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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by kilo8 on August 7, 2015, at 21:11:17
I want to try Lamotrigine for depression. My doc agreed. He told me to start with 25mg and then increase with 5mg weekly which is a very slow titration. Others increase 25mg per week.
Anyway, what worries me is the risk of Steve Johnson Syndrome. I have GAD and I don't want to be paranoid and check my body every day for rashes. How do I deal with this?
I also read that harmless rashes are a frequent side effect. But how on earth shall I differentiate between a "harmless rash" and Steve Johnson?
What I also want to avoid is having to get off the drug in case I should get a rash and then in the end it was a harmless rash.
If the doc simply says get off it in case there is a rash then there is also the danger that you get off the drug and it wasn't even necessary and maybe the drug would have helped.And is it true that Lamotrigine makes your memory worse? This would be very bad.
Posted by kilo8 on August 7, 2015, at 21:16:34
In reply to Lamotrigine: Scared of Steve Johnson Syndrome, posted by kilo8 on August 7, 2015, at 21:11:17
ps: I think I'd not want to go any higher than 200mg maximum.
Do you usually feel an effect even at a lower dose or is it possible that it only works at a certain dose like for example 300mg and anything below 300mg doesn't do anything?
I'd be scared to go too high cause if I needed to get off it then it would take very long to taper down.
Posted by SLS on August 8, 2015, at 7:47:47
In reply to Re: Lamotrigine: Scared of Steve Johnson Syndrome, posted by kilo8 on August 7, 2015, at 21:16:34
The following titration schedule is suggested by the manufacturer for people NOT taking another anticonvulsant:
Week 1 & 2: 25 mg/day
Week 3 & 4: 50 mg/day
Week 5: 100 mg/day
Week 6: 200 mg/dayI think there are starter-packs available.
Your doctor might have an excellent reason for titrating Lamictal more gradually than this, but I had no problems using this schedule. I would follow your doctor's instructions. He may have found through experience with his patients that dosages lower than 200 mg/day deserve more time to work. Of course, you can always ask him. Certainly, your chances of getting SJS will be reduced with the slower titration schedule. His prescription actually mirrors a rechallenge schedule suggested for people who have already demonstrated a sensitivity to Lamictal.
To discontinue Lamictal, you can taper the dosage more rapidly.
- Scott
Posted by baseball55 on August 8, 2015, at 20:40:45
In reply to Lamotrigine: Scared of Steve Johnson Syndrome, posted by kilo8 on August 7, 2015, at 21:11:17
If you titrate slowly up to 200mg with no rash and take it for a couple of weeks at 200 with no rash, then you're almost certainly not going to get the rash - that's the whole point of the titration. So I don't think you need to remain paranoid and anxious once you're on the target dose.
200mg works for me. I have no memory or cognitive problems at all. In fact, lamotrigine has no sx at all, for me.
I wasn't aware that lamotrigine is likely to cause benign rashes at first, which might be mistaken for SJS. Where did you hear this?
If you did have to discontinue, you can titrate off pretty quickly. It is an anti-seizure drug and abrupt discontinuation of anti-seizure drugs can cause seizures, but you can discontinue over a few days, not weeks. I have done it in the past.
> I want to try Lamotrigine for depression. My doc agreed. He told me to start with 25mg and then increase with 5mg weekly which is a very slow titration. Others increase 25mg per week.
>
> Anyway, what worries me is the risk of Steve Johnson Syndrome. I have GAD and I don't want to be paranoid and check my body every day for rashes. How do I deal with this?
>
> I also read that harmless rashes are a frequent side effect. But how on earth shall I differentiate between a "harmless rash" and Steve Johnson?
>
> What I also want to avoid is having to get off the drug in case I should get a rash and then in the end it was a harmless rash.
> If the doc simply says get off it in case there is a rash then there is also the danger that you get off the drug and it wasn't even necessary and maybe the drug would have helped.
>
> And is it true that Lamotrigine makes your memory worse? This would be very bad.
Posted by kilo8 on September 8, 2015, at 19:55:36
In reply to Re: Lamotrigine: Scared of Steve Johnson Syndrome, posted by baseball55 on August 8, 2015, at 20:40:45
Hello,
I don't know where I read it but I read that harmless rashes occur in like 10% of the people.Anyway, what I don'r understand is why are the titration protocols in such a way that you jump up 25mg at once? Wouldn't it be smarter to titrate more mildly and increase 5mg every day or every few days instead of simply jumping from 25mg to 50mg?
Would this not increase the risk of getting SJS cause your body has less chance to adapt to it?
Posted by porkpiehat on September 16, 2015, at 13:39:18
In reply to Re: Lamotrigine: Scared of Steve Johnson Syndrome, posted by kilo8 on September 8, 2015, at 19:55:36
I've been on Lamictal for 10 years and I definitely have a love-hate relationship with it. I've never been terribly worried about SJS.
Cognitive problems for me have been pretty pronounced, but they seem to be dose dependent. I'm very med sensitive and I've found a big difference between the manufacturers. I've also had problems with sleep and headaches.
Each time I've lowered my dose or switched brands I've suffered a profound depressive/mood swing episode, and I've never really suffered mood swings previously. I can't seem to get below 150mgs now. However I think what you are taking it with matters to. If I were to ramp up my celexa to full strength I'm guessing it would be easier to come down.
The upsides were mood, interpersonal anxiety, and motivation and were also significant.
Posted by kilo8 on September 19, 2015, at 17:09:07
In reply to my two cents...., posted by porkpiehat on September 16, 2015, at 13:39:18
Hello everyone,
I take it for depression. I thought since antidepressants don't really help me I needed to try something else. I have tried nearly all newer antidepressants and now only TCAs and MAOI would be left and they don't really mix very well with adhd stimulants. And TCA also have side effects which suck. I tried anafranil once and had to get off it cause my pulse was getting way too high.I was hoping that maybe lamotrigine helps with going from 4/10 to 1/10 and simply makes the depression a bit more stable. I mean I don't feel 1/10 all the time but I am always anxious, melancholic, feeling guilty. Antidepressants changed nothing about this generally negative state. If lamotrigine could at least keep me a bit more stable it would already be helpful.
But I'm afraid that no drug can change the way I am. I have always been anxious and melancholic. I don't know how other people experience life. For me it's not very fun.
I wonder how fast does Lamotrigine start to work?
I mean does it only start when you reach the necessary amount? Like for example if somebody "needs" 300mg then will it not do anything at 200mg?And how fast does it work? I mean titrating up takes very long does this titration time basically not count at all cause during all this time you still haven't reached your "target dose"?
But I don't even know how high to go. I'd be afraid of going too high like for example above 200mg.
Or will 200mg not work while 300mg or 400mg suddenly might work? How likely is this? I mean do I need to go as high as possible to see if it helps me at all?
Posted by herpills on September 22, 2015, at 7:48:32
In reply to Re: my two cents...., posted by kilo8 on September 19, 2015, at 17:09:07
most people notice a benefit once they reach 100mg but this might not be enough for the level of syptom control you are looking for.
I wouldn't worry too much about what your final dose is going to be.
I think most people take between 150-200mg...some people take more.
I don't think it's a matter of...you don't feel anything at all, then all of a sudden it's working...but that's just been my experience, I felt better at 100mg and actually stayed at that dose for a year, then went up again to 150mg.
Posted by kilo8 on October 12, 2015, at 22:24:52
In reply to Re: my two cents.... » kilo8, posted by herpills on September 22, 2015, at 7:48:32
Hello,
I am at 60mg now. It will take a while until I reach 100mg.
So far I don't think it does much. I mean just a few days ago I got acute anxiety and depression when I thought about things which worry me. It felt the same way as it felt before at different times when I experienced the same feeling.
My hope is that maybe lamictal could take the edge of such things but maybe it won't. Antidepressants also didn't help me with this. I mean if a drug doesn't help with things like this then why even take it!?
This is the end of the thread.
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