![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by JahL on March 10, 2001, at 13:10:40
Hi.
I'm on Lamictal 37.5md/day. This a/noon I forged a link btwn my last hypomanic episode 3 days ago & the taking of 0.5 Clonazepam the night b4.
Kinda missing the hypomania (infinitely better than persistent dysphoria), I took another 0.5mg/Clonazepam & 1hr later-boom-I'm up again.
Anyone know what's going on here? I don't remember reading anything about Clonazepam increasing Lamictal serum levels. Obviously I am concerned about the implications of rapidly increasing these.
Clonazepam on it's own does nothing-there's definitely a synergy @ work.
Thanx 4 any ideas...
Jah.
Posted by judy1 on March 10, 2001, at 14:14:26
In reply to Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely?, posted by JahL on March 10, 2001, at 13:10:40
Jah,
That's really interesting. I'm also on that combo (100mg lamictal and 6mg klonopin)+risperdal and xanax and have never noticed a synergistic effect. Actually, klonopin acts in a sedating fashion but is not strong enough to prevent a manic episode for me. I think you may be cycling independently of the meds (your lamictal dose is really low). Curious to see other's reactions.Take care, Judy
Posted by SLS on March 11, 2001, at 11:14:03
In reply to Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely?, posted by JahL on March 10, 2001, at 13:10:40
> Hi.
>
> I'm on Lamictal 37.5md/day. This a/noon I forged a link btwn my last hypomanic episode 3 days ago & the taking of 0.5 Clonazepam the night b4.
>
> Kinda missing the hypomania (infinitely better than persistent dysphoria), I took another 0.5mg/Clonazepam & 1hr later-boom-I'm up again.
>
> Anyone know what's going on here? I don't remember reading anything about Clonazepam increasing Lamictal serum levels. Obviously I am concerned about the implications of rapidly increasing these.
>
> Clonazepam on it's own does nothing-there's definitely a synergy @ work.
>
> Thanx 4 any ideas...
> Jah.
Hi Jah.Even though it doesn't sound quite right to me, it is possible that clonazepam is producing a phenomenon known as "disinhibition". Disinhibition is roughly the way alchohol works to allow people to get "high" and say and do things they would not otherwise do because of those healthy inhibitions that serve to control behavior. With benzodiazepines like clonazepam, disinhibition can produce a spectrum of behavioral and affective changes that range from euphoria to anger and rage.
I don't know.
- Scott
Posted by Cece on March 11, 2001, at 22:46:51
In reply to Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely?, posted by JahL on March 10, 2001, at 13:10:40
> Hi.
>
> I'm on Lamictal 37.5md/day. This a/noon I forged a link btwn my last hypomanic episode 3 days ago & the taking of 0.5 Clonazepam the night b4.
>
> Kinda missing the hypomania (infinitely better than persistent dysphoria), I took another 0.5mg/Clonazepam & 1hr later-boom-I'm up again.
>
> Anyone know what's going on here? I don't remember reading anything about Clonazepam increasing Lamictal serum levels. Obviously I am concerned about the implications of rapidly increasing these.
>
> Clonazepam on it's own does nothing-there's definitely a synergy @ work.
>
> Thanx 4 any ideas...
> Jah.
Hello-I think we spoke before re Lamictal? I too got effects from it while I was still at very low levels as you are ( I progressed VERY slowly up to my present 125mg.
But, I take other mood stabilizers too- A little Depakote (which is calming for me but also potentiates Lamictal), and Nuerontin, and I take Xanax.
From the things that you've written recently, you sound like you are indeed playing around on the edge of hypomania (or mania?). From my limited viewpoint, I also doubt that it's the Klonopin combo. I think that you need a guiding hand- are you being honest with your pdoc? It is so nice to be up after being down so long, but it's more than a good idea to do it in a healthy way.
Lamictal's a great med- hold your horses on it and find something to balance it out right for you. Sounds like Klonopin isn't the right balancer.
Good luck,
Cece
Posted by SLS on March 12, 2001, at 8:20:45
In reply to Re: Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely? » JahL, posted by Cece on March 11, 2001, at 22:46:51
Hi Cece and Jah,
> But, I take other mood stabilizers too- A little Depakote (which is calming for me but also potentiates Lamictal), and Nuerontin, and I take Xanax.
I think using Depakote to help prevent a manic reaction to Lamictal is a great idea in unequivocal bipolar disorder. I don't know if it would be desirable to so quickly add it if the self-reported hypomania is questionable. It would be a difficult judgment call that hopefully a doctor's experience can resolve. Certainly, mood liability appearing around the dosing to Klonipin is a confounding variable in coming to a decision. Actually, if true hypomania or full mania emerges with treatment, many doctors use this to diagnose bipolarity when it had not been suspected previously. This might be an important distinction to help choose future directions of treatment should it become necessary. As I am sure your doctor would be aware, taking Depakote affects dramatically the blood levels of Lamictal. Most often, the level of Lamictal is doubled, requiring a reduction in dosage. The general rule is to cut the dosage of Lamictal in half.
I think combining Lamictal with Neurontin has been growing in usage since the NIMH reported success with it for treating bipolar depression.
I am still suspect that Lamictal by itself is unreliable to prevent or control severe mania in many people.
- Scott
Posted by judy1 on March 12, 2001, at 10:30:17
In reply to Re: Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely?, posted by SLS on March 12, 2001, at 8:20:45
Hi Scott,
You and I share the same views about Lamictal, but when I expressed them to part of my bipolar team at UCSD they claimed to have no manic rx to a 200-400mg dose in their rapid cycling patients. (I don't know how many BP1s there were). Having been part of a research team doing clinical trials on different meds, I recognized the shelves of binders containing data in the office. I was under the impression that there are reported (published) papers describing this phenomena, I've experienced it 2x myself- with you pointing out very politely that I was getting manic. I go again on the 19th, do you have suggestions on how to broach this subject? Or is it possible like they said I'm just doing my cycling thing? Any input appreciated as always.
Take care, Judy
Posted by SLS on March 12, 2001, at 16:18:08
In reply to Re: Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely? » SLS, posted by judy1 on March 12, 2001, at 10:30:17
Hi Judy,
The first of the following two abstracts was authored by some pretty impressive personages. This is one article that I wish I could get my hands on and give to a statistician to interpret the results independent of the conclusions offered. They seem pretty tentative about touting lamotrigine as a robust medication to treat rapid-cyclicity. The statistical result offered of 41% efficacy versus 26% placebo doesn't seem terribly impressive to me, although it might be considered such in light of the refractory nature of rapid-cycling presentations. I know this sounds silly and overly simplistic, and I'm sure that it is, but 41%-26%=14%. What? Only 14% better? I'm not sure that a (p = .036) is a terribly high level of confidence either. I'll let someone who really knows something in this area educate me. However, I don't suppose I would complain too much if I were to find myself in that 14% group.
If the mood-stabilizing efficacy of lamotrigine monotherapy is as mediocre to prevent mania as it is to prevent rapid-cyclicity, perhaps it is incapable of offsetting the manic pressure produced by the drug's antidepressant properties. The net effect from using lamotrigine would be the development of mania or rapid-cyclicity for some people. It is interesting that several papers I came across described the rate of switching to be "low" for lamotrigine. I gather, then, that it does happen, even under the scrutiny of unsuspecting, and perhaps skeptical observers.
For my part, 200mg lamotrigine failed to hamper in any way my shooting into a Nardil-discontinuation rebound mixed-mania. Too many people on the most current Psycho-Babble postings have described manic-type reactions to lamotrigine to ignore taking a closer look at it.
If I find something more concrete that you can show your medical team, I will let you know. Otherwise, you may want to simply try adding Neurontin.
You are frequently in my thoughts, Judy.
Take care.
- Scott
-------------------------------------------
5: J Clin Psychiatry 2000 Nov;61(11):841-50A double-blind, placebo-controlled, prophylaxis study of lamotrigine in
rapid-cycling bipolar disorder. Lamictal 614 Study Group.Calabrese JR, Suppes T, Bowden CL, Sachs GS, Swann AC, McElroy SL, Kusumakar V, Ascher JA, Earl NL, Greene PL, Monaghan ET
University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Ohio, USA.
BACKGROUND: Patients with rapid-cycling bipolar disorder are often treatment refractory. This study examined lamotrigine as maintenance monotherapy for rapid-cycling bipolar disorder. METHOD: Lamotrigine was added to patients' current psychotropic regimens and titrated to clinical effect during an open-label treatment phase. Stabilized patients were tapered off other psychotropics and randomly assigned to lamotrigine or placebo monotherapy for 6 months. Time to additional pharmacotherapy for emerging symptoms was the primary outcome measure. Secondary efficacy measures included survival in study (time to any premature discontinuation), percentage of patients stable without relapse for 6 months, and changes in the Global Assessment Scale and Clinical Global Impressions-Severity scale. Safety was assessed from adverse event, physical examination, and laboratory data. RESULTS: 324 patients with rapid-cycling bipolar disorder (DSM-IV criteria) received open-label lamotrigine, and 182 patients were randomly assigned to the double-blind maintenance phase. The difference between the treatment groups in time to additional pharmacotherapy did not achieve statistical significance in the overall efficacy population. However, survival in study was statistically different between the treatment groups (p = .036). Analyses also indicated a 6-week difference in median survival time favoring lamotrigine. Forty-one percent of lamotrigine patients versus 26% of placebo patients (p = .03) were stable without relapse for 6 months of monotherapy. Lamotrigine was well tolerated; there were no treatment-related changes in laboratory parameters, vital signs, or body weight. No serious rashes occurred. CONCLUSION: This was the largest and only prospective placebo-controlled study of rapid-cycling bipolar disorder patients to date; results indicate lamotrigine monotherapy is a useful treatment for some patients with rapid-cycling bipolar disorder.
Publication Types:
Clinical trial
Multicenter study
Randomized controlled trialPMID: 11105737
-----------------------------------------------------
30: Ann Pharmacother 1999 Jul-Aug;33(7-8):864-7Lamotrigine--an effective mood stabilizer?
Maidment ID
Hellesdon Hospital, Norwich, Norfolk, United Kingdom.
OBJECTIVE: To review the literature regarding the use of lamotrigine as a mood stabilizer, and to discuss its efficacy in treating this condition. DATA SOURCES: Data were obtained from MEDLINE, Micromedex, and Cochrane collaboration searches from January 1985 to July 1998. DATA SUMMARY: There are insufficient data to confirm that lamotrigine is an effective mood stabilizer. There are no controlled studies, and the current evidence is from case studies and open trials. Furthermore, only one study shows any evidence of effectiveness in the manic phase, although this may be because the data tend to relate to a treatment-refractory population. CONCLUSIONS: From the current evidence, lamotrigine cannot be recommended as a mood stabilizer except when conventional therapies have failed.
Publication Types: Review Review, tutorial
PMID: 10466917
Posted by judy1 on March 12, 2001, at 17:41:18
In reply to Re: Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely? » judy1, posted by SLS on March 12, 2001, at 16:18:08
For your kindness and help. I am going to print out these 2 abstracts and bring them Monday. I agree the first was not statistically significant. I hope you are doing better- take care, judy
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.