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

[revlow]

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.

[Anelize]

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.

[myrkkyhammas]

even 25mg got rid of my depression but but more i took, the more manic i got.

like i've said before, unless you have bipolar lite, lamictal probably isn't your thing.

[revlow]

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.

[Loon-A-TiK]

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.

[revlow]

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.

[ncc1701]

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--

[Dweii]

For me... Never.

[revlow]

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.

[sita]

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.

[revlow]

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.

[sita]

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.

[Pastafarian]

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.

[revlow]

Thanks, Pastafarian. And many thanks to everyone else, too.

[Amethyst]

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.).

[Pastafarian]

92.5 mg

vivid nightmares.

[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.

[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.

[nnxt]

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.

[Amethyst]

I'm at 200 and rode it out for 2 weeks.

[revlow]

Here's an update:

I'm still at 400. Same story: at first feel better after an increase. In the last week, got more irritable, bit more depressed, and though haven't launched back into full-fledged toe snapping, I've started getting the urge again. (I know, I keep saying it's a weird tic -- but it is extremely annoying, without Lamictal I haven't been able to control it in about 15 years, and being without it has been a blessing, if only between Lamictal increases.)

So, I don't know. I see my doc tomorrow. I do trust him, so I don't have that problem. I don't know how much he's going to want to keep raising it, or if he'll want to add something to it. Not thrilled about the later. Hate that Russian Roulette of just throwing more crap at the problem.

I do miss some of the "spark" of hypomania, but what else is new? Wish I had some more enthusiam for doing things (like figuring out how to make a living), but I don't. I guess a firm kick in the butt is in order.

Well, I'm rambling.

I think this is difficult for all of us. Like trying to nail a blob of mercury.

Thanks again to everyone for all your feedback.

[ncc1701]

Heya revlow,

Went up to 250 tonight.

Life events I guess.

Psych put me on Imovane prn (zopiclone, racemic Lunesta for you Americans ) and you can *see* how well it's working as I'm on CB at 2230.

Likely upping to 300 this week.

--ncc--

[Pastafarian]

HOLY FUCK!

Okay.  So I'm investigating a house where there was a murder by two women.  I walk in the yard, and over top is a mess of spiderwebs with tons of spiders.  And there's a bird that lands on the fence and if it breaks the webs looking for a spider, they'll all fall on me.  I fear spiders, and I freak out.  Lucky it goes somewhere else, so I rush out and go to the neighbour's place.  He invites us in and I ask about the murders.  He talks for awhile about not much happening, and as I pull the shades back to look at the house I see that the images of the two women are patchwork quilted into the curtains!  I freak out and tell this man he has to get out for his own safety, and that's when he starts telling me thet "they'll" take care of me and it's obvious that he's under their influence.  I keep freaking out and that's when I wake up.  I had to wake my SO up because I was so scared.  Then she got freaked out as I described the dream.  The image of the curtains continues to haunt me.

Anyway, 112.5mg.  My mood, motivation and concentration continues to improve.  But that was some fuckin' dream.

[nnxt]

Nightmares... yes, everyday. It makes things interesting, though last week I woke up suddenly and gasped. That was bad...

[revlow]

Yeah, I've been having some friggin' weird dreams of late. Don't think it's likely to be Lamictal dose related -- didn't hit me the first almost 3 weeks at 400 mg. Just in the last week. Shit, they've been doozies. Sometimes very frightening, like what you described Pastafarian.

See my doc next Monday. I fucked up and was sure my last appt was scheduled for Monday of this week, but it had actually been the Friday before. Shoot. Very unlike me. Fortunately, they were able to fit me in this coming Monday. Anxious to see him and what we'll do next -- or is that "looking forward to seeing him"?

Lot of other stressors in my RL; don't know how much this anxiety is contributing to my feeling that I've yet to hit my sweet spot with Lamictal. Just still don't feel I'm quite "there". Irritable. Sometimes depression. Urge to toe-snap. Anxiety or Lamictal levels, hormones, or something else? Tend to think it's Lamictal.

Of course, am still greatly better than when I first started taking Lamictal. Boy, was I nuts then!

[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.

<{POST_SNAPBACK}>

My GP wants me to stay at 100, but he was the one who had no idea what lamictal was when I came in from the hospital with an rx for it. So I don't trust HIS opinion. So if you don't trust pdoc's opinion, get another.

Although I have to say that my friend went from 200 to 300 and noticed no change, so if 200 is doing it for you I'd be happy.

Ameth

<{POST_SNAPBACK}>

The outbursts continued once a week.  They're not pretty, and they involve my partner, so I titrated up to 210.  Irritability, and more frequent manic attacks with rage now, so up to 215 today.  I expect to stabilize at 225 or 250 and see how that feels.

Eesh--your doctor had no idea what it was?  At least I'm in a major city, but more reason to expect more from this p-doc.  It's a waste of money going to see him most of the time.

[ncc1701]

Heya,

Hunh.

Nightmares.  Whole life.  Every damned night.  Until starting Lamictal.

None.  Whoa, what a relief to not be scared to go to sleep.

None -- until I started sleeping again (started Imovane).

L got *rid* of them for me.

Cripes I hope this is the Imovane.

Upping Lamictal to 275 tomorrow.

Revlow, I hope things even out for you.

--ncc--

[freesoul]

Lamictal drives me NUTS!!!

I actually like it cause it doesn't make me feel stoopid or drunk like the Tegretol does, but...

Started at .25, and it got rid of a pretty bad depression in days. wow, effective. Except I got migraines and it felt like I'd been run over by a truck...muscle aches? more like spasms.

I stayed there 2 weeks, had headaches all of the first one. I went up to .50, more headaches and...I cant sleep. i switched it to mornings and it was amazing how it would wake me up, like taking a ritalin almost. Made me hyper.

Started to feel depressed again in Feb, as usual...I have a spring-fall pattern of breakdowns. So we upped...I came within an inch of mania. Again, in days. But, funny enough, I yawned for the first few hours after I took it (and sure enough more headaches)

I took more Tegretol and then ended up feeling real sick...tegretol toxicity, turned out. But before we knew what it was we cut down on the Lamictal, logical thing since it was the last thing changed. Two days after I was a TOTAL mess: crying, cutting, unable to function. Uhmmm...very scary. It was a telling moment...

So, now between .75, alternating with 100. Sometimes it gives me insommia and sometimes it makes me tired. I constantly have to change when I take it. I get quite a few migraines.

I don't, however, slip into depression except momentarily. The same, however, cannot be said of hypomania. And most of the time I don't really know what mood I'm in...don't know what to put down in my chart. Does that qualify as "sweet spot"? did I go over? not yet there?

I don't know if the thing is working well, too well, or at all.

PS sorry for the selfish long posting.

[revlow]

PS sorry for the selfish long posting.

<{POST_SNAPBACK}>

No worries. We're all struggling with this bastard, right?

[Guest Guestifarian]

Titrating up REAL slow takes care of the headaches.  I only got headaches for a few days around 30-50 mg.

125 mg now.  Switched to mornings cuz i've not been sleeping and i've screwed my schedule up by napping in the afternoons.

I'm also beginning to wonder if the sweet spot has come and gone, but it's hard to tell when i'm not sleeping.

[Guest Guestifarian]

like i've said before, unless you have bipolar lite, lamictal probably isn't your thing.

<{POST_SNAPBACK}>

AFAIK lamictal is statistically one of the most effective MSs if not the most.  Depakote and lithium are the other biggies, rounding out the thre most effective MSs.  I don't know why you say what you say, but for most bipolars, it's one of these three.  Topamax, tegretol, and the off-label stuff don't compare, and for the most part, reputable doctors use them as a last resort after the big three have been tried.

People whine and complain about the big three MSs far too often, and i think it is harmful as people who have not tried them may be scared to try the three most effective drugs. 

Trying a new drug is always a wonderful experience.  I get hopeful and optimistic at the thought of getting a little bit of help.  If it doesn't help, then that wonderfulness is gone.  And your statement seems to further belittle that hopefulness.

Be helpful.

[revlow]

Titrating up REAL slow takes care of the headaches.

[Guest Guestifarian]

Yes and no. Your milage may vary.

<{POST_SNAPBACK}>

Individual results may vary.

[ncc1701]

Heya,

Indeed.

Four mood stabilizers.

Lithium.  Epival.  Tegretol.  Lamictal.

(And Tegretol just has so many drug interactions it's not worth it for first-line.)

Unfortunately we have nothing but trial-and-error to figure out which drug(s) will work for whom.

(Interestingly in Canada lithium is the *only* Health Canada indicated mood stabilizer.  Which is not a problem, unless you're on the government drug benefit plan, in which case if lithium doesn't help you're screwed.)

Other drugs can help too, which is why some people are on Zyprexa or whatever.

Revlow, freesoul, I really hope things settle out for you.

And.

There's no such thing as bipolar lite.

--ncc--

[NARS]

Heya.  I'm sorry it's a struggle, revlow.  I was doing great on my lamictal-wellbutrin combination until my pdoc and I said "gee, isn't it supposed to be better for BP to get off of ADs?"  After going off of wellbutrin I had a nasty irritable (OK, rage-filled) depression and nightmares followed by hallucinations.  I'm pretty sure it wasn't a mixed state because it lacked that agitated bug-eyed high energy state, and the hallucinations always came with the awful terrifying dreams.

Anyhow, I'm back on 150 wellbutrin and doing a little better.  I've also gone from 10mg ambien to 5mg.  No more nightmares and I'm sleeping a little better, and the panic and most of the irritability is gone.  I'm seeing my pdoc tomorrow, but I'm thinking the ambien was bad for me without the wellbutrin, and the wellbutrin seems to be necessary for me, even with lamictal. 

I too was excited by the thought that I could get by with lamictal monotherapy, but at least for now it doesn't look that way.  And you know what?  Who cares?  If taking my little purple pill twice a day is what keeps me sane and smart and happy, I'm happy to go along with it.

Push that mediocre pdoc of yours a little. 

freesoul, here's hoping that upward titration will help; it usually does help mania at higher doses than you're at.  100 was better than 75, and 200 was amazingly better than 100.  And I used the standard manufacturer-recommended titration (25 two weeks, 50 two weeks, 100 one week, then 200).  I did get some SEs while titrating, but frankly I think I did well with fewer episodes of SEs because of fewer dose changes due to the fast titration. 

[revlow]

NARS:

Thanks! Glad to hear you are doing better taking Wellbutrin again.

Unfortunately there is no pdoc in the picture, mediocre or otherwise. Posted a rant about it yesterday: http://www.crazyboards.org/index.php?showtopic=10399

Brief recap: I live in a remote town. Have a wonderful internist; after doing what he can with Lamictal he wants to refer me to a pdoc in the nearest city. From what I undertand, they are basically all shit. This week doc referred me to a pdoc he said was good. Call said pdoc's office; he doesn't take insurance. Costs $400 just to walk in the door.

So back to square one. I've been pushing my doc to write a script for the prescription Omega 3 called Omacor. Think I felt better when I was briefly taking Omega 3/Fish Oil, but I broke out in horrible hive-like patches. So a trial with Omacor makes sense to me. But again doc wants me to see pdoc at this point, so he wouldn't prescribe.

I left a message at doc's office. He's about to go out of town for 2 weeks, so I think I'll go to his office and wait till I get some kind of answer Friday (he's off Thurs).

It's a bitch, isn't it? Again, glad to hear you've hit a good combo. I'll keep my fingers crossed for you.

[zef]

Hey everybody.

I'm at 300 mg and have finally felt a lessening of rage and complete despond. I'm still super-horrible-whopping-bad depressed but not as much as I was before. It's a different-feeling depression, like some of the bipolar difficulty has lifted and left me the depression that was underneath all the agitation and desperation. I have no idea if this is the "sweet spot" or not. Is it possible that at 300 mg I'm just feeling the beginning of relief, and that I might be in better shape on an even higher dose? I really can't tell. I just know that I'm definitely more stable.

I still can't figure out the supposed antidepressant effects of Lamictal except to remember that my doc said they're absolutely nothing like the effects of an SSRI. He said they're more subtle, which I guess is why I'm confused about whether I'm on the right dose or if a higher dose would be the sweet spot.

[revlow]

Here's an update:

Yea...my doc (internist) listened to me this last visit!

Lately, he'd been wanting to refer me to one of the few pdocs in this area (all from what I've heard and seen to be horribly expensive and not so talented). I've had other legitimate reasons why I didn't want to go this route.

My doc had been gone for a month. When I saw him on Monday, I explained to him that since he'd been gone and I was getting worse and didn't have any other options while he was away, I'd gone ahead and raised my Lamictal dose by 50 mg, and as a result had been doing better.

He was not upset and agreed I seemed better since he'd seen me last. He also told me the Lamictal blood levels test he'd taken then had showed I was in the middle of the therapeutic range. This allayed his concerns that with my high dosage, I might be in the toxic levels. Since we still have some room to tweak the Lamictal, and though I'm better I still don't seem quite "there", he agreed that going up some more (50 mg within this next month) made sense. (I'm on hormone replacement therapy, so cut amount I'm getting in half. Also when I was on Effexor, it took 450 mg before I'd gotten any AD effect -- so maybe it takes more with me with these meds in general?)

I'd given him a couple other options: adding either Wellbutrin or Trazodone. Neither did jack shit as ADs when I'd tried them alone years ago, but I'd figured they'd be safer to add than other ADs re: BPII (and at least Trazodone had helped me sleep). I said my preference was to raise the Lamictal, and he agreed. But I'd wanted to give him some options.

I strongly did NOT want to be pawned off on one of the quack pdocs here. So was very happy doc listened to me, and agreed with my logic. Also, he approved of my taking Omega 3/Fish Oil. (Wouldn't prescribe Omacor. ) I've been trying a different brand of Omega 3 and so far have not had the extreme rashes I had with the first brand I'd tried.

So that's my update.

[unipolarbear]

Who knows when you hit the sweet spot! I titrated very slowly at first, but that was alost a year ago. No headaches, thankfully. But I had a lamictal test and the pdoc said it was low. So we upped it to 150 in the morning and 150 at night. We haven't done a test in a while. I think the theory is that if it isn't in the bloodstream then it isn't working. I was feeling fine before, but now I have the racing thoughts that just won't stop. So I'm not sure if it's the lamictal or not.

[revlow]

Might be worth doing a blood test?

God, I hate the racing thoughts. I can relate.

Hope you feel better soon.

revlow