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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by 3 Beer Effect on February 8, 2002, at 17:43:08
I am starting with 25 mg of lamictal/day as a mood-stablizer/antidepressant & my dose is to be increased by 25 mg each week. I am quite depressed & was wondering at what dose range does Lamictal work as an anti-depressant. Is Lamictal as strong of an antidepressant as the SSRIs (which I can't tolerate-mania/insomnia). I take the lamictal once at night because it seems to cause nausea for me- Why do some people take it twice a day if the half life is 32.8 hours?
Why does Lamictal have anti-depressant properties? It only has a "weak inhibitory effect on the serotonin 5HT3 receptor & weak effects at sigma opoid receptors." "Lamictal did not inhibit the uptake of serotonin, norepinephrine, dopamine, or aspartic acid."
Posted by JohnX2 on February 8, 2002, at 21:09:54
In reply to Lamictal as anti-depressant- how? what doses?, posted by 3 Beer Effect on February 8, 2002, at 17:43:08
Hi,
I'm not sure about the exact pharmacokinetics,
but perhaps at very low doses the 1/2 life is
not quite 32.8 hrs. I know once you get at least
over 100 mg, once a day dosing is just fine.I myself have been pondering the AD effects of
Lamictal. I seem to be getting serotonin reuptake
like side effects. Mainly loose stools. At 150
mg, it cured my major depression but did not
resolve the rest of my bipolar illness. Since I
added topamax I am retesting the med at 225-300 mg
where the medicine in the past would give me a
tension headache and numb out my emotions very
similar to Zoloft. This time at 225 I actually
am feeling really good, I hope it is not
fool's gold.I did see another abstract suggesting that Lamictal
increased the brain chemical Taurine which is
a weak NMDA antagonist and a GabaB receptor enhancer.
I don't know what the downstream effects of this
are.Alas, I think Lamictal is still a mystery.
I really would like to know what makes this tick.
If it really is the Taurine mechanism that is
doing the trick, then their is a simpler medicine
called Acamprosate that is a carrier molecule for
the amino acid Taurine that doesnt have all the
silly dosing issues that Lamictal does. It might
be interesing just to take that with a regular
anti-depressant. Again, another one of my
hairbrained schemes to make psychopharmacology
easier on the patients.Regards,
John> I am starting with 25 mg of lamictal/day as a mood-stablizer/antidepressant & my dose is to be increased by 25 mg each week. I am quite depressed & was wondering at what dose range does Lamictal work as an anti-depressant. Is Lamictal as strong of an antidepressant as the SSRIs (which I can't tolerate-mania/insomnia). I take the lamictal once at night because it seems to cause nausea for me- Why do some people take it twice a day if the half life is 32.8 hours?
>
> Why does Lamictal have anti-depressant properties? It only has a "weak inhibitory effect on the serotonin 5HT3 receptor & weak effects at sigma opoid receptors." "Lamictal did not inhibit the uptake of serotonin, norepinephrine, dopamine, or aspartic acid."
Posted by anniebananie on February 8, 2002, at 22:31:16
In reply to Lamictal as anti-depressant- how? what doses?, posted by 3 Beer Effect on February 8, 2002, at 17:43:08
I began to notice a difference at 50mg and am now on 200mg.
Good luck and increase by 12.5mg if you need to.
Annie
> I am starting with 25 mg of lamictal/day as a mood-stablizer/antidepressant & my dose is to be increased by 25 mg each week. I am quite depressed & was wondering at what dose range does Lamictal work as an anti-depressant. Is Lamictal as strong of an antidepressant as the SSRIs (which I can't tolerate-mania/insomnia). I take the lamictal once at night because it seems to cause nausea for me- Why do some people take it twice a day if the half life is 32.8 hours?
>
> Why does Lamictal have anti-depressant properties? It only has a "weak inhibitory effect on the serotonin 5HT3 receptor & weak effects at sigma opoid receptors." "Lamictal did not inhibit the uptake of serotonin, norepinephrine, dopamine, or aspartic acid."
Posted by djmmm on February 9, 2002, at 4:07:17
In reply to Lamictal as anti-depressant- how? what doses?, posted by 3 Beer Effect on February 8, 2002, at 17:43:08
> I am starting with 25 mg of lamictal/day as a mood-stablizer/antidepressant & my dose is to be increased by 25 mg each week. I am quite depressed & was wondering at what dose range does Lamictal work as an anti-depressant. Is Lamictal as strong of an antidepressant as the SSRIs (which I can't tolerate-mania/insomnia). I take the lamictal once at night because it seems to cause nausea for me- Why do some people take it twice a day if the half life is 32.8 hours?
>
> Why does Lamictal have anti-depressant properties? It only has a "weak inhibitory effect on the serotonin 5HT3 receptor & weak effects at sigma opoid receptors." "Lamictal did not inhibit the uptake of serotonin, norepinephrine, dopamine, or aspartic acid."Lamictal *does* inhibit the reuptake of serotonin *and* norepinephrine *and* dopamine
(Eur J Pharmacol. 1998 Sep 25;358(1):19-24.)most mood stabilizers have some serotonin activity:
Tegretol: stimulates strotonin
Neurontin: increases serotonin concentrations in human whole blood
lithium: may increase density and sensitivity of 5ht2 receptors
depakote: may increase serotonin activity via 5ht1a autoreceptors
etc, etc
Posted by JohnX2 on February 9, 2002, at 21:01:35
In reply to Re: Lamictal as anti-depressant- how? what doses?, posted by djmmm on February 9, 2002, at 4:07:17
Hi,
Ok, This would explain my response to Neurontin.
I always got weird dreams on that one. Gotta be
serotonin!Lamictal dosage bumping giving me Zoloft like
effects.Anyways, 3Beer, maybe you could take a low dose
of Zyprexa to help offset any mania/irritation that
Lamictal would induce?Regards,
John
> > I am starting with 25 mg of lamictal/day as a mood-stablizer/antidepressant & my dose is to be increased by 25 mg each week. I am quite depressed & was wondering at what dose range does Lamictal work as an anti-depressant. Is Lamictal as strong of an antidepressant as the SSRIs (which I can't tolerate-mania/insomnia). I take the lamictal once at night because it seems to cause nausea for me- Why do some people take it twice a day if the half life is 32.8 hours?
> >
> > Why does Lamictal have anti-depressant properties? It only has a "weak inhibitory effect on the serotonin 5HT3 receptor & weak effects at sigma opoid receptors." "Lamictal did not inhibit the uptake of serotonin, norepinephrine, dopamine, or aspartic acid."
>
> Lamictal *does* inhibit the reuptake of serotonin *and* norepinephrine *and* dopamine
> (Eur J Pharmacol. 1998 Sep 25;358(1):19-24.)
>
> most mood stabilizers have some serotonin activity:
>
> Tegretol: stimulates strotonin
>
> Neurontin: increases serotonin concentrations in human whole blood
>
> lithium: may increase density and sensitivity of 5ht2 receptors
>
> depakote: may increase serotonin activity via 5ht1a autoreceptors
>
> etc, etc
Posted by Blue Cheer 1 on February 10, 2002, at 0:29:49
In reply to Lamictal as anti-depressant- how? what doses?, posted by 3 Beer Effect on February 8, 2002, at 17:43:08
> I am starting with 25 mg of lamictal/day as a mood-stablizer/antidepressant & my dose is to be increased by 25 mg each week. I am quite depressed & was wondering at what dose range does Lamictal work as an anti-depressant. Is Lamictal as strong of an antidepressant as the SSRIs (which I can't tolerate-mania/insomnia). I take the lamictal once at night because it seems to cause nausea for me- Why do some people take it twice a day if the half life is 32.8 hours?
Lamictal is an excellent antidepressant and mood stabilizer (for some) in bipolar disorder. I think the package insert says to take it in divided doses if you're using more than 200 mg or 250 mg/day. I've been taking it for four years this week - always at bedtime (200 mg. to 350 mg.).
>
> Why does Lamictal have anti-depressant properties? It only has a "weak inhibitory effect on the serotonin 5HT3 receptor & weak effects at sigma opoid receptors." "Lamictal did not inhibit the uptake of serotonin, norepinephrine, dopamine, or aspartic acid."I forget now. Calcium and sodium channels, glutamate?
I think you'll find it has the least side effects of any of the anticonvulsants used in bipolar disorder.
Good luck with it.Blue
Posted by anniebananie on February 13, 2002, at 18:35:30
In reply to Re: Lamictal as anti-depressant- how? what doses?, posted by djmmm on February 9, 2002, at 4:07:17
Posted by Chrissy on March 21, 2002, at 18:10:13
In reply to Re: Lamictal as anti-depressant- how? what doses?, posted by JohnX2 on February 8, 2002, at 21:09:54
John how is the topamax, lamictal combo working out? I am taking Prozac and added topamax couple of months ago. Having terrible anxiety and even went into depression. But I like other effects of topamax. Would like to try your combo. any info would help
Chrissy
Posted by JohnX2 on March 22, 2002, at 21:01:36
In reply to Re: Lamictal as anti-depressant- how? what doses?, posted by Chrissy on March 21, 2002, at 18:10:13
Hi Chrissy,
I'm not sure on your diagnosis. But I have been through a lot of medicines for a bipolar diagnosis. I have faired vary well using Lamictal as my primary mood stabilizer and antidepressant. I really haven't had any major depressive spells (except one or 2 bumps) while at a thereapeutic dose of the medicine. I added topamax to mainly help with some headaches. I suspect it is helping with mood fluctuations but it is hard to tell. It also allowed me to lower Klonopin dosing substantially.
What is it about topamax that you like? I guess I'm a bit confused about your comments regarding going into more irritation and depression? Do
you feel that the prozac is not cutting it?
Regards,
John
> John how is the topamax, lamictal combo working out? I am taking Prozac and added topamax couple of months ago. Having terrible anxiety and even went into depression. But I like other effects of topamax. Would like to try your combo. any info would help
> Chrissy
Posted by Zo on March 26, 2002, at 16:33:38
In reply to Re: Lamictal as anti-depressant- how? what doses? » Chrissy, posted by JohnX2 on March 22, 2002, at 21:01:36
Chrissy, I'd look to the Topamax first, as the culprit. Maybe taper that way down, and see how you feel.
Lamictal is WAY more promising as an AD.Zo
Posted by JohnX2 on March 27, 2002, at 4:25:34
In reply to Re: Lamictal as anti-depressant- how? what doses? » JohnX2, posted by Zo on March 26, 2002, at 16:33:38
Chrissy,
Ditto on Zo's comment. Lamictal is the workhorse for my cocktail. Try to get into a good Lamictal dosage (probably 100-300 mg). Maybe you can reign in on the other medicines. Be careful with the Lamictal dosing strategy, check around for the other threads on this issue. Topamax is more of a fringe medicine for mood stabilization. MANY people use Lamictal as a primary mood stabilizer/AD with an anti-depressant adjunct.
Seems Lamictal has a trigger dose for wiping the major depressive lows. For me it was 150 mg. Don't remember what it was for Zo? Have seen other people at 225 mg, 300 mg+.
Lamictal is generally less intrusive than ADs (especially once you get past 100 mg start up effects). For those that do well, they seem to bitch the least about side effects (IMO, including me).
Regards,
John
> Chrissy, I'd look to the Topamax first, as the culprit. Maybe taper that way down, and see how you feel.
> Lamictal is WAY more promising as an AD.
>
> Zo
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