[tnlibrarian]

At my last appointment my doctor said the 300 mg. of Lamictal isn't enough to control my moods and the rapid cycling. She said she doesn't like to go beyond 300 mg. I noticed some of you are on a higher dose than that. She added on Seroquel but part of the reason for that was due to hallucinations and having trouble sleeping, even with Ativan.

Does anyone else's doctor limit how much they are willing to prescribe?

[madisgram]

if your doc suggests up to 300mgs i'd value her opinion in spite of this quote below. sounds like pdoc is tweaking your dx by adding other rx. see if you respond well to these additions first, imo, and i'm no doc so take this with a grain of thought.

11. What is the usual final dose of lamotrigine? When used as an antidepressant or as a mood-stabilizing agent the final dose of lamotrigine is most often between 100 and 200 mg/day. Some people require doses as high as 600 mg/day to achieve a good antidepressant effect. Such doses should be avoided in patients taking valproate because of the pharmacokinetic effect of valproate that increases plasma levels of lamotrigine, and the accompanying increased risk of serious dermatological side effects.

http://www.psycom.net/depression.cen...motrigine.html

[brypowers]

Becca, If I were you I would demand a consult for endocrine to eliminate physiological possibilities. I was referred after a simple testosterone check that revealed “Low T”. I was put on testosterone and felt much better. Consequently and unrelated, the testasterone rendered me infertile, but we want children. My endocrine then switched to HCG, which is the opposite of Testosterone that forces my body to create it naturally.... Anyway

For me, every time I get a small relief from the illness through medical intervention, I try to study it and through behavioral and cognitive therapy, I have made improvements but still cycle too. The therapy has given me tools to identify the triggers, sometimes I am able to intervene, and try to make better decisions that will not lead to a “pulling of that trigger”. I still fail, all the time, however the severity decreases every time. I'm going to one-day go into remission hopefully.

Personal Case Study:
I DO NOT advise this, but I have gone so far as to experimented with my medication. I purposely stopped taking lamictal for a period of about four weeks. I quickly realized why I needed it. I didn't ask my doc if I could do it because they would not recommend it. But, after about two weeks I fessed up simply because I had so much to report. Also, during that period I was in weekly therapy so I felt as if I had a safety net. I was keeping a journal and closely monitoring my behavior.

Off lamictal, at about the third week, I figured it was all out of my system, so I could trust the symptoms as genuine “ME”. I was able to recognize/remember one particular sensation from a long time ago. It was a familiar feeling that at the time my doctors and I believed was anxiety. But this time, w/ out the anti-convulsive med (lamictal) it was as if my frontal lobe had white noise in it, like a subtle vibration or buzzing. I was more agitated and really felt edginess, was having suicidal thoughts, could not concentrate and was much more anxious. I went back on it and the improvement was obvious once again. After a few weeks of thinking about that scenario from a slightly scientific perspective, it made sense; I had just identified a major symptom and treated it. Just knowing that one small feature of this illness was “Real” and “Treatable” was auxillarating and motivating.
Trust me, it wasn’t as easy as it sounds written down. At the time, my mind was playing tricks on me, and I could not make sense of any of these realizations until after the fact.
Every minor improvement is a small success. One smart primary care doc answered a question I had, “Why am I falling apart, why do I need all this medication?”, “Ah, you’re fine, they’re all just minor tweaks, we all need them.”she said.

So, I wonder if you are cycling over the following:
1. hormonal imbalance
2. PTSD lingering from some time in the past that has simply changed they way your brain works
3. lack of cognitive / behavioral therapies
4. short term / long term goals / attitude towards your situation
5. Wrong meds
6. all of the above -- like me

[dragonfly2]

My pdocs have always been hesitant to go above 300 mg with my Lamictal too. The general opinion is that there isn't much of a benefit from going above 300 mg. They generally reserve the higher dosages for patients taking Lamictal for epilepsy.

[kindachaotic]

I have been as high as 400mg but it didn't help, only made me worse really. Only slept 2-4 hrs & hypomanic.
Turns out that 150-175mg is a really good dose with rest of cocktail.

Don't know if this helps but hope you feel better soon.

[Moreta]

I take 400 mg of lamictal. I went down to 100 mg and got severely depressed. The one part I don't like is that I've lost a lot of my cognitive functions and have word finding issues.

[tcmoon52]

Originally Posted by tnlibrarian

At my last appointment my doctor said the 300 mg. of Lamictal isn't enough to control my moods and the rapid cycling. She said she doesn't like to go beyond 300 mg. I noticed some of you are on a higher dose than that. She added on Seroquel but part of the reason for that was due to hallucinations and having trouble sleeping, even with Ativan.

Does anyone else's doctor limit how much they are willing to prescribe?

Becca Lamictal never was enough for me. It wasn't until my Psych added Seroquel, that my rapid cycling and insomnia came under control. Seroquel is a wonderful medicine for me.

[33yankee33]

My pdoc just bumped me up to 400mg, but only because giving me more than 900mg of Lithium would raise my levels too high. It's to curb my mania and hypomania. Don't know if it will make better or worse, but I'll find out.

[Anneinside]

Since starting ECT I have been at 200mg as Lamictal is an anti-seizure med. Before that I was at 400mg and that is as high as my pdoc goes.

[AniManiac]

I was reading through the long-form drug details on Lamictal because I was interested in the pharmacokinetics - half-life and relation of body weight to dosage.

One thing that jumped out for me was that it said that for bipolar, there was no substantial/consistent improvement for 400mg vs 200mg. The conclusion was basically that if 200mg isn't doing it, 400mg probably won't either (and side effects become more likely).

So the add-on drug is probably the way to go, as others and your pdoc have suggested...