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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Tim B on November 20, 2003, at 21:07:52
Hello everyone,
I am a new member and have been lurking for about two weeks to get a feel for things before I hop on in. I hope that this message finds each of you well and I'm glad I found this group.
Let's see, a little about me. I am 45, male, and I live in Washington DC. I was diagnosed with bipolar back in 1991 so I guess I've been dealing with the issues for more than ten years now. Over the years the diagnosis has evolved into what I feel is pretty accurate at this point of Bipolar II. When I first presented it was of course for depression and have been under continuous treatment for most of the past 12 years. There were two periods, after two - three years of stability where I tried to drop the meds and fly "clean" so to speak but the stability would always devolve and I would end up going back on the meds again.
Right now I'm severely depressed and was pretty suicidal for a while and found it necessary to take some time off of work and deal with this current situation for a period of time. Kind of brought it on myself because I wanted to monkey around with my meds and started to change thing around in July. Things were going pretty well for awhile and I was hopeful about the situation. But then disaster struck towards the latter part of October and I went totally down into the pits. It was unusual for me because I destabilized and went to pot over the course of a single weekend and I've never really experienced such a rapid onset. Usually I can see them coming so this one really confused me. I do have a fairly technical question and was hoping some of you could share your experience and perhaps offer some advice.
Lets see... I was on 1000mg Depakote, 600mg of Serzone, with Ambian as needed for sleep. That was my routine since late 1999 and it worked *adequately* (note lack of enthusiasm). Nothing great but it kept me relatively stable. That with some very generous flexibility at work and I was able to function pretty well since going on that regimen. Towards the beginning of this year I started to want to try for something better because I seemed to have settled into a fairly continuous mixed state and was having increasing problems keeping things under control. That and the black box warning about Serzone had me wanting to drop that drug specifically. Weight gain had me wanting to get off the Depakote.
Right now I am on 75mg of Lamictal and 300mg of Wellbutrin. I really didn't want the Wellbutrin because I had tried that one before and didn't really find it of much help. But the doc wasn't enthusiastic about my first thought which was to go back to the only drug that I found really addressed my symptoms which was an MAOI (Parnate). I guess they really don't like that class of drugs any longer. I had also suggested substituting Lamictal for the Depakote since I've been hearing good things about it in my research.
I have been here for about four weeks now and still am fluctuating wildly. My thoughts on Wellbutrin are the same and I feel that I am under medicated on the Lamictal. I have an appointment next week and really got to figure something out because I need to get back to my office. I am a Network Manager for a Federal Agency and my absence is causing some turmoil at work.
So here is my plan and my question. I was going to say let's start titrating the Lamictal up towards 200mg since I am totally off the Depakote now. Drop the Wellbutrin down to 100-150mg a day with a single dose XL or SR in the morning. Add in a SSRI flavor of the month (Lexapro 10mg??). Was reading Dr. Bob's and saw that the Wellbutrin SSRI combination was a fairly common approach. This actually disappoints me because I was hoping to get down to one drug maybe the Lamictal and not add a third for >>even more fun<<! Note sarcasm.
I have responded to SSRIs in the past but they usually would, as expected, peter out for me after some varying period of time. My initial experience with Prozac so many years ago was a lifesaver. Hate the sexual side effects that they would usually cause. I dealt with the nausea because heck, I needed to loose weight anyhow and the constant urge to ralph made me eat less. Food tends to be my only addictive behavior. So here finally is the question (phew!). What are your collective experiences with a Wellbutrin SSRI combo? Would all of you say that this is a good approach or should I press my doc to give me Parnate since I know it works? Keep the Lamictal at a higher dose or same dose?
Comments? Compare and contrast? <g> Thanks everyone.
Posted by Flipsactown on November 21, 2003, at 4:13:22
In reply to Intro and Question -- Wellbutrin SSRI Combo, posted by Tim B on November 20, 2003, at 21:07:52
Hello Tim,
That was quite an intro--very concise and to the point.
I have been taking A/D's for over 12 years. Note: A/D's. Eventually you will have to take more then one A/D to enhance it's effectiveness. In my case, my pdoc maxed me on prozac at 80mgs and slowly added desipramine which made prozac more effective. I alternated every couple of years with prozac and zoloft with desipramine for the longest time until the combo pooped out. I have been on wellbutrin, celexa, paxil, effexor, etc. Currently, I am on 100mgs prozac, 60mgs remeron and 300mgs of lamictal. I am currently pretty much depression free after the lamictal was introduced 8 weeks ago.
Like you, I researched online and discovered lamictal. Lamictal is generally used as an anti-seizure med but was found to be effective in treating both unipolar and bipolar depression. I am unipolar. Fortunately, lamictal worked for me and I did not get the dreaded, sometimes fatal, rash that lamictal is know for (knock on wood.)
I got very sick when I tried effexor and had the withdrawal symtoms that you are referring to. Also, it is possible that you are reacting to the prozac. Give the prozac-lamictal a chance and hopefully, you will get the same results I did. Remeron was added to enhance prozac. In fact my pdoc prescribed 100mgs prozac which is 20mgs over the recommended dosage. Also, remeron, which I take at bedtime is very sedating and allows me to sleep well. The only thing negative about the remeron is the weight gain issue. I have gained 15lbs since I stared taking remeron. I tried to get off remeron on my own without consulting my pdoc (not a wise thing to do) and whamo, my depression returned a couple of days after I took my last remeron pill. Needless to say I went back on remeron and viola, no more depression.
I hope this gives you the information you want and some hope. Good luck.
Flipsactown
> Hello everyone,
>
> I am a new member and have been lurking for about two weeks to get a feel for things before I hop on in. I hope that this message finds each of you well and I'm glad I found this group.
>
> Let's see, a little about me. I am 45, male, and I live in Washington DC. I was diagnosed with bipolar back in 1991 so I guess I've been dealing with the issues for more than ten years now. Over the years the diagnosis has evolved into what I feel is pretty accurate at this point of Bipolar II. When I first presented it was of course for depression and have been under continuous treatment for most of the past 12 years. There were two periods, after two - three years of stability where I tried to drop the meds and fly "clean" so to speak but the stability would always devolve and I would end up going back on the meds again.
>
> Right now I'm severely depressed and was pretty suicidal for a while and found it necessary to take some time off of work and deal with this current situation for a period of time. Kind of brought it on myself because I wanted to monkey around with my meds and started to change thing around in July. Things were going pretty well for awhile and I was hopeful about the situation. But then disaster struck towards the latter part of October and I went totally down into the pits. It was unusual for me because I destabilized and went to pot over the course of a single weekend and I've never really experienced such a rapid onset. Usually I can see them coming so this one really confused me. I do have a fairly technical question and was hoping some of you could share your experience and perhaps offer some advice.
>
> Lets see... I was on 1000mg Depakote, 600mg of Serzone, with Ambian as needed for sleep. That was my routine since late 1999 and it worked *adequately* (note lack of enthusiasm). Nothing great but it kept me relatively stable. That with some very generous flexibility at work and I was able to function pretty well since going on that regimen. Towards the beginning of this year I started to want to try for something better because I seemed to have settled into a fairly continuous mixed state and was having increasing problems keeping things under control. That and the black box warning about Serzone had me wanting to drop that drug specifically. Weight gain had me wanting to get off the Depakote.
>
> Right now I am on 75mg of Lamictal and 300mg of Wellbutrin. I really didn't want the Wellbutrin because I had tried that one before and didn't really find it of much help. But the doc wasn't enthusiastic about my first thought which was to go back to the only drug that I found really addressed my symptoms which was an MAOI (Parnate). I guess they really don't like that class of drugs any longer. I had also suggested substituting Lamictal for the Depakote since I've been hearing good things about it in my research.
>
> I have been here for about four weeks now and still am fluctuating wildly. My thoughts on Wellbutrin are the same and I feel that I am under medicated on the Lamictal. I have an appointment next week and really got to figure something out because I need to get back to my office. I am a Network Manager for a Federal Agency and my absence is causing some turmoil at work.
>
> So here is my plan and my question. I was going to say let's start titrating the Lamictal up towards 200mg since I am totally off the Depakote now. Drop the Wellbutrin down to 100-150mg a day with a single dose XL or SR in the morning. Add in a SSRI flavor of the month (Lexapro 10mg??). Was reading Dr. Bob's and saw that the Wellbutrin SSRI combination was a fairly common approach. This actually disappoints me because I was hoping to get down to one drug maybe the Lamictal and not add a third for >>even more fun<<! Note sarcasm.
>
> I have responded to SSRIs in the past but they usually would, as expected, peter out for me after some varying period of time. My initial experience with Prozac so many years ago was a lifesaver. Hate the sexual side effects that they would usually cause. I dealt with the nausea because heck, I needed to loose weight anyhow and the constant urge to ralph made me eat less. Food tends to be my only addictive behavior. So here finally is the question (phew!). What are your collective experiences with a Wellbutrin SSRI combo? Would all of you say that this is a good approach or should I press my doc to give me Parnate since I know it works? Keep the Lamictal at a higher dose or same dose?
>
> Comments? Compare and contrast? <g> Thanks everyone.
>
Posted by Flipsactown on November 21, 2003, at 4:33:27
In reply to Intro and Question -- Wellbutrin SSRI Combo, posted by Tim B on November 20, 2003, at 21:07:52
Hello Tim,
Disregard the effexor comments as I got you confused with another post. But do increase the lamictal because from my research lamictal's A/D
effectiveness is in the higher dosage 300 to 500mgs. Also wellbutrin did nothing for me but adding lamictal maybe a different story.Flipsactown
> Hello everyone,
>
> I am a new member and have been lurking for about two weeks to get a feel for things before I hop on in. I hope that this message finds each of you well and I'm glad I found this group.
>
> Let's see, a little about me. I am 45, male, and I live in Washington DC. I was diagnosed with bipolar back in 1991 so I guess I've been dealing with the issues for more than ten years now. Over the years the diagnosis has evolved into what I feel is pretty accurate at this point of Bipolar II. When I first presented it was of course for depression and have been under continuous treatment for most of the past 12 years. There were two periods, after two - three years of stability where I tried to drop the meds and fly "clean" so to speak but the stability would always devolve and I would end up going back on the meds again.
>
> Right now I'm severely depressed and was pretty suicidal for a while and found it necessary to take some time off of work and deal with this current situation for a period of time. Kind of brought it on myself because I wanted to monkey around with my meds and started to change thing around in July. Things were going pretty well for awhile and I was hopeful about the situation. But then disaster struck towards the latter part of October and I went totally down into the pits. It was unusual for me because I destabilized and went to pot over the course of a single weekend and I've never really experienced such a rapid onset. Usually I can see them coming so this one really confused me. I do have a fairly technical question and was hoping some of you could share your experience and perhaps offer some advice.
>
> Lets see... I was on 1000mg Depakote, 600mg of Serzone, with Ambian as needed for sleep. That was my routine since late 1999 and it worked *adequately* (note lack of enthusiasm). Nothing great but it kept me relatively stable. That with some very generous flexibility at work and I was able to function pretty well since going on that regimen. Towards the beginning of this year I started to want to try for something better because I seemed to have settled into a fairly continuous mixed state and was having increasing problems keeping things under control. That and the black box warning about Serzone had me wanting to drop that drug specifically. Weight gain had me wanting to get off the Depakote.
>
> Right now I am on 75mg of Lamictal and 300mg of Wellbutrin. I really didn't want the Wellbutrin because I had tried that one before and didn't really find it of much help. But the doc wasn't enthusiastic about my first thought which was to go back to the only drug that I found really addressed my symptoms which was an MAOI (Parnate). I guess they really don't like that class of drugs any longer. I had also suggested substituting Lamictal for the Depakote since I've been hearing good things about it in my research.
>
> I have been here for about four weeks now and still am fluctuating wildly. My thoughts on Wellbutrin are the same and I feel that I am under medicated on the Lamictal. I have an appointment next week and really got to figure something out because I need to get back to my office. I am a Network Manager for a Federal Agency and my absence is causing some turmoil at work.
>
> So here is my plan and my question. I was going to say let's start titrating the Lamictal up towards 200mg since I am totally off the Depakote now. Drop the Wellbutrin down to 100-150mg a day with a single dose XL or SR in the morning. Add in a SSRI flavor of the month (Lexapro 10mg??). Was reading Dr. Bob's and saw that the Wellbutrin SSRI combination was a fairly common approach. This actually disappoints me because I was hoping to get down to one drug maybe the Lamictal and not add a third for >>even more fun<<! Note sarcasm.
>
> I have responded to SSRIs in the past but they usually would, as expected, peter out for me after some varying period of time. My initial experience with Prozac so many years ago was a lifesaver. Hate the sexual side effects that they would usually cause. I dealt with the nausea because heck, I needed to loose weight anyhow and the constant urge to ralph made me eat less. Food tends to be my only addictive behavior. So here finally is the question (phew!). What are your collective experiences with a Wellbutrin SSRI combo? Would all of you say that this is a good approach or should I press my doc to give me Parnate since I know it works? Keep the Lamictal at a higher dose or same dose?
>
> Comments? Compare and contrast? <g> Thanks everyone.
>
Posted by CraigD on November 21, 2003, at 13:26:45
In reply to Re: Intro and Question -- Wellbutrin SSRI Combo » Tim B, posted by Flipsactown on November 21, 2003, at 4:33:27
I have a tentative diagnosis of BP II but depression and anxiety/social fear are very prominant and recurring.
If I try a mood stabilizer, I want something subtle and easy (don't we all) seeing as I may not even have BP II. I was thinking Neurontin or Lamictal.
Any opinions on either?
Posted by Tony P on November 21, 2003, at 22:10:55
In reply to Re: Intro and Question -- Wellbutrin SSRI Combo » Tim B, posted by Flipsactown on November 21, 2003, at 4:33:27
I found Wellbutrin worked too well for me - I became hypomanic and anxious on the full dose, and adding Serzone (an atypical SRI) put me over the top - felt like serotonin syndrome but maybe it was too much NE stimulation. Later found that I could tolerate 75-100 mg Wellbutrin with 400 mg Serzone, but I still had some hypomanic symptoms and behaviour and problems sleeping.
Anyhow, I have now been rediagnosed tentatively as Bipolar II or maybe the newly suggested III (manic episodes mainly when on A/D) and am starting Lamictal today. I wonder if its mood stabilizing effect would make Wellbutrin possible for me if the Lamictal is not sufficient. I worry about the anhedonic effect some people have described on stabilizing meds. I certainly felt much better on Wellbutrin except for the anxiety -- more enthusiasm for life, more capacity for joy, better sense of self-worth.
Posted by CraigD on November 25, 2003, at 11:07:16
In reply to Re: Intro and Question -- Wellbutrin SSRI Combo, posted by Tony P on November 21, 2003, at 22:10:55
I had the exact same experience adding WB to my Serzone. I enjoyed the hypomanic-type feeling but couldn't concentrate before long and was punching holes in the wall. I attributed it to NE overstimulation myself but the doctors just scratch their heads. You almost want to refer them to Babble cause they just don't seem to get it sometime.
I only seem to experience hypomanias (if that's what they are) on SSRIs or the day after a night of drinking.
I'd love to know how the Lamictal is working for you
-Craig
This is the end of the thread.
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