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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by MistressJes on March 19, 2010, at 3:03:37
Hi,
I am a 24 year old female recently diagnosed with Bipolar II after years od being treated for depression and anxiety unsuccessfully. My psychiatrist started me on Lamictal, and when I hit 50 mg, it was like somebody turned on my "normal" switch. I felt better than I had in years (minus those awesome hypomanic days).
Then, he increased the dose to 100mg, and everything spiraled straight to hell again. In fact, I'm cycling harder and faster, it seems. He said it is okay to go back down to 50mg, but everything I read says that the target dose is 200mg. Also, I am worried that going back down after being at 100mg is going to make things worse. And now I am doubting myself, wondering if those two weeks of normality on the 50 mg were just part of the cycle and NOT relief from the medication.
Has anybody else had similar issues with Lamictal? Has anybody had any changes when they take 50 mg twice a day as opposed to 100mg once a day? What did you do with your dosage?I'm seriously losing hope here. I'm tired of feeling good for a little while and being teased by the medication, thinking it might actually work this time. It is to the point where I hope that if they can't fix me soon, they can just put me on something that will zombify me so that I can just function without feeling and stop hurting people I love.
Jes
Posted by SLS on March 19, 2010, at 6:57:49
In reply to Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 19, 2010, at 3:03:37
It often happens that an individual will experience a brief improvement to Lamictal at dosages as low as 50mg, only to see the improvement disappear. I am not aware of there being a dosage window for Lamictal wherein a lower dosage produces a greater improvement than a higher dosage. For me, it was advantageous to arrive at a dosage of 200mg. I, too, experienced brief improvements at lower dosages. Perhaps you are an exception. It sometimes happens that a brief improvement occurs upon dosage reductions as well. In any event, I would continue to raise the dosage were I were in your position.
- Scott
Posted by Phillipa on March 19, 2010, at 12:18:07
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by SLS on March 19, 2010, at 6:57:49
Welcome to babble and seriously Scott is very very knowledgeable of all meds. I agree with him as I'm unipolar and took lamictal got to 50mg with no changes at all in emotions maybe some anger. But had to stop from serious excessive sailvation I looked and felt like a Saint Bernard with the saliva running out of my mouth. But I've heard it's a great med and what's this about a long acting lamictal now on the market? I need to google that. Best of luck to you and maybe a call to your doc also? Phillipa
Posted by polarbear206 on March 19, 2010, at 15:14:09
In reply to Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 19, 2010, at 3:03:37
> Hi,
> I am a 24 year old female recently diagnosed with Bipolar II after years od being treated for depression and anxiety unsuccessfully. My psychiatrist started me on Lamictal, and when I hit 50 mg, it was like somebody turned on my "normal" switch. I felt better than I had in years (minus those awesome hypomanic days).
> Then, he increased the dose to 100mg, and everything spiraled straight to hell again. In fact, I'm cycling harder and faster, it seems. He said it is okay to go back down to 50mg, but everything I read says that the target dose is 200mg. Also, I am worried that going back down after being at 100mg is going to make things worse. And now I am doubting myself, wondering if those two weeks of normality on the 50 mg were just part of the cycle and NOT relief from the medication.
> Has anybody else had similar issues with Lamictal? Has anybody had any changes when they take 50 mg twice a day as opposed to 100mg once a day? What did you do with your dosage?
>
> I'm seriously losing hope here. I'm tired of feeling good for a little while and being teased by the medication, thinking it might actually work this time. It is to the point where I hope that if they can't fix me soon, they can just put me on something that will zombify me so that I can just function without feeling and stop hurting people I love.
>
> Jes
>You didn't include in your above post if you are taking another drug with the Lamictal. Do you have more hypomania than depressions? If you are on an AD, the Lamictal will give the AD a boost. This can contribute to your cycling. It does cause an increase in anxiety when you start. Did he raise your dose too fast from 50 to 100? Keep in mind that if you are on an AD and the dose is too high with the addition of Lamictal, you may need to back off very slowly while titrating the Lamictal.
Posted by obsidian on March 19, 2010, at 21:51:19
In reply to Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 19, 2010, at 3:03:37
I don't know how long you've been on lamictal, but it seemed that everytime my dose got raised I got irritable, not fun, angry a lot
since getting up to 200, and getting through that period, my effexor xr has been decreased
the irritability is gone, I'm feeling better, didn't think I could.the question about whether you're also taking an AD is important.
good luck
Posted by morganator on March 19, 2010, at 22:21:10
In reply to Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 19, 2010, at 3:03:37
Your definitely way too young to be feeling so bad. I really hope you find some relief soon and get back to enjoying life the way someone your age should be. I did not have a good time with Lamictal. For you it may be a wonder drug. I really hope it is.
Have you ever considered taking a low dose of lithium? I think all of us struggling with mental illness should be on a low dose of lithium. It truly is an amazing substance and may actually be good for your brain.
Posted by MistressJes on March 19, 2010, at 23:53:11
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by morganator on March 19, 2010, at 22:21:10
Hey all,
I am not on any other medications at the moment, except for ativan as needed for anxiety (which has been about 3-4 times a week now; more than I have ever had to use it before).
I called the doc, and he said to go back down to 50mg until I see him again, but I am afraid that the effects will diminish. I couldn't actually have a discussion with him, because the receptionists at his office have a "NOBODY speaks to the doc, no way, no how" attitude.
I only took 50mg at about 5:30 am yesterday, and I already feel better tonight. I don't know if that is because of the dosage change, or not (doubtful). I am trying to avoid going on anything that requires me to get weekly blood tests, because I am uninsured right now (crappy job situation - horrid benefits, or lack thereof).
I should probably mention that I was only on the 100mg dose for 12 days, but it kept getting gradually worse. I've flip flopped from hypomanic to depressive in a week. I'm just trying to stay away from people that I care about.
I don't know if I should listen to the doc or try to stick it out. I see him again on April 7th, which is a long way away to somebody going through this. What to do?Thanks
Jes
Posted by MistressJes on March 19, 2010, at 23:54:50
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by SLS on March 19, 2010, at 6:57:49
> It often happens that an individual will experience a brief improvement to Lamictal at dosages as low as 50mg, only to see the improvement disappear. I am not aware of there being a dosage window for Lamictal wherein a lower dosage produces a greater improvement than a higher dosage. For me, it was advantageous to arrive at a dosage of 200mg. I, too, experienced brief improvements at lower dosages. Perhaps you are an exception. It sometimes happens that a brief improvement occurs upon dosage reductions as well. In any event, I would continue to raise the dosage were I were in your position.
>
>
> - ScottIs it normal to go from great to horrible upon a dose increase?
Posted by SLS on March 20, 2010, at 1:50:55
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 19, 2010, at 23:54:50
> Is it normal to go from great to horrible upon a dose increase?
With regard to depression, I don't recall hearing of anyone who experienced this. However, I am confused as to what you mean by "horrible". Depression? Dysphoric hypomania? From what I can see, Lamictal can launch someone into hypomania or precipitate over-activation and irritability. If you are having a dysphoric reaction to Lamictal, it is probably best to lower the dosage or discontinue it. I have noted that quite a few people have had this reaction. However, I haven't followed anyone to observe what were the outcomes.
- Scott
Posted by MistressJes on March 20, 2010, at 2:31:45
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by SLS on March 20, 2010, at 1:50:55
Scott,
Well, when I first started the 100mg, I started getting anxious and extremely irritable. Then, about two days later, I launched into hypomania for 3 days, after which I promptly crashed hard and fast into depression. However, the hypomania wasn't dysphoric...in fact, it was pretty stellar.You think maybe the dose is actually too low at 100mg even thought I felt good at 50mg? That maybe the good feeling I got from 50mg was just a little bump upwards in mood before I went into hypomania? This crap is rediculously complicated to figure out, especially trying to tease out what the medication is doing and how you are cycling.
Jes
Posted by SLS on March 20, 2010, at 7:00:19
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 20, 2010, at 2:31:45
> Well, when I first started the 100mg, I started getting anxious and extremely irritable. Then, about two days later, I launched into hypomania for 3 days
Have you experienced mania before? Under what circumstances. Is it hypomania, or is it a more severe mania? Do you cycle?
> after which I promptly crashed hard and fast into depression.
Ouch. That sucks. That initial swing into depression is often the worst.
> However, the hypomania wasn't dysphoric...in fact, it was pretty stellar.
As you found, allowing mania to develop can set one up for a depressive switch. It is usually just as important to treat the mania as it is the depression. There are some exceptions. These involve a stable hypomania that does not interfere with one's daily function. This is an infrequent occurrence, though.
> You think maybe the dose is actually too low at 100mg even thought I felt good at 50mg?
This is usually the case with Lamictal. Sometimes, one will begin experiencing cognitive and memory impairments as the dosage is increased. This can limit dosage. However, most people do fine at 200mg.
> This crap is rediculously complicated to figure out...
It certainly can be.
It is sometimes difficult to avoid the temptation to attempt to predict with certainty the outcome of treatmtent. The presentations of major depressive disorder and bipolar disorder involve a heterogeneity of biology and treatment outcomes.
If bipolarity is involved in your case, you might need a mood stabilizer or antipsychotic to temper and stabilize your mood while you continue your treatment with Lamictal. Lamictal is not much of an antimanic agent.
- Scott
Posted by MistressJes on March 21, 2010, at 2:20:08
In reply to Re: Lamictal: Bipolar II dosing difficulties » MistressJes, posted by SLS on March 20, 2010, at 7:00:19
It's only hypomania, I don't think I have ever had true mania, or at least I didn't meet all the criteria. It seems I do tend to cycle from normal to hypomanic to depressed. It can happen with me in the course of 6 months or a week. Lately, it has been happening in shorter periods of two weeks or less.
My pdoc wants to get me at a consistent dose with the lamictal, then add an antidepressant. I thought lamictal was a mood stabilizer.
Posted by SLS on March 21, 2010, at 5:39:57
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 21, 2010, at 2:20:08
> I thought lamictal was a mood stabilizer.
Sort of.
Lamictal works from the "bottom up" to attack the depressive phase of bipolar disorder. It won't bring someone down from an existing mania, and doesn't do a very good job at preventing it either. However, there is some literature that suggests that it can penetrate an ultra-rapid cycle. In this case, I would say that it is a mood stabilizer. It works well with lithium, as lithium works from the "top down". These are all generalizations, of course. I'm sure there are exceptions.
- Scott
Posted by Phillipa on March 21, 2010, at 19:58:06
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by SLS on March 21, 2010, at 5:39:57
Hence why it's used in unipolar depression as a booster? Phillipa
Posted by MistressJes on March 24, 2010, at 14:40:31
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by SLS on March 21, 2010, at 5:39:57
Well, I've been back on the 50mg dose since the 18th, and I am feeling much better. I feel "normal" again; not too low, not too high. I feel like I'm in control again. I don't know what the hell is going on, but I'm thinking I'm just gonna stay at the 50 mg dose until it stops working, cause maybe at that point the 100's won't mess me up as bad.
Posted by SLS on March 24, 2010, at 19:07:29
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 24, 2010, at 14:40:31
> Well, I've been back on the 50mg dose since the 18th, and I am feeling much better.
I am very surprised to see you display a therapeutic dosage window with Lamictal. I hope you continue to improve.
- Scott
Posted by morganator on March 24, 2010, at 21:43:01
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 24, 2010, at 14:40:31
I couldn't go higher than 75 mg of Lamictal. Any dose of 100 or more made my brain feel like it was swimming in cement.
Posted by MistressJes on March 25, 2010, at 1:01:00
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by morganator on March 24, 2010, at 21:43:01
Man, what a weird drug. I'm still doing well on the 50mg dose, except for the occasional irritability and anxiety, but it's mild. If it means not cycling fast and loose like I was, I'll gladly take it. I see the pdoc on the 7th of April, so I'll let you all know what he does then, or if there are any changes. I think he's going to add a antidepressant. I hope that doesn't spark a whole new round of fun.
Posted by herpills on March 25, 2010, at 14:38:42
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 25, 2010, at 1:01:00
I would talk to pdoc about going back up on the lamictal before trying antidepressant. I am also BPII, and AD just causes cycling. I had very nice AD response on 100mg lamictal. Stayed at that dose for almost a year, then had bad hypomania that wouldn't stop so had to go up to 200mg. And yes it is a weird drug, seems like there is a wide variety of responses for people compared to other meds, also dosing is tricky.
herplls
> Man, what a weird drug. I'm still doing well on the 50mg dose, except for the occasional irritability and anxiety, but it's mild. If it means not cycling fast and loose like I was, I'll gladly take it. I see the pdoc on the 7th of April, so I'll let you all know what he does then, or if there are any changes. I think he's going to add a antidepressant. I hope that doesn't spark a whole new round of fun.
Posted by MistressJes on March 26, 2010, at 21:41:10
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by herpills on March 25, 2010, at 14:38:42
The 100 mg dose is where I started ultra-rapid cycling, hence why I went back down to 50 mgs. So far, so good.
Posted by SLS on March 27, 2010, at 8:16:11
In reply to Re: Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 26, 2010, at 21:41:10
> The 100 mg dose is where I started ultra-rapid cycling, hence why I went back down to 50 mgs. So far, so good.
Lamictal is a weird drug. There are so many different ways that someone can react to it. It is amusing to read that the NIH uses Lamictal in the long-term treatment of ultra-rapid cyclicity. I'm sure that it works for many people in this capacity. Unfortunately, you are not one of them.
- Scott
Posted by MistressJes on April 8, 2010, at 1:29:55
In reply to Lamictal: Bipolar II dosing difficulties, posted by MistressJes on March 19, 2010, at 3:03:37
Hi all!
I visited the pdoc today, and we're adding citalopram, 20mg/day. That means I will be on that as well as the 50mg of lamictal. I am quite worried though, reading all the stuff on how it causes loss of libido in so many people. Sometimes, the only thing that gets you through the work day is the promise of what you can have when you get home, you know? I don't wanna lose something that is important to me and enjoyable.
Is anybody else on celexa and lamictal? Is celexa particularly bad for sexual side effects? Does anybody know the likelihood of developing them?Jes
P.S.
The lamictal at 50mg continued to work fine, barring some anxiety here and there and very slight mood flux. Can't complain too much.
Posted by mellow on April 12, 2010, at 23:26:36
In reply to Re: Adding Celexa, posted by MistressJes on April 8, 2010, at 1:29:55
I know its been a few days but i thought i should respond to this topic. I'm sorry you aren't feeling well Jes, but you also have to realize you just got your diagnosis. Its been four years since i was told i was bipolar and i am just getting everything running smooth. It all comes together in little bits and pieces. It takes a lot of work and patience to keep up with this condition. I hope you know it will all be ok. I thought i would never be ok and now i look back and laugh at the days of being completely insane!
I take the Celexa/Lamictal combo with some great success. I'm on 20mgs Celexa and 100mgs Lamictal as well as 50mgs Topomax and 2mgs Risperal.
My doc brought me down to 10mgs of Celexa during a jittery hypo manic swing a year ago and he brought me back to 20mgs when the depression set in. I stabilized quickly when i got back to 20.
The sexual side effects will pass. Its worth sticking it out for a couple of months until they do. They went away for me at least.
I also believe antipsychotics are great for bipolar. Risperdal has saved me a time or two when i could feel myself getting way too high or extremely anxious.
I hope you do well on your new cocktail.
> Hi all!
> I visited the pdoc today, and we're adding citalopram, 20mg/day. That means I will be on that as well as the 50mg of lamictal. I am quite worried though, reading all the stuff on how it causes loss of libido in so many people. Sometimes, the only thing that gets you through the work day is the promise of what you can have when you get home, you know? I don't wanna lose something that is important to me and enjoyable.
> Is anybody else on celexa and lamictal? Is celexa particularly bad for sexual side effects? Does anybody know the likelihood of developing them?
>
> Jes
>
> P.S.
> The lamictal at 50mg continued to work fine, barring some anxiety here and there and very slight mood flux. Can't complain too much.
This is the end of the thread.
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