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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by alienatari on June 24, 2005, at 20:07:21
Hey all. How is it going? :)
My depression is still pretty bad even though I have been on clomipramine now for 3 months. But I have only been on 150mg for a few weeks or so. I dont see my pdoc for another 6 weeks :(
Anyway, at the moment I am really depressed and can't focus or do anything. I can't sleep at night and I am so drowsy and tired during the day.
Thanks Ed for the suggestion of Lamictal, I will definatly ask my pdoc about that (my old pdoc was very anti lamictal for some reason and put me on tegretol instead which was awful). I dont know if it has been approved for bipolar depression in Australia yet, I hope it does soon so its not so expensive If I do go on it.
Would stimulants benefit me? There is no way in hell im ever taking another antipsychotic again in my life so if he suggests that I wont do it. The only thing I havent tried are stimulants. Ive been on almost every antidepressant in Australia and they dont really work on me.
Well clomipramine is starting to help my OCD though and is definatly helping my anxiety so much. I need help with my depression though :(
My old pdoc said to me, no joke he really said this, "chris we have tried everything so I dont know what else there is to do" lol. I wonder why i left him heheh.
Any suggestions would be greatly appreciated but please no neuroleptics or ECT.
Thanks and take careChris :)
Posted by ed_uk on June 24, 2005, at 20:50:47
In reply to What next?, posted by alienatari on June 24, 2005, at 20:07:21
Hi Chris!
>I dont know if it has been approved for bipolar depression in Australia yet........
It seems that Lamictal is not currently approved for bipolar depression in Australia. I've just been doing some research.
Love,
Ed x
Posted by alienatari on June 24, 2005, at 23:48:08
In reply to Re: What next? » alienatari, posted by ed_uk on June 24, 2005, at 20:50:47
Ahh, that sucks. Thanks Ed. It was suppose to be approved about 5 months ago, maybe longer. They have been talking about adding it to the PBS for Bipolar for a long time.
As per your email, you were saying I would probably only need 100mg because I am on Valproate right?
That would cost me about $55 a month which isn't too bad I guess. Do you have any other drug suggestions Ed?
I dont know if i should ask my new pdoc about it or just let him make the decisions. My old pdoc use to get really upset when I would suggest drugs lol.
take care
Chris
> Hi Chris!
>
> >I dont know if it has been approved for bipolar depression in Australia yet........
>
> It seems that Lamictal is not currently approved for bipolar depression in Australia. I've just been doing some research.
>
> Love,
> Ed x
Posted by alienatari on June 24, 2005, at 23:51:48
In reply to Re: What next? » alienatari, posted by ed_uk on June 24, 2005, at 20:50:47
I just found out we have generic Lamictal in Australia and got all excited but its only about $15 cheaper per 56 tablets. Brings it down to about $47 a month. Oh well.
> Hi Chris!
>
> >I dont know if it has been approved for bipolar depression in Australia yet........
>
> It seems that Lamictal is not currently approved for bipolar depression in Australia. I've just been doing some research.
>
> Love,
> Ed x
Posted by ed_uk on June 25, 2005, at 20:42:16
In reply to Re: What next?, posted by alienatari on June 24, 2005, at 23:48:08
Hi Alien!
>PBS
What's the PBS?
>As per your email, you were saying I would probably only need 100mg because I am on Valproate right?
Just a guess :-) Valproate interacts with Lamictal so a lower dose might work well. Because of the interaction, you'd have to start Lamictal at an extremely low dose and increase gradually.
>That would cost me about $55 a month.....
Can you affford it? Hope so :-)
>Do you have any other drug suggestions Ed?
If clomipramine doesn't work, I think it would be a good idea to try Nardil.
Love,
~Ed
Posted by alienatari on June 26, 2005, at 2:47:50
In reply to Re: What next? » alienatari, posted by ed_uk on June 25, 2005, at 20:42:16
Thanks Ed *hugs*
I have this website on bipolar that I have been reading about for a long time. It discusses the interactions between lamictal and valproate.
I really hope I dont have to go on Nardil :(
I dont want to stop clomipramine as it is helping me soooo much with my anxiety, and is just starting to help with the OCD (I've been on it for almost 3 months now I think). But it isn't doing anything for my depression :(
Oh yea, the PBS stands for the "Pharmaceutical Benefits Scheme". So basically you don't pay full price of any medication that is on it. I also get an extra discount because I have a healthcare card. So say I was on 20mg of Zyprexa per day, that would roughly cost around about $400 per month to the Australian government (going by when I was on it, it might be cheaper now) but you pay roughly only $30 (and about $7 if you have a healthcare card). So to get a medication like this, that is expensive, you need an authoritive script. In Australia only people with Bipolar and Schizophrenia are entitled to this (though many psychiatrists will lie to get their patients the drugs for other reasons, however some wont and will force their patients to pay the full amount which is huge).
Anyway, there is no way my psychatrist (i doubt any would) would lie and say I have epilepsy and need Lamictal for it. It is just on the verge of being put on the PBS, I really hope it goes on it soon. At the moment, the only drugs on the PBS for Bipolar are, Zyprexa, and Valproate, Tegretol and Lithium. But Valproate, Lithium and Tegretol are cheap now.
I have been on many atypical antipsychotics on the PBS that are only for psychosis but I was on them for psychosis, or atleast my doctor "believed" that I was psychotic. I really dont know if I was though. I was when I was manic, or at the end of it atleast. But then again, isnt the very definition of mania a form of psychosis?
So, yea. If I do go on Lamictal I really hope it goes on the PBS and I dont have to get it as a private script
take care
Chris :)
> Hi Alien!
>
> >PBS
>
> What's the PBS?
>
> >As per your email, you were saying I would probably only need 100mg because I am on Valproate right?
>
> Just a guess :-) Valproate interacts with Lamictal so a lower dose might work well. Because of the interaction, you'd have to start Lamictal at an extremely low dose and increase gradually.
>
> >That would cost me about $55 a month.....
>
> Can you affford it? Hope so :-)
>
> >Do you have any other drug suggestions Ed?
>
> If clomipramine doesn't work, I think it would be a good idea to try Nardil.
>
> Love,
>
> ~Ed
>
Posted by ed_uk on June 26, 2005, at 8:25:40
In reply to Re: What next?, posted by alienatari on June 26, 2005, at 2:47:50
Hi Chris,
>It discusses the interactions between lamictal and valproate.
See...........
Sounds more like an adverse effect of Lamictal than a drug interaction........
In order to reduce the risk of developing a rash, it's important to start Lamictal at a very low dose and to increase gradually. Patients on valproate need to be started on lower doses of Lamictal and titrated more gradually because valproate increases the blood level of Lamictal.
Does valproate increase the risk of the Lamictal rash? It certainly might do.........but I'm not conviced - provided that the initial Lamictal dose is very low and titration is very gradual.
Lamictal + valproate can cause additive side effects such as tremor, sedation and incoordination........another reason to initiate Lamictal at a very low dose.
>"Pharmaceutical Benefits Scheme"
So it's a co-payment system - you pay a percentage?
>In Australia only people with Bipolar and Schizophrenia are entitled to this (though many psychiatrists will lie to get their patients the drugs for other reasons, however some wont and will force their patients to pay the full amount which is huge).
In the UK, all NHS prescriptions cost £6.50 unless you have an exemption - in which case you pay nothing. Exemptions include >60yrs, diabetes etc. No mental health conditions are exempt.
>Lithium
When you tried Li, what was your dose and plasma level? Did it help at all? I know you had lots of side effects, what were they?
>But then again, isnt the very definition of mania a form of psychosis?
You can have mania with or without psychotic features eg. hallucinations, delusions etc.
>So, yea. If I do go on Lamictal I really hope it goes on the PBS and I dont have to get it as a private script
Me too :-D
Love,
Ed xx
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