Posted by dewdropinn on July 30, 2007, at 12:52:37
In reply to lamotrigine - anyone on 800 mg/day?, posted by Keith Talent on July 29, 2007, at 3:40:27
I can certainly understand the reaction to this query from some posters -- FDA guidelines suggest 200mg as the ceiling for treatment of mood disorders, which creates the perception that anything over 200mg is heroic. Bipolar specialists and researchers commonly prescribe way over 200mg. I've taken 400mg for years.
Lamictal lends itself to high dosing because it has minimal impact on endocrine, liver and kidney function -- so physiologically there's no greater risk in taking 25mg than 1000mg (except for possible depletion of folate which is easily treatable.) Epileptics commonly take 800mg, so you aren't entering uncharted territory by any means. Epilepsy is believed to be closely related to bipolar, so it would seem to make sense that the drugs and dosing may often run a parallel course.
I suspect that your doctor is a bipolar specialist, is probably involved with research, and definitely knows his stuff. I don't think many psychiatrists would consider pushing the dose to 800mg, and most would be very uncomfortable prescribing 400mg -- not because of safety issues, but because it deviates from traditional treatment guidelines. These higher doses are not at all uncommon for the research crowd.
So, you're by no means putting yourself at risk, it sounds like you're in good hands, and hopefully the increase in dose proves beneficial.
Drew
> Currently on 400 mg/day (split into 2 doses) for a bipolar spectrum disorder. Only been on this dose for a week, so too early to tell if it will help. My psychiatrist is going to keep me on this dose for 6 weeks, then either increase it to 800 or add lithium (probably at 1.2 mEq/L).
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> As for the posts re lamotrigine memory impairment, this drug was developed for epilepsy in the (erroneous) belief that folate increased the likelihood of seizures. So yes, it does have an anti-folate action, but this has nothing to do with its antiepileptic/mood stabilizing properties. It would be interesting to see a double-blind, randomized controlled trial on the effects of folate supplementation on memory/cognition in patients on lamotrigine (or has this been done already?).
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poster:dewdropinn
thread:772668
URL: http://www.dr-bob.org/babble/20070730/msgs/772913.html