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New here but long time bipolar

Talk about meds, side effects, and the 'med-go-round'.

by susie » Fri Dec 15, 2017 11:06 pm

Well to make a long story short, been on bipolar meds for probably 20yrs. i lean more toward the depressive side i would say. My "hypo-manic" side would be more one of anger or irritation. Since i'm a sensitive, i've been on the minimum of meds which is 100 mg Lamictal and 300 mg Lithium carbonate.
Went on HRT after starting perimenopause late June and OMG talk about hell on earth. The HRT helped a lot of symptoms (sex drive, hot flashes, night sweats, etc.) but i didn't know, until Dr. Google, that HRT can lower Lamictal blood levels by up to 50% and i THINK that's what happened to me, i felt myself sliding off into the abyss (darkness, obsessive compulsive thoughts which i never really realized i suffered from. The negative loop going on and on, emotional outbursts.. you get the drift) so i went ahead on my own and upped my Lamictal to 125 mg. My GP has been the one rx'ing, haven't seen a pdoc in years and years since i was semi ok on those doses.

Anyway, that did help a bit and my GP sent my to a psychiatrist who questioned my bipolar dx (got dx'd in the 90's as rapid cycling mixed states and she says a lot has changed since then) and dx'd me has having GAD which i know i have but suggested i titrate the Lamictal up to 200 mg and drop the Lithium (not all at once). I tried going up to 150 mg a month ago and got increased anxiety, dropped back down and was still in emotional darkness and turmoil so tried again, back up to 150 mg for 2 weeks and i felt better. SO...Sunday night i upped it to 175 mg. First couple days of course, i felt a bit stuperous but OK. Going to sit on this dosage awhile as it seems i am benefiting from it and if i'm truly bipolar which i really think i am, i will probably need to be on at least 200 mg esp if i'm on HRT. (my thyroid is fine).

OH, i also lowered my lithium by dumping out 1/2 contents of one capsule so i'm probably taking 250 mg, i did that a couple days ago and it helped the stupor.

My question is: long does it take for true benefits/effects to be seen with a Lamictal dose increase? Would it be 4-6 weeks? i don't want to keep raising if i don't have to but i certainly will if i continue to feel well. ALSO..the Lithium. I know there's caution to titrate down real slow on that, how long should i sit on 250 mg til i lower it again? The psych said something interesting...that they are now doing much more "mono" therapy as opposed to multiple meds, i am wondering if i would do just fine off Lithium esp since being on a low dose for over 15 years?

Thanks for any input and sorry for the lengthy post
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by Pancake » Sat Dec 16, 2017 12:24 am

Can't help with your meds question Susie, just saying Hi and welcome (:

Idk about monotherapy being trendier right now or not - (I only take a mood stabiliser regularly, benzo prn, therapy whenever I can) but others are taking multiple meds. We're a mixed bag here, do what works for you, when you figure out what that is (:

Forgive me if I missed it, I don't see any mention of therapy in your post? Most of us find it important.
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by Spm24 » Sat Dec 16, 2017 5:57 am

Each dosage increase of Lamictal I could see some positive steps forward in a short period of time. Bit did not feel the full effect for six to eight weeks it all depended.
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by hal » Sat Dec 16, 2017 6:55 am

Welcome to our community, Susie.

'm glad you've seen a pdoc (psychiatrist). It's the rare GP who has a really good grasp on drugs for BP. But even more importantly, BP meds need to be managed -- they have different effects on different people, and these effects can change over time. So it's not set and forget, as with many other meds.

Also, as you note, with many of them it may takes weeks to see if they are working or not. That's why it's not a great idea for us to experiment. We need professional guidance (again, why a pdoc is important). We get impatient and may jump to conclusions. Granted, sometimes, for various reasons, it may be hard to get a pdoc's advice when we need it. And certainly, once we've been together and trust his built up, pdoc might okay a little fiddling.

It's important to have mutual trust. That's why I urge you to find a pdoc you like and trust.
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by AvantGarde » Sat Dec 16, 2017 7:40 am

Welcome :)

I agree that we shouldn't mess with meds ourselves. No matter how long we've been in the game and think we understand it, a good doc always knows best. If your pdoc isn't really in tune with your issues, it's best to find a new one with who you can actually work with. I'm sure you know this, though.

I also have the "are you in therapy?" usual question :)
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by Mocha » Sat Dec 16, 2017 10:44 am

Susie.....Are you discussing your med changes with your pdoc? You mentioned making several med changes on your own. That's just not cool. Included your Lithium.....Again not cool.

You're not a medical professional......or a pharmacologist.

How long has it been since you've had your Lithium blood levels checked? They are very very important. How long has it been since you've seen you've seen your pdoc? Is he aware of how you're taking your meds?

If you want to get better, you need to reach out for help, and follow your pdoc's directions.

Many of take multiple medications our pdocs Rx's.....we don't screw around . I take the following:
*Lamictal 400/mg IR
*Tegretol 800/mg
*Topamax 400/mg
*Klonopin .5mg/prn
*Zoloft 100/mg
*Lamical 100/mg ER

Monotherapy would never work for me, keep me go see your pdoc. Doesn't mean you would have to take that many of course....... :)

You can get better.

And as the others said......therapy is so very important.....

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by Mom2dani » Mon Dec 18, 2017 5:19 am

When I was first diagnosed and started on the low dosage of Lamictal to be increased 10 days after, i increased it on my own earlier.... when I shared this on this forum I was told don’t do that, you aren’t a doctor. I wasn’t offended because you know what, they’re right.

I’m not a psychiatrist or pharmacologist. I could have jacked myself.

Now I follow her directions and prescriptions to a T. I wait patiently for things to go into effect because I trust that they will. Not lecturing but yeah, we aren’t educated In psychiatry, medicine or pharmacology.

I’m on 4 meds right now..
Lamictal 400mg
Effexor 75mg
Ability 10mg
Klonopin 5 mg

And through her direction I’m feeling more stable every day.

Just be careful and please follow your pdoc’s instructions, ok?
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by Duckysmom » Mon Dec 18, 2017 6:27 am

Just welcoming you to the community and agreeing with those above. No judgement, just good advice.

Do you see a therapist?
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by susie » Mon Dec 18, 2017 12:06 pm

Thank you all for your replies, i wasn't notified that i received any although i did check the "notifications" box..

i was put on meds by my pdoc (excellent doc) in mid 90's. After trying many meds back then, we settled on Lamictal and Lithium and i just sat on them from there, i am somewhat treatment resistant and cannot tolerate the "normal dose" of meds, say, Lithium, i never got above 300 mgs because of S/E's. Lamitcal i tolerate well but it was an add on at that point and never pursued BECAUSE..

i was w/o health insurance for years. Easy to say you need to go to a pdoc but if you're going to the food bank to eat, well, one simply cannot afford it. Luckily we had a GP that was a family friend and would see and RX the meds basically for free, i couldn't even afford BW even though it has always tested low.

FF to the health care /insurance changes a few years ago and when things began to tighten up and GP's basically refer everything out, i still didn't have health insurance. Finally i got it (MEDICAID) and found a GP. Since initiated HRT and finding out for myself they can lower blood levels of Lamictal, i told my GP and she said she wasn't comfortable managing bipolar meds, referred me to a pdoc but for some reason, their policy was to evaluate and advise the GP with doses.

SHE advised GP to slowly increase the Lamictal and drop Lithium at some point, so i've been following that advise. She also questioned the Bipolar diagnosis and dx'd me as having GAD, which i already know i have but i do not agree with her questioning BP dx because i know myself and i am responding to Lamictal. She said ultra rapid cycling/mixed states was kind of the "thing" back in the 90's to be dx'd and that really isn't the case today, well that doesn't mean i am not that... i do believe i am.

Anyway, i am following her orders in slowly increasing Lamictal (from the 100 mg i've been on for years) and i'm now at 175 mg. i am cognizant enough to know there will be ups/downs and was wondering, since i haven't increased meds for years, about long term effects, i do know i can see results in days.

AFA having a pdoc, i have to go to what i was referred to, Tuesdays and Thursdays they are open to have you go in and fill out a bunch of paperwork within certain hours and they assign you (supposedly), a pdoc. It's MEDICAID so i do not really have the option to shop around, i will get what i will get. I will pursue that but honestly don't have much hope in getting quality care, although i'll never know until i try, i suppose. In the meantime, i know the recommendation is to slowly increase Lamictal. i am aware by now of my body's responses and that i have never really completely stabilized or had complete resolution of my symptoms despite trying many meds, so for me, slow goes and i know that cognitive therapy right now wouldn't be good for me, it usually makes me much worse until i can at least stabilize.

FWIW despite being ultra rapid cycling mixed states bipolar, i've been married 36 years, have endured many trials/tribulations (as most people have) and have never gone off my meds or destabilized my life in any way, i am a very compliant patient and really the only thing that has driven me to address my meds is the HRT--which women should be aware of, it has it's benefits but if you have any psychiatric disorder, it can push you to the edge...

EDIT: forgot to ask, basically my question was, with each med adjustment, i know to expect a period of adjustment whether good or bad, for instance with the latest Lamical increase, i felt more feelings of happiness (thus, less depression) but a few days into it, more mixed states which i know is normal, just wondering (since it's been literally years since i've adjusted meds) how long does that period of possible instability last? Like... could it be weeks on same dosage before i REALLY see the benefits? What are your experiences?

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