![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 40. Go back in thread:
Posted by SLS on March 28, 2002, at 7:18:17
In reply to Re: Provigil for cognition? Yesss!, posted by jazzdog on March 27, 2002, at 20:01:51
> In another thread, there's some speculation that lamictal and provigil might eventually counteract one another because one stimulates glutamate and the other reduces it...
> - Jane
Hi.This was my initial concern as well when I tried the combination almost two years ago. Sometimes it pays handsomely to be dumb. Sometimes not. In this case, I would also like simply to know how someone else responded to the combination. My ability to best evaluate my trial of Provigil was confounded by my having started taking sulpiride the week prior. (A neuroleptic antipsychotic with antidepressant properties at low dosages). I was taking Lamictal 300mg at the time. Within an hour of my first 100mg dosage of Provigil, I felt a significant improvement. It lasted for one or two hours, but this is sometimes exactly what becomes a positive prognosticator of future long-term response. Unfortunately, I abandoned the trial after only three days when I began to feel like a zombie and experienced a great deal of anxiety, which is uncharacteristic of me. I discontinued both sulpiride and Provigil on the same day. For the next two weeks, I felt much worse than I could account for by my baseline depression. I blamed Provigil and its possibly antagonistic effects to Lamictal. Of course, I can't be sure because I changed two things at once. It could just as easily have been sulpiride. Not smart.
The "smart" part of me still leans in favor of blaming Provigil, but my reactions to some drugs are atypical. Sometimes, one drug will kick another out of bed (an untenable metaphor that I'm too lazy to replace). The offending drug somehow changes the dynamics of the system and renders a previously helpful drug regime useless. This is not a common occurrence, though.
- Scott
Posted by Elizabeth on April 4, 2002, at 5:52:12
In reply to Re: Unbelievable. 600mg? Malpractice., posted by SLS on March 27, 2002, at 19:13:04
Hardly. I've certainly heard of people taking that much. When I tried Lamictal (for a completely off-label use), I went up to 500 mg. (It didn't do me any good at any dose in that range.)
It's not clear how much people need for mood disorders -- it seems to be quite variable, though, and I would certainly allow for the possibility that some need high-end doses. Pharmacokinetic factors may play a role in some cases. Also, remember that the therapeutic serum level range for Depakote goes higher in bipolar d/o than epilepsy -- this could easily be the case for Lamictal as well. Therapeutic levels of Lamictal haven't been established, AFAIK, but it's worth considering the possibility that using higher doses would improve the response rate and the degree of response in mood disorders. I certainly don't think it's been studied enough that we can definitely say that it's no good increasing the dose past a certain amount. Lamictal's general safety and tolerability make it reasonable to consider that higher doses might be beneficial. Just because it's not the primary indication, that doesn't mean that the effective dose is likely to be lower -- it could just as easily be higher.
-elizabeth
Posted by JohnX2 on April 4, 2002, at 10:05:35
In reply to high-dose Lamictal: why not?, posted by Elizabeth on April 4, 2002, at 5:52:12
I think you 2 are missing the point of Zo's post.
The doctor tried to titrate the dose to 600 mg in just a *few weeks*.John
> Hardly. I've certainly heard of people taking that much. When I tried Lamictal (for a completely off-label use), I went up to 500 mg. (It didn't do me any good at any dose in that range.)
>
> It's not clear how much people need for mood disorders -- it seems to be quite variable, though, and I would certainly allow for the possibility that some need high-end doses. Pharmacokinetic factors may play a role in some cases. Also, remember that the therapeutic serum level range for Depakote goes higher in bipolar d/o than epilepsy -- this could easily be the case for Lamictal as well. Therapeutic levels of Lamictal haven't been established, AFAIK, but it's worth considering the possibility that using higher doses would improve the response rate and the degree of response in mood disorders. I certainly don't think it's been studied enough that we can definitely say that it's no good increasing the dose past a certain amount. Lamictal's general safety and tolerability make it reasonable to consider that higher doses might be beneficial. Just because it's not the primary indication, that doesn't mean that the effective dose is likely to be lower -- it could just as easily be higher.
>
> -elizabeth
Posted by Elizabeth on April 7, 2002, at 19:26:14
In reply to Re: high-dose Lamictal: why not? » Elizabeth, posted by JohnX2 on April 4, 2002, at 10:05:35
> The doctor tried to titrate the dose to 600 mg in just a *few weeks*.
How many weeks? I had no trouble getting up to 500 within a month or so.
When titrating a medication (in either direction), the phrase to remember is: "as tolerated!"
-elizabeth
Posted by Zo on April 8, 2002, at 21:45:10
In reply to Re: high-dose Lamictal: why not? » JohnX2, posted by Elizabeth on April 7, 2002, at 19:26:14
Yes-- but I think the inability to tolerate is, unfortunately, quite confusing. One must sort out, while in a confused and confusing state, whether this is due to drug or dose, whether these side effets will or will not go away.
n general, I think that creeping up on doses is the only rational way to get on a med and be also capable of making these crucial decisions as symptoms occur.
Zo
Posted by Bob on April 9, 2002, at 1:33:47
In reply to Re: high-dose Lamictal: why not? » Elizabeth, posted by Zo on April 8, 2002, at 21:45:10
> Yes-- but I think the inability to tolerate is, unfortunately, quite confusing. One must sort out, while in a confused and confusing state, whether this is due to drug or dose, whether these side effets will or will not go away.
>
> n general, I think that creeping up on doses is the only rational way to get on a med and be also capable of making these crucial decisions as symptoms occur.
>
> ZoVery well said, Zo! Sorting out what side effects might pass and which ones will not is quite a daunting task; actually it's not really possible. The only thing you can do is see if you can stand the side effect long enough for it to go away. Unfortunately, sometimes this can get you in trouble. The drug lottery is not a fun game.
Posted by Elizabeth on April 11, 2002, at 8:37:29
In reply to Re: high-dose Lamictal: why not? » Elizabeth, posted by Zo on April 8, 2002, at 21:45:10
> Yes-- but I think the inability to tolerate is, unfortunately, quite confusing. One must sort out, while in a confused and confusing state, whether this is due to drug or dose, whether these side effets will or will not go away.
What I mean by "as tolerated" is that one should increase the dose only if:
1) you haven't yet reached the target dose (or an effective dose)
2) the side effects are at worst mild and easily tolerated.
I *don't* mean that you should just put up with any side effect you get and hope that it will go away!
Anyway, I think that a month or so is enough time to reach a highish dose of Lamictal, assuming that the side effects don't get bad (i.e., that you tolerate the dose you're at). If you do have trouble with side effects, of course, you can and should drop back to a dose that is tolerated.
For example, the first time I went from 300 to 375 mg/day of Effexor, I got jittery, so I dropped back to 337.5 mg, where the jitters were at worst mild. I took the 337.5 for a few days, then increased to 375 again, this time without difficulty.
> n general, I think that creeping up on doses is the only rational way to get on a med and be also capable of making these crucial decisions as symptoms occur.
The question is, how slow do you have to creep if you're tolerating the drug? I think that, up to the target dose, it's usually fine to increase every few days (obviously there's some variation depending on the specifics of the drug).
-elizabeth
Posted by Mondeo on April 12, 2002, at 4:56:03
In reply to Re: high-dose Lamictal: why not? » Elizabeth, posted by JohnX2 on April 4, 2002, at 10:05:35
>
> I think you 2 are missing the point of Zo's post.
> The doctor tried to titrate the dose to 600 mg in just a *few weeks*.
>
> John
>
>
>
> > Hardly. I've certainly heard of people taking that much. When I tried Lamictal (for a completely off-label use), I went up to 500 mg. (It didn't do me any good at any dose in that range.)
> >
> > It's not clear how much people need for mood disorders -- it seems to be quite variable, though, and I would certainly allow for the possibility that some need high-end doses. Pharmacokinetic factors may play a role in some cases. Also, remember that the therapeutic serum level range for Depakote goes higher in bipolar d/o than epilepsy -- this could easily be the case for Lamictal as well. Therapeutic levels of Lamictal haven't been established, AFAIK, but it's worth considering the possibility that using higher doses would improve the response rate and the degree of response in mood disorders. I certainly don't think it's been studied enough that we can definitely say that it's no good increasing the dose past a certain amount. Lamictal's general safety and tolerability make it reasonable to consider that higher doses might be beneficial. Just because it's not the primary indication, that doesn't mean that the effective dose is likely to be lower -- it could just as easily be higher.
> >
> > -elizabethDear Elizabeth,
as a Lamictal user(since a couple of months,for BP2),I agree totally with your opinion,being a courageous one,mainly because of the so little professional info.about this promising med,in general and its proposed dosages,in special ; I myself,on my own,have had to go up and up,for the time being up to 400mg(taken in 2 partial dosages each 12 hours) ; there are very few docs taking the responsability advising and ACCEPTING (without too much hesitation)such higher dosages administration
My opinion as a BP2 sufferer since 1972 !(normally and as usually,I haven't been aware of this dx for so many years and as always,resuming myself thenjust to different AD'S,the best PARTIAL results being obtained then,with Celexa ) ; so MY opinion is that Mood Stabilizers are indeed important or even obligatory(not only for BP1,BP2 etc.,but also for UP's) and the most difficult questions are just arising from this point on:
a)which Mood Stabilizer? the old traditional ones with all of their shortcomings,or the newest generation,though lacking info.about
b)which should be the MAXIMAL dosage worth to be checked,tried(normally,presuming no serious side effects encountered ),before deciding(without any doubt) that a specific Mood S.(Lamictal etc.)isn't efficient enaough(or at all)even at that (?)higher dosage
c)should Mood S.be used as a monotherapy(even if still facing mild depr.breakthroughs)or as an adjunctive to the best AD ?I myself(again almost on my own)consider that the correct steps should be according to the 3 ones(the same order)as mentioned above ; Probably,permitting ourselves even dosages high as 500-600mg Lamictal(already acceptable for Epilepsy)before switching to another one and starting the "testings"with another one.
I do hope that such correspondence between us,may overcome the professional shortage I have been referring to; so,let's go ahead and exchange further on as much "trial and error" experiences(sometimes very difficult ones)best luck for ALL of us looking for the BEST solution,on our own
Mondeo
Posted by Mondeo on April 14, 2002, at 23:26:36
In reply to Re: high-dose Lamictal: why not? » Zo, posted by Elizabeth on April 11, 2002, at 8:37:29
HI,Elizabeth,
as a Lamictal user(since a couple of months,for BP2),I agree totally with your opinion,being a courageous one,mainly because of the so little professional info.about this promising med,in general and its proposed dosages,in special ; I myself,on my own,have had to go up and up,for the time being up to 400mg(taken in 2 partial dosages each 12 hours) ; there are very few docs taking the responsability advising and ACCEPTING (without too much hesitation)such higher dosages administration
My opinion as a BP2 sufferer since 1972 !(normally and as usually,I haven't been aware of this dx for so many years and as always,resuming myself thenjust to different AD'S,the best PARTIAL results being obtained then,with Celexa ) ; so MY opinion is that Mood Stabilizers are indeed important or even obligatory(not only for BP1,BP2 etc.,but also for UP's) and the most difficult questions are just arising from this point on:
a)which Mood Stabilizer? the old traditional ones with all of their shortcomings,or the newest generation,though lacking info.about
b)which should be the MAXIMAL dosage worth to be checked,tried(normally,presuming no serious side effects encountered ),before deciding(without any doubt) that a specific Mood S.(Lamictal etc.)isn't efficient enaough(or at all)even at that (?)higher dosage
c)should Mood S.be used as a monotherapy(even if still facing mild depr.breakthroughs)or as an adjunctive to the best AD ?
I myself(again almost on my own)consider that the correct steps should be according to the 3 ones(the same order)as mentioned above ; Probably,permitting ourselves even dosages high as 500-600mg Lamictal(already acceptable for Epilepsy)before switching to another one and starting the "testings"with another one.
I do hope that such correspondence between us,may overcome the professional shortage I have been referring to; so,let's go ahead and exchange further on as much "trial and error" experiences(sometimes very difficult ones)
best luck for ALL of us looking for the BEST solution,on our own
Mondeo
> > Yes-- but I think the inability to tolerate is, unfortunately, quite confusing. One must sort out, while in a confused and confusing state, whether this is due to drug or dose, whether these side effets will or will not go away.
>
> What I mean by "as tolerated" is that one should increase the dose only if:
>
> 1) you haven't yet reached the target dose (or an effective dose)
>
> 2) the side effects are at worst mild and easily tolerated.
>
> I *don't* mean that you should just put up with any side effect you get and hope that it will go away!
>
> Anyway, I think that a month or so is enough time to reach a highish dose of Lamictal, assuming that the side effects don't get bad (i.e., that you tolerate the dose you're at). If you do have trouble with side effects, of course, you can and should drop back to a dose that is tolerated.
>
> For example, the first time I went from 300 to 375 mg/day of Effexor, I got jittery, so I dropped back to 337.5 mg, where the jitters were at worst mild. I took the 337.5 for a few days, then increased to 375 again, this time without difficulty.
>
> > n general, I think that creeping up on doses is the only rational way to get on a med and be also capable of making these crucial decisions as symptoms occur.
>
> The question is, how slow do you have to creep if you're tolerating the drug? I think that, up to the target dose, it's usually fine to increase every few days (obviously there's some variation depending on the specifics of the drug).
>
> -elizabeth
Posted by SLS on April 15, 2002, at 20:53:24
In reply to Re: high-dose Lamictal: why not?, posted by Mondeo on April 14, 2002, at 23:26:36
Hi Mondeo.
> My opinion as a BP2 sufferer since 1972 !(normally and as usually,I haven't been aware of this dx for so many years and as always,resuming myself thenjust to different AD'S,the best PARTIAL results being obtained then,with Celexa )
I have been suffering from a treatment-resistant bipolar depression for many years. Like so many other people on this board, I have tried most of the available medications along with ECT. I have not yet tried Celexa. I am curious to know how you would characterize your partial response to it. Also, would you be kind enough to list the drugs that have benefited you in the past. For me, MAOIs and tricyclics have been helpful, along with Lamictal. Drugs that have made me worse include Wellbutrin, Vivactil (protriptyline), and reboxetine.
> so MY opinion is that Mood Stabilizers are indeed important or even obligatory(not only for BP1,BP2 etc.,but also for UP's)
That's an interesting idea. I don't think I have seen any studies designed specifically to systematically test the use of lithium and mood-stabilizing anticonvulsants in unipolar depression.
I tend to treat Lamictal as a drug that possesses two separate and distinct therapeutic properties. It might be that its mood-stabilizing and antidepressant effects are in dependant of each other and attributable to separate physiological activities. If this is true, I don't think Lamictal can be considered as an example to support an argument to be made for the utility of mood-stabilizing drugs in general to treat unipolar depression.
Supportive of my treatment of Lamictal as a drug possessing dual thymic properties are the observations that it:
1. inhibits voltage-dependent sodium channels and stabilizes neuronal membranes - a property it shares with the mood-stabilizing anticonvulsants like Depakote and Tegretol. This is most likely the mechanism by which it acts as an anticonvulsant and mood-stabilizer.
2. decreases the concentration of extracellular glutamate in the hippocampus by the inhibition of its release, leading to a reduction in the stimulation of the NMDA receptors found there. The reduction of NMDA receptor stimulation has been observed to increase the levels of dopamine and neuronal activity in areas of the limbic system - brain regions known to be involved in motivational drive and reward. Lamotrigine seems to characterized as a potent inhibitor of glutamate release relative to the other AEDs. I am guessing that it is this property that is responsible for the antidepressant effects lamotrigine demonstrates for both bipolar and unipolar depressions.
- Scott
Posted by Mondeo on April 16, 2002, at 9:23:14
In reply to Re: high-dose Lamictal: why not? » Mondeo, posted by SLS on April 15, 2002, at 20:53:24
hey SLS
well,as far as Unipolar depr.treated with Mood S.there ARE already a few articles and if you consider it so much important,I may try to find them for you,BUT anyway knowing that some and certain BP3 or BP4 are a result of AD's long term administration,it worth reconsidering this aspect,too.Normally in this case such an administration would be targeting another aspect,the one of prophylactic,while in the case of BP2,it(Lamictal,for instance) works first as a treatment med,mainly targetting the depr.phase,allowing to avoid AD.scelexa is a good med.,but it has the risks,too as described above ; I haven't have better results(almost free of side effects than with it,but I consider making a very good switch to Lamictal and I dare to suggest you the same ; be aware of the fact that in general and in MY case,too you may have to reach(slowly,very slowly)dosages of 300mg and even up to 500-600,in case you won't have any side effects
Good Luck and keep me informed about YOUR experience with it
Mondeo
Posted by jazzdog on April 16, 2002, at 11:24:42
In reply to Re: high-dose Lamictal: why not? » Mondeo, posted by SLS on April 15, 2002, at 20:53:24
Hi Scott -
I'm considering combining my lamictal (currently 300 mg) with provigil, to improve my sluggish cognition. It appears, however, that they have an opposite effect on glutamate levels. Do you know if that's true, and if so, what it means? Thanks for your help -
- Jane
Posted by SLS on April 16, 2002, at 21:35:18
In reply to Re: lamictal and provigil? » SLS, posted by jazzdog on April 16, 2002, at 11:24:42
Hi Jane.
> I'm considering combining my lamictal (currently 300 mg) with provigil, to improve my sluggish cognition. It appears, however, that they have an opposite effect on glutamate levels.
I was concerned about exactly the same thing when I added Provigil to the 300mg of Lamictal that I was taking two years ago.
> Do you know if that's true,
It is true that various experiments have demonstrated that Provigil increases, while Lamictal decreases, the amount of glutamate that accumulates in between neurons. Glutamate is the most pervasive excitatory neurotransmitter in the brain, and increasing glutamate activity in certain structures can produce increased wakefulness and motivation. However, without more information, one cannot draw any definite conclusions as to how these experimental observations are to be interpreted.
Example: It might be that Lamictal reduces the release of glutamate only when neurons are stimulated repetitively at high frequencies. It could thus be acting as a sort of squelch filter to prevent runaway excitation. Perhaps Provigil raises the baseline amount of glutamate that remains during the period in between nerve impulses. It could thus decrease the amount of glutamate needed to be released to transmit any one excitatory message. These two actions are not necessarily antagonistic.
> and if so, what it means? Thanks for your help -
Hmmm.
I really don't know what it means. The brain is so complex, that I am usually reluctant to forecast what the result of any treatment will be based upon simplistic models that use so little of the limited and incomplete information available. I am probably too conservative in this regard, but I would rather plead ignorance than exclude possibly effective treatment options without empirical justification.
Now...
Unfortunately, I was impatient enought to make two changes at the same time. I added the Provigil within a week of beginning sulpiride, a neuroleptic antipsychotic with antidepressant properties. I experienced what I like to call a "blip" mood-lift immediately after taking my first dose of 100mg Provigil. It faded by the end of the day, but I was optimistic just the same. However, by the third day I began to experience a mind-numbing, foggy-brained cognitive disruption that led me to discontinue both Provigil and sulpiride simultaneously. For the next two weeks, my depressive state was very much worse than it had been before I started the two drugs. Because I changed two variables at the same time, I can't determine which of them was responsible for this deterioration in my condition. I have suffered similar cognitive side-effects from neuroleptic antipsychotics other than sulpiride, so it is possible that it was the sulpiride rather than a Lamictal + Provigil interaction that produced the negative effect.
I wish I could give you some guidence as to whether or not Lamictal and Provigil interact with one another antagonistically in such a way as to prevent a positive therapeutic effect or cause harmful side-effects. Since the consequences of guessing wrong could be substantial, I would be inclined to wait and see if anyone else has tried this combination, and use such empirical evidence to aid you in making a decision.
I am currently taking Lamictal 300mg and imipramine (a tricyclic antidepressant). I will most likely add Nardil (an MAOI) to these.
I write too much. I hope you can make heads or tails of this. If it makes no sense to you - and I'm not sure it does to me - my best answer to your questions is simply that I don't know. I just used a fancy way of saying it. :-)
For what it's worth, I am again considering adding Provigil to Lamictal. I might try adding S-AMe first, though.
- Scott
Posted by SLS on April 16, 2002, at 21:53:17
In reply to Re: high-dose Lamictal: why not?, posted by Mondeo on April 16, 2002, at 9:23:14
> hey SLS
Hi Mondeo.
> well,as far as Unipolar depr.treated with Mood S.there ARE already a few articles and if you consider it so much important,I may try to find them for you,
I would like to see them. I would be happy if they worked for both bipolar and unipolar.
> BUT anyway knowing that some and certain BP3 or BP4 are a result of AD's long term administration,it worth reconsidering this aspect,too.
What are the definitions of BP3 and BP4?
One of my doctors said that I am the BP3. This is a diagnosis proposed to be added to the DSM-V manual. I am always depressed. I become manic only as a reaction to medication. I have never experienced spontaneous remissions or manias. I am taking Lamictal 300mg. It helps slightly with depression. However, it did not prevent Nardil from causing mania in me. (Actually, it was the abrupt discontinuation of Nardil that caused the mania).
> Normally in this case such an administration would be targeting another aspect,the one of prophylactic,while in the case of BP2,it(Lamictal,for instance) works first as a treatment med,mainly targetting the depr.phase,allowing to avoid AD.s
I don't know. I have not seen many people with depression respond well and continuously to Lamictal monotherapy. I could be wrong.
For me, Lamictal does nothing unless I am taking a tricyclic. Conversely, a tricyclic does nothing for me unless I am taking Lamictal.
> celexa is a good med.,but it has the risks,too as described above ; I haven't have better results(almost free of side effects than with it,but I consider making a very good switch to Lamictal and I dare to suggest you the same ; be aware of the fact that in general and in MY case,too you may have to reach(slowly,very slowly)dosages of 300mg and even up to 500-600,in case you won't have any side effects.
I will consider Celexa if Nardil does not work.
Thank you for taking the time to respond to my questions.
Sincerely,
Scott
Posted by Mondeo on April 17, 2002, at 3:58:11
In reply to Re: high-dose Lamictal: why not?, posted by SLS on April 16, 2002, at 21:53:17
Hi,SLSwell,I must be honest with you as I have to reconsider my previous statements ; the reason for trying and push up Lamictal dosage has been the fact that things(depr.)weren'r really O.K. and the idea has been that by "going up"with its dosage,I shall achieve the so called efficient dosage,even if it would be a higher one,BUT as life is stronger than our wish(mainly while considering such maladies as ours),
I have just now realized that though Lamictal is indeed an AD ,too(not only Mood Stabilizer),it isn't good enough for a monotherapy,even at higher dosages,high as up to almost 500mg and I(and my doc.)have decided not to climb further on ; on the contrary,start reducing its dosage(even targeting the so called "normal"and "common"known dosage of 100-150)and start again...administering Celexa(eventually not so highly dosed as the 40mg I have been on,before switching to Lamictal)
So,I can just advise you (as it seems that you face a similar way of suffering as mine :more depr.with some hypomany,eventually induced by the AD's)to insist on an AD(and certainly Celexa is a quite good one regarding side effects)and eventually augment with Lamictal(being one of the most inoffensive Mood St.,moreover that it is also a so called AD)If you(and me too)will manage with this combo,you(and me)can consider yourself as a lucky guy,since both meds are the newest ones on the market,sharing very good side effect-free properties.Presuming that you(and me)are indeed "pure"BP(2,3..4),or even recurrent UP(I shall provide you with abstracts regarding Mood Stb. for Unipolars,too)such a combo should be logical ; it probably won't be the case for BP1,as Lamictal as a milder antimanic(but a stronger AD)
I hope that this message too is a useful one and do't hesitate exchanging more data with me(or any other interested about this thread)
In case you find our cases similar enough to continue a more personal correspondence,you can provide me with your e-mail and I shall certainly write to you immediately
>
> Hi Mondeo.
>
>
> > BUT anyway knowing that some and certain BP3 or BP4 are a result of AD's long term administration,it worth reconsidering this aspect,too.
>
> What are the definitions of BP3 and BP4?
>
> One of my doctors said that I am the BP3. This is a diagnosis proposed to be added to the DSM-V manual. I am always depressed. I become manic only as a reaction to medication. I have never experienced spontaneous remissions or manias. I am taking Lamictal 300mg. It helps slightly with depression. However, it did not prevent Nardil from causing mania in me. (Actually, it was the abrupt discontinuation of Nardil that caused the mania).
>
> > Normally in this case such an administration would be targeting another aspect,the one of prophylactic,while in the case of BP2,it(Lamictal,for instance) works first as a treatment med,mainly targetting the depr.phase,allowing to avoid AD.s
>
> I don't know. I have not seen many people with depression respond well and continuously to Lamictal monotherapy. I could be wrong.
>
> For me, Lamictal does nothing unless I am taking a tricyclic. Conversely, a tricyclic does nothing for me unless I am taking Lamictal.
>
> > celexa is a good med.,but it has the risks,too as described above ; I haven't have better results(almost free of side effects than with it,but I consider making a very good switch to Lamictal and I dare to suggest you the same ; be aware of the fact that in general and in MY case,too you may have to reach(slowly,very slowly)dosages of 300mg and even up to 500-600,in case you won't have any side effects.
>
> I will consider Celexa if Nardil does not work.
>
> Thank you for taking the time to respond to my questions.
>
>
> Sincerely,
> Scott
Posted by jazzdog on April 17, 2002, at 11:59:27
In reply to Re: lamictal and provigil? » jazzdog, posted by SLS on April 16, 2002, at 21:35:18
Thanks Scott -
Good luck with the SAMe -I've been thinking of it too, but you can't get it easily in Canada.
I wonder if lamictal doesn't have the peculiar ability to boost both seratonin and dopamine, with the result that seratonin-heavy types like me find it a soporific, and dopamine-heavy types find it activating. I've been struck by just how dissimilar reactions to it are. But one thing's for sure -as JohnX2 has often pointed out, it allows coming off other drugs to be a much smoother process. I finally got off zoloft after trying for years - no rebound depression, no anxiety.
- Jane
Posted by Zo on April 21, 2002, at 22:21:57
In reply to Re: lamictal and provigil? » jazzdog, posted by SLS on April 16, 2002, at 21:35:18
I started a thread somewhere here, I think it got archived, about the very strict dose window of Provigil--exceed that window, and you will feel crappy, perhaps even crappier than before.Maybe I oughta start a Provigil FAQ. . . !
Zo
Posted by Ron Hill on April 22, 2002, at 0:28:55
In reply to Re: lamictal and provigil? » jazzdog, posted by SLS on April 16, 2002, at 21:35:18
> I might try adding S-AMe first, though.
--------------------------This is the trial of the century that I have been waiting for! Better than the upcoming Barretta trial, even better than the OJ trial. Get your seats ladies and gentleman because once the show starts you will not want to be caught too far from your monitors and keyboards.
Scott, remember to take your B-6, folic, and sublingual bioactive B-12 (methylcobalamin) with the SAM-e.
Supercharged SAM-e: B Vitamins, Folate Increase the Supplement’s Effectiveness
by ImmuneSupport.com Staff12-01-1999 - Homocysteine is a sulfur-containing amino acid involved in several important methyl and sulfur transfer reactions, and is actually beneficial in small amounts. When homocysteine levels begin to rise in the body, excessive accumulation of homocysteine in the body fluid compartments is normally prevented by degradation through two enzymatic reactions called transsulfuration and remethylation. These two processes have to be functioning for homocysteine to be kept in control and for SAM-e to function in the body. Importantly, these same enzyme reactions cannot occur without proper levels of folate, vitamin B 6 (pyridoxal 5- phosphate), and vitamin B12 (cobalamin). If you take SAM-e to promote better health (lighter mood, comfortable joints and a detoxed liver), you also need adequate levels of B vitamins and folic acid to help the SAM-e do its job.
When the body has proper levels of folic acid, Vitamins B6 and B12, the enzymatic break-down of homocysteine occurs either through remethylation, which converts it into methionine, the SAM-e building block; or through transsulfuration, which turns it into glutathione, a powerful antioxidant.
But when those processes become sluggish, the homocysteine levels in the body begin to rise. Large homocysteine levels left unchecked in the body, become an invitation to disease, including heart attack, stroke, cancer, birth defects, depression and perhaps CFS and FM.
A published Swedish study showed results of which demonstrate consistently high homocysteine levels and low concentrations of vitamin B12 in the cerebrospinal fluid (CSF) of patients meeting established clinical criteria for Chronic Fatigue Syndrome and Fibromyalgia.
Those taking SAM-e should be aware that the healthy benefits they experience are not due to SAM-e alone. SAM-e may be the “team leader” however, folic acid, vitamin B6 and vitamin B12 are crucial members of the team that contribute to its success. It is only by incorporating the entire team that one can achieve the victory of better health and well-being.
Source:
Evarts, Jeremy Lucius. “New Study Links Fibromyalgia and Chronic Fatigue Syndrome to Low Vitamin B12 and High Homocysteine in Cerebrospinal Fluid.” Healthwatch, August 1998.
Cowley, Geoffrey and Underwood, Anne. "What is SAMe?" Newsweek, July 5, 1999.
Brown, Richard, M.D., Bottigileri, Teodoro, Ph.D., Colman, Carol. Stop Depression Now. New York, 1999.Best wishes Scott!
-- Ron
Posted by IsoM on April 22, 2002, at 0:46:32
In reply to SLS is going to try SAM-e? Well it's about time! » SLS, posted by Ron Hill on April 22, 2002, at 0:28:55
Posted by Ron Hill on April 22, 2002, at 1:13:23
In reply to Make Me Your SAMe Poster Girl of 2002! ;-) (nm) » Ron Hill, posted by IsoM on April 22, 2002, at 0:46:32
Posted by IsoM on April 22, 2002, at 2:01:07
In reply to Nope. All poster girls must ACTUALLY TAKE SAM-e (nm) » IsoM, posted by Ron Hill on April 22, 2002, at 1:13:23
...or just send me a large supply & I can be both before -
"Notice How Pathetic This Woman Looks?"
and then the after pix -
"Now See the Great Difference, Folks? Hard To Believe It's The Same (SAMe) Person."
Posted by Ron Hill on April 22, 2002, at 15:06:23
In reply to But I can be your sad example: Without SAMe » Ron Hill, posted by IsoM on April 22, 2002, at 2:01:07
Posted by screwedup on May 1, 2003, at 17:33:43
In reply to Increase Lamictal very SLOWLY, posted by Zo on March 25, 2002, at 16:51:07
I am on Lamictol 200 mg a day along with several other drugs and the combination isn't working though I do think Lamictol as a mood regulator probably is or was at 150 mg. pretty good. Before I increased I definately felt more stable, but was still very depressed.
Anyway the reason I am posting is because increasing lamictol slowly is ESSENTIAL not only for reasons of side effects but because studies even those done by the drug maker have shown that lamictol can cause a deadly rash. It took me around 5 to 8 weeks to work up to 50 mg after that it went faster. I have seen that several folks have mentioned the presence of a rash, and fortunately it sounds like they told their Psychiatrist and other doctors quickly. However, there are cases that even stoping the medication all together will not cure this deadly rash. Also, slow titration will not prohibit it in all cases.
My doctor told me about this - actually I asked him why I had to wait so long to get to the minimum therapeutic dose, and he told me because it could cause a certain type of rash. Probably like many of you being in a desparate search for happiness/sanity I said, "I don't give a damn about a rash." Then he said, "the rash can kill you." In my normal suicidal state, I wondered if this was really a bad thing. However, I was a good girl and titrated slowly, but I also went to a number of the pharmaceutical websites and found information about lamictal and this rash. Of course I can't remember the exact number but it was something like 1 in 1,ooo die from lamictol use primarily because of dosing up too quickly.
Sorry I went on so long and I never had the rash, but it scared me as I read through these emails and saw how many people were dosing up quickly and the prevalence of the rash side effect. So please be careful.
Posted by Billski99 on October 24, 2003, at 8:02:11
In reply to Re: Provigil for cognition? Yesss!, posted by Zo on March 26, 2002, at 17:18:44
I recently (four days ago) started Provigil (200 mg) along with (Wellbutrin XL 300 mg) and (Lexapro 20mg 2x/day). I have never taken ANY of these drugs before. From what I read about Provigil it sounded like the perfect happy medium between coffee and amphetamine, but it hasn't had that effect on me... at least yet.
Does it take a while for the Provigil to "kick in". Are there any possible adverse interactions I should be aware of?
Thanks for any and all help!
Bill
Posted by Katt on October 25, 2003, at 23:05:55
In reply to Re: Provigil for cognition? Yesss!, posted by Billski99 on October 24, 2003, at 8:02:11
It makes me sooooo manic people around me people can't stop laughing. I become a hoot. I take it everyday.
> I recently (four days ago) started Provigil (200 mg) along with (Wellbutrin XL 300 mg) and (Lexapro 20mg 2x/day). I have never taken ANY of these drugs before. From what I read about Provigil it sounded like the perfect happy medium between coffee and amphetamine, but it hasn't had that effect on me... at least yet.
>
> Does it take a while for the Provigil to "kick in". Are there any possible adverse interactions I should be aware of?
>
> Thanks for any and all help!
>
> Bill
This is the end of the thread.
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