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5 hours ago, browri said:

So I was reading up on the titration for lamotrigine. Originally, it was 25mg for 2 weeks, 50mg for 2 weeks, then 100mg for 2 weeks, and then you could increase by 50mg every week, but apparently after 2 weeks on 100mg, it looks like you can jump right to 200mg if you haven't shown any signs of the rash titrating up. The author of this modified titration suggestion doesn't give much indication if this is for more acute treatment or if it should be titrated ++50mg/week for tolerability in the case of maintenance.

That's interesting. My target dose is 100mg and I'm hoping I won't need more than that. But if I do I think I'll still increase it slowly to hopefully minimise side effects. 

It'll be interesting to see how I'm doing once my psych let's me taper off sertraline. I'm hoping lamotrigine can keep me from becoming really angry without it. The aim is to get off sertraline (because of tiredness and sexual dysfunction) but he wants me to keep bupropion. 

@browrido you think it's possible to feel a benefit from only 25mg lamotrigine? I have been feeling strangely not-depressed lately. But it could be the bupropion and sertraline combo. Weirdly, I'm not getting the same "oomph" from bupropion that I was getting before.

5 hours ago, argh said:

Fwiw I didn't go from 100 to 200. I went to 150, which I'm sticking with for the time being.

Sounds like it's a good dose for you. Out of curiosity, how different does 150 feel compared to 100?

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28 minutes ago, Melancholya said:

That's interesting. My target dose is 100mg and I'm hoping I won't need more than that. But if I do I think I'll still increase it slowly to hopefully minimise side effects. 

It'll be interesting to see how I'm doing once my psych let's me taper off sertraline. I'm hoping lamotrigine can keep me from becoming really angry without it. The aim is to get off sertraline (because of tiredness and sexual dysfunction) but he wants me to keep bupropion. 

@browrido you think it's possible to feel a benefit from only 25mg lamotrigine? I have been feeling strangely not-depressed lately. But it could be the bupropion and sertraline combo. Weirdly, I'm not getting the same "oomph" from bupropion that I was getting before.

Sounds like it's a good dose for you. Out of curiosity, how different does 150 feel compared to 100?

150 feels much calmer though it took about 3 weeks after the bump to feel that. Initially it was like 100 with the side effects coming back

Look at the graph here. Week 2 is still at 25.

Note the improvement

https://psychopharmacologyinstitute.com/section/lamotrigine-is-not-slow-comments-about-its-efficacy-in-bipolar-depression-2059-4119

 

My initi target dose is 200 but when I asked the doc he was like how do you feel and I'm like I'm good. So we stuck at it.

I'm also Asian and apparent we have a lower clearance rate so 150 for me is probably 200 for you or around there.

Unless you are Asian. Then hello fellow Asian.

Edited by argh

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27 minutes ago, Melancholya said:

That's interesting. My target dose is 100mg and I'm hoping I won't need more than that. But if I do I think I'll still increase it slowly to hopefully minimise side effects. 

 

For me the last thing I wanted to do was split up titration, every time I made a dosage change no matter if I was on 100 mg or 500 mg I would again experience mainly insomnia and other side effects that nothing could touch. These lasted for about a week. It did not matter if it was just a small increase. I found there was a limit, for me, of how large an increase I could handle, increases of more than 75 mg dramatically affected me cognitively for about a week. My doc OK'ed taking increases above 100 mg as I was trying to get to 600 mg/day, a standard dose for epilepsy. It takes forever to get to 600 mg/day doing small dose increases every week.  

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4 hours ago, notloki said:

 

For me the last thing I wanted to do was split up titration, every time I made a dosage change no matter if I was on 100 mg or 500 mg I would again experience mainly insomnia and other side effects that nothing could touch. These lasted for about a week. It did not matter if it was just a small increase. I found there was a limit, for me, of how large an increase I could handle, increases of more than 75 mg dramatically affected me cognitively for about a week. My doc OK'ed taking increases above 100 mg as I was trying to get to 600 mg/day, a standard dose for epilepsy. It takes forever to get to 600 mg/day doing small dose increases every week.  

Yeah, I find that generally I am rather sensitive to medications so I think increasing slowly is a good idea for me too. 

4 hours ago, argh said:

Unless you are Asian. Then hello fellow Asian.

Dammit, I'm not Asian! Guess I'm not really bizarro world female you. 😢 

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15 minutes ago, Melancholya said:

Yeah, I find that generally I am rather sensitive to medications so I think increasing slowly is a good idea for me too. 

Dammit, I'm not Asian! Guess I'm not really bizarro world female you. 😢 

Lol or this further solidifies your role as bizzaro world me as that's another bizzaro world aspect, not just a different sex and cool sounding accent but also a different race.

The plot thickens

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18 hours ago, Melancholya said:

do you think it's possible to feel a benefit from only 25mg lamotrigine? I have been feeling strangely not-depressed lately. But it could be the bupropion and sertraline combo. Weirdly, I'm not getting the same "oomph" from bupropion that I was getting before.

Yes it is quite possible. For a long time, lamotrigine got relegated to a "maintenance-only" status meaning, it was generally regarded as not effective in acute treatment because of the long titration to the doses necessary for full symptom control. However, more recent literature seems to indicate that lamotrigine can and many times does show improvement in symptoms as early as 50mg. It wouldn't be far-fetched for the same to be said for 25mg. Lamotrigine has a widely varying half-life and it's possible the half-life is longer in you than average leading to higher concentrations of lamotrigine with lower dosing.

Said another way, the fact that you think you may actually already be seeing a response at just 25mg could be placebo OR it could mean that lower doses of lamotrigine will work well for you. For most, positive effect doesn't really settle in until between 50mg and 100mg. This could be a good sign.

I think you said you go to 50mg this Wednesday? Per usual, expect a few days of side effect weirdness and then it will slowly go away like it did for 25mg. If you haven't given up on lamotrigine at this point, then I'd say you can reasonably expect to be able to handle the rest of titration without issue. Each dose increase shouldn't be any WORSE than the last one. In fact, each dose increase should get easier as you go higher.

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Good luck. Remember the side effects pass.

It's a really rocky titration

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4 minutes ago, argh said:

Good luck. Remember the side effects pass.

It's a really rocky titration

Did you feel quite tired as part of your side effects? I mean I am used to my energy fluctuating but up until maybe yesterday I felt my energy levels were pretty good, now today I am dog tired and I wonder if the increase in lamotrigine has done that? 

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1 minute ago, Melancholya said:

Did you feel quite tired as part of your side effects? I mean I am used to my energy fluctuating but up until maybe yesterday I felt my energy levels were pretty good, now today I am dog tired and I wonder if the increase in lamotrigine has done that? 

25 was not sedating.

50 and 100 were.

150 is neutral.

I'm guessing if I went to 200 it might be activating

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2 minutes ago, argh said:

25 was not sedating.

50 and 100 were.

150 is neutral.

I'm guessing if I went to 200 it might be activating

Oh shiiiiit I don't want it to be sedating 

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Just now, Melancholya said:

Oh shiiiiit I don't want it to be sedating 

It isnt like knock you out sedating but  it is a bit tiring. If you were in a minor up mood, you night be coming down

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37 minutes ago, argh said:

It isnt like knock you out sedating but  it is a bit tiring. If you were in a minor up mood, you night be coming down

Yeah I think I am. Feel like rubbish. 

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14 minutes ago, Melancholya said:

Yeah I think I am. Feel like rubbish. 

here's hoping it's mild one if it is. maybe being med sensitive, it will cushion the fall somewhat as lamotrigine is the only mood stabilizer which is primarily one that stablizes "from the bottom" as in it works for depression, where other mood stablizers are known to stabilizes "from the top" meaning it's mainly manic based. not that they don't also have corresponding mood effects, that's where they are just stronger.

i'm sort of on an upswing but aside from the buying and uncharacteristic purchase it isn't too bad. Like I'm definitely in a better mood than normal/stable but it isn't too much better. Things are not super sharp and vivid, thoughts are a bit faster but not racing..i am forgetful/spacy again, which is another tell for me. Also extra aggressive at work, but that's expected of me/my team so that is great for work, but i'm usually the mellow guy.

if i didn't know to look for elevation i'd be like..ok this is weird, but i wouldn't be like wtf is going on?

Edited by argh
not vivid and sharp. dang.

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Fatigue is typically another one that passes with time. It may linger in a sub-level kind of way but it won't be noticeable in the way that it is now.

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1 hour ago, browri said:

Fatigue is typically another one that passes with time. It may linger in a sub-level kind of way but it won't be noticeable in the way that it is now.

Excellent 😊 I am so tired of feeling tired, lol.

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