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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by ricker on September 8, 2008, at 11:42:45
At my last appointment,my p/doc wanted to try lamictal. He said he had been "on the fence" as far as prescribing?
Well, Ive been on A/D's for 20+ years and I must say I felt an immediate response? Feelings I've not had since pre-depression era., even at the 25mg. starting dose!
I am now at 100mg. and started to notice a slight decline... irratable, slightly depressed.
My zoloft had been decrease fromm 100mg. to 50mg. at the start of lamictal as this seemed to actually help with startup of lamictal for some reason?
I've been on zoloft for approx. 5 years and for the most part, responded well. My mood began to flatten and I became quite irratable prior to lamictal.
I am scheduled to see p/doc this Thursday, so my question is this, should I ask to have lamictal titrated up to the 200 - 300mg range and see if it helps? I am leaning to this before increasing zoloft back to 100mg. --- in hopes of preventing ssri numbness?
After reading so much literature as of late, the one thing that stands out is; many patients are treated with A/D's prior to mood stabilizer treatment. This may actually increase "soft" cycling in some.... depression, irratability, slighty over-elavated mood?Since this is my "first" actual mood stabilizer trial, I'm a bit confused as you can see by my marathon post!
I also take remeron 15mg at night.
All thoughts/replies greatly appreciated.
Regards, Rick
Posted by dbc on September 8, 2008, at 12:06:06
In reply to lamictal experts - quetionn?, posted by ricker on September 8, 2008, at 11:42:45
just keep going up and see what happens. Theres no fixed dose for lamictal, it seems to vary greatly for each person.
Posted by chiron on September 9, 2008, at 22:11:56
In reply to lamictal experts - quetionn?, posted by ricker on September 8, 2008, at 11:42:45
I'm definitely not an expert. It's such a not-so-fun gamble. I had also been on just ADs for about 20 yrs, mostly Zoloft. I would suspect it caused later "soft" cycling. I increased my dose once & it made me more depressed. I have been on Lamictal about a year now. I haven't noticed any magical effects, but I would guess it has helped me stabilize somewhat. I am up to 300. I read all these happy stories about getting to the right dose and the world turns around, but I guess that's not going to happen to me. All of the other stabilizers I tried had terrible effects on me.
I also take Celexa, Wellbutrin, and Xanax.
Anyway... You could still be adjusting to the Lamictal. If you haven't been on 100mg of the Lamictal for very long I would wait and see if it passes. Many people experience agitation when titrating that usually goes away. And people vary on what dose works for them. It sucks to wait, but it also sucks if you get worse and don't know what it is.
If you decreased Zoloft at the same time you started Lamictal that's hard to be sure what gave the mood improvement, or both?
I would guess that it might be best to stay at that Lamictal dose for a while longer to see if it gets better. If it does, probably increase it some more before Zoloft. If not- maybe increase Zoloft, decrease Lam, or add to...?
Posted by yxibow on September 10, 2008, at 3:19:33
In reply to Re: lamictal experts - quetionn?, posted by chiron on September 9, 2008, at 22:11:56
It varies wildly but it is a good antidepressant for the right person (even being an AED).
Some of these things as mentioned before may pass. Some people may just be irritable on it eventually and will have to discontinue, but at 100 I would wait.
I know it is a long haul -- it has to be, because SJS (the big rash) is serious and that is why it is increased slowly (even for epileptics I would imagine).
It took a long time for me to get to 250, I'm not sure if it is contributing 10%, 20%, who knows, but it is probably doing something to features of depression. I dont have any rash. Once you get to about 200 the titration can increase a bit faster because it is fairly (not completely) determined that the patient is not susceptible to the serious problem.
-- tidings
Posted by henryo on September 18, 2008, at 18:42:06
In reply to Re: lamictal experts - quetionn?, posted by yxibow on September 10, 2008, at 3:19:33
Lamictal works pretty well for me. 250 a day for years. It caused no weight gain or sexual problems. When I did get depressed I knew from experience it would be far worse without Lamictal.
My thoughts (for what they are worth) I would keep going up on the Lamictal 25 a week. See what happens. Try not to move two pieces of the equation at the same time. If you do that, you can't tell which did what. That said I won't do a cocktail greater than 3 meds. Nobody can track all the possible interactions. When they suggested a fourth med I chucked it all and looked for a different single med solution. Thats how I came to try Lamictal. But it was painful waiting to build up to a high enough dose.
100 is a pretty low dose for Lamictal. I think the low end of therapeutic window is usually 250 and it goes up to 400+. But do what works for you. None of these meds effect any of us in the same way.
I have taken Lamictal for years and it was the best thing I have ever been on until I added Deplin. That addition/augmentation was so good I've cut back on the Lamictal. I found it was over activating. I could watch myself sleep- very weird. But the Deplin Lamictal combo is great for me. And the best part is Deplin is not a pharmaceutical in the usual sense of the word. It is "medical food". I do take Klonopin to sleep most nights. I can't say enough about what Deplin has done for me. But I also would not want to quit Lamictal completely.
Good luck. Keep trying, you will find a good solution.
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