![[dr. bob]](/dr-bob-sm.gif)
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 starlight on July 7, 2003, at 15:09:43
I'd like to know what people's experiences have been with dosages of lamictal higher than 200 mgs a day.
thanks,
Starlight
Posted by Maxime on July 8, 2003, at 4:07:12
In reply to High Dosages of Lamictal, posted by starlight on July 7, 2003, at 15:09:43
I would as well. Plus how do you know when you have reached the proper dosage and how do you know if you have gone too far.
Maxie
> I'd like to know what people's experiences have been with dosages of lamictal higher than 200 mgs a day.
> thanks,
> Starlight
>
Posted by Henryo on July 8, 2003, at 4:54:56
In reply to High Dosages of Lamictal, posted by starlight on July 7, 2003, at 15:09:43
No help, I' sitting tight at 200mg a day, I think you know if, you feel better and have no negative side effects. I have spoken to some people here recently who are taking 400mg a day. Maybe they will respond.
Posted by Penny on July 8, 2003, at 8:16:08
In reply to Re: High Dosages of Lamictal, posted by Henryo on July 8, 2003, at 4:54:56
I'm one of those people - I take 200mgs 2x a day, and doc says there's room for increase if needed.
He tests the level of Lamictal in my system fairly regularly (bloodwork and it takes about 2 weeks to get results!), and told me that between 2 and 4 mcg/mL plasma concentrations are considered to be therapeutic levels - my level is currently about 2.4.
According to the Lamictal website, 500mgs/day is the max recommended dose (400mgs/day in divided dose for BPI patients). They say average plasma conc. for those doses are between 2 and 5 mcg/mL, but levels can be higher, and higher is recommended for treatment of epilepsy.
However, it all depends on your response to the med. If you're achieving satisfactory results from a lower dose, then increasing the dose doesn't really matter much, I wouldn't think. My doc continued to raise my dose because my mood was still fluctuating pretty rapidly.
Posted by starlight on July 8, 2003, at 17:22:11
In reply to Re: High Dosages of Lamictal, posted by Penny on July 8, 2003, at 8:16:08
I remember you saying that you took 400 mgs p day. I'm doing better at 200 than I was at 150, but wouldn't mind going up some more. I think I tend to swing due to situational things even though I try not to. Thanks for the info. I didn't realize that 500 was the max recommended dosage.
Of other note, I think I posted this earlier, when I switched from taking the 25mg tabs to the 100 mg tabs, the cost went down over 70 bucks! Can you believe that? For months I've been paying about 120 bucks for that med, and my new tabs cost 44 bucks. Crazy eh!
starlight
Posted by Griobhtha on July 10, 2003, at 12:17:51
In reply to High Dosages of Lamictal, posted by starlight on July 7, 2003, at 15:09:43
I have been taking 300 (150x2/day) for about a year. I've never noticed any side effects other than a headache for a day or two after increasing dosage.
At 300 I noticed a slight stabilization of mood (At the time Effexor was causing me to swing). It has definitely helped with a slight AD effect and helped keep me keep steady while changing AD's. Switching AD's has caused more destabilization however and my doc has insisted on a low dose of lithium to augment rather than more lamictal (This is a different doc than gave me the lamictal -- I'm at a university hospital with rotating student docs).
I've read where AD effects of lamictal tend to become prominent in the 350-450 range.
PDR information at the web site (lamictal.com) hints at decreased folate levels, which especially for women would indicate the need for supplements. It also states that it tends to accumulate in the kidneys, but what the long term effects of this for humans is may not be known for a while.
Posted by HenryO on July 11, 2003, at 1:21:50
In reply to High Dosages of Lamictal, posted by starlight on July 7, 2003, at 15:09:43
Great information, Thanks you guys.
Posted by Jack Smith on July 11, 2003, at 12:07:18
In reply to Re: High Dosages of Lamictal, posted by HenryO on July 11, 2003, at 1:21:50
Henry O,
I read some of your posts from about a year ago praising risperdal in combo with some other AD's. I am currently on 300mg Effexor and getting a good but not complete response. Would you recommend augmentation with Lamictal or Risperdal? I have depression with a strong anxiety/irritability component.
Thanks,
JACK
Posted by avid abulia on July 12, 2003, at 21:20:54
In reply to Lamictal Q's » HenryO, posted by Jack Smith on July 11, 2003, at 12:07:18
Hey all,
If anyone ever reads my posts (well, i guess someone probably does, but i am not terribly useful on here and i don't even come often cuz of that)... well, you would know that i have extensive experience with taking Lamictal.
I also (heh, probably similar to most or all of you here) read obsessively about the mechanism of action of meds...
Well, what has been found with Lamictal when used to treat cocaine addiction, is that if it is used in the usually *neurological* method of usage when getting a therapeutic level fast is quite important, which they also seem to do a lot at hospitals i've been in where they wanna get patients in and out fast fast fast food mental health, with a fairly rapid upward titration of 50mg every three days, it is little better than placebo for cocaine cravings. However, when titrated upwards more slowly, 12.5-25mg every 1-2 weeks, it takes longer to reach a therapeutic level but the effects on cocaine craving are pronounce, indicating that a slower titration has a greater effect at sensitizing dopamine receptors (there has been talk on some research papers i have read indicating that lamictal has an in vivo monoaminergic reuptake mechanism, however most medline papers indicate that it actually works by sensitizing monoamine receptors, not through reuptake inhibition)...
Well, so the point of that being, i don't know how fast you guys are going up on your lamictal doses, but most of the research indicates that the slower, the better.
I personally take 200mg of Lamictal twice per day, and i was initially started in the psych hospital with the fast-food approach, and was up to 200mg per day within two weeks. And it didn't have all that great of an antidepressant effect on me, at that point, but it was still a great prophylactic. Later on, upon receiving a diagnosis of epilepsy during hospitalization for an acute exacerbation of mood disorder, which prompted a doc to want to raise my dose, i told her about the studies for cocaine addiction showing much better effects with slow titration, and i convinced her to allow me to titrate up to her recommended dose of 400mg. by increments of 12.5 mg every two weeks. I had a lot of patience, by then, because i had been depressed for a long enough time out of my life that i was willing to wait things out if there was even a chance that doing it so slow would be better.
Well, long story short, i started to notice i wasn't depressed anymore along about 300mg., and by the time i got up to 400mg. i didn't feel anti-depressed, i felt... normal. Does anyone else know what i am talking about? To me, antidepressants don't seem to actually take away the pain of depression... they are like the morphine i occasionally had to use when i was getting migraines, i still knew i hurt, but i just didn't care so much anymore. Well, with Lamictal at 400mg., titrated in such a slow manner, it was like i actually *didn't hurt* any more.
Not to say i never had a relapse... that is the nature of the beast. But, Lamictal at that dose makes the relapses bearable, and it leads to complete inter-episodic recovery, whereas i nothing else before did that.
And i think the addition of Keppra to it, which happened to occur during a depressive relapse, has actually made me... i dunno... not just on the right medications, but actually better. I dunno if that makes since to any of you...
Este, son las cosas de vida, I'm a babbling psycho.
~AA
Posted by HenryO on July 14, 2003, at 4:51:12
In reply to Lamictal Q's » HenryO, posted by Jack Smith on July 11, 2003, at 12:07:18
Jack, I'm flattered but I don't think I'll be much help. I was taking Prozac, Ritalin(Concerta), Risperdal and Pindolol(a.k.a. Visken). It was a cocktail I came to by just adding one thing and then another that seemed be helping. After about two years of it my depression was holding steady but my sexuallity was wasted. That is the primary reason I went in search of something else and how I came to switch to Lamictal. I think the Lamictal is also a better AD than that cocktail, for me.
I don't have any real anxiety issues. I couldn't handel Effexor. It made me feel too medicated. I believe in Lamictal more than Risperadal. I found Risperadal to be a bit deadening which isn't all bad sometimes. But I took a small dose of Risperadal. I just don't have a lot experiences with Effexor combinations.
Actually the best augmentation drug I have tried to date is Pindolol. It's a beta blocker it ought to have some beneficial effect on anxiety. I keep it around in case of fire. It helps greatly when severe emotional pain flares up in my brain.
Anyway I don't think my experience is very germane to your considerations. Wish I could be more help. I haven't felt any nervous jumpy (Wellbutrin) type side effects from Lamictal, if that helps.
Posted by Barbara Cat on July 16, 2003, at 10:28:17
In reply to Lamictal Q's » HenryO, posted by Jack Smith on July 11, 2003, at 12:07:18
Anyone know of successes using just lamictal (in higher doses) for bipolar symptoms, mainly mixed states depression? All this talk about compromised kidney function concerns me.
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.