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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by linkadge on May 27, 2007, at 10:36:36
So, doctor wanted me to give lamotrigine a fair trial. I decided to try it again.
Has anyone noticed acute dysphoria from lamotrigine? Like a sudden onset blah / mild irritability etc.
I don't really like this substance.
Linkadge
Posted by Phillipa on May 27, 2007, at 11:37:57
In reply to lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 10:36:36
Even though I only took 25 to 50mg I found myself getting angry and smashed a plastic bottle across a storefront didn't connect the two until later. Love Phillipa
Posted by kaleidoscope on May 27, 2007, at 12:50:28
In reply to lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 10:36:36
Hi Link
>Has anyone noticed acute dysphoria from lamotrigine? Like a sudden onset blah/mild irritability.......
Irritability has been reported as a side effect of lamotrigine.
My impression of lamotrigine.......
1. Fewer side effects than most antiepileptics.
2. First line treatment for certain types of epilepsy (especially partial seizures).
3. Often not very effective for depressive disorders. May provide some benefit as a maintenance treatment for bipolar disorder but the obligatory slow dose titration makes it an inappropriate treatment for a severe depressive episode.
4. Lamictal is expensive. The price of generic lamotrigine in the UK is falling.
I'm more concerned about topiramate (Topamax)............
1. Very little (or no) evidence of efficacy in any psych disorder. No convincing evidence of efficacy in bipolar disorder.
2. High incidence of side effects, some of which are severe.
3. Exceptionally expensive.
4. Topiramate is an effective treatment for certain types of epilepsy. It is also proven to be an effective agent for migraine prophylaxis.
5. Topiramate may be overused in psychiatry because of its tendency to cause weight loss......at the cost of many side effects and unproven efficacy in bipolar disorder.
My impression of gabapentin and pregabalin............
1. Some efficacy in partial epilepsy.
2. Some efficacy in GAD for pregabalin.
3. No evidence of efficacy in bipolar disorder.
Valproate (Depakote)........
1. Effective in most types of epilepsy.
2. Very useful in the treatment of acute mania.
Levetiracetam (Keppra).......
1. Effective in epilepsy.
2. No evidence of effectiveness in bipolar disorder.
Tegretol.........
1. Very effective treatment for partial-onset seizures.
2. Some evidence of efficacy in bipolar disorder (as an antimanic). Depakote is much better proven.
Posted by linkadge on May 27, 2007, at 13:06:24
In reply to Re: lamotrigine dysphoria anyone?, posted by kaleidoscope on May 27, 2007, at 12:50:28
Thanks for the information. I guess there is probably a lot of hype about lamotrigine. It may be a wonder drug for some, but I have never noticed anything fantastic about it.
Linkadge
Posted by sunnydays on May 27, 2007, at 13:11:30
In reply to lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 10:36:36
I don't know. For me, it's the first time I've felt normal in a long time. I just added 50mg of Lamictal to 20 mg of Lexapro, and I feel just 'normal' for the first time. No longer crushed by depression all the time. It's wonderful for me.
sunnydays
Posted by kaleidoscope on May 27, 2007, at 13:13:28
In reply to Re: lamotrigine dysphoria anyone?, posted by kaleidoscope on May 27, 2007, at 12:50:28
It's interesting how a strange tendency has emerged among some US pdocs to prescribe the newer-generation anticonvulsants for bipolar disorder.
Depakote has good evidence of efficacy in the treatment of acute mania. Whether it's useful in the long term is less clear due to a surprising lack of high quality research. Lamictal has some value as a maintenance med. Tegretol may have some value in the treatment of mania, but it's certainly not first line.
Apart from Depakote, Lamictal and (to a lesser extent) Tegretol, none of the other antiepileptics have been shown to be useful in the treatment of bipolar disorder. I get the impression that they are being prescribed more frequently than they ought to be. Some pdocs seem to have abandonned evidence-based medicine completely. Lithium, Depakote and certain APs (such as olanzapine) have the best evidence of effectiveness in the treatment of mania. Prophylaxis is more difficult. Similarly, treatment of bipolar depression can be very difficult, there is no ideal treatment. If antidepressants (eg. an SSRI) are prescribed for a severe depressive episode, they should not generally be continued after the depression has resolved. Long-term use may be destabilising......and this may not be prevented by 'mood stabilisers'.
Posted by kaleidoscope on May 27, 2007, at 13:24:30
In reply to Re: lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 13:06:24
Hi Link
An interesting feature of lamotrigine seems to be its apparantly high 'poop out' rate. A lot of 'babblers' have said that it works briefly but then they have to increase the dose to maintain the benefit, and then it poops out again.......and so on.....
Some people swear by it though :)
K
Posted by kaleidoscope on May 27, 2007, at 13:26:09
In reply to Re: lamotrigine dysphoria anyone? » linkadge, posted by sunnydays on May 27, 2007, at 13:11:30
Hi Sunnydays
- brilliant that you're feeling so much better. Best of luck :)
Posted by Denise190466 on May 27, 2007, at 13:38:10
In reply to lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 10:36:36
I didn't really feel like I was taking anything when I took Lamictal for about three months, I felt like I might as well be taking smarties. However, after the lamictal trial, I eventually went onto Paxil and it started to work for some reason. Not sure why, I was thinking maybe the lamictal made some changes to my brain. But again, I'm probably just clutching at straws.
By the way I'm not bipolar.
Denise
Posted by psychobot5000 on May 27, 2007, at 14:08:31
In reply to lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 10:36:36
>
> Has anyone noticed acute dysphoria from lamotrigine? Like a sudden onset blah / mild irritability etc.
>
>Empatic yes, and yes. I don't think it's a good drug for depression. The large scale studies have now born that out.
My experience with Lamictal is as follows: immediate, rapid improvement (within 2 hours post dose, and lasting...maybe two days before beginning to decrease) that didn't last out the week. What I was left with was a baseline mood state, plus 'the blahs' as you put it. Also cognitive issues that developed over the period of weeks that I took it. It probably left me below my baseline mood state.
I think the thing that tricks patients and docs about this med is the initial rapid improvement, though studies show that improvement tends to disappear within seven weeks, if not more rapidly. And of course there's a dangerous inverse to the rapid improvement it offers when initiating or increasing dose: lowering the dose or stopping the drug causes acute dysphoria, beyond what chronic dysphoria it may cause when continuing to be taken. So it's hard to quit, because in the short-term you feel even worse.
And yes, there was something beyond low mood that it caused, that I can only describe as 'blahs.' A sort of dulling of emotion, maybe. I can't say it gave me irritability, though.
So my opinion is this: stay away, especially for unipolar depression. It's scary the number of times you can read people saying "I didn't really think Lamictal was helping me, but whenever I stop taking it I feel like crap...so I guess it must be...." Took me 2 trials to realize myself what it did to me, and I'd rather fewer people had to go through that sort of experience.
Normally, I'd just say that all this was just my personal experience, of course. But this article (which likely you're already familiar with) says otherwise in very convincing terms:
http://www.mcmanweb.com/news.htm
Posted by kaleidoscope on May 27, 2007, at 14:43:37
In reply to Re: lamotrigine dysphoria anyone? YES. » linkadge, posted by psychobot5000 on May 27, 2007, at 14:08:31
Fascinating article. I've read the NICE guidelines. It's interesting to find out that there are actually relatively few meds which have been shown to be effective in bipolar disorder. Many of the most commonly used options are supported by poor evidence.
Posted by psychobot5000 on May 27, 2007, at 15:02:14
In reply to Re: lamotrigine dysphoria anyone? YES. » psychobot5000, posted by kaleidoscope on May 27, 2007, at 14:43:37
>...It's interesting to find out that there are actually relatively few meds which have been shown to be effective in bipolar disorder. Many of the most commonly used options are supported by poor evidence.
>
>It's really too bad, isn't it. Seems like Lithium and a few other old drugs are almost the only reliable ones. Hopefully they'll come up with something better in the next few years.
Psychbot
Posted by linkadge on May 27, 2007, at 15:05:47
In reply to Re: lamotrigine dysphoria anyone?, posted by kaleidoscope on May 27, 2007, at 13:13:28
I gather that bipolar depression is the most disabling. My mother has essentially been in a depressive phase for the last 20 years. The lithium has done little to curb the depression.
Her doctor didn't think that lamictal had much evidence as a mood stabilizer, and just opted to max out the lithium.
Its unfortunate that they can't do more for bipolar depression (or even depression in general).Linkadge
Posted by linkadge on May 27, 2007, at 15:07:21
In reply to Re: lamotrigine dysphoria anyone?, posted by Denise190466 on May 27, 2007, at 13:38:10
Its possable that the lamictal helped the SSRI's work again. There is some evidence that it can help in tollerance to certain meds.
For instance, some studies suggested that it slowed tollerance to L-dopa in parkinsons.
Linkadge
Posted by kaleidoscope on May 27, 2007, at 15:08:30
In reply to Re: lamotrigine dysphoria anyone? » kaleidoscope, posted by psychobot5000 on May 27, 2007, at 15:02:14
Personally, I think lithium is underprescribed. It can cause side effects of course but so do newer drugs.....which often don't work. Blood level monitoring can help determine then correct dose and minimise side effects.
Depakote is very useful for acute manic episodes and possibly for maintenance treatment.
Atypical APs can be useful but side effects are a major problem, especially weight gain and metabolic disturbances. In general, Zyprexa seems to cause a lot more weight gain than lithium. Zyprexa is very effective for acute mania.
K
Posted by linkadge on May 27, 2007, at 15:10:18
In reply to Re: lamotrigine dysphoria anyone? YES. » linkadge, posted by psychobot5000 on May 27, 2007, at 14:08:31
You're right!
People say that about a lot of meds (I didn't think it was helping untill I tried to get off of it)
Unfortunately, withdrawl symptoms from a drug are not evidence that it is doing anything.
Linkadge
Posted by linkadge on May 27, 2007, at 15:13:30
In reply to Re: lamotrigine dysphoria anyone? YES. » psychobot5000, posted by kaleidoscope on May 27, 2007, at 14:43:37
If it is of any interest, I read that lamotrigine does not promote hippocampal neurogensis, like lithium, depakote, and antidpressants.
Many of the anticonvulsants like tegretol etc, impair neurogenesis.
Linkadge
Posted by gardenergirl on May 27, 2007, at 15:35:50
In reply to Re: lamotrigine dysphoria anyone? YES., posted by linkadge on May 27, 2007, at 15:13:30
I definitely had irritability with Lamictal once I hit 125 mg and then 150 mg. It eventually decreased, but it was not pretty for a few weeks. Since I started lithium, I'm doing a lot better. It makes me wonder if the lamictal is necessary for me, but I don't want to rock the boat right now.
gg
Posted by Maxime on May 27, 2007, at 20:20:52
In reply to lamotrigine dysphoria anyone?, posted by linkadge on May 27, 2007, at 10:36:36
Hi
Yes, my depression became worse on Lamictal. I went up to 150 mg and then I finally put my food down and said "enough". The sad part is that I had such high hopes for the med and you have to tritrate it slowly.
I've from several people (not on this board) about dysphoria & lamictal.
Sorry link.
Maxime
> So, doctor wanted me to give lamotrigine a fair trial. I decided to try it again.
>
> Has anyone noticed acute dysphoria from lamotrigine? Like a sudden onset blah / mild irritability etc.
>
> I don't really like this substance.
>
> Linkadge
Posted by Bonnie_CA on May 28, 2007, at 1:13:07
In reply to Re: lamotrigine dysphoria anyone? » linkadge, posted by sunnydays on May 27, 2007, at 13:11:30
> I don't know. For me, it's the first time I've felt normal in a long time. I just added 50mg of Lamictal to 20 mg of Lexapro, and I feel just 'normal' for the first time. No longer crushed by depression all the time. It's wonderful for me.
>
> sunnydays
I'd have to agree, especially since we have similar regimes. I'm taking 10mg of Lexapro and 200mg of Lamictal a day. I'm so much more normal, I think, more what I pictured to be normal than I felt previously. I was getting anxious when I dropped to 5mg of Lexapro but that seems to be leveled out at 10mg. I haven't had any noticeable side effects. It's been good to me so far.-Bonnie
Posted by deniseuk190466 on May 28, 2007, at 12:00:39
In reply to Re: lamotrigine dysphoria anyone? » Denise190466, posted by linkadge on May 27, 2007, at 15:07:21
Thanks Link, maybe I'll ask my psychiatrist about putting me on it again for a couple of months.
I'm sort of at giving up mode right now though.
Thank God for Zyprexa.
Denise
Posted by theo on May 30, 2007, at 21:14:50
In reply to Re: lamotrigine dysphoria anyone? » linkadge, posted by sunnydays on May 27, 2007, at 13:11:30
When do you take your Lamictal, morning or bedtime?
This is the end of the thread.
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