Posted by Ritch on December 27, 2002, at 10:20:28
In reply to LAMICTAL-END OF MY ROPE-PLEASE HELP, posted by Peter on December 27, 2002, at 3:51:44
> Hello:
> Here's the deal: for a few weeks I've been experiencing consistent mixed mood states of dysphoria/agitation/depression/irritation, and just hopelesness. I can't leave my apartment. I can't smile or laugh. I feel the worst I've ever felt.
> After being diagnosed with cyclothymia/SP/ 'depressive-anxiety'/ADD in the years since 1997, I've been placed on every anticonvulsant and non-anticonvulsant mood-stabilizer (including lithium), a variety of benzos (I still take klonopin and restoril), every SSRI, stimulants, beta-blockers, moclobemide, effexor, dopamine agonists, naltrexone, you name it. I've gone to 3 different doctors for consultations (other than the one I've been going to for 7 years).
> I'm SO sick of all this. I attempted weaning off of everything numerous times, but symptoms came back. Different pdocs have given me different diagnoses. My steady one thinks everything centers around the Bipolar spectrum, while the last pdoc I went to for consultation said there's nothing suggesting that I've ever been manic or hypomanic and that's it's important to target my MAIN symptoms-anxiety and depression, rather than bog me down with all these mood-stabilizers. But all the SSRI's helped for a time but then heightened my impulsivity & alcohol cravings. So this last consultation doc suggested TCA's for me, which I've never tried. She then spoke with my current doctor and now she respects his opinion and he respects her opinion-BUT WHAT ABOUT ME?!
> Right now, I've been taking lamictal since the beginning of October, slowly titrating to my current dose of 50mg, while decreasing zoloft (now down to 37.5mg) and decreasing depakote (down from 750mg to 375mg). Aside from klonopin and restoril, I also take adderall 40mg and ambien 10mg.
> After telling my normal pdoc of my recent moods, he said something that makes NO SENSE to me: he said these bad feelings CAN be due to the lamictal, but they also CAN be due to my recent REDUCTION of zoloft and depakote (I reduced both of them a bit within the last week or two). Fine. But then he tells me to 'therefore' start tapering off the zoloft and depakote completely!! WHAT!?%&^@* I mean, if the reduction of zoloft & depakote is causing this, then wouldn't FURTHER reducing them HEIGHTEN rather than alleviate these bad feelings? Likewise, if the lamictal itself is the culprit, taking the time to taper off of aoloft and depakote would be redundant and possibly detrimental.
> I don't know what to do. I can't meet with my pdoc again until JAN. 14. He told me all this over the email. I'm the guinea pig ingesting all this stuff-and he's just sitting back and thinking about 'possible', 'reasonable' steps for me to take. I'm sick of it all. Please, any comment or consolence of any kind? I need human interaction. Thanks,
> PeterPeter, I haven't tried any Lamictal, but I have read some posts here about agitation from it. Also, FWIW, I have had two or three episodes over the last few years with Depakote withdrawal reactions. Those have been extremely nasty and sound precisely like the symptoms you describe. I had a stomach flu a while back and had to stop my Depakote for a couple of days, and WHEWW!, I felt totally electrified and agitated. That is interesting that your pdoc wants to lower the Depakote even further. Depakote and Lamictal interact in an unusual way, they BOTH tend to increase each other's blood levels. If you do nothing but reduce the Depakote, the Lamictal blood level should drop as well. That could be the angle that he is looking at (to get the Lamictal level lower). He probably thinks the Lamictal is what is setting you off. The trouble is that any withdrawal reaction from the reduced Depakote could "mask" the benefits from the Lamictal level falling as a result. Could you ask him about leaving everything the same and just reducing the Lamictal instead and see what he says? Also, do you think the Adderall could be contributing to your agitation? I hope you get better soon, that is a not a fun place to be at all...
poster:Ritch
thread:133324
URL: http://www.dr-bob.org/babble/20021223/msgs/133350.html