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Lamictal = Bipolar?


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Guest threesixty

New here, looking for a little help: I have absolutely no idea why I've been given a script for Lamictal!

I have a difficult time, for some reason, asking my p-doc why he's having me take what I'm taking. I've had several appointments now where they've switched pills up and tooled around with the dosages, but I've never bothered asking too many questions.

My main question is: Is bipolar disorder basically the only reason a pdoc would prescribe Lamictal? (I mean, in terms of my 'rents health insurance: they need a "label" to cover pills to cure "the disease," so isn't bipolar disorder the only legal way my doc could have prescribed me lamictal?

I really don't think I'm bipolar. I've reported periods where my mood has shifted substantially, but it's always been more of a seasonal thing than anything else. I'm always happier and far less depressed in the warmer months...

I've been (super infrequently) taking Klonopin and Xanax for "anxiety," according to my doc. This time around, the "reason" box on the prescription for Lamictal reads "mood". They told me it would help with my irritability.

To recap: 1) If a doc prescribes you Lamictal, can you be pretty sure that doc thinks you're bipolar?

2) What other reasons might a (responsible) doctor (rationally) prescribe Lamictal to help with?

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First of all, hi and welcome.

Second of all, to answer your question, no; you don't have to be diagnosed as BP to be prescribed lamictal. Lamictal can be used to treat depression. I'm not sure how often this happens (and I'm too lazy to go digging around google right this minute--it is 5am after all), but it does.

Also, lamictal is an anticonvulsant that is perscribed to people with epilepsey.

Perhaps your pdoc thinks you're epileptic.

Kidding.

edited because it's 5am and i'm typing in the dark.

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Berry and Qwerty have done an excellent job of responding.

Let me add that Lamictal is a mood stabilizer, that is also a modest antidepressant. By stabilizing the mood swings it may also help reduce the anxiety problems. And in general, it's probably better to control an underlying problem with a mood stabilizer in order to reduce anxiety, than to use benzos as a band aid.

welcome, a.m. ;)

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I agree with what everyone else said. Maybe he is giving it to you for mood stabilization. I've been given mood stabilizers but I don't have bipolar. I just have trouble maintaining a certain mood and I have severe depression. I think you need to ask your doctor for a straight answer. If you don't like him/her find another one. Keep looking until you find a doctor that talks to you how you like. You may also want to ask him/her what they have down as your diagnosis.

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I have a difficult time, for some reason, asking my p-doc why he's having me take what I'm taking. I've had several appointments now where they've switched pills up and tooled around with the dosages, but I've never bothered asking too many questions.
Unfortunately, you do need to ask. Would it be easier to write out your question and give it to him at the start of the next visit? Or to fax or call ahead?

(I mean, in terms of my 'rents health insurance: they need a "label" to cover pills to cure "the disease," so isn't bipolar disorder the only legal way my doc could have prescribed me lamictal?
Nope. "Off-label" prescribing is entirely legal, and it's generally covered by insurance.

I really don't think I'm bipolar. I've reported periods where my mood has shifted substantially, but it's always been more of a seasonal thing than anything else. I'm always happier and far less depressed in the warmer months...
Good topic/question for your next visit. Please note that seasonality does not rule out manic-depressive illness.

2) What other reasons might a (responsible) doctor (rationally) prescribe Lamictal to help with?
Off the top of my head, all off-label except the epilepsy indication: Depression, epilepsy, HIV neuropathy, cluster B personality disorders and associated affect instability/impulsivity, certain obscure headaches...

You might find Phelps' writeup helpful (the link is to an overview, and then you can go to the Lamictal page.)

Good luck talking with your doc. If I'm reading you correctly, the issue is more that you're uncomfortable asking, rather than him being unwilling to discuss the topics. Does he know that you feel awkward asking the questions? Letting him know that might be a good start.

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Lamictal is definitely used as an offlabel prescription for depression. It's often effective when other treatments fail or have intolerable side effects, but it's never used as a first line for simple depression because of it's price.

A one month supply of Lamictal generally costs close to $150. Zoloft can be obtained for $5 a month without insurance. Yes, it's officially a psychiatric tic-tac.

Zoloft's side effects are probably a bit more benign too (other than the sexual side effects).

In general, SSRIs are much cheaper, and they're probably a bit safer.

When all else fails, Lamictal's definitely worth a try. It has fewer side effects than ECT.

As for anxiety, Lamictal isn't normally effect It actually causes me more anxiety. In general though, people seem to think it doesn't have much of an effect on anxiety.

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I really don't think I'm bipolar.

That sounds all too familiar to me. I don't think I'm bipolar (technically Bipolar II) but I'm taking Lithium, Wellbutrin, Lamictal and Prozac. Hmm.

Okay, since I've had recurrent episodes of major depression maybe my pdoc is erring on the side of caution at this point by prescribing mood stabilizers in addition to antidepressants. (I know major depressive episodes can be precursors to bipolar disorder.) That would make sense, yes?

Then again my pdoc *does* use the term "bipolar" when discussing things with me, so my current, official list of diagnoses must include Bipolar II as an already confirmed disorder. (Not simply a "rule out" dx.) Right?

Aaauugh! I don't want to be bipolar and I still don't believe I am!

I'm not hypomanic, I'm not, I'm not, I'm not!

Sometimes I'm just a little more...um...bold and daring than other people. And maybe a little crankier. And so what if I go into an occasional teeny-tiny mini-rage when people really, really, REALLY tick me off? Everybody does stupid things, and has different moods, and gets angry at times...

Oh well... I really do like my pdoc a bunch so I'll ask him for the 100th time if I'm absolutely, 100%, for sure bipolar.

And then I won't believe it if he says I am.

Aaaaaaugh! I don't know anything anymore...

P.S. And I'm not in denial either!

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hi,

this may seem a bit off topic, but since it was posted i think its ok for me to ask.

reborn wrote :

A one month supply of Lamictal generally costs close to $150. Zoloft can be obtained for $5 a month without a prescription. Yes, it's officially a psychiatric tic-tac.

Zoloft's side effects are probably a bit more benign too (other than the sexual side effects).

why are you comparing lamictal to zoloft? and secondly, where in the USA can you get zoloft without a prescription? and if you say "the internet" well, then thats a problem.

db

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LOL, I meant without insurance. I was tired when I posted that ;) I tend to type without thinking. Personally, I'm shocked that you can buy prescription drugs for $5.

I was comparing it to Zoloft because sertraline is a typical first line treatment for depression. I was just trying to explain why it's a first line treatment. It's flat out superior for unipolar depression (assuming SSRIs are effective)

Unless you want to throw away money and take a slightly more dangerous drug, Zoloft, Prozac, Celexa, Effexor, or Wellbutrin etc may be a better choice.

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I think the most important issue here isn't the labeling of your illness, but more of your need of self- advocacy when it comes to your medication. You should ask questions. You should give feedback to your pdoc, that's the only way he/she knows that the meds are working or not. For years, I just trusted my doctors and never questioned them giving me AD's. I would just quit taking them when I would go manic (not saying that that is what would happen to you). I was on benzos for years before someone figured out that it wasn't anxiety spawned depression.

Also, Lamictal is not just prescribed for Bipolar and Epilepsy but also for Unipolar Depression.

For the first month and a half, I hounded my pdoc for a dx. He refused to give it until he was completely certain of what it was that I was really suffering from. He asked me once, "Why is it so important for you to know what it is that you have? Can it be enough for now that you aren't suffering anymore?" It might be something to ask yourself first.

I would suggest though, to write out a list of questions for your pdoc. If they are open and honest with you, they will be happy to answer any of them. They love to explain things, trust me. Having a patient who advocates for themselves is more apt to know when something is wrong.

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