Lamictal - Therapeutic Level

[revlow]

I'm BPII, lifelong refractory MDD. I need some advice/feedback from people who know. Been on Lamictal since late Aug., very slow titration, now up to 125. Well, actually tonight will go up to 137.5 -- titrate up by 12.5 every 3 or 4 days now. I'm also titrating off Cymbalta, now take 30 mg. every 4th day (I divide into fourths, so approx 7.5 a day) -- my doc's been having me stay at this level of Cymbalta for several weeks.

Been reading CB for probably 1.5 months, which was extremely helpful in getting through some very unpleasant SEs (yup, the headache and muscle aches). These SEs are pretty much gone.

I've been posting in the past couple weeks. I think doing so has helped me to realize my ability to focus and concentrate is coming back, as well as the process itself helping me to focus. (Sorry...very convoluted sentence.) I think I'm pretty well past the mind-numbing, soul-robbing depression. I also think I might be getting a bit hypomanic, sort of too obsessive/compulsive about these boards! (Can CB become addictive?! Yeah, I already know the answer to that...anything can become addictive!)

I'm wondering...how do you know when you've hit a therapeutic level with Lamictal? I know that might sound simplistic, but I don't think it really is. I don't think it's just a simple "When the depression lifts" kind of answer. Or do you just "know" when you've hit the right level?

I can't rely on a pdoc or tdoc to help me through this. There are none in the small town where I live, I don't have a car, and even if I could get to the nearest city about 45 min. away, from what I know they're not very good (I did try one tdoc there...a complete waste, and I just can't deal with the strain of trying to get there to see another crap shoot). I do have a wonderful internist, who not only is the doc prescribing my Lamictal, et al., but is very attuned to where I'm at (and is an incredibly brilliant doctor -- he's one of the guys who first identified CFIDS -- as well as caring person), so that may easily be enough. But I would love to hear people's own stories of how and when they knew. (Geez...sounds a lot like love, doesn't it?)

Any feedback greatly appreciated.

[Loon-A-TiK]

First, welcome to the CB community! You have a place here to learn about your condition(s) and inform yourself on what you're putting into your body, wtih as much as us crazy but not medical professional people can tell you about our own experiences. It isn't weird, in my opinion, to be very very interested in our boards and want info. I love CB! I'm interested in the science and it helps me feel not so unique, not so alone. It is safe to "come out" here, because no one has to see our faces or know our names, though I am getting ready to actually post my pic and not my nice angel pics. This would be a big "coming out" step to me, like telling the world that I was a lesbian (I'm not a lesbian).

For all the world to see me and identify me on the street, I live in Lakewood, Ohio, and know I'm a LOON!!! This would be de-stigmatizing I think, like coming out as LGBTA.

So, about Lamictal- and this for me has held true for the majority of my psych meds- Lamictal's usual "target" range that they've found in studies to work best is 200mg. Many people, especially women, take more, because the birth control pill makes Lamictal clear twice as fast/heavily, so 400mg to my body really means I'm taking 200mg.  It is likely that your pdoc/internist/whoever will want you up to 200mg somehow.

With a BP2 dx, that covers the MDD. That dx is included in the BP2. You just have more depression than hypomania. BP depression can really suck. BP1 people spend about 3x as much time in depression than they do in mania, and BP2 people about 40% more time. The Lamictal is very good against BP depression but will only hold so much against mania. But you haven't indicated too much of an issue with mania.

Why such a slow titration? The "RASH" isn't as big a deal as people make it out to be. Personally, I had zero side effects from Lamictal. I love it. But different people have varying experiences.

Cymbalta seems to be the trend right now, though everyone I've met (including my mom) who has taken it has hated it, HA!

**********

Finally, after all that, to answer your question, only you can know when you're at your best dose. You will just feel stable. You can up the dose to see if you are more stable on a higher dose, and play with it that way. I needed the "top dose" that my pdoc thought made sense without the addition of a second mood stabilizer. You may do well with 2 mood stabilizers as well, and maybe the AP group would be a good place to look. Seroquel is being taken to the FDA with very robust trial results for approval to treat BP depression along with the BP mania it is already approved for, making it, along with Lamictal, the only drug FDA approved for monotherapy in BP. And it was also tested and tried in BP2. They didn't ignore BP2 this time!

peace

Loon

[sirwriter]

I'm BPII, lifelong refractory MDD. I need some advice/feedback from people who know. Been on Lamictal since late Aug., very slow titration, now up to 125. Well, actually tonight will go up to 137.5 -- titrate up by 12.5 every 3 or 4 days now. I'm also titrating off Cymbalta, now take 30 mg. every 4th day (I divide into fourths, so approx 7.5 a day) -- my doc's been having me stay at this level of Cymbalta for several weeks.

Been reading CB for probably 1.5 months, which was extremely helpful in getting through some very unpleasant SEs (yup, the headache and muscle aches). These SEs are pretty much gone.

I've been posting in the past couple weeks. I think doing so has helped me to realize my ability to focus and concentrate is coming back, as well as the process itself helping me to focus. (Sorry...very convoluted sentence.) I think I'm pretty well past the mind-numbing, soul-robbing depression. I also think I might be getting a bit hypomanic, sort of too obsessive/compulsive about these boards! (Can CB become addictive?! Yeah, I already know the answer to that...anything can become addictive!)

I'm wondering...how do you know when you've hit a therapeutic level with Lamictal? I know that might sound simplistic, but I don't think it really is. I don't think it's just a simple "When the depression lifts" kind of answer. Or do you just "know" when you've hit the right level?

I can't rely on a pdoc or tdoc to help me through this. There are none in the small town where I live, I don't have a car, and even if I could get to the nearest city about 45 min. away, from what I know they're not very good (I did try one tdoc there...a complete waste, and I just can't deal with the strain of trying to get there to see another crap shoot). I do have a wonderful internist, who not only is the doc prescribing my Lamictal, et al., but is very attuned to where I'm at (and is an incredibly brilliant doctor -- he's one of the guys who first identified CFIDS -- as well as caring person), so that may easily be enough. But I would love to hear people's own stories of how and when they knew. (Geez...sounds a lot like love, doesn't it?)

Any feedback greatly appreciated.

[sun_zoom_spark]

I think you have to consider your cocktail when determining the right dose where Lamictal will really help. I take lithium too so there's no telling what will happen until you get there.

At 50 mg. I started to feel a little better. Nagging mild to moderate depression starts to fade a little. Seventy-five and one-hundred the same. A little better.

Then I started to take a dose in the a.m. at 25 and 100 at night. I felt totally strange the first day. Day two I felt like a million bucks. Stayed that way for two weeks. Upped the morning dose to 50 mgs., 100 at night. Went into a state of agitation and the anxiety that left me six months ago came back to greet me. Dropped back down to 25 in the morning for the last two weeks and I'm going to stay there until I see my doc in two weeks.

I've never been able to get that feeling back that I had four weeks ago. Go figure. These damn drugs do wonders for your head.

[revlow]

Thank you all. I appreciate all your feedback, and look forward to any other postings as well.

Loon-A-TiK: Yes, I think I can say simply that I'm BP II now. Until recently, the only doctor to mention that as a possibility was in 1991. Other than that, I'd just been referred to as "refractory depression". After reading more and more (especially http://www.psycheducation.org/start/BPIntro.htm ), I think it's safe to say I've always been bipolar. Among many other "Soft Signs" of bipolarity I also have, the too-many-treatments-tried-to-list refractory depression itself, plus the fact I've been severely depressed for as long as I can remember seem to scream it. There may be differences between researchers as to the age of onset before the first episode of major depression as an indicator, but none of them list before age 4.

I do have some Qs as to if I have some other type(s) of BP...mixed states, NOS. But in the long run, I don't think specific label matters as much as knowing I'm somewhere on the bipolar spectrum, and that I'm finally (at age 50) getting the meds I need. Yea!

This place is great. Thanks again!

[Batou]

revlov,

As always YMMV, some people feel depression lifting at a dose as low as 25-50mg. Lamictal is more likely to show a noticeable difference 100-200mg.

For me, at 200mg I really began to feel better but then it seemed to poop out. As sirwriter said, the Lamictal PI sheet and some research says that there is no measureable therapeutic difference between the 200mg vs. 400mg dose, however, I did notice a difference at 400mg.

I have taken 400mg for almsot for two years now. For a short period of time I even took 500mg.

[Todd]

Hi revlow:

I mostly have had an odd, hate relationship with Lamictal from the very beginning, but we have learned that I need it more than it needs me. My pdoc and I set a target dose of 200mg from day one. I did a slow titration to 100mg, and did not notice any benefit. I took another four weeks to get to 200mg, and started to notice an antidepressant effect at that time. I was six months into the great Lamictal experiment before I felt that it helped bring some stability into my life. From 200mg, I tried 225mg, better, 250mg, not better, so 225mg is my final resting place, my therapeutic dose.

I was very patient with Lamictal. We only made one change at a time, so it was pretty easy to tell what was the dosage changes did for me. I still like to think that I hate Lamictal, but I also consider it the cornerstone of my cocktail. It kicks my bipolar depression in the ass

[revlow]

Thank you both, Todd and Erika.

Erika, have a Q for you: are you taking oral contraceptives or other hormones? Just wondering, since woman taking these may need higher doses. (The hormones increase the clearance of Lamictal from the system -- you probably already know this.  ) I'm on BC pills, so I think it may be likely I'll need a higher dose in the long run. Just wondering if that's the case with you...or is it simply the "some people just need the higher doses" thing happening? (I was on 450 mg. of Effexor for years, so I know that can be the case.) I don't know, maybe I'll start an informal poll of women taking Lamictal here?

Todd: I like "Lamictal does the job for me, it's just not a big talker, and is insiduous in its methodology." Not sure if this is the same thing, but I have a feeling that this titrating experience with Lamictal is going to be like nailing a blob of mercury. I've already had positive effects come and go, like 4 great nights of sleep in a row (1st time in my life), then - poof - gone. Funny stuff, isn't it?

 

[Guest me]

lamictal makes me feel heavily medicated.

[revlow]

lamictal makes me feel heavily medicated.

<{POST_SNAPBACK}>

How long have you been on it?

[Steve@3AM]

Rev -

Thanks for the thread!

Todd -

Your response was very helpful to me. I'll try to look for the more subtle effects and try to sort out the differences between Wellbutrin and Lamictal. Keep titrating upward.

Steve

[tallulah]

hey rev.

lamictal has been my wonder drug. i am bp1, and refused lithium/depakote treatment (mainly because i never thought i was that sick. heh. silly girl, slap! doc is still yelling to get me on lithium). my doc then suggested lamictal therapy and it worked wonders for my depression. i had some ups and down as far as doses went - lamictal also brought out mania after 200mg, but did shit for my depression until 250mg. so we added topamax which i take 300mg for, which really stabilizes me.

ive been stuck in a horrible mixed state for over a month, so we've upped my lamictal dosage to 300mg.  right now im having a problem with being overly tired (which is strange because its ALWAYS been activating for me?) so we'll see how it goes over the next little while.  ive always taken my meds in the morning, so im going to have to split now - 200mg in the morning, 100mg at night.

waiting for that good spot again. may have to go down to 275mg, see if that makes a difference...OR go a bit higher.  maybe add something or see if lowering topamax makes a difference. who knows.

the land of crazy meds...enjoy your ride.

[revlow]

Thanks to all for your continuing replies. (You're welcome, Steve!)

I developed a rash a couple of weeks ago and was very disappointed and upset.

[FrogBox]

I'd echo what Todd said: it's kind of "Whoa, I feel kinda normal. How long have I been like this?"

I didn't get anything till I hit 100-150mg, and at that dose I was still up and down, but I could feel it slowing and getting less intense. I've been at 200mg now for a few months, and I feel great. My moods are very stable, prolly better than a 'normal' person, but I'm still struggling with the emotional/relationship aftermath. But that's not something chemistry can ever fix...

[revlow]

I'd echo what Todd said: it's kind of "Whoa, I feel kinda normal. How long have I been like this?"

I didn't get anything till I hit 100-150mg, and at that dose I was still up and down, but I could feel it slowing and getting less intense. I've been at 200mg now for a few months, and I feel great. My moods are very stable, prolly better than a 'normal' person, but I'm still struggling with the emotional/relationship aftermath. But that's not something chemistry can ever fix...

<{POST_SNAPBACK}>

Thanks, FrogBox.

I'm at 150 mg. now, generally feeling better. Definitely the severe depression has lifted -- but still not quite sure yet what "normal" is going to be. Saw my doc yesterday; he says he think I'm almost at the right level, doesn't think it will take too much more. Says he wants to see what happens to my cycling...but since I've never really been aware what my cycling actually is, I'm kind of clueless. I've just always been depressed, sometimes extremely. I've also generally been kind of hyper (fast thinking, fast talking) often at the same time, but always fatigued -- my description of it is being "tired, but wired".

I'm still unsure what type of BP I have. I asked the doc yesterday, and he said that he wasn't ready yet to make a firm diagnosis, but that so far I've been responding to the Lamictal similarly to other BPIIs he's treated. He is really a super doc, very tuned into me and my moods -- so I trust him, and I'm sure he'll help me figure this out.

At this point, I don't feel quite ready enough to start looking work again. No real emotional/relationship aftermath for me to deal with (helps not being in a relationship and not having any friends )...but I sure have an awful lot of financial crap facing me.

It is good to hear from others what their experiences have been.

Thanks, again.

[Steve@3AM]

Yeah, "helps" a lot!! 

It eliminates the "stress" of trying to deal with a relationship - but it also doesn't "test" you - so the relationship thing remains a scary unknown. If the opportunity ever comes around again we'll see whether it helps the panic!

If not, I guess I add more - or different - meds and hope for another opportunity!

[ncc1701]

Heya revlow et al,

Yah I'm not sure Lamictal i175 (should update my sig) is the end of the story.

I see my psych for the first time tomorrow, finally, cripes it's been a long haul.

I wonder about augmenting with Wellbutrin.  I wonder about bumping Lamictal.  I wonder about something for social phobia, like maybe propranolol.

Rage and nightmares are gone.

But, still sad and fragile, you should have *seen* how I freaked when CB was offline lastnight.

And, still scared to death of people.

Still, without Lamictal, I wouldn't even know I *had* these sadness/fear problems.

I'd be too angry.

Good luck with your own search!

--ncc--

[Batou]

Erika, have a Q for you: are you taking oral contraceptives or other hormones? Just wondering, since woman taking these may need higher doses. (The hormones increase the clearance of Lamictal from the system -- you probably already know this.  ) I'm on BC pills, so I think it may be likely I'll need a higher dose in the long run. Just wondering if that's the case with you...or is it simply the "some people just need the higher doses" thing happening? (I was on 450 mg. of Effexor for years, so I know that can be the case.) I don't know, maybe I'll start an informal poll of women taking Lamictal here?

<{POST_SNAPBACK}>

revlow,

I am not on any kind of birth control or hormone replacement. I seem to have a high tolerance for medications in general, plus my moods have been stubborn about stabilizing.

[revlow]

Thanks, ncc1701 and Steve@3AM. 

Yeah, Steve...it's a bitch isn't it? My last real relationship was maybe 9 years ago, and it was so insane and miserable that after that (and several other bad ones before), I pretty much decided I didn't really trust either my judgement or my ability to actually have a healthy relationship with my depression. The only friends I've made have been through work -- and once I'd lose my job, I'd lose my friends. I'd try to keep up the friendships, but no one else would follow through. For which I really can't blame them, given how much *fun* it is being around depression (as well as someone who's been pissed off most of the time).

I don't seem to miss the relationship stuff as much as I do having money, and knowing that I could keep a job. Immediately prior to my writing this post, I had to ask my father (who of course barely understands this illness) for money to help pay my rent and my insurance premium. I can't describe how much I *hate* doing this. (I'm not some kid -- I'm 50).

All I can do is hope that I'm finally on the right path med wise, and maybe -- just maybe -- the rest of it will work itself out. I know I'll have to put in the effort, but I'm hoping to have some sort of "platform" of basic emotional stability on which to build first. I've tried it without this, just gutting it out and white-knuckling it trying to be "normal" -- and god knows, that doesn't work!

Thanks again.

[revlow]

Thanks, Erica! Didn't see your message when I posted my last one.

[Steve@3AM]

NCC -

There seem to be a lot of similarities between your thoughts here and mine. Probably not working from same "problem" base but I am doing the Wellbutrin with the Lamictal. I wish I had stuck w/ Lamictal by itself, but that's a problem when 2 docs are involved! 2nd one decided I should go back on Wellbutrin without waiting. I can't tell which is doing anything - or not - yet. I feel "somewhat" better, but haven't really tested it in more personal social situations.

I was also thinking about propranolol. From what I read, however, it didn't really seem to be the right choice. There was another one called  ? (forgot!) that  is similar but supposed to have longer term action. It still didn't sound right for "long term" anti anxiety. Maybe I need to add a regular anxiety med to the mix? (Besides, one of the possible side effects of propranolol was "loss of libido" and that would seem to defeat part of the purpose! ) (I need all I can get!)

Like you - and probably a lot of others - My anxiety level increased a bunch when the site went bye bye! It made me realize how much I really NEED these boards and a few people in particular. The thought that I had no other way to connect with them if this site goes away is still really scary. But I don't know what we can do about it aside from giving out personal e-mail addresses. Probably not a good idea - in general. Maybe to a few select people?

I consider myself "relatively" stable - though I'm beginning to figure out how shakey the foundation really is! I REALLY felt sorry - or scared - for those who are less stable. It could have been a major disaster, I think, for some people.

Steve 

[ncc1701]

Heya Steve,

Yah it makes me think -- at times when I was even less stable -- the loss (however temporary) of CB would be even more devastating.

I too have mixed feelings about the safety of giving out email addresses to internet friends.

I might make up a new one solely for that purpose, which I can stay away from/delete if needed.  Don't know.

Good point about propranolol.  I hadn't thought of that, to be brutally honest.  Beta-blockers *can* mess up libido.

And like you I *don't* need that side effect.

Hm.

Let me/us know how the Lamictal/WB combo works for you.

I'll ask my new psychiatrist tomorrow.

--ncc--

[Steve@3AM]

Good suggestion re "special" e-mail addresses. I guess my current e-mail has that ability. I'd just never figured a use for it. Maybe I'll look into it and then send it to the people I feel most connected with. (Probably best to PM the person first to see if they want it!  )

[revlow]

Yeah, I know...I was really concerned last night for some of the people (especially newbies) I'd known had already posted some pretty desperate messages. In some ways it was kind of good for me -- after the initial shock. Temporarily made me take a break from my CB addiction! Good for the neck and shoulders to actually get away from the computer now and then! 

I'm curious...propranolol? I'm unfamiliar with its psych use. Only know it as a treatment for high blood pressure and chest pain; personally I use it in the early 80s briefly to help prevent my headaches. So, it's used this way as well. Hmmm...this wacko brains stuff gets more and more curious all the time.

I was on only a couple of *crazy* med combos in the early 90s, so at least I've pretty much been able to tell what's effected what -- with the exception of now, I think, just because I am looking at the whole picture. Not just looking at the depression, but the whole kit and caboodle. I am still taking approx. 7.5 mg of Cymbalta a day, so??? But I never felt it did anything for me in the 1st place. For the time being, my doc wants me to keep that tiny bit in my body.

The only combo I really remember from that time in the 90s was when I was tried briefly on lithium and Tofranil. When it finally kicked in it was great! I felt wonderful (in retrospect, I think I was probably a bit hypomanic). But then it pooped out after 4 days! And no amount of trying to tweak the amounts made a difference. I can't tell you how depressed that made me.

But then, I was in an open Effexor study. Effexor worked fairly well for me for several years (then pooped out). However, now looking back on it, I wish the BPII idea had been pursued more back then as well.

PS - I just read ncc1701's new post (arrived as I was writing this). I think what ncc1701 means is to create a new account at one of the freebie email places, like hotmail, etc. Is that what you meant, ncc1701?

[Steve@3AM]

Rev-

Oh ! - but wouldn't it still work with just a "secondary" e-mail address that you could dump? - I do remember, now, reading about doing this for some communications that might draw spam.

I've seen Propranolol being used for "stage fright"/performance anxiety. Not long lasting. And not the kind of "performance" I was concerned with!

[ncc1701]

Heya revlow and Steve,

Actually, depending on your server, either email option would work.

I just made one up on my current server; I have done this before and deleted it after one use.

I also have a couple of throwaway emails on hotmail.

And for propranolol -- as I've posted elsewhere, I didn't think about the libido stuff, which I *really* don't need.

I was thinking more for surviving Christmas.

--ncc--

[revlow]

Oh ! - but wouldn't it still work with just a "secondary" e-mail address that you could dump? - I do remember, now, reading about doing this for some communications that might draw spam.

<{POST_SNAPBACK}>

Not sure what you mean -- do you mean creating a secondary account at one of these freebie email services? If that's what you mean, then yes...exactly. A dumpably 2nd account. Pain in the ass if you are used to using an email client like Outlook, 'cause it means you have to check your email in two places -- the regular "POP" email in your email client; the web-based email (like hotmail) in your browser. But if you're already using web-based email, then creating another account at the same site should make it pretty easy to keep track of your email. (I hope this makes sense )

If you're talking about creating a 2nd account through a POP mail account (like the kind you usually get with your Internet service provider), then I'm not sure how you can do it -- that is unless you get multiple POP accounts with your ISP account. (Again, sorry...this is a very convoluted answer.)

I've seen Propranolol being used for "stage fright"/performance anxiety. Not long lasting. And not the kind of "performance" I was concerned with!

<{POST_SNAPBACK}>

Oh, of course! I'd forgotten about that use. The term "stage fright" brought it all back.

[revlow]

ncc1701:

Ah...just read your answer. Much better than mine!

However, when you say server, I assume you mean that you have your own domain name, right? Then that's a breaze...you can set up accounts till the cows come home. But it also means that people know your domain (the "whatever.com" part of "secondacct@whatever.com"). 

[Steve@3AM]

No. I was thinking my ISP allows multiple e-mail accounts. Could then dump the temp one when no longer needed.

[revlow]

Steve: Perfect. Actually I should look into that with my ISP as well. No...I'm going to look into it! 

[NARS]

Wow, your original Q was a long time ago, Rev, but I wanted to point out that lamictal has 2 different effects for many people: 1) an AD effect that can show up with as little as 25mg and increases until you hit something like 200mg (assuming no meds that change lamictal's clearance from your system), and 2) a mood stabilizing effect that doesn't really kick in until somewhat higher doses, usually 200mg or more.  These effects were quite distinct; I didn't get any stabilization until I hit around 100 or so, was much better on 200, and considering the wellbutrin I'm taking 300 has been OK.

Propranolol: a marvelous medication for what I call performance anxiety.  When I'm in court or leading religious services my heart starts racing, I sweat like crazy, and my brain freezes.  This doesn't happen so much with lamictal, but I now take propranolol prophylactically (ooh, lots of syllables!!) when I've got a big event, a scary hearing, etc.  It just halts the feedback loop or whatever it is that winds me up so badly.  I can concentrate, I can live with my mistakes, I'm sane and reasonable, just as though I were in a normal situation and 200 people weren't looking at me. 

I read an article somewhere whining about how musicians and actors are using a "mind-altering drug" (propranolol) to enhance their performances.  Bunk.  Performers have been abusing alcohol and drugs as long as there have been performers.  At least propranolol doesn't speed you up, slow you down, or make you otherwise stoned.  It just stops the whole adrenaline thing.  Or something.

If you use it a lot it can give you metabolic syndrome or have other side effects.  It's not great for continuous use unless you really need the blood pressure thing. 

[revlow]

Wow, your original Q was a long time ago, Rev, but I wanted to point out that lamictal has 2 different effects for many people: 1) an AD effect that can show up with as little as 25mg and increases until you hit something like 200mg (assuming no meds that change lamictal's clearance from your system), and 2) a mood stabilizing effect that doesn't really kick in until somewhat higher doses, usually 200mg or more.

[sita]

This is my second time on Lamictal, titrating extremely slowly after a hot flash/fever scare the first time.  Both times I've noticed AD effects at 25mg.

But a funny thing happened this time.  I had just titrated up to 25mg (5 a week), and finally got a scrip for 25mg tabs in addition to the 5mg I had been using.  So I'm feeling pretty good, no fever/hives, and start the 25mg tabs along with a couple 5mg.  A couple weeks go by & I have a couple bouts of very depressive episodes, major irritability and even contemplate leaving my BF I'm so out of my mind.  Episode after episode.

Only to notice that the 25mg tabs look exactly like the 5mg I'm taking.  I call the pharmacy & the damn pharmacist *&((ed up, gave me 5mg tabs instead of the 25.  So I had effectively titrated down from 25mg instead of up.  I can't help but think it was tied to the episodes I'd been having....when he confirmed his error I cursed him out, hung up, and fell on the bathroom floor sobbing.  I realize how much we invest in drugs like this one, which has helped me in the past but which is not without its pitfalls and complications.....To date I've been on it about 3 months and am still only at 35mg.

Good luck. 

[revlow]

Good luck.

[revlow]

An Update: Well, I seem to have fallen back into depression the past couple of days. Not the most horrible yet, but definitely not as good as I'd been feeling for the past couple of weeks. I'm at 150 mg of Lamictal. I see my doc tomorrow. I've been at 150 for the past week and 1/2. I'd been feeling good since about 125 mg; my doc has had me titrating up at only 12.5 mg, so it's actually been about 2.5 -3 wks of feeling good. Now back to crap.

I'm not really aware of my "cycling" (being most likely BPII, and mainly depressed -- though hyper), so I guess this is a start? The last time I saw my doc (week and 1/2 ago) he said he thought I was getting close to the right dose for me, wanted to see when I'd stop cycling.

Last week NARS wrote:

Wow, your original Q was a long time ago, Rev, but I wanted to point out that lamictal has 2 different effects for many people: 1) an AD effect that can show up with as little as 25mg and increases until you hit something like 200mg (assuming no meds that change lamictal's clearance from your system), and 2) a mood stabilizing effect that doesn't really kick in until somewhat higher doses, usually 200mg or more.

[NARS]

Wow, that's a sllllllooooooowwww titration.  My impression was that once you get past 100, you can go up by bigger jumps without the side effects.  That was certainly my experience.  I went 2 weeks at 25, 2 weeks at 50, 1 week at 100, then straight to 200.  Actually had fewer SEs at 100 and 200.  My point is only that you're going up very slowly, so it will take you longer to get to wherever it works for you.  IMHO, of course, I'm not a doctor, yada yada yada.  Some people think more lamictal is bunk.  Some of us have experience huge relief once we go from 100 to 200, or from 200 to 300.  Or even 300 to 400.

Anyhow, I'm sorry it's rough right now. 

As for exactly what mood stabilization is, I don't know that there's an easy definition.  Yes, a mood stabilizer should stop "mood swings."  But in doing so, it should take the extremes out of all your moods.  The irritability should lessen, as should the anxiety, whether you're "depressed" or "manic."

I put those in quotations because I've come to realize that what I used to think was depression was actually some form of a mixed state--depressive thoughts and physical feeling at the same time that I had agitation and delusions, which led to irritability and anxiety.  The mix changed from time to time.  Sometimes I'd be more manic, all the way to pretty intense mania; and sometimes I'd get almost pure depression.  Most of the time I was in some kind of somewhat depressed mixed state.

Once I took mood stabilizers my mood was more normal, whatever that means.  And I stopped cycling in and out of mania, hypomania, mixed states, and depression.  I noticed my anxiety and irritability went down (ADs never did that!).  When I charted my moods between -3 and +3, I was right around zero most of the time.

I hope this is helpful.  I hope that you do get to try more lamictal just to see if it would work better at higher doses.  Maybe just maybe you haven't really gotten to mood stabilization at 150.  Maybe all you're getting is the AD effect, which would certainly poop out if you're not stable.  I don't know.  I just hope it gets better soon.

[revlow]

Thanks, NARS. Fortunately, I'm not one of those people who has to "fight" with their docs re: meds. He's really open to my suggestions. He just also happens to be conservative in his approach, which I generally appreciate. In this situation though, I'm going to be pushing to speed this up.

I've written about this elsewhere, but here it is again. My doc is my internist. I live in a small mountain town, no pdocs, no tdocs. He is exceptionally bright and keeps up on everything, including MI treatments. (This is also one of the 2 guys who first identified CFIDS, so again a very sharp guy.) He's very tuned into me, my symptoms, etc. But, of course, the down side is his experience is going to be more limited than a pdoc's in treating with Lamictal. He's used it with about 30 patients, they've all been treated successfully with it -- no poop-out, etc. I was the 1st patient he had with Lamictal side effects, the headaches & muscle aches, etc. So, I just might be more complicated than what he's used to, which wouldn't be the first time.

Thanks for the good thoughts. I'll let you know what happens.

[revlow]

Yet another update...

Saw my doc today and I think I may have found another piece of the puzzle. Here's the background: The last time I saw my doc, I came in with printouts of GSK's info on how hormones effect Lamictal, and vice versa. As we all know, not super concrete evidence, but something. I told him I was certain something is going on with my hormone levels. He has always been receptive to my questions and suggestions, so he ordered up some tests.

Well, they came back showing that my estrogen is in the basement. Super low, even extremely low for menopausal women. The last I knew (when I saw my ob/gyn in August) I was still in perimenopause -- but obviously that could have changed as well. My estrogen level now might as well be zero, it's that low. Could easily account for all the hair loss.

So, now my doc is very concerned that my estrogen level is effecting my depression. He wanted me to call my ob/gyn today, which I have done. Left all my info with his nurse. I am just hoping he will prescribe something over the phone and that I won't have to see him. It's very hard for me to get there. It's over an hour away, I don't have a car, my housemate's car runs like shit (and has shitty tires and transmission, which in the snow is a bitch), and -- yes -- there is absolutely no public transportation where I live. So, not easy. I explained all this to the nurse. Hopefully he will do this over the phone, but to be honest my guess is that he won't.

My doc agreed to my increasing the Lamictal to 175 mg, which still isn't much but it's something. I do understand his concern: he wants to go about this as systematically and scientifically as possible, and so long as my estrogen is out of whack...who knows what's going on.

So that's where I'm at now. Will keep you posted.

[revlow]

An update on the update...

Now I'm totally confused, and really pissed off. Heard back from the ob/gyn's nurse. At first she said the doctor said I was in menopause. Then she asked if I was still taking such-and-such (a name I'd never heard) for birth control. I said no, I'm taking Mircette (geez...just look at my friggin' chart, plus I'd told her on the phone earlier today!). She then said in that case, the doctor says it's normal, that the Mircette would cause the levels to show up that way on the test results.

Anyway, I'm so sick and tired of these doctors. I wish they would just communicate with each other! I'm still not very sure if the ob/gyn understands what symptoms I am having, such as the hair loss -- I mean his nurse couldn't even get my meds straight, so how can I trust she conveyed the rest? I think what I will do is to write a note to each doctor, making sure that all the issues are in writing, and asking them to speak with one another.

And here's the other Q: if the Mircette gives test results that look like menopause, how can the ob/gyn know that I am actually not in menopause? Wouldn't he have to take me off the Mircette and re-test? (Which I would dread, as I had to go off Ortho Tri-Cyclen this summer and be tested before he declared I was in perimenopause and prescribed the Mircette -- but how else do you know, right?)

I hate this mess.

PS -Okay, even further off topic than the rest...so a real threadjack here. I'm just so pissed right now that I'm going through all this perimenopausal/menopausal crap, and for my sister it was nothing. It might has well been a sneeze for all she went thorough. Ladies, you'll *love* this...she even liked the few hot flashes she had! She thought they were "kinda fun...a trip..."

Don't you just hate her?

[NARS]

I hear you, sistah.  I'm in the moonscape wilderness of the aging reproductive system myself.

Is mircette a BCP?  If so the lamictal and hormones are probably interacting.  I don't think it's anecdotal that lamictal is seriously reduced in your bloodstream if you take hormones.  The prescribing info doesn't say there's a chance of it; it says it reduces it by 40%.

And lamictal affects hormone levels; it seems to clear out oral hormones faster than usual too.  So the thing goes both ways.

Can you high thee to an endocrinologist?  You need someone who actually understands all our girly parts and hormones to make sense of this mess. And even though it'll be a drive, a doctor really needs to see you and talk over your labs with you to give you good advice.  Phone visits suck, even if the doc already knows you. As for me, I'm going to start up with a pdoc who spends a lot of time studying the effects of hormones, BP, meds, and all that.  Holistic, you know.

[revlow]

NARS:

Thanks. I know, from reading your posts elsewhere, we're both in this mess, aren't we? No fun.

The nearest endocrinologist is about 3 hours away. I know I've got to work out my transportation problems, but unfortunately that's not going to be anytime soon. For the moment I'm pretty much left to deal with the docs I have. I will be very interested in learning what you find out.

Mircette is a BCP. It's actually helped to diminish my hot flashes tremendously -- pretty well eliminated them. I'd been on Ortho Tri-Cyclen before. Mircette has a lower dose of hormones. Unlike Ortho Tri-Cyclen, which has 7 days of placebo, Mircette has only 2 days of placebo and 5 days of a lower dose than the rest of the month. The theory is it provides a steadier dose of hormones throughout the month. So far it seems to be working, as least with the hot flashes.

But this Lamictal/hormone balance is another matter. And with that I think I'm going to have to get persistent in getting these guys to work with one another. Or maybe I will have to figure out a way to get to an endocrinologist. It's a bear, though. Last winter I had sinus surgery and the ENT was 3 hours away (in good weather). Think of driving through a blizzard over the Donner Pass in a bad car and you get the idea. That's literally what I had to do almost every time I saw the guy.

I have a theory that women who had a difficult time in puberty will have a difficult time with menopause more often than women who sailed through puberty with no problems. I asked my ob/gyn if he thought this theory held water, and he said indeed it did. With my sister, she -- boom -- went through puberty, and -- boom -- went through menopause. It simply happened, no problems. With me, I had a miserable time with puberty and really didn't get everything straightened out till I was in my early 20s. Perimenopause certainly hasn't been much easier.

Let's keep each other posted. Thanks again!

revlow