Posted by SLS on April 10, 2004, at 9:38:52
In reply to Re: Higher doses of lamictal? » SLS, posted by rod on April 10, 2004, at 6:45:48
Hi Roland.
> > I really don't profit from Lamictal until I reach a dosage of 300mg per day.
> How did you tolerate Lamictal at the beginning, when you where titrating up? Any problems, side effects?
I experienced some mild itching in the beginning and upon dosage increases. It generally didn't last for more than a day or two. I also experienced a bit of ataxia (difficulty walking a straight line) and memory difficulties. I think there were some mild cognitive effects as well.
> I am asking, because I am not sure what to do with my 200mg Lamictal. Its not noticeable working very well, but when I try to decrease the dose I feel increased depression, and lightheadness etc.
That sounds like a return of depression or a depressive rebound. I guess it makes sense to hope that Lamictal still has the potential to provide you some added benefit. For me, the difference in my functionality between 200mg and 300mg is significant (when combined with a TCA), and I would endorse a trial at the higher dosage. It makes sense to move up cautiously, but I doubt you would experience anything untoward going up by 50mg for one week and then to increase to 300mg if you are now tolerating 200mg well. I think it is important to point out that 200mg did help me some, so there was a partial response. It sounds like you are gleaning at least some benefit at 200mg as well. That might be an indicator that you will do better at a higher dosage. I hope so.
> This might go into the direction of seizure like things.
I doubt it. Again, it sounds like a depressive rebound, as dizziness can be a symptom of depression, and it might be exaggerated as the result of the reduction in dosage of Lamictal and a resultant depressive rebound.
> Maybe this will all wear off after some time, because I never did decrease my dosage from 200 to 150 any longer than 2 days.
Interestingly, some people actually experience a transient improvement upon the reduction of dosage.
> When I first started Lamictal it worked wonderful on 50mg the first week (decreased anxiety, eliminated restlessness, etc.).
This is quite common. Many people report an improvement in depressive symptoms during the first few weeks of treatment and at the low dosages that are, of course, necessary to avoid a rash reaction. This antidepressant effect then plateaus and fades. One might then feel better immediately upon a dosage increases. However, it is my impression that as monotherapy, most people are disappointed by Lamictal.
Wow. That sounds unpleasant. I really don't know what to make of all of that. However, they can all be accounted for by the adverse effect profile of Lamictal if you look at the manufacturer's labelling:
http://www.rxlist.com/cgi/generic/lamotrigine_ad.htm
> confusion
> back/neck pain,
> headache
> clumsiness = ataxia
> muscle weakness = asthenia
> arms, hands, leg, feet felt totally numb = paresthesiaI'm not sure that any of these things represent a paradoxical seizure. I'm glad that they resolved for you.
> How would you describe the effect of Lamictal at 300mg? Is it activating, stimulating (in a pleasant way), motivating?
I would say yes to all of that.
> Can you say its targeting the core of your depression?
That's a great question. I would say that the combination of Lamictal + imipramine brings me up about 15% improvement over my unmedicated baseline depression. For me, it has been a critical difference such that I am more functional and better able to take care of myself. I would say that it is a global improvement, although mild. But I'll take anything I can get!
Just so that you are aware, I am currently fooling around with memantine (Namenda), a recently approved drug indicated for the treatment of moderate to severe Alzheimer's Disease. I chose memantine for a number of reasons; chief among them is that I am partially responsive to Lamictal. The two drugs reduce glutamatergic neurotransmission, albeit through different mechanisms. I am so scared to jinx things by saying that I am beginning to respond to it, but... We'll see.
I hope I helped answer your questions. Lamictal is a valuable drug, but it is probably best used in combination with other drugs when treating affective disorders: either an AD for depression or lithium for rapid cycling bipolar disorder.
I wish you all the best.
:-)
- Scott
poster:SLS
thread:332555
URL: http://www.dr-bob.org/babble/20040407/msgs/334848.html