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So, I am currently at 125mg on my Lamictal.  I was manicy and nutso from about 50mg -> 100mg.  This last week at 125 has been the most stable I have been in awhile.  My pdoc wanted me to go to 150 after two weeks.  My question is, should I see if I ought stay at 125 for a little while longer?  Does 25mg make that much difference?  Are the long term side effects going to be any worse one way or the other?  How long does it take at a particular level to know if it is the sweet spot?  Any insight would be appreciated.

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just adding moral support cuz the ways of my pdoc are a mystery to me--and she wants to keep it that way. i've annoyed her on more than one occasion with my vigilante med opining.

when i needed more stabilizing at 100mg lamictal, instead of raising my dose, my pdoc added lithium. now, i asked her why one's lamictal dose would be raised--and i got the inscrutable reply: depends on clinical response. ergo, i still have no idea why she chose this route.

one theory i've toyed with is that while the mood stabilizing properties go up with higher lamictal doses, the anti-depressant mania-fanning effects also increase. i may be wrong....but hey, i tried.

vii

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Who knows? Every time I upped the dose, I went batshit for a few days. Going from 150-175, I really lost it completely, so I jumped straight up to 200 after about three days at 175.

Going up from 50 I cycled wildly, and din't begin to slow down until 150. At 200, I'm fine and it took me maybe a week to realise I could stop holding my breath...

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i had good spots at many different places on lamictal.

at 75mg, i didnt want to go any higher.

at 100mg, the depression set in so bad i wanted to kill myself.

125mg, i felt batshit retardedly crazy and uncomfortable in my own skin.

150mg was another good spot - didnt want to go higher

...and so on.

i got to 200mg and my cycling started.

it has helped my depression a GREAT deal.

doc wanted to see me between 200-300mg, so im stuck at 250mg.  i FEEL great, but im on an AC combo right now - the most stable ive ever been...

just hang in there - youll get to where you need to be. 

xo

ash

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just adding moral support cuz the ways of my pdoc are a mystery to me--and she wants to keep it that way. i've annoyed her on more than one occasion with my vigilante med opining.

when i needed more stabilizing at 100mg lamictal, instead of raising my dose, my pdoc added lithium. now, i asked her why one's lamictal dose would be raised--and i got the inscrutable reply: depends on clinical response. ergo, i still have no idea why she chose this route.

one theory i've toyed with is that while the mood stabilizing properties go up with higher lamictal doses, the anti-depressant mania-fanning effects also increase. i may be wrong....but hey, i tried.

vii

<{POST_SNAPBACK}>

My pdoc is a mystery to me as well.  So far he is doing what I want, so I haven't asked too many questions.

Last visit, he asked if I wanted to try Lithium to help with the mania or keep going up on Lamictal.  I said, "Let's just stick with Lamictal for now."  Lithium scares me.  He also mentioned the possiblity of trying an AP if I still have problems with mania at the next visit.  Since I have more problems on the depression side, I am going to stay with the Lamictal and see how it goes.  After yesterday and today, I think I still need to go higher.

Still wondering about the long-term effects.  How much does dosage level affect them?

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Long term effects?  Dosage level?  Welll... My totally UNprofessional viewpoint is, they're not related.  You get what effects you get.  Change dosages or meds, change/lose effects.  So long as you don't quit cold turkey, of course; that would be...bad.

Erm, lessee, what next...

Do you go up on dosage/ is there a sweet spot?  Well, IF the dosage is working, yeah, you could stay on it; BUT...Lamictal is one of those whack-ass meds that just does NOT behave how you want/expect it to.  You may have to up it in the future, or lower it, or whatnot.  However, 200 is the usual dose for most people, depending on what other meds they're on (some will double its efficacy, for instance, thus requiring half the dose).

Now, you say you're scared of lith and are having more problems with depression.  BUT...in your initial post you said you were manicy/nutso?  Well, you could try just the Lamictal, but don't toss lith out just yet.  Personally, I HIGHLY prefer it over an AP.  Really, it's not so bad, for most (I shivered at the thought of it too, but hey!--not much on the side effects, er, side!), and it's a HELL of a lot less tiring than AP's.

At any rate, hoped that helped some.

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Thanks CNS.  That was helpful.  I forgot to include that I was on Prozac until a couple of weeks ago.  Once I got to 20mg, Mr. Manic made his appearance.  Since I tapered off it, the mania has been pretty non-existant.  I am attributing that to the combination of stopping Prozac and getting to a decent dose on the Lamictal.

Thursday was a pretty crappy day.  Work and personal life both sucked.  Took the day off on Friday cuz I felt like shit.  In the past, this suckiness might have lasted for a week or two or longer.  I think it has already past, so hopefully that is Lamictal doing its thing. 

Thanks for the replies.

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Lamictal's antidepressant effects tend to diminish between 150-200mg. That is, you still get an antidepressant effect, it's just that as you increase the dosage above that point you don't get that much more of an increase in effect as you increase your dosage.

That's from crazymeds.us's lamictal page.  But you know, I've never seen anyone post on what happens with too much lamictal, that is, if you hit your "sweet spot" and go right past it.  I'm at 200, feeling pretty good, but still a tiny bit of cycling, so wondering whether to ask for 250...

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I need to titrate up to 50 mg tommorrow from my sample pack.  I am scared to because I think I'll freak out and have a panic attack.  should I take one 25 mg pill in the morning then the other at night?  or should I take two 25 mg pills at once?

;)

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Does it make any sense at all to say try not to get all worried about having a panic attack?  The more you worry, the more tense & anxious you'll be, and the more likely to panic.  Maybe.  I don't know.  Gosh I'm helpful, aren't I.

I'm not sure it would make much difference if you split the dose, given the weird half-life of lamictal.  I might guess you should just continue taking it at the same time.  And be sure to give yourself time-outs during the day to see how you feel. 

Many do not get manic at all on lamictal, so don't make it happen by expecting it.  I got myself all wound up about starting tegretol, and thought I was going manic, when in fact I was slipping into a straight-up depression.  It was just fear.  Fear feels like mania to me, so it was easy to get confused.

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Thank you for your concerns... I have noticed that no matter when i take the 25 mg pill, I am exhausted all day then up all night.  I don't get why this is.  I am very med sensitive and I'm a panic type person (obviously  ;) )  I just don't want to have my heart race when I up the dose.  again I appreciate your suggestions.

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Another thing to consider when you're splitting your dose am/pm:

Are you taking it 12 hours apart?

If you're not, it may be the cause of one dose being stimulating and one dose being sedating; ie: one has not reached its end state when the other one is being added in. 

I have noticed (anecdotal evidence only here), that when my schedule is off (I take my meds 3x/day), my reaction to them varies.

Just a thought.  YMMV.

6

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This might be a stupid question, but here goes....How should you switch from taking a med. at night to taking it in the morning.  I would like to start taking my Lamictal in the morning instead of bedtime and my foggy brain can't seem to figure out a "quick" way to do this.  Obviously I could skip the nighttime dose and take it first thing in the morning, but I'm skipping a dose...sort of...I'm confused...

Any help would be very much appreciated!!

aimee (feeling foolish for this stupid question...)

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Hey, I got double hijacked.  That's cool though.  Whatever helps peoples.

I need to titrate up to 50 mg tommorrow from my sample pack.  I am scared to because I think I'll freak out and have a panic attack.  should I take one 25 mg pill in the morning then the other at night?  or should I take two 25 mg pills at once?

;)

<{POST_SNAPBACK}>

My experience, and some others that have posted, is that the lower doses of Lamictal are were most of the side effects happen.  The only one you really have to worry about is "the rash".  It is not uncommon to get a minor rash, but "the rash" is pretty rare.  Still, you should be aware of any rashes you might get.  Don't panic or anything if you get one.  Call your pdoc or go to the emergency room.  As Jerod says on the crazymeds page for Lamictal, it takes awhile for the "the rash" to get bad.  You have plenty of time to treat it if it appears.  That being said, changing your dose is usually when you have the most trouble.  It usually gets better after a couple of days.  It is worth the effort to get through the crappy parts.  A lot of people have been helped by Lamictal.

As far as when to take it, as others have said, it depends on how it affects you.  I started out taking it at night, but switched to morning cuz I found it activating.  Talk to your pdoc and find a schedule that works for you. 

HTH

This might be a stupid question, but here goes....How should you switch from taking a med. at night to taking it in the morning.  I would like to start taking my Lamictal in the morning instead of bedtime and my foggy brain can't seem to figure out a "quick" way to do this.  Obviously I could skip the nighttime dose and take it first thing in the morning, but I'm skipping a dose...sort of...I'm confused...

Any help would be very much appreciated!!

aimee (feeling foolish for this stupid question...)

<{POST_SNAPBACK}>

Don't feel foolish.  That's what we are here for.  We were all unwise to the ways of the crazymeds at some point. 

I am not a doc, so don't take my word for it, but usually it is recommend that you do exactly what you suggested.  Skip the nighttime dose and take it in the morning.  Talk to your doc if you want to be sure.

Now, back to me damnit.  If anyone cares, I am at 150 now.  First couple of days all I wanted to do was sleep, but I had a decent amount of energy today so that is good.  Here's to hoping 150 is a sweet spot. B)

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Hey synthetic!  Thanks for the help and I'm sorry for the hijack!! :)

I see pdoc tomorrow, so I am going to hold off on switching to the morning until after I see him.  I am trying my hardest to be the "good" patient and make sure I talk to pdoc before I try switching things around.  He likes it when I do that...you know...I'm like the good little puppy that gets a pat on the head when I keep him informed!! ;)

Lucky you at 150mgs!!!  I'm still at 75mgs and long for the days of higher doses, so the rapid cycling shit stops!!!  Oh well...I'll be starting 100mgs tomorrow!!  On my way up...

Again, thanks a bunch for your help!! B)

aimee

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Hey synthetic!  Thanks for the help and I'm sorry for the hijack!! :)

I see pdoc tomorrow, so I am going to hold off on switching to the morning until after I see him.  I am trying my hardest to be the "good" patient and make sure I talk to pdoc before I try switching things around.  He likes it when I do that...you know...I'm like the good little puppy that gets a pat on the head when I keep him informed!! ;)

Lucky you at 150mgs!!!  I'm still at 75mgs and long for the days of higher doses, so the rapid cycling shit stops!!!  Oh well...I'll be starting 100mgs tomorrow!!  On my way up...

Again, thanks a bunch for your help!! B)

aimee

<{POST_SNAPBACK}>

No problem.  I hear on the good little puppy routine.  My family doc got pissed cuz I didn't give Lexapro enough of a chance.  He wasn't the one experiencing the mixed-state from hell.  My pdoc has been pretty good about listening to me and working with me on my treatment, so I do my best to be a good patient.

Just as an FYI, Lamictal is not as good for rapid cycling as some other ACs.  It also isn't as good for some people that have more problems with mania than depression.  I don't know what your dx is or what your symptoms are, but something to keep in mind. 

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  • 3 weeks later...

So, I have another question.  It's been about three weeks at 150mg and I am still cycling up and down, though it is much milder than it has been in the past.  There has been a lot of stress in my personal and professional life, so that isn't helping.  I have a pdoc appt on the 29th and I wanted to get some opinions.  I wanna go up to 200mg.  From what I have seen around here, that is the standard dose for BP.

1  How long did/does it take to level out once you are at a theraputic dose?  Basically, how long til I know how well it is working?

2.  If he suggests another AC, it is probably going to be lithium since he has suggested that in the past.  Any experiences with Lamictal and lithium where you started with Lamictal and then added lithium?

3.  If he suggests an AD, I am not taking another SSRI.  Both Prozac and Lexapro fucked me up.  Any suggestions for non-SSRIs that work well with BP?

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