[darkeyes]

I know there "she" goes again. Hey Cam, can you tell me is it true that in some taking Lamictal they can experience mood swings similar to what one would consider "rapid cycling" brought on by the med.? I know they claim it should help do just the opposite, but lately while I'm in the process of titrating now up to 200mgs. I've been getting more hyper, you know agitate easier, not unless it is the begining of menopause symptoms, or that maybe my husband has been getting on my nerves more than ever, ha!ha! I mentioned it to my doc. he says, "I don't know". Even then I got annoyed, bit my tongue cause I wanted to say "duh, what do you know"? But I did not say anything,the rational me understands that the doc doesn't have a "crystal ball", ha!ha! I'm not expecting you to posess a "mystical crystal ball" either but was just wondering if you have heard of this happening, and also I've been finding that I am up at night similar to the way one is when they have shifted into a manic or hypomanic "mode", I ask myself am I getting hypomanic again or is this a side effect cause I read insomnia can be a side effect but drowsiness can be too, paradox?? I understand you are busy, so is my doc, I'm lucky if he gives me the usual "15 minutes" so who ever gets back with info I'll appreciate, but I know yours is always more exact cause that is more your area I must say Cam, I think you are "tops" in your field I think I speak for everyone hear. Hope life has been treating you well, and good ole bptoo, he's quite a guy
"darkeyes"

[CamW]

Darkeyes - Bipolar disorder is one sh***y thing to live with. Unfortunately, no matter how well controlled a person is with medication, or for how long, a breakthrough manic episode can occur. Seldom can it be stopped from happening. Docs will up the mood stabilizer dose for awhile, but this is more for the patient's psychological state moreso than for any good it will do.

Even if the person is taking an atypical antipsychotic like Risperdal (risperidone) or Zyprexa (olanzapine), an increase of dose does little to nothing. In most other disorders (eg. schizophrenia) the atypicals, and to greater extent, the conventional antipsychotics (eg. Haldol - haloperidol; Mellaril - thioridazine) at least make the person groggy. It seems that this is not the case for breakthrough manic episodes in bipolar disorder.

What we are doing by giving maintenance medication in bipolar disorder is (hopefully) decreasing the number of episodes one may experience in a lifetime. Fewer episodes means a decrease in the "kindling effect".

The kindling effect is the phenomenon where one episode "kindles" the next. That is, the next episode will come sooner, be more severe, and last longer than the previous one. By decreasing the number of manic episodes in a person's lifetime, the less of a chance there is for the kindling to occur.

In the days before effective medications for bipolar disorder, many sufferers ended up being institutionalized for their own safety. Families just could not take care of the person on their own. Can you imagine the guilt involved in this; watching your loved one just get worse and worse.

Anyway, all that you can do is hang in there, show this post to hubby (aren't husbands supposed to get on your nerves, anyway?), and ride out the storm. The episode should pass in 10 to 14 days (usually); then the lithium (you are still taking lithium, aren't you?) should begin to hold you, again.

The Lamictal (lamotrigine) mainly only works for the depressive part of the bipolar episode. I don't think that it does much for the mania. That is why they usually use the newer anticonvulsants (Neurontin - gabapentin; Topamax - topiramate; and Lamictal), although Topamax and Neurontin do seem to keep the manic episodes at bay in some people.

And yes, I have heard of "manic switch" (going from depression to mania) when adding Lamictal to the mix. It does not happen very commonly, especially when compared to traditional antidepressants. The tricyclic antidepressants (eg. Elavil - amitriptyline; Tofranil - imipramine) and the MAOIs (eg. Nardil - phenelzine; Parnate - tranylcypromine) are the worst offenders for manic switch, but this phenomenon has been seen with all antidepressants. Some researchers think that the antidepressant is relieving the depressive episode of the person with bipolar disorder, but in doing so, the mania that was being kept in check by the depression no longer comes rushing out. This is only a theory, and does not apply to all cases of manic switch.

I sorry, but I am going to give you the same answer as your GP. I dunno what's going on; you just have to wait a couple of weeks (to a month or so) to see if this present combo will work properly for you.

I hope that this is of some help to you. - Cam

P.S. No need to butter me up ; this is just my job.

<font color=blue>"The minute you or anybody else knows what you are you are not it, you are what you or anybody else knows you are and as everything in living is made up of finding out what you are it is extraordinarily difficult really not to know what you are and yet to be that thing." - Gertrude Stein, 1937</font color=blue>

[darkeyes]

Thanks Cam,
My doc is a psychiatrist, and I am no longer onLithium, it has been for about 2 months or more, he saw I was slipping too much into the depressed state for too long (about 6 months) and that I was not really a "typical manic" manic depressive, mor of the bipolar II, which I've been diagnosed as, which leans more to the depressed side to start with which tend to have more severe depressions than bipolar I people, with the risk of suicides being higher than that found in the bipolar I's, which I've read to be the case most often, I'm only going on by which I've read. This is why we switched to Lamictal but still kept with the Topamax also (100 mg), I am wondering if maybe it is the Topamax he needs to increase, I just called his office and left a msg. for him to call me about this idea. You see I started to see myself requiring less sleep, similar to 2yrs ago when this all happened, it got so bad I was existing on 2 hrs. of sleep a day, and even functioning, getting A's & B's in college oh and yes, churning out papers for the classes like a machine, wow, amazing what a little mania could do! ha!ha! It is a good thing if one could harness it, but we know how it eventually wins most of the time
I've done my reading on the kindling effect, that whole phenomenon is frightening in itself isn't it? God, how I wish and a million other people too, for a "real" miracle cure, it scares me so much to think I can eventually get worse someday, and possibly lose total control, you never know!
When I get real sad and mad about having this, I say at least when you have a terminal physical illness the beauty part is you eventually die, it kills you!! This kind of illness tortures your mind and your families too, and sometimes to the ultimate extent that you lose the battle too, to death, the possibility of suicide. Sorry to lay such a grim picture of this on you and our viewers but it is important that people see the reality us bipolars have to deal with everday of our lives, for the rest of our lives even though we have meds. that help we still have to deal with those "sneeky break through episodes" and they are down right "mean" and give us quite a "battle" beyond what anyone's imagination.
Besides all my ranting, I hope you are having a "great day"
BTW You need not be so modest, you are terrific, I'm not buttering you up, dear!!

"darkeyes"

"darkeyes"