A Real “Head Case” Today

September 2, 2008 in ADD, Bipolar Disorder, Facts About Patient Anonymous, Health, Medicine, Meds, Neat Neuro Stuff, Seizures

Okay, this may take me a long time to write.  I don’t know where to begin or quite how to put it in order.

OMG.

Alright.  I was wondering if I cycled last night.  After all of these years of dealing with Bipolar I had become very good at monitoring my moods.  Everyone, do mood charting.  It’s very helpful–or at least I have found it to be so.  However, now that I am Ms. Super-Fast-Ultradian-Cycler, it is impossible for me to do that.  I cycle within 24-48 hours.  I can only retrospectively say, “Hey, did I cycle?” Well, on rare occasion, I may recognise it as it is happening but again, it is rare.

I was thinking about how I yelled at the dogs in the upstairs tenant’s flat.  When do I raise my voice in such a way? Never? A clue.  Irritability.  Then, I proceeded to get really hyper.  In the midst of this, I often mistake it for the “H” in ADHD.  That form of being so “hyper” can be easily confused with being (hypo)manic.  I have ADD Inattentive Type so I usually don’t get the “H” part of ADHD.

Later, I just felt something was wrong so I called and left a message with Merlin #1 and cancelled my appt. for today.  Something went off in my head (no pun intended) and I suspected I would be too depressed to make it.  And yet, somehow…I still didn’t clue in.

I did wake up feeling depressed but now? I have absolutely NO clue how I feel.  This may be why and also what triggered me to go all over the mood map? Or at least part of the reason?

My neuro wanted to increase my Clobazam/Frisium up from 10mg to 20mg.  This is minor–not a big deal.  He also wanted to increase my Lamictal/Lamotrigine from 150mg to 200mg.  There is no titration here, just a straight increase.  I picked up the meds on Sunday so…now it’s Tuesday.  I am so bloody cognitively impaired (I’ll get to that) I can’t remember but I think I started it all on Monday.  That would make sense as I had the meds so why wait? For what? A rainy day?

OMG.  Cognitively impaired indeed.  Unbelievably dizzy and nauseous.  These are definite side effects for either/and/or/both/whatever of those in the Bipolar/Epilepsy/Seizure Disorder camps–where I both happily live as I have just written above! Not to mention mood lability and all of that as well as a side effect.

Lamictal also increases Topamax/Topiramate levels by 15%.  I am on 300mg of that so is my body saying, “Hey, now you’re on 345mg!” Is that significant? Who is to say?

When my brain went completely bust and I was cycling like I hadn’t in years when I got laid off, we jumped right up from 200mg to 300mg with the Topamax! Wow, I thought my brain was going to start leaking out of my ears when I was cycling? Crap, that jump made me feel pretty nuts then too.  Indeed, titrations should generally be done but I was in such rough shape…in real danger…Merlin #1 and I just did it after discussing.

Lamictal is a really tricky Anticonvulsant and of them all, a slow and steady titration is pretty much always recommended.  Now, due to my crazy seizure activity of late, neuro may have just decided to make the jump.  Some M.D.s go as slow as 12.5mg over every two weeks.  Some are a little more “brave” and go 25mg every two weeks.

Whee! Nice bang to my bean by taking it right up to another 50mg?

My brain will adjust.  It did with the immediate jump up to 100mg with the Topamax.  It just took a couple of days, I think? Yes? Shit though…more time out of commission?

So, probably just as well that I cancelled Merlin #1.  Since this increase has turned me into rather a disaster, I wouldn’t have been able to make it anyway.

Wow.  Let’s hear it for my crazy head, all of the damn things that make it go spastic and my rainbow of a cocktail.

Huzzah!

6 Replies

  1. experimental chimp

    September 2, 2008 at 8:48 pm

    Ah, med talk.

    Lamictal’s slow titration is mostly due to the possibility of developing the dreaded rash. This is much more likely when you start taking it, which is why a conservative titration starts from 12.5mg and increases slowly.

    It’s much less dangerous to increase the dose when people are already on a reasonable amount. So increasing from 150mg to 200mg isn’t unusual. When I was starting Lamictal, my titration went through 25mg, 50mg, 100mg, 150mg and 200mg, with an increase every two weeks. The jump to 200mg could definitely cause side-effects though. Plus, Lamictal has fairly strong anti-depressant effects, which kick in at 200mg, so that can cause some initial hyperness and irritibility and so on.

    Since you’re already taking Lamictal, the extra 50mg shouldn’t have much effect on your topamax levels.

    Anyway, hopefully it should settle down in a few days as you get used to the extra 50mg.

  2. patientanonymous

    September 3, 2008 at 2:01 pm

    Hi chimpy, good to see you popping by for yep…another one of my med or science-y posts.

    Yes, I forgot to mention “The Rash” as I was too out of it. For those that don’t know, with Lamictal, you can break out in “The Rash.” Well, you can break out with a rash with just about any AC but Lamictal carries the worst reputation as with “The Rash” it is more common. Not to mention “The Rash” can lead to SJS–Stevens-Johnson Syndrome that can be fatal.

    No other AC has “The Rash” that can lead to SJS.

    Now, let’s not get all up in arms re: Lamictal! It’s pretty rare but there is a chance…just a VERY slim one!

    And yes, if you are already on it, much less dangerous–that was my rationale with the big Topamax jump. And also yes, the anti-depressant effects. It’s basically the best adjunct for people with Bipolar who have issues with Depression. Or at least it has shown to be?

    And yes, they said that the Topomax increase was not “significant.” I was just saying with my bean, who the hell would know? Lordy. It’s a full bag of tricks so with my luck? *rolls eyes*

    Thanks, love. My mood/s seems to have hopefully settled a bit. Oh dear did things get worse last night! OMG! I dropped two Valiums within a few hours! Anxiety, depression, major Cognitive Distortion land…not pretty.

    I’m still nauseous as all hell, dizzy and tripped out in the brain department. Pretty stoned and concentration? Oh, surely you jest!

    Sleep was pretty interesting too. At about 0400hrs I raced to the bathroom to get a Gravol/Dimenhydrinate and then some funky…either Hypnopompia/Hypnagogia and maybe some Sleep Paralysis?

    *shrug*

  3. beartwinsmom

    September 3, 2008 at 2:40 pm

    (((((PA))))) A mood chart is an excellent idea. I think I should probably make one for me.

    Yikes on the increase in meds. Why the increase in Lamictal? Because of the seizures?

    In my not-so-medically-trained-background (I am not a Dr. like you, dear LOL), I think the stress of trying to find a job is causing you to have seizures. Even subliminally, the stress is wreaking havoc on your brain.

    More (((((hugs)))) for you.

  4. patientanonymous

    September 3, 2008 at 4:41 pm

    Hi mom, thanks for the hugs. Yes, I am a big proponent of mood charting. I used to do it quite often and even prior to going to see neuro, I used to do it for any seizure stuff.

    Yes, the Lamictal (and Clobazam) increase(s) are for the seizures.

    I know, this is kind of screwed up. Even the Topamax wasn’t like this and ironically, I had more side effects when starting the Topamax in the beginning than the Lamictal! How ridiculous, I say! Ugh.

    Haha…yes, Dr. PA!

    My seizures have always been idiotpathic (I mean idiopathic-haha again) so neuro and I have always just scratched out heads at it all and left it at that–not to mention, I’ve had the Simple Partials all of my life. So many “theories” as to why…

    Stress is definitely one of them! Stress is completely a known cause of seizure activity. And I will not disagree that the stress is screwing up my brain, even apart from any seizure business. No, it totally is!

    Hugs back,
    PA

  5. experimental chimp

    September 4, 2008 at 5:52 am

    Interestingly, SJS is a concern with some other anti-convulsants, though with carbamazepine (Tegretol) this is strongly associated with an allele of the human leukocyte antigen gene, common to Han Chinese, Thai and Malay populations. It’s also a problem with some of the older agents like phenytoin (Dilantin) and phenobarbital, though I think that’s more common in children.

    Lamictal’s anti-depressant properties are interesting. GSK, the manufacturer, did try to get it approved for depression before the patent expired, but the initial clinical trials didn’t show a benefit, so the effort wasn’t successful. However, it’s started to be used off-label for people with treatment-resistant depression, which is kind of interesting. It’s definitely made me feel a whole lot less depressed.

    Glad to hear you’re feeling a bit better. Look after yourself.

  6. patientanonymous

    September 4, 2008 at 12:43 pm

    Oh chimpy, you’re just so damn good! It’s equally good that I am not of a competitive nature. *wink*

    That’s very interesting. I think that is really all I have to say about all of that. I mean really…what else is there to say? *laughing*

    Yes, I like Lamictal. It’s done great things for me as an adjunct. We started it before with my GP (as I/we couldn’t find a psychiatrist) before I went inpatient in the spring of last year. Of course we had just started it so it took a while to get me titrated to the right dose. I’m really glad it’s helped you too.

    I’m quite surprised that I managed to get along with Topamax as monotherapy for several years as with it being a Temporal Lobe drug, it pretty much requires some kind of adjunct? Again, we all know my brain is so screwed with four comorbidities. I guess I was definitely an anomaly–but we all know that too–hardy har har.

    I suppose it took another Brain Go Boom to finally say, “Hey…so much for livin’ alone there!” And it’s all going to hell now with the increased seizures and migraines so I honestly don’t know what to say.

    At least stims are simple for my damn ADD! And thank bloody god neuro hasn’t said boo about the possibility of my stim lowering my threshold! But shit…it never did when I started taking it so I’m sticking to my guns that IT is not the problem! You’re not taking away my damn Biphentin!!!

    And don’t even bother to tell me that with prolonged use it CAN STILL lower your threshold! I won’t have any of it! *PA turns head and walks away in denial*

    *laughs again*


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