Tweaking Meds

11 days ago I called and left a rambling message for Brent about feeling worse and fearing that I was going to screw up my job and could we please do something about this before April?  His nurse called me back and after some phone tag she interrogated me about what was going on and asked me to hold on a moment while she went to talk to Brent.  He didn’t want to change anything without seeing me, but they squeezed me in for an appointment the next morning.

10 days ago I saw Brent, for the 4th time in a month.  I repeated all the information on how I was feeling and he said we could either increase Lamictal or Wellbutrin, but that his preference would be Lamictal.  I had mentioned the persistent thoughts of self-harm, and he thought it would help with that.  So we agreed to increase my total daily dose to 75 mg, with 50 mg in the morning and 25 mg at night, because I said that it tends to give me difficulty with sleeping if I take it too close to bedtime.

I went ahead and took the extra 25 mg for that morning when I got home, so today makes the 11th day on the new dose.  For the first several days I was feeling rather agitated and irritable, and my pre-existing urge to run away from everything I attended was persisting.  I want to say there’s been a hint of improvement since then, but I can’t put my finger on what has improved.  I guess maybe that I’m really not thinking about self-harm all the time, but it’s hard to see that as improvement when I actually acted on it for the first time in 5 months.

I still have no motivation, but I’m trying to force myself to do things anyway.  Basic life necessities, like helping with the dishes or doing the laundry or taking a shower before going out in public.

It’s 11 more days until I see Brent again.  I don’t think we’re done adjusting the medication yet.

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8 thoughts on “Tweaking Meds

  1. My meds are messing with me I have a call into the Dr as we lowered my anti depressant and now I’m in a pretty bad depressive state. I hope yours gets worked out soon it sucks having the ideation

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  2. It’s good you have a doctor who listens to you and works with you regarding your meds rather than ignoring your desires and prescribing whatever he thinks is best regardless of your input. So many stories out there about people who have doctors who don’t listen to them.

    I wish you well regarding getting some things done today. It’s not always easy.

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  3. The Pdocs (Psychiatrists) can only handle so many patients but in my opinion, I don’t think they understand the emergency that is really going on. Shuffling your feet while you wait for an increase in Lamictal to kick in and start working so you can function (and that doesn’t include work) for a week is unacceptable. I’m a fighter and usually win if I’m not ok. That’s one thing I’ve learned. I’m not saying you are, but being as proactive as you possibly can from knowledge on the drugs, ways to get in to see the Pdoc immediately. I’ve got them down pat. Granted I’ve been with the same psychiatrist since 1999 so I have basically, under his supervision, taken my own lead when something is off. I’m not a Pdoc but have been on Lamictal since 1999, back when it was brand. I process meds at an unusually high metabolic rate so I need high doses to get what another person would get off of a small dose. Personally, I think that you are not on enough Lamictal. I’m unusual and on 800 mg but somethings wrong. Have you ruled out/not ruled out Lamictal as the answer? How long have you been on this drug and what doses? What are you being treated for? Bipolar Disorder? You can’t wait for the Pdoc. It sounds like you are making an effort but you’ve got to barrage his office with “I need it now.” Namaste my friend.

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    • I’ve been on the Lamictal since the beginning of January. Started at 25 mg and then increased to 50 mg (both during an inpatient stay). When I followed up as an outpatient Brent saw that I was doing better and didn’t want to increase the dose if there wasn’t a problem to be fixed, as that could lead to maxing out the dose unnecessarily and not having an option to go up if there were problems in the future.

      I know I have a problem with being assertive enough, but I really pushed for it this time. I see him again in 10 days and will tell him I think we need to increase it a little more.

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      • I’m impressed that you were more assertive and pushed. I used your Blog Post about Tweaking as the topic of my Bipolar Disorder Blog today. You are welcome to read it. 50 mg? That’s ridiculous for him to say, maxing it out. How long have you been seeing him? If you read up on Lamictal at all in treatment for Bipolar Disorder, you haven’t even touched the surface my dear as being therapeutic. I don’t like Brent from the things I’ve read. I’m very opinionated. Don’t take offense on my Post in regards to you. You were a catalyst and I’m thankful for that. Namaste. http://seemercuryfalling.org

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      • The therapeutic daily dose range appears to lie between 200 to 400 mg, with the majority of studies demonstrating efficacy at the lower end of this range.
        A standard initiation and titration practice involves the initiation of lamotrigine at a daily dose of 25 mg, and increasing this to 50 mg per day after one to two weeks, then doubling the dose every one to two weeks until a dose of 200 mg per day is reached.

        My personal opinion is to have him kick you up to 200 mg – 400 mg. I’m not impressed with Brent. I’m sorry if that offends you but he doesn’t even have you to a therapeutic dose. 50 mg Brent?

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655087/

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        • I’m the opposite of you – I tend to be sensitive to small doses. I totally respect his approach of making adjustments slowly, I just want him to be adjusting SOMETHING when I’m not feeling well.

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          • I see. I validate you. Keep pushing. It’s your body, mind and life. If something’s not right, he has to comply when it’s in your best interest and you are the one who knows if you are ok, not him. I can respect his opinion, but I think your gut and intuition is the better of the two. I will keep reading your blog. It’s really interesting and thanks for replying back.

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