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do you notice a small (25mg)difference


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last week i bumped up from 150mg lamotrigine to a whopping 175... because the random pdoc who's never seen me doesn't like to give more than 150 and i insisted that was supposed to be the plan to get to at least 200.

i don't notice a difference AT ALL. is it just too soon, or is this dose increase small enough that i won't feel much difference anyway?

i wanted it to counteract some of the serotonin-crashing i'm doing from effexor withdrawal - keep things a little more even than wanting to hurt things/myself one minute and clarity the next. it's not working. am i barking up the wrong tree anyway? i've been on that last 37.5 effexor for a few months now.

i feel like i need options quick. i'm coping very badly with the stress in my life right now which you all know just compounds things anyway (guilt). since i have no quick pdoc options (except for the er who probably won't touch my meds at all, just send me home with a handful of zyprexa which is NOT the answer), i'm going to take this to my gp this week.

i wanna know what i'm talking about when i get there. i wanna know first if i am waiting a reasonable time for the lamotrigine to make a difference. i wanna know if i should ask for a serotonin bridge like prozac, or go back up to 75 on the effexor (wasn't crashing then). i don't want to be given more benzos or another aap - i don't need to numb my pain, i need to be able to deal with it reasonably instead of like a crazy lady.

i know nobody here is qualified to give med advice, but my gp is an idiot and will probably consider my suggestion first, because he doesn't want to bother with my crazy head meds anymore. so i want an educated opinion i guess. something i don't think i can do well right now on my own ;)

thanks if you can help.

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Lysergia, I recently had my lamictal upped from 300 to 350. It took a few weeks to notice the difference, but i am feeling oh so much better. No depression, except on my b=day, which was jan. 19. existential crisis/midlife crisis. My mood chart has never looked so good. i hope this helps and i hope you will feel better soon. mel

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yay for you mel! i am glad it's working well for you.

i'm noticing some huge improvements with the dose i'm on... but i can't seem to stay reasonable and it's probably the effexor wonking my mood around. i thought another 25 would do the trick, since every increase has been good thus far. maybe i should hang on another week, it might do something yet.

thanks for replying ;)

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Hey Lys...

I can't comment on anything but the Lamictal (that's what we call it here). The ramp up is slow, but then as you get higher in the dosing, the jumps get bigger - so I went from 12.5 to 25, to 50, to 100, to 150. With each increase, I felt better and better. I think I'd do well to take more (200), but my pdoc decided to add depakote instead (I don't think it's going so well).

I know there are others around here who are much more well versed in the effects of one med in comparison to another than I am. Keep us posted on how it's going. I hope you're feeling better soon, I know this is a particularly stressful time for you and that having crazy med problems should be the least of your worries.

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  • 4 months later...
Guest MillerMan

I was at 300 mg for 18 months and couldn't begin to describe how well Lamictal was working for me. However, at 250 (when I was ramping up to find the right dosage at first) I was still having anger and cycling, though not nearly as bad as when I was on no Lamictal. We went to 300 and it was perfect.

I began to have anxiety attacks at 18 months (not related to Lamictal...i've now been on it for 2 years) and decided with my pdoc to cut down to 200. To avoid withdrawal I went down 25 mg a week (STILL had withdrawal...think its just something you have to deal with). When I got to 225 I began having outbursts because of my suddenly returned SEVERE irritably and was crying at random times. I went back to 250 and no dice. 275 was a little better. 300 is the right dose for me. Anxiety was dealt with by reading books about coping, etc. No meds...

In conclusion, Lamictal is VERY dose-sensitive. 25 mg makes a WORLD of difference for me and, according to my pdoc, a lot of people. The only reason we moved down such a dramatic dose was because I was basically losing my mind the anxiety attacks were so severe and I was convinced it was because of the meds (wrong!)

Honestly though, you have to give dose-changes time. I would say a month every 25 mg as long as you're under control. You dont want to find yourself on too-high a dose of an AC because going down is hell. Hope this helped...

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Lamictal's antidepressant effects typically max out around 100mg for most people, and its anti-manic effects start at 100mg. By increasing the dose, you're likely only increasing its capacity to prevent mania.

If you're having trouble with stress in your life, you would probably be best off getting therapy. Generally, drugs work best on randomly triggered mental problems whereas therapy works best on environmentally triggered problems. Consider going to a book store and buying some self-help books.

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I recently got raised to 225 a day, from 200. I've been unbelievably tired lately. I don't know if it's from that or not, since I always have bad insomnia. I didn't even think such a low raise in lamictal could affect me, but maybe that's what my problem has been?

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;)

Lysergia,

I made great improvement after getting to 300 mg. I went to 400 mg but it did not increase the efficacy. I went back down to 300 mg.

For me, it only brought me up some out of depression. My recent hospitalization is bringing me much more out of depression. I am still 300 mg.

I was most sensitive to the dosage increases in the beginning.

Warmly,

Sushine Outside

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Lamictal's antidepressant effects typically max out around 100mg for most people, and its anti-manic effects start at 100mg. By increasing the dose, you're likely only increasing its capacity to prevent mania.

Oops, forgot to mention one thing. Lamictal is often only half as effective in females as it is in males, (It's a very sexist drug) so its antidepressant effects could potentially extend up to 200mg or even 400mg if you're a female on an antagonist such as trileptal.

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thanks to everyone who shared their experience with this.

i've been having a really bad slide back down, and i'm not sure yet which med i'd be more comfortable increasing (for a little while, not necessarily forever). for some reason my doc is loathe to give me 200mg or more of lamotrigine, not sure why, but he is CONVINCED that the max effective dose is 200. maybe i need to find an abstract or something that says otherwise and give it to him.

or i could go up to 450 on the wellbutrin for a little while. i'm having major issues with lack of energy, so maybe that's the better route for me.

i dunno. i guess i'll see what he says.

fwiw until my thyroid crapped out, the 175mg lamotrigine and the 300XL wellbutrin were working wonders.

- rita

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Lamictal is pretty crappy at preventing mania in general compared to most stuff used for mood control, and for a lot of people it's more of an antidepressant than doing much of anything else. It's more that it's good at treating depression without triggering mania. There are a whole lot of other things that are usually more effective for the "up" end of things, like, well, pretty much everything else, including most of the APs. For what it's good at (raising the bottom end towards the middle without also raising the top end), it's one of the best things out there (except for the people it doesn't work for, like any med). It's also not half bad for seizures, which is where the higher doses usually come into play, but that's another story entirely.

It also has plenty of interactions that cause it to not work as well, although "being female" isn't directly one of them, at least not enough to say "half as effective". The reason there's a gender difference is that its effectiveness is pretty heavily changed by certain hormone levels, particularly the ones changed by hormonal birth control. Starting/stopping many of the different hormonal birth control options available can significantly change how much Lamictal you need to take for the same effect. The meds most well-known for changing blood levels a bunch are things like Topamax a little, Trileptal and Tegretol a bunch, and Depakote a ridiculous amount.

If you're taking anything like that and/or anything else that screws with hormones or your liver in the right way, you can see a benefit from taking fairly large amounts of Lamictal, and just like with anything else, there are always some people who respond to higher or lower doses than average. There's no particular reason that more can't be effective, and it's approved by the FDA for doses much higher than 200mg/day. In the worst case, it doesn't help more or has more side effects, and you lower it again after finding that out.

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Lamictal is pretty crappy at preventing mania in general compared to most stuff used for mood control, and for a lot of people it's more of an antidepressant than doing much of anything else. It's more that it's good at treating depression without triggering mania. There are a whole lot of other things that are usually more effective for the "up" end of things, like, well, pretty much everything else, including most of the APs. For what it's good at (raising the bottom end towards the middle without also raising the top end), it's one of the best things out there (except for the people it doesn't work for, like any med). It's also not half bad for seizures, which is where the higher doses usually come into play, but that's another story entirely.

It also has plenty of interactions that cause it to not work as well, although "being female" isn't directly one of them, at least not enough to say "half as effective". The reason there's a gender difference is that its effectiveness is pretty heavily changed by certain hormone levels, particularly the ones changed by hormonal birth control. Starting/stopping many of the different hormonal birth control options available can significantly change how much Lamictal you need to take for the same effect. The meds most well-known for changing blood levels a bunch are things like Topamax a little, Trileptal and Tegretol a bunch, and Depakote a ridiculous amount.

If you're taking anything like that and/or anything else that screws with hormones or your liver in the right way, you can see a benefit from taking fairly large amounts of Lamictal, and just like with anything else, there are always some people who respond to higher or lower doses than average. There's no particular reason that more can't be effective, and it's approved by the FDA for doses much higher than 200mg/day. In the worst case, it doesn't help more or has more side effects, and you lower it again after finding that out.

;)

WOW. This guy knows what he is talking about. I have been on Lamictal since the Fall of last year. I've done a lot of research and agree with everything Nalgas says. We know he is smart and educated anyway but, I just had to chime in.

Amazed,

Sunshine Outside

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Lamictal is pretty crappy at preventing mania in general compared to most stuff used for mood control, and for a lot of people it's more of an antidepressant than doing much of anything else. It's more that it's good at treating depression without triggering mania. There are a whole lot of other things that are usually more effective for the "up" end of things, like, well, pretty much everything else, including most of the APs. For what it's good at (raising the bottom end towards the middle without also raising the top end), it's one of the best things out there (except for the people it doesn't work for, like any med). It's also not half bad for seizures, which is where the higher doses usually come into play, but that's another story entirely.

It also has plenty of interactions that cause it to not work as well, although "being female" isn't directly one of them, at least not enough to say "half as effective". The reason there's a gender difference is that its effectiveness is pretty heavily changed by certain hormone levels, particularly the ones changed by hormonal birth control. Starting/stopping many of the different hormonal birth control options available can significantly change how much Lamictal you need to take for the same effect. The meds most well-known for changing blood levels a bunch are things like Topamax a little, Trileptal and Tegretol a bunch, and Depakote a ridiculous amount.

If you're taking anything like that and/or anything else that screws with hormones or your liver in the right way, you can see a benefit from taking fairly large amounts of Lamictal, and just like with anything else, there are always some people who respond to higher or lower doses than average. There's no particular reason that more can't be effective, and it's approved by the FDA for doses much higher than 200mg/day. In the worst case, it doesn't help more or has more side effects, and you lower it again after finding that out.

thank you so much nalgas. this actually made sense to me which is a huge feat right now heh. you should be a teacher ;)

so if girlie hormones and lamotrigine play funny together (i've been sterilized forever so none of that here), i wonder if TSH plays funny with lamotrigine. i'm going to see what i can find about that - and compare it to what the doctor says.

i wish we didn't have to do research just to go to a doctor who already makes a bazillion dollars for supposedly knowing these things already.

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I am on 600mg. I don't know why doctors are afraid to prescribe such a high dose, but Dr. Ivan Goldberg has found high doses to be extremely helpful. It annoys me though, even though my psychiatrist will prescribe that dose, every session he asks me if it is too high. Whenever you have a problem psychiatrist, my advice is to find one that takes kickbacks. That doctor will have no problem prescribing certain medications.

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There is a good reason that they're reluctant to use very large doses, like 600mg/day, although resisting using more than 200mg/day is a bit silly. When drugs go through trials in the approval process, they compile vast amounts of data and generate tons of statistics about various things. The approved and recommended doses are based on the results of the trials showing at what dose most people start having an improvement from the med (for a particular condition/symptom) and at what dose above which most people don't see any further improvement and/or above which the risk of side effects increases significantly faster than any additional benefit.

For example, while Topamax (which I'm using in my example because I know the numbers for it better off the top of my head) is technically approved for up to 800mg/day, it is very, very rarely used above the normal recommended max dosage of 400mg/day, because for the vast majority of people there's no point in taking more than that. It only rarely does a better job of controlling symptoms at higher doses, and the risk of all sorts of side effects goes up drastically. I did go up to 500mg/day for a few months on it, because I tolerated 300-400mg/day extremely well compared to most people, and we hoped that a little more would control the last bit of seizury stuff I had going on (which it did for a while, but not indefinitely).

Because of the potential for crappy side effects being even higher at that point, I'm glad that my doctor asked me once or twice a month, at least at first, how it was working out just to keep an eye on things. In general, a decent number of people don't even tolerate the normal max dose of a lot of meds, and it's fairly unusual for someone to do well on something higher than that, so it's not like a lot of doctors have a lot of experience with enormous doses of meds. If they are willing to raise them past that somewhat artificial limit, they are generally going to want to be cautious. Some are more conservative and might not want to do that in the first place, because of the risks involved. It's not unreasonable of them.

However, with that said, 200mg/day of Lamictal is way, way under the recommended max dose. It's pretty commonly used up to 400mg/day, and I think the approved max might even be something like 500mg/day, but I'd have to look that up.

thank you so much nalgas. this actually made sense to me which is a huge feat right now heh. you should be a teacher

Actually, I have been a tutor before, and I've been considering teaching for a while. There are some things I'm pretty good at, and there are some things I'm not; explaining things to people who are willing to try to understand them (even if they don't know anything about them) is in the former category. My dad's been teaching for most of his adult life, too. I think he's actually better at it than I am in large groups/classroom settings, but I think I win in small groups or one on one. He's better with people than I am, but I'm better at coming up with multiple ways to explain things and adapt them to different people when one way doesn't work for them.

Not to get totally off-topic or anything...

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i wish we didn't have to do research just to go to a doctor who already makes a bazillion dollars for supposedly knowing these things already.

Not to double post or anything (oops, too late), but one of the reasons they end up getting behind on some of the newer research or uses for meds is because we're going to see them. When they're fresh out of school and their residencies and whatnot, they can be relatively up to date, since they've been spending all their time learning and were taught (somewhat) modern things in the process. After they go into practice and spend all day every day seeing patients, it's a lot of work just to go from appointment to appointment all day long and be on call some of the time, too, so while they are supposed to (and usually do to some extent) keep up with the latest stuff coming out in journals and all that, there's only so much time in the day. (I had a couple roommates who were in med school and then became doctors, and their dad was a doctor, too, and they really don't have any time to do much at all a lot of the time outside of working that they could be spending doing more research, unless they decided to stop sleeping or something.)

Of course, some of them are much better than others at staying current, and some just aren't any good occasionally/unfortunately. I like my doctor a lot, and he's very good at what he does, but he and I both know that I have a lot more free time than he does to sit around researching stuff between appointments. He's pretty up to date on what meds exist, including the brand new ones, and he has his PDR and the hospital's supply of medical journals and all that, but he doesn't have 16 hours of free time a day like I do to look up obscure off-label uses of things or unusual reactions to them.

What he does have is 30 more years of experience than I do and a bunch of other medical knowledge I don't. Between his experience and my free time, we work pretty well together and come up with a bunch of ideas. Unless they spend less time seeing patients and more time studying, even the best doctors can only be so current with things. Of course, it sounds like some of them could stand to shift the balance of their use of time a bit more towards learning about things, since there are definitely some out there who don't know enough about what they're doing, but there's already a shortage of doctors and nurses in a lot of specialties which would only get worse if they started spending less time seeing patients. I don't think there's any easy solution to crank out extra doctors while also simultaneously training them better, but that's pretty much what would have to be done to really fix that side of things properly.

...aaaaand I'm going to go do something else now, before I end up writing twice as much off-topic stuff as everything else everyone else in this thread has said combined. Heh.

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Hi Lysergia

I know everyone else has already probably answered all the questions but i thought i might just add my bit too, if you come back to check this topic.

I am currently at 400mg of lamotrigine. I picked it myself, after doing badly with both lithium and valproate. My doctors knew about it, but not much really. Before i started it my pdoc at the time had to call his friend, a pharmacist, and ask him questions about it, and about dosing. Then I asked for lower, slower dosing myself, since i was worried about the rash. I've pretty much directed my own increases for this one, since my GP wasnt really 'in the know' either about this. Mainly i think because here in Australia its for epilepsy, only off label for bipolar. My current/new pdoc has much more knowledge about it and pushed my dose up from 300 - 400mg. Pretty much, i noticed no mood stabilising effects until i hit 200mg, and then it was pretty weak until i got to 400mg. In the middle of that i started on the pill, so thats part of the reason I have gone so high. Two days ago i stopped the pill and started Tegretol as well - so, its not done the whole job for me. Its also not working as an antidepressant for me, so i guess its not...strong enough.

Because i take higher doses, my last several increases...between 200mg and 400mg have been in 50mg increments. So I have hardly noticed a difference there as i've made that transition in a week or two, and then another week after that i start noticing the effects. This may be because im just a bit out of it though ;) When i first started, i was so excited to be on a drug that didnt feel like it was killing me that i think i convinced myself that each increase was doing me wonders :) looking at my pattern of moods back then though, uh, well, i was pretty much hypomanic or depressed the whole time and think i got more from the seroquel i was on at the time than the lamictal.

I think your pdoc has a point in that as far as antidepressant qualities go you wont get much beyond 200mg, but as a mood stabiliser i definitely think higher has been helpful. My pdoc has several patients on this drug and a few of them are higher than 400mg.

second opinion time?

(and i agree, Nalgas your explanations were very clear. also, sorry for yabbering on a bit here :) )

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