New Lamictal Study

[Robbie]

My PDoc called me last night and said that a new study by the NIH is about to be published in which they found that 50 mg of Lamictal is 90% as effective as 200 mg.

I'm at 62.5 and he told me there was no need to go any higher, that I'm already at that "sweet spot," minus 10% or so.

I know that a lot of posters will disagree with this, so remember that I'm only the messenger, not the author of the study, which I understood was a blind study by reputable scientists.

Of course I forgot the name of the scientific journal where the study is going to be published next month, but when I find out I'll post it.

Rob

[NARS]

Interesting.  I was on 50 for 2 weeks, I think, at least one, I forget the titration schedule.  I was quite jittery, felt slightly manic, and while I was no longer depressed I was definitely not stable.  Within two days of increasing to 100 I was markedly more stable and less jittery.  At 200 I felt lovely.  But I recently had breakthrough mania and increased to 300, where I again feel lovely.

I've heard that for MDD or treatment-resistant depression the antidepressant effects don't get much better after 100 mg, but for BP most posters here have needed more.  But YMMV, and it depends on what other meds you're taking too.  If 50 does it, hell, why take more?  But I'd hate to see someone quit lamictal because their pdoc won't let them take more than 50 and then gives up on it if he doesn't see results at that level.

[seven]

I've heard that for MDD or treatment-resistant depression the antidepressant effects don't get much better after 100 mg, but for BP most posters here have needed more.

[Robbie]

It's a surprising finding, that 50 mg is about as good as it gets.

What I don't understand is what standard they use to decide all this.

I mean, Lamictal is a very subtle drug.  And as I understand it, the drug begins to go "silent" in your body, no matter what dosage.

So while you might be jittery at 50 mg the first two weeks, if you kept taking it for a month instead of titrating, the same effect might have happened as going up to 100 mg.

The problem is that its all so subjective.  Is there really a "sweet spot" and is that the same for everybody?

Are we doing ourselves a dis-service by trying to find a "sweet spot."  I didn't think Lamictal worked like that.

I thought that its antidepressant effects were almost a side effect, and the great value of Lamictal was stability.

I thought that you could only judge the stability after a long period, a year or more, to understand how the drug was helping you, if at all.

Anyway, I can't wait to read this new study, because if it's true that 50 mg works 90% as good as 200 mg, that would change the way all of us take this drug.

[seven]

I mean, Lamictal is a very subtle drug.

[NARS]

I would have probably killed myself rather than wait a year at 50mg.  I was pretty much climbing out of my skin, and my depression wasn't all the way gone, and I wasn't stable.  I guess theoretically it could have passed, but it sure didn't feel like it was changing.

And when I'm stable on lamictal I don't feel doped up at all.  Not at 200.  Not at 300.

Every drug works differently on each of us.  We have different "flavors" of BP or epilepsy or whatever that need treatment.  We metabolize them differently.  We are taking different medications aside from the psychmed.  So there is no such thing as a single dosage that works for everyone.  200 is just a target; many do well on 100, others need 400.  It depends.

I know I sound irritable right now but that's because I've been having insomnia.  And it turns out it's not the lamictal, and probably not even just because of the wellbutrin--I'm in perimmenopause (or is it premenopause), and I'm having hot flashes.  No, really.  I'm starting estradiol tonight and crossing my fingers that I'll get a full night of sleep--sans soaking sweats--soon.

Oh, and seven, I apologize for the flippant remarks about TRD and MDD; I was just doing a poor imitation of someone who knows about them based on scanning a few posts about it. 

[Steve@3AM]

The original post says NIH says 50 is as effective as higher doses.

QUESTION - FOR WHAT?

Lamictal appears to have many different uses. Some off label. What EXACTLY was the NIH study about???

Also, remember that (per poster) it was 90% as effective. That probably means that even with whatever it was they were studying, 10% were not OK at that dose. Could be that that 10% needed 100 or 200 or 400 etc.

One should rarely trust second hand information re studies. Now if Kassiane said it I would tend to believe it!

[faith]

Well, I'm at 50 mg right now, and have been for a while (on week 3 at 50 mg, if I'm not mistaken). If this is as good as it gets, then Lamictal is not for me  It is definitely ramping up my agitation at this dosage. It could definitely be doing more for the depression as well but I have to admit my appetite has improved and the crying jags are mostly-over. I'm still gonna be going up to 100 mg at next pdoc appointment, or else be trying something else. Not giving up hope till I make the 100 mg mark, though- I've heard too many good things about Lamictal for the people it works on! Since I will have been at 50 mg for a month by that point, I will let you know if the agitation decreases by then on its own if you'd like.

[seven]

Oh, and seven, I apologize for the flippant remarks about TRD and MDD; I was just doing a poor imitation of someone who knows about them based on scanning a few posts about it.

[Robbie]

I'm sorry I started this thread without having the specific information as to where the study will be published.

It sounds suspicious to me too.

My PDoc always sounds suspicious.  Ha.  But this is the first time he's called me out of the blue with information.

As far as staying at any dosage for only two or three weeks and making a determination about Lamictal's effectiveness, the one thing I believe is that Lamictal is a long-term drug, not like most antidepressant--not like most other drugs.  Whatever dosage you're on, the drug has long-term effects that can't be judged by a titration after two or three weeks.

I don't think it's fair to say after a month on Lamictal at any dosage that it's not working.  The agitation you feel after week two can disappear in week three after the body begins to adjust.  I think that's what the PDoc means by "going silent."

I was told it's not the kind of drug where there are instant results, and that only after a year or so could I look back at the year that passed and compare it with the year before.  Did I have less depressions?  Do I bounce back from bad moments more quickly?  Did it inhibit the kindling mechanism?

I will find out the name of the study--I don't believe it was a "little" study by the NIH--and I'll post it here the second I find out specifically who did the study in which publication we can find it.

In the interim I wish everyone peace of mind, whatever dosage you're on.

By the way, I'm on Lamictal monotherapy, so I experience the drug pure and raw, without the effects of other medications, for better or for worse.

Rob

[number_6]

And then you have people like me.

BP1-hypomania to mania.  Always.  No depression.  Ever.

Lamictal is my baseline drug. 

I'm obviously not taking it for depression. 

I am a quick metabolizer of any drug, and psychotropics are no exception.  I was on 100mg for about a year, then went up to 200mg.  That lasted about 3 years before I had to titrate up to 300mg.  In a flash of brilliance both last December and this past August, I tried to decrease my level back to 200mg.  (once without approval, once with)

What a stupid fucking idea.

Total decompensation.

50mg?  I guess I'm in that 10%, then.

6

[gretl]

I was told it's not the kind of drug where there are instant results, and that only after a year or so could I look back at the year that passed and compare it with the year before.  Did I have less depressions?  Do I bounce back from bad moments more quickly?  Did it inhibit the kindling mechanism?

Christ.  If I had to wait a year to tell if a med is working ...

I wouldn't.  I would switch.  Would your GP give you a blood pressure med and tell you "Wait a year, it's subtle"?    If a person diagnosed as bipolar isn't feeling any positive effect at 50mg but can afford to wait a year and see, they can probably get by with diet and exercise and meditation.

So perhaps giving a dose 2-3 weeks won't tell you the longterm effects.  If you can tough it out, give it another 2-3 weeks.  Not a year.

[tomtyger]

And then there's this:

Has this study even been published yet? Is all this upset due, in fact, to one person's interpretation of what a study is expected to say?

If/when the study's available, read it. And don't believe what someone else says is in it: read it yourself even if it's a struggle.

I've been on lamictal 400mg/day for years now, and together with effexor the combo is my base line and my stability. Actually, without lamictal and effexor, I wouldn't be able to tell a base line from a crocodile!

tom

[Robbie]

You're all correct, I shouldn't have posted until I read the study myself.  Or until it was published.  I promise I will find out where and post the information.

I didn't mean to cause any agitation.  It just stunned me to hear about it, and it was certainly very unusual for my PDoc to call me at 9:30 at night to tell me about it.  Very unusual.

As for waiting a whole year to decide if Lamictal is working, I said the same exact thing.  Who wanted to wait an entire year?

But it seems to me that the effects of Lamictal are subtle.  It's not mainly about stabilizing moods day to day, it's about being stable in the long run, breaking the cycles of deep depressions.  (It doesn't do much for mania, I'm told, and as an antidepressant it only "lightly" brushes up against serotonin and dopamine receptors, so I read, but sometimes enough to make some people manic.)

So as I understand it, Lamictal isn't about feeling better quickly, like an antidepressant or other kinds of stabilizers.

I guess the year-long concept is that only after a considerable amount of time can you look back and say, "Wow, 2005 was a much better year for me than the year before."  Allegedly, the PDoc promises, if I stick with Lamictal 2006 will be the best year ever, and so on.

As for the dose, I'm confused myself.

So again I'm sorry to have posted without knowing the name of the study, but unless my PDoc was smoking something funny, it's going to be published next month in a legitimate medical journal and its reputable.

But like everything else, it could be wrong.

[Steve@3AM]

Baselines don't have long noses?

Or is that alligators?

("convulsing" w/ laughter!)

[NARS]

So perhaps giving a dose 2-3 weeks won't tell you the longterm effects.  If you can tough it out, give it another 2-3 weeks.  Not a year.

Heck, I won't wait more than a week or two before I report bad results to my pdoc.

Maybe what he meant is that it takes a while to see exactly what dose you need, even if you seem stable.  I seemed stable for about 6 weeks at 200, but then began to spin out, and am now at 300 and so far am doing fine.  But I could break through again and need more.  And then I could break through and need an adjunct med.  Lamictal is great, but it doesn't always work as monotherapy, much as we might want it to.

I think it does seem surprising he'd call you at home out of the blue to tell you about a study that hasn't been published yet.  Was he telling you to stop your titration?  Maybe he's relying on some hearsay from a researcher or a pdoc who knows a researcher.  It sounds pretty sketchy to base current treatment from a new study that contradicts all the other study results on lamictal. 

Do post the article or a link when it comes out--given his call, I'm sure your pdoc will give you a copy the minute it comes out.

[Steve@3AM]

Robie - I think you're correct. Allow for "long term". You do have to be able to sens a bit in the short term whether it's doing ANYTHING or not, though - or really is doing BAD things even after you allow for adjustments etc.

NARS - I think 1-2 weeks for a med is way to fast to judge unless your getting major bad side effects.

PS - Robbie - don't YOU feel bad about your initial posting. It was the right thing to do. It made people look and respond and analyze and everyone (I think/hope) got information out of it. You passed on information. It was the Pdoc that should have thought and checked before he said anything to YOU.

THANK YOU for giving us the opportunity to evaluate his wierd behavior!

[Niz]

My PDoc called me last night and said that a new study by the NIH is about to be published in which they found that 50 mg of Lamictal is 90% as effective as 200 mg.

<{POST_SNAPBACK}>

Question: Is this for Bipolar disorder, or for seizures? Because I take Lamictal for seizures (the fact that it helps with my bipolar I is a pleasant side effect ) and 50mg didn't really do much for me. Once I got up into 100mg-200mg, my seizures got less frequent.

[ncc1701]

Heya,

Sounds more like BP indication but that's just a guess.

And considering blood levels of Lamictal don't correlate with oral doses ... not sure how useful this study will be.

Sometimes, like my first psych said, it's whatever works.

--ncc--

Edited a moment later to add:

And that is pretty unprofessional of your psych, Robbie.

You did a good thing by posting.

--ncc--

[AirMarshall]

Robbie,

Don't feel bad about posting.  If my Pdoc called me to talk about a study that would be pretty unusual and I'd be on the boards in a minute.  The CB grapevine is faster than the journals!

For me 100mg was much better than 50mg. Now I must say that Lamictal didn't give instant results but each week for about 3 months I could see a noticeable improvement.

The manufacturer says the effective range is 100 - 200mg.  But we have quite a few members now who are taking 300 or even 400mg, so it looks like, if anything Pdocs aren't considering a high enough range if results aren't good.

A.M.

[Sam]

Interesting.

[NARS]

Sam: Short answer is yes.  Remember the standard disclaimer that I'm not a pdoc, I haven't seen you, I don't know exactly what your symptoms are.  But what you're reporting here seems to be AD triggered mania.

I'm guessing you meant 300 wellbutrin, not 30.  I'm also guessing--since this is definitely a YMMV thing--that if you'd stayed on the higher dose of lamictal you may  have gotten more mood stabilization.  With more AD, you're likely to be less stable.  300 is a stiff dose of wellbutrin for most BPs; with the added lexapro, I don't really know.  Both are better than other ADs for BP, but without enough stabilizer they can both trigger mania.

Remember that for us BPs, "depression" may actually be a mixed state, especially if your depression before the ADs was anxious or irritable.  In which case more stabilizer, not more AD, would be indicated.  Now, with the increased ADs, it's hard to say if the lamictal just isn't working or if you just have too much AD in your system. 

Or, as we keep saying, you may need an extra mood stabilizer.  But IMHO, and for myself, and with lots of caveats, my personal opinion is that it's worth trying to get stable on one medication so long as you can tolerate higher doses.  So far it's working for me with lamictal.  But some (A.M. is a good example) need an adjunct mood stabilizer to help the lamictal.

Like many, I got symptoms of mania for a short period of time after every dosage increase except the most recent from 200 to 300.  And even then I got some irritability (see my posts from last week and weekend).  In my case it went away within 3 days.  But you may take longer to get stable on lamictal, which has metabolites with all kinds of weird half-lives.

And more wellbutrin made me manic, even on 200 of lamictal.  So be careful, my friend.

(edited because I couldn't spell "Sam")