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I went off Lithium yesterday, because of extreme tremor and major weight gain. Weight gain and a former eating disorder doesn't go together. That could send me straight back to hell.

At the same time my pdoc upped my Lamictal to 400 mg. Could that prevent classic BP1 manias? Is it enough?

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Heya Helena,

Maybe.  But probably not.

According to the PI anyway.

Lamictal is better than Li for lows, and Li is better than Lamictal for highs.

Suppopsedly.  YMMV.

Be very vigilant about your prelude to mania.

And diligent in the lifestyle stuff we're all supposed to be doing.

Hope monotherapy works for you, but I wouldn't hang my hat on it.

Ugh, I just read over  that and it sounds really pessimistic, sorry!

Try it and be vigilant, and you might need PRNs, but that's okay.


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Well, I'm hoping for the best. Even if I feel kinda pessimistic too... Worst case I can go back on Lithium I guess.

Lamictal has been great for depression, but I have no idea if it prevents mania for me.

Hoping for the best. Cross your fingers people!

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I looked at the BP consensus study a little while back.  It's a survey of the more experienced pdoc recommendations for BP treatment.  Here's a link:  BP_2000.pdf.  It's from a neat site:  www.psychguides.com  Sadly, updated 2004 report costs $$$--about $20 for a reprint.  But the patient guide looks like the consensus is similar.  Let me know if anyone gets it...

The 2000 report says:

1.  Lamictal isn't recommended for acute mania; pdocs would rather use Depakote or Lithium (slight preference for lithium for BPI and Depakote for BPII.

2.  Lamictal is very high on the list as an adjuct to lithium for BPI and BPII.

3.  Lamictal is very high on the list for maintenance therapy for both BPI and BPII.

My take is that they don't recommend lamictal for acute mania (or acute mixed state) because it takes up to 2 months to get to a good stabilizing dose.  But once the patient stabilizes, they consider lamictal a first choice in most cases to either switch to or use as an adjunct. 

It's a very interesting report, and the main site has "expert consensus guidelines" for treatment of several forms of mental interestingness.  The archived ones are free, but it looks like new ones have to be paid for.

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When I first got off Lithium (I had been pretty stable for 14 years on Lithium) and switched to Lamictal 200 mg, I had hypomanic reaction and sleeplessness/anxiety and so took 50 mg of Seroquel to sleep for a while.  However, I could not tolerate the side effects of Seroquel.  My nurse practitioner recently titrated the Lamictal up to 250 mg and I feel pretty stable today along with Klonopin and Wellbutrin.  But who knows - I may have to go up to 300 Lamictal or even take an antipsychotic if I need to stay sane.  It is interesting to hear about such good luck with the Topamax/Lamictal combo.  I haven't heard of anybody taking this together.

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