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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by theo on August 8, 2004, at 13:10:12
I'm currently on 100mg Lamictal. I mentioned to my pdoc I wanted to add a low dose of an SSRI and she said no, she wants me to ramp up to 150mg of Lamictal.
When should one stop increasing the Lamictal for antidepressant qualities and add a low dose antidepressant to boost it? I am going to go to 150mg but don't see much of a reason to increase above that unless there is a magical difference above 150mg for antidepressant qualities.
I mainly have a problem with anxiety/depression and my pdoc thinks the anxiety may be my mania side surfacing, although I have anxiety 24/7. If I'm indeed BPII, I can accept that and I think a mood stablizer is helpful for people with anxiety that aren't bipolar, but she's trying to say "if you keep increasing the Lamictal, you shouldn't need to add an antidepressant."
Any thoughts would be greatly appreciated.
Posted by SLS on August 8, 2004, at 13:15:17
In reply to Lamictal dosage question?, posted by theo on August 8, 2004, at 13:10:12
> I'm currently on 100mg Lamictal. I mentioned to my pdoc I wanted to add a low dose of an SSRI and she said no, she wants me to ramp up to 150mg of Lamictal.
Your doctor might ultimately have guessed wrong to choose Lamictal as monotherapy, but you really can't pass judgment on it until you reach 200mg.
- Scott
Posted by theo on August 8, 2004, at 13:21:59
In reply to Re: Lamictal dosage question?, posted by SLS on August 8, 2004, at 13:15:17
So are you saying 200mg is the minimum dose to see if Lamictal can be used for monotherapy for depression?
Seems like I've seen several threads where after 150-200mg you get increased mood stabilization but not much more antidepressant effects.
Posted by woolav on August 8, 2004, at 14:10:37
In reply to Re: Lamictal dosage question? » SLS, posted by theo on August 8, 2004, at 13:21:59
interesting..my pdoc added lamictal to my ssri, and it did help. I have depression and anxiety too. But dont think I am BP2...She thinks a theraputic level of lam is 100mg and then my prozac. (20mg). But I have read people taking 300mg of lamictal and other meds. So, its confusing.......
S
Posted by SLS on August 8, 2004, at 14:41:54
In reply to Re: Lamictal dosage question? » SLS, posted by theo on August 8, 2004, at 13:21:59
> So are you saying 200mg is the minimum dose to see if Lamictal can be used for monotherapy for depression?
>
> Seems like I've seen several threads where after 150-200mg you get increased mood stabilization but not much more antidepressant effects.
I don't recieve the maximum antidepressant benefit from Lamictal until I reach 300mg. However, I think my case is too atypical to use as an example. Lamictal is sort of funny. A lot of people experience a wonderful antidepressant effect during the first few weeks at dosages of 50-75mg. This more often than not dissipates quickly, and higher dosages are necessary to recapture any improvement. I don't see that many people having success with Lamictal monotherapy for depression. It seems to be more effective as an augmentor. However, I just don't think there is enough uniformity in the way people respond to Lamictal to be able to designate absolute dosage thresholds for therapeutic effect. 200mg has been the most common average dosage I have seen quoted for use in bipolar depression.
- Scott
Posted by karen m. on August 9, 2004, at 0:38:44
In reply to Re: Lamictal dosage question?, posted by SLS on August 8, 2004, at 14:41:54
> > So are you saying 200mg is the minimum dose to see if Lamictal can be used for monotherapy for depression?
> >
> > Seems like I've seen several threads where after 150-200mg you get increased mood stabilization but not much more antidepressant effects.
>
>
> I don't recieve the maximum antidepressant benefit from Lamictal until I reach 300mg. However, I think my case is too atypical to use as an example. Lamictal is sort of funny. A lot of people experience a wonderful antidepressant effect during the first few weeks at dosages of 50-75mg. This more often than not dissipates quickly, and higher dosages are necessary to recapture any improvement. I don't see that many people having success with Lamictal monotherapy for depression. It seems to be more effective as an augmentor. However, I just don't think there is enough uniformity in the way people respond to Lamictal to be able to designate absolute dosage thresholds for therapeutic effect. 200mg has been the most common average dosage I have seen quoted for use in bipolar depression.
>
>
> - Scotti agree with scott in terms of i didn't get much out of lamictal until i reached 300 mg. it kind of kicked in then. my pcdoc is determined to use lamictal as a monotherapy. as scott mentioned, there seem to be periods of more effectiveness than others. i have not gone back into a depression since starting lamictal but on the flip side i am still irritable, anxious and uncoordinated in brain and body movements after finally reaching 300mg. apparently one has to take the good with the bad. i imagine my pcdoc will now increase my dosage since the idea of me grawing my husbands arm off holds little appeal to either of us. i'd be curious to know how those folks that are on a higher dose are doing.
/karen/
Posted by theo on August 9, 2004, at 7:10:35
In reply to Re: Lamictal dosage question?, posted by SLS on August 8, 2004, at 14:41:54
That's the problem I've been having. I felt good for a couple of days at 50mg, almost a little euphoric, but after a few days it stopped and I couldn't wait for the time to pass so I could up my dose. The same happened at 75mg but at 100mg it stabilized but she still wanted me to go to 150mg and stay there a while to see if we need to go to 200mg. After 100mg my pdoc said I could increase by 50mg every week, but I went to 125mg for a few days then to 150mg. I understand some agitation with a dose increase, but if it stays after a week would that be a sign to drop back down in dose?
Posted by woolav on August 9, 2004, at 9:02:03
In reply to Re: Lamictal dosage question?, posted by theo on August 9, 2004, at 7:10:35
Theo, i hope others answer your question. I am curious about that one too..I just got to 50mg and have felt better the last few days, I think next week i go to 75mg, then 100mg. I think my pdoc wants to keep me at 100mg. Are u taking other meds with lamictal??
S
Posted by theo on August 9, 2004, at 9:54:27
In reply to Re: Lamictal dosage question?, posted by woolav on August 9, 2004, at 9:02:03
I'm taking 250mg of Keppra twice daily which is been great for anxiety but nothing for depression. Also, by itself with the 1/2 life 6-8 hours, you have to take it 3 times daily or you start to feel it wear off. I will probably stop the Keppra when I hit 150mg of Lamictal to get a true read on it.
What else are you taking with Lamictal?
Posted by woolav on August 9, 2004, at 12:21:04
In reply to Re: Lamictal dosage question? » woolav, posted by theo on August 9, 2004, at 9:54:27
Im taking 20mg of prozac and 2mg daily of xanax..
Posted by Mags on August 9, 2004, at 21:25:09
In reply to Re: Lamictal dosage question?, posted by woolav on August 9, 2004, at 12:21:04
I agree with Scott that everyone's experience with lamictal is different. I am BPII (rapid cycler)and take 250mg of Lam and 300 mg Topamax. When I was on mono Lamictal I felt great at 50 mg for a good 6 months about a year ago....I have heard of people taking up to 400-600 MG of Lamictal..the problem is how long it takes to get there 'cause of the slow titration!!
If you are not experiencing any S/E's, I would keep trying.....
Posted by Mags on August 9, 2004, at 21:30:32
In reply to Re: Lamictal dosage question?, posted by Mags on August 9, 2004, at 21:25:09
P.S. I am still not there yet...we are still titrating the Lam up and we are also going to try hypermetabolic doses of thyroid ......
Posted by karen m. on August 10, 2004, at 0:18:06
In reply to Re: Lamictal dosage question?, posted by Mags on August 9, 2004, at 21:30:32
very strange day today in terms of cycling high in the morning and very depressed in the afternoon to where i was crying out of nowhere. now that i am at 300 lamictal i didn't expect these types of experiences. anyone else still have this at this dosage?
Posted by waki on August 11, 2004, at 17:43:25
In reply to Re: Lamictal dosage question?, posted by karen m. on August 10, 2004, at 0:18:06
It may be a good thing what your experiencing.
I've been on 400 mg per day of Lamictal I think for at least 2 years. For the longest time I took it in the morning or closer to noon if I forgot to take it in the morning.
I really never knew what the lamictal did for me except my p-doc said it was a rocket booster to meds and it appeared to keep me from bottoming out.
I then started taking these other meds and started to feel better.
What is interesting is that when I took the lamictal, i felt a sedating strange slightly depressed feeling.
My point is I felt like crap for so long that the Lamictal did not drop me any more because I was already emotionally and physically in the sewer.
I then started PM dosing the lamictal at night before bed.
I felt even better in the day. I believe the lamictal even relaxes me slightly before bed.
I have tried to get off this lamictal many times, but I developed a dependency towards it. I'm going to wait until I feel better to go off it. They (research department) still have a lot of work to make me feel better.
I want off the lamictal because in my personaly opinion I believe that "we" (people on anti Dep's) sometimes become complacent and leave our cocktails alone.
I believe our cocktails become so complicated that we don't know which are helping us or which are hindering us.
My goal is obviously to feel better and get my life back. However my second objective is to take as minimal of meds as possible.
The less med's I take the more clearer I sem to understand how these drugs effect me.
My point is I had to feel better to know that the lamictal made me feel worse at the moment i took it.
This is the end of the thread.
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