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Lamictal is indeed an interesting choice for mania because it is generally considered to be better for depression than for mania. You really need something like lithium, Depakote, or Tegretol or an antipsychotic to abort the mania.

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9 hours ago, jt07 said:

Lamictal is indeed an interesting choice for mania because it is generally considered to be better for depression than for mania. You really need something like lithium, Depakote, or Tegretol or an antipsychotic to abort the mania.

I second lithium, Depakote, or Tegretol. However, if you go on Depakote, your pdoc would need to half your Lamictal dose, while if you go on Tegretol, your pdoc would have to double your Lamictal dose. You wouldn't feel any different from the Lamictal dose changes because it has to do with how the metabolism of Lamictal interacts with these two meds. Depakote slows down metabolism of Lamictal, so you need lower doses of it; Tegretol increases metabolism of Lamictal, so you need higher doses of it.

E.g.:

If your normal Lamictal dose is 200 mg/day...

On Depakote, you would be reduced to 100 mg/day.

On Tegretol, you would be increased to 400 mg/day.

 

A combo of Lamictal + Depakote or Lamictal + Tegretol would be good because you have Lamictal stabilizing and treating from below plus the Depakote/Tegretol treating and stabilizing from above. Lamictal + lithium would be good too since lithium has been known to have both antimanic and antidepressant properties (though I believe that depends on the dosage: Low doses have antidepressant properties, whereas higher doses have antimanic properties, so I've read... don't quote me on that).

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Shouldn’t be on an ssri or snri if manic.

 

For me, I need to be on an antipsychotic when manic and I won’t come down from mania with a mood stableizer alone.

everyone is different but I always need to start at a high dose of an antipsychotic to get down from mania and usually I require hospitalization because my mania becomes psychosis.

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What about trying an antipsychotic like Zyprexa or Risperdal for about a week to abort the mania? It would only be for a week or two so you shouldn't have to worry about weight gain or long-term side effects.

75 mg of Lamictal is likely not doing anything. For depression, you need at least 100 mg and for mood stabilization you need about 200 mg. The actual dosages may vary for individuals though because Lamictal is a strange med with sweet spots and everyone is different.

There is no need to be scared to try things. All meds have unpleasant start-up side effects, but these almost always go away or lessen in intensity after a few weeks. You just have to plow through it for a while. Worst comes to worst, if you cannot in any way tolerate a med, you simply contact your pdoc and stop taking it. The meds won't damage you and nothing is permanent. 

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