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Please tell me about your lamictal titration.  Mine has been such a rocky titration.  I thought at first that it was going to be the medication that makes me stable.  Now at 175mg,  I feel all over the place.  A few days ago, I felt pretty good, like I was heaing to normalcy.  Today I am feeling like I drank too much coffee.  My klonopin is barely helping now.  

I have had so much instability titrating.  It seems that at first I get hyper, and then things start to settle, and I feel more normal, and then I get depressed.  I only titrated up 12.5mg at a time because of how difficult it is to titrate up.

Well last week, I got so tired of waiting, so I titrated up by 25mg, and I felt some hyperness the first 2 to 3 days, then felt pretty good one day, and now I feel overly hyper.  When does it get better. I have been so treatment resistant it is scary.  The only thing that calms me is klonopin, and I have tried so many other meds.  

I am calling pdoc today, but I have reacted so strangely to medication, I think he is confused too.  Please tell me it gets better.

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It gets better. Once you reach your target dose and don't increase anymore, then after a few days everything settles down and these problems go away. I have found that things got easier for me once I got over 100 mg. You will reach a point where things calm down.

I suffered from severe anxiety and mood swings titrating up. It's just one of those things we have to live through to reap the benefits.

Edited by jt07
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The only major titrations I had on Lamictal were when I was first started on it 10 years ago. My pdoc gave me one of those blister boards instructing me on when to take my first 6 weeks of doses. At its max back then, I topped out at 100 mg. Since then I've gone up to 200 mg, and that was in 50-mg increments, years apart. I didn't really notice any negative side effects, except that the first few days I was a bit jittery and talky, so I guess it sort of made me temporarily manic. I had more energy and was more engaged in my life. Maybe that would seem hyper to some people, but I tend to be extremely depressive much more than hypomanic (or manic), so being more interested in my life was probably my version of hyper.

Titration problems really do scare me, though. If I ever have to change again, it will worry me to no end. I've done it how you have, titrating myself, with Zoloft, but that was before I knew I had bipolar and I was trying to navigate the dosage with my moods.

For the most part, I have been thankful for Lamictal because it has made a huge difference in my mood. I hope your jitters go away and everything evens out and you feel closer to normal.

 

 

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Hi, GreenTea. Welcome to the show. If you need any help figuring out how the boards work, please feel free to PM me or one of the other mods.

I understand that you're impatient, but Lamictal is not a med that rewards fast titration. If your body is used to 12.5 mg increases and it just got a sudden 25 mg infusion, it doesn't surprise me that you're feeling weird. It's very much a sweet spot med. And just because there's a recommended target dose, there's no guarantee that that dose is what you need. I started LTG in 2011 (and have been on it ever since), and I crept up in dosage incredibly slowly. I was at 75 mgs for months, because for a time that worked well for me. I didn't arrive at my current dose of 300 mgs/day until last summer.

Talk it over with your doctor, but there isn't any reason to keep going up if you feel good at a given dose. If you need more later, you can always up it then.

And yes, the adjustment period can be very uncomfortable. LTG can be very activating, giving you anxiety, irritation, physical twitchiness, headaches, and muscle stiffness. It does get better.

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Anyone mind if I jump in on the conversation?  I had some questions about upping the dosage (via my docs instructions), and I wasn't sure if I should post my own question or not.  

 

I started on 25mg for 2 weeks, starting my first dose at night, since my doctor said it tends to make people sleepy.  It had the opposite effect, causing extreme and unpleasant insomnia.  I took it in the AM instead, and all was well.  I had such a good, positive energy the first week (I tend to go a bit hypomanic whenever starting a medication, although this time it really just seemed like a "normal" person's energy level.).  The second week I leveled out, and was feeling a lot better all around.  My doctor instructed me to go up to 50mg this week.  I know that it tends to be activating for me, so I took 1 25mg pill upon waking, and another a few hours later.  I am suddenly finding myself fatigued and sad.  I know that changes like this tend to happen when titrating up on medications, but has anyone else had this reaction?  I'm wondering if 25mg was the right dose for me?  Has anyone stayed on 25 or 50mg and felt good there?  I'm of course going to stay at 50mg to see how I feel the next 2 weeks, but just looking for some experience with either continued fatigue on higher doses, or success at lower doses.  

Thanks all!

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You are not going to feel right until you reach your stable dose and have not changed it for several weeks. Generally that tends to be at least 100 mg but somewhere in the 100-200 mg range is common. Doses lower than 100 mg tend not to work. I got hard to treat insomnia every time I changed the Lamictal dose I used to take.

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I started at 25mg, it plundged me into darkness for quite a while, I was actually feeling better for a few days when two weeks later it was time for my up to 50mg... I missed 3 days of school because I didn't have enough energy to get out of bed. I stayed on 50mg for a month. then I when right to 100mg, I actually started functioning again almost instantly but I had pounding headaches that did not stop until I jumped up to 200mg, then they almost instantly abated. I was on 200mg for half a year, it was working a little, but I still wasn't stable, so I when to 300mg, and went manic. A year later I was still really depressed so I went to 400mg , and it has been pretty peachy ever since... 

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Thank you everyone.  So the manic part is over, and now I am depressed again.  I hope that I reach my therapeutic dose soon, but no one said this illness was easy to deal with.  Actually I don't think I am depressed as much as I am anxious, but I think the anxiety is from depression.  Sometimes I feel really good,  but doesn't last long.  I probalby will call pdoc today to see what he thinks I need to do.  I have been on 175mg for over a week.

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Another question.....is it normal when you level out after each titration, you level out and you are still depressed/anxious.  I would think as you dose up your anxiety/depression would get better than on the previous dose.   Was that your experience?  I am so scared that the next dose will do the same thing which is it make me crash down again into depression/anxiety.  I called pdoc, and he wasn't sure what to do, but eventually said he wanted to titrate up to 187.5.

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I was in a serious depressive episode when I started Lamotrigine. I had left my job because I basically couldn't function, and I was suicidal with a plan that I was basically delaying day-by-day on the promise that I would at least wait to see if a new medication would make a difference. I did 2 weeks at 25 mg, 2 weeks at 50 mg, then went to 100 mg, was there for maybe a month before going to 150 mg briefly on the way up to 200 mg. I noticed some improvement right away, but things were still rough for a while. I would feel actually good for a few days, then really low for a few, then okay etc. until I got to 100 mg. I basically stopped feeling suicidal after a few weeks at 100 mg and wasn't bouncing around as much, but I still wasn't quite good, so we went up further. I don't remember why I didn't stay at 150mg for longer and basically only did it as a step to 200 mg. I'm now on 250 mg, and the last 50 mg increase was in response to increased anxiety when we lowered my antidepressant. So it was a bit rocky for me, but maybe less so than for a lot of people. I attribute a lot of the ups-and-down to the illness itself, and the fact that at lower doses I was getting some effect, but the original symptoms were breaking through. It makes sense also that even once you've hit what will end up being your target dose, that it will take a week or two for things to level out since it's not like meds flip a switch that completely overrides everything else. 

 

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I withdrew from a hefty dose of cymbalta (which I never should have been on, but was misdiagnosed and the Dose was doubled by a different doc for off label reasons) and started on lamictal (and shortly thereafter increased on it) at the same time. I went from being nearly comatose with depression into a horrible mixed state - I was totally hysterical - and almost jumped off of a parking garage. I probably should have been hospitalized. It lasted for a couple of weeks. I look at pictures from the time (it was around the holidays) and I look shattered and washed out. I started at 50 (or maybe 25?) and increased in increments to 75, 100, then to 150, now at 200. We have always done it slowly because I am sensitive to meds and was concerned I would develop the rash if we went too quickly and I want this med in my arsenal. I tapered down and finally stopped the cymbalta after probably 3-4 weeks. It took me over two months to get through withdrawals, it was so bad. That plus initiating the lamictal and bumping it from 50 to 75 to 100 made me one crazy motherfucker. Like others, I think once I got to 100 other increases weren't as bad. It took a while before pdoc thought I should go to 150, then 200. I didn't get any hypomania bumps when I went to 150 or 200. I attributed the mixed state to the abrupt withdrawal of one and the initiation of the other, but maybe it had more to do with the lamictal.

i should add that I am doing ok with it now - it hasn't erased my BP disorder, but at least I'm not paralyzed by depression, and I feel more stable. I have much less hypomania. The hypomania i do have now is unpleasant but also muted, unlike the FUN!!!! hypomania I had off the drug.

Edited by Renarde
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I think with any spych-med is that they all take time, like its slow, you dont notice it until someone from your family or friends says something like "wow you have been really up-beat lately" or "wow you have been really calm lately". And thats  when you realize if its doing well or not, that other people noticed.

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  • 5 weeks later...

lamotrigine caused some anxiety and jitters when I was going up AND down. The anxiety usually leveled out after 4-7 days but my mood wouldn't be totally right for sometimes at least 2 weeks. Lamotrigine takes time but it can work really well for many people.

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  • 1 month later...

My titration was rocky as well. Same pattern as you describe. The hyperness after every dose increase is very normal. Lamictal/lamotrigine is very activating - especially at lower doses.

the hyperness shouldn’t persist though. So keep an eye out for that. 

For me - I can’t go higher than 75 mg, since 100 mg made me really depressed.

 

best of luck!

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  • 3 weeks later...
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