What Should I Do? I Don't KNow What to Do.

These are my meds:
Lamictal 200mg
Pristiq 75mg
Trilafon 10mg
Klonopin 2mg

I can't stand feeling flat anymore. All of my creativity, which was so immensely inspiring to me, is just gone. Gone. I see her (pdoc) tomorrow...well, I "see" her, as on my computer screen - I told her 2 weeks ago, so she agreed to drop my Lamictal from 225 down to 200. Well, of course that didn't do anything.

The Lamictal seems only to smush mania; it doesn't do anything for any other symptoms.

She's a terrific pdoc, it's just that she's hell-bent on keeping my mania down. That's her focus, it seems.

What should I do? What can I tell her tomorrow? I'm thinking of dropping my Lamictal down and not telling her, just see how it goes for a week or 2.

Be careful with lamictal. If you stop taking it for 2-3 days you have to start titrating all over again.

If it helps, I used to take lamictal for depression and it worked well for me.

Your creativity is still there, you just have to find another way of coaxing it out of yourself.

I have been depressed for years now and I still manage to create...I just changed how I got to my creativity. I used to rely on my natural motivation but I don't have that now.

I sort of convince myself to try something creative and I keep convincing myself until I finally get up and start working. I have to push myself to keep with it and to go back to it even when I don't feel like it.

It sort of becomes a habit and the creativity flows from that. It takes a while and some work but it is possible.

The problem with being manic and then having it under control, is that 'mania' makes everything exciting and it is easy to motivate yourself. I don't know how your meds affect you, but I went through many different combinations over 22 of my first bipolar episode. Being flat is horrible. I believe that everyone has there own combination of meds that work for them, so I think you should keep trying new ways, but don't do it without you Pdoc knowledge, because if something goes wrong, your Pdoc will be able to bring you back.

I found all benzos to be flat inducing.

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Originally Posted by Scooter9 Be careful with lamictal. If you stop taking it for 2-3 days you have to start titrating all over again. Thank you for your reply, Scooter. Yes, that's what upsets my dpdoc. Although, I wouldn't stop taking it...I'd just like to lower it and see what happens. See how I feel. If it helps, I used to take lamictal for depression and it worked well for me.

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Quote:

Originally Posted by Startingagain The problem with being manic and then having it under control, is that 'mania' makes everything exciting and it is easy to motivate yourself. I don't know how your meds affect you, but I went through many different combinations over 22 of my first bipolar episode. Being flat is horrible. I believe that everyone has there own combination of meds that work for them, so I think you should keep trying new ways, but don't do it without you Pdoc knowledge, because if something goes wrong, your Pdoc will be able to bring you back.

Hi Startingagain, thank you for your answer.

That's absolutely true - mania (or better, hypomania...full mania is a big problem for me) is its own motivator.

I've been on so many meds and med combinations, it's embarrassing. It seems to me that at this point, my current pdoc (I've been with her for about 3 years) believes that I'm stable, so why rock the boat? But living with this blllaaaahhh is...to me, it's not stable. It's half-dead. I feel like a fish lying on the sand, just near the water but not in it, and there I am with my mouth opening and closing, gasping for air.

I appreciate your understanding. When I have my appointment with her tomorrow, I am going to try to be assertive and really impress upon her that something needs to be altered. If I make a list of how I feel it would look like depression. But I don't feel depressed, I just feel almost entirely unmotivated.

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Originally Posted by Nammu I found all benzos to be flat inducing.

Hi Nammu , I agree with that. I remember when I first took Klonopin I felt subdued - although back then, I was so stressed it felt like a relief to be really mellow. But my life was entirely different...I was a wife and mom with young children; I was on the run almost constantly. I needed a "Mother's Little Helper" and Klonopin was it.

Now I've been on K-pin for such a long time (over 20 years) that I'm sure it has no effect on me anymore, except that I'm physically addicted to it. I do plan on speaking with my pdoc about starting to go off the K-pin. But this flatness...something major, one of the stronger drugs needs to change...or be replaced. Or something like that.

Hi Beth,

Are you sure it's the Lamictal? My experience with meds is kind of limited so far but I have noticed a "flattening" effect on Seroquel myself. Could your AP be playing a role in this? Is it possible to try switching to a different AP? Like others have said, maybe the benzos could be playing a role as well.

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Originally Posted by FluffyDinosaur Hi Beth, Are you sure it's the Lamictal? My experience with meds is kind of limited so far but I have noticed a "flattening" effect on Seroquel myself. Could your AP be playing a role in this? Is it possible to try switching to a different AP? Like others have said, maybe the benzos could be playing a role as well.

No, I'm not sure it's the Lamictal. That's what's so frustrating. The only reason I'm pointing to the Lamictal is because I started feeling that flat affect when I hit the therapeutic dose of Lamictal. It wasn't there for Klonopin, and it was present long before my AP. So that leaves either Lamistal, Pristiq - or both. She's insistent about not lowering either. I wish she'd just give it a chance. If I react badly, I would be willing to return to the original dose.

In that case I understand your suspicions. I think if I were in your shoes I would also want to try and drop below the therapeutic dose for Lamictal and see what happens. It's a shame your Pdoc isn't open to this. What if you suggest temporarily introducing another mood stabilizer to be "safe" while lowering the Lamictal? Maybe that would make your Pdoc feel safer about it?

Yes it is harder to get creativity going by the way I described. I would much prefer if it came on it's own through motivation but that's just not an option for me.

I understand what you mean about seeing 5 colors versus 15 but it's you that's seeing the colors in both cases. Just try to remember what you were feeling then and try to recreate it.

I'm not saying it's easy but for me it works because I haven't found a med or lifestyle that's helping me out of the depression I'm in so I had to do something. I know I'm a creative person so I dug deep to try to bring it out again despite the depression.

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Originally Posted by Scooter9 Yes it is harder to get creativity going by the way I described. I would much prefer if it came on it's own through motivation but that's just not an option for me. I understand what you mean about seeing 5 colors versus 15 but it's you that's seeing the colors in both cases. Just try to remember what you were feeling then and try to recreate it. I'm not saying it's easy but for me it works because I haven't found a med or lifestyle that's helping me out of the depression I'm in so I had to do something. I know I'm a creative person so I dug deep to try to bring it out again despite the depression.

Thank you, Scooter. Your perspective is wise

I had the appointment with my pdoc today and, much to my absolute shock, she agreed to prescribing 175mg. of Lamictal. I was taking 225, before that 200.

My hope is to regain a degree of my natural personality, not so much of a lack of fire. My hope is to be more normal, not a zombie. (Although, I am a little bit nervous...I hope I don't de-stabilize now. If I feel the least bit of weirdness I will definitely increase the dose back to 200mg.)

I'm really glad to hear that, and I hope it helps. I understand the nervousness, I hope your Pdoc will keep close tabs on you to see how you're doing?

Yes, she will. I know she's opposed to dropping the Lamictal. I'm pretty sure agreed out of worry that I'll drop it way down myself.

Great, that's good! I suppose it's the net result that counts regardless of her reasons for agreeing.

Bethrags: How possible is it for you to see a different pdoc for a 2nd opinion?

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Originally Posted by mugwort2 Bethrags: How possible is it for you to see a different pdoc for a 2nd opinion?

Hi mugwort, I see only 1 pdoc, the same one for 3 years. I also have a therapist, but she doesn't do anything with meds.

I've wondered, too, how people get "second opinions" from a pdoc or from any doctor. I've always assumed that those people have amazing health insurance or are wealthy enough to pay out of pocket.

I’m glad she was open to listening to thins. I can remember many times being flat was my main complaint and it was dismissed so I quit the profs and the meds. Always for a while I was ok but inevitably I’d cycle up and down. It’s a really good sign when they listen. Good luck.

I found that adjusting my wellbutrin between 1/2 a 75mg tablet and as much as 150 mg when I go too far down, like when more and more things are upsetting these days. Now I have to cut the wellbutrin back because some things are becoming resolved in my life and I was too irritable with the higher dosage of wellbutrin. I have mixed episodes, not a joy, crying at the sappy parts of my own writing, and picking out a family compound we could buy to put us all in the same state. We can afford it, but the stress would be tremendous, especially getting everyone to chip in and , oh, what's that again, be a family???? LOL Who ever heard of such a thing! You'll get a good mix of the meds. Keep at it. It took me many years of refining to find a mix that works for now, with my life as it is.

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Originally Posted by luvyrself I found that adjusting my wellbutrin between 1/2 a 75mg tablet and as much as 150 mg when I go too far down, like when more and more things are upsetting these days. Now I have to cut the wellbutrin back because some things are becoming resolved in my life and I was too irritable with the higher dosage of wellbutrin. I have mixed episodes, not a joy, crying at the sappy parts of my own writing, and picking out a family compound we could buy to put us all in the same state. We can afford it, but the stress would be tremendous, especially getting everyone to chip in and , oh, what's that again, be a family???? LOL Who ever heard of such a thing! You'll get a good mix of the meds. Keep at it. It took me many years of refining to find a mix that works for now, with my life as it is.

Thank you, luv. My baseline seems to be mildly mixed, with more intense episodes happening from the mild mixed.


I used to feel like I was failing whenever I had to change meds or doses. I'm finally accepting that bipolar disorder, by its very nature, requires fairly frequent med adjustments.

I hope you are feeling a bit better, BethRags. I know you started this thread a while ago. How is the 175 mg Lamictal doing?

My original thought was the same as Nammu's but I saw your response that you've been on Klonopin for a very long time. I'm not a fan of benzos at all and remember that when I took 2 mg of Klonopin I was extremely miserable and depressed. I forced my psychiatrist to lower the dose, but I know that has to be done very slowly. At a lower dose, the extreme tired and "flatness" as Nammu and FluffyDinosaur mentioned, went away to a good degree.

Thanks for asking, Soupe du jour. Actually, I am going to jot some notes onto my "tracking" thread here in Bipolar because the Lamictal situation is stupidly complicated.