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For the last few weeks the mania episodes have been breaking through my meds. It was so bad last week I was rapid cycling all over the place.. I called the Pdoc on a emergency basis and he immediately called me back... I was not halucinating and still able to keep myself together. His response was to up my dosage of Lamictal to 100mgs in the morning and 200mgs at night. Because I am titrating from 200mgs up to three hundred I am getting the usual side effects of change in dosage..

My question to the board is: the normal dosage is 200mgs,,,, I know that others take larger dosages on the boards... at what point should I worry about toxicity or too much in the system... Also,, is a Lamictal increase a good way to help with mania or hypermania?

I also take a low dosage of cymbalta.... for six months this combo and Klonopin have kept the depression and anxiety to the lowest levels I have been in years.. I was feeling that I was stablizing until last week...

Any help would be really appreciated!!!

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i dont really know what you mean by lamictal 'toxicity'.

i personally experienced this problem.  when i hit 200mg, i went insane. i hit a full blown manic episode. hallucinations, no sleep for days, crawling out of my skin insane. it was horrible  ;)

i added topamax to the mix and upped my lamictal to 250mg and it REALLY helped me. anyway...

because i got stuck in a mixed state a while back we upped the lamictal again to 300mg and it knocked me on my ass. so...the 300mg really may help *you*.

im now at 275mg and its great.

again, this is just my personal experience.

tal.

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Hi icthus:

For epilepsy, 500mg of Lamictal per day is a very common maintenance dose, if and only if you do not take any medications containing valproate.

There also is a blood test that measures lamotrigine levels that may provide peace of mind.

Hope this helps.

Todd.

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Heya icthus:

1.  Supposedly no ceiling/toxic dose of Lamictal, as I've learned while looking at blood levels (in me) while on and off birth control.  Apparently, raw levels mean nothing.  This is like Neurontin and unlike Tegretol, as anticonvulsants go.

2.  Crappy mania effects seem to be common (according to CB people, and there are a lot of us) while titrating Lamictal, but also seem to be either transient or dose-related.  They seem to go away when people either increase or decrease their dose.

3.  No, Lamictal is *not* an effective treatment for mania.  If you are acutely manic, you might need lithium or an antipsychotic to bring you down.  Then, with luck, you'll be on a good dose of Lamictal which can supposedly stave off mania.

Without looking anything up, that's what I can come up with.

Hope this helps.

--ncc--

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Heya Todd,

Yah I missed the boat on that one.

Sorry, didn't mean to be obtuse.

Yes, overdose is possible, and has happened.

But nobody seems to know how much Lamictal you have to take to overdose.

That's actually one reason I thought it would be a good drug for *me,* because I would be concerned (if I was my doctor) about my increasing dosage without medical consultation.

Like Neurontin.  You/I **can** of course overdose, and I should have made that clear in my original post.

It's just that there's no *known* limit of dosage above which it becomes an overdose.

Seems very individual (as does everything related to this weird and wild friend) to me.

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I would like to thank the boards again for your help..

I get a little nervous when my Pdoc just says increase the dosage... It almost seems as if he never gave it any thought ... I trust him but have had experiences in the past where Pdocs have just increased as a trial... at my expense mind you!! "here try these,, Oh they didnt work well try these,, just up the dose,, too much.. well lets back down"

I too read and talked with GSK about over dose.. They said it can happen but did not give me a dosage.. This is what brought up my questions..

Thanx again for all the Help! ;)

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ncc, sorry, but it's not true that lamictal isn't good for controlling mania.  It just isn't good for controlling acute mania.  If you're not on lamictal and are manic, starting lamictal is probably not the first thing you'd want to do.

But everyone's right that until you hit a therapeutic dose, lamictal can be activating and get you feeling pretty manic.  However (lots of "buts" here, huh?) the strange deal with lamictal is that more is usually better.  AD effects occur at low levels; mood stabilization kicks in at higher levels.

Yes, 200 is the target dose for most.  But some of us need more.  Dosages for BP can go upwards of 400; if you take certain meds (tegretol, BC pills or hormone replacement) that make you clear lamictal quickly, you can take even more than that. 

So IMHO you could consider taking your pdoc's advice and increasing the lamictal.  Now that you've gone through 90% of the titration, it might well be worth it.  If you do hit your own private sweet spot you will feel wonderful, stable, and strangely normal. 

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ncc, you are so cute.  I know what you mean about making a mistake in a post.  I usually respond by rolling over on my back and exposing my neck so the alpha dog can chew on it to show how dumb I am.  I'm trying to get better about it.

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