lamotrigine during acute hypomania?

[catotheyounger]

my pdoc is trying to put me on it because I've tried 2 other mood stabilizers and got a bunch of side effects (plus no results). But I've read that taking it during acute mania/hypomania is a bad idea. Is this true? should I be worried? I asked her about it and she said not to worry about it.

[basuraeuropea]

from what i know, it's not a bad idea, but it's generally not going to work as well to quell an active period of mania/hypomania as other select medications. from what i understand, if you need to reduce or eliminate an active manic/hypomanic episode there are more effective medications to do so, e.g., antipsychotics, atypical antipsychotics, depakote, etc.

i'd talk to your doctor again if you are totally manic right now and need immediate attention.

[Iceberg]

I agree that it’s maybe not the best first line med for acute episodes, but it also depends on past med history. Have you tried other meds beside the two stabilizers? 

[CrazyRedhead]

On 8/29/2022 at 9:40 AM, catotheyounger said:

my pdoc is trying to put me on it because I've tried 2 other mood stabilizers and got a bunch of side effects (plus no results). But I've read that taking it during acute mania/hypomania is a bad idea. Is this true? should I be worried? I asked her about it and she said not to worry about it.

I would agree with @Iceberg and @basuraeuropea that lamictal might not be the first line treatment for acute mania.

Have you tried anything else besides mood stabilzers, such as any APs (antipsychotics), any AAPs (atypical antipsychotics)?

Edited August 30, 2022 by CrazyRedhead

[DogMan]

My knowledge is that it won’t make the situation worse 

 

And hypomania, unlike mania might not warrant drastic measures like an AAP to bring you down ASAP. Your doctor might see the current cycle as low risk

[Iceberg]

42 minutes ago, DogMan said:

hypomania, unlike mania might not warrant drastic measures like an AAP to bring you down ASAP. Your doctor might see the current cycle as low risk

I agree, This is very possible. Although some people do have a bit of a rocky titration when starting lamictal, it usually resolves after a little while on the med

[browri]

On 8/30/2022 at 3:40 PM, DogMan said:

My knowledge is that it won’t make the situation worse 

Agreed. Lamictal definitely won't make you MORE hypomanic, but resounding what most have said here, lamotrigine is somewhat less useful in acute episodes, particularly episodes of mania/hypomania. However, the long titration even limits lamotrigine's usefulness in acute depression. Lamotrigine is better served as a foundational med that prevents further episodes.

On 8/30/2022 at 3:40 PM, DogMan said:

And hypomania, unlike mania might not warrant drastic measures like an AAP to bring you down ASAP. Your doctor might see the current cycle as low risk

However, this is also true. Many instances of bipolar 2 with hypomania do respond to lamotrigine, albeit slowly.

On 8/30/2022 at 4:23 PM, Iceberg said:

I agree, This is very possible. Although some people do have a bit of a rocky titration when starting lamictal, it usually resolves after a little while on the med

This may be the reason why it's sometimes viewed as less useful as an acute med. The titration is slow, but for some it can be slightly rocky.

[catotheyounger]

wym by "rocky"?

[basuraeuropea]

2 hours ago, catotheyounger said:

wym by "rocky"?

it's difficult to titrate. symptoms may worsen before they get better. your mood might be all over the damn place while increasing, stabilize and then be all over the place upon increasing the amount again. it's not a smooth titration for many by any means. it wasn't for me, although the amount of distress felt during the titration process did lessen after reaching 100mg/day.

Edited October 3, 2022 by basuraeuropea