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hi!

i have a few questions about it. i hope you can help me a bit.

i am not bipolar. but since antidepressants don't help me with my depression i now want to try other things. i asked my doc

about lamitcal and he agreed.

however lamotrigine seems like a totally different animal to me compared to what i tried so far which worries me .

i mean so far i only tried antidepressants. lamictal is totally different.

steve johnson syndrome is especially frightening to me. how quickly did you titrate?

my doc told me to start with 25mg and then increase 5 mg every 7 days. but this way it will take REALLY long for me to even reach 100-150mg.

 

i also don't know how do you even know if you have steve johnson syndrome? what if i get a small rash and then freak out? how do I know how to behave?

 

and what if I work myself up to let's say 150mg and then realize it doesn't work or that I get side effects how quickly can i get off it?

 

and how well does lamotrigine mix with other drugs like antidepressants, benzos, stimulants?

 

and what side effects does it have? i read some people get hair loss, acne or their memory is impaired.

how often does the memory impairment happen? since i'm a student I cannot take anything which impaires my memory. lyrica also made me feel

like me memory gets worse and this is why i got off it. if lamictal does the same then I dont know if i should even try it.

 

or are there any supplements or foods which you must NOT take when you take lamotrigine? i take a lot of stuff like:

fish oil, spirulina, B vitamins, vitamin C, vitamin D, L-Glycine (supposedly helps with ocd)

How do I know if any supplement which I take doesn't mix well with lamotrigine?

 

I also drink alcohol, is this a problem with lamotrigine?

 

 

Edited by regis
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Hi, welcome to CB!

I have been on lamictal for years without any problems.  The SJS rash is rare.  There are people who get it, but it isn't a common side effect.  If you get ANY type of rash though, I would get it checked out.  Sometimes people might get a rash that has nothing to do with SJS.  

It is a very slow titrate up.  I would go by what your psychiatrist (pdoc) says to do.  I started at 25 mg, then worked my way up very slowly to 200 mg, currently.  If you are at 150 mg and have side effects I would try to wait it out because they might wear off.  The exception is if your DR says to come off of it, in which case you'd wean down off of it.  From what some people have said here on CB, it is a rocky titration.  I did not have that problem though.

I am on Prozac, Wellbutrin, xanax, and klonopin with no problems, along with other meds (see sig).

Side effects can vary.  With all the meds I am on I am not sure what causes what at this point, but I do have hair loss from something.  My memory sucks, but that has started recently, many years after starting lamictal.  It could be from anything, or not even related to meds at all.

About the supplements, you'd have to run those by your DR, either primary DR or pdoc.

Drinking alcohol is a bad idea for anyone on meds.

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Yes, lamotrigine does take quite a while to titrate to a therapeutic dose. You have to also come off it in the same way, through a slow titration. My titration was similar to melissaw.

In my experience, I didn't have an interaction problem with other supplements or drugs. The major side effect that bothered me was the cognitive problem. It did seem to affect my memory and word recall was a little harder.

If you mix lamotrogine with alcohol then you will have a very bad hangover the next day.

Just my experience, but people react to meds differently.

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This worries me. If it is known to make memory worse and if getting off it also takes a long time then I dont know if I should get on it.

What if I work myself up to 150mg and then notice my memory gets too bad on it and then I need months to get off it!? As a student I cannot really afford this.

I have really important exams next year.

I already worried about my memory when I was trying out lyrica and I felt paranoid cause I couldn't tell if my memory was getting worse or not. I mean this isn't easy

to find out. I may not remember something and then I don't even know if this is normal or not. How shall I find out if it affects my memory or not?

 

And I also read that lamictal worked really well for some people at a certain dose let's say 50mg and then when they got higher it stopped working and when they went

back to 50mg it also didn't work anymore! Is this so? Then how shall I know when to stop? If there is some kind of magical dosage which if you go higher stops working

then this would really suck.

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Unfortunately, it really is trial and error with lamotrigine. However when it works for people, it seems to work great. It really seems to be an all or none medication. Your pdoc will help with your titration and determine if you've stabilized at a level.

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Just because others have gotten the side effect of memory impairment, doesn't mean you will.  Everyone is different, and everyone will experience the side effects of the med differently, if they even have any side effects to begin with.

And like sam78 said above, it is trial and error to start/stop any medication.  You have to trust your pdoc that s/he knows what they are doing, and will only do things in your best interest.  I hope you have a pdoc you can trust. 

How do you determine memory loss from no memory loss?  Everyone now and then forgets a word or something, but that isn't memory loss, IMO.  Memory loss, IMO has to do with it interfering with your life.  You might not even get the side effect of memory impairment to begin with though.  So I wouldn't worry right away, FWIW.

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One of the potential symptoms of major depression is cognitive issues, including memory and word recall. So, one has to ask oneself -- is this the medication or my [still untreated] condition?

I'm just entering my second month with lamotrigine (I titrate up to 50mg tonight -- started at 12.5mg and then 25mg after two weeks) and aside for some agitation along the way, no major side effects. I already had some cognitive issues beforehand, so it's hard to say if lamotrigine has made them worse -- but I'm having cognitive testing in a few weeks and will have at least a baseline after that.

My other possible diagnosis (although it's likely to be bipolar) is drug resistant depression. My p-doc said he'd treat both the same way: start with lithium and then add lamotrigine if the depression doesn't life (it didn't).

Lithium is also another, although not very often used, treatment for unipolar depression. Lithium's a fun game; if you want to know more, there's lots to read on here, or ask. :)

Finally, I'm not your mother, but please consider the not drinking whilst both switching meds and trying to get better. It's a false economy -- I speak from painful experience here.

Good luck.

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I have recently gone to 200 mg. It certainly was kind of a jolt with each dosage increase. Symptoms that I was having would increase over a few days then calm down again. It seems to take a long time to really have it be highly effective, both from my own experience and what I have read from others' experiences.

I see the Pdoc again in 4 weeks, so by then I can hopefully have some solid feedback to him on if it seems to work, and see what he says about the dosage. He told me that his target dose is usually 200mg but higher doses are not uncommon. Again it's about only taking as much as you need for it to be effective.

It's helped my depression for sure, but I'm still tackling my anxiety for which I take some Vistaril. People have had a lot of mixed reports on Vistaril for anxiety but if I take it 3x a day I seem to do better. As always YMMV.

I have stopped drinking altogether. I was not much of a drinker to being with, but I figure it's one less variable to try to weave into the equation. I've also been meditating at least once and usually 2x a day. The meditation has been recommended to my by so many people, and they say it just works better and better over time.

For the memory loss - I have noticed some word loss and "blankage". I've never remembered names very well so thanks a lot Lamictal!!

I did not really have/or are having any other side effects from it. I guess the only thing is that early on I felt like it limited my energy. In some activities it was like my power dial could only go to 85% and no higher.

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Hi everyone,

if you're on a high dose of lamictal let's say 200mg and decide you need to get off it then how quickly can you get off it? Do you also have to go in 5mg per week steps!?

Cause then it would take awfully long before you're off it again which is scary.

 

Also how high did you start? My doc told me to start with 25mg and then increase 5mg every week. But why start directly with 25mg?

Wouldn't it be better to start with 5mg and then increase every dew days with 5mg? What if 25 is too high to start with and then you get SJS?

I mean if SJS occurs when you dose too high and too fast then to me it seems better to start as low as possible which would be 5mg.

 

Also what happens if you miss a day and then take your usual dose could this also cause SJS when you're on a high dose 100mg or more?

 

Another thing which worries me is that my doc looked up lamotrigine in his pharmacology advisory booklet and the author says in there that lamotrigine

must not be taken with sertraline (even though this is a common combo). I don't know the exact explanation but somehow both drugs seem to affect each other

and when you take sertraline then lamotrigine cannot be metabolized the way it is normally metabolized and then it's metabolized in some other way and this

causes toxic byproducts in the body which raises the risk of SJS. What worries me about this is that I cannot really find anything online about this drug-drug interaction

between sertraline and lamotrigine and if this rarely known interaction exists then what if other drugs also should not be taken with lamotrigine and we don't even know

it yet? Then whenever you have to take another drug you must always be afraid and think what if this drug somehow interferes with lamotrigine? This really sucks.

My doc also told me if I want to start lamotrigine then I have to get off vortioxetine first because vortioxetine is so new and it's not possible to know if it's really safe

with lamotrigine. :(

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regis -

These are questions you really need to talk over with your doctor because no one here can give medical advice. That said, I believe that 25 mg is the usual starting dose unless you are taking some other drug that interferes with its metabolism in some way, namely Depakote or Tegretol. I take lamotrigine with a whole host of other meds in my cocktail, and I've never had a problem. I think you're over thinking this and are freaking out unnecessarily.  

Let your doctor do the doctoring and keep away from reading pharmacology books. 

Edited by jt07
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I started at 25 mg lamictal and worked my way up to 400 mg/day.  My DR says not to go off of it too fast. It might take awhile to go off of, but better than having any side effects.  Right now I am on about 14 meds, one being lamictal, and I have no side effects.  My memory sucks, but it is most likely caused by the combo of all meds.

regis -

These are questions you really need to talk over with your doctor because no one here can give medical advice. That said, I believe that 25 mg is the usual starting dose unless you are taking some other drug that interferes with its metabolism in some way, namely Depakote or Tegretol. I take lamotrigine with a whole host of other meds in my cocktail, and I've never had a problem. I think you're over thinking this and are freaking out unnecessarily.  

Let your doctor do the doctoring and keep away from reading pharmacology books. 

I agree in full with jt. 

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Wow! 14 different meds.

 

How do you make sure that there are no drug-drug interactions? What really freaked me out is reading in a book that sertraline supposedly makes the blood levels of lamotrigine

go up and that this is dangerous. This was absolutely new to me and I also could not find anything about this in Stephen Stahl's books and his books are the standard.

But at drugs.com it also mentions this interaction and now I'm even more worried cause I used to think that if I read all the popular books about psychopharmacology and check the interactions then I'm safe but obviously there are interactions which aren't even mentioned in the books.

 

http://www.drugs.com/ppa/lamotrigine.html

Sertraline may elevate lamotrigine plasma concentrations increasing the pharmacologic effects and risk of adverse reactions. Monitor the clinical response of the patient. If an interaction is suspected, adjust the lamotrigine dose as needed when starting or stopping sertraline.

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Once again, you are over-thinking this. And who is Stephen Stahl, and what standard does he purport to meet?

Talk about this with your pdoc. You are really working yourself up over things you can't know. I know it would be nice if you already knew what was going to happen, but unfortunately, psychiatric meds don't work that way.

25mg is the typical starting dose. I was on Depakote when I started it, so I started at 12.5, but that is because of an interaction between Depakote and Lamictal.

And I am sitting here scratching my non-SJS, lamictal rash on my forearm. As far as side effects go, that is pretty mild. I did have some word finding difficulty at first, but not anymore. Many, many side-effects go away with the passage of time.

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Wow! 14 different meds.

 

How do you make sure that there are no drug-drug interactions? What really freaked me out is reading in a book that sertraline supposedly makes the blood levels of lamotrigine

go up and that this is dangerous. This was absolutely new to me and I also could not find anything about this in Stephen Stahl's books and his books are the standard.

But at drugs.com it also mentions this interaction and now I'm even more worried cause I used to think that if I read all the popular books about psychopharmacology and check the interactions then I'm safe but obviously there are interactions which aren't even mentioned in the books.

 

http://www.drugs.com/ppa/lamotrigine.html

Sertraline may elevate lamotrigine plasma concentrations increasing the pharmacologic effects and risk of adverse reactions. Monitor the clinical response of the patient. If an interaction is suspected, adjust the lamotrigine dose as needed when starting or stopping sertraline.

I wasn't sure of drug to drug interactions.  I had to try the meds first before i knew.  I know the potential ones, but I really didn't have lasting side effects of the meds I am on (if I had I wouldn't be on them now).

Like said before, you should really ask your pdoc about all of this, and trust your pdoc to help you out.  If you don't trust your pdoc, then I'd suggest finding a new one.

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But the problem is my pdoc is rather young and not very experienced. I clearly notice this when I ask him questions.

But he is the best pdoc I could find others were even worse. When I ask him something he usually needs to look it up in his advisory.

This is why I also do not have that much trust in his advice.

 

I read lamictal can cause a rash in 10%. But then how shall I know if it's a serious rash or a harmless rash? I have GAD. If I got a rash I'd freak out. Great. :(

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Lamictal has a WAY lower incidence of SJS than that. The statistics: Stevens–Johnson Syndrome (SJS), a dermatological emergency is a rare condition; with a reported incidence of around 2.6 to 6.1 cases per million people per year with a mortality rate of around 5%. That is per *million.* And the mortality rate isn't even as high as your estimate of SJS as a whole. We do have some people on the boards who have had SJS, but we attract the "hard cases." People who are stable aren't seeking out places like Crazyboards.

Some of the people who got SJS regret it because they liked lamictal so much. That is worth mentioning.

If you develop a rash, call your pdoc right away. S/he may decide to pull you off of it. But, anti-convulsants often cause rashes. I have a rash on my left forearm from lamictal right now. It's clearing up, though. I've been on it for 8 or 9 years now, so I don't have to worry about SJS.

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