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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Opolonio on July 11, 2000, at 23:02:40
I am treatment resistant mixed-type Bipolar and
unfortunately I have no choice but to go to a community
mental health center for treatment. My doctor is
unexperienced. She probably wouldn't have prescribed
Neurontin as my mainline mood stabilizer if I hadn't
already been taking it for three years when I started
with her. After almost ten years of trying different
combinations of meds, Neurontin was the first one that
stopped my mixed episodes. I was still depressed when
I started to see this doctor and I can't handle
antidepressants, so I suggested supplementing the
Neurontin with Lamictal and, after getting a second
opinion, she agreed to try it. I had just started to
respond to it at 200 mg daily when she refused to raise
the dosage. She is presently waiting to hear from the
doctor who gave her the second-opinion about the
advisability of raising the Lamictal dosage, and I'm
confident that he'll be in favor of it. My problem is
this -- since I've started taking the Lamictal the
dosage of Neurontin that I'm taking, 600 mg qid is not
doing as well as far as keeping me stable. I believe
that my Neurontin dosage should be raised as well. I
would be interested in any comments.
Posted by SLS on July 12, 2000, at 7:44:00
In reply to Lamictal and Neurontin in combination, posted by Opolonio on July 11, 2000, at 23:02:40
Dear Opolonio,
> After almost ten years of trying different combinations of meds, Neurontin was the first one that stopped my mixed episodes.Prior to Lamictal, what else were you taking in combination with Neurontin?
> I had just started to respond to it at 200 mg daily when she refused to raise the dosage.
I need a minimum of 300mg of Lamictal for it to provide me with any improvement. The range for bipolar depression is between 50-300mg, the average being 200mg.
> My problem is this -- since I've started taking the Lamictal the dosage of Neurontin that I'm taking, 600 mg qid is not doing as well as far as keeping me stable. I believe that my Neurontin dosage should be raised as well. I would be interested in any comments.
A few.
1. The NIH recently published a report describing success with the Lamictal + Neurontin combination. Unfortunately, they failed to mention dosages. This combination brought someone diagnosed as bipolar II out of a depression that was not responsive to antidepressants or other mood stabilizers. The combination of medications was more effective than either one by itself.
2. For some people, Lamictal can actually cause mania and rapid-cycling. Of anticonvulsant mood stabilizers, it is the only one that possesses true antidepressant properties. I don't know if these two facts are related.
3. For me, adding Neurontin to Lamictal made me feel worse. After an initial improvement, my depression became worse, and it has left me more unstable, despite having discontinued it a month ago. The residual instability has subsided, though. I had once taken Neurontin without Lamictal, and I don't remember it producing this effect.
Questions:
1. Is depression your main problem, or are manic symptoms also resistant to treatment?
2. Have you ever combined an antidepressant with Neurontin?
3. Have you ever tried Wellbutrin or Parnate?
- Scott
Posted by Opolonio on July 12, 2000, at 17:03:05
In reply to Re: Lamictal and Neurontin in combination, posted by SLS on July 12, 2000, at 7:44:00
> Dear Opolonio,
>
(edited)
> Prior to Lamictal, what else were you taking in combination with Neurontin?I was taking Neurontin alone as my mood stabilizer
> 1. The NIH recently published a report describing success with the Lamictal + Neurontin combination...Would you provide me with a URL for that document if it is available on the Web, please?
> Questions:
>
> 1. Is depression your main problem, or are manic symptoms also resistant to treatment?Neurontin has kept me from having any significant manic symptoms for over 3 years now. After I finally gave up on antidepressants altogether it had a subtle mood-brightening effect but that was insufficient as far as relieving my depression. I have been depressed for a very long time now, my longest depression ever, and while I'm overjoyed that I no longer have to worry about my mixed episodes, which were horrifying, I don't like the idea of spending the rest of my life battling depression.
> 2. Have you ever combined an antidepressant with Neurontin?
I don't toleraate antidepressants. Even when they don't bring on a mixed episode they make me anxious and make my insonia much worse as soon as they 'kick-in', and I have taken nearly every antidepressant that the FDA has approved since Prozac. I haven't taken an MAOI, but I'm not interested, since most of the foods that I like would be proscribed, but more importantly, they have a reputation for being 'energizing'. I have industrial-strength insomnia -- I don't need to be energized.
> 3. Have you ever tried Wellbutrin or Parnate?
I don't tolerate 'stimulating' antidepressants at all. I have comorbid Panic Disorder, and antidepressants in general, but especially Prozac and Wellbutrin, have greatly increased my perceived anxiety and worsoned my insonia.
>
> - ScottI started to feel my depression lift in a way that it never has before, without an increase in anxiety, when my Lamictal dosage was increased to 200 mg, but I still have problems with motivation and I still cry for the slightest reason. This is why I would like to try increasing the Lamictal.
Posted by SLS on July 13, 2000, at 21:28:02
In reply to Re: Lamictal and Neurontin in combination, posted by Opolonio on July 12, 2000, at 17:03:05
Hi Opolonio.
I hope the dosage increase of Lamictal does the trick. I have twice tried to reduce my dosage from 300mg to 200mg. Both times, I began to deteriorate. I recovered the improvement immediately upon returning to 300mg each time.
Given the descriptions of how people respond to the European drug adrafinil, and its lack of sympathomimetic (amphetamine, Ritalin) properties, I think it would be a worthwhile treatment to consider. I wish that I could recommend Provigil, which is available in the U.S., but I have not yet experienced an adequate improvement to do so. I have been on it for only four days, however. If I am not satisfied with my response to it, I will probably try adrafinil next to compare their effects on me. From there, I will consider adding Parnate to whichever one has produced the most improvement. Adrafinil really does sound like an interesting choice for you. There are quite a few weeks worth of threads devoted to this drug. I'm sure you've read them.
The article I referred to was contained in a publication called the Bipolar Network News. It is available as a PDF Adobe Acrobat file. If you can find it in another format, please let me know.
http://www.bipolarnetwork.org/new_site/BNN/
BNN Vol. 6., Iss. 1
- Scott
This is the end of the thread.
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