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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Landon Winstead on August 6, 1999, at 21:02:01
My doctor is on the "cutting edge" of the research in psychopharmacology, and because I have not responded to Lithium or Depakote suggested Lamactil, beginning at a small dose. He stated that there have been some studies in the literature to indicate that it can work in bipolar disorder when other medicines have failed.
Have you come across any of these studies? What do you think?
Posted by Craig on August 7, 1999, at 1:15:55
In reply to lamactil for atypical bipolar disorder?, posted by Landon Winstead on August 6, 1999, at 21:02:01
Lamictal is started at low doses because of the rare possibility of developing a severe rash. Gradually increasing the dose minimizes the risk of getting the rash. Lamictal also has an antidepressant effect. Since lithium and Depakote didn't work for me either, I'm now taking Lamictal.
Posted by Chris A. on August 7, 1999, at 1:28:37
In reply to lamactil for atypical bipolar disorder?, posted by Landon Winstead on August 6, 1999, at 21:02:01
Promising evidence is coming in on Lamictal (check medline for lamotrigene). In my bipolar mind it would be the next mood stabilzer of choice (YMMV). If your doc is recommending it he must think like I do. It purportedly has some antidepressant effect, which is encouraging. I've taken it for most of the past two and one-half years with no discernable side effects. The big-bad-rare rash scares a lot of people off. I understand the risk is lessened by starting at a very low dose and titrating up very slowly. Good Luck.
Chris A.
Posted by Donald F on January 26, 2000, at 15:45:11
In reply to Re: lamactil for atypical bipolar disorder?, posted by Chris A. on August 7, 1999, at 1:28:37
> Promising evidence is coming in on Lamictal (check medline for lamotrigene). In my bipolar mind it would be the next mood stabilzer of choice (YMMV). If your doc is recommending it he must think like I do. It purportedly has some antidepressant effect, which is encouraging. I've taken it for most of the past two and one-half years with no discernable side effects. The big-bad-rare rash scares a lot of people off. I understand the risk is lessened by starting at a very low dose and titrating up very slowly. Good Luck.
>
> Chris A.My doc started me on Lamactil about 6 weeks ago for bipolar disorder. As described I started with a very low dose and titrated my way up to my present dose of 4 tabs.
I have a type of bipolar disorder which is very long term. The intervals can take several months and primarily result in deep depression.
I am taking Lamactil in addition to Lithium and I do believe it has had a stabalizing effect on me. Time will tell.
Posted by Scott L. Schofield on January 26, 2000, at 17:25:29
In reply to Re: lamactil for atypical bipolar disorder?, posted by Donald F on January 26, 2000, at 15:45:11
> > Promising evidence is coming in on Lamictal (check medline for lamotrigene). In my bipolar mind it would be the next mood stabilzer of choice (YMMV). If your doc is recommending it he must think like I do. It purportedly has some antidepressant effect, which is encouraging. I've taken it for most of the past two and one-half years with no discernable side effects. The big-bad-rare rash scares a lot of people off. I understand the risk is lessened by starting at a very low dose and titrating up very slowly. Good Luck.
> >
> > Chris A.
>
> My doc started me on Lamactil about 6 weeks ago for bipolar disorder. As described I started with a very low dose and titrated my way up to my present dose of 4 tabs.
>
> I have a type of bipolar disorder which is very long term. The intervals can take several months and primarily result in deep depression.
>
> I am taking Lamactil in addition to Lithium and I do believe it has had a stabalizing effect on me. Time will tell.Lamictal (lamotrigine) is one of the few drugs capable of budging my stubbornly depressed bipolar psychobiology. It definitely does display antidepressant properties in some people. For me, it helps provide a slight, but stable improvement that allows me to indulge in such exotic and esoteric activities like reading and writing (I still have trouble adding single-digit numbers in my head, though). The average effective dosage of Lamictal in bipolar disorder seems to be around 200 mg/day. The dose range for its indicated use in epilepsy is 300 - 600 mg/day. I seem to need 300 mg/day. It is important to note that these dosages must be cut in half if Lamictal is to be used in combination with Depakote.
Some investigators assert that Lamictal is also useful when treating cases that present with rapid-cyclicity. There are similar thoughts regarding Neurontin (gabapentin).
The rash can be lethal and it is not rare.
The PDR and package-insert for Lamictal provides an excellent titration schedule.
- Scott
Posted by blackwater on January 30, 2006, at 17:57:55
In reply to Re: lamactil for atypical bipolar disorder?, posted by Scott L. Schofield on January 26, 2000, at 17:25:29
Please state exactly what you mean by that? Jeez, if not rare how common is it??
Posted by 45mercySt on June 19, 2006, at 21:07:58
In reply to ReYou say rash is deadly and not rare?, posted by blackwater on January 30, 2006, at 17:57:55
Hi there... I've been on Lamictal for 5 years with a year off in between the 2nd and 3rd year. It has been, by far, the best stablizer for me (I have cyclothymic-type bipolar and ADD).
My doctor and I have a great relationship and we share a lot of information - to my understanding the "rash" is uncommon. For it to be deadly is exceedingly rare. In clinical trials it affected between 0.08% to 1.3% of patients depending on population (indication epilepsy,bipolar; also, mono vs. adjunctive therapy classes), and resolved in nearly all patients after the drug was withdrawn. (for the actual stats refer to page 13-14 of the package insert found at http://us.gsk.com/products/assets/us_lamictal.pdf) Furthermore, the patients in the trials were started on the dose at which the drug is expected to be fully effective - not started low and titrated up over time. When Lamictal is titrated in this way the "rash" IS RARELY observed.
If you want to find out more about the "rash", read up on Stevens-Johnson syndrome. It is actually caused spontaneously by a myriad of drugs. The extreme (potentially) fatal reaction is known as toxic epidermal necrosis (TEN), and is extremely rare - there were no cases observed in clinical trials. Again, both of these conditions have been known to occur idiopathicly and due to other meds.
Unless you have some pre-existing autoimmune problem such as arthritis, lupus, MS, etc. or have reacted significantly to medications in the past, I would not eliminate Lamactil due to concern over the rash. Especially if other meds have failed you. With the right supervision, Lamactil is proving to be quite safe and effective.
This is the end of the thread.
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