![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by phillybob on March 8, 2001, at 20:37:11
In reply to Re: Spoke too soon... » Cece, posted by JahL on March 4, 2001, at 17:25:46
I have read your info Cece and thanks for it ... and, Jah, I am also sharing your trial (in a way)!
Upon recently ending a successful and yet sadly unsuccessful [check out my topamax experiences' last post: http://www.dr-bob.org/babble/20010302/msgs/55563.html] trial with a different neuromodular drug, topiramate, I have, after a week plus off, started Lamictal too at 12.5 mgs/day as monotherapy for my BPII rapid cycling dysthymic-type condition (all of the details, again, are in my posts in the topamax thread).
So far, for the past 4 days, I've already felt some mild improvement (somewhat consistent in depression-lifting but not in energy level). Only side-effect so far was a (provoked) laughing fit which I could not seem to shake. It was definitely a giddiness which I am not inclined to have so I will attribute it to the med.
I'll keep watching (as is my pdoc) for signs of (hypo)mania. Intention is to keep at 12.5 mgs/day for another week and a half to see what happens. (as I'm hugely sensitive to meds, in general, I am not expecting to need too much but we'll see, huh?). If I become too semi-permanently giddy, I'll think of adding topamax (anew) or neurontin.
Keep posting, Jah! I feel a kinship in a lot of ways.
Posted by JahL on March 9, 2001, at 9:29:17
In reply to current Lamictal trials in action, posted by phillybob on March 8, 2001, at 20:37:11
> > I have read your info Cece and thanks for it ... and, Jah, I am also sharing your trial (in a way)!
> > Upon recently ending a successful and yet sadly unsuccessful [check out my topamax experiences' last post: http://www.dr-bob.org/babble/20010302/msgs/55563.html] trial with a different neuromodular drug, topiramate, I have, after a week plus off, started Lamictal too at 12.5 mgs/day as monotherapy for my BPII rapid cycling dysthymic-type condition (all of the details, again, are in my posts in the topamax thread).Howdy, fellow Lamactil inductee!
I remember following yr Topiramate trial & thinking @ the time that Lamactil would be a better choice considering the chronic depression angle (as with myself). Apathy prevented me from posting my thoughts (not so amotivated on Lamactil)!> > So far, for the past 4 days, I've already felt some mild improvement (somewhat consistent in depression-lifting but not in energy level). Only side-effect so far was a (provoked) laughing fit which I could not seem to shake. It was definitely a giddiness which I am not inclined to have so I will attribute it to the med.
Benefits made themselves apparent soon after titration to 25mgs. Most dramatic has been the improvement in cognitive functioning & the near-elimination of social phobia (to the point where I have stopped taking Sulpiride-my S.phobia. med of the last yr). I think the true AD properties kick in @ higher doses (usually 100-200mg), although I have a feeling you & I might get away with less! Like you, my 'energy levels' haven't improved yet.
> > I'll keep watching (as is my pdoc) for signs of (hypo)mania. Intention is to keep at 12.5 mgs/day for another week and a half to see what happens. (as I'm hugely sensitive to meds, in general, I am not expecting to need too much but we'll see, huh?). If I become too semi-permanently giddy, I'll think of adding topamax (anew) or neurontin.
I too am taking it slow. 12.5mg increase/week. Unless you're desperately depressed this is probably a prudent measure; IMO (fwiw) Lamactil is potentially too good a drug to miss out on through impatience.
> > Keep posting, Jah! I feel a kinship in a lot of ways.
DITTO!
Jah.
Posted by phillybob on March 19, 2001, at 18:42:25
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on March 9, 2001, at 9:29:17
So, Jah, how does it go?
I've been up to 25 mg/day for almost a week and the verdict is still out. It sure beats nothing, though! Starting to get a few things done again. Since I am very sensitive, I am still going to take it very slow. I am thinking I may not even get up to 50 mg/day. I do think, in hindsight, with so many of my other medications trials, that the amounts taken (usually the recommended, sometimes more) were too much for me. We shall see. P.S. It's still monotherapy on my end.
Posted by JahL on March 21, 2001, at 16:48:45
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on March 19, 2001, at 18:42:25
> > So, Jah, how does it go?
(hi Bob)
Frustrating. No great advance upon the improvements (in cognition, co-ordination & s. phobia) I reported previously, though it's unrealistic (going by what I've read) to expect my current dose (67.5mg) to deliver the kind of results that doses of btwn 100 & 200+mg seem to.The tortuously slow dose ramping is starting to wind me up; I'm considering jumping 12.5mg every 5 days instead of 7. The worry is of course that I'll invoke the rash & have to start all over again!
Only side-effect I've noticed is slight GI discomfort.
Whatever happens tho', I'm already impressed enough w/Lamictal to keep it on board.
Keep us posted & stick with it!
Jah.
~
> > I've been up to 25 mg/day for almost a week and the verdict is still out. It sure beats nothing, though! Starting to get a few things done again. Since I am very sensitive, I am still going to take it very slow. I am thinking I may not even get up to 50 mg/day. I do think, in hindsight, with so many of my other medications trials, that the amounts taken (usually the recommended, sometimes more) were too much for me. We shall see.> > P.S. It's still monotherapy on my end.
(Me also.)
Posted by phillybob on March 21, 2001, at 19:57:04
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on March 21, 2001, at 16:48:45
Hey, Jah, hang in there, Friday's coming (a 70's expression, I believe). Friday'll be euthymia, for our purposes.
As far as titration, last week my pdoc explained how it would probably be okay to increase a bit faster because once past the beginning period, increases in dosage become a smaller percentage of the whole that one is taking.
In other words, in the beginning, a jump from 12.5 mg to 25 mg is a 100% increase. 25 mg to 50 mg is likewise a 100% increase. But, 50 mg to 75 mg then becomes just a 50% increase and 75 mg to 100 mg becomes a smaller 33% increase, etc., etc.
I also read somewhere that the first month is most important so that the body can acclimate to the drug. Once getting through that first month of adjustment, the likelihood of developing the rash is quite small. So, I've read, at least.
Nonetheless, I met with the pdoc tonight, and I'm gonna sally forward with a 12.5 mg/day increase some time this weekend for a total of 37.5 mg/day. I am going to split the dosage, for now. 25 mg then 12.5 mg later.
The pdoc has also more or less given the thumbs up to increase that to a total of 50 mg/day a bit quicker than we had been going, and then hang out there for a bit.
Yep, it's frustrating, this patience thang. I find that the not complete positive effects that I have kind of wear off by the afternoon. Perhaps, the higher doses will make it last for the day and perchance make me all better. Patience.
Posted by Bob on March 21, 2001, at 21:50:29
In reply to Re: current Lamictal trials in action, posted by phillybob on March 21, 2001, at 19:57:04
> Hey, Jah, hang in there, Friday's coming (a 70's expression, I believe). Friday'll be euthymia, for our purposes.
>
> As far as titration, last week my pdoc explained how it would probably be okay to increase a bit faster because once past the beginning period, increases in dosage become a smaller percentage of the whole that one is taking.
>
> In other words, in the beginning, a jump from 12.5 mg to 25 mg is a 100% increase. 25 mg to 50 mg is likewise a 100% increase. But, 50 mg to 75 mg then becomes just a 50% increase and 75 mg to 100 mg becomes a smaller 33% increase, etc., etc.
>
> I also read somewhere that the first month is most important so that the body can acclimate to the drug. Once getting through that first month of adjustment, the likelihood of developing the rash is quite small. So, I've read, at least.
>
> Nonetheless, I met with the pdoc tonight, and I'm gonna sally forward with a 12.5 mg/day increase some time this weekend for a total of 37.5 mg/day. I am going to split the dosage, for now. 25 mg then 12.5 mg later.
>
> The pdoc has also more or less given the thumbs up to increase that to a total of 50 mg/day a bit quicker than we had been going, and then hang out there for a bit.
>
> Yep, it's frustrating, this patience thang. I find that the not complete positive effects that I have kind of wear off by the afternoon. Perhaps, the higher doses will make it last for the day and perchance make me all better. Patience.***********
Hey phillybob! It's Bob from the Topomax thread.
I was just hoping that if this Lamictal thread has a long and prosperous life like like the Topo one, that comparisons will begin to be drawn between the two as relative therapeutic effects.
Just a thought. It doesn't sound like any of you guys on this thread for Lamictal are ready for that yet though, as you guys still seem to be trying to reach adequate doses.
Bob
Posted by JahL on March 22, 2001, at 13:36:08
In reply to Re: current Lamictal trials in action, posted by phillybob on March 21, 2001, at 19:57:04
> > As far as titration, last week my pdoc explained how it would probably be okay to increase a bit faster because once past the beginning period, increases in dosage become a smaller percentage of the whole that one is taking.
> > In other words, in the beginning, a jump from 12.5 mg to 25 mg is a 100% increase. 25 mg to 50 mg is likewise a 100% increase. But, 50 mg to 75 mg then becomes just a 50% increase and 75 mg to 100 mg becomes a smaller 33% increase, etc., etc.Thanks Bob, that makes a lot of sense.
> > I also read somewhere that the first month is most important so that the body can acclimate to the drug. Once getting through that first month of adjustment, the likelihood of developing the rash is quite small. So, I've read, at least.
Yeah, the general consensus seems to be that the first couple of months are the most critical.
I'll probally hit 75mg, & stay there for a week before making the jump to the magic figure of 100mg.
> > Nonetheless, I met with the pdoc tonight, and I'm gonna sally forward with a 12.5 mg/day increase some time this weekend for a total of 37.5 mg/day. I am going to split the dosage, for now. 25 mg then 12.5 mg later.
> > The pdoc has also more or less given the thumbs up to increase that to a total of 50 mg/day a bit quicker than we had been going, and then hang out there for a bit.
> > Yep, it's frustrating, this patience thang. I find that the not complete positive effects that I have kind of wear off by the afternoon. Perhaps, the higher doses will make it last for the day and perchance make me all better. Patience.I too am finding the response a little erratic (& am p*ssed off the hypomania's stopped!), but like youself, am expecting a more consistent, robust response @ more 'therapeutic' levels (I think the definitive Lamotrigine study 4 rapid-cyclers showed around *3 times* the reponse @ 200mg, compared with a 50mg dose).
I think Lamotrigine is split @ higher doses, so this may help with the afternoon 'dip'.
J.
Posted by Lexie on March 24, 2001, at 19:27:15
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on March 22, 2001, at 13:36:08
Well, you have all heard me brag on my pdoc, he has had me taking Topamax 400 mgs. almost one year now with Lamictal 500 mgs. Never any side effects to mention. I was doing so well I took it on myself to stop the lamictal, didn't think I needed it. Guess I was wrong. When I went back to see the doc he decided he would rather I try Gideon with the topamax. I did, it nearly killed me, nasua, fatigue etc.., When I called him he didn't want to give up on the Gideon. He wanted me to continue! What is up with this? I want my Lamictal? He even said eventually he wants to take me off the Topamax. So what's the scoop? Did Dr. Wonderful find out something not so wonderful about these drugs he is not telling me? Have any of you heard what is supposta be so wonderful about Gideon? Those 500 mgs. of Lamictal are looking pretty good right about now, I am not going anywhere near that Gideon "Poison"!!!!!! Lexie
Posted by JahL on March 24, 2001, at 19:50:59
In reply to It's Lexie the Lamictal/Topamax Poster Child, posted by Lexie on March 24, 2001, at 19:27:15
> >Well, you have all heard me brag on my pdoc, he has had me taking Topamax 400 mgs. almost one year now with Lamictal 500 mgs. Never any side effects to mention. I was doing so well I took it on myself to stop the lamictal, didn't think I needed it. Guess I was wrong. When I went back to see the doc he decided he would rather I try Gideon [do you mean Geodon?] with the topamax. I did, it nearly killed me, nasua, fatigue etc.., When I called him he didn't want to give up on the Gideon. He wanted me to continue! What is up with this? I want my Lamictal?
Sounds like you need it!
> > He even said eventually he wants to take me off the Topamax. So what's the scoop? Did Dr. Wonderful find out something not so wonderful about these drugs he is not telling me? Have any of you heard what is supposta be so wonderful about Gideon?
Zyprexa w/o the weight gain?
> >Those 500 mgs. of Lamictal are looking pretty good right about now, I am not going anywhere near that Gideon "Poison"!!!!!! Lexie
The only really worrying thing I've read about Lamotrigine is its melanin-binding properties, which mean it could theoretically accumulate in the eyes longterm, possibly causing damage (!) However this aspect was reviewed during trials & nothing significant showed up (over a yr I think).
Having read some of yr previous posts, I too wonder why yr pdoc won't put you back on Lamictal. If it ain't broke, why fix it?
J.
Posted by phillybob on April 3, 2001, at 22:43:55
In reply to Re: It's Lexie the Lamictal/Topamax Poster Child » Lexie, posted by JahL on March 24, 2001, at 19:50:59
Okay, Jah, what gives?
I'm not doin' so hot here (no side effects but no improvement). Slowly I titrate. I'm at 50 mg but seem to be so down and out that I'm not even excited 'bout the next jump up ... which I should be doin' to 75 mg tomorrow or the next day or the next (I have to look at a calendar). Okay, now I'm gonna cut and paste from a recent more clear-headed post of mine cause I'm feelin' lazy (but first, I'm gonna hypothesize in this here parenthetical that I'm getting a cold which is why I am so cranky and unproductive ... at least, that hypothesis makes me feel a little better) ...
I've added 5 mg/2X daily of Adderall after some thinkin' about my past experiences and recently talkin' with the younger bro about his experiences. I definitely have always had ADD problems but never got past a Ritalin trial, for some reason. I remember reading John L's concise analysis and discussion of "line of fire" approaches, including benign and fast-acting stimulants ( http://www.dr-bob.org/babble/20000209/msgs/20873.html ). Anyway, the pdoc and I discussed Adderall and Dexadrine and felt, based upon my bro's success, Adderall would be worth a trial right now.
Nonetheless, based upon my brief (almost 2 months) but "total" "cure" for my symptoms (atypical-type AD-treatment-resistent depression ... an oxymoron?) with Topamax, I think this class of "neuromodulatory" drugs would have good long-term efficacy for me. [From the Topamax Experiences thread ( http://www.dr-bob.org/babble/20001231/msgs/50878.html ), I discontinued Topamax due to a bad side effect of receding gums; however, I would certainly re-visit it at a lower dose in the future as an adjunct for a partial or in lieu of a failed Lamictal response.
Okay, I'm done with re-cycling posts for now. So tell us, Jah, what have you been up to lamictally-speaking?
Posted by katrina on April 5, 2001, at 9:14:55
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on April 3, 2001, at 22:43:55
I am in my second week on lamictal and up to 50 mgs. I find it helps stabilize my mood; I seem more even keel.
Posted by JahL on April 5, 2001, at 12:18:31
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on April 3, 2001, at 22:43:55
> > Okay, Jah, what gives?
> > I'm not doin' so hot here (no side effects but no improvement). Slowly I titrate. I'm at 50 mg but seem to be so down and out that I'm not even excited 'bout the next jump up ... which I should be doin' to 75 mg tomorrow or the next day or the next (I have to look at a calendar). Okay, now I'm gonna cut and paste from a recent more clear-headed post of mine cause I'm feelin' lazy (but first, I'm gonna hypothesize in this here parenthetical that I'm getting a cold which is why I am so cranky and unproductive ... at least, that hypothesis makes me feel a little better) ...> >So tell us, Jah, what have you been up to lamictally-speaking?
'Bout the same as you Bob. Tho' it's keeping my head above water, I feel only marginally better than when unmedicated (but @ least I'm not obsessively suicidal). Delayed delivery of most recent refill means I've been loitering @ 75mg for a couple of weeks; today I'm up to 100! Unfortunately most of the start-up benefits have dissipated, tho' according to Scott's TRD post above, this would seem to be par for the course.
On a more positive note, the fact that we share a lack of response is probably down to our low dosing. I'm yet to read of a sub-150mg robust response.
I think it's time to accelerate (my) upwards titration (with yr previous reasoning as to why this is OK in mind), tho' I'm pleased to have taken it so slowly thus far. To begin with, 75mg promoted noticable 'itching' of the skin (kinda like sunburn), which seems to have faded w/o progressing into anything more worrying.
Like you I have ADD-like probs (in fact have US dx, but I'm not so sure; I think they're just a symptom peculiar to my form of depression) & have tried all the available stims to absolutely no effect.
I sense a note of frustration in yr post; believe me, you're not alone. I'm kinda used to waiting 2 or 3 weeks 4 a result, not 3 months (& then there's no guarantee)! I think some of my frustration has crept into a couple of my posts recently, so I'm consciously avoiding anything remotely controversial on this board for now;-)
Anyway, chin up (focus on 150-200mg?) & I'll keep ya posted.
Jah.
BTW did you know Lamictal depletes folate concentrations? Supplementation is rec'd.
Posted by phillybob on April 5, 2001, at 13:23:18
In reply to Re: current Lamictal trials in action » phillybob, posted by JahL on April 5, 2001, at 12:18:31
Hi, Jah. Thanks for your response. I was right about the cold (which has since more properly manifested itself) addin' a cloud of negativity to me. I guess it's a relief that I'm actually showin' the symptoms now and like attributing such dramatic falls to something, like a cold. (good defense mechanism, for me).
Good to hear that you are chugging along with your trial (cause your the front man in this trial). :)
> BTW did you know Lamictal depletes folate concentrations? Supplementation is rec'd.
I did not know that but have been supplementing anyway as a holdover from the need for a B-Complex Stress Tab for cognitive difficulties and extremity tingling during my Topamax days ( http://www.dr-bob.org/babble/20010319/msgs/57126.html ).
Regards,
Bob
Posted by KarenB on April 6, 2001, at 13:50:28
In reply to Re: current Lamictal trials in action » JahL, posted by phillybob on April 5, 2001, at 13:23:18
Hi guys, mind if I join the party?
I just titrated up to 75mg last night, taking it 25mg per titration and staying on each dose for one week. It was the night from hell.
30 min. after my dose, I got dizzy, like I was drunk. My husband was already asleep and I maneuvered my way to the bedroom to lie down. I then got the worst headache I have had in my entire life. I mean, this was unbelievable. Then, my feet and head started itching like crazy. I did not sleep one minute all night. Whew! The next afternoon (yesterday), I experienced flushing in my face and a mild rash on my legs.
Believe or not, I am going to continue and try taking it in the a.m. for two more days. If the adverse reaction persists, I throw in the towel. If not, I'm hanging in there to get to the therapeutic range and see if it helps my condition. I am Bipolar with rapid cycling and mixed states. Of course, I told my doctor about all this and will keep in touch with her if anything worsens.
I took my first a.m. dose three hours ago. I was holding my breath to see what would happen. Fortunately, only a moderate headache and flushing on my face. It looks like I've been out in the sun.
Oh, BTW, I am on 600mg Trileptal in the a.m., 1200 p.m., 40mg Geodon a.m. and p.m. as well
I'll keep you posted and be anxious also to see your progress.
Karen
Posted by JahL on April 6, 2001, at 14:13:57
In reply to Re: current Lamictal trials in action, posted by KarenB on April 6, 2001, at 13:50:28
> > Hi guys, mind if I join the party?
Hi Karen. Welcome to Lamictalworld.
> > I just titrated up to 75mg last night, taking it 25mg per titration and staying on each dose for one week. It was the night from hell.
Just a thought. Bearing in mind Lamictal seems to present the most danger during the first month or so, yr upwards titration seems a little fast to me. The consensus of opinion (including, I think, the PDF) seems to favour this regime:
25mg x 2weeks
50mg X 2weeks
75mg X 2weeksIf you make it through this OK, Lamictal can be increased by larger increments. So you can see you've gone twice as fast as rec'd. I wonder if it isn't worth dropping back to 50mg, & stay there for a week so as not to aggravate the rash. Then go to 75mg. It would be a shame to have to discard such a potentially useful drug.....
Anyway, hope the rash resolves itself, & keep us posted.
Jah.
-----------------------------------------
> 30 min. after my dose, I got dizzy, like I was drunk. My husband was already asleep and I maneuvered my way to the bedroom to lie down. I then got the worst headache I have had in my entire life. I mean, this was unbelievable. Then, my feet and head started itching like crazy. I did not sleep one minute all night. Whew! The next afternoon (yesterday), I experienced flushing in my face and a mild rash on my legs.> Believe or not, I am going to continue and try taking it in the a.m. for two more days. If the adverse reaction persists, I throw in the towel. If not, I'm hanging in there to get to the therapeutic range and see if it helps my condition. I am Bipolar with rapid cycling and mixed states. Of course, I told my doctor about all this and will keep in touch with her if anything worsens.
> I took my first a.m. dose three hours ago. I was holding my breath to see what would happen. Fortunately, only a moderate headache and flushing on my face. It looks like I've been out in the sun.
> Oh, BTW, I am on 600mg Trileptal in the a.m., 1200 p.m., 40mg Geodon a.m. and p.m. as well
> I'll keep you posted and be anxious also to see your progress.
> Karen
Posted by KarenB on April 6, 2001, at 17:18:37
In reply to Re: current Lamictal trials in action » KarenB, posted by JahL on April 6, 2001, at 14:13:57
I think, the PDF) seems to favour this regime:
>
> 25mg x 2weeks
> 50mg X 2weeks
> 75mg X 2weeks
>
Jah,Thanks for the recommendation, but I will continue following my doc's instructions - something I have never completely done before because I was cursed for the longest time with boneheaded doctors who gave me SSRI after SSIR after...well, you get the picture. I am not a lemming but she is the first "good one" I have ever found. Sadly, she is retiring the end of this year. She is quite excellent. That just figures, doesn't it? I also have a friend who has endured a mild rash and is receiving benefit from the drug.
I have read this whole thread and am intrigued by the notion that Bipolars generally have higher than average I.Q.s I know I do. That is, unless I have sustain more cognitive damage than I realize from my illness. I would be interested to see if anyone has done a survey/research on this.
On proper medication, I write quite a bit on this board. If I am not doing well, you won't hear much from me. Something must be right- I am writing again - and that's good.
BTW, I was wondering...seeing as you are British, do our US figures of speech and slang sound odd to you? I have a British friend and I am charmed by her brand of English.
Karen
> Anyway, hope the rash resolves itself, & keep us posted.
Thanks. I will. You too.
>
> Jah.
> -----------------------------------------
>
>
> > 30 min. after my dose, I got dizzy, like I was drunk. My husband was already asleep and I maneuvered my way to the bedroom to lie down. I then got the worst headache I have had in my entire life. I mean, this was unbelievable. Then, my feet and head started itching like crazy. I did not sleep one minute all night. Whew! The next afternoon (yesterday), I experienced flushing in my face and a mild rash on my legs.
>
> > Believe or not, I am going to continue and try taking it in the a.m. for two more days. If the adverse reaction persists, I throw in the towel. If not, I'm hanging in there to get to the therapeutic range and see if it helps my condition. I am Bipolar with rapid cycling and mixed states. Of course, I told my doctor about all this and will keep in touch with her if anything worsens.
>
> > I took my first a.m. dose three hours ago. I was holding my breath to see what would happen. Fortunately, only a moderate headache and flushing on my face. It looks like I've been out in the sun.
>
> > Oh, BTW, I am on 600mg Trileptal in the a.m., 1200 p.m., 40mg Geodon a.m. and p.m. as well
>
> > I'll keep you posted and be anxious also to see your progress.
>
> > Karen
Posted by KarenB on April 9, 2001, at 9:28:33
In reply to Re: current Lamictal trials in action » JahL, posted by KarenB on April 6, 2001, at 17:18:37
Hi guys -
The terrible side effects were only for the first day of titration up to 75mg. I have had a little dizziness and GI trouble (mild) but no killer headache and no more rash. I am not really looking forward to Wednesday, though, when I titrate up to 100mg.
How are you all doing?
Karen
Posted by sweetmarie on April 14, 2001, at 6:30:05
In reply to Re: current Lamictal trials in action » KarenB, posted by JahL on April 6, 2001, at 14:13:57
How are you two doing on the Lamictal front?I`m up to my 3rd week on 250 mg and no change at all. Should I call it a day?
Do you think you could you let me know please?
Ta,
Anna.
Posted by JahL on April 14, 2001, at 14:36:46
In reply to Re: current Lamictal trials - JahL and Phillybob » JahL, posted by sweetmarie on April 14, 2001, at 6:30:05
> > How are you two doing on the Lamictal front?Can't say I'm feeling too clever on 125mg. Head above water but that's all.
> > I`m up to my 3rd week on 250 mg and no change at all. Should I call it a day?
Hmm. You'd have hoped for something by now. However some posters (ie SLS) have noted that 300mg+ is needed for a response. Given that you've come this far I would've thought that it's probably worth exploring the upper limits of the dose range (up to 400mg). Beyond this, I dunno. Unfortunately you're saddled with the same decrepit health system as myself.
As for me, since I haven't heard from my pdoc in over 5 wks, I'm about a week away from self-administering some polypharmacy...
J.
Posted by phillybob on April 14, 2001, at 14:51:20
In reply to Re: current Lamictal trials - JahL and Phillybob » JahL, posted by sweetmarie on April 14, 2001, at 6:30:05
> How are you two doing on the Lamictal front?
Hi, Anna! I'm up to 100 mg/day (just 2 days at this level) and not really noticing anything either.
I had, of late, been toying with Adderall as an adjunct but seemed to, after an initial good going, have negative effects from such (same thing happens for me with Ritalin). Anyway, now I've added some Prozac (20 mg/day) just yesterday because I have not been that well, and I always get an initial boost for up to a couple of weeks with Prozac after re-visiting it (as long as it's been quite a while since I last took it). Long-term trials with Prozac at varying levels (as high as 80 mg/day, I believe) have never been able to maintain positive effects, though.
Maybe WITH the Lamictal, the Prozac could have long-term efficacy? Who knows. Regardless, of all of the AD's I've taken (which is all of the newer ones that are legal in the US), including a couple of Tricyclics, Prozac has the least (practically none) negative side effects for me and I tolerate it very very well.
I will still be titrating up on Lamictal also. (Sometimes, it is hard for me to resist the urge to add Topamax into the mix ... but I really need to see what's up with Lamictal, once I get to a higher therapeutic level, before doing so).
A little over a year ago, I was going to trial Parnate (an MAOI) but during my clearing out period (getting other AD's out of my system), I had a positive bounce and ended up back on other ADs eventually when that subsided. I'd consider an MAOI again, too, but from what I've read on that, I've seen a lot of "pooping out" with that (though some people are getting many years out of it before that occurs). I guess I think a mood stabilizer will be a good long-term help for me.
> I`m up to my 3rd week on 250 mg and no change at all. Should I call it a day?Sorry, it is not working for you the best. It seems from what I've read on this board, no one has had success with it as monotherapy and, as an adjunct, it doesn't seem as if anyone really knows whether it is helpful or not. My guess so far is that because it is such a benign additional drug, the benefits may not really be anything at all. We shall see.
Anyway, I am glad your day in the hospital is finally near, and we are all hoping that you recieve the treatment which leads you to the euthymic land. :)
Best wishes, Bob.
P.S. No calling it a day on the Lamictal yet. It just very well might be the right adjunct for you for whatever the docs in the hospital have in mind to add to your med mix. You've only got a few days!
Posted by sweetmarie on April 14, 2001, at 16:01:57
In reply to Re: current Lamictal trials » sweetmarie, posted by JahL on April 14, 2001, at 14:36:46
> Can't say I'm feeling too clever on 125mg. Head above water but that's all.
That`s unfortunate, although it is still a relatively low dose that you are on. I think that dosages can go up to 300 mg and beyond.
> > > I`m up to my 3rd week on 250 mg and no change at all. Should I call it a day?
>
> Hmm. You'd have hoped for something by now.That`s what I was thinking. Having said that, it`s only a third of the proposed combo (the others are Zispin and Efexor, which haven`t been added, but will be next week when I go to this place in Newcastle). I was HOPING that Lamictal would do the trick on it`s own though.
However some posters (ie SLS) have noted that 300mg+ is needed for a response. Given that you've come this far I would've thought that it's probably worth exploring the upper limits of the dose range (up to 400mg). Beyond this, I dunno. Unfortunately you're saddled with the same decrepit health system as myself.
I didn`t know you were from this country. The NHS Mental Health services are terrible. I`ve been waiting for this hospital admission for 9 months now. Anyway, I could rant and rave about this all day (I`m very angry about services here), but I won`t. It doesn`t serve any purpose, except to stress me out further.
> As for me, since I haven't heard from my pdoc in over 5 wks, I'm about a week away from self-administering some polypharmacy...
How can you do that in this country? I thought that prescription drugs were all that are available to us.
Anyway, good luck with whatever you choose.
Anna.
Posted by sweetmarie on April 14, 2001, at 16:17:10
In reply to Re: current Lamictal trials - JahL and Phillybob » sweetmarie, posted by phillybob on April 14, 2001, at 14:51:20
> Hi, Anna! I'm up to 100 mg/day (just 2 days at this level) and not really noticing anything either.
As I just said to Jah, that is still a relatively small dose. >
> I had, of late, been toying with Adderall as an adjunct but seemed to, after an initial good going, have negative effects from such (same thing happens for me with Ritalin). Anyway, now I've added some Prozac (20 mg/day) just yesterday because I have not been that well, and I always get an initial boost for up to a couple of weeks with Prozac after re-visiting it (as long as it's been quite a while since I last took it). Long-term trials with Prozac at varying levels (as high as 80 mg/day, I believe) have never been able to maintain positive effects, though.
I`ve heard this happens a lot with Prozac. Frankly, it didn`t do anything for me at all, but then I took it on it`s own.
> Maybe WITH the Lamictal, the Prozac could have long-term efficacy? Who knows.
Worth a try.
Regardless, of all of the AD's I've taken (which is all of the newer ones that are legal in the US), including a couple of Tricyclics, Prozac has the least (practically none) negative side effects for me and I tolerate it very very well.
There must be countless other combinations that you can add Prozac to (if the Lamictal doesn`t help).
> I will still be titrating up on Lamictal also. (Sometimes, it is hard for me to resist the urge to add Topamax into the mix ...
Did Topamax work then? It`s a new one on me - presumably because we don`t have it over here.
but I really need to see what's up with Lamictal, once I get to a higher therapeutic level, before doing so).
They reckon on 4 weeks at therapeutic dose (or that`s what I`ve heard).
> A little over a year ago, I was going to trial Parnate (an MAOI) but during my clearing out period (getting other AD's out of my system), I had a positive bounce and ended up back on other ADs eventually when that subsided. I'd consider an MAOI again, too, but from what I've read on that, I've seen a lot of "pooping out" with that (though some people are getting many years out of it before that occurs).
I know that some people do `poop out` - I myself was very well for 3 weeks with it (not Parnate, but Nardil). I also know of people who absolutely swear by it, and say that it`s turned their life around. I think it`s worth a try, but be aware of the possible weight gain - I`ve put on a huge amount of weight and haven`t been able to shift it. Having said that, if it had worked then this wouldn`t be such a catastrophy.
I guess I think a mood stabilizer will be a good long-term help for me.
Have you tried Lithium? Didn`t do me any favours, but I`ve heard that it has excellent results in others.
> > I`m up to my 3rd week on 250 mg and no change at all. Should I call it a day?
>
> Sorry, it is not working for you the best. It seems from what I've read on this board, no one has had success with it as monotherapy and, as an adjunct, it doesn't seem as if anyone really knows whether it is helpful or not. My guess so far is that because it is such a benign additional drug, the benefits may not really be anything at all. We shall see.As I also said to Jah, it`s meant as a part of my new combination, so maybe it`ll work in that capacity. I was hoping it would work on it`s own though (but we all know what happened to hope).
> Anyway, I am glad your day in the hospital is finally near, and we are all hoping that you recieve the treatment which leads you to the euthymic land. :)
Thanks.
No calling it a day on the Lamictal yet. It just very well might be the right adjunct for you for whatever the docs in the hospital have in mind to add to your med mix. You've only got a few days!
O.K.Anna.
Posted by SLS on April 14, 2001, at 20:44:32
In reply to Re: current Lamictal trials - JahL and Phillybob » JahL, posted by sweetmarie on April 14, 2001, at 6:30:05
>
> How are you two doing on the Lamictal front?
>
> I`m up to my 3rd week on 250 mg and no change at all. Should I call it a day?
>
> Do you think you could you let me know please?
I lost my crystal ball last week, so any suggestion I may offer would be little more than a guess.I haven’t followed enough people as they progressed through their Lamictal trials to be confident enough to project an outcome. However, 200mg is sort of a “sweet-spot” for attaining an antidepressant response in bipolar disorder. I don’t know if the same thing is true of unipolar major depression. For epilepsy, the range promoted by the PDR is 300mg – 500mg. I need 300mg to get what I can out of it, although I really never “hung-out” at 250mg to see if it would stick. My impression of Lamictal is that if it is going to work at a particular dosage, 3 weeks at that dosage would be enough to evaluate its usefulness.
At some point, you may just want to make changes in your other drugs and keep taking Lamictal for a while. I would consider this a good idea if you are bipolar. Perhaps it makes sense to raise the dosage to 300mg now and give it no more than two weeks before making changes. Of course, the appearance and magnitude of side effects will enter as part of your decision making process. I wish I could be more confident in the range of experiences of people taking Lamictal to tell you that you have given it long enough. My gut tells me that you have sufficiently explored 250mg to make a change.
Sorry.
- Scott
Posted by sweetmarie on April 15, 2001, at 7:20:48
In reply to Re: current Lamictal trials - JahL and Phillybob » sweetmarie, posted by SLS on April 14, 2001, at 20:44:32
> I lost my crystal ball last week, so any suggestion I may offer would be little more than a guess.
>
> I haven’t followed enough people as they progressed through their Lamictal trials to be confident enough to project an outcome. However, 200mg is sort of a “sweet-spot” for attaining an antidepressant response in bipolar disorder. I don’t know if the same thing is true of unipolar major depression. For epilepsy, the range promoted by the PDR is 300mg – 500mg. I need 300mg to get what I can out of it,And what`s that?
although I really never “hung-out” at 250mg to see if it would stick. My impression of Lamictal is that if it is going to work at a particular dosage, 3 weeks at that dosage would be enough to evaluate its usefulness.
> At some point, you may just want to make changes in your other drugs and keep taking Lamictal for a while.
I am going to make changes - Venlafaxine and Mirtazapine are to be added when I go into hospital next week (just as soon as I am `off` the Nardil, Valproate and Trimipramine that I have been uselessly taking for over a year).
I would consider this a good idea if you are bipolar. Perhaps it makes sense to raise the dosage to 300mg now and give it no more than two weeks before making changes.
This is not going to be up to me - I will be under the care of a specialist, as I`m sure I`ve said. It will be up to him (and his cronies) to decide about medications etc. I don`t lke this scenario very much, but having agreed to be treated by him, I guess I must trust in his judgement (at least whilst I am in hospital).
Of course, the appearance and magnitude of side effects will enter as part of your decision making process.
No side effects (so far).
I wish I could be more confident in the range of experiences of people taking Lamictal to tell you that you have given it long enough. My gut tells me that you have sufficiently explored 250mg to make a change.
> Sorry.
Don`t be.
Anna.
Posted by Lexie on April 15, 2001, at 13:59:52
In reply to Re: current Lamictal trials - JahL and Phillybob, posted by sweetmarie on April 15, 2001, at 7:20:48
Hi it's me Lexie
Just a reminder, I am taking 400 mgs. Topamax and 500 mgs. Lamictal and it was a long tuff road to get there. Keep hanging in there. I had Doctor's visists about every 2 to 3 weeks between the increases and they were only 50 mgs at a time I wanted to give up each time. Today I am doing great. Everyone is differn't though. If it wasn't for the encougagement here (Noa) I would have given up early on. I recently started to go off the Lamictal and try Geodon. I am right back with the Lamictal. I try not to post to often I know you all must get tired of hearing my same old stuff but I am not sure who has heard me. Hope this helps. If you have heard this before, sorry. Lexie
This is the end of the thread.
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