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I’ve been on lamotrigine for 10 years and it’s been great for treating bipolar depression. But now I feel like I’m slipping into depression. My pdoc wants to check a blood level, for the first time, which I’ve never heard of. Has anyone had theirs checked, and was it helpful?  It’s true I’m afraid to possibly increase at all, but wondering if others are getting levels checked?

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3 hours ago, sugarsugar said:

I’ve been on lamotrigine for 10 years and it’s been great for treating bipolar depression. But now I feel like I’m slipping into depression. My pdoc wants to check a blood level, for the first time, which I’ve never heard of. Has anyone had theirs checked, and was it helpful?  It’s true I’m afraid to possibly increase at all, but wondering if others are getting levels checked?

I have, but basically to make sure nothing is very wrong ... my pdoc doesn’t tie it to effectiveness 

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Almost all of the anticonvulsants have therapeutic blood level monitoring tests. You are lucky as most drugs don't. What dose are you on ? Generally Lamictal us pretty well side effect free until 300 mg, I made it to 450 mg without side effects. I was on Lamictal for seizures and had the blood test once I reached a level dose to see if I was a normal, slow, or fast metabolizer. If I was a fast one I would need to take more. I was a normal metabolizer

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I had Lamotrigine blood level checked after long time on 300mg.

The result was close to the lower end, so it was safe to increase the dose to 400mg.

Didn't check again, but I probably should...

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General sentiment is that for bipolar disorder, lamotrigine blood levels aren't as relevant to treatment response as those blood levels would be when treating epilepsy. Meaning if you have seizures you want to make sure you have steady levels throughout the day to ensure proper seizure control. However, for bipolar disorder, steady levels throughout the day don't seem to be necessary for mood control for most people unlike valproate or lithium.

Speaking of valproate though, there are scenarios where you could be prescribed valproate and lamotrigine, at which point a doctor would likely always test the lamotrigine level. I was on the combo briefly, and because those two meds can do unpredictable things to each other's metabolism, it's best to keep an eye on the level. Valproate can increase lamotrigine's level, but lamotrigine can either increase or decrease valproate. Depends on the person. When you have interactions like that, then you test lamotrigine levels. Otherwise, you only test them if you have epilepsy and you're on higher dose lamotrigine (>200mg).

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I used to be on a higher dose, I forget what, but titrated down to 75 mg, couldn’t go lower. I didn’t discuss the rationale for checking levels for depression but guess I’ll find out. Have never had to titrate back up, I’m nervous about that. I should wait and see if that’s the plan before I think too much about it. 

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Keep in mind that the standard dose for seizures is 600 mg up to 1200 mg or more. People take these doses without issue. Tolerability does not change just because you are taking Lamictal for other indications. 

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