![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 115. Go back in thread:
Posted by Scott L. Schofield on March 24, 2000, at 15:21:43
In reply to Re: Lamictal and Hair Loss-Scott, posted by sherry on March 24, 2000, at 8:07:11
> One of the medications I took caused the same thing(red,dry patches on my face). I used Avon's Anew, and it completely controls it. If I miss more than one day of using it though, the patches return. Anew is a alpha hydrox that helps to turn over dead skin cells. You may want to give it a try. Even if you don't use Avon's there are others you can by at Walmart that do the same thing. I also use Nuetrogena's T/GEL shampoo for the dandruff, and it works great. May be worth a trial for you as well. Have a great day.
> ~Sherry
Thanks !
- Scott
Posted by FLMALE on June 1, 2000, at 22:55:33
In reply to Re: Xanax Withdrawal, posted by alan on January 12, 1999, at 9:03:15
> > > > Anyone ever take xanax for an extended period and try to detox and have problems or success. I have had problems only to be put back on xanax after trying other drugs for symptoms I had not had before taking xanax.....anyone with anything similar.....or has anyone heard of anything similar.....
> > > --------------Try aswitching to Klonopin, and reduce the amount as gradually as possible.
> > Were you even able to stop the Xanax utilizing the Klonopin regimen? If so, how long did it take? How long and how much Xanax had you been taking?
> I've shifted to valium and detoxed very, very slowly lowering dosage by minute amounts and had no touble at all. Are you surre the new symptoms were due to going off the xanax? Not a rising tide of depression, say, or whatever? Well, good luck. Take all the time you need as long as you are moving in the right direction overall.
>
>> Hi, I have been taking Xanax for anxiety and was has never been "fully" diagnosed as CFIDS, formerly Chronic Fatigue Syndrome. Initially, I was started on .25 mg 3 times per day. This was in March of 1995. During one of the latter parts of last year, I visited my physician to advise that I seemed to be becoming "tolerant" to the medication and was having what I have since learned to be both "withdrawal" symptons, as well as symptoms that can occur from "long-term" usage of the medication. Rather than to help with the problems (less and less sleep, tingling sensations, etc. --- some of the worst symptoms of withdrawal/long-term use), my doctor switched me to two tablets per day rather than three. After several days it was more than I felt I could bear. I was not sleeping at all and felt as if I would go unconscious at any time due to the "sensation of pain" that I was feeling. Fortunately, my Primary Care Physician agreed to prescribe the medication and was a bit amazed that a physician would lower the dosage but yet not respond when I pleaded and described what I was going through. Of course, this helped, but the "tolerance" to the "3 0.25 mg tablets per day" grew, and the latter part of 1999 the dosage was increased to "3 0.50 mg tablets per day". That has been nearly a year and I have found myself experiencing the same symptoms of "tolerance/withdrawal feelings/long-term usage" again. After many sleepless nights, I decided to try to find what is fairly new to me, the Tahitian Noni Juice, which is supposed to be wonderful for "calming you", "addiction to medications", as well as numerous other things. I followed the dosage prescribed by a physician and continued with the normal dose of Xanax but noticed that as each day went by, I was becoming more and more alert, sleeping less, and having even "stronger" tingling feelings. This is not surprising, as the juice was described as ridding your body of chemicals and toxins, so I was really not getting any effect from taking the Xanax at the same time. After the fifth day, I remained awake for over 28 hours straight (and of course had to get up and deal with work, which was mentally and physically devastating). I decided to "STOP" taking the Tahitian Juice, as it obviously was either working too fast and was thereby increasing my symptoms of little sleep into absolutely "NO" sleep, tingling sensations into that of "SEVERE tingling/jitteriness", as well as a few other symptoms of withdrawal that I'm sure most of you are familiar with. At this point it has been seven days since I "STOPPED" taking the Tahitian Juice, have continued taking the Xanax as prescribed, but these symptoms continue to feel "heightened" as they did a week ago when I was taking the juice. I am curious if anyone has experienced this, as I just recently read about the juice and actually read a posting by a physician who recommended the juice for withdrawal to Xanax. I wish I could offer more help, as this seemed to be my last hope. I have tried (unsuccessfully) several times to decrease the Xaxax dosage by only a minute amount but it seems by the second or third day even "THAT" small of a reduction results in more severe symptoms. I, too am concered, as I have been taking it for five years and can see only where it can be increased to once again be effective. Also, I don't want to end up taking the maximum dosage and going through anything more severe than I already am. I was once taking Klonopin (prescribed for what a neurologist termed, "a benign tremor" --- prior to taking the Xanax --- I had begun having invulontary tremors in my hands, arms, and legs --- tremors that were "NOT" associated with feelings of anxiety --- tremors that occurred at some of the happiest moments in my life) and after two years of it, it too lost its effectiveness. After being told that some people have to take up to nine doses a day and I as at that time on three tablets per day with no relief from the tremors, I went through nearly six months of severe withdrawal and swore I would "NEVER" take the medication again. Hence, now I and going through the same thing, only more severe, with the Xanax and am in quite a dilemna. I would appreciate "ANY and ALL" responses to this by anyone who can relate or any physician who could possibly help, as it has devastated my life and working is becoming more and more difficult to endure.
--------------------------------------------------------------------------------
Posted by JudithC on June 2, 2000, at 17:36:14
In reply to Re: Xanax Withdrawal, posted by FLMALE on June 1, 2000, at 22:55:33
Flmale,I am confused by your/someone's/whomever's post so help me out here,please: are YOU the one asking for help about the Xanax withdrawal or are you trying to help someone???? I understand some of the context of this post,but only some....
If you need to talk with a person who has withdrawn from a benzo then I will be more than happy to discuss this with you. I have been off of Ativan since the summer of 1997;however,I am suffering from "protracted benzo withdrawal" and with this in mind,if I may share anything such as difficulties in withdrawing or relaying info about other websites which are totally benzodiazepine directed then I will be glad to help you.
JudithC
Posted by FLMALE on June 2, 2000, at 18:48:26
In reply to Re: Xanax Withdrawal » FLMALE, posted by JudithC on June 2, 2000, at 17:36:14
>
>
> Flmale,I am confused by your/someone's/whomever's post so help me out here,please: are YOU the one asking for help about the Xanax withdrawal or are you trying to help someone???? I understand some of the context of this post,but only some....
>
> If you need to talk with a person who has withdrawn from a benzo then I will be more than happy to discuss this with you. I have been off of Ativan since the summer of 1997;however,I am suffering from "protracted benzo withdrawal" and with this in mind,if I may share anything such as difficulties in withdrawing or relaying info about other websites which are totally benzodiazepine directed then I will be glad to help you.
>
> JudithCHi, JudithC, and thanks for responding. I am not certain which of the postings I responded to, but it was included at the beginning of mine. The posting was in reference to someone attempting to decrease Xanax dosage and was having difficulties. Since I have reviewed many websites and have found that this one contains the more related and understanding comments, I decided to post my entire situation from the date that it started back in 1987 (that was when the symptons of the CFIDS started, but I had no idea what it was until 1995 when I had gathered much research and visited the first physician who started me on the Xanax (0.25 mg/3 day)). I know the references to CFIDS and separate references to tremors (unrelated to anxiety) seem a bit confusing but there WAS one piece of information that I neglected to post. When I was in high school I contracted some form of encephalitis and upon exiting a coma, experienced severe tremors and shaking in my neck, hands, arms, practically all over. After several months, the tremors subsided completely and I never had trouble with them again until 1995 (eight years after I began having MOST of the symptoms associated with CFIDS) and visited a neurologist, as even at that time I was aware that the tremors did not necessarily go hand-in-hand with any anxiety that I might experience. Thus, it's a two-fold problem. My reference to both problems was to also relate my encounter with the withdrawal from Klonopin (administered by the neurologist for tremors but not diagnosed by him due to anxiety) and subsequently being placed on Xanax once I began to feel so weak and exhausted, continuing in a highly-stressful job. I have since realized that the tremors are something I can live with, as they do not occur that often. However, the problem with the Xanax continues to remain. My current physician has continued to prescribe it and that is my primary conern at this point (the stronger feelings of withdrawal or jitteriness as if I've built up a tolerance to the dosage, even after it was raised to 0.50 mg/3 day approximately a year ago). In short, I was relating to the posting that I, too have been attempting (without any success) at times to slowly decrease the Xanax but always ended up raising it back to the prescribed dosage. Also, I was trying to provide some information in relation to the "natural/herbal" method that I attempted but seemed to have a rebound effect (Tahitian Noni Juice). Thanks in advance for any additional information that you can provide.
Posted by LesaH on November 29, 2000, at 23:49:43
In reply to Re: Xanax Withdrawal » JudithC, posted by FLMALE on June 2, 2000, at 18:48:26
> >
> >
> > Flmale,I am confused by your/someone's/whomever's post so help me out here,please: are YOU the one asking for help about the Xanax withdrawal or are you trying to help someone???? I understand some of the context of this post,but only some....
> >
> > If you need to talk with a person who has withdrawn from a benzo then I will be more than happy to discuss this with you. I have been off of Ativan since the summer of 1997;however,I am suffering from "protracted benzo withdrawal" and with this in mind,if I may share anything such as difficulties in withdrawing or relaying info about other websites which are totally benzodiazepine directed then I will be glad to help you.
> >
> > JudithC
>
> Hi, JudithC, and thanks for responding. I am not certain which of the postings I responded to, but it was included at the beginning of mine. The posting was in reference to someone attempting to decrease Xanax dosage and was having difficulties. Since I have reviewed many websites and have found that this one contains the more related and understanding comments, I decided to post my entire situation from the date that it started back in 1987 (that was when the symptons of the CFIDS started, but I had no idea what it was until 1995 when I had gathered much research and visited the first physician who started me on the Xanax (0.25 mg/3 day)). I know the references to CFIDS and separate references to tremors (unrelated to anxiety) seem a bit confusing but there WAS one piece of information that I neglected to post. When I was in high school I contracted some form of encephalitis and upon exiting a coma, experienced severe tremors and shaking in my neck, hands, arms, practically all over. After several months, the tremors subsided completely and I never had trouble with them again until 1995 (eight years after I began having MOST of the symptoms associated with CFIDS) and visited a neurologist, as even at that time I was aware that the tremors did not necessarily go hand-in-hand with any anxiety that I might experience. Thus, it's a two-fold problem. My reference to both problems was to also relate my encounter with the withdrawal from Klonopin (administered by the neurologist for tremors but not diagnosed by him due to anxiety) and subsequently being placed on Xanax once I began to feel so weak and exhausted, continuing in a highly-stressful job. I have since realized that the tremors are something I can live with, as they do not occur that often. However, the problem with the Xanax continues to remain. My current physician has continued to prescribe it and that is my primary conern at this point (the stronger feelings of withdrawal or jitteriness as if I've built up a tolerance to the dosage, even after it was raised to 0.50 mg/3 day approximately a year ago). In short, I was relating to the posting that I, too have been attempting (without any success) at times to slowly decrease the Xanax but always ended up raising it back to the prescribed dosage. Also, I was trying to provide some information in relation to the "natural/herbal" method that I attempted but seemed to have a rebound effect (Tahitian Noni Juice). Thanks in advance for any additional information that you can provide.Ladies:
I am a 5 milligram per day, 6 year xanax addict. I have no emotion I am flatlined. Help
Posted by Coachnanci on December 4, 2000, at 12:05:18
In reply to long term lamictal , anyone???????????????????????, posted by Amanda S on March 23, 2000, at 15:21:14
> Has anyone experienced weight gain while on Lamictal. My pdoc told me that this is a "charge neutral" med when it comes to weight gain. I was on Topimax/Effexor previously - but with no luck. Now I am on just one med and feel really good. No manic episodes and no real deep swings into depression. But, I have gained about 10 pounds. I figured feeling better was more important than the weight - but am joining Weight Watchers to take off what I put on. Anyone else with similar experience? Can you lose weight or is this a waste of time? Thanks.
Nancy
Posted by shellie on December 4, 2000, at 16:16:05
In reply to Weight gain and lamictal, posted by Coachnanci on December 4, 2000, at 12:05:18
> > Has anyone experienced weight gain while on Lamictal.
Nancy, I also gained weight (over ten pounds) while on lamictal. Recently when discusing this with my pdoc, I have questioned whether the weight was due to an increase in prolactin levels caused by the lamictal. In my case, while on lamictal, my breasts were enlarged and extremely uncomfortable. She does believe that the weight gain and breast pain were related, and we may try to treat them by using a medication to lower my prolactin levels.
Otherwise, I found it totally impossible through diet and intense exercise to lose the weight.If you are not feeling any breast discomfort, then this probably does not apply to you. shellie
Posted by Coachnanci on December 5, 2000, at 8:23:08
In reply to Re: Weight gain and lamictal » Coachnanci, posted by shellie on December 4, 2000, at 16:16:05
> > > Has anyone experienced weight gain while on Lamictal.
>
> Nancy, I also gained weight (over ten pounds) while on lamictal. Recently when discusing this with my pdoc, I have questioned whether the weight was due to an increase in prolactin levels caused by the lamictal. In my case, while on lamictal, my breasts were enlarged and extremely uncomfortable. She does believe that the weight gain and breast pain were related, and we may try to treat them by using a medication to lower my prolactin levels.
> Otherwise, I found it totally impossible through diet and intense exercise to lose the weight.
>
> If you are not feeling any breast discomfort, then this probably does not apply to you. shellieHi Shellie -
Thanks for responding to my post. Yes, that's exactly where I gained the most weight - was my breasts, also. So, are you going to be treated with a medication to lower prolactin levels? I wonder if other mood stabilizers such as Tegretol have the same affect? I have done so well on the Lamictal but cannot stand the added weight. Please keep me posted how you do and thanks so much for sharing the information.
Nancy
Posted by shellie on December 5, 2000, at 9:28:09
In reply to Re: Weight gain and lamictal, posted by Coachnanci on December 5, 2000, at 8:23:08
Nancy, I had gone off the lamictal because of the weight gain and was trying other meds (including topopax). None of them had the same side effect, but neither did they provide relief for me. Now I'm going to start back on the lamictal (but maybe not until after Christmas), so it will be a while until I know if I will be able to control the side effect. But I'll let you know--probably in January. Shellie
Posted by Coachnanci on December 5, 2000, at 10:58:25
In reply to Re: Weight gain and lamictal, posted by shellie on December 5, 2000, at 9:28:09
Thanks, Shellie ... you gave me some good information. I am going to follow-up with my primary physician and pdoc to check it out. I, too, went through so many different meds and so far, Lamictal has been the best med I've been on. I don't feel medicated and the relief from the mania/depression have been tremendous. Best regards for the holiday. I look forward to hearing about your progress then.
Nancy >
Nancy, I had gone off the lamictal because of the weight gain and was trying other meds (including topopax). None of them had the same side effect, but neither did they provide relief for me. Now I'm going to start back on the lamictal (but maybe not until after Christmas), so it will be a while until I know if I will be able to control the side effect. But I'll let you know--probably in January. Shellie
Posted by SLS on December 5, 2000, at 17:13:18
In reply to Re: Weight gain and lamictal » Coachnanci, posted by shellie on December 4, 2000, at 16:16:05
> > Has anyone experienced weight gain while on Lamictal.
> Nancy, I also gained weight (over ten pounds) while on lamictal. Recently when discusing this with my pdoc, I have questioned whether the weight was due to an increase in prolactin levels caused by the lamictal. In my case, while on lamictal, my breasts were enlarged and extremely uncomfortable. She does believe that the weight gain and breast pain were related, and we may try to treat them by using a medication to lower my prolactin levels.
Otherwise, I found it totally impossible through diet and intense exercise to lose the weight.> If you are not feeling any breast discomfort, then this probably does not apply to you. shellie
Hi Girls.I don't think the weight gain and breast enlargement / tenderness produced by Lamictal (lamotrigine) are related to prolactin. I can't find any evidence that prolactin is affected in any way by Lamictal. Unfortunately, I don't have my PDR with me nor the package-insert. Is prolactin elevation listed as a side-effect?
Many drugs produce weight gain for which the mechanisms are not well understood. SSRIs can produce weight gain *and* breast enlargement without elevating prolactin levels. Interestingly, the magnitude of weight gain seems highest in those women who also experience breast enlargement. Perhaps there is a direct association between these two phenomena.
For me, Lamictal has produced about a 10 pound increase in body weight, but no breast enlargement. I'm not sure how to feel about that.
Perhaps Lamictal does cause an elevation of prolactin that would explain your observed weight-gain and macromastia. This sort of thing may not have shown up during clinical testing, as the subjects were either healthy or suffering from epilepsy and were already taking other anticonvulsant drugs. The altered neuroendocrine function demonstrated in major depression and bipolar depression might account for a different responsiveness to specific drug challenges. Perhaps Lamictal is among them.
While it is still on my mind, I proposed in a prior post the possibility that SSRI induced weight-gain might be overrepresented in a treatment-resistant population or a population dominated by atypical depression and bipolar depression, both of which share many clinical features. Perhaps SSRI weight-gain reflects an idiosyncratic serotonergic dysregulation peculiar to these two subgroups.
I don't know how expensive the blood work is, but it would be very fruitful to establish what your baseline level of prolactin is before starting Lamictal. If it increases significantly during treatment, then you can probably use one of the standard remedial treatments for hyperprolactinemia. It might not hurt to try Mirapex (pramipexole) or Parlodel (bromocriptine) anyway, as both of these drugs are dopaminergic and are sometimes used as adjuncts to treat treatment-resistant depression (TRD). Traditionally, Parlodel has been used to treat hyperprolactinemia. However, AndrewB recently suggested the use of Mirapex, as it might make for a better antidepressant. I don't see that Mirapex is yet being used to treat hyperprolactinemia, even though it shares some basic pharmacodynamic properties with Parlodel: dopamine receptor agonism (stimulation) and prolactin secretion inhibition. Perhaps it is not as effective as Parlodel. I like the Mirapex alternative, though. You can always determine how well it treats elevated prolactin levels by taking a blood test.
So that there be no confusion, let me emphasize that this has not been a joke.:-) (obligatory)
- Scott
--------------------------------------------------------
* In the following study of SSRIs, only Paxil (paroxetine) produced an elevation of serum prolactin levels. However, this effect seems to be biphasic and time-dependant. Prolactin is elevated during the second week of administration, but returns to normal after three weeks and beyond. This normalization is probably caused by the type of neuroadaptive changes that are also thought to facilitate the therapeutic antidepressant effects of these drugs.1: J Affect Disord 1997 Nov;46(2):151-6 Related Articles, Books, LinkOut
Breast enlargement during chronic antidepressant therapy.Amsterdam JD, Garcia-Espana F, Goodman D, Hooper M, Hornig-Rohan M
Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Recent reports of mammoplasia during selective serotonin re-uptake inhibitor (SSRI) therapy suggested that this side effect may be more common than previously reported. We examined 59 women receiving > or = 2 months treatment with an SSRI or venlafaxine for changes in breast size in relation to menopausal status, weight gain and duration of drug therapy. Serum prolactin, estradiol and beta-hCG were also measured before and during treatment in a subgroup of patients. Twenty-three out of 59 patients (39%) reported some degree of mammoplasia. Significantly more SSRI vs. venlafaxine patients reported mammoplasia (p < 0.01). Eighty-four percent with mammoplasia had weight gain vs. 30% without mammoplasia (p < 0.001). The rate of mammoplasia was unrelated to age, menopausal status or duration of treatment. Serum prolactin increased during treatment in the paroxetine subgroup (p < 0.03). In conclusion, antidepressant-induced mammoplasia may be more common than previously expected.
PMID: 9479619, UI: 98140246
-----------------------------------------------------------
: Psychopharmacology (Berl) 2000 May;150(1):120-2Serotonin transporter (5-HTT) promoter genotype may influence the prolactin response to clomipramine.
Whale R, Quested DJ, Laver D, Harrison PJ, Cowen PJ
University Department of Psychiatry, Warneford Hospital, Oxford, UK.
RATIONALE: A 44-base-pair insertion/deletion polymorphism in the promoter region of the human serotonin (5-HT) transporter (5-HTT) gene gives rise to a bi-allelic polymorphism designated long (l) and short (s). The s variant is associated with a lower expression of 5-HTT sites and a reduced efficiency of 5-HT reuptake. OBJECTIVE: The aim of the present study was to determine whether the increase in brain 5-HT function produced by acute 5-HT reuptake blockade is influenced by the 5-HTT promoter l/s polymorphism. METHODS: We measured the increase in plasma prolactin that follows acute administration of the tricyclic antidepressant clomipramine as an index of 5-HT neurotransmission in 14 healthy female subjects (7 with ss genotype and 7 with ll genotype) using a placebo-controlled crossover design. RESULTS: Clomipramine-induced prolactin release was significantly greater in subjects with the ll genotype. CONCLUSION: Our findings suggest that acute 5-HT reuptake blockade produces a greater increase in 5-HT neurotransmission in subjects with the ll genotype than in those with an ss genotype. These results are consistent with clinical data indicating that subjects with an ss genotype may have a poorer therapeutic response to selective serotonin reuptake inhibitor (SSRI) monotherapy.
PMID: 10867985, UI: 20325938
----------------------------------------------------------
17: Psychopharmacol Bull 1993;29(2):155-61Fenfluramine challenge test as a predictor of outcome in major depression.
Malone KM, Thase ME, Mieczkowski T, Myers JE, Stull SD, Cooper TB, Mann JJ
Laboratory of Neuropharmacology, Western Psychiatric Institute and Clinic, University of Pittsburgh, School of Medicine, PA 15213.
It has been reported that low pretreatment cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) levels may correlate with better clinical response to selective serotonin reuptake inhibitors (SSRI) compared to non-serotonergic antidepressant drugs. We examined the hypothesis that serotonergic system status, as measured by the prolactin (PRL) response to fenfluramine (FEN), may predict outcome in a heterogenous sample treated with various types of antidepressant treatment. Higher PRL response predicted a favorable outcome for males and females treated with either pharmacotherapy, psychotherapy [milieu therapy with or without cognitive behavior therapy (CBT)], or electroconvulsive therapy (ECT). All patients in the high PRL response group responded to antidepressant therapies. Patients receiving ECT had the highest proportion of treatment responders, the highest degree of treatment response, and, unlike drug or psychotherapy treatment, improved significantly whether in the high or low PRL response group. PRL response to a single dose fenfluramine challenge may be a useful predictor of response to pharmacological or psychotherapeutic treatments in major depression. By contrast, ECT is an effective short-term treatment independent of pretreatment serotonergic responsivity.
PMID: 7507256, UI: 94120037
Posted by shellie on December 5, 2000, at 21:04:48
In reply to Re: Weight gain and lamictal, posted by SLS on December 5, 2000, at 17:13:18
Scott, thanks for the info. I tried to find your post on types of weight gain, but didn't succeed. What I'm wondering, in thinking about the weight gain associated with lamictal, if you've taken into account the following: unlike many of the ads, I lost all of the weight I gained within two weeks after discontinuing lamictal, without changing exercise or eating habits. So it must be a fairly specific type of weight gain. And I know it was not fluid retention, because dieretics did nothing, although they do work for me premenstrually.
Do you address weight gain (aside from water retension) that is lost immediately upon elimination of the drug? Do you have any theories?
If it is due to increased prolactin levels, the med choices seem to have more side effects than the problem. In an internet search there seems to be quite a lot of validity for using primrose oil for breast pain. What I don't know is if the pain is eliminated, if the weight gain would also be affected.
Back to work, bye for now. Shellie
Posted by shellie on December 5, 2000, at 21:07:34
In reply to Re: Weight gain and lamictal » SLS, posted by shellie on December 5, 2000, at 21:04:48
I'm glad your breasts have not gotten larger. Perhaps some other glanular tissue has become enlarged? bye, bye, bye
Posted by Coachnanci on December 6, 2000, at 8:23:20
In reply to Re: Weight gain and lamictal, posted by SLS on December 5, 2000, at 17:13:18
> > > Has anyone experienced weight gain while on Lamictal.
>
> > Nancy, I also gained weight (over ten pounds) while on lamictal. Recently when discusing this with my pdoc, I have questioned whether the weight was due to an increase in prolactin levels caused by the lamictal. In my case, while on lamictal, my breasts were enlarged and extremely uncomfortable. She does believe that the weight gain and breast pain were related, and we may try to treat them by using a medication to lower my prolactin levels.
> Otherwise, I found it totally impossible through diet and intense exercise to lose the weight.
>
> > If you are not feeling any breast discomfort, then this probably does not apply to you. shellie
>
>
> Hi Girls.
>
> I don't think the weight gain and breast enlargement / tenderness produced by Lamictal (lamotrigine) are related to prolactin. I can't find any evidence that prolactin is affected in any way by Lamictal. Unfortunately, I don't have my PDR with me nor the package-insert. Is prolactin elevation listed as a side-effect?
>
> Many drugs produce weight gain for which the mechanisms are not well understood. SSRIs can produce weight gain *and* breast enlargement without elevating prolactin levels. Interestingly, the magnitude of weight gain seems highest in those women who also experience breast enlargement. Perhaps there is a direct association between these two phenomena.
>
> For me, Lamictal has produced about a 10 pound increase in body weight, but no breast enlargement. I'm not sure how to feel about that.
>
> Perhaps Lamictal does cause an elevation of prolactin that would explain your observed weight-gain and macromastia. This sort of thing may not have shown up during clinical testing, as the subjects were either healthy or suffering from epilepsy and were already taking other anticonvulsant drugs. The altered neuroendocrine function demonstrated in major depression and bipolar depression might account for a different responsiveness to specific drug challenges. Perhaps Lamictal is among them.
>
> While it is still on my mind, I proposed in a prior post the possibility that SSRI induced weight-gain might be overrepresented in a treatment-resistant population or a population dominated by atypical depression and bipolar depression, both of which share many clinical features. Perhaps SSRI weight-gain reflects an idiosyncratic serotonergic dysregulation peculiar to these two subgroups.
>
> I don't know how expensive the blood work is, but it would be very fruitful to establish what your baseline level of prolactin is before starting Lamictal. If it increases significantly during treatment, then you can probably use one of the standard remedial treatments for hyperprolactinemia. It might not hurt to try Mirapex (pramipexole) or Parlodel (bromocriptine) anyway, as both of these drugs are dopaminergic and are sometimes used as adjuncts to treat treatment-resistant depression (TRD). Traditionally, Parlodel has been used to treat hyperprolactinemia. However, AndrewB recently suggested the use of Mirapex, as it might make for a better antidepressant. I don't see that Mirapex is yet being used to treat hyperprolactinemia, even though it shares some basic pharmacodynamic properties with Parlodel: dopamine receptor agonism (stimulation) and prolactin secretion inhibition. Perhaps it is not as effective as Parlodel. I like the Mirapex alternative, though. You can always determine how well it treats elevated prolactin levels by taking a blood test.
>
>
> So that there be no confusion, let me emphasize that this has not been a joke.
>
> :-) (obligatory)
>
>
> - Scott
>
>
> --------------------------------------------------------
>
>
> * In the following study of SSRIs, only Paxil (paroxetine) produced an elevation of serum prolactin levels. However, this effect seems to be biphasic and time-dependant. Prolactin is elevated during the second week of administration, but returns to normal after three weeks and beyond. This normalization is probably caused by the type of neuroadaptive changes that are also thought to facilitate the therapeutic antidepressant effects of these drugs.
>
>
>
> 1: J Affect Disord 1997 Nov;46(2):151-6 Related Articles, Books, LinkOut
>
>
> Breast enlargement during chronic antidepressant therapy.
>
> Amsterdam JD, Garcia-Espana F, Goodman D, Hooper M, Hornig-Rohan M
>
> Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
>
> Recent reports of mammoplasia during selective serotonin re-uptake inhibitor (SSRI) therapy suggested that this side effect may be more common than previously reported. We examined 59 women receiving > or = 2 months treatment with an SSRI or venlafaxine for changes in breast size in relation to menopausal status, weight gain and duration of drug therapy. Serum prolactin, estradiol and beta-hCG were also measured before and during treatment in a subgroup of patients. Twenty-three out of 59 patients (39%) reported some degree of mammoplasia. Significantly more SSRI vs. venlafaxine patients reported mammoplasia (p < 0.01). Eighty-four percent with mammoplasia had weight gain vs. 30% without mammoplasia (p < 0.001). The rate of mammoplasia was unrelated to age, menopausal status or duration of treatment. Serum prolactin increased during treatment in the paroxetine subgroup (p < 0.03). In conclusion, antidepressant-induced mammoplasia may be more common than previously expected.
>
> PMID: 9479619, UI: 98140246
>
> -----------------------------------------------------------
>
>
> : Psychopharmacology (Berl) 2000 May;150(1):120-2
>
> Serotonin transporter (5-HTT) promoter genotype may influence the prolactin response to clomipramine.
>
> Whale R, Quested DJ, Laver D, Harrison PJ, Cowen PJ
>
> University Department of Psychiatry, Warneford Hospital, Oxford, UK.
>
> RATIONALE: A 44-base-pair insertion/deletion polymorphism in the promoter region of the human serotonin (5-HT) transporter (5-HTT) gene gives rise to a bi-allelic polymorphism designated long (l) and short (s). The s variant is associated with a lower expression of 5-HTT sites and a reduced efficiency of 5-HT reuptake. OBJECTIVE: The aim of the present study was to determine whether the increase in brain 5-HT function produced by acute 5-HT reuptake blockade is influenced by the 5-HTT promoter l/s polymorphism. METHODS: We measured the increase in plasma prolactin that follows acute administration of the tricyclic antidepressant clomipramine as an index of 5-HT neurotransmission in 14 healthy female subjects (7 with ss genotype and 7 with ll genotype) using a placebo-controlled crossover design. RESULTS: Clomipramine-induced prolactin release was significantly greater in subjects with the ll genotype. CONCLUSION: Our findings suggest that acute 5-HT reuptake blockade produces a greater increase in 5-HT neurotransmission in subjects with the ll genotype than in those with an ss genotype. These results are consistent with clinical data indicating that subjects with an ss genotype may have a poorer therapeutic response to selective serotonin reuptake inhibitor (SSRI) monotherapy.
>
> PMID: 10867985, UI: 20325938
>
> ----------------------------------------------------------
>
>
> 17: Psychopharmacol Bull 1993;29(2):155-61
>
> Fenfluramine challenge test as a predictor of outcome in major depression.
>
> Malone KM, Thase ME, Mieczkowski T, Myers JE, Stull SD, Cooper TB, Mann JJ
>
> Laboratory of Neuropharmacology, Western Psychiatric Institute and Clinic, University of Pittsburgh, School of Medicine, PA 15213.
>
> It has been reported that low pretreatment cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) levels may correlate with better clinical response to selective serotonin reuptake inhibitors (SSRI) compared to non-serotonergic antidepressant drugs. We examined the hypothesis that serotonergic system status, as measured by the prolactin (PRL) response to fenfluramine (FEN), may predict outcome in a heterogenous sample treated with various types of antidepressant treatment. Higher PRL response predicted a favorable outcome for males and females treated with either pharmacotherapy, psychotherapy [milieu therapy with or without cognitive behavior therapy (CBT)], or electroconvulsive therapy (ECT). All patients in the high PRL response group responded to antidepressant therapies. Patients receiving ECT had the highest proportion of treatment responders, the highest degree of treatment response, and, unlike drug or psychotherapy treatment, improved significantly whether in the high or low PRL response group. PRL response to a single dose fenfluramine challenge may be a useful predictor of response to pharmacological or psychotherapeutic treatments in major depression. By contrast, ECT is an effective short-term treatment independent of pretreatment serotonergic responsivity.
>
> PMID: 7507256, UI: 94120037Thanks, Scott and Shellie for the informative replies. I had pretty much decided to have blood tests to see where my Prolactin levels are. I have been monitoring my weight fairly closely and have noticed that I have been holding steady after the initial 10 pound weight gain. I have only been on the Lamictal for 2 going on 3 months now. I am hoping the weight gain will not continue. Though I feel 1000% better - the weight gain would be an issue for me, if it continues. I am hopeful that some of the new medications being developed (depakote light and pregabilin) might be available in the near future and perhaps they won't have the same side-affects. I am also going to talk with my pdoc about all of this. I also read the elevated prolactin levels can increase the risk of breast cancer plus worsen osteoporosis (which I already have).
Again, thanks so much for the information, Scott. I just started taking evening primrose oil. I wonder, Shellie, if that might help with the weight issues. I also take L-Carnitine which helped me lose weight before all of this. I will let you know how it goes.
Nancy
Posted by shellie on December 12, 2000, at 16:46:18
In reply to Re: Weight gain and lamictal, posted by Coachnanci on December 6, 2000, at 8:23:20
Nancy, I have just begun lamictal again and will also try primrose. My understanding is that it takes several months for primose oil to work. So lets compare notes in a month or two. Shellie
Posted by salarmy4me on December 29, 2000, at 21:22:53
In reply to Weight gain and lamictal, posted by Coachnanci on December 4, 2000, at 12:05:18
I don't believe that there is any chance of weight
gain on Lamictal, assuming a person is not prone
to gain weight anyway from lifestyle.
Posted by shellie on December 30, 2000, at 8:43:47
In reply to Re: Weight gain and lamictal » Coachnanci, posted by salarmy4me on December 29, 2000, at 21:22:53
> I don't believe that there is any chance of weight
> gain on Lamictal, assuming a person is not prone
> to gain weight anyway from lifestyle.What do you mean, "you don't believe.."
Glaxo Welcome--the manufacturer of lamictal provides data that reports that 25% of people over 12 who take lamictal have a greater or equal to 5% weight gain and 19% have a 10% or more weight gain.
(www.glaxowellcome.ch/gw/fr/neuro/lamictal/monograph/monograph009.html).I gained 9 lbs on lamictal and lost it within days after I discontinued that medication.
If I would you, I would check my facts, before offering my "beliefs".
Posted by SLS on December 30, 2000, at 10:20:13
In reply to Re: Weight gain and lamictal, posted by shellie on December 30, 2000, at 8:43:47
Hi guys. Wellcome back.I believe that 300 milligrams of Lamictal equals 10 pounds of SLS.
I am sure that the holiday season equals 5 pounds of SLS.
- Scott
Posted by shellie on December 30, 2000, at 22:26:52
In reply to Re: Weight gain and lamictal, posted by Coachnanci on December 6, 2000, at 8:23:20
> I just started taking evening primrose oil. I wonder, Shellie, if that might help with the weight issues. I also take L-Carnitine which helped me lose weight before all of this. I will let you know how it goes.
>
> NancyNancy-I talked to my gyn this week and she thinks primrose oil will make things worse because it stimulates estrogen. I know there is a lot written on primrose oil and PMS, but now I'm not sure I should be taking the primrose oil for this. She said to definitely increase intake of vitamin E, but I already take a healthy dose of it. So I'm pretty confused. Will set up a prolactin test for the end of this week or next. Did you get yours yet? Also, how long did it take for the lamictal to help and at what dose? Shellie
Posted by Coachnanci on January 2, 2001, at 9:25:01
In reply to Re: Weight gain and lamictal, posted by shellie on December 30, 2000, at 8:43:47
Hi Scott and Shellie -
Nancy here again ... I went off the Lamictal and also lost the weight - but a little more slowly than you, Shellie. I am now on Depakote (500 mg suspended release) and Adderrall (for my ADHD). So far, I feel really good ... all the sleepy periods are gone and my attitude has been pretty decent. I know Depakote can cause weight gain - but I figure that I am on such a low dose plus the Adderrall should counter any weight gain. Here's hoping. In the meantime - I have started back to the gym with regular workouts plus I have cut back on the sugar.
Scott, I liked your "Wellcome Back" ... no pun intended of course < smile > ... great sense of humor ... happy New Year guys.
Also, the Pdoc's do tell you the lamictal does not cause weight gain ... that's what so funny ...
I don't believe that there is any chance of weight
> > gain on Lamictal, assuming a person is not prone
> > to gain weight anyway from lifestyle.
>
> What do you mean, "you don't believe.."
>
> Glaxo Welcome--the manufacturer of lamictal provides data that reports that 25% of people over 12 who take lamictal have a greater or equal to 5% weight gain and 19% have a 10% or more weight gain.
> (www.glaxowellcome.ch/gw/fr/neuro/lamictal/monograph/monograph009.html).
>
> I gained 9 lbs on lamictal and lost it within days after I discontinued that medication.
>
> If I would you, I would check my facts, before offering my "beliefs".
Posted by Coachnanci on January 2, 2001, at 11:05:02
In reply to Re: Weight gain and lamictal, posted by shellie on December 30, 2000, at 22:26:52
Hi Shellie,
I have recently added soy isoflavones along with the Primrose Oil. I also take a healthy dose of E and C.
Regarding the Lamictal, I was on 25 mg twice a day and seemed to be fine on it. Every week got better and better. Only problem was the horrible sleepy periods that almost made me feel like I had narcolepsy. However, I talked with the Pdoc who also felt it could be part of the ADHD, etc. This whole thing is so frustrating at times.
As I said in an earlier post - I just started with Depakote. I am sure it's too early to tell about weight issues ... but I managed to not eat excessively over the New Year's weekend. If anything - I probably ate less do to some diahrea as a side affect.
Anyway - I will keep you posted. Here's hoping it works out.
Nancy
>
> I just started taking evening primrose oil. I wonder, Shellie, if that might help with the weight issues. I also take L-Carnitine which helped me lose weight before all of this. I will let you know how it goes.
> >
> > Nancy
>
> Nancy-I talked to my gyn this week and she thinks primrose oil will make things worse because it stimulates estrogen. I know there is a lot written on primrose oil and PMS, but now I'm not sure I should be taking the primrose oil for this. She said to definitely increase intake of vitamin E, but I already take a healthy dose of it. So I'm pretty confused. Will set up a prolactin test for the end of this week or next. Did you get yours yet? Also, how long did it take for the lamictal to help and at what dose? Shellie
Posted by shellie on January 2, 2001, at 17:53:42
In reply to Re: Weight gain and lamictal, posted by Coachnanci on January 2, 2001, at 11:05:02
Hi Nancy. Thanks for the update. For now I'm sticking with lamictal, although after four weeks on it, I can no longer zipper my pants. But I am trying to do the treadmill for 45 minutes everyday and some other exercises, abs, etc. to compensate and hopefully lose the other extra pounds I have put on in the last year.I'm getting my prolactin tested at the end of this week. I'll be interested if it is high or if it's my estrogen levels that have climbed. Meanwhile I feel like I'm wearing someone else's chest and it's too heavy for me!
But I've tried so many meds in the last year that I've got to take a break and this worked for me last year so I'm trying (not succeeding) to not be upset about my weight.
later, Shellie
Posted by SLS on January 2, 2001, at 22:23:53
In reply to Re: Weight gain and lamictal, posted by shellie on January 2, 2001, at 17:53:42
> But I've tried so many meds in the last year that I've got to take a break and this worked for me last year so I'm trying (not succeeding) to not be upset about my weight.
Don't worry. I'll still love you.
:-)
- Scott
Posted by SLS on January 2, 2001, at 22:32:09
In reply to Re: Weight gain and lamictal, posted by Coachnanci on January 2, 2001, at 11:05:02
Hi Nancy.
> Regarding the Lamictal, I was on 25 mg twice a day and seemed to be fine on it. Every week got better and better. Only problem was the horrible sleepy periods that almost made me feel like I had narcolepsy. However, I talked with the Pdoc who also felt it could be part of the ADHD, etc. This whole thing is so frustrating at times.
Does this sleepiness occur at the middle or towards the end of a dosing period? If it does, you might want to try increasing the Lamictal to 100mg temporarily to see if you are not experiencing some sort of depressive relapse somnolence associated with an ebb of drug levels. I would suspect that this is the case if you get a "kick" immediately after taking a dose.
- Scott
Posted by SLS on January 2, 2001, at 22:36:42
In reply to Re: Weight gain and lamictal » Coachnanci, posted by SLS on January 2, 2001, at 22:32:09
Oops. I guess you stopped taking Lamictal already.
Never mind.
I wish for you continued success with Depakote. I never gained much weight on it, even at 3000mg.
- Scott> Hi Nancy.
>
> > Regarding the Lamictal, I was on 25 mg twice a day and seemed to be fine on it. Every week got better and better. Only problem was the horrible sleepy periods that almost made me feel like I had narcolepsy. However, I talked with the Pdoc who also felt it could be part of the ADHD, etc. This whole thing is so frustrating at times.
>
> Does this sleepiness occur at the middle or towards the end of a dosing period? If it does, you might want to try increasing the Lamictal to 100mg temporarily to see if you are not experiencing some sort of depressive relapse somnolence associated with an ebb of drug levels. I would suspect that this is the case if you get a "kick" immediately after taking a dose.
>
>
> - Scott
>
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