![[dr. bob]](/dr-bob-sm.gif)
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 Beckett on October 23, 2014, at 17:21:05
I'd like to discuss with lamictal users how you found your optimal dose. I think this stuff works for rapid cycling up to a point.
After a mixed episode, my doc raised it to 250 mg. Now I have weird back pain, a massive headache, ear ringing. Clearly this is due to lamictal, so I am stepping down.
150 mg seemed best. The intent was (besides dampening mood) to budge some unresolved symptoms, etc. I was hopeful. I was at 200 mg. for a few weeks and felt dopey....
(No rash.)
Posted by oceansun on October 23, 2014, at 22:14:27
In reply to Lamictal and diminishing return, posted by Beckett on October 23, 2014, at 17:21:05
I had a huge improvement in mood stabilization and depression from 100 mg to 200 mg. The higher I go the better it seems to get (I'm moving from 400 mg to 600 mg right now). My only side effect was headache and cognitive issues, which didn't get any worse the higher the dose.
That's just my experience. If you feel 150 mg is the best and the dopeyness at the higher dose was bad, then stick with the 150 mg. Maybe your doc can add another med instead? I don't know what you're already taking...
Posted by Beckett on October 23, 2014, at 22:46:41
In reply to Re: Lamictal and diminishing return » Beckett, posted by oceansun on October 23, 2014, at 22:14:27
Hi, I read your post yesterday, and I was curious, so I appreciate your reply. What is your titration schedule?
Yea, I know that I know best. Sort of. I don't want to miss an optimal dose because I titrated up too quickly, or because I am skiddish regarding medication.
What do you think of the personal stories about people having difficulty coming off or titrating down from lamictal? If I felt confident about decreasing after a few months, I might ride out a longer trial.
I don't recall...are you treating BPll?
Posted by Christ_empowered on October 24, 2014, at 13:37:49
In reply to Re: Lamictal and diminishing return » Beckett, posted by oceansun on October 23, 2014, at 22:14:27
Interesting....I'm thinking about asking my pdoc to drop my 1200/trileptal and raise the lamictal from 100 to 200. Apparently, the Abilify+Lamictal combo has been studied a little bit for Bipolar I. Higher doses of Abilify are good anti-manic and tolerable in terms of EPS and sedation, but not so much the best AD in the world. So, with Lamcital on board...seems clean, modern, and relatively safe.Anyway, Beckett...Lamictal does that to some people. Like, a relative of mine, she used to be on 400. Then, later during the day, her mind would wander and she'd have trouble finding words. She's usually quite articulate. At one point, the cognitive weirdness (which her former shrink didn't recognize, or chose not to) resulted in an "ADD" diagnosis, so now she's on a low(ish) dose Adderall XR.
Anyway, the old shrink moved away to the Mother Country and she got a replacement. Now, its 150/Lamictal w/ the 20mgs Adderall XR.
I think there are all too often also gender issues in psychiatry. I'm queer, so I usually like female shrinks. Male pdocs...man, they dope women and queers up, no lie. My current one is OK, I guess, but I miss my old female, European shrink. I say that because my female relative got a female shrink as a replacement, and now she's on a lower dose of lamictal and doing a-OK, no probs.
This post kinda rambled...sorry :-)
Posted by oceansun on October 24, 2014, at 20:39:06
In reply to Re: Lamictal and diminishing return » oceansun, posted by Beckett on October 23, 2014, at 22:46:41
Well, I wouldn't recommend this, but I've increased by 50 mg and will go to 500 in a few days. I never had a rash (fingers crossed). I just happen to not be sensitive to Lamictal side effects other than headache. Titrating slower than you have (like 12.5 mg a week or two) might be good if you wish to try going up on it again. I'm a huge fan of Lamictal, so I can't really be objective ;).
I haven't stopped taking Lamictal since I started it (many years ago) so I don't know about withdrawal effects -- I didn't know there were any. Hmm.
I don't have bipolar, I'm just moody.
> Hi, I read your post yesterday, and I was curious, so I appreciate your reply. What is your titration schedule?
>
> Yea, I know that I know best. Sort of. I don't want to miss an optimal dose because I titrated up too quickly, or because I am skiddish regarding medication.
>
> What do you think of the personal stories about people having difficulty coming off or titrating down from lamictal? If I felt confident about decreasing after a few months, I might ride out a longer trial.
>
> I don't recall...are you treating BPll?
Posted by oceansun on October 24, 2014, at 21:44:36
In reply to Re: Lamictal and diminishing return, posted by Christ_empowered on October 24, 2014, at 13:37:49
Ha, I like the idea of a meds regimen being "clean, modern." Like a brand new kitchen ;).
I haven't read much on Abilify for Bipolar I. Not sure Lamictal alone could stop mania, so definitely a mood stabilizer of some kind with it at any dose. I do have cognitive problems with Lamictal -- definitely can't find words sometimes, and I think I used to be smarter. And my memory is shot -- I can't remember Monday.
I used to have a guy pdoc and he let me do whatever I wanted with my meds. Not sure that was always the best idea. Now I have a female pdoc and she's conservative, I'm surprised she's willing to go higher with Lamictal. Go figure.
Isn't it...sad? frustrating?...that many of us are on this board because we don't entirely trust our pdocs to pick the right medication for us?
Posted by Beckett on October 25, 2014, at 18:56:34
In reply to Re: Lamictal and diminishing return » Christ_empowered, posted by oceansun on October 24, 2014, at 21:44:36
This is an interesting discussion. Good luck with your increase. I had a laugh when you described yourself as 'just moody'. I feel sooooo much better after letting the lamictal increase wash out. I think, after all, that I will go to the lower dose. I see my doc in about three weeks....
One of the worst symptoms I have is rumination which includes repetitive thoughts. I have never increased antidepressants to a high dose. Maybe that will be my next direction.
I'm curious about your experiences with AD's and how you have settled on lamictal as a treatment--if this isn't too big a question.
Posted by Beckett on October 25, 2014, at 19:04:26
In reply to Re: Lamictal and diminishing return, posted by Christ_empowered on October 24, 2014, at 13:37:49
That approach could be interesting for you. I do think lamictal helps with the smaller ups and downs that other stabilizers and AE do not address. I recall you have mood dips or drifts.
My last doc was gay. I liked him personally, but he did not give me enough guidance, so I was left with too much responsibility for my own treatment and not enough input. He did recommend ect, and even gave me a book about it to read, but I was terrified! That might be under the umbrella over-medication :-). Usually I end up with male shrinks by default. My first shrink, and the one who gave me perhaps the most accurate diagnosis was a woman. I was like a clean slate then, with no prior dx's to obscure the picture.
Posted by oceansun on October 25, 2014, at 19:31:50
In reply to Re: Lamictal and diminishing return » oceansun, posted by Beckett on October 25, 2014, at 18:56:34
Thanks! Yep, just moody, that's me ;). I'm glad you feel better now, Lamictal just isn't a good drug for everyone.
Rumination was/is a huge problem for me too. SSRIs never touched it, but I wasn't at high doses. I tried Paxil and Prozac and Zoloft. I read a while back that they're really good for OCD but not particularly for obsessive thoughts. That's one of the reasons I left SSRIs behind, plus they numbed me.
For me, anxiety was behind the ruminations, and Abilify (at 10-15 mg but no lower) helped a ton. Also, now, DBT therapy; but DBT requires distance from it to be useful to me, and that couldn't have happened without Abilify.
I've been on most classes of ADs -- SSRIs, SNRIs, MAOIs, mood stabilizers, antipsychotics. I came to both Lamictal and Abilify purely based on theory and my symptoms. I also take Wellbutrin, but not sure what that's doing for me except it causes depression when I try to discontinue it.
I forget, what meds are you taking again? Would you consider an AP? Sorry for such a long post!
Posted by phidippus on October 31, 2014, at 21:54:26
In reply to Lamictal and diminishing return, posted by Beckett on October 23, 2014, at 17:21:05
I was on as much as 300 mg of Lamictal and went nuts. It made my OCD baaaad...
Lamictal IS not the best mood stabilizer for rapid cycling. What else have you been on?
Eric
Posted by Beckett on November 1, 2014, at 10:18:11
In reply to Re: Lamictal and diminishing return » Beckett, posted by phidippus on October 31, 2014, at 21:54:26
Lamictal, lithium, topamax, Saphris.
What do you think is good for rapid cycling?
My vocabulary has taken a hit.
Posted by Beckett on November 1, 2014, at 10:42:38
In reply to Re: Lamictal and diminishing return » Beckett, posted by oceansun on October 25, 2014, at 19:31:50
Hi yourself :). I thought obsessive parts were a part of OCD? Idk. So glad you found something that works with abilify. Anxiety? Sigh. We're well acquainted. Sounds like you've trialled many meds. How were the MAOIs? I've taken dbt and benefitted. Not able to find it where I now live. Seems like you've got a nice, small regime. Right now I take lexapro, lamictal, and a smallish amount of lyrica.
I like chatting with you.
Posted by oceansun on November 2, 2014, at 11:41:58
In reply to Re: Lamictal and diminishing return » oceansun, posted by Beckett on November 1, 2014, at 10:42:38
I like chatting with you too! But I see from Admin you are leaving this board? Gee, I hope not!
I can't find the article about OCD and obsessional thoughts again but will continue looking -- so much for The Googles.
The MAOIs Nardil and Parnate didn't help me with anything except restrict my eating habits ;). I had high hopes for Nardil, but alas. It just made me gain 40 lbs in 3 months.
How does Lyrica help you precisely? I'm thinking about Neurontin, but since I read that you need high doses for anxiety I'm shying away from it, as I fear weight gain again.
DBT is great -- I'm sorry you can't find a group where you live. Maybe there's a group online? Or buy Linehan's instructional book? Although that's not at all the same as attending a group :(.
Hope you stay!
> Hi yourself :). I thought obsessive parts were a part of OCD? Idk. So glad you found something that works with abilify. Anxiety? Sigh. We're well acquainted. Sounds like you've trialled many meds. How were the MAOIs? I've taken dbt and benefitted. Not able to find it where I now live. Seems like you've got a nice, small regime. Right now I take lexapro, lamictal, and a smallish amount of lyrica.
>
> I like chatting with you.
Posted by phidippus on November 3, 2014, at 10:51:06
In reply to Re: Lamictal and diminishing return » phidippus, posted by Beckett on November 1, 2014, at 10:18:11
For some reason Depakote seems to be the choice for rapid cycling. Tegretol is good for any kind of bipolar. The only sucky thing is blood monitoring on both meds. Trileptal is Tegretol's baby brother and doesn't require blood monitoring.
I'm surprised Lithium didn't do it for you.
You could do Depakote with one of the AAPs with antidepressant qualities like Geodon or Latuda.
What are you having more trouble with? Mania or depression?
Eric
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.