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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 Greg A. on July 30, 2003, at 10:57:31
Anyone taking relatively high doses of Lamictal - 400 mgs or above. I have found that at 300mgs I improved greatly but have recently gone to 375 to maintain the improved state. I am wondering about increasing it even more should I experience another decline. My pdoc has no patients on this high a dose and can offer no advice.
Greg
Posted by JackD on July 30, 2003, at 14:11:27
In reply to Lamictal (lamotrigine) High Doses, posted by Greg A. on July 30, 2003, at 10:57:31
I went up to 400mg to maintain an effect, but then my shrink and I gave up.
Posted by Greg A. on July 30, 2003, at 14:36:16
In reply to Re: Lamictal (lamotrigine) High Doses, posted by JackD on July 30, 2003, at 14:11:27
Did it work effectively at some time? For what length? Did your doc specify no higher?
Thanks,
Greg
Posted by maryhelen on July 30, 2003, at 21:56:06
In reply to Lamictal (lamotrigine) High Doses, posted by Greg A. on July 30, 2003, at 10:57:31
I just got to 300 mg. of Lamitcal. At 150 mg. I had such a good response, felt better than I can ever remember feeling. In fact, it kinda scared me. It was such a strange feeling not to be depressed, to be able to do things, to laugh, look forward to the day. This effect only lasted about 3 weeks. I had gone up to 200 mg. by the time I saw my pdoc. He said to up it to 300 mg. which I just reached about a week ago. I am going to hang in, but I am not even close to feeling the same.
I have heard so many people say they had a quick but short response to Lamitcal. This is such a frustrating med. I wish I knew why and how it worked. When I went on the internet to get info from GlaxoSmithKline Inc., they said 200 mg. is the recommended dose for depression, but it was bi-polar they kept referring to. I have treatment resistant depression. They gave no further discussion to dosing. I really don't think we can get an answer right now.
Do we keep going up if it stops working? How high? I am taking it with Parnate but I am coming off it, was at 90 mg. now at 40 mg. Are you on another med?
How long were you at 300 mg. before you had the improvement? I really hope you can maintain it.
I will be watching this post for other input. I really wish we could just get to a point where we could stabilize on it.
maryhelen
Posted by Greg A. on July 31, 2003, at 12:12:34
In reply to Re: Lamictal (lamotrigine) High Doses, posted by maryhelen on July 30, 2003, at 21:56:06
Thanks for your comments, maryhelen. You have experienced much of what I have with lamotrigine and you nailed it when you said, “It was such a strange feeling not to be depressed, to be able to do things, to laugh, look forward to the day.” I got that effect at about 200mgs but it only lasted a week. I had been extremely depressed for many months before and was quite suicidal, fighting it every day. I had tried ECT last fall with no benefit, in fact I felt worse. It was such a relief to get even a week of improvement just to remind me of how I was supposed to feel. I then went to 250 and then 300mgs and I had almost 2 months of feeling the way you have described. Just when I was beginning to forget about how I might feel each day, I suddenly went downhill rather drastically. I upped the dose to 375mgs and felt good for another week. Then today I went to 450. I feel good. I seem to get an almost instant reaction to it unlike antidepressants – and also a precipitous decline. Lamotrigine was developed as an anti seizure med for epilepsy and is prescribed off label treatment for depression and bipolar disorder. The info for depression says 200mgs but for epilepsy/seizures says the usual dose is 500mgs.
Interestingly my doc changed my diagnosis from treatment resistant depression to BPII when I started the lamotrigine. She felt that my resistance to anti depressants plus my slight hypomanic symptoms indicated a new approach.
I am also on lithium, celexa, clonazepam. I am hopeful, as you are, that I will arrive at a level of lamotrigine where I will feel good for a long time.No luck on Parnate?
Greg
Posted by Peter S. on July 31, 2003, at 13:04:26
In reply to Re: Lamictal (lamotrigine) High Doses, posted by maryhelen on July 30, 2003, at 21:56:06
Wow- my sediments exactly!
I got up to 600mg of Lamictal as the wonderful effects continued to keep wearing off. I now take 50mg in the morning 5 days a week approximately. For me Lamictal has an immediate effect which last 4 to 5 hours. It is not as good as when I first took it and if I take it every day, I build tolerance. I find that the 50mg dose is ideal for me and going higher doesn't make a lot of difference.I'm also taking 20mg of Lexapro and 600mg of Lithium. The Lexapro seems to be making a slight difference but I'm thinking of going up to 30mg- if I can tolerate the sleepiness/fatigue.
I wish I knew what was going on with the Lamictal! I hope you figure out the right combo for you maryhelen (and to Greg too).
Peter
> I just got to 300 mg. of Lamitcal. At 150 mg. I had such a good response, felt better than I can ever remember feeling. In fact, it kinda scared me. It was such a strange feeling not to be depressed, to be able to do things, to laugh, look forward to the day. This effect only lasted about 3 weeks. I had gone up to 200 mg. by the time I saw my pdoc. He said to up it to 300 mg. which I just reached about a week ago. I am going to hang in, but I am not even close to feeling the same.
>
> I have heard so many people say they had a quick but short response to Lamitcal. This is such a frustrating med. I wish I knew why and how it worked. When I went on the internet to get info from GlaxoSmithKline Inc., they said 200 mg. is the recommended dose for depression, but it was bi-polar they kept referring to. I have treatment resistant depression. They gave no further discussion to dosing. I really don't think we can get an answer right now.
>
> Do we keep going up if it stops working? How high? I am taking it with Parnate but I am coming off it, was at 90 mg. now at 40 mg. Are you on another med?
>
> How long were you at 300 mg. before you had the improvement? I really hope you can maintain it.
>
> I will be watching this post for other input. I really wish we could just get to a point where we could stabilize on it.
>
> maryhelen
Posted by colin wallace on July 31, 2003, at 15:51:26
In reply to Re: Lamictal (lamotrigine) High Doses » maryhelen, posted by Peter S. on July 31, 2003, at 13:04:26
Hi guys,
I've been see-sawing up and down with my Lamictal doses for over a year, with an almost identical reaction to Peter's(we've spoken about this quite a few times before).
I reached 350mg on monotherapy,achieved phenomenal results, but kept experiencing a rapid diminution of the effect, causing instability and breakthrough depression.
I added 20mg Prozac three months or so back(I was previously unable to tolerate any antidepressant)and recaptured the effect, and at this point returned to a 300mg Lamictal dose.
The results have so far been consistent,and get better as the Prozac continues to build on its effects.
I do believe that the Lamictal will again begin to fade at some point, and then I intend to add a small dose of valproate, for two reasons;firstly, it gave me a similar feeling of stability to Lamictal(without any AD effect), and secondly because, as valproate reduces the clearance of lamictal by a half, this means you can get away with taking half your usual dose of Lamictal, and theoretically achieve the same results.
Of course, this assumes you already have a solid response from an antidepressant in place along with the lamictal.
This is just my personal plan of attack, and I may even bring the valproate into play in advance of any Lamictal 'poop out'....just to pre-empt things a little!!Let us know how you go guys, and Pete, I'm sending your girlfriend back to you, as she seemed to have a puncture.... :)
Posted by maryhelen on July 31, 2003, at 21:49:15
In reply to Re: Lamictal (lamotrigine) High Doses, posted by colin wallace on July 31, 2003, at 15:51:26
What is valproate? When I was reading the info presented by GlaxoSmithKlein,it was referred to quite often. I took it as being a negative to combine the two. So to reduce the clearance of Lamitcal by a half is a good thing? I do not seem to be able to grasp or understand all of the chemical reactions, receptors, all of the HT things, that you and so many others do here at psycho babble. I guess I cheat and try to learn from everyone else's research.
One thing that I do know, is that Lamitcal is a real puzzle to me.
maryhelen
Posted by colin wallace on August 1, 2003, at 3:48:32
In reply to Re: Lamictal for Colin, posted by maryhelen on July 31, 2003, at 21:49:15
> What is valproate? When I was reading the info presented by GlaxoSmithKlein,it was referred to quite often. I took it as being a negative to combine the two. So to reduce the clearance of Lamitcal by a half is a good thing? I do not seem to be able to grasp or understand all of the chemical reactions, receptors, all of the HT things, that you and so many others do here at psycho babble. I guess I cheat and try to learn from everyone else's research.
>
> One thing that I do know, is that Lamitcal is a real puzzle to me.
>
Hi Maryhelen,Lamictal is a puzzle to me too;but anyway, valproate is another anticonvulsant(like Lamictal)which is used quite effectively as a mood stabilizer, although unlike Lamictal, it has no innate antidepressant qualities (too much of it can cause depression).
It can safely be combined with Lamictal, although the risk of initial rash is higher in those taking both meds- basically, they increase each others blood levels(by prolonging elimination from the body;a bad idea to jump in and take regular amounts of both, as the risk of rash is much higher than on either alone.
But the flip side is that you can take less of each, and still have the same 'effective' amount in your system.Quite safe if done gradually.
And as for Lamictal being a puzzle, I was only thinking yesterday that the AD properties of Lamictal could in some respects be regarded as a 'side-effect', and just like any other side-effect, some people eventually adjust and gain complete tolerance, whilst others never
overcome(in this case, a highly desirable side-effect)!!Here's to not gaining tolerance!!
Col.
Posted by maryhelen on August 1, 2003, at 10:27:34
In reply to Re: Lamictal for Colin » maryhelen, posted by colin wallace on August 1, 2003, at 3:48:32
Colin ..... that is a very interesting observation about the possibility that the AD properties of Lamitcal could be regarded as a side effect. Assuming this could be true, and why not considering we are all going crazy trying to figure out Lamitcal, like you said, this is a side effect we would not want to tolerate.
It does makes sense, though. During how many drug trials have we seen participants getting unexpected results for other maladies not related to the intentions of the drug.
I am going to ask a question which will probably show how little I understand about how all of these drugs for depression work.
When I spoke to my pharmasist about Lamitcal and the quick and amazing response, he said that it works on the CNS. My heart missed a beat because my understanding was that the drugs I took and ended up abusing, pain meds, benzos, etc. worked on the CNS and that is why I cannot take them now because my body has built up a tolerance and I need more and more for the same effect. He said all antidepressants work the same way.
I thought most antidepressants, Effexor, Paxil, Luvox, on and on, worked on our brain chemistry, and that is why we do not get addicted.
Anyway, I have now exposed my lack of knowledge and ignorance, even though I have taken more meds and combos for depression than I will ever remember. At the same time it makes sense when you are talking about possibily building up a tolerance to Lamitcal.
Can you sort out what I am trying to say Colin and give me your input?
maryhelen
Posted by yesac on August 2, 2003, at 17:28:01
In reply to Re: Lamictal for Colin, posted by maryhelen on August 1, 2003, at 10:27:34
Hi maryhelen,
I think that the bit about the AD properties of Lamictal being like a side effect is very interesting too.
But, I wanted to address your questions about how the drugs "work".... well, brain chemistry IS part of the CNS. The CNS is made up of the brain and spinal cord. A lot of the drugs also work in the peripheral nervous system which causes a lot of the side effects. Some types of drugs are more addictive because of the particular effects that they exert, the particular neurotransmitter(s) that they affect, their mechanisms of action, and other reasons. Most of the antidepressants, while they do work in the central nervous system, are not addictive and you do not develop a tolerance.
It's all very complicated, basically. I am certainly not any kind of expert - far from it - but I did study neuroscience in college so I'd like to think that I have some concept of what goes on in the ol' brain!
I hope that helped!
This is the end of the thread.
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