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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by platinumbride on April 4, 2004, at 15:55:28
I was on lamictal for quite a while until I spent a month without it and realized that I felt no different without it than I had with it.
But now I have read that some people are on doses of up to 500 mgs. I was on 200. Do you think that it might be worth trying to take it again, this time at a higher dosage?
(Just skip to the bottom few paragraphs if you want the abridged version...)
I am currently on 1200 mgs of trileptal and 400 of wellbutrin. I don't know if it is me and my attachment to being depressed, somehow, or simply that the cocktail isn't working, but....well, it isn't working!
I have been on the trileptal at this doseage only for a few weeks, so I guess I can give it more time...the wellbutrin, however, has been a part of my life since late last year.
I also take neurontin and klonopin as needed, which is like every day, because I have so much anxiety. Neurontin calms me down and eases my depression a bit, but it doesn't necessarily make me want to leave the house of my own volition! (And I desperately need to leave the house if I am not going to feel like life is one big funeral. Some people don't, but I do).
The problem with neurontin is that even on a low dose, i want to eat everything that isn't tied down(well, even things that are tied down ha ha). And I am waaaaay too obese to be adding more poundage.
Hence, the goal of trying to 86 the neurontin with trileptal. Trileptal isn't doing it alone, hence the notion that perhaps another shot at lamictal at a higher dose and perhaps along with the tripleptal...
And now that I have purchased a three month supply, I do'nt know WHAT to do about the stupid wellbutrin!
Soooooo, after all that, I guess I just want to know if anyone has had minor miracles happen with lamictal above 200 mgs, when previously there had been nothing.
Thanks
Posted by SLS on April 4, 2004, at 19:56:51
In reply to Higher doses of lamictal?, posted by platinumbride on April 4, 2004, at 15:55:28
> Soooooo, after all that, I guess I just want to know if anyone has had minor miracles happen with lamictal above 200 mgs, when previously there had been nothing.
I really don't profit from Lamictal until I reach a dosage of 300mg per day.
- Scott
Posted by Tony P on April 5, 2004, at 0:38:58
In reply to Re: Higher doses of lamictal?, posted by SLS on April 4, 2004, at 19:56:51
> > ...I just want to know if anyone has had minor miracles happen with lamictal above 200 mgs....
>
> I really don't profit from Lamictal until I reach a dosage of 300mg per day.
>
> - ScottI am now on 300 mg and find a noticeable improvement from 200 or 250. My pdoc has one patient on 600 mg.
The intial studies by the mfgr. that showed no improvement above 200 mg are all very well, but we're all different, and the exceptions don't show up in a small sample (or get discarded as "bad data"!).
Tony P
Posted by platinumbride on April 5, 2004, at 8:29:40
In reply to Re: Higher doses of lamictal?, posted by Tony P on April 5, 2004, at 0:38:58
Posted by T_R_D on April 5, 2004, at 12:54:04
In reply to Higher doses of lamictal?, posted by platinumbride on April 4, 2004, at 15:55:28
I'm a little late on this response as you've already seen two folks but I agree whole heartedly. Upping the Lamictal may help. I've just started it and am on 50mg. I feel like poo. I can't wait to up it but I know I have to take my time to avoid The Rash... I do find it reassuring when reading that others have reaped its benefit. I really hop it works for me too...I've had a lot of heartache from meds...
Good luck PB and keep us informed!
Karen
Posted by platinumbride on April 5, 2004, at 16:00:08
In reply to Re: Higher doses of lamictal?, posted by T_R_D on April 5, 2004, at 12:54:04
> I'm a little late on this response as you've already seen two folks but I agree whole heartedly. Upping the Lamictal may help. I've just started it and am on 50mg. I feel like poo. I can't wait to up it but I know I have to take my time to avoid The Rash... I do find it reassuring when reading that others have reaped its benefit. I really hop it works for me too...I've had a lot of heartache from meds...
>
> Good luck PB and keep us informed!
> KarenYes...heartache from meds....well put.
I hope it works for you. It is now up there with lithium and depakote as "first line" treatment for bipolar stuff.
Posted by rod on April 10, 2004, at 6:45:48
In reply to Re: Higher doses of lamictal?, posted by SLS on April 4, 2004, at 19:56:51
> I really don't profit from Lamictal until I reach a dosage of 300mg per day.
Dear Scott,
May I sak you some questions about Lamictal?
How did you tolerate Lamictal at the beginning, when you where titrating up? Any problems, side effexts?
I am asking, becasause I am not sure what to do with my 200mg Lamictal. Its not noticeable working very well, but when I try to decrese the dose I feel increased depression, and lightheadness etc. This might go into the direction of seizure like things. Maybe this wil all wear off after some time, because I never did decrease my dosage from 200 to 150 any longer than 2 days.
And Maybe you had similar start-up effexts like me.
When I first started Lamictal it worked wonderful on 50mg the first week (decreased anxiety, eleminated restlessness, etc.). But then I experienced confusion, severe back/neck pain, headache, clumsiness, muscle weakness, hearing your phone winging and you name shout, without it really happen (I thing this was a weak paradox seizure aggravating reaction), sometimes my arms, hands, leg, feet felt totally numb. Touching them felt like touching eg. the arm from someone else.
But all this side effects went away after some weeks and dont have any of them anymore. Did you have had similar reactions?
How would you describe the effect of Lamictal at 300mg? Is it activating, stimulating (in a pleasant way), motivating? Can you say its targeting the core of your depression?many thanks
Roland
Posted by SLS on April 10, 2004, at 9:38:52
In reply to Re: Higher doses of lamictal? » SLS, posted by rod on April 10, 2004, at 6:45:48
Hi Roland.
> > I really don't profit from Lamictal until I reach a dosage of 300mg per day.
> How did you tolerate Lamictal at the beginning, when you where titrating up? Any problems, side effects?
I experienced some mild itching in the beginning and upon dosage increases. It generally didn't last for more than a day or two. I also experienced a bit of ataxia (difficulty walking a straight line) and memory difficulties. I think there were some mild cognitive effects as well.
> I am asking, because I am not sure what to do with my 200mg Lamictal. Its not noticeable working very well, but when I try to decrease the dose I feel increased depression, and lightheadness etc.
That sounds like a return of depression or a depressive rebound. I guess it makes sense to hope that Lamictal still has the potential to provide you some added benefit. For me, the difference in my functionality between 200mg and 300mg is significant (when combined with a TCA), and I would endorse a trial at the higher dosage. It makes sense to move up cautiously, but I doubt you would experience anything untoward going up by 50mg for one week and then to increase to 300mg if you are now tolerating 200mg well. I think it is important to point out that 200mg did help me some, so there was a partial response. It sounds like you are gleaning at least some benefit at 200mg as well. That might be an indicator that you will do better at a higher dosage. I hope so.
> This might go into the direction of seizure like things.
I doubt it. Again, it sounds like a depressive rebound, as dizziness can be a symptom of depression, and it might be exaggerated as the result of the reduction in dosage of Lamictal and a resultant depressive rebound.
> Maybe this will all wear off after some time, because I never did decrease my dosage from 200 to 150 any longer than 2 days.
Interestingly, some people actually experience a transient improvement upon the reduction of dosage.
> When I first started Lamictal it worked wonderful on 50mg the first week (decreased anxiety, eliminated restlessness, etc.).
This is quite common. Many people report an improvement in depressive symptoms during the first few weeks of treatment and at the low dosages that are, of course, necessary to avoid a rash reaction. This antidepressant effect then plateaus and fades. One might then feel better immediately upon a dosage increases. However, it is my impression that as monotherapy, most people are disappointed by Lamictal.
Wow. That sounds unpleasant. I really don't know what to make of all of that. However, they can all be accounted for by the adverse effect profile of Lamictal if you look at the manufacturer's labelling:
http://www.rxlist.com/cgi/generic/lamotrigine_ad.htm
> confusion
> back/neck pain,
> headache
> clumsiness = ataxia
> muscle weakness = asthenia
> arms, hands, leg, feet felt totally numb = paresthesiaI'm not sure that any of these things represent a paradoxical seizure. I'm glad that they resolved for you.
> How would you describe the effect of Lamictal at 300mg? Is it activating, stimulating (in a pleasant way), motivating?
I would say yes to all of that.
> Can you say its targeting the core of your depression?
That's a great question. I would say that the combination of Lamictal + imipramine brings me up about 15% improvement over my unmedicated baseline depression. For me, it has been a critical difference such that I am more functional and better able to take care of myself. I would say that it is a global improvement, although mild. But I'll take anything I can get!
Just so that you are aware, I am currently fooling around with memantine (Namenda), a recently approved drug indicated for the treatment of moderate to severe Alzheimer's Disease. I chose memantine for a number of reasons; chief among them is that I am partially responsive to Lamictal. The two drugs reduce glutamatergic neurotransmission, albeit through different mechanisms. I am so scared to jinx things by saying that I am beginning to respond to it, but... We'll see.
I hope I helped answer your questions. Lamictal is a valuable drug, but it is probably best used in combination with other drugs when treating affective disorders: either an AD for depression or lithium for rapid cycling bipolar disorder.
I wish you all the best.
:-)
- Scott
Posted by katia on April 10, 2004, at 17:37:36
In reply to Re: Higher doses of lamictal? » rod, posted by SLS on April 10, 2004, at 9:38:52
Hi fellow Lam users,
I just restarted Lamictal three weeks ago and have just upped it to 50mg and have had terrible irritability, tearfulness, agitationnnnnn, wanting to crawl out of my skin almost in the past two days since upping it.Previously when I took Lam. in combo w/ Depakote, I got euphoric upon increases. Now w/ Trileptal, I am experiencing this terrible agitation.
Anyone else experience this while titrating up? Do you think by increasing the Trileptal it'll help? I'm only at 300mg.
thanks-
Susan
Posted by rod on April 10, 2004, at 18:19:47
In reply to Re: Higher doses of lamictal? » rod, posted by SLS on April 10, 2004, at 9:38:52
Dear Scott
>For me, the difference in my functionality between 200mg and 300mg is significant (when combined with a TCA)
You really helped me to find decision.
I will try it at 300mg soon.
And yes, I also take a TCA (well not really, but you know what I mean) Nortripyline at 150mg. 175mg is counterproductive and just resuls in unpleasant drowsiness. So its 150mg. Also amisulpride and Neurontin.>> Maybe this will all wear off after some time, because I never did decrease my dosage from 200 to 150 any longer than 2 days.
>Interestingly, some people actually experience a transient improvement upon the reduction of dosage.
hmmm, maybe i really need this molecule in my brain.
I will try 300, and if that is crap, I can quit anyway.
Happy easter Scott
Roland
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