Posted by yxibow on November 13, 2008, at 1:26:47
In reply to Re: Suppose you have unipolar depression -- » NKP, posted by azalea on November 12, 2008, at 22:27:04
> Sounds like stopping the lamotrigine caused a turn for the worse. While the rash is concerning, perhaps an option would be to retry lamotrigine, but start at a lower dose and titrate more slowly this time. Dr. Phelps (psychiatrist in Oregon and creator of psycheducation.org) recommends starting at 12.5mg lamotrigine and increasing by 12.5mg weekly. This is more conservative than the manufacturer recommendation. He has noticed a decrease in rash incidence with the more gradual titration.
>
> > After she left the clinic, there was a dramatic improvement for a few weeks, but these last few days (especially since dropping the lamotrigine) it seems she is getting worse, not better. Considering her history, this is of great concern for me.
> >
> > Any thoughts?
> >
> > Thanks.
>
>Its a possibility, but rechallenging something that may already have caused a sensitivity is something not to be taken lightly. Going slowly, its a very long titration, and you can run the possible rare risk of SJS more perhaps this time. I don't know the studies on this, so I can't confirm this.
As far as the other medications are concerned, I hope she responds to BuSpar but probably less than 1/3 see some significant results.
I would have the doctor consider upping the Lithium. Lithium is one of the fastest ways to stop suicidality.
Possibly go up slightly on the Seroquel, carefully, monitoring for side effects, and only using the MED (minimum effective dose.
If you have to post something, I think its important to not mince words. Suicide is a common thought in a number of mental illness disorders and is one of the major causes of death in schizophrenia and other related illnesses.
The aunt I never knew, as mental illness runs on my mothers side, 99% likely killed herself, I wont go into the ugly details, she had a not so great psychiatrist and a not so great boyfriend. This affected my grandfather and my grandmother greatly not to mention her two sisters. But that was the 70s and only the beginning of medications for BP-II.
I nearly attempted it myself, because I saw what was a tic coming and also because I had hopelessness in my future -- I was seen several times but never admitted (fortunately, because of HIPAA rules) to the hospital. But perhaps it was right by my caretakers that this provided some insight into my feelings and what was going on.
I still have thoughts, I think people with low self-esteem and the lack of hope for hope, yes, that's a curious statement but there's a point to it, but at the same time I cling on to some hobbies and I know that there isn't infinite time to get me to where I want or as much as possible (we all I think would like to be "normal" but what is that really ?)
I have some rather difficult symptoms that in my mind especially separate me from life and the "normal" things that people do even if they are feeling bad, bugged out bored, etc... with my orphan disorder, visual problems, I don't think at this point I still could enjoy, understand a movie in the theater (24fps) or be in a crowded bar with disco lights and all or watch TV for hours like I used to, especially on a regular old TV.
But I repeat parts of my disorder, this isn't about me, this is about your friend... I'm going on tangents.
I think some of those minor changes might help. And perhaps Depakote, if she hasn't already tried it.
Of course the increased Lithium means increased monitoring salts and weight issues and various other side effects.
However, weighing the issues that have gone on before versus side effects -- I don't know, that's a very personal thing for her and her relations.
-- best wishes
Jay
-- Jay
poster:yxibow
thread:862336
URL: http://www.dr-bob.org/babble/20081106/msgs/862743.html