Jump to content
CrazyBoards.org

Recommended Posts

Hi, I've been on Lamictal since early March, and have titrated up to 250mg. This is in addition to 20mg of fluoxetine and lithium. Also Zyprexa, which I am coming off slowly (I'm down to 1.25mg, but not taking it seems to make me feel a bit anxious/agitated).

Anyway, the addition of Lamictal made me feel better than I have in 1 1/2 years (apart from a short-lived remission on fluoxetine + Zyprexa). I was getting interested in things again, and thinking more positively about the future.

Until last Wednesday (six days ago), when I started to feel a bit strange again - a bit anxious and quite depressed. And absolutely terrified that I would slide back in to the horrible agitated depression I had suffered for so long.

I called my psychiatrist last week, and he suggested seeing how I felt in a few days, and if the downturn hadn't stopped, increasing my dose to 300mg, which I have done today. I know there is a theory that Lamictal doesn't have any increased efficacy above 200mg for depression, but there are others who disagree, including the esteemed Bipolar II expert Dr Phelps: http://www.bipolarworld.net/Phelps/ph_2004/ph1144.htm

Does anyone have any experiences they can share? Is what I'm experiencing likely to be just a blip? I'd be particularly interested in anyone who has had to be on a high dose before experiencing the full effect of Lamictal on depression.

I'm not bipolar, as far as I know, but I have a bipolar father and have had recurrent depression since I was about 10 years old (an indication, according to Dr Phelps, of "soft bipolarity")!

cheers,

Andrew

Link to comment
Share on other sites

Sorry to say that I don't have any experience with Lamictal but I have experienced the dreaded poop-out. I think I've been more disappointed by the experience than romantic relationships going sour because there's simply no reasoning with neural pathways. At least you can try to work things out with a boyfriend/girlfriend, right?

I may be slightly less than no help at all but I was thinking while reading your post that perhaps you're still grappling with the effects of coming off the Zyprexa? I had a hellish time coming off of Abilify last year. Just a thought. I don't think that the effects of coming off meds can be underestimated.

Since you just increased your Lamictal dose to 300mg today, I'd hold tight and hope that does the trick, for starters. Also, you're right - it could be a blip. Then, there is the med change thing going on in your system. Give things a chance to catch up and stabilize. If you keep going South, however, check back in with your pdoc before too long - just to be safer than sorry.

I hope you're feeling an upturn again soon, Andrew.

Link to comment
Share on other sites

Thanks Green Tara. Your post was definitely useful, and it's nice to get some support. I agree that coming off the Zyprexa might be contributing to how I feel. I'm pretty sure it wasn't actually helping with my depression (I had several months of horrible depression while taking 5mg), but I guess it could still be difficult coming off it.

You're right, I guess I just need to hold tight and hope that it is just a blip and that the extra Lamictal will do the trick.

Link to comment
Share on other sites

andrew_UK...

I'd thought you'd been following the ongoing thread I'd started Lamictal: when do you hit the 'sweet spot'?, but I just checked and it was a different andrew.

Anyway, long story short, I've had several blips as I've been titrating up. And as you can see by my signature, I've titrated up a long ways. Keep in mind I'm taking female hormones, so actually half the amount of Lamictal is getting in my system -- but even then, still a pretty hefty amount.

At least for me I do great for a while, then my body seems to adjust to it I guess? And I'll start getting minor symptoms creeping in. I've got to believe there will be an end to this, some time when I truly will reach my ultimate "sweet spot".

Be patient. Take care.

revlow

Link to comment
Share on other sites

At a seminar 2 years ago, Dr. Fred Goodwin, expert on bipolar, and former head of NIH, said that he felt that so called 'medication poopout" was probably NOT the fault of the medication failing to work, but rather the treated condition worsening and breaking through. He suggested increasing dosage and giving the medication to work, rather than immediately switching meds.

A.M.

Link to comment
Share on other sites

At a seminar 2 years ago, Dr. Fred Goodwin, expert on bipolar, and former head of NIH, said that he felt that so called 'medication poopout" was probably NOT the fault of the medication failing to work, but rather the treated condition worsening and breaking through. He suggested increasing dosage and giving the medication to work, rather than immediately switching meds.

Thanks for the info, AM. Sounds like wise advice to me.

Link to comment
Share on other sites

Andrew, I am Bipolar 2 and have been taking lamictal-300 mg-for over a year and it has kept me mostly stable. I started taking it because no AD's would touch my long-term suicidal depression and I was suspected to be BP. I was a mess until I got up to 300 mg. I even had to stop working (last 6 wks of the school year-I'm a teacher-needless to say, I got fired for having "too many issues". ) Anyway, I still have episodes now and then that don't last long, but I started taking wellbutrin a couple of months ago.

I don't know if that helped. Be really glad you're not bipolar-it sucks donkey dong. mel1

Link to comment
Share on other sites

"Too many issues"- funny. Me too, Mel1.

I have been on Wellbutrin 450mg. I was too stimulated on it (not sleeping) so I went down to 300mg (Dr approved). Then, I started feeling that a depression was coming and my doctor upped my Lamictal from 400 to 450mg- instead of upping my wellbutrin. I am not sure that anybody on this site has been on high doses (excpet the one guy that said he upped to 800mg for Xmas with family).

I have to say that I am not sure if it would have really been a depression, but I didnt want to find out. It could have been me just not being manic. So, I question the high dose. I do know that my anger and rage is still gone. If nothing else, that is enough to keep me on Lamictal.

Where am I going with this? arggh!

Link to comment
Share on other sites

Andrew, I am Bipolar 2 and have been taking lamictal-300 mg-for over a year and it has kept me mostly stable. I started taking it because no AD's would touch my long-term suicidal depression and I was suspected to be BP. I was a mess until I got up to 300 mg.

I too went through many ADs which didn't help (and I suspect in some cases made things worse) before going on Lamictal. I am now up to 300mg, and it seems to be doing the trick. The breakthrough depression a couple of weeks ago does seem to have been just a blip, and I'm hoping the increase to 300 will keep things stable. I'm starting to feel somewhere near normal for the first time in 2 1/2 years, so for me the Lamictal has been a bit of a godsend.

Link to comment
Share on other sites

Yippee! So glad to hear this, Andrew. (Been out with the flu or I would have congratulated you sooner!)

Best,

revlow

Thanks Revlow - sorry about your flu. But I'm back in depression land again, feeling really wierd and terrified of my horrible severe depression coming back.

However, I suppose my recovery from the last dip suggests that this is just another blip. I'm up and down like a yo-yo at the moment - so much for Lamictal being a "mood stabiliser"! Having said that, I still believe that it's helped me a lot, and hopefully will continue to do so.

Link to comment
Share on other sites

Hiya Andrew-

I believe the theory that it isn't that our meds don't work anymore, it is that our disorders break through the meds. Sorry to use this analogy, but for women, it isn't like feminine protection doesn't work, it just may not hold as much as we need... ;)

you may need to add-on an AD or something. i didn't see if you were on one or not- sorry. but there was a point where i was on paxil and wb at the same time.

take care

Link to comment
Share on other sites

you may need to add-on an AD or something. i didn't see if you were on one or not- sorry.

take care

Thanks Loon-A-Tik. I am on fluoxetine as well - 20mg, but I am loathe to increase that because of the sexual side fx. My 1 1/2 year depression has absolutely killed my libido anyway! I'm also on lithium, but was hoping to get off that once I'd stabilised on the Lamictal.

I seem to be cycling between feeling normal (well, relatively) and feeling crap, like my horrible depression is coming back. And in the last 10 days or so the crappy days have been more prevalent than the good days....

I wonder if, as I really felt I was getting better on 200mg of Lamictal, I should think about going back to that from my current 300mg. My psych would probably think not, and I don't have an appt for 3 weeks (though I can phone him). Or should I be thinking of increasing to 350 or 400? I'm confused....

Link to comment
Share on other sites

I'm here to tell you that if you're on a cocktail and changing any of the meds it can be hard to tell what's causing what. You've only been on lamictal since March, which probably means you only recently got to your current dosage, which probably means you haven't leveled out on it yet. Then, you're currently cutting down on Zyprexa. I'm no expert, but one guess is that 200 of lamictal worked well if combined with Zyprexa; but if you're cutting the zyprexa, you may need more lamictal to compensate. My guess is that as you wean yourself off of zyprexa you'll keep being a little unstable.

And I saw a huge difference between 200 and 300 lamictal. We increased it to 400 when I got depressed. Now it turns out the depression was probably from decreasing thyroid meds.

Keep us updated and hang in there; these things take (aargh!) time.

Link to comment
Share on other sites

Like revlow, I've had multiple blips while taking lamictal. I rapid cycle into depression about every four days (on average) when things aren't working like they're supposed to. The right dose of lamictal keeps things at my baseline, with an occasional down day, instead of regular cycling.

I started at 100, went up to 200, 300, and now am on 400. I'm rapid cycling again, and at my pdoc appt tomorrow, am going to see what we are going to do about that. I sure as hell don't want to increase my seroquel, or add another drug. I hope that an increase in lamictal will hold me.

Link to comment
Share on other sites

Hey NARS, like your signature - great song from a great band. And the book that inspired Crown of Creation, John Wyndham's The Crysalids isn't bad either!

You're right, decreasing the Zyprexa is probably contributing to my wobbly periods, but I'm being much more conservative tapering down than my psychiatrist suggested - too many bad experiences coming off meds (Lexapro for example). I think I'm now on about 1mg - difficult to tell, as I keep shaving bits off! Hoping to be off it within the next week....

I think I'll probably end up increasing to 400mg of Lamictal - it's worth trying at least, especially as it has made a real difference to me in general. Actually feeling a bit better the last couple of days, so hopefully....

Anelize - good luck with your Lamictal increase!

Link to comment
Share on other sites

  • 4 weeks later...

The dreaded poop-out (or breakthrough depression) has reared its ugly head again, after three weeks or so of feeling really good. I know there was a trigger, a horrible argument with my partner, but that was resolved quickly.

However, it made me really anxious, and the (pretty much free-floating) anxiety has continued to build over the last week. I'm not sleeping properly, and feel pretty awful all the time. I have an important interview tomorrow and don't know if I can handle it....

I'm absolutely terrified of going into depression again, as I've really started to get my life back on track and be optimistic about the future.

I think lamotrigine was really helping. I'm currently on 300mg, and I wonder if an increase to 350 or 400mg might be worth trying? Does anyone now if you can go from 300 straight to 400, or would I have to step up to 350 first?

Only thing that concerns me a bit is that I have a really small rash on my back (I think it may be ringworm), but from what I've read that doesn't seem to be an early symptom of SJS! I've had it checked out by my GP, and he says just to keep a watch on it....

Link to comment
Share on other sites

FWIW, I have found coming off Zyprexa absolute hell. I'm OK for about a week, then I start getting agitated, the my thoughts start speeding up and I can feel myself losing my grip. I'm off to the pdoc week after next, so I'll let you know what he says about it.

Link to comment
Share on other sites

Andrew, I can't remember how long you've been at this dose, but if it's less than a month or two it may not be pooping out; you may have adjusted and can now tell you need more.

Or, you could be reacting to the days getting shorter.

Or, maybe you're reacting to stopping the zyprexa? I've found it takes a lot longer than I think to level out on any psych med, or to react to going off of it. When do you see your pdoc next?

Oh, and I went directly from 200 to 300, and from 300 to 400. The danger is usually as you're titrating up at low doses, although it sounds like there are cases of The Rash with people who've been on it for a while. And as you've figured out, a small rash on your back isn't much like S/J. But as with anything, watch it.

Link to comment
Share on other sites

Boy, I'm probably not much help, being sort of stable at 100 lamictal and 150 effexor.

If it were me, I'd be listening closely to those who say, coming off the zyprexa is not just a walk in the park, even if you are shaving bits off of it. When I shave bits off, I make myself stay on the next shaved bit for at least a week. I don't shave from 5 mg to o over a week period.

I know the blips downward suck real bad. I get that. I also am terrified if a blip downwards occurs, that it might just keep going and I'll be in the sewer for a long time. So I share apprehension about the right meds keeping me stable, and oh shit, here's a blip! AAAAARRRRRG...

So, do not judge (but DO monitor) changes going on when coming off a medication. Note what is happening, sleep, diet, dosages, moods... and then your data can help you and your doc figure out what to change or not change. Lamictal is interesting. Has sort of a differential effect on things rather than a straightforward linear type affect. Yes, it's called a mood stablizer. But it also enhances at times antidepressant meds.

It's hard to have to be patient with med changes. Just trust the process...and track your mood changes, appetite and sleep changes.

Hope it works out. I love lamictal, but I also know from hindsight that it took 3-5 months to get the dosage where it was stable for me.

BTW, when titrating up, I'd go thru a giddiness, a not wanting to eat mood, a bit of too energized activity. so then I had a crash.... hadn't eaten right in a week. Had to really do my food well, then the meds worked better and haven't had a dip since then. MUST EAT.

Anyhow , hope you are keeping cool if you live in a location in the latest heat wave....

And do things slow so you know what is going on. Lamictal is great for me, thank you god and the corporate drug companies.

Luli

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...