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Dr. Bob is Robert Hsiung, MD,
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Posted by tensor on November 5, 2006, at 6:15:00
My fifth week with Lamictal, one week at 100mg. The only time i noticed any improvement was the two days after raising the dose from 50mg to 100mg(a week ago). Since that, no improvement at all. Currently it's like before i started Lamictal, no effect but no side effects either. My sex life is improved, but can't really enjoy that thanks to my depression, i have no energy.
I'm wondering, since i got a little transient response going from 50 to 100mg, is this indicating that i need a higher dose? Is there any point to stay at 100mg, does it need more time etc.
Currently i do not work, and haven't done so for appr. two months. I have feelings of guilt, my employer is wondering why i never recover. Last time i was away ill i did not work for seven months, which was a nightmare. My employer wonder if that's going to happen again.. sigh.
I'm gonna call my pdoc tomorrow and i'm wondering if i should call for a higher dosage, 150 or 200mg. What do you think?/Mattias
Posted by ed_uk on November 5, 2006, at 7:10:23
In reply to Lamictal, when will it ever work?, posted by tensor on November 5, 2006, at 6:15:00
Hi Mattias,
Since you have no side effects, but no benefit, increasing the dose would seem sensible. You could try 150mg first, then 200mg if 150mg is not adequate.
Regards
Ed
Posted by tensor on November 5, 2006, at 7:26:29
In reply to Re: Lamictal, when will it ever work?, posted by ed_uk on November 5, 2006, at 7:10:23
Hi Ed :-)
Yeah, i think so too, thanks. Often you know you have reached an adequate dose through the side effects, particularly with TCA's i.e if your mouth is dry as a desert, no sex drive, weight gain, sweatings etc. but no improvement then you can usually say the med is not gonna work for you.
Can you say this with Lamictal, when you respond to it, what are the typical side effects at that dose?
I hope you understand what i'm trying to say here./Mattias
Posted by ronaldo on November 5, 2006, at 7:38:38
In reply to Lamictal, when will it ever work?, posted by tensor on November 5, 2006, at 6:15:00
> My fifth week with Lamictal, one week at 100mg. The only time i noticed any improvement was the two days after raising the dose from 50mg to 100mg(a week ago). Since that, no improvement at all. Currently it's like before i started Lamictal, no effect but no side effects either. My sex life is improved, but can't really enjoy that thanks to my depression, i have no energy.
> I'm wondering, since i got a little transient response going from 50 to 100mg, is this indicating that i need a higher dose? Is there any point to stay at 100mg, does it need more time etc.
> Currently i do not work, and haven't done so for appr. two months. I have feelings of guilt, my employer is wondering why i never recover. Last time i was away ill i did not work for seven months, which was a nightmare. My employer wonder if that's going to happen again.. sigh.
> I'm gonna call my pdoc tomorrow and i'm wondering if i should call for a higher dosage, 150 or 200mg. What do you think?
>
> /MattiasFound this for you Matt. Hope it helps...
"9. How is treatment with lamotrigine initiated?
In people not taking carbamazepine or valproate, lamotrigine is usually initially prescribed at an initial dose of 12.5 or 25 mg a day and the dose increased by 12.5 or 25 mg every week or two.
In people taking valproate the initial dose of lamotrigine is often 12.5 mg/day and the drug is increased by 12.5 mg every ten days or two weeks.
In people taking carbamazepine somewhat larger initial doses and more rapid increases in dose are possible".
"11. What is the usual final dose of lamotrigine?
When used as an antidepressant or as a mood-stabilizing agent the final dose of lamotrigine is most often between 100 and 200 mg/day. Some people require doses as high as 600 mg/day to achieve a good antidepressant effect. Such doses should be avoided in patients taking valproate because of the pharmacokinetic effect of valproate that increases plasma levels of lamotrigine, and the accompanying increased risk of serious dermatological side effects".
Website: http://www.psycom.net/depression.central.lamotrigine.html
Above website will tell you most of what you want to know.
I think you have to be careful if you are taking other anti-convulsants. They can affect the blood levels.
You also have to start off very gently due to the danger of developing a rash. One rash, SJS, is particularly nasty, fatalities have been reported.
It is very NB that you increase the dose slowly. It seems you have been at 100 mg for only one week. Maybe you could increase it to 125 mg for a fortnight and then increase to 150 mg. They say that the slower you increase the better your chances of avoiding the rash. Some of the rashes are not dangerous, but SJS is.
"12. How long does it take for lamotrigine to 'kick-in?'
While some people notice the antimanic and antidepressant effects early in treatment, others have to take a therapeutic amount of lamotrigine for up to a month before being aware of a significant amount of improvement".
Seems like you should give it another month, say at 150, Matt. If that doesn't work you could take it to 175 mg or 200 mg remembering to increase the dose slowly.
SJS = Stevens-Johnson syndrome
see http://www.medterms.com/script/main/art.asp?articlekey=14086
....Alan
Posted by tensor on November 5, 2006, at 7:56:49
In reply to Re: Lamictal, when will it ever work?, posted by ronaldo on November 5, 2006, at 7:38:38
Hi Alan,
Thank you for the article. I have a feeling my pdoc wants to keep me at 100mg for another week. All this waiting is frustrating. But i have respect for Lamictal, rash is no fun, i've been lucky so far not belonging to the unlucky 10%.
I will give my pdoc a call tomorrow, if he's in his office, i will let you know how it turned out.
Again thanks,
Mattias
Posted by Phillipa on November 5, 2006, at 10:54:16
In reply to Re: Lamictal, when will it ever work? » ronaldo, posted by tensor on November 5, 2006, at 7:56:49
Tensor I tried it for an augmenting agent for depression and at 50mg had an uncommon side effect excessive salivation and had to stop. I did like the med. though. Good luck. Love Phillipa
Posted by clint878 on November 5, 2006, at 12:40:44
In reply to Re: Lamictal, when will it ever work?, posted by ronaldo on November 5, 2006, at 7:38:38
600mg a day! I can't even tolerate 50mg/day.
If I took 600mg a day, I would probably end up killing myself through accidental injury. The side effects at that dose must be astronomical, and I doubt that would be worth tolerating even if it completely cures your depression.
Posted by ronaldo on November 5, 2006, at 13:21:20
In reply to Re: Lamictal, when will it ever work? » ronaldo, posted by clint878 on November 5, 2006, at 12:40:44
> 600mg a day! I can't even tolerate 50mg/day.
>
> If I took 600mg a day, I would probably end up killing myself through accidental injury. The side effects at that dose must be astronomical, and I doubt that would be worth tolerating even if it completely cures your depression.Hi clint,
I agree with you, 600 mg does sound extreme. But if Ivan Goldberg says 600 mg he must have come across it somewhere. It must take for ever to get there at 25 mg per week titration. About six months I reckon.
....Alan
Posted by ed_uk on November 5, 2006, at 16:05:49
In reply to Re: Lamictal, when will it ever work? » ed_uk, posted by tensor on November 5, 2006, at 7:26:29
Hi Mattias
>Can you say this with Lamictal?
Not really, I don't think it works with Lamictal. The only time you know you are gonna respond, is when you respond!
Ed
Posted by ed_uk on November 5, 2006, at 16:07:16
In reply to Re: Lamictal, when will it ever work? » ronaldo, posted by clint878 on November 5, 2006, at 12:40:44
>The side effects at that dose must be astronomical
Not necessarily, some people get very few side effects with Lamictal. I am sorry that your side effects have been so bad.
Ed
Posted by ed_uk on November 5, 2006, at 16:19:58
In reply to Re: Lamictal, when will it ever work? » clint878, posted by ronaldo on November 5, 2006, at 13:21:20
>It must take for ever to get there at 25 mg per week titration. About six months I reckon.
When lamotrigine is used alone, the usual titration schedule is as follows........
25mg per day for 14 days
50mg per day for a further 14 days then 75mg or 100mg dailyOnce you've reached 100mg per day, the dose can be increased by a *maximum* of 50-100mg every 7-14 days. In the treatment of epilepsy, as monotherapy, the usual maintenance dose is 100-200mg per day. Similar doses are used to treat bipolar disorder. The highest dose I've seen on a prescription was 700mg per day - or 800mg I forget (for epilepsy).
Regards
Ed
Posted by rovers95 on November 5, 2006, at 16:45:51
In reply to Lamictal, when will it ever work?, posted by tensor on November 5, 2006, at 6:15:00
> My fifth week with Lamictal, one week at 100mg. The only time i noticed any improvement was the two days after raising the dose from 50mg to 100mg(a week ago). Since that, no improvement at all. Currently it's like before i started Lamictal, no effect but no side effects either. My sex life is improved, but can't really enjoy that thanks to my depression, i have no energy.
> I'm wondering, since i got a little transient response going from 50 to 100mg, is this indicating that i need a higher dose? Is there any point to stay at 100mg, does it need more time etc.
> Currently i do not work, and haven't done so for appr. two months. I have feelings of guilt, my employer is wondering why i never recover. Last time i was away ill i did not work for seven months, which was a nightmare. My employer wonder if that's going to happen again.. sigh.
> I'm gonna call my pdoc tomorrow and i'm wondering if i should call for a higher dosage, 150 or 200mg. What do you think?
>
> /MattiasWhat else are you taking with it??? My results have become even more pronounced in the last few days as i have removed the SJW and rhodiola....dont no why this is maybe 1) too much serotonin or 2)sjw reducing blood levels of lamictal (as it has been found to have this effect on other drugs).
Stick l-theanine alongside it-thats whats working for me....100 mg 4 times a day should do the trick. Think this effect is explained by a study i found somewhere that lamictal increases the ad effects of the NMDA enatgonist ketamine. For this matter you should prob stick high dose chelated mag alongside it too?! you will prob no within a few days if your gona get results from this combo?!
Also dropping the caffeine (which increases glutamate) has helped me big time!!!
best wishes - let me no how u get on!!!!
mark
Posted by tensor on November 5, 2006, at 18:08:26
In reply to Re: Lamictal, when will it ever work?, posted by rovers95 on November 5, 2006, at 16:45:51
Hi Mark!
>What else are you taking with it???
I take:
100mg nortriptyline
15mg remeron
2mg clonazepam
Supps: Fish oil Omega3, B vitamins, folic acid and chromium.Thanks for the tips, however, I would rather not add anything to my regime before i have completed the Lamictal trial, which maybe ends at 200mg if not before. The reason for this is that it's difficult to know which substances are causing what.
If i stay non-respondant to Lamictal i might try the supps you're recommending. Btw, >"For this matter you should prob stick high dose chelated mag alongside it too?", are you talking about magnesium? I use to take magnesium in the past but stopped for some reason. Think i will buy a container at next visit to the pharmacy./Mattias
Posted by rovers95 on November 5, 2006, at 18:57:05
In reply to Re: Lamictal, when will it ever work? » rovers95, posted by tensor on November 5, 2006, at 18:08:26
> Hi Mark!
>
> >What else are you taking with it???
>
> I take:
> 100mg nortriptyline
> 15mg remeron
> 2mg clonazepam
> Supps: Fish oil Omega3, B vitamins, folic acid and chromium.
>
> Thanks for the tips, however, I would rather not add anything to my regime before i have completed the Lamictal trial, which maybe ends at 200mg if not before. The reason for this is that it's difficult to know which substances are causing what.
> If i stay non-respondant to Lamictal i might try the supps you're recommending. Btw, >"For this matter you should prob stick high dose chelated mag alongside it too?", are you talking about magnesium? I use to take magnesium in the past but stopped for some reason. Think i will buy a container at next visit to the pharmacy.
>
> /Mattias
>
>At the moment i am only taking it with l-theanine,
relora, a high strength multi-vitamin along with sublingual b12. I also get twice weekly magnesium injections and now taking 800mcg folic acid with the lamictal. Might add the rhodiola back in aswell and see how i go on?! In the past ive had my vitamin levels tested and have balanced my them. I do sometimes take klonopin in social situs and when my sleep isnt too gud!!I must tell you im not some sort of clean living hippy (well i didnt used 2 be anyway!) but the failures of my "conventional" ad trials has kinda forced me to pursue the "natural" path.
Yeah slogars chelated magnesium is worth a go, not
oxide (no more absorbable than sand) or citrate-not particularaly useful in the body!see....... http://www.coldcure.com/html/dep.html
Raising the lamictal dose sounds like a good idea but i really cant praise the theanine enough, it has no known drug interactions-and you should no within an hour of 200-300mg if its gona work for you. Also if you feel that 1 of your meds isnt workin for you, you maight even get better results with the lamictal if you cut it out, but i wud see what your pdoc says 1st!!
gud luck, hope u start getting some better results
mark
Posted by tensor on November 6, 2006, at 6:46:30
In reply to Re: Lamictal, when will it ever work? tensor, posted by rovers95 on November 5, 2006, at 18:57:05
Hi Mark,
have you tried other amino acids than l-theanine? I'm thinking of l-tyrosine or DL-pheylalanine, which are thought to have AD effect because od being precursors to a few neurotransmitters.
I went to a nutrition shop today and bought magnesium 400mg, i'm now thinking about an amino acid after all.>I must tell you im not some sort of clean living hippy (well i didnt used 2 be anyway!) but the failures of my "conventional" ad trials has kinda forced me to pursue the "natural" path.
I recognize that, in the past i tapered off all my prescribed psych meds and went for a more natural approach, however, it didn't work so i started over with the AD's again. But they don't exclude each other, so i'm keen on new approaches incl. amino acids.
/Mattias
Posted by rovers95 on November 6, 2006, at 15:07:01
In reply to Re: Lamictal, when will it ever work? tensor » rovers95, posted by tensor on November 6, 2006, at 6:46:30
> Hi Mark,
>
> have you tried other amino acids than l-theanine? I'm thinking of l-tyrosine or DL-pheylalanine, which are thought to have AD effect because od being precursors to a few neurotransmitters.
> I went to a nutrition shop today and bought magnesium 400mg, i'm now thinking about an amino acid after all.> >I must tell you im not some sort of clean living hippy (well i didnt used 2 be anyway!) but the failures of my "conventional" ad trials has kinda forced me to pursue the "natural" path.
>
> I recognize that, in the past i tapered off all my prescribed psych meds and went for a more natural approach, however, it didn't work so i started over with the AD's again. But they don't exclude each other, so i'm keen on new approaches incl. amino acids.
>
> /Mattias
Yeah iv tried some l tyrosine..it defo works when u take it on an empty stomach i took 1g of it and i was "buzzing" for a few hours great for social anxiety not for relaxing (GAD). Search up on theanine on the net.i find it has strong AD and also some good anti-anxiety properties, helps me sleep great too. NMDA antagonists are way more powerful than other AD's in my experience, hence the recent ketamine antidepressant trial!!the way i understand it theanine it increases dopamine and gaba and decreases glutamate through its NMDA antagonist properties. by far and away the best supplement ive used and seems to be even better with the lamictal!! Tried ketamine once earlier this year and it worked short term..........but i dont advise this!!!! Persuaded my pdoc to let me hav a trial of memantine too, just gona see how this goes!!
Also tried 5htp-didnt really notice much, but not sure its the serotonin boost i need!!
hope this helps!!!
mark
Posted by BryanII on November 6, 2006, at 16:03:41
In reply to Lamictal, when will it ever work?, posted by tensor on November 5, 2006, at 6:15:00
Tensor,
Patience is my least favorite virtue (even worse that moderation), but it was really justified for Lamictal.
My response ratcheted up, with gains followed by backsliding. It was only after reaching 200 mg (at about 2 months) that I had really sustained improvement.
I was surprised at continued improvement over the next five weeks at the same 200 mg dose. Gradual, subtle, but essential to getting back to work. Motivation, initiation, and reasonably sharp thinking only picked up 10 weeks after starting lamictal. I thought I would never make it and despaired quite often along the way. Depression and fatigue derailed my career for about 6 years and this is as well and productive as I have been since 1997. Nowhere near what I once was, but still an amazing improvement. I hope it lasts.
So, patience (don't scream!) and good luck.
Bryan
Posted by tensor on November 6, 2006, at 16:25:34
In reply to Re: Lamictal, when will it ever work?, posted by BryanII on November 6, 2006, at 16:03:41
Bryan,
thanks for your encouraging story. I have understood that i have to be patient with this med. However, i'm getting a little impatient because my mood is deteriorating, i'm worse now that than when i raised dosage to 100mg. I wonder why, in the beginning of this depressive episode i had more energy than now, now i barely make it out of bed.
Being at home sick for a long period is not a good thing, not for yourself, for your relations to other people and the prospects of keeping your job. It's hard not to be frustrated and impatient./Mattias ..not screaming..
Posted by tensor on November 6, 2006, at 16:31:16
In reply to Re: Lamictal, when will it ever work? tensor, posted by rovers95 on November 6, 2006, at 15:07:01
Hi Mark,
i talked to the nutrition shop and they did not have l-theanine in stock but they will look into to it, will probably have it in the end of this week.
Thanks,
Mattias
Posted by BryanII on November 6, 2006, at 17:03:02
In reply to Re: Lamictal, when will it ever work? » BryanII, posted by tensor on November 6, 2006, at 16:25:34
> Bryan,
>
> thanks for your encouraging story. I have understood that i have to be patient with this med. However, i'm getting a little impatient because my mood is deteriorating, i'm worse now that than when i raised dosage to 100mg. I wonder why, in the beginning of this depressive episode i had more energy than now, now i barely make it out of bed.
> Being at home sick for a long period is not a good thing, not for yourself, for your relations to other people and the prospects of keeping your job. It's hard not to be frustrated and impatient.
>
> /Mattias ..not screaming..Mattias,
I experienced something similar (mood deterioration). I think that it was both biochemical and thought-based. With both psych meds and thyroid hormone, I experienced backsliding on the way up; perhaps neurochemical/endocrine readjustment. Really, really discouraging. Then I started worrying about it and driving myself further down.
It was just as you describe: isolated at home, bad state of mind, bad for relationships, hard on my wife, terrible fear of losing job permanently. Frustration and impatience, even a degree of paranoia, are totally justified. You've just got to fight it and hang in there. I hope it works out. Be kind to yourself.
Confession: my wife's encouraging me to be patient and not talk BS to myself barely made a dent in my ruminations.
Posted by tensor on November 6, 2006, at 17:43:30
In reply to Re: Lamictal, when will it ever work?, posted by BryanII on November 6, 2006, at 17:03:02
Bryan, i will talk to a pdoc wednesday about my meds and dosages, i will post a topic on what we decided.
Take care,
Mattias
Posted by tgo on November 9, 2006, at 20:57:14
In reply to Re: Lamictal, when will it ever work? » BryanII, posted by tensor on November 6, 2006, at 17:43:30
I found my mood was flat, no emotions on lamictal. Has anyone else noticed this and is it dose related? Adding an AD didn't help.
Posted by clint878 on November 10, 2006, at 7:33:49
In reply to Re: Lamictal flatness?, posted by tgo on November 9, 2006, at 20:57:14
I did not notice this. In fact, before taking the Lamictal, I was unable to allow myself to have any emotions because they would quickly get out of control. Now, I can allow emotions because they won't completely ruin me.
Posted by ronaldo on November 11, 2006, at 2:13:37
In reply to Re: Lamictal flatness?, posted by tgo on November 9, 2006, at 20:57:14
> I found my mood was flat, no emotions on lamictal. Has anyone else noticed this and is it dose related? Adding an AD didn't help.
What you describe is what I experience on Lithium and Zyprexa. I was hoping to add Lamictal precisely to address this problem yet you say it causes this effect. Interesting....
...ronaldo
Posted by fuchsia on November 16, 2006, at 5:45:48
In reply to Re: Lamictal flatness?, posted by tgo on November 9, 2006, at 20:57:14
> I found my mood was flat, no emotions on lamictal. Has anyone else noticed this and is it dose related? Adding an AD didn't help.
My mood hasn't been flat at all and I'm on 400mgs. Prior to taking the lamictal I had all sorts of wild tumultuous moods that didn't relate to anything. These are pretty much gone and now my moods are much more normal and reactive. I do still get recurring depressions though.
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