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Dr. Bob is Robert Hsiung, MD,
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Posted by BetweenDreams81 on January 18, 2011, at 15:47:31
In reply to Re: Generic Lamictal (lamotrigine) experiences?, posted by mellow on January 18, 2011, at 6:41:35
I'm glad it works so well for you...I am hoping that I do not have too much of a battle figuring out the right mix. Even just the xanax is helping out right now...BUT I also have to keep some thoughts/impulses in check...like I was just thinking today about what stallion to breed my mare to! (aaaggghhh!) My big issue on the hypomanic(?) side has been the significant impulsive purchases which put me into MAJOR financial ruin. Last 4 years running I have purchased or leased an accumulation of 8 horses...that is not such a great thing when I cannot afford the upkeep, or fall back into a depression that leaves me hibernating and not able to leave the house to find work (self employed).
Thank goodness I am down to 3 horses in my care...even this is quite expensive.
The depression side of things can be utterly debilitating. I think this is why he decided to go the route of Lamictal (??) since acording to him it seems to work better with those who are more on the depressive side of the scale.
I have noticed that it seems to go in cycles with the seasons...is this typical at all??? or am I just nuts?? Impulsive decisions are often around May-August...start feeling low and depressive around Oct. with the lowest point usually around Feb...I'm feeling that cycle this past season/year for sure.
Posted by BetweenDreams81 on January 18, 2011, at 15:56:59
In reply to Re: Generic Lamictal (lamotrigine) experiences? » BetweenDreams81, posted by emme on January 17, 2011, at 17:00:54
Thanks emme for the link!...I added the other link for the Rx discount card...which seems really uncomplicated and you can print it out to use right away.
Thanks for the advice to stick with brand for a few months...that sounds like a good idea. To get a clear read on if it is really going to work I probably should at least stick to the brand. If I had adverse reactions with the generic without trying the brand first I may give up on a good thing...so hopefully it works out just fine.
Posted by morgan miller on January 18, 2011, at 16:38:21
In reply to Re: Generic Lamictal (lamotrigine) experiences? » morgan miller, posted by BetweenDreams81 on January 18, 2011, at 15:19:29
Hey BD,
The worst side effect I experienced with lamictal was my brain feeling as if it just simply was not functioning at a high level. I remember after about 6 weeks on lamictal and being at 150 mg, it took me 2 hours to clean my friend's very small 1 bedroom apartment kitchen. I just could not get my motor going. At somewhere between 75 and 125 mg, I experienced a feeling of not wanting to talk and having some difficulty doing so as well. In my experience of taking antidepressants and mood stabilizers, no medication seemed to negatively affect my neurological function as much as Lamictal, with the exception of maybe Zyprexa.
Lamictal has been shown to possibly negatively impact Long Term Potentiation, which I believe has something to do with synaptic communication/plasticity that impacts memory formation. This might explain many complaints of cognitive impairment with Lamictal.
I don't think Lamictal has the ability to impair neurological function in the long run and I do think it is something you will recover from if you do experience such impairment, but as with any of these drugs, there is always some risk that someone may experience long term issues.
What makes you surprised it was the first plan of action?
I guess I am not really surprised as much as I do not agree with it. I think there are other medications out there that are less likely to be as invasive. I have a hard time believing that lamotrigine's potential for therapeutic benefit is the best fit for you. I would personally prefer to try a low dose of a few SSRIs as I do not think the potential for harm is as great. Also, lamotrigine is an anti-epileptic, it was developed specifically for this use, not for depression, anxiety, or mood issues.
I am all for the medication that is most likely to make someone feel good in a way that makes it easier for them to behave in a more productive fashion, with the least potential for harm and side effects. I took Zoloft for years and would still be on it had I not stopped. But if most psychiatrists knew I was bipolar(I did not at the time) they likely would have wanted me to try to get off Zoloft and transition to a new class of drugs. Why not stick with a drug that helps me feel good and normal much of the time and has been shown over and over again to not have a negative impact on someone's cognitive ability/neurological function for a large part of the population of people that try it. All you have to do is search the internet. You will not find the kinds of complaints about drugs like Zoloft that you find with drugs like Lamictal. I understand many doctors are worried about making someone feel manic with SSRIs so they try a drug like lamotrigine instead. I also understand that lamotrigine has helped many people. I am all for keeping lamotrigine in the toolbox of psychiatrists as a potential therapy for their patients. I just think that lamotrigine is still going through this honeymoon/drug du jur phase and this is influencing doctors to prescribe it more than it should be for patients that would be better off on other medications in the long run.
Lamotrigine is a heavy heavy duty medication, one that I believe is much more so than medications like SSRIs. IMHO, more caution should be used when prescribing it.All that said, I do not want to discourage you from trying something that might end up being a very good treatment for you. I'm sorry if I have discouraged you or instilled any fear in you.
Morgan
Posted by BetweenDreams81 on January 18, 2011, at 16:56:21
In reply to Re: Generic Lamictal (lamotrigine) experiences? » BetweenDreams81, posted by morgan miller on January 18, 2011, at 16:38:21
Thanks for the info Morgan....it is something to keep in mind. I do think he was afraid to put me on SSRI's because I have been swinging abit and maybe because my reaction to Adderall is so extreme, it definitely throws me into mania/hypomania. It could be because my mom is on an SSRI and even though she is still taking it, I know it is not all that effective cause I'm living with her and see her everyday. Could be that he is taking into consideration my sister's history of reacting to different drugs as well. Who knows why this was his first lineup...I will ask him next time I talk with him though, just to at least find out his usual progression of trial/error.
We'll see how it goes, but if I do notice the signs you are talking about, at least I know about them and can 'hopefully' be mindful enough to notice and talk with him about it. I am glad to know of this, but I think I am also good at keeping an open mind...and I am soooo driven to get my life back on track that I am trying my best to maintain a good mind set that is as optimistic as possible while still being well-grounded in reality.
Thank you for sharing your experience!
Posted by BetweenDreams81 on January 18, 2011, at 17:22:56
In reply to Re: Generic Lamictal (lamotrigine) experiences? » BetweenDreams81, posted by morgan miller on January 18, 2011, at 16:38:21
...I don't want to jinx myself, but I think I qualify for the GSK Bridges to Access program...cross fingers. That would be a huge weight off of my shoulders financially speaking!
Posted by morgan miller on January 18, 2011, at 17:36:45
In reply to Cross Fingers!..., posted by BetweenDreams81 on January 18, 2011, at 17:22:56
That would be great! I hope you do qualify for this!
Posted by bleauberry on January 18, 2011, at 17:43:51
In reply to Generic Lamictal (lamotrigine) experiences?, posted by BetweenDreams81 on January 17, 2011, at 15:57:34
One of the examples of generic lamictal that stands out in my mind is that of SLS, which he commented on in this thread. Over the years there have been multiple examples.
One doctor I know will not even prescribe generics at all. He has seen enough troubles, failures, bizarre side effects, and relapses with them that he does not consider them reliable in the effort to move progress forward. Most doctors I think do not have their eyes fully open to see the clues and trends that are right in front of them every day. They assume what everyone else assumes, that is, generics are equivalent to brand. They aren't. Different is different, in SLS's own words, and I agree.
You know the old saying, "you get what you pay for." I personally believe with maybe 70% of meds on the market, that is true. $4 fluoxetine is NOT the same as $100 prozac. Even the claim that the active ingredient is identical is misleading.
My doctor did actually have one generic pain killer he preferred over brand because he got better results with it. He didn't have any bias one way or the other, he just watched for consistent trends. He was much more of a medical detective with his patients than most doctors are. Generics didn't provide consistent trends except in the disappointment department, most of the time. Not enough observed consistent performance to be first line anyway.
The topic spans many drugs. It isn't just lamictal. I've noticed the difference myself several times. Twice I didn't even know I had been switched, so it was truly a blind experience. Even for a common headache, I find brand Advil to be much better than the generic. The generic works, but not with the same oomph.
I think a wise strategy is to begin any treatment with the expensive brand. Assuming it does well, which it may or may not, then try switching to generic and see what happens. It might stay well, or it might fall apart. If it stays well, then you can save a ton of money. If it doesn't, go back to brand. For someone to start a treatment on say, example, generic lamictal, and then fail that trial, well, they never really tried lamictal, so they can't say lamictal didn't work for them!
To me, the following meds in generic form were absolutely horrible experiences: Lamictal, modafinil, prozac, xanax. I did fine on brand prozac, brand xanax, and brand modafinil. Lamictal just wasn't for me no matter, but at least the brand version was tolerable. Generic not.
Odd, but just as my doctor found one generic to be more reliable than brand, I too found that generic Ritalin is much better for me than brand. The real stuff just feels aweful to me.
Posted by BetweenDreams81 on January 18, 2011, at 18:02:50
In reply to Re: Generic Lamictal (lamotrigine) experiences?, posted by bleauberry on January 18, 2011, at 17:43:51
Thank you bleauberry for sharing your experience...I feel the same way about staying with the brand Lamictal after reading so many stories...at least to know whether it is the right thing or not...and hopefully I really do qualify for the GSK Bridges to Access program which would provide me with their brand name meds.
Now about Xanax (should mention, it is generic)
How long does one normally feel its effects? I am currently taking 0.25 mg 2x/day. I definitely notice it when it kicks in...I get uber drowsy for about 30 min, and then I'm fine...for 3-4 hours in a stressful situation or if I am particularly low or negative...longer, about 6-8 hours if I'm not stressed out to begin with. When I feel it "stop" working I automatically have a feeling like there is a hampster wheel of negative thoughts/feelings and anxiety running through my head. Sometimes, I can feel my heart rate increase...again, 30 min after I take the xanax, it's gone again.
Now I can see why this can become habit forming. I have never had an "addictive" personality so I don't 'think' I'm feeling addicted to it?? Is this an indication that I am still adjusting to it? Does this sound like it needs to be increased or XR formula? Or??? Just noticing and wondering...I want to be careful and responsible with this drug. I have e-mailed pdoc about it.
Posted by Phillipa on January 18, 2011, at 18:46:49
In reply to Now about Xanax (alprazolam) » bleauberry, posted by BetweenDreams81 on January 18, 2011, at 18:02:50
Been on it for many years and haven't increased dose. Some need regular xanax if they take the long acting. Personally it didn't work for me. Some say it doesn't release consistently. Greenstone is the only xanax I'd take. Made by manufacturer of real name brand xanax. Phillipa
Posted by BetweenDreams81 on January 18, 2011, at 19:25:03
In reply to Re: Now about Xanax (alprazolam) » BetweenDreams81, posted by Phillipa on January 18, 2011, at 18:46:49
Thanks Phillipa, What dosage do you take? (if it isn't too personal)
Posted by Phillipa on January 18, 2011, at 20:05:23
In reply to Re: Now about Xanax (alprazolam) » Phillipa, posted by BetweenDreams81 on January 18, 2011, at 19:25:03
Before any other meds and just a benzo .25 mg three times a day. Or 4 hard to remember. And now just under lmg bedtime only. Phillipa ps benzos for 40 years yes it's true
Posted by ed_uk2010 on January 19, 2011, at 16:12:24
In reply to Re: Generic Lamictal (lamotrigine) experiences?, posted by bleauberry on January 18, 2011, at 17:43:51
>You know the old saying, "you get what you pay for." I personally believe with maybe 70% of meds on the market, that is true. $4 fluoxetine is NOT the same as $100 prozac. Even the claim that the active ingredient is identical is misleading.
That's interesting, because Eli Lilly's wholesale price for branded Prozac in the UK is currently £1.28 (exc. VAT) for a pack of 30 capsules - so that's about $2. The cost of manufacturing will be a few pennies/cents per pack. Your $100 pack has several thousand percent profit margin for the manufacturer. The cost of manufacturing Prozac is very similar to the cost of manufacturing the generics. Since your knowledge of the pharmaceutical industry does not appear to be great, it might be best to avoid making such dramatic statements.
Posted by morgan miller on January 19, 2011, at 22:13:21
In reply to Re: Generic Lamictal (lamotrigine) experiences? » bleauberry, posted by ed_uk2010 on January 19, 2011, at 16:12:24
I think what BB means is that if brand truly is more effective than generic, you do have to pay quite a bit more for the brand, at least here in the U.S.
I'm sure you already know this Ed, but the cost of brand medications in the U.S. is ridiculously high.
I understand what you mean about the wholesale price and the manufacturing price.
Posted by morgan miller on January 19, 2011, at 23:31:14
In reply to Now about Xanax (alprazolam) » bleauberry, posted by BetweenDreams81 on January 18, 2011, at 18:02:50
I personally do not believe anyone that might fall within the bipolar spectrum should be taking such a strong and short lived benzo like Xanax. Because of the short life of Xanax, it can be destabilizing in the short or long run IMO. This drug is a very quick fix and does not lead to anything good in the long run. At least with mood stabilizers, there is much evidence of neuroprotective and neurogenic properties. I'm not a big fan of Lamictal and how it can potentially negatively impact the brain, but there is some evidence that it can also do some good things for the brain, two of these being increasing brain antioxidant levels and protection against glutamate toxicity.
I hope you can get off Xanax soon and find something that makes you more stable and helps you feel much better.
Posted by ed_uk2010 on January 20, 2011, at 16:20:51
In reply to Re: Generic Lamictal (lamotrigine) experiences? » ed_uk2010, posted by morgan miller on January 19, 2011, at 22:13:21
>I think what BB means is that if brand truly is more effective than generic....
As is often the case (in my opinion), BB made quite a number of unreasonable claims.
With respect to lamotrigine, the UK Department of Health has stated that it is not routinely necessary to prescribe by brand name (for epilepsy).
Posted by morgan miller on January 20, 2011, at 21:24:27
In reply to Re: Generic Lamictal (lamotrigine) experiences? » morgan miller, posted by ed_uk2010 on January 20, 2011, at 16:20:51
>As is often the case (in my opinion), BB made quite a number of unreasonable claims.
I understand. Though, I do believe it is very possible that people can have better responses to brands than generics.
Posted by ed_uk2010 on January 23, 2011, at 13:25:02
In reply to Re: Generic Lamictal (lamotrigine) experiences?, posted by morgan miller on January 20, 2011, at 21:24:27
>I do believe it is very possible that people can have better responses to brands than generics.
If that's the case, some people will respond better to generics than brands. Or perhaps generics which have brand names applied, as some do.
Anyway, BB's claims went far beyond that.
Posted by morgan miller on January 23, 2011, at 20:09:20
In reply to Re: Generic Lamictal (lamotrigine) experiences? » morgan miller, posted by ed_uk2010 on January 23, 2011, at 13:25:02
> >I do believe it is very possible that people can have better responses to brands than generics.
>
> If that's the case, some people will respond better to generics than brands. Or perhaps generics which have brand names applied, as some do.I think I told you about my experience with Zoloft. I switched to generic for a month and my stomach was upset along with not quite feeling as good. Now, maybe I didn't feel as good because my stomach was upset half the time. Every doctor I've spoken to admits there may be a difference in how people respond to some brand and generic psychiatric medications. I forget the explanation my last pdoc gave me. I think he also spoke of a few of his patients responding better to generics. Anyway, we've talked about this before. I understand your and others stance on the brand vs. generic issue.
Posted by gritslad on January 23, 2011, at 20:24:03
In reply to Generic Lamictal (lamotrigine) experiences?, posted by BetweenDreams81 on January 17, 2011, at 15:57:34
Take the generic. I've never used anything but and it works well for me.
Posted by ed_uk2010 on January 24, 2011, at 16:07:36
In reply to Re: Generic Lamictal (lamotrigine) experiences?, posted by morgan miller on January 23, 2011, at 20:09:20
>Every doctor I've spoken to admits there may be a difference in how people respond to some brand and generic psychiatric medications.
I think a major problem here is that most doctors don't actually know much about pharmacy and the generics industry. It is not their area of expertise.
Posted by morgan miller on January 24, 2011, at 20:21:18
In reply to Re: Generic Lamictal (lamotrigine) experiences? » morgan miller, posted by ed_uk2010 on January 24, 2011, at 16:07:36
> >Every doctor I've spoken to admits there may be a difference in how people respond to some brand and generic psychiatric medications.
>
> I think a major problem here is that most doctors don't actually know much about pharmacy and the generics industry. It is not their area of expertise.This is true. I would hope that at least a good psychiatrist would.
Posted by BetweenDreams81 on January 25, 2011, at 0:38:40
In reply to Re: Now about Xanax (alprazolam), posted by morgan miller on January 19, 2011, at 23:31:14
Holy moly! Yes, I see exactly what you mean now about the short life of the xanax, and have brought it up with doc. Especially not a great combo when another person in your life is mad manic and toxically critical/irritable at the same time.
On the other hand, do you think it is healthy to try dealing with some anxiety without popping a pill to just get rid of it?...this was an extreme situation and I think merited using something to settle my ping-pong exploding brain, but I don't want to just flat line either. I don't feel necessarily that I am flat, but it definitely is not the answer to getting to the bottom of the anxiety. Or, is it partially also a matter of the Lamictal not kicking in yet? (not expecting it to just yet, still at 25 mg)
Does Klonopin have the same effect as xanax, just longer acting? Or does it make a person flat with a sluggish mind?
Posted by Hombre on January 25, 2011, at 7:03:45
In reply to Re: Now about Xanax and ? about Klonopin » morgan miller, posted by BetweenDreams81 on January 25, 2011, at 0:38:40
Since I feel like we have some symptoms in common, namely anxiety, insomnia, and late-night racing thoughts (correct if I'm wrong about this), you might want to look into Seroquel at a pretty low dose, like 25mg to start, as a possible plan B or C. It's predictable with inducing sleep onset and it acts all day to calm anxiety.
The thing with benzos especially is that you don't know you need one until you are already pretty uncomfortable. I found myself carrying a few .5mg lorazepam pills on me "just in case". That's no way to live. With one dose of Seroquel at night, as long as I don't overdo the caffeine I am mellow. It also has a definite antidepressant effect, which is probably enhanced by my taking antidepressants.
Don't be frightened by the "antipsychotic" label or anything else you might here. Just keep it as an option, that's all.
Posted by BetweenDreams81 on January 25, 2011, at 7:44:54
In reply to Re: Now about Xanax and ? about Klonopin, posted by Hombre on January 25, 2011, at 7:03:45
Thank you Hombre, I really appreciate you input...yes, I do feel I have very similar symptoms that you have described...here and on the other forum. I will mention the Seroquel to pdoc and see what he thinks.
What you describe about keeping the lorazepam on hand wherever you are...that is exactly what I have been doing lately, and while it is fairly quick acting...it would be nice to not have several reminders everyday that I am only calm and not spinning my top off just because I am taking a med...and once a day would be quite convenient.
I am not generally turned off by the "titles" things are given...if they work, they work. Hell, Lamictal is an anti-convulsant lol.
Posted by morgan miller on January 25, 2011, at 14:01:38
In reply to Re: Now about Xanax and ? about Klonopin » morgan miller, posted by BetweenDreams81 on January 25, 2011, at 0:38:40
>Especially not a great combo when another person in your life is mad manic and toxically critical/irritable at the same time.
Are you speaking of your mother? This is likely one of the two main reasons why you developed any mental health issues that have interfered with your ability to live a full productive life. Our environment plays just as big a role if not bigger for most of us as our genetics in what we struggle with mentally in adulthood. Which is why I put so much emphasis on therapy.
I do think klonopin is the best option for benzos in most cases. It should at least be the first one that doctors try on their patients. I don't think klonopin was any more flattening than Xanax, at least not for me. Klonopin has an 8 to 12 hour half life and is much smoother in it's effects IMO. I would try a very low dose of klonopin, just enough to make your anxiety manageable, not enough to wipe it out. Wiping out anxiety should not really be the goal with most medications anyway. It's making things very manageable so that we function well and do all the other good things in life that make us feel good and relieve our anxieties. I think if a medication wipes out all anxiety, we are too medicated at that point, in a way that we lose the "good" anxiety that gives us a sense of urgency to do the things we need to do to both survive and thrive.
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