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Lamictal (lamotrigine): when do you hit the 'sweet spot'?


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Here's the basic Q, as said in the title: How do you know when you hit the sweet spot? I felt pretty good at 350 mg; then my toe snapping tic resurfaced. Here's the lengthy explanation of what I mean by that: Toe Snapping: OK it's weird, but is it a BP symptom?. It's a very annoying, distracting, and constant tic, and Lamictal has off and on rid me of this as I've titrated up (have no clue why it's dampened this, but it does). So once it started again, I went up to 375 mg. That worked okay, tic stopped, but still didn't feel quite "there" yet. So doc and I agree to up to 400 mg.

Want to hear how people knew they'd reached their sweet spot? I've heard that generally (at least in the U.S.) the common treatment plan is to go to where you feel good, then add more till you feel worse, then back off. What exactly are the symtoms of "feeling worse"? And what are the signs that you are actually at that "sweet spot" dosage? How do you know?

I've got some complicating factors. As most people here know, I'm on a pretty high dose of continual hormone replacement therapy, so it made sense to go up to 400 mg; really means I'm only getting 200 mg. And the hormone therapy itself (plus menopause) may be affecting my mood.

I feel like crap tonight, feel a breakthough of depression. Been crying off and on for a couple hours. There are even more complications, which could be adding to this. Basically everyone I care about in my life is going through a serious health crisis. Mother recovering from a bad fall and a head injury, and possible mini-stroke(s). Father just had lengthy quadruple heart stent surgery, and is suffering complications. Looks pretty certain that roommate has prostate cancer; waiting on the biopsy. Lots more details here: Breathing a sigh of relief...my mom had a close call.

The death of Dana Reeve hit me surprisingly hard today. Woke up this morning to the news and immediately started crying. Usually not one to get overly wrapped up in celebrity or even the deaths of celebrities, but this one was different.

So I don't know what this all means. I'm hoping very much that Lamictal is all I'll need to take; really not thrilled at the possibility that I'll need to add more meds.

It's quite possible that this depression is just transient. And I've certainly have enough circumstances to cause it, though up till now I have been handling all of it well, been very even keel. Am also getting hit with those "You're just a loser" thoughts.

At least tonight I'm wondering if it's related to my dose of Lamictal, and would love to hear people's stories of how they knew when they'd hit the right dosage for them, and how they knew when they'd gone over it.

Thanks,

revlow

PS - My apologies for the length of this post.

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Here's the basic Q, as said in the title: How do you know when you hit the sweet spot?

Do you track your moods over a period of time, say on Moodtracker or some other system?

I was on 300, and was consistently feeling "blah".  Not in a full on depression, but not what I would call good either.  I wasn't happy, the glass was half empty, negative thoughts all the time, stuff like that.  I looked at my moodtracker and I was consistently below baseline (mildly depressed) for the last 3 months.  My pdoc bumped me up to 400, and within days, literally, I felt like a new person.

I can't live without that moodtracker.  Using it helps me catch things that I'm too obtuse (or too close to, if that makes sense) to see.

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myrkkyhammas: I'm BPII, or possibly some other "lite" NOS variety. Lamictal has been working pretty well, just not sure I'm at that sweet spot yet. Would like to know: How people know when they are at their right 'sweet spot' dosage, or how they know when they've gone past it. I guess I need to specify that I'm asking this of people for whom Lamictal has worked.

Anelize: No, I haven't been using a moodtracker. I probably should, but haven't for three reasons:

1) I've been doing pretty well for awhile; really not anything to report till last night.

2) For whatever reason, I'm actually good at remembering when my moods have changed, and what they changed to; and

3) It's just another friggin' thing to do.

Of course, maybe I'm just being lazy. I should try it. But honestly with me, I don't see the point. If something really significant happens, I usually either write about it here or put a note in my datebook, and then put it on my list for my next doctor's visit.

One of the potential drawbacks to doing some kind of moodtracker I see for me is that if I do this ritual daily, I can easily see myself ruminating in a very negative way. If I take the time to think about how I'm doing, my life seems like crap and I get depressed. So, again for me, it's usually better to not think about it. It's not denial. It's more my way of dealing with my MI as best I can.

I don't know if this makes sense or just seems like an excuse. For me it makes sense. Sort of like when I stopped weighing myself everyday, my eating disorders got better.

PS - Should have first said thank you both for responding!

Hope I didn't come off too snarky. Thank you again.

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For me, finding the right dose was a matter of my pdoc believing in Lamictal and me responding to higher doses. He felt that Lamictal was doing most of the work in my stability and transformation into a *normal* human being, so when I felt like shit he'd dick around with the Lamictal and raise it. The last rise was in my last hospitalization when it went up to 400mg (I was on birth control so that was like 200mg).

Since I'm at the maximum dose my new pdoc wants me to take, I think she's going to put her faith in Abilify this time and mess with that along with the Lamictal.

But to answer your question, basically, when something hit the fan he raised the Lamictal. I responded well, and then if something else hit the an he'd raise it again, and I'd feel better again. Had I felt worse he would have lowered it. My cocktail at the time was Lamictal 400mg, Paxil 20mg, Seroquel 200mg, and Wellbutrin 300mg. Now my new pdoc has me on Lamictal 200mg (no birth control), and Wellbutrin 150mg, recently added Abilify at 15mg, and also the Klonopin. I haven't given the Abilify enough of a chance yet, but I don't know if it will hold my BP in. I may need some Lithium.

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Thanks, Loon-A-TiK. Appreciate the feedback and it makes sense.

It occurred to me that something else might be going on. Several weeks ago I started taking Omega 3/Fish Oil. I also started having horrible skin problems. I figured it must be the Lamictal, but it occurred to me that since it coincided with my starting the Fish Oil, maybe I should do a trial period without it to see if that might be the cause. Too soon to tell re: the skin, but maybe going off it contributed to my brief meltdown?

Who knows? It's all so tricky with this shit. Like trying to nail a blob of mercury.

Thanks again.

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Heya revlow,

Catching up now after a very strange week.

I had withdrawals off fish oil, and wouldn't discount that as a factor.

In terms of the "sweet-spot," I dunno except what others have said.  I seem okay now, but not great, and I don't know if I should go up, split the dose, or what.

Re the mood-tracking:  I use one with dots.  I just colour in the dots like an exam.  Then at an appointment I can just show the dots, they make a pattern, and we can see what's been screwing me up/helping me.

The dots are the only way I figured out those antibiotics were screwing me up in the fall.

--ncc--

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Thanks to both of you for the feedback.

Having a weird day. Again sleep problems last night, even with Ambien CR and Klonopin. Added the Klonopin when the Ambien wasn't cutting it. Finally fell asleep, then woke up too early. You know the story. Crap.

This whole business is all so weird. Maybe I should add the fish oil back in. My skin does seem to have calmed down a bit since stopping it, but of course who knows? Might be just coincidence that I haven't had a huge flareup. Also wondering if maybe the brand/quality of fish oil might be part of it?

This sucks. But then I don't need to tell you that, eh?

In terms of the "sweet-spot," I dunno except what others have said.  I seem okay now, but not great, and I don't know if I should go up, split the dose, or what.

<{POST_SNAPBACK}>

I know. Pretty much describes where I'm at (apart from depressive episode yesterday). I keep wondering how much of it is just that I miss the hypomania, at least for certain aspects. I miss having some clue what I'm going to do next. When I was hypomanic, at least I'd have ideas of what to do, how to put some idea into action to pull myself up out of the dulldrums and actually make something of a living. (Okay, I couldn't sustain it, but it was something.) Now I just feel adrift.

I envy you your professional life, ncc. Not the specifics, not what it is...just that you are able to do it. I envy NARS' and other's ability to do this as well.

I don't know how the fuck I'm going to be able to pull myself up at this point. I don't know how much all the stress of my family, etc. is adding to this, or if I'm just still plain depressed, or if I just don't have the will or desire without hypomania. Or just a lazy slob. Whatever, I'm not getting it done (or knowing what or how to do so) and feel like shit. Alas.

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Revlow, thanks for asking the question.  I had been forewarned to expect some mood swings after a titration, but haven't started noticing anything until I increaded from 170 to 200. 

Now irritability has set in big time--at times I can't even stand to hear my boyfriend's voice--I yearn not to be bothered or else beware! 

And I suspect my psyche is dealing with depth of the depression; I cry right after a moment of irritability.  Note I am under severe pressure from myself concerning work.

But just a week or few days just before the titration I was feeling so good--I'd talk to random people while waiting on line for shoes at the cobbler, and felt so 'up'.  My interpersonal skills were great.  I thought, this is it!  It's working!

But now the mood swings are very sudden at 200 (is this the definiton of 'rapid cycling'; still don't understand some of the terms); I freak out at the drop of a hat, with the ability to control it 50% of the time.  I am a bit scared they will get worse--should I wait & stabilize or go up??

It's so damn hard to figure this thing out.

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Yup, I'm still learning all the terms myself. I found this description here: http://bipolarsupport.org/modules.php?name...iewtopic&t=2777. If you scroll down you'll see the definitions of the different types of cycling. I hope this is accurate. If someone has better info, please chime in.

I know all this is frustrating, isn't it? Be sure to mention the changes to your pdoc. Maybe your sweet spot is somewhere between 170 and 200? Or like you say, you need to ride it out?

If you're a woman and are taking birth control pills or hormone replacement, of course you have to keep in mind that you will probably need a higher dose of Lamictal in the long run, as these have been shown to increase the apparent clearance of Lamictal by approximately two-fold.

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If you're a woman and are taking birth control pills or hormone replacement, of course you have to keep in mind that you will probably need a higher dose of Lamictal in the long run, as these have been shown to increase the apparent clearance of Lamictal by approximately two-fold.

<{POST_SNAPBACK}>

Ah, no, not on the pill any more.  Everyone here was quite enlightening.  I switched to the ring about a month ago.  My body could certainly be freaking out over its new interpretation of 200mg.

I doubt my p-doc will be able to provide any conclusive evidence to suggest I should titrate back down or to keep going.  He's not very good, and I don't have time to find another right now, so sharing experiences with others has been great.

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I'm up to 80mg lamictal, titrating up by 5 and then 7.5 mg every three days (e.g. next 87.5, then 92.5, then 100, etc.).  I had headaches starting at 25mg but stopping by 60 for the most part.  I had the impression of hypomanic symptoms around 60 (esp. jaw clenching) but no longer see that as best as I can tell.  Or if I do, it's pretty minor.  I may be a little more agitated, but not sure.  I think recently I have seen an increase in insomnia symptoms, but who knows, as that seems to have a life of its own.  I seem to be cycling through the symptoms.  Hooray?

I have at times thought that my mood has been better due to lamictal, but recent life events have basically confounded the lamictal experiment by throwing in depression for reasons other than BP.  That's right, I'm getting regular person depression too.  I'm not sure what my sweet spot will be, but i have enough 5mg and halvable 25mg pills to titrate up to 175mg with no more than a 7.5mg jump.  So I hope it's on or before 175.

It may be more than a month before the sweet spot hits, but send me a PM if you want to share experiences revlow.

btw, titrating up this slowly has worked wonders.  The side effects have been way mild.

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All I can say is "I don't know" because I haven't hit the sweet spot yet. I'm at 75mg and titrating up 25 mg every 2 weeks (or no faster than a week said the dr at the hospital) currently my dr has given me a month's worth of 75 but I see him again in 2 weeks and will beg for my next increase. And I thought I was going slow...? 5 and 7.5 mg at a time? yikes!

Ameth

I'm up to 80mg lamictal, titrating up by 5 and then 7.5 mg every three days (e.g. next 87.5, then 92.5, then 100, etc.).
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Guest Guestifarian

I feel really great.  Maybe i've hit a sweet spot...

i guess i'll keep going up to see if it keeps getting better, but if this is my peak i'll be pleased with that too.

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Guest Guest_sita_*

I'm at 200 and rode it out for 2 weeks.  Feeling a lot more stable, although there's an outburst once a week.  But I'm able to control the mini-outbursts at work.

Don't know if I should titrate up a bit?....Although today I took 210.  I'm just wondering if a bit more would do the trick 100%?  p-doc hasn't gotten back to me--but to be honest not sure I would trust his opinion.

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200mg here. Going to be tweaking the AM to PM only. I feel better most of the time. I have never felt this way before. Titrating up to this has been slow and torturous. It was harsh for me. About 4 weeks to reach 200 ala the starter kit party pack.

The only downside is that I'm terribly lazy and sleepy. That could be the Zoloft. Well that lazy part could just be me.

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