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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Topdog on May 26, 2013, at 13:05:32
Hi,
I starting loading with Lamictal 100mg 5 days ago, I use it to backfire depression. Any idea when will it kick in? Is it like AD-s and take 2 weeks?
How does it feel when it first strikes, will it be like OMG.. it just started working (similar, when a SSRI-s or MAOi-s first kicks in) or will it be more gradual, like..i suppose it is doing something..? I have read earlier posts of course, put haven't got straight answer.
Good luck!
Posted by polarbear206 on May 26, 2013, at 13:26:54
In reply to When will Lamictal kick in?, posted by Topdog on May 26, 2013, at 13:05:32
> Hi,
>
> I starting loading with Lamictal 100mg 5 days ago, I use it to backfire depression. Any idea when will it kick in? Is it like AD-s and take 2 weeks?
>
> How does it feel when it first strikes, will it be like OMG.. it just started working (similar, when a SSRI-s or MAOi-s first kicks in) or will it be more gradual, like..i suppose it is doing something..? I have read earlier posts of course, put haven't got straight answer.
>
> Good luck!
It was gradual for me. Good response around 150 mg to 200mg. I take it with effexor.
Posted by baseball55 on May 26, 2013, at 19:46:07
In reply to Re: When will Lamictal kick in?, posted by polarbear206 on May 26, 2013, at 13:26:54
I noticed that my suicidal thoughts had stopped when I got up to 200mg (which took a few weeks) and remained at that level for about a month. There was no aha! moment. I just gradually noticed that the suicidality had calmed down.
Posted by SLS on May 27, 2013, at 5:08:28
In reply to When will Lamictal kick in?, posted by Topdog on May 26, 2013, at 13:05:32
> Hi,
>
> I starting loading with Lamictal 100mg 5 days ago,Of course, this is not recommended, especially for de novo (first time) administration. The danger of precipitating Stevens-Johnson syndrome (SJS) is much greater under these conditions. It was a gamble for you to take loading doses of Lamictal, but you might be lucky enough to come out ahead.
> I use it to backfire depression. Any idea when will it kick in? Is it like AD-s and take 2 weeks?
What does it mean to "backfire" depression?
You might not have to wait 2 weeks. There doesn't seem to be a latency in the emergence of therapeutic effect other than the time it takes to titrate the dosage. Some people get a "blip" improvement at 50 mg/day, only to watch it disapear very quickly. There might be a similar transient improvement upon dosage increases until one reaches dosages of 150 mg/day and higher. 200 mg/day seems to be the mode. I need 300 mg/day.
> How does it feel when it first strikes, will it be like OMG.. it just started working
I found that the improvement produced by Lamictgal is closer to being a OMG onset rather than a gradual emergence.
Good luck with Lamictal. It seems to me that more people profit from using Lamictal as an adjunct to other psychotropic drugs rather than being used monotherapeutically.
- Scott
Posted by ed_uk2010 on May 27, 2013, at 6:15:16
In reply to Re: When will Lamictal kick in? » Topdog, posted by SLS on May 27, 2013, at 5:08:28
Hi Scott,
>I need 300 mg/day.
In the treatment of epilepsy, increasing the dose above 300mg is not usually any more effective than 300mg. There are of course a few exceptions. Anyway, I suspect the same is true in bipolar disorder.
Posted by SLS on May 27, 2013, at 6:47:18
In reply to Re: When will Lamictal kick in? » SLS, posted by ed_uk2010 on May 27, 2013, at 6:15:16
> Hi Scott,
Hi Buddy.
> > I need 300 mg/day.
> In the treatment of epilepsy, increasing the dose above 300mg is not usually any more effective than 300mg.I didn't know this. I had thought that for epilepsy, a great many people need to go to 500 mg/day. Thanks for the information.
> Anyway, I suspect the same is true in bipolar disorder.
It seems to me that most responders to Lamictal in bipolar disorder do well at 200 mg/day.
- Scott
Posted by Dinah on May 27, 2013, at 9:42:14
In reply to When will Lamictal kick in?, posted by Topdog on May 26, 2013, at 13:05:32
I only know Lamictal is working when I stop taking it. It's very smooth. I just feel more stable.
My favorite sort of med.
Posted by Topdog on May 27, 2013, at 14:04:01
In reply to When will Lamictal kick in?, posted by Topdog on May 26, 2013, at 13:05:32
Thanks Scott, it's always pleasure to read your posts, they are thorough and well-written!
Posted by ed_uk2010 on May 27, 2013, at 14:05:15
In reply to Re: When will Lamictal kick in? » ed_uk2010, posted by SLS on May 27, 2013, at 6:47:18
Hello,
>I didn't know this. I had thought that for epilepsy, a great many people need to go to 500 mg/day. Thanks for the information.
In epilepsy, most patients who are going to respond well (or remit) on a particular medication do so at fairly moderate doses. Only a minority experience substantial additional benefit by taking very high doses.
For example, the dose of valproate should rarely need to exceed 30mg/kg/day in divided doses, which often amounts to about 2g per day. Carbamazepine is normally effective at up to 800mg per day in divided doses - and doses should rarely exceed 1200mg.
The dose of lamotrigine depends partly on whether it is used alone or with other medications, but is usually between 100mg and 400mg per day. Lamotrigine is potentiated by valproate, both on a pharmacokinetic and pharmacodynamic level. In contrast, lamotrigine levels are reduced by enzyme-inducing drugs such as carbamazepine and phenytoin. Very high doses of lamotrigine eg. 500-700mg/day are occasionally used in refractory epilepsy for patients also taking enzyme-inducing drugs, but adverse effects may be increased, any there may be little additional benefit above 400mg.
Optimal lamotrigine doses for the majority of adults with focal or generalised epilepsy are as follows:
Monotherapy:
100mg to 200mg per day, sometimes up to 300mg per day, rarely more. Around 200mg/day may be chosen as an initial target dose, or the drug may be titrated to effect.Combination therapy with valproate:
Very gradual titration up to 100-200mg per day. Not more than 200mg per day.Combination therapy with an enzyme-inducing drug: 200mg to 400mg per day, always in divided doses.
Posted by SLS on May 27, 2013, at 17:30:38
In reply to Re: When will Lamictal kick in? » SLS, posted by ed_uk2010 on May 27, 2013, at 14:05:15
This is the end of the thread.
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