Posted by Mondeo on April 12, 2002, at 4:56:03
In reply to Re: high-dose Lamictal: why not? » Elizabeth, posted by JohnX2 on April 4, 2002, at 10:05:35
>
> I think you 2 are missing the point of Zo's post.
> The doctor tried to titrate the dose to 600 mg in just a *few weeks*.
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> John
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>
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> > Hardly. I've certainly heard of people taking that much. When I tried Lamictal (for a completely off-label use), I went up to 500 mg. (It didn't do me any good at any dose in that range.)
> >
> > It's not clear how much people need for mood disorders -- it seems to be quite variable, though, and I would certainly allow for the possibility that some need high-end doses. Pharmacokinetic factors may play a role in some cases. Also, remember that the therapeutic serum level range for Depakote goes higher in bipolar d/o than epilepsy -- this could easily be the case for Lamictal as well. Therapeutic levels of Lamictal haven't been established, AFAIK, but it's worth considering the possibility that using higher doses would improve the response rate and the degree of response in mood disorders. I certainly don't think it's been studied enough that we can definitely say that it's no good increasing the dose past a certain amount. Lamictal's general safety and tolerability make it reasonable to consider that higher doses might be beneficial. Just because it's not the primary indication, that doesn't mean that the effective dose is likely to be lower -- it could just as easily be higher.
> >
> > -elizabethDear Elizabeth,
as a Lamictal user(since a couple of months,for BP2),I agree totally with your opinion,being a courageous one,mainly because of the so little professional info.about this promising med,in general and its proposed dosages,in special ; I myself,on my own,have had to go up and up,for the time being up to 400mg(taken in 2 partial dosages each 12 hours) ; there are very few docs taking the responsability advising and ACCEPTING (without too much hesitation)such higher dosages administration
My opinion as a BP2 sufferer since 1972 !(normally and as usually,I haven't been aware of this dx for so many years and as always,resuming myself thenjust to different AD'S,the best PARTIAL results being obtained then,with Celexa ) ; so MY opinion is that Mood Stabilizers are indeed important or even obligatory(not only for BP1,BP2 etc.,but also for UP's) and the most difficult questions are just arising from this point on:
a)which Mood Stabilizer? the old traditional ones with all of their shortcomings,or the newest generation,though lacking info.about
b)which should be the MAXIMAL dosage worth to be checked,tried(normally,presuming no serious side effects encountered ),before deciding(without any doubt) that a specific Mood S.(Lamictal etc.)isn't efficient enaough(or at all)even at that (?)higher dosage
c)should Mood S.be used as a monotherapy(even if still facing mild depr.breakthroughs)or as an adjunctive to the best AD ?I myself(again almost on my own)consider that the correct steps should be according to the 3 ones(the same order)as mentioned above ; Probably,permitting ourselves even dosages high as 500-600mg Lamictal(already acceptable for Epilepsy)before switching to another one and starting the "testings"with another one.
I do hope that such correspondence between us,may overcome the professional shortage I have been referring to; so,let's go ahead and exchange further on as much "trial and error" experiences(sometimes very difficult ones)best luck for ALL of us looking for the BEST solution,on our own
Mondeo
poster:Mondeo
thread:100086
URL: http://www.dr-bob.org/babble/20020408/msgs/102850.html