Posted by bleauberry on March 9, 2010, at 17:58:21
In reply to lamotrigine starting dose (when added to venlafxin, posted by europerep on March 9, 2010, at 14:50:05
Everyone is different and everyone reacts different, and that is why I do not believe in one size fits all. Which is what a starter pack is. Which is what a target dose is. Which is what a titration schedule is. I disagree with all of those. The better strategy, in my opinion, is to let your own reaction guide the journey.
The primary risk with lamictal is the rash, which can be serious enough for hospitalization and sometimes even death. The primary risk of getting that rash is by starting at too high of a dose and by increasing dose too rapidly. Since everyone's biology is different, there is no way to know what those doses are from person to person.
Generally speaking, the safe starting dose of lamictal is 12.5mg. Simply cut the pills in half. See how you do for a week, then maybe go for 25mg. See how it goes for a couple weeks, then add another 12.5mg for a total dose of 37.5mg. This might be overly cautious, but that's just the way I am. I've learned some harsh lessons over the years, in terms of bad reactions as well as worsening of the original condition. Some people do very poorly on lamictal, and I'm one of them. It made me suicidal where I had not been suicidal prior to taking it. It can also be a miracle to some people.
Probably the only drawback, assuming it works, is that clinical studies show its longterm efficacy is not great. In clinical studies it delayed the return of depression but did not prevent it.
Personally I would forget the instructions and instead cut the pills in half. Others would say do what your doctor instructed. We all have to make our own decisions what is the wisest path.
I can think of better ways to treat TRD, starting for example with Parnate and Nardil before resorting to a drug like lamictal who's primary purpose is to control seizures not depression. But every doctor has their own favorite way of doing things, so I guess we kinda got a go with the flow as long as keep that doctor on our payroll.
poster:bleauberry
thread:939005
URL: http://www.dr-bob.org/babble/20100305/msgs/939023.html