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Hello Doctor: I Feel Like I May Be Approaching Good
Question: Hello Doctor:
I feel like I may be approaching good mix (I have added trileptal) but need some assistance as something needs to be omitted.
A week ago I was still taking 25-35mgs tianeptine sulfate and 124-150 mgs Lamictal. My mood wasn't hitting rock bottom, but there is no brightness in my mood. Kind of an empty but remotely satisfied kind of way, sometimes apathetic.
Ruminative anxiety and cognitive/verbal problems in interpersonal sitations were worsening, as well as an obsessive fear of my roommate; Increasing lack of confidence: Memory is a problem. Irritability and anger a growing problem.
Last week, when I couldn't control my rage around my mother, I took 150 mgs of trileptal, which worked in the past with paranoid ideations and anger, Surprisingly I felt a lift in my mood and motivation. social anxiety, and verbal/cognitive performance. I became more social and less angry. My brain became less racy.
Unfortunately My sex drive has dropped and I have even become avoidant of dating situations. There is a tinge of anger creeping in at the end of the day. Obsessive terror over roommate continues. I know feel like I have added an SSRI (fear of sex, late night shopping)
I know that the Lamictal is the primary source for the constant ruminative anxiety, the staging fights in my mind, and irritatbilliy. but it typical provides me with mental energy and some confidence...
know that the tianeptine slows things down somewhat and can make me feel warm and safe but in a disconnected way...
Sooo This morning I took only my trileptal (150mg) and I felt non-combative and emotionally open at work (maybe a little flaky). I still had my sex drive a feeling of warmth towards people. Then at noon I took 50mgs Lamictal....my throat/voice got tight very quickly, and I began ruminating and social interactions became more robotic. Cognition slowed down. I started feeling more shy with people.
However I have not taken the tianeptine and my sex/dating drive is still present. I know that it will disappear when the tianeptine is taken.
Would you suggestion removing one or the other drug? Can tianeptine be decreased rapidly?
I feel like I may be approaching good mix (I have added trileptal) but need some assistance as something needs to be omitted.
A week ago I was still taking 25-35mgs tianeptine sulfate and 124-150 mgs Lamictal. My mood wasn't hitting rock bottom, but there is no brightness in my mood. Kind of an empty but remotely satisfied kind of way, sometimes apathetic.
Ruminative anxiety and cognitive/verbal problems in interpersonal sitations were worsening, as well as an obsessive fear of my roommate; Increasing lack of confidence: Memory is a problem. Irritability and anger a growing problem.
Last week, when I couldn't control my rage around my mother, I took 150 mgs of trileptal, which worked in the past with paranoid ideations and anger, Surprisingly I felt a lift in my mood and motivation. social anxiety, and verbal/cognitive performance. I became more social and less angry. My brain became less racy.
Unfortunately My sex drive has dropped and I have even become avoidant of dating situations. There is a tinge of anger creeping in at the end of the day. Obsessive terror over roommate continues. I know feel like I have added an SSRI (fear of sex, late night shopping)
I know that the Lamictal is the primary source for the constant ruminative anxiety, the staging fights in my mind, and irritatbilliy. but it typical provides me with mental energy and some confidence...
know that the tianeptine slows things down somewhat and can make me feel warm and safe but in a disconnected way...
Sooo This morning I took only my trileptal (150mg) and I felt non-combative and emotionally open at work (maybe a little flaky). I still had my sex drive a feeling of warmth towards people. Then at noon I took 50mgs Lamictal....my throat/voice got tight very quickly, and I began ruminating and social interactions became more robotic. Cognition slowed down. I started feeling more shy with people.
However I have not taken the tianeptine and my sex/dating drive is still present. I know that it will disappear when the tianeptine is taken.
Would you suggestion removing one or the other drug? Can tianeptine be decreased rapidly?
Hello Doctor:
I feel like I may be approaching good mix (I have added trileptal) but need some assistance as something needs to be omitted.
A week ago I was still taking 25-35mgs tianeptine sulfate and 124-150 mgs Lamictal. My mood wasn't hitting rock bottom, but there is no brightness in my mood. Kind of an empty but remotely satisfied kind of way, sometimes apathetic.
Ruminative anxiety and cognitive/verbal problems in interpersonal sitations were worsening, as well as an obsessive fear of my roommate; Increasing lack of confidence: Memory is a problem. Irritability and anger a growing problem.
Last week, when I couldn't control my rage around my mother, I took 150 mgs of trileptal, which worked in the past with paranoid ideations and anger, Surprisingly I felt a lift in my mood and motivation. social anxiety, and verbal/cognitive performance. I became more social and less angry. My brain became less racy.
Unfortunately My sex drive has dropped and I have even become avoidant of dating situations. There is a tinge of anger creeping in at the end of the day. Obsessive terror over roommate continues. I know feel like I have added an SSRI (fear of sex, late night shopping)
I know that the Lamictal is the primary source for the constant ruminative anxiety, the staging fights in my mind, and irritatbilliy. but it typical provides me with mental energy and some confidence...
know that the tianeptine slows things down somewhat and can make me feel warm and safe but in a disconnected way...
Sooo This morning I took only my trileptal (150mg) and I felt non-combative and emotionally open at work (maybe a little flaky). I still had my sex drive a feeling of warmth towards people. Then at noon I took 50mgs Lamictal....my throat/voice got tight very quickly, and I began ruminating and social interactions became more robotic. Cognition slowed down. I started feeling more shy with people.
However I have not taken the tianeptine and my sex/dating drive is still present. I know that it will disappear when the tianeptine is taken.
Would you suggestion removing one or the other drug? Can tianeptine be decreased rapidly?
I feel like I may be approaching good mix (I have added trileptal) but need some assistance as something needs to be omitted.
A week ago I was still taking 25-35mgs tianeptine sulfate and 124-150 mgs Lamictal. My mood wasn't hitting rock bottom, but there is no brightness in my mood. Kind of an empty but remotely satisfied kind of way, sometimes apathetic.
Ruminative anxiety and cognitive/verbal problems in interpersonal sitations were worsening, as well as an obsessive fear of my roommate; Increasing lack of confidence: Memory is a problem. Irritability and anger a growing problem.
Last week, when I couldn't control my rage around my mother, I took 150 mgs of trileptal, which worked in the past with paranoid ideations and anger, Surprisingly I felt a lift in my mood and motivation. social anxiety, and verbal/cognitive performance. I became more social and less angry. My brain became less racy.
Unfortunately My sex drive has dropped and I have even become avoidant of dating situations. There is a tinge of anger creeping in at the end of the day. Obsessive terror over roommate continues. I know feel like I have added an SSRI (fear of sex, late night shopping)
I know that the Lamictal is the primary source for the constant ruminative anxiety, the staging fights in my mind, and irritatbilliy. but it typical provides me with mental energy and some confidence...
know that the tianeptine slows things down somewhat and can make me feel warm and safe but in a disconnected way...
Sooo This morning I took only my trileptal (150mg) and I felt non-combative and emotionally open at work (maybe a little flaky). I still had my sex drive a feeling of warmth towards people. Then at noon I took 50mgs Lamictal....my throat/voice got tight very quickly, and I began ruminating and social interactions became more robotic. Cognition slowed down. I started feeling more shy with people.
However I have not taken the tianeptine and my sex/dating drive is still present. I know that it will disappear when the tianeptine is taken.
Would you suggestion removing one or the other drug? Can tianeptine be decreased rapidly?
Brief Answer:
Tianeptine can be stopped immediately
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
First of all I like to inform you that effects observed with use of trileptal are not surprising and they are well within limits. Although trileptal is not recommended for depression because there is inadequate data to support its use. Since this is showing good effect there is no doubt that we need to explore it further with higher dose.
The recommdeded dose of trileptal in bipolar depression ranges between 450 mg per day to 1200 mg per day so increasing it further to 450 mg per day is well recommended.
Since tianeptine is there in the prescription over more than a month and no noticeable positive effect are evident with its use I do not think there is any harm if tianeptine is removed from the prescription. The withdrawal effects of tianeptine are well tolerated in most cases and thats why it can be stopped abruptly.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Tianeptine can be stopped immediately
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
First of all I like to inform you that effects observed with use of trileptal are not surprising and they are well within limits. Although trileptal is not recommended for depression because there is inadequate data to support its use. Since this is showing good effect there is no doubt that we need to explore it further with higher dose.
The recommdeded dose of trileptal in bipolar depression ranges between 450 mg per day to 1200 mg per day so increasing it further to 450 mg per day is well recommended.
Since tianeptine is there in the prescription over more than a month and no noticeable positive effect are evident with its use I do not think there is any harm if tianeptine is removed from the prescription. The withdrawal effects of tianeptine are well tolerated in most cases and thats why it can be stopped abruptly.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Brief Answer:
Tianeptine can be stopped immediately
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
First of all I like to inform you that effects observed with use of trileptal are not surprising and they are well within limits. Although trileptal is not recommended for depression because there is inadequate data to support its use. Since this is showing good effect there is no doubt that we need to explore it further with higher dose.
The recommdeded dose of trileptal in bipolar depression ranges between 450 mg per day to 1200 mg per day so increasing it further to 450 mg per day is well recommended.
Since tianeptine is there in the prescription over more than a month and no noticeable positive effect are evident with its use I do not think there is any harm if tianeptine is removed from the prescription. The withdrawal effects of tianeptine are well tolerated in most cases and thats why it can be stopped abruptly.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Tianeptine can be stopped immediately
Detailed Answer:
Hello,
Thanks for using healthcaremagic.
I read your query and understand your concerns.
First of all I like to inform you that effects observed with use of trileptal are not surprising and they are well within limits. Although trileptal is not recommended for depression because there is inadequate data to support its use. Since this is showing good effect there is no doubt that we need to explore it further with higher dose.
The recommdeded dose of trileptal in bipolar depression ranges between 450 mg per day to 1200 mg per day so increasing it further to 450 mg per day is well recommended.
Since tianeptine is there in the prescription over more than a month and no noticeable positive effect are evident with its use I do not think there is any harm if tianeptine is removed from the prescription. The withdrawal effects of tianeptine are well tolerated in most cases and thats why it can be stopped abruptly.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
thank you...
I am reading that trileptal decreases blood levels of lamictal...should I increase the levels of Lamictal? it is responsible for combative ruminations, which is part of my problem.
I remember reading before that trileptal acts as a mild serotonin releaser in addition to its other functions? I know that when I added it to MOAI (year ago) I starting to get spikes in body temperature and sweating, so I stopped immediately.
I am worried this will have a paradoxical effect of increasing my irritability (low doses of serotonergics make me angry) over time. This happened in my last trial with tianeptine: Open feelings at first gave way to explosive irritability.
I want to pick you brain in another thread about finding a good approach to my borderline traits of interpersonal sensitivity (I think this is why I have repeatedly terrible combative relationships at work and home), and the best combination of drugs.
I am reading that trileptal decreases blood levels of lamictal...should I increase the levels of Lamictal? it is responsible for combative ruminations, which is part of my problem.
I remember reading before that trileptal acts as a mild serotonin releaser in addition to its other functions? I know that when I added it to MOAI (year ago) I starting to get spikes in body temperature and sweating, so I stopped immediately.
I am worried this will have a paradoxical effect of increasing my irritability (low doses of serotonergics make me angry) over time. This happened in my last trial with tianeptine: Open feelings at first gave way to explosive irritability.
I want to pick you brain in another thread about finding a good approach to my borderline traits of interpersonal sensitivity (I think this is why I have repeatedly terrible combative relationships at work and home), and the best combination of drugs.
thank you...
I am reading that trileptal decreases blood levels of lamictal...should I increase the levels of Lamictal? it is responsible for combative ruminations, which is part of my problem.
I remember reading before that trileptal acts as a mild serotonin releaser in addition to its other functions? I know that when I added it to MOAI (year ago) I starting to get spikes in body temperature and sweating, so I stopped immediately.
I am worried this will have a paradoxical effect of increasing my irritability (low doses of serotonergics make me angry) over time. This happened in my last trial with tianeptine: Open feelings at first gave way to explosive irritability.
I want to pick you brain in another thread about finding a good approach to my borderline traits of interpersonal sensitivity (I think this is why I have repeatedly terrible combative relationships at work and home), and the best combination of drugs.
I am reading that trileptal decreases blood levels of lamictal...should I increase the levels of Lamictal? it is responsible for combative ruminations, which is part of my problem.
I remember reading before that trileptal acts as a mild serotonin releaser in addition to its other functions? I know that when I added it to MOAI (year ago) I starting to get spikes in body temperature and sweating, so I stopped immediately.
I am worried this will have a paradoxical effect of increasing my irritability (low doses of serotonergics make me angry) over time. This happened in my last trial with tianeptine: Open feelings at first gave way to explosive irritability.
I want to pick you brain in another thread about finding a good approach to my borderline traits of interpersonal sensitivity (I think this is why I have repeatedly terrible combative relationships at work and home), and the best combination of drugs.
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
It is true that there is minor interaction between trileptal and lamotrigine but in most of the individuals the interaction is insignificant. I mean to say that there is no need for dose adjustment as the interaction have no practical value as per the available literature.
Combative ruminations are part of depression and obsessive thinking and I do not think the medication is cause. It is rightly possible that with adequate control over depression we can hope better resolution of combative ruminations.
Regarding worsening of irritability we need to have a open approach as the response to individual differs. Generally speaking trileptal helps in decreasing the irritability in most individuals owing to its membrane stabilising properties.
In my opinion rather than making a opinion/judgement a proper dose of trileptal need to be build off to have proper effect of trileptal. Before that it may be our own thinking which could be contributing to certain problems.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
It is true that there is minor interaction between trileptal and lamotrigine but in most of the individuals the interaction is insignificant. I mean to say that there is no need for dose adjustment as the interaction have no practical value as per the available literature.
Combative ruminations are part of depression and obsessive thinking and I do not think the medication is cause. It is rightly possible that with adequate control over depression we can hope better resolution of combative ruminations.
Regarding worsening of irritability we need to have a open approach as the response to individual differs. Generally speaking trileptal helps in decreasing the irritability in most individuals owing to its membrane stabilising properties.
In my opinion rather than making a opinion/judgement a proper dose of trileptal need to be build off to have proper effect of trileptal. Before that it may be our own thinking which could be contributing to certain problems.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
It is true that there is minor interaction between trileptal and lamotrigine but in most of the individuals the interaction is insignificant. I mean to say that there is no need for dose adjustment as the interaction have no practical value as per the available literature.
Combative ruminations are part of depression and obsessive thinking and I do not think the medication is cause. It is rightly possible that with adequate control over depression we can hope better resolution of combative ruminations.
Regarding worsening of irritability we need to have a open approach as the response to individual differs. Generally speaking trileptal helps in decreasing the irritability in most individuals owing to its membrane stabilising properties.
In my opinion rather than making a opinion/judgement a proper dose of trileptal need to be build off to have proper effect of trileptal. Before that it may be our own thinking which could be contributing to certain problems.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
It is true that there is minor interaction between trileptal and lamotrigine but in most of the individuals the interaction is insignificant. I mean to say that there is no need for dose adjustment as the interaction have no practical value as per the available literature.
Combative ruminations are part of depression and obsessive thinking and I do not think the medication is cause. It is rightly possible that with adequate control over depression we can hope better resolution of combative ruminations.
Regarding worsening of irritability we need to have a open approach as the response to individual differs. Generally speaking trileptal helps in decreasing the irritability in most individuals owing to its membrane stabilising properties.
In my opinion rather than making a opinion/judgement a proper dose of trileptal need to be build off to have proper effect of trileptal. Before that it may be our own thinking which could be contributing to certain problems.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
thanks!
Just to clarify, my feeling was that the small serotonin release from trileptal was causing my irritability. This must be a bipolar reaction or just my own polymorphism but I have always found that lower amounts of serotonergics (either trying to stay at a low dose of SSRI or when tapering down) I am prone to spontaneous rage.
I had other SSRI-like symptoms such as mood brightening, aversion to sex, and spending increase.
I had to stop the trileptal for now because my moods were swinging wildly throughout the day and my doctor told me now that it interferes with my HIV medications.
If I am able to return to trileptal, would it maybe help to add some lithium orotate for some mild control of this?
Just to clarify, my feeling was that the small serotonin release from trileptal was causing my irritability. This must be a bipolar reaction or just my own polymorphism but I have always found that lower amounts of serotonergics (either trying to stay at a low dose of SSRI or when tapering down) I am prone to spontaneous rage.
I had other SSRI-like symptoms such as mood brightening, aversion to sex, and spending increase.
I had to stop the trileptal for now because my moods were swinging wildly throughout the day and my doctor told me now that it interferes with my HIV medications.
If I am able to return to trileptal, would it maybe help to add some lithium orotate for some mild control of this?
thanks!
Just to clarify, my feeling was that the small serotonin release from trileptal was causing my irritability. This must be a bipolar reaction or just my own polymorphism but I have always found that lower amounts of serotonergics (either trying to stay at a low dose of SSRI or when tapering down) I am prone to spontaneous rage.
I had other SSRI-like symptoms such as mood brightening, aversion to sex, and spending increase.
I had to stop the trileptal for now because my moods were swinging wildly throughout the day and my doctor told me now that it interferes with my HIV medications.
If I am able to return to trileptal, would it maybe help to add some lithium orotate for some mild control of this?
Just to clarify, my feeling was that the small serotonin release from trileptal was causing my irritability. This must be a bipolar reaction or just my own polymorphism but I have always found that lower amounts of serotonergics (either trying to stay at a low dose of SSRI or when tapering down) I am prone to spontaneous rage.
I had other SSRI-like symptoms such as mood brightening, aversion to sex, and spending increase.
I had to stop the trileptal for now because my moods were swinging wildly throughout the day and my doctor told me now that it interferes with my HIV medications.
If I am able to return to trileptal, would it maybe help to add some lithium orotate for some mild control of this?
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for reverting back to me.
Although the literature is scarce but it is quite possible that you have increased rage following use of serotonergic medications. However this information coupled with poor response with different set of medications I feel possibility of bipolar disorder should be considered rather than depression. My assumption is also based on the fact that almost all mood stabilisers helped you in different but definite manner over the years.
Considering the possibility that you are probably dealing with bipolar disorder (type II) I feel we need to focus on medications which are quite helpful in bipolar depression. The approved medications include Lurasidone, Quetiapine, lamotrigine and lithium. Since lamotrigine is already used in different dosage I feel we need to have a trial with other alternatives.
Considering the fact that you have rage, combative ruminations, racing of mind, inattention as major issues across the different hours of day I feel seroquel should be the next choice.
Regarding trileptal, if it was causing excessive mood swings than there is no point of continuing it. It is also true that it is not recommended with antiretroviral (hiv) medications.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for reverting back to me.
Although the literature is scarce but it is quite possible that you have increased rage following use of serotonergic medications. However this information coupled with poor response with different set of medications I feel possibility of bipolar disorder should be considered rather than depression. My assumption is also based on the fact that almost all mood stabilisers helped you in different but definite manner over the years.
Considering the possibility that you are probably dealing with bipolar disorder (type II) I feel we need to focus on medications which are quite helpful in bipolar depression. The approved medications include Lurasidone, Quetiapine, lamotrigine and lithium. Since lamotrigine is already used in different dosage I feel we need to have a trial with other alternatives.
Considering the fact that you have rage, combative ruminations, racing of mind, inattention as major issues across the different hours of day I feel seroquel should be the next choice.
Regarding trileptal, if it was causing excessive mood swings than there is no point of continuing it. It is also true that it is not recommended with antiretroviral (hiv) medications.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for reverting back to me.
Although the literature is scarce but it is quite possible that you have increased rage following use of serotonergic medications. However this information coupled with poor response with different set of medications I feel possibility of bipolar disorder should be considered rather than depression. My assumption is also based on the fact that almost all mood stabilisers helped you in different but definite manner over the years.
Considering the possibility that you are probably dealing with bipolar disorder (type II) I feel we need to focus on medications which are quite helpful in bipolar depression. The approved medications include Lurasidone, Quetiapine, lamotrigine and lithium. Since lamotrigine is already used in different dosage I feel we need to have a trial with other alternatives.
Considering the fact that you have rage, combative ruminations, racing of mind, inattention as major issues across the different hours of day I feel seroquel should be the next choice.
Regarding trileptal, if it was causing excessive mood swings than there is no point of continuing it. It is also true that it is not recommended with antiretroviral (hiv) medications.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for reverting back to me.
Although the literature is scarce but it is quite possible that you have increased rage following use of serotonergic medications. However this information coupled with poor response with different set of medications I feel possibility of bipolar disorder should be considered rather than depression. My assumption is also based on the fact that almost all mood stabilisers helped you in different but definite manner over the years.
Considering the possibility that you are probably dealing with bipolar disorder (type II) I feel we need to focus on medications which are quite helpful in bipolar depression. The approved medications include Lurasidone, Quetiapine, lamotrigine and lithium. Since lamotrigine is already used in different dosage I feel we need to have a trial with other alternatives.
Considering the fact that you have rage, combative ruminations, racing of mind, inattention as major issues across the different hours of day I feel seroquel should be the next choice.
Regarding trileptal, if it was causing excessive mood swings than there is no point of continuing it. It is also true that it is not recommended with antiretroviral (hiv) medications.
I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Kampana
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