![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 1085. Go back in thread:
Posted by Bob on January 10, 2001, at 15:42:33
In reply to Re: The benefits of Topamax (more), posted by phillybob on January 9, 2001, at 15:09:36
> Topamax/Alcohol effects? New Year's Eve, I imbibed much alcohol and had a great time, but was couch-bound and fairly useless the entire next day (moreso than a normal hangover). I will likely be avoiding alcohol WHENEVER possible (in other words, perhaps, only when I have absolutely nothing to do the next day like New Year's Eve).
>
> I've been having a sore throat (could be a cold due to cold/rainy weather but perhaps more susceptible due to topamax?).
>
> Appetite has started to be suppressed a bit during the day, but since I'm a fairly decent binge-eater, once I get started at night, there I go ... :) I understand, that some weight loss effects, if they do occur, are more likely to occur at around a 200/mg or above dosage.
>
> Oh yeah, some visual blurriness (of course, I did get lasik eye surgery a month ago with similar side effects but this could easily be topamax-related since it had been a while since I had this now, and I've read of such on past posts ... eye pressure, etc.)Geez, man! It's almost like I'm readin' my own post here! I too drank some champagne on New Year's Eve, not long after starting on Topo, and payed a heavy price the next day. Lesson learned: avoid alcohol on topomax. I too have a sore throat, although I get this crap every year. The thing is, I feel especially depressed this year and I don't know whether it's from being sick, or from a bad response to topirimate, or what? I too, have also experienced varying pressure in my right eye, with accompanying blurry vision that waxes and wanes as the dosage increases. It is an alarming side effect, but one which always seems to fade. One annoying side effect you don't mention that I experiece is a persistent rash, not unlike that which I had when I tried lamotrigine, but not as serious. It has largely faded, but not entirely. I am taking my time with increasing the doses, and am only up to 25mg twice per day. I've been on it for about 18 days now. Sometimes I feel ok, sometimes I don't, I rarely feel great. I'm also on 10mg of Celexa and 12.5mcg of T4, for what it's worth. I'm feelin' kinda low right now and I don't know whether it's because of a lack of topo, Celexa, or my cold. I might have to change something soon.
Posted by phillybob on January 10, 2001, at 16:23:55
In reply to Re: The benefits of Topamax (more) » phillybob, posted by Bob on January 10, 2001, at 15:42:33
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.
1999/10/14At 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)
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
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)
>
> 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.
Posted by phillybob on January 12, 2001, at 12:00:05
In reply to Re: The benefits of Topamax (more) » phillybob, posted by Bob on January 10, 2001, at 20:01:32
Please share. I am just responding to this to bring it up on the new page. Maybe others who have posted on similar discussion threads in the past would like to either add their two cents again or cut and paste links to their previous discussions to this as well. Eventually, we might compile the information into a concise link or something or other. :) Thanks, all!
Posted by phillybob on January 12, 2001, at 12:17:59
In reply to Topamax (Topiramate) Experiences, posted by phillybob on January 12, 2001, at 12:00:05
Posted by phillybob on January 15, 2001, at 15:46:50
In reply to Topamax (Topiramate) Experiences, posted by phillybob on January 12, 2001, at 12:00:05
I shall assume that some of you out there are finding this information helpful or interesting so I shall continue forth.
I have in the past couple of days finally increased my Topamax dosage to 200 mg/day (100mg in the morning and 100 mg in the evening). After contemplating leveling off or even reducing the dosage, due to mind-racing or even sub-hypomanic-type feelings (not, though, undepressed), I have decided to be patient and persistent.
The most difficult side effect has been getting regular sleep, which may have more to do with my lack of personal schedule, due to not working right now. I tried to change the dosing time to all at one time (evening, then just morning), but am now most comfortable in the split dosages. I have moved up to the 200 mg daily relatively quickly, in a matter of 3 weeks, and the only side effect which seems to remain, of notice, is tingling fingers, toes and face (which I think vitamin B something can help). I do also have some lingering sinus type effects which I am comfortable now attributing to the Topamax. Dry mouth continues. One evening, I did seem to have sustained erection difficulty (I am certain, Topamax-related). I continue to drink much water (for fear of the dreaded kidney stone). No weight loss. While appetite seems to be suppressed at times, at other times, I seem to react the opposite (though I think this binge type eating is something that will stop as I adjust to the higher dosages of the medication). Regardless, the cognitive difficulties have all but dissipated and most other side effects (i.e. somnolence) seem to disappear upon a few day adjustment to each new dosage plateau.
As far as feeling, I am feeling quite a bit better, due to feeling less depressed and more consistent. I am more focused and have more energy.
I think it is too early to tell, but perhaps, as I begin to work again and get back on schedule, I might even, perchance, begin to enjoy (for real) some things (there have been some peeks) on a regular basis. I think it will be relatively easy for me, because I have always succeeded, more or less, in duping the world of my illness (thus have no "substantial" personal problem patterns to contend with ... but enough that continued personal therapy is quite warranted).
I have been a fairly decent actor. I just disappear during the especially difficult major depressive episodes. My award-winning dysthymic and sub-hypomanic acting periods are enough to tide me over with others during the darker times.
Now, I hope to really but only succeed with myself. Let's see. I'll keep posting.
Let me wax philosophical here for a sec (if I haven't already) and hypothesize that I have been hyper-sensitive to all of the meds I've tried in the past due to their "switching" abilities as well as my expectations. This time I have been more patient and my expectations are probably more ... perhaps due to the medication itself ... reasonable. I don't know. It's kind of a jumble, what I'm trying to say. I'll post back next week with an update and more clarification on what I'm trying to say. Regards.
Posted by Bob on January 15, 2001, at 17:26:52
In reply to Re: Topamax (Topiramate) Experiences, posted by phillybob on January 15, 2001, at 15:46:50
> I shall assume that some of you out there are finding this information helpful or interesting so I shall continue forth.
>
> I have in the past couple of days finally increased my Topamax dosage to 200 mg/day (100mg in the morning and 100 mg in the evening). After contemplating leveling off or even reducing the dosage, due to mind-racing or even sub-hypomanic-type feelings (not, though, undepressed), I have decided to be patient and persistent.
>
> The most difficult side effect has been getting regular sleep, which may have more to do with my lack of personal schedule, due to not working right now. I tried to change the dosing time to all at one time (evening, then just morning), but am now most comfortable in the split dosages. I have moved up to the 200 mg daily relatively quickly, in a matter of 3 weeks, and the only side effect which seems to remain, of notice, is tingling fingers, toes and face (which I think vitamin B something can help). I do also have some lingering sinus type effects which I am comfortable now attributing to the Topamax. Dry mouth continues. One evening, I did seem to have sustained erection difficulty (I am certain, Topamax-related). I continue to drink much water (for fear of the dreaded kidney stone). No weight loss. While appetite seems to be suppressed at times, at other times, I seem to react the opposite (though I think this binge type eating is something that will stop as I adjust to the higher dosages of the medication). Regardless, the cognitive difficulties have all but dissipated and most other side effects (i.e. somnolence) seem to disappear upon a few day adjustment to each new dosage plateau.
>
> As far as feeling, I am feeling quite a bit better, due to feeling less depressed and more consistent. I am more focused and have more energy.
>
> I think it is too early to tell, but perhaps, as I begin to work again and get back on schedule, I might even, perchance, begin to enjoy (for real) some things (there have been some peeks) on a regular basis. I think it will be relatively easy for me, because I have always succeeded, more or less, in duping the world of my illness (thus have no "substantial" personal problem patterns to contend with ... but enough that continued personal therapy is quite warranted).
>
> I have been a fairly decent actor. I just disappear during the especially difficult major depressive episodes. My award-winning dysthymic and sub-hypomanic acting periods are enough to tide me over with others during the darker times.
>
> Now, I hope to really but only succeed with myself. Let's see. I'll keep posting.
>
> Let me wax philosophical here for a sec (if I haven't already) and hypothesize that I have been hyper-sensitive to all of the meds I've tried in the past due to their "switching" abilities as well as my expectations. This time I have been more patient and my expectations are probably more ... perhaps due to the medication itself ... reasonable. I don't know. It's kind of a jumble, what I'm trying to say. I'll post back next week with an update and more clarification on what I'm trying to say. Regards.phillybob:
are you on topirimate, and topirimate alone?
what is your assessment of what your condition would be if you were on no drug whatsoever? for instance... if i were to taper off all meds, i would probably be in the hospital within two weeks, maybe sooner.
Posted by phillybob on January 15, 2001, at 18:06:10
In reply to Re: Topamax (Topiramate) Experiences, posted by Bob on January 15, 2001, at 17:26:52
Hey, Bob. If you read my posts closely, you'll see, I'm flyin' with the Topamax solo. Also, when I started this round, it was comin' off of a recent quick and scary dip into a major depressive episode ... the very beginning of one. I got my butt right back into the pdocs office because it came so shortly after a period where I caught myself sayin' "I haven't felt this great in I can't remember how long." So, basically, I kind of felt like it to be some kind of cycling action, for sure.
Everyone is different, but my story can be traced to my posts here. My first posts here were looking into an MAOI as I was "washing out" and miserable during such period. But, then, a sort of hypomanic switch might have gone off or the withdrawal of the AD med boosted me (some here have talked about that experience) and I moved on. These couple of posts should give you some background ... http://www.dr-bob.org/babble/20000302/msgs/25482.html and http://www.dr-bob.org/babble/20001231/msgs/51266.html
Posted by Bob on January 15, 2001, at 21:10:36
In reply to Re: Topabob, posted by phillybob on January 15, 2001, at 18:06:10
> Hey, Bob. If you read my posts closely, you'll see, I'm flyin' with the Topamax solo. Also, when I started this round, it was comin' off of a recent quick and scary dip into a major depressive episode ... the very beginning of one. I got my butt right back into the pdocs office because it came so shortly after a period where I caught myself sayin' "I haven't felt this great in I can't remember how long." So, basically, I kind of felt like it to be some kind of cycling action, for sure.
>
> Everyone is different, but my story can be traced to my posts here. My first posts here were looking into an MAOI as I was "washing out" and miserable during such period. But, then, a sort of hypomanic switch might have gone off or the withdrawal of the AD med boosted me (some here have talked about that experience) and I moved on. These couple of posts should give you some background ... http://www.dr-bob.org/babble/20000302/msgs/25482.html and http://www.dr-bob.org/babble/20001231/msgs/51266.htmlphillybob:
you mentioned in your posts awhile back when you were building up on the topirimate that you were thinking about adding some effexor or something to the mix to get some AD effect. i guess you now feel like you don't need that any longer?
Posted by phillybob on January 16, 2001, at 11:04:43
In reply to Re: Topabob, posted by Bob on January 15, 2001, at 21:10:36
> you mentioned in your posts awhile back when you were building up on the topirimate that you were thinking about adding some effexor or something to the mix to get some AD effect. i guess you now feel like you don't need that any longer?
Well, I feel less likely to attempt to add something and more likely to be patient and take a let's see and let's get back on a schedule/routine attitude and see what happens attitude ... before I make any decisions ... which I think is good.
It has only been just over 3 weeks, so it is VERY early. I have (as many of us) been there, done that. But, because this is not an AD and I'm not taking an AD or any OTHER meds whatsoever and everything I've read about mood stabilizers (well, it's not quite approved for such :) seems to point to efficacy for my situation, I am hopeful (which is always in and of itself a good input into helping a med be successful) that it might actually be the right thing for me.
Sure, I'd like an AD or something more for a lift. That's my nature. Always has been. Probably always will be. Heck, I'm the type of person that when everything is going okay would probably just like ... to get high. But, maybe that's okay, once in a while. The rest of the time, sobriety (and I've never ever had any substance abuse problem whatsoever, so y'all know) is the way to go. Perhaps, topiramate (Topamax) will help me deal with the sobriety a little better because I sure as heck was having my share of troubles before.
Well, this whole reporting on Psychobabble is very therapeutic for me, in the least. So thanks for listening (at least, I know you are listening Bob ... and for you others, if there are others, Bob is not me! :).
I will keep posting. Later this evening, though, I am getting out of Dodge (actually, Philadelphia, of course) for the browner pastures of New York City until the weekend, so I don't think I'll be online much until then. If all works out with my health, my life, etc., I should be posting less frequently (but still updating), that's for sure (off my duff and working!) Regards, phillybob.
Posted by Bob on January 16, 2001, at 19:47:04
In reply to Re: Topabob, posted by phillybob on January 16, 2001, at 11:04:43
> > you mentioned in your posts awhile back when you were building up on the topirimate that you were thinking about adding some effexor or something to the mix to get some AD effect. i guess you now feel like you don't need that any longer?
>
> Well, I feel less likely to attempt to add something and more likely to be patient and take a let's see and let's get back on a schedule/routine attitude and see what happens attitude ... before I make any decisions ... which I think is good.
>
> It has only been just over 3 weeks, so it is VERY early. I have (as many of us) been there, done that. But, because this is not an AD and I'm not taking an AD or any OTHER meds whatsoever and everything I've read about mood stabilizers (well, it's not quite approved for such :) seems to point to efficacy for my situation, I am hopeful (which is always in and of itself a good input into helping a med be successful) that it might actually be the right thing for me.
>
> Sure, I'd like an AD or something more for a lift. That's my nature. Always has been. Probably always will be. Heck, I'm the type of person that when everything is going okay would probably just like ... to get high. But, maybe that's okay, once in a while. The rest of the time, sobriety (and I've never ever had any substance abuse problem whatsoever, so y'all know) is the way to go. Perhaps, topiramate (Topamax) will help me deal with the sobriety a little better because I sure as heck was having my share of troubles before.
>
> Well, this whole reporting on Psychobabble is very therapeutic for me, in the least. So thanks for listening (at least, I know you are listening Bob ... and for you others, if there are others, Bob is not me! :).
>
> I will keep posting. Later this evening, though, I am getting out of Dodge (actually, Philadelphia, of course) for the browner pastures of New York City until the weekend, so I don't think I'll be online much until then. If all works out with my health, my life, etc., I should be posting less frequently (but still updating), that's for sure (off my duff and working!) Regards, phillybob.> > > > > > > > > > > > > > > > > > > > >
Well... I hope the topomax works out for you, because then, it just may work out for me also (then we'll both be happy). I am in the first month of solo tompirimate treatment also, and definitely feel sometimes like I should be augmenting it with an AD. I have resisted that temptation however and, like you, have adopted a wait and see approach. The depression seems to be lightening up sometimes, but who the heck knows - it's way too early. Earlier in my psychopharmacological trials and travails, I was on Depakote for a good while - more or less solo. It was my only real prior experiment with an anti-seizure med, and looking back on it, there was more than adequate control of anxiety, and some control of depression, but almost no drive to do anything.
Posted by Lexie on January 19, 2001, at 20:11:02
In reply to Topamax Experiences?, posted by Kingfish on January 4, 2001, at 7:29:48
Kelly
I have been taking Topamax 400 mgs. (200 a.m. and 200 p.m.) and 500 mgs. Lamictal (200 a.m. and 300 p.m.) and I am doing very well. If you have been reading my recent posts on the social board have been going through some heart renching personal problems, and despite all of that, I am for the first time not feeling suicidal. Any other time these events would have pushed me over the edge or at the very least hospitalized me. Finding the proper dose was a very long process and everyone is different. Good luck to you. Lexie
Posted by maribeth on January 21, 2001, at 7:38:05
In reply to Re: Topamax Experiences?, posted by Lexie on January 19, 2001, at 20:11:02
> Kelly
> I have been taking Topamax 400 mgs. (200 a.m. and 200 p.m.) and 500 mgs. Lamictal (200 a.m. and 300 p.m.) and I am doing very well. If you have been reading my recent posts on the social board have been going through some heart renching personal problems, and despite all of that, I am for the first time not feeling suicidal. Any other time these events would have pushed me over the edge or at the very least hospitalized me. Finding the proper dose was a very long process and everyone is different. Good luck to you. LexieGood to finally get a handle on what folks have been on dose-wise.
I see my pdoc this coming week and feel I need something more than 200/total
per day although I feel the mood stability somewhat. Good luck to you and keep us posted. Maribeth
Posted by maribeth on January 21, 2001, at 9:36:05
In reply to Re: Topamax Experiences? » Lexie, posted by maribeth on January 21, 2001, at 7:38:05
> > Kelly
> > I have been taking Topamax 400 mgs. (200 a.m. and 200 p.m.) and 500 mgs. Lamictal (200 a.m. and 300 p.m.) and I am doing very well. If you have been reading my recent posts on the social board have been going through some heart renching personal problems, and despite all of that, I am for the first time not feeling suicidal. Any other time these events would have pushed me over the edge or at the very least hospitalized me. Finding the proper dose was a very long process and everyone is different. Good luck to you. Lexie
>
> Good to finally get a handle on what folks have been on dose-wise.
> I see my pdoc this coming week and feel I need something more than 200/total
> per day although I feel the mood stability somewhat. Good luck to you and keep us posted. MaribethLexie,Bob,Phillybob, etya'll --
I just read back over all of your earlier posts and thought perhaps
it would be helpful for the rest of you to know that I have been on Effexor XR
300 mgm and Seroquel 300 mgm and was so for a year prior to starting
on Topamax. I was OK, but the Topamax has made
me much more "level" --I am not BP, my pdoc started it for weight loss. However,
I have yet to lose any weight, and I am at 100 total per day. Maribeth
Posted by phillybob on January 21, 2001, at 21:19:58
In reply to Re: Topamax Experiences?, posted by maribeth on January 21, 2001, at 9:36:05
Hi, kids! Back from my NYC trip. Great time! (business and pleasure). 200 mg/day (100 mg am and 100 mg pm). Just pushed it to 250 mg/day today (125 and 125) as I've kind of felt like I could use a tweaking it up a tad. I don't know.
These numbers we often are shooting for seem so arbitrary considering we patients come in all shapes and sizes. And then compound that with the fact that this drug happens to be approved only as an anticonvulsant right now, and we're usin' it for something entirely different! I did though just now on medscape see it referred to as a NEUROMODULATORY drug. I kind of like that one.
Still not taking anything else except I have added a B-Complex Stress thing-a-ma-tab (B12,folic acid, etc.) to help with the tingles (face, finger and toe tips) and it has.
And, Bob, I had, for the first time, since New Year's Eve, a couple of beers last night, and today did not seem to have the tremedously untoward effects that I did that time. Maybe, once adjusted to the drug, alcohol in moderation is okay? Hmmmm. Anyone else want to add?
Still get the old visual disturbances (eye pressure?) typically in the morning and fairly often. Anyone else?
Not much weight loss to speak of. Less food cravings and binging at times, but other times not. Overall, perhaps some weight loss due to less alcohol, more exercise/activity (due to less depression), and somewhat more overall eating stability.
Overall, I'm pretty satisfied with my 3 plus weeks of topiramate monotherapy. Lamictal add-on is always an intriguing one. Damn that Lexie, filling me with those novel ideas! :) (jes' kiddin' of course 'bout damnin' Miss Lexie)
Posted by Bob on January 21, 2001, at 22:24:33
In reply to Re: Topamax Experiences?, posted by phillybob on January 21, 2001, at 21:19:58
> Hi, kids! Back from my NYC trip. Great time! (business and pleasure). 200 mg/day (100 mg am and 100 mg pm). Just pushed it to 250 mg/day today (125 and 125) as I've kind of felt like I could use a tweaking it up a tad. I don't know.
>
> These numbers we often are shooting for seem so arbitrary considering we patients come in all shapes and sizes. And then compound that with the fact that this drug happens to be approved only as an anticonvulsant right now, and we're usin' it for something entirely different! I did though just now on medscape see it referred to as a NEUROMODULATORY drug. I kind of like that one.
>
> Still not taking anything else except I have added a B-Complex Stress thing-a-ma-tab (B12,folic acid, etc.) to help with the tingles (face, finger and toe tips) and it has.
>
> And, Bob, I had, for the first time, since New Year's Eve, a couple of beers last night, and today did not seem to have the tremedously untoward effects that I did that time. Maybe, once adjusted to the drug, alcohol in moderation is okay? Hmmmm. Anyone else want to add?
>
> Still get the old visual disturbances (eye pressure?) typically in the morning and fairly often. Anyone else?
>
> Not much weight loss to speak of. Less food cravings and binging at times, but other times not. Overall, perhaps some weight loss due to less alcohol, more exercise/activity (due to less depression), and somewhat more overall eating stability.
>
> Overall, I'm pretty satisfied with my 3 plus weeks of topiramate monotherapy. Lamictal add-on is always an intriguing one. Damn that Lexie, filling me with those novel ideas! :) (jes' kiddin' of course 'bout damnin' Miss Lexie)**********************
phillybob,lexie,etc...
I'm up to 100mg BID 50mg am, 50mg pm for about a week now, and have been on topo for about a month total. I too am getting the tingling. It is starting to get prominent in my hands and wrists - especially towards the outer parts of my hands. I even get a little bit of it in my heels! I imagine if I end up working up to 250mg like you phillybob, I will be getting much more tingling. The blurry vision has died down for the most part, as has the rash; but again, I'm sure it would all be back with dose increases. I have started to feel a little bit of what seems to be a lifting of depression maybe??? Could it possibly be? It also seems like I could be getting a slight bit of relief from my anxiety and muscle tension troubles. I am still taking trace amounts of Celexa and T4 in the am (10mg and 12.5mcg respectively) and have been withdrawling from those. I think as a result I have been experiencing more emotional lability than I would normally be encountering had I been stable on a med, and just added tompirimate. The reason I'm mentioning this, is because it unfortunately makes it hard to assess what feelings and effects are a result of the topo and what are a result of the other meds. Oh well... one day at a time. I'm have hope that this topomax may have something promising for me in the future. I just hope that it can have a good AD effect without the need to augment it with further meds.
Bob
Posted by Kingfish on January 22, 2001, at 8:31:49
In reply to Re: Topamax Experiences?, posted by Bob on January 21, 2001, at 22:24:33
Hi! Since I started this thread, I thought I'd add my two cents again, finally. Thanks so much to everyone for the wonderfully helpful information.
As for my experiences in the interim, I have increased my Topamax to 100 mg taken all in the pm because I had a problem with sedation during the day if I took any in the am (I slept three to four hours every day). Like Bob and phillybob, I am having tingling in my hands, especially my fingers, and some soreness. The other effects, such as strange tastes in the mouth, motor problems, have stopped. I'm shooting for 200 mg a day right now. I take 40 mg of Celexa and Neurontin as needed. Am diagnosed as BPII.
Still seems to be helping me, though I do feel I need something more, so hopefully finding an optimum dose will do it.
If anyone finds any new info on the drug, I'm sure we'd all appreciate it. Thus far, it seems like all we know is that Kidney Stones can develop.
Adios!
Posted by Lexie on January 22, 2001, at 19:57:02
In reply to Re: Topamax Experiences?, posted by Kingfish on January 22, 2001, at 8:31:49
> Hi! Since I started this thread, I thought I'd add my two cents again, finally. Thanks so much to everyone for the wonderfully helpful information.
>
> As for my experiences in the interim, I have increased my Topamax to 100 mg taken all in the pm because I had a problem with sedation during the day if I took any in the am (I slept three to four hours every day). Like Bob and phillybob, I am having tingling in my hands, especially my fingers, and some soreness. The other effects, such as strange tastes in the mouth, motor problems, have stopped. I'm shooting for 200 mg a day right now. I take 40 mg of Celexa and Neurontin as needed. Am diagnosed as BPII.
>
> Still seems to be helping me, though I do feel I need something more, so hopefully finding an optimum dose will do it.
>
> If anyone finds any new info on the drug, I'm sure we'd all appreciate it. Thus far, it seems like all we know is that Kidney Stones can develop.Hi Kingfish, Phillybob, Bob and Everyone
Glad to hear that the Topamax is working so well. It is the only thing that has worked for me and I have been going down this road a long time and traveling the Topamax/Lamictal Road since June. Like a lot of you I am also BP 2. I have lost weight a total of 30 pounds I am 5' 9" and am a little low for my height so watch what you ask for you just might get it. My doc is threatening to lower the Topamax (remember I take 400 per day, that is the high end) if I don't gain some weight back and I am getting some grief from family about the weight loss. I am having such good luck with the depression lifting especially the suicidal thoughts (that went away when the Lamictal was added, remember I take 500 mgs of Lamictal that is also high, I have been a tough case) I don't want to decrease the Topamax. Looks like I will be having those "Krispy Kremes" for breakfast. The weight loss came about as no longer a craving for sweets that I had with AD's and the craving to binge. As for the odd taste, I had to give up carbonation forever, it makes me gag! The tingling you describe started for me in the beginning but went away, I don't know if it will be the same for everyone, but for me it did go away. Good Luck to all of you. Lexie, AKA the Damn Ms. Lexie Gotta, love you, Phillybob and Thanks to you Kingfish for starting such an interesting thread
>
Posted by Bob on January 22, 2001, at 21:02:23
In reply to Re: Topamax Experiences?, posted by Lexie on January 22, 2001, at 19:57:02
> > Hi! Since I started this thread, I thought I'd add my two cents again, finally. Thanks so much to everyone for the wonderfully helpful information.
> >
> > As for my experiences in the interim, I have increased my Topamax to 100 mg taken all in the pm because I had a problem with sedation during the day if I took any in the am (I slept three to four hours every day). Like Bob and phillybob, I am having tingling in my hands, especially my fingers, and some soreness. The other effects, such as strange tastes in the mouth, motor problems, have stopped. I'm shooting for 200 mg a day right now. I take 40 mg of Celexa and Neurontin as needed. Am diagnosed as BPII.
> >
> > Still seems to be helping me, though I do feel I need something more, so hopefully finding an optimum dose will do it.
> >
> > If anyone finds any new info on the drug, I'm sure we'd all appreciate it. Thus far, it seems like all we know is that Kidney Stones can develop.
>
> Hi Kingfish, Phillybob, Bob and Everyone
> Glad to hear that the Topamax is working so well. It is the only thing that has worked for me and I have been going down this road a long time and traveling the Topamax/Lamictal Road since June. Like a lot of you I am also BP 2. I have lost weight a total of 30 pounds I am 5' 9" and am a little low for my height so watch what you ask for you just might get it. My doc is threatening to lower the Topamax (remember I take 400 per day, that is the high end) if I don't gain some weight back and I am getting some grief from family about the weight loss. I am having such good luck with the depression lifting especially the suicidal thoughts (that went away when the Lamictal was added, remember I take 500 mgs of Lamictal that is also high, I have been a tough case) I don't want to decrease the Topamax. Looks like I will be having those "Krispy Kremes" for breakfast. The weight loss came about as no longer a craving for sweets that I had with AD's and the craving to binge. As for the odd taste, I had to give up carbonation forever, it makes me gag! The tingling you describe started for me in the beginning but went away, I don't know if it will be the same for everyone, but for me it did go away. Good Luck to all of you. Lexie, AKA the Damn Ms. Lexie Gotta, love you, Phillybob and Thanks to you Kingfish for starting such an interesting thread
> >Lexie:
Just a couple of quick questions... I am a relative newcomer to this thread.
How long did it take you to build up to, and then stabilize on those high doses of lamictal and topomax; in other words, to get where you are now?
Is that all you are taking is those two meds, or are you supplementing with others? Are you getting good AD effects from them?
Bob
Posted by natg on January 23, 2001, at 3:54:24
In reply to Re: Topamax Experiences?, posted by Bob on January 22, 2001, at 21:02:23
Hi,
i have a question for my sister who has a binge- eating disorder. Would Topomax be an option for her? If so, how exactly is it helpful?Feedback and suggestions appreciated.
Nat
Posted by Lexie on January 23, 2001, at 5:00:53
In reply to Re: Topamax Experiences?, posted by Bob on January 22, 2001, at 21:02:23
> > >
>
> Lexie:
>
> Just a couple of quick questions... I am a relative newcomer to this thread.
>
> How long did it take you to build up to, and then stabilize on those high doses of lamictal and topomax; in other words, to get where you are now?
>
> Is that all you are taking is those two meds, or are you supplementing with others? Are you getting good AD effects from them?
>
> BobI took just Topamax from June to September and got relief at about the 250 level and the optimum relief at 400. Topamax helped me mostly with the anger and acting out highs. I was experiencing a lot of suicidal thoughts and severe depression when my doctor added the Lamictal. It was added in a starter pack slowly because you can get a sometimes very serious rash if started to quickly. The manufacture makes a started pack that your doctor will give you at no charge (mine did). That takes 5 weeks at the end of 5 weeks you are up to 150 it still goes slowly from there it was the beginning of November and tons of support from Noa that kept going without giving up to make it to the 500 level, my doctor says that for my condition Topamax max's out at 400 and Lamictal max's out at 600, I plan to stay where I am with the Lamictal. I take no other AD's the Lamictal is more than I could have ever hoped for. I am sure the results are not for everyone, but it worked for me. My doctor has been known as one of the best in my area for Medication issue's. I am VERY lucky. I am also very lucky to insurance, without it these meds would cost 600.00 per month. Good Luck, Lexie
Posted by Lexie on January 23, 2001, at 5:08:42
In reply to Topomax question, posted by natg on January 23, 2001, at 3:54:24
> Hi,
> i have a question for my sister who has a binge- eating disorder. Would Topomax be an option for her? If so, how exactly is it helpful?
>
> Feedback and suggestions appreciated.
>
> NatI read a while back, when first researching this medication that a University did a research project on Binge eating and Topamax. It was a Controlled study where some participants were given Topamax and some a placebo. The ones given the Topamax did far better controlling their binge eating than the ones taking the placebo. I was taking it for BP 2, I stopped binging and lost 30 pounds) I just don't know if a Doctor will prescribe to for that, although they perscribe it for BP and it is only FDA approved for eplipsy, so who know's? Hope this helps. But I am no doctor just someone offering some advise. All My Best, Lexie
Posted by KarenK on January 23, 2001, at 11:39:06
In reply to Re: Topamax Experiences?, posted by Kingfish on January 22, 2001, at 8:31:49
There was an article on topamax in Medscape on cognitive dysfunction. I'll include the link. I'm finding that this side effect is largely going away with time. What do you think? Comments?
http://jnnp.bmjjournals.com/cgi/content/abstract/69/5/636
KarenK
Posted by phillybob on January 23, 2001, at 18:56:41
In reply to Re: Topamax Experiences?, posted by KarenK on January 23, 2001, at 11:39:06
Karen, regarding cognitive dysfunction, I'll agree that it seems to dissipate, more or less, the more that the time has elapsed from the last dosage increase. I am sure, however, those tremendously sensitive to intellectual "calibrations" would notice something, but for me, no me importa (Spanish for this is of no importance to me).
natg, I am certain that medscape had had an article pointing to the efficacy of topiramate in the treatment of binge eating. My own anecdotal consumption experiences (at about a 225 mg/day dosage), however, are quite humorous. Whereas I did not finish my cheese fries at lunch today (something I would have never heretofore have done), I did just now eat an entire sleeve of Snackwell crackers (something I always have been inclined to do and do quite well, I might add). Sigh. :)
Posted by Bob on January 23, 2001, at 21:30:33
In reply to Topomax question, posted by natg on January 23, 2001, at 3:54:24
> Hi,
> i have a question for my sister who has a binge- eating disorder. Would Topomax be an option for her? If so, how exactly is it helpful?
>
> Feedback and suggestions appreciated.
>
> NatMy personal opinion here would be, if she needs emergency relief, she should go on an established SSRI first, and then maybe transition to somthing like topomax later. I don't think mood stabilizers and anti-siezure meds have been shown to have strong anti-obsessive properties... but I could be completely wrong here. I would not advise anybode to take my word alone for it. Ask a medical professional!
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