- Joined
- Nov 3, 2009
- Messages
- 7,589
Lamotrigine is a great drug. Of interest, rashes on this medication are pretty common but often would disappear when you decrease the dose. Many of my patients had to be taken off it due to rashes and some wanted to retry it. With very slow titration, I'd say, only about 50% developed rashes the second time. Stevens-Johnson is a very serious and potentially life threatening complication, but the rate is low. There may be some genetic predisposition to it. (For example - a small group of Chinese coming from an isolated island are so sensitive to Tegretol, another antiepileptic and mood stabilizing drug, that they all would develop Stevens-Johnson on it.) Likely, there is a huge genetic factor in Lamictal-induced Stevens-Johnson.
Re. Lithium - I have to speak up because it is a great drug. Fortunately, and very unfortunately, it was the first "bipolar" drug. We can not even imagine what were the lives of these poor people in pre-lithium days. I think the stigma dates back to these days. And then Lithium emerged, and it was a miracle drug. Of course, no one was aware of its toxicity, and in my residency program, I saw some hapless patients from these "early Lithium" days, all on dialysis and with severe Parkinsonism. Some of them, likely, were alive because of Lithium.
In high doses Lithium becomes nasty. Used as augmentation therapy, at 300-600 mg, it may be pretty well-tolerated and benign. I know people who use 75 mg.! It is like a vitamin, an additive, and it still works! The highest suicide rate is in Japan. But there are communities In Quita Prefecture who have higher levels of natural lithium in their water supplies. They have measurably fewer suicides than other areas. There is a neuropsychiatrist, Takeshi Terao, who published an article in the British Journal of Neuropsychiatry. He offered adding microdoses of Li into drinking water, like we now do with fluoride, to build up resistance to mood swings. Personally, I do not believe it will fly, but I surely believe in statistics.
I just do not want people who have been offered Lithium to get discouraged. Like with any drugs, small doses are very well-tolerated, large doses are very nasty. It may cause headaches (so can Lamotrigine) but curiously, it has been used to treat one specific type, cluster headaches. There is no major company standing behind Lithium, no one sells it at $ 15.00 a pill, like Abilify, so it is not advertised and no studies are done, but there is much evidence suggesting that small doses can prevent or delay Alzheimer's.
As to stigma, I totally agree that the biggest stigma is associated with schizophrenia. Partially, it had to do with horrible treatments, all these insulin shocks... Also, it was a thrash bin, and 90% of Asperger's and bipolar disorder with psychotic features, and schizoaffective disorder, all got there. But now we see new stigmas emerging. Asperger's is becoming a new stigma. Depression is not stigmatizing any longer, and bipolar is rapidly becoming de-stigmatized. Much owing to people like, Pandora, who are open and courageous and really committed to spreading awareness about this problem.
(Do not read it guys, I am biologist, and tend to explain everything the same way.)
Genetically we are still tribal people, and existence of bipolar tribal members, who could find a deer and organize other tribe members to hunt it, who would find new better lands, who would surely leave posterity due to certain hypersexuality, was a positive thing. March mania can also be explained, the snow is off, there is a need for new pastures for the horses to graze, who would be the first one to search for these pastures? But in tribal times, people had ample chances to burn their energy. These days, we are sitting in cubicles and driving cars, physical activity is limited, and it worsens the mood.
MTG - I am from Seattle.
Sapphirelover - I am very happy that paracetamol did not work.
Re. Lithium - I have to speak up because it is a great drug. Fortunately, and very unfortunately, it was the first "bipolar" drug. We can not even imagine what were the lives of these poor people in pre-lithium days. I think the stigma dates back to these days. And then Lithium emerged, and it was a miracle drug. Of course, no one was aware of its toxicity, and in my residency program, I saw some hapless patients from these "early Lithium" days, all on dialysis and with severe Parkinsonism. Some of them, likely, were alive because of Lithium.
In high doses Lithium becomes nasty. Used as augmentation therapy, at 300-600 mg, it may be pretty well-tolerated and benign. I know people who use 75 mg.! It is like a vitamin, an additive, and it still works! The highest suicide rate is in Japan. But there are communities In Quita Prefecture who have higher levels of natural lithium in their water supplies. They have measurably fewer suicides than other areas. There is a neuropsychiatrist, Takeshi Terao, who published an article in the British Journal of Neuropsychiatry. He offered adding microdoses of Li into drinking water, like we now do with fluoride, to build up resistance to mood swings. Personally, I do not believe it will fly, but I surely believe in statistics.
I just do not want people who have been offered Lithium to get discouraged. Like with any drugs, small doses are very well-tolerated, large doses are very nasty. It may cause headaches (so can Lamotrigine) but curiously, it has been used to treat one specific type, cluster headaches. There is no major company standing behind Lithium, no one sells it at $ 15.00 a pill, like Abilify, so it is not advertised and no studies are done, but there is much evidence suggesting that small doses can prevent or delay Alzheimer's.
As to stigma, I totally agree that the biggest stigma is associated with schizophrenia. Partially, it had to do with horrible treatments, all these insulin shocks... Also, it was a thrash bin, and 90% of Asperger's and bipolar disorder with psychotic features, and schizoaffective disorder, all got there. But now we see new stigmas emerging. Asperger's is becoming a new stigma. Depression is not stigmatizing any longer, and bipolar is rapidly becoming de-stigmatized. Much owing to people like, Pandora, who are open and courageous and really committed to spreading awareness about this problem.
(Do not read it guys, I am biologist, and tend to explain everything the same way.)
Genetically we are still tribal people, and existence of bipolar tribal members, who could find a deer and organize other tribe members to hunt it, who would find new better lands, who would surely leave posterity due to certain hypersexuality, was a positive thing. March mania can also be explained, the snow is off, there is a need for new pastures for the horses to graze, who would be the first one to search for these pastures? But in tribal times, people had ample chances to burn their energy. These days, we are sitting in cubicles and driving cars, physical activity is limited, and it worsens the mood.
MTG - I am from Seattle.
Sapphirelover - I am very happy that paracetamol did not work.
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