Lamitrogine
We’re increasing it to 150mg/day, keeping the 1200mg of lithium and 150mg of Effexor XR the same, and I’m having my lithium levels checked. Hopefully, things will improve.
LAMICTAL (lamotrigine), an antiepileptic drug (AED) of the phenyltriazine class, is chemically unrelated to existing antiepileptic drugs. Its chemical name is 3,5-diamino-6-(2,3-dichlorophenyl)-as-triazine, its molecular formula is C9H7N5Cl2, and its molecular weight is 256.09. Lamotrigine is a white to pale cream-colored powder and has a pKa of 5.7. Lamotrigine is very slightly soluble in water (0.17 mg/mL at 25°C) and slightly soluble in 0.1 M HCl (4.1 mg/mL at 25° C).
INDICATIONS
…
Bipolar Disorder
LAMICTAL is indicated for the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy.
Structural formula of lamitrogine
The effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established.
The target dose of LAMICTAL is 200 mg/day. In the clinical trials, doses up to 400 mg/day as monotherapy were evaluated, however, no additional benefit was seen at 400 mg/day compared to 200 mg/day. Accordingly, doses above 200 mg/day are not recommended.
To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations of LAMICTAL should not be exceeded.
SERIOUS RASH REQUIRING HOSPITALIZATION AND DISCONTINUATION OF LAMICTAL, INCLUDING STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS, HAVE OCCURRED IN ASSOCIATION WITH THERAPY WITH LAMICTAL. RARE DEATHS HAVE BEEN REPORTED, BUT THEIR NUMBERS ARE TOO FEW TO PERMIT A PRECISE ESTIMATE OF THE RATE.
Adverse Events & Side Effects
Dream abnormalities occur in about 6% of lamitrogine users.
More common side effects include headache (25%), rash (11%), dizziness (10%), diarrhea (8%), dream abnormality (6%), and pruritus (6%). Events that occurred in 5% or more patients but equally or more frequently in the placebo group included: dizziness, mania, headache, infection, influenza, pain, accidental injury, diarrhea, and dyspepsia. Adverse events that occurred with a frequency of less than 5% and greater than 1% of patients receiving LAMICTAL and numerically more frequent than placebo included fever, neck pain, migraine, flatulence, weight gain, edema, arthralgia, myalgia, amnesia, depression, agitation, emotional lability, dyspraxia, abnormal thoughts, dream abnormality, hypoesthesia, sinusitis, and urinary frequency.
Adverse Events Following Abrupt Discontinuation
In the 2 maintenance trials, there was no increase in the incidence, severity or type of adverse events in Bipolar Disorder patients after abruptly terminating LAMICTAL therapy. In clinical trials in patients with Bipolar Disorder, 2 patients experienced seizures shortly after abrupt withdrawal of LAMICTAL. However, there were confounding factors that may have contributed to the occurrence of seizures in these bipolar patients.
Mania/Hypomania/Mixed Episodes
During the double-blind, placebo-controlled clinical trials in Bipolar I Disorder in which patients were converted to LAMICTAL monotherapy (100 to 400 mg/day) from other psychotropic medications and followed for durations up to 18 months, the rate of manic or hypomanic or mixed mood episodes reported as adverse experiences was 5% for patients treated with LAMICTAL (n = 227), 4% for patients treated with lithium (n = 166), and 7% for patients treated with placebo (n = 190). In all bipolar controlled trials combined, adverse events of mania (including hypomania and mixed mood episodes) were reported in 5% of patients treated with LAMICTAL (n = 956), 3% of patients treated with lithium (n = 280), and 4% of patients treated with placebo (n = 803).
Why Non-Cutters Should Worry Less: In Defense of Self-Mutilation, part four
How Much Should Cutting Worry Non-Cutters, as Opposed to, Say …
I don’t know. What are they worried about?
Cutting or any other act of self-mutilation is worrisome, of course, because it means that the person in question is not at peace with his/her world, that his/her emotional and psychological turmoil is not relieved by any socially acceptable means, and that s/he does not feel s/he can trust the coping skills endorsed by his/her parents, healthcare providers, teachers, etc., to take the place of self-harm. It means that the person probably feels a degree of lostness, loneliness, emptiness, sadness, anxiety, hatred, self-loathing, confusion, anger, and lots of other difficult emotions that may far surpass any negative emotion you have felt in your own life. It means that this person, in some sense, is exploring his/her own mortality and is, statistically, more likely to attempt suicide than a random person from the general population. If it were my friend of sibling or child, I would worry too, about the overall condition. (You should realize, of course, that freaking out, yelling at the person, imposing a Nazi-like set of rules, demanding sweeping changes right away, and/or inviting the person into a sweetly sanitized version of your world where everything will just be all right … These interventions are more likely to make things worse than better.)
But the cutting itself … What are you worried about?
Infection? That is a real concern, but it can be minimized with clean razors or knives, some rubbing alcohol or another antiseptic, and some gauze pads. When a cutter accepts the impulse to self-injure as a way of coping without burdening it with moral labels, the cutter will be more likely to do it safely.
Suicide? Cutting is not suicidal behavior, and does not necessarily indicate suicidal ideation. I sincerely doubt cutters are any more at risk for suicide than other depressed people with other less-than-ideal coping mechanisms like excessive drinking. Worry about the depression
Cutting as the New Teen Craze? No. There is a study published in summer 2007 claiming that 46% of teens have deliberately injured themselves (as opposed to 4% of the general population) and a 2008 Canadian study claiming 17.6% (or “one of six”) young people age 14 to 21 has done so. I suspect these studies are flawed and their numbers inflated, however. There is an enormous difference between generations in terms of what behavior would be reported in a psychological survey and how.
Teens today live in a more open culture in terms of psychological and psychiatric issues, and an arts and entertainment culture that often wears its pain on its sleeve (see emo). My guess is they are much more likely to report (and possibly more likely to overreport or falsely report) self-injury. Older cohorts, on the other hand, are less likely to admit to self-injury even on an anonymous survey—and this is increasingly true as we go back to older and older generations.
Categories of self-injury in these studies may be troublesome also. The articles linked above do not give sufficient detail to seriously examine this issue, but the numbers seem ridiculously high to me, so I find it suspicious. Behaviors listed in the articles include “cutting or burning skin, … biting or hitting oneself,” “scratching, … and minor overdoses of drugs (… prescription drugs [or] street drugs) and alcohol.” So every kid who pukes or passes out on drugs or booze is a self-injurer? Does hitting oneself include slapping oneself to stay awake? Does hitting or banging one’s head against a wall count (even though that probably would have been an expression of rage in older generations, not a deliberate self-injury)? Do injuries from Jackass-style pranks, backyard wrestling, or extreme sports count?
Don’t worry about the “fad”—the real fad is emo, which is essentially the same as that folk-singer-songwriter-confessional-poet-david-bowie-joy- division-robert-smith-morrissey-sad-grunge thing we all grew up on. It is no more dangerous now than it was then.
Cutting itself is not as dangerous as the hype suggests. I’d place it above habitual overeating, but below thrill-seeking extreme sports-type stuff on the danger scale. The risk is manageable. Like most addictions or habitual maladaptions, it will at some point cease to give the cutter what s/he wants, at which point a decision must be made, help must be sought (in my opinion), and recovery must begin.
Until then, friends and family of cutters, especially if you are non-cutters, need to focus on harm reduction and the underlying depression, anxiety, frustration, and/or stress lying under the self-injury. If you fuck this up by freaking out, moralizing, pontificating, accusing, etc., you will be much worse for the kid than the razor itself.
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D34r f15h: Why are black people so loud?
Black People Say It Loud
Let’s be fair here: There are plenty of African-Americans who are not so loud, who are, in fact, pretty quiet. But I know what you mean. Black folks seem to speak at higher volumes than white folks whether they’re happy (hanging out with friends, conversing on public transportation, watching a movie in the theater) or angry (scolding their children or significant others or complete strangers). They hold intimate conversations in public spaces at embarrassing pitches, shouting things that white people would be ashamed to whisper in the company of strangers. Why is this?
Well, several factors apply, it seems to me. For most of them, you can Google “Why are black people so loud?” and find many helpful responses, from “Because they’re ignorant little picaninnies” to “Shut up, you fucking racist cracker.” Beyond that, here are my humble contributions to the debate:
First, the level of frustration is high for black mothers in particular. With so many absentee or no account black fathers, black mothers often feel as though they are alone in the difficult task of raising black children, who may or may not be more prone to bad behavior than white children. (I don’t think they are any worse than white kids, but the black mothers I hear yelling at them all the time might disagree, at least in private, if there is such a thing as “private” for black mothers.)
Secondly, black folks have been told to shut up for a long time, and at some point along the way, maybe with the advent of the Black Power movement in the mid-late ’60s, they became sick of it. Empowering messages transmitted through negro music such as blues, rhythm & blues, soul, funk, and rap encouraged them to make some noise. To do otherwise would be to capitulate to white culture and assume the mantles of “Uncle Tom” and “Aunt Jemima.” Ever since slavery, lots of black folks have carried chips on their shoulders. I don’t blame them. I mean, if I went back far enough, I could probably find slaves in my own ancestry, but for African-Americans, the brutal and repressive condition was much more recent and in the country in which they still live. That doesn’t excuse them from taking personal responsibility for their lives, but it’s something. They’re mad as hell about not being able to talk as loud as they wanted to back then, and so they are not going to take it anymore.
I hope my wisdom has enlightened you on this issue, dear reader. Next time you are annoyed with a loud black person, just tell them, “I am so glad you are no longer a slave, but could you assert your freedom a little more quietly or farther away from me, please?” And if you thought they were loud before …
Marching forward to death
Death of a Star
Hello all.
It’s been a while since I posted. Not that anyone really reads this blog, but that’s not the point. Anyway, it occurs to me that one way to measure the time between now and the last time I posted is to compile a list of some of the famous people who have died during that time and to do a mini-analysis of that list. So, without further …
These are people who died, Aug. 22, 2008 – April 14, 2009, with occupation, age, death date, and cause of death.
- Andre “Dr. Dre, Jr.” Young, Jr. // famous son // 20 // August 23, 2008 // overdose, heroin and morphine
- Del Martin // lesbian rights activist // 87 // August 27, 2008 // Complications from a bone fracture, declining health previous, old age
- Killer Kowalski // professional wrestler // 82 // August 30, 2008 // heart failure
- Jerry Reed // country music singer, actor // 71 // August 31, 2008 // complications from emphysema
- Don LaFontaine // voice actor, movie trailer voice guy // 68 // September 1, 2008 // pulmonary embolism, pneumothorax
- Bill Meléndez // animator (Peanuts) // 91 // September 2, 2008 // unknown, old age
- Anita Page // silent film actor, 1st Academy Awards // 98 // September 6, 2008 // natural, old age
- David Foster Wallace // writer // 46 // September 12, 2008 // suicide
- Norman Jesse Whitfield // songwriter, producer (Motown, psychedelic soul) // 68 // September 16, 2008 // complications of diabetes
- Paul Newman // actor // 83 // September 26, 2008 // lung cancer
- Gidget Gein // musician, Marilyn Manson bass player // 39 // October 8, 2008 // overdose, heroin
- Rudy Ray Moore // comedian, actor, Dolemite // 81 // October 19, 2008 // complications of diabetes
- Anne Pressly // TV news anchor, Little Rock, AR // 26 // October 25, 2008 // trauma, beating
- Mitch Mitchell // musician, Jimi Hendrix Experience drummer // 62 // November 12, 2008 // “natural causes,” unknown
- MC Breed // musician, rapper // 37 // November 22, 2008 // kidney failure
- Munetaka Higuchi // musician, Loudness drummer // 49 // November 30, 2008 // liver cancer
- Paul “Bentley” Benedict // actor, “The Jeffersons” // 70 // December 1, 2008 // unknown
- Bettie Page // pinup model, fetish film actor // 85 // December 11, 2008 // pneumonia
- W. Mark “Deep Throat” Felt // FBI agent, informant // 95 // December 18, 2008 // unknown, old age (congestive heart failure probable indirect cause)
- Harold Pinter // playwright // 78 // December 24, 2008 // cancer
- Eartha Kitt // actor, singer, dancer, Catwoman // 81 // December 25, 2008 // colon cancer
- Freddie Hubbard // musician, jazz trumpeter // 70 // December 29, 2008 // complications from heart attack
- Jett Travolta // famous son // 16 // January 2, 2009 // seizure
- Ricardo Montalban // actor, Fantasy Island host, fine Corinthian leather enthusiast // 88 // January 14, 2009 // unknown, old age
- Andrew Wyeth // artist, painter // 91 // January 16, 2009 // old age
- John Updike // writer // 76 // January 27, 2009 // cancer
- James Whitmore // actor // 87 // February 6, 2009 // lung cancer
- Socks // First Cat under the Clinton Administration // 19 // February 20, 2009 // euthanized, possible cancer
- Paul Harvey // radio personality, storyteller // 90 // February 28, 2009 // unknown, old age
- Ron Silver // actor // 62 // March 15, 2009 // esophageal cancer
- Nicholas Hughes // marine biologist, son of poets (Sylvia Plath, Ted Hughes) // 47 // March 16, 2009 // suicide
- Natasha Richardson //actor // 45 // March 18, 2009 //accident, epidural hematoma
- Dan Seals // musician, wuss-rocker // 61 // March 25, 2009 // cancer
- Irving R. Levine // journalist, bow-tie aficionado //86 // March 26, 2009 // prostate cancer
- Andy Hallett // actor, singer, Host // 33 // March 29, 2009 // heart failure
- Deborah Digges // poet, memoirist // 59 // April 10, 2009 // suicide
- Marilyn Chambers // porn star, actor, Personal Choice Party candidate for US VP // 56 // April 12, 2009 // unknown, “natural causes”
by age % (n)
0-17 2.7% (1)
18-25 5.4% (2)
26-35 5.4% (2)
36-49 16.2% (6)
50-60 5.4% (2)
61-74 21.6% (8)
75-100 43.2% (16)
cause of death by age
overdose 2 (18-25, 36-49)
old age 7 (75+)
heart failure 2 (75+, 26-35)
emphysema 1 (61-74)
pulmonary embolism 1 (61-74)
suicide 3 (36-49, 50-60)
diabetes 2 (61-74, 75+)
cancer 9 (lungX2, unspecifiedX, colon, prostate 75+; esophageal, unspecified 61-74; liver 36-49;)
violence 1 (26-35)
“natural”/unknown 3 (61-74, 50-60)
kidney failure 1 (36-49)
pneumonia 1 (75+)
heart attack 1 (61-74)
seizure 1 (0-17)
euthanasia 1 (18-25)
trauma 1 (36-49)
cause of death by occupation
overdose 2 (none or unknown, musician)
old age 7 (activist, animator, actorX2, politics, law enforcement, artist, radio personality)
heart failure 2 (wrestler, actor)
emphysema 1 (musician, actor)
pulmonary embolism 1 (voice actor)
suicide 3 (writer, scientist & son of poets, poet)
diabetes 2 (musician, comedian, actor)
cancer 9 (lung, colon, esophageal actorX2; liver, colon musician; unspecified playwright, writer, musician; prostate journalist)
violence 1 (journalist)
“natural”/unknown 3 (musician, actor, porn star)
kidney failure 1 (musician)
pneumonia 1 (model)
heart attack 1 (musician)
seizure 1 (none or unknown)
euthanasia 1 (politics)
trauma 1 (actor)
