolerance to heat etc, etc... Now I'm on a small, vestigial dose of T4 (12.5mcg, and will most likely nix that soon). It's REALLY frustrating to try a treatment that works that well for a little while and then stops working. I'm sure you all probably know what I mean though.
Anyway... enough B.S. for one post.
poster:Bob
thread:50878
URL: http://www.dr-bob.org/babble/20001231/msgs/51412.html