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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by europerep on March 9, 2010, at 14:50:05
hey there..
as the latest attempt to combat my TRD the professor at the university clinic prescribed me lamotrigine.. hm, it's what I suggested to my original doc (at the same clinic) already two months ago, but ok..
I received a "starter box", which contains 42 tablets 25mg each.. it says I am supposed to take 25mg for two weeks, then 50mg for two weeks, and then maybe go higher, BUT the instructions inside the box says this is ONLY (it's highlighted like that in the text) for those who start lamotrigine while taking nothing else.. for those who add lamotrigine to other medications there is no starter box..
what does this mean? can I actually increase the amount of pills I take before two weeks have passed? because, in fact, if I have to wait another two months before even getting near a therapeutic dose, I am not going to start this.. I intended to finally propose the buprenorphine option to someone, but I decided to not even try it when my suggestion of phenelzine already earned me a "but we don't use it anymore since 20 years ago!" .. right.. why is still being sold then? maybe I should just steal a block of blank prescriptions and prescribe it to myself, I mean this can't be true.. and I don't even get it, so many modern medications mention "isolated cases of death" as adverse effects as well, only with MAOIs it is known what it is caused by..and what's with the all the people who don't have the possibility to research their diseases on the net etc., in order to put such nonsense into perspective?..
I'm sorry, I am just very disappointed right now.. if someone who has added lamotrigine to venlafaxine, an SNRI, or also an SSRI could tell me how he/she did it, that would be very appreciated! thanks a lot! byebye..
Posted by Phillipa on March 9, 2010, at 16:35:55
In reply to lamotrigine starting dose (when added to venlafxin, posted by europerep on March 9, 2010, at 14:50:05
I added to luvox and benzos and was instructed to take 25mg for two weeks then 50mg for two weeks as adjunt to luvox. But go slow as the next step up then I think is 100mg. Good luck Phillipa
Posted by bleauberry on March 9, 2010, at 17:58:21
In reply to lamotrigine starting dose (when added to venlafxin, posted by europerep on March 9, 2010, at 14:50:05
Everyone is different and everyone reacts different, and that is why I do not believe in one size fits all. Which is what a starter pack is. Which is what a target dose is. Which is what a titration schedule is. I disagree with all of those. The better strategy, in my opinion, is to let your own reaction guide the journey.
The primary risk with lamictal is the rash, which can be serious enough for hospitalization and sometimes even death. The primary risk of getting that rash is by starting at too high of a dose and by increasing dose too rapidly. Since everyone's biology is different, there is no way to know what those doses are from person to person.
Generally speaking, the safe starting dose of lamictal is 12.5mg. Simply cut the pills in half. See how you do for a week, then maybe go for 25mg. See how it goes for a couple weeks, then add another 12.5mg for a total dose of 37.5mg. This might be overly cautious, but that's just the way I am. I've learned some harsh lessons over the years, in terms of bad reactions as well as worsening of the original condition. Some people do very poorly on lamictal, and I'm one of them. It made me suicidal where I had not been suicidal prior to taking it. It can also be a miracle to some people.
Probably the only drawback, assuming it works, is that clinical studies show its longterm efficacy is not great. In clinical studies it delayed the return of depression but did not prevent it.
Personally I would forget the instructions and instead cut the pills in half. Others would say do what your doctor instructed. We all have to make our own decisions what is the wisest path.
I can think of better ways to treat TRD, starting for example with Parnate and Nardil before resorting to a drug like lamictal who's primary purpose is to control seizures not depression. But every doctor has their own favorite way of doing things, so I guess we kinda got a go with the flow as long as keep that doctor on our payroll.
Posted by polarbear206 on March 9, 2010, at 19:26:12
In reply to lamotrigine starting dose (when added to venlafxin, posted by europerep on March 9, 2010, at 14:50:05
> hey there..
>
> as the latest attempt to combat my TRD the professor at the university clinic prescribed me lamotrigine.. hm, it's what I suggested to my original doc (at the same clinic) already two months ago, but ok..
> I received a "starter box", which contains 42 tablets 25mg each.. it says I am supposed to take 25mg for two weeks, then 50mg for two weeks, and then maybe go higher, BUT the instructions inside the box says this is ONLY (it's highlighted like that in the text) for those who start lamotrigine while taking nothing else.. for those who add lamotrigine to other medications there is no starter box..
> what does this mean? can I actually increase the amount of pills I take before two weeks have passed? because, in fact, if I have to wait another two months before even getting near a therapeutic dose, I am not going to start this.. I intended to finally propose the buprenorphine option to someone, but I decided to not even try it when my suggestion of phenelzine already earned me a "but we don't use it anymore since 20 years ago!" .. right.. why is still being sold then? maybe I should just steal a block of blank prescriptions and prescribe it to myself, I mean this can't be true.. and I don't even get it, so many modern medications mention "isolated cases of death" as adverse effects as well, only with MAOIs it is known what it is caused by..
>
> and what's with the all the people who don't have the possibility to research their diseases on the net etc., in order to put such nonsense into perspective?..
>
> I'm sorry, I am just very disappointed right now.. if someone who has added lamotrigine to venlafaxine, an SNRI, or also an SSRI could tell me how he/she did it, that would be very appreciated! thanks a lot! byebye..Hello, I take Lamictal with effexor. Start low and slow as you were instructed. You need to be patient while you titrate. It has been a life saver for me. Can't say enough good things about it. Have been on it long term. My p-doc has many of his patients on it who have also been on it for years. Good Luck. :)
Posted by emmanuel98 on March 9, 2010, at 19:35:37
In reply to Re: lamotrigine starting dose (when added to venlafxin, posted by bleauberry on March 9, 2010, at 17:58:21
I think I titrated up a week at a time. Started on 25 for a week, then 50, then 75, then 100. I stayed on 100 for two weeks then went to 200, which is the target dose. I have to say that lamictal did nothing for me. Nothing good, nothing bad. It just had no effect at all.
Posted by obsidian on March 11, 2010, at 22:00:11
In reply to lamotrigine starting dose (when added to venlafxin, posted by europerep on March 9, 2010, at 14:50:05
I take lamictal and effexor, going up slowly on lamictal is important
there is a med or two...I think, that when taken with lamictal affects dosages, but whatever it is, it isn't effexor
(to the best of my knowledge, and not being a pdoc and all)the two meds have worked for me, and I didn't think anything could
I got some irritability initially every time I raised the lamictal, but that subsided, and I'm now in the process of lowering the effexor, got some anxiety with that, which thankfully has dissipated for the most part.
good luck,
sid
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