Lamictal - sweet spot drug?

[Mechante]

Hi,

I was just wondering about people's experiences starting on Lamictal. I just started taking it a couple weeks ago after my Wellbutrin proved ineffective and SSRIs tendency to make me go crazy persuaded my psychatrist to start me on this drug. Right now my problem is depression - sobbing, crying, theatrical stuff. I hate it. So we're trying to get it under control.

Anyway, so here's my question. I was okay - even a little better - on 25mg, then my psychiatrist bumps me up to 50mg and everything turns to shit. Crying more, screaming more, missing more classes due to my being a flailing emotional psycho... I can't put up with this much longer because I'm likely to get kicked out of the house and flunk out of school. I see my psychiatrist on Thursday and can't wait to tell her all that's changed since she last saw me. But I think she plans to increase my dose to 100mg... should I be scared? I can't afford to go even more nutso on this stuff. Or should I be excited because of the potentiality that at 100mg things will level out?

Any shared experiences would be appreciated.  B)

[tallulah]

i think youll find that most people have had similar experiences. 

for some, they dont have to go over 100mg, for me personally 200-250mg work REALLY well for my depression. all depends on YOU.

if the drug is going to work for you - just give it time...it WILL get better.

ash

[NARS]

At 100 I was much more stable than I was at 50.  It's weird, but lamictal doesn't tend to kick in as a mood stabilizer until you get over 100 mg.  It's likely that at 50 you're getting all the AD and not enough of the stabilizer.

Your doc may suggest using something else while you're still at the lower doses, until you're at 150 or 200, and once lamictal stabilizes you you will be able to go off the second med.  But definitely report all your symptoms.  There's no reason you have to suffer all of this, and hopefully things will level out.  And if lamictal doesn't work or you can't tolerate it long enough to hit your very own sweet spot, she needs to know that too.

If you can, call your pdoc tomorrow and alert her (or her staff) that you may need extra time on Thursday and that you're not doing well.  That way she can think about solutions.  Good luck, and hang in there.

[Steve@3AM]

I just started recently so I can't give first hand experience of higher doses. I have read on other posts, though, that there are often major changes when you bump up and you need to allow time for it to stabilize. May also be possible that you bumped up too soon. Were you at 25 for 1 week or 2? Are you working from the "starter pack"?

Also, are you still taking Wellbutrin? That wasn't clear. How much are or were you taking?

Good luck

Please keep us posted about how you do, I learn a lot from these posts.

[NARS]

Oh, yeah, even though the wellbutrin wasn't working before you started the lamictal, the combination may be too much AD for you anyways.  I did fine at first on lamictal and 450mg of wellbutrin, but recently spun out badly, and only got better after taking more lamictal and less wellbutrin.  And my pdoc says I may have to drop the wellbutrin entirely eventually (but I'm BP and have mixed states, so YMMV).  So are you still taking wellbutrin, and how much?  Inquiring minds want to know. 

[berelain326]

I've had pretty cool experiences with Lamictal. My pdoc started me on 25mg for two days, then 50 for two more days. I was ehh...and when I started teh agitated, pissed off, I hate teh world kind of thing, she had me add 25mg for two days, then go up to 100mg for two days. (Never guess what pattern she's going with. )

That's worked well for the most part (I see the pdoc next week and I might have to take it up a notch, I'm taking everything as a personal attack lately, as well as being kind of moody). Call your pdoc and tell her (or him) the effects, she might tell you to increase your dose even before you get there.

[NARS]

Yikes, berelain, that's a really fast titration.  You haven't gotten the rash, but it's been shown that the slower titration recommended by Glaxo has vastly reduced the risks of SJS (aka The Rash).  As SJS can be disfiguring and/or fatal, I'd have asked for a little zyprexa or something to knock out the nastiness rather than hurry it up so fast and risk having to discontinue the med because of a deadly syndrome.  I'm glad you're OK, but I sure wouldn't think it's a good idea in general.

[Steve@3AM]

berelain -

Do you really mean 2 DAYS? or 2 weeks??

The titration schedule on the starter pack calls for 2 WEEKS at 25mg then 2 WEEKS at 50!

Your schedule - if correct - sounds waayyy fast to me. Especially considering potential side effects.

Any other Lamictal users have opinion?

[hollow log]

Hi,

Anyway, so here's my question. I was okay - even a little better - on 25mg, then my psychiatrist bumps me up to 50mg and everything turns to shit. Crying more, screaming more, missing more classes due to my being a flailing emotional psycho... I can't put up with this much longer because I'm likely to get kicked out of the house and flunk out of school. I see my psychiatrist on Thursday and can't wait to tell her all that's changed since she last saw me. But I think she plans to increase my dose to 100mg... should I be scared? I can't afford to go even more nutso on this stuff. Or should I be excited because of the potentiality that at 100mg things will level out?

Any shared experiences would be appreciated.  B)

<{POST_SNAPBACK}>

Hi Mechante,

I started Lamictal a couple of months ago.  I've just gone up to 125mg.  My shrink only recommended going up 25mg every two weeks, for every increase, and I'm really glad she did.  The side effects that you are experiencing were similar to mine after every increase: all anger/crying/irritability was exacerbated.  I realise now how important it was to follow the 2 week/25mg plan.  Some people seem to be able to go up quicker, but that wasn't for me.  Things could level out at 100mg, who knows, but if you don't feel comfortable with that yet then no one can force you.

Also because I wasn't sleeping very well I went on 12.5mg of seroquel at night, and that had a flow on effect into the day which helped with irritability/anxiety/anger also.  It might be worth considering. 

Cheers,

Tim

[Mechante]

Thanks for your responses everyone.

I'm still taking the Wellbutrin but we're tapering off it really slowly... I'm at 150mg now and considering I started on 100mg I wouldn't be surprised if that's how my pdoc wants to take me off the drug. The highest I was ever on with the Wellbutrin is 300mg.

I never got a starter pack of Lamictal *jealous*  but I did go two weeks @ 25mg and this is one week @ 50mg. I expect to be bumped up to 100mg next week. 50mg isn't holding me... although I haven't cried yet today, so whoo-hoo!

Tim, I'm also on 2mg risperdal which I assume would help out with daytime irritability and anxiety like your Seroquel does, but I'm not really sure how much risperdal is doing for me anymore, aside from sending me to the endocrinologist.

I just really hope this drug works for me. I'm also on lithium and I've read about so many people having great experiences combining the two. Please please please let me be one of those people. 

[Steve@3AM]

I think that's the way a lot of us feel whenever we read about someone's success with a med!

Hope you're successful, too. (and ME, too!)

[synthetic]

When I started Lamictal I was also taking Prozac so it is hard to say what effect exactly the Lamictal was having.  At 20mg of Prozac and 50mg of Lamictal, I was manic for several weeks.  Once I got off the Prozac and got to 100mg of Lamictal, I evened out.  Now at 150 and it doesn't seem to be a sweet spot for me.  Actually felt better at 100mg, but that may have just been the relief of getting rid of the Prozac.

[NARS]

I never got a starter pack of Lamictal *jealous*

Don't feel too bad.  My pdoc just gave me a scrip for a bottle of 25mg tabs and gave me very complete written instructions on how to titrate up following the exact schedule the starter pack gives you. So long as you're organized enough to track the schedule, it should be no problem.

Of course, as anxious and depressed as I was, I kept the schedule on top of my dresser and marked the schedule on a calendar I kept beside it.  I also use a weekly pillbox.  With all that I was right on target the whole time.  Obsessive?  Sure.

[Guest billycat]

Hi      I have been on 100mg. lamictal for about 5 months now and doc increased welbutrine from 300mg to 450 and like Nars I felt the was just too much

I think that was what has been causing my migraines to get worse.

This past month has been really bad for ...I guess rapid cycling is what it is called???    anyway  I am now on 150 mg lamictal for 2 weeks then up to 200mg.

I think the Lamictal is what has made the most difference for me  and I feel comfortable at the 300 welbutrine.

Good Luck I hope you have sucess with the lamictal.

[AirMarshall]

Hi Mechante,

Haven't seen you for a while.

[Niz]

My doc actually wanted me to start Lamictal at 50mg, but I was paranoid and did 25mg for the first four days before kicking it up a notch. After one week of 50mg, I went up to 50mg twice a day, and after that one week, up to 100mg twice a day.

When I first hit the 100mg twice a day, I had crazy mood swings where I went from absolutely manic to depressed to manic again, and I'm taking Lamictal for my seizures...

[Mechante]

Hi Mechante,

Haven't seen you for a while.

[ncc1701]

Heya,

OK a bit late to this thread.

I am cautiously optimistic about my Lamictal monotherapy.

At 25 mg - I slept through the night for the first time since ... well ... ever as far as I can tell.  My constant nightmares went away and have not returned.

I titrated up slow-w-w-wly because I was/am terrified of having to stop due to THE RASH.  So I did 25 mg increases every 2 weeks until now I'm at 150.

By 50 mg -- med effect, I don't know, maybe just not being sleep-deprived -- I felt able to do some CBT exercises and am sort of doing them now.  I was never un-depressed enough to do them before.

150 mg feels un-depressed, so I'll stay here for a bit until I know what un-depressed feels like without thinking it's hypomania.

The dose varies greatly even in the same person over time, so the guidelines are really more like best guesses.

Good luck finding your cocktail.

--ncc--

[AirMarshall]

Mechante,

I think your Pdoc sounds pretty perceptive. I would not suggest monkeying around with the Lithium or anything else.  If you are having lengthy crying jags, then decreasing the Lithium is not the thing to do. 

As far as the Lamictal titration,  if you haven't had problems so far then your doc's suggestion sounds reasonable.  Do you have any significant skin problems or allergies?    Has it given you headaches or the all over body muscle aches?

Some people are incredibly sensitive to it, others not at all.

When I first started, i had headaches at every step, body aches, stiff muscles.  And I used the starter pack over 5 weeks.

When I went off it over 4 or 5 days, I had a mild headache for a day or two. 

When I started up a second time, I took 4 100mg tabs in about 24 hours, with only passing headache (don't do as I do!); doubled up the Lithium too.

For me, Lithium started to work within a week.  Lamictal was very subtle after 50mg level, I didn't feel a difference, but could tell each week that I felt a little better.  This went on for about 3 months.

NCC1701: glad things are going well.

Mechante:  Do note that Lamictal is energizing for some, sedating for others.  You may need to adjust whether you take it in the morning or at night. I finally figured out that it is energizing for me, so I take in the morning now.  Really helped my sleep.

Cheers, all,  A.M.

[NARS]

She's making it sound like I'll only be one week on 100mg and then she'll increase it to 200mg. Does this sound like a good idea?

Yes, that's what I did, and that's the "standard" titration schedule.  But listen thou to A.M.; so long as your pdoc knows what's going on it will likely be just ducky.

I actually got less severe side effects at each increase.  That is, when I went from 25 to 50 I had backaches, headaches, and irksome nausea for 4-5 days after the change.  When I went from 50 to 100 I had the same symptoms but they weren't as bad and only lasted about 3 days.  When I went from 100 to 200, same thing, except they were even milder and only lasted a few days.  And recently when I had to go to 300 I hardly noticed it; I was just a little queasy the first day until I ate some solid food.

Good luck, Mechante--you're still going through a lot of med changes, so try to hang in there!

[kylixer]

Am I the only one up to 400 mg a day?  Every two months or so I've had to increase it 50 mg.  The effects (especially the ability to ward of depression) just eventually faded away.

No other drugs for me either, except for the occassional adderall.

I'm the only high-doser huh?

    I'd feel so alone if it wasn't for the big bad bottle of 200 mg. Lamictals     

Oh, hi everyone --- VERY cool board. 

[firedancer]

I am having the same problem.  I'm on week 4 on taking 50mg and I'm worse than I was at 25mg.  I'm emotional: crying, weepy, angry, one minute I'm up and the next I'm down.  I go back to my pdoc in a week.

I was tapering off Effexor XR (on 37.5mg) while I was on 25mg the first 2 weeks (the Effexor alone wasn't working at all).  I thought (before I read this) that maybe that particular combo was working, but now it may be the dosage of Lamictal?

I'm confused.