Lamictal - therapeutic dosage for depression/bipolar?
June 13, 2014 5:30 AM   Subscribe

Okay, so I don't really have bipolar but I was prescribed Lamictal off-label for depression since the SSRI's were giving me all kinds of side effects (none on Lamictal, yay!) I'm on 150 mg right now, and I am doing a lot better. I do, however, still go into these dark moods every once in a while. I heard that the therapeutic dose is closer to 200mg, and am debating asking my psychiatrist to bump me up. Details inside.

I noticed a difference once I got to 100mg, and it's only been better at 150. I am not as sensitive and anxious as I was before Lamictal, which is AWESOME. I don't go hypomanic, which is nice. Also, my negative moods, compared to before, are waaaaaay less frequent and I tend to rebound more quickly. In short, I think this is the best med I've ever been on. But I do still spiral down from time to time, and am wondering if bumping the med up one more time would be a good idea. My idea is that I noticed a big difference going from 100 to 150, wouldn't it be a good idea to see if 200 would pull me up even more?

I understand that everyone gets down sometimes, and so I wonder if increasing the Lamictal any further would be going too far. I don't think I'm technically depressed anymore, although I still have anxiety. And since I've been on meds ever since middle school I can't really remember what it's like to have a "normal" level of sadness/negativity. I also don't want to invite any possible side effects, since I seem to have been dodging them so far.

MeFites who are taking/have taken Lamictal - What's your sweet spot for this med? For people who went up from 150, did 200 make a positive difference? And if there are any psychiatrists on the board - what is the usual therapeutic dosage of Lamictal for depression/bipolar? Thanks :)
posted by CottonCandyCapers to Health & Fitness (13 answers total) 5 users marked this as a favorite
Response by poster: thereemix - true enough. I'd mainly like to hear some anecdotal positive + negative experiences of bumping Lamictal to the 200+ range, since I haven't been able to find too much reliable information online and my psychiatrist gave a rather vague answer as well (which I can understand).

I'd also like to hear from psychiatrists on their experiences prescribing Lamictal.

I don't think I'm bipolar, but am definitely closer symptom-wise to Bipolar II than I.
posted by CottonCandyCapers at 6:22 AM on June 13, 2014 [2 favorites]

I don't have any experience, but you might find more answers at Crazy Meds.
posted by maurreen at 7:19 AM on June 13, 2014

I was on Lamictal at around 150 for bipolar II. I don't remember the exact dosage, but I know that once I hit a good place with it, upping it didn't make a difference - so I was brought back to whatever the minimum was that was still effective. What ended up making the difference for me was adding Topamax on top of Lamictal (YMMV, and Topamax is not right for a lot of patients because of some possible side effects).
posted by my left sock at 9:38 AM on June 13, 2014

Best answer: I'm not a psychiatrist, but I did have to learn about psych meds. My general takeaway from it was that the therapeutic dose varies greatly from patient to patient (so really no point asking what the "usual" therapeutic dose is here) and the best way to manage your patient on these meds is to check in regularly and titrate as needed. Of course they want to start you low, in case of side effects. But many people require a significant period of gradual, upward titration of their doses before they find the sweet spot of maximum therapeutic effect with minimal side effects. So, you should absolutely talk to your doctor about it. I think more people would get better results from their psychiatric meds if they (and their doctors) were more proactive about titrating the dose for maximal effect.

(This is not specific to Lamictal, though, just a general theme among these types of drugs. Also, you didn't say how long you've been at your new dose, but I'm assuming you know it takes some time to adjust and wouldn't be asking if you'd only been on it for like, three days.)
posted by GastrocNemesis at 10:43 AM on June 13, 2014

I've been on Lamictal at various dosages for 8 years. I'm on 100mg + an SSRI now (for bipolar II)*. I think at one point I was up to 250mg when I was taking just that drug without an antidepressant. Anyhow, sure, I think it's worth trying a higher dosage to find out if that's right for you. My psychiatrist and I knew the dosage was too high when I became too sleepy on it (difficult to wake up in the morning, groggy). But I don't know whether or not that is a common side effect.

*If you're not aware, for Bipolar II lamictal + a low dose antidepressant are sometimes used to lift a mood that's too low with the lamictal alone. It has to be done carefully since the antidepressant can cause hypomania and cycling.
posted by kitcat at 10:46 AM on June 13, 2014

Best answer: I never got to 150mg because it turns out I can't tolerate Lamictal, but if it's working well for you, and you think you might get further benefits, it's not going to hurt to try going up. If you get side effects, or there doesn't seem to be and additional improvement after a reasonable adjustment period, go back down.
posted by catatethebird at 11:13 AM on June 13, 2014

When I went from 150 to 200, I got a whopping case of double vision. Going back down to 100 solved the problem.
posted by scratch at 11:48 AM on June 13, 2014

Just for another point of anecdata, I'm on 400mg daily of lamictal plus 150 of wellbutrin, for treating bipolar II. I had been on 300mg for a while, augmenting it with 2mg of ativan a day to treat general anxiety, but my pdoc wasn't happy with the amount of time I was staying on benzos and switched me to buspar. At that point I was OK with general anxiety, but had more acute anxiety attacks which I couldn't handle without the ativan. pdoc suggested bumping the lamictal to 400, and that worked for me.

But yes.... the therapeutic doses of lamictal vary wildly, especially for off-label uses. Your absolute best bet is to talk to your doctor about increasing, and do it slowly. If you're not already, keep a mood journal and watch for trends. Monitoring and adjusting the doses of a new medication can be one of the most frustrating things about psychatic treatment, but it will help a lot with things like this. Follow your doctor's advice as always, but my general understanding is that as long as you titrate slowly, and watch for SJS, there aren't any real hazards to cranking up the dosage until it stops helping any more (YMMV IANAD and all that.)
posted by jammer at 12:42 PM on June 13, 2014

Best answer: My initial titrate was to 150 but over the years got cranked to 400. I get a side of clonazepam for bed, wellbutrin in the am, and I just came off dexedrine for an extra kick in the pants.

General theory on psych meds is if they are tolerable and sort of work, raise dose until they totally work, become intolerable, or you hit max. 400 mg lamictal is max. There's nothing wrong with taking 150 vs 200 if the dose works. If it doesn't fully work, have a conversation with your doctor.
posted by crazycanuck at 5:02 PM on June 13, 2014

I used to take it, at higher doses. Talk to your doc, but I noticed no real side effects with an increase.
posted by St. Alia of the Bunnies at 6:32 PM on June 13, 2014

I'm at 350, for Bipolar I. But I take a crapton of other stuff with it. I have no side effects.
posted by Biblio at 2:52 PM on June 15, 2014

Response by poster: Thanks for the advice! I'll be upping the Lamictal starting tomorrow.
posted by CottonCandyCapers at 6:55 AM on June 20, 2014

Seems you've made your decision, but here's my experience:

I have been at 200mg since December 2013 and it has helped enormously. My usual depressive episode that sets in in late October and lasts until early January was curtailed to a much more minor (in intensity and duration) one. I essentially felt only slightly-to-not depressed during that time period and had only about 3 days of my typical more severe depression. This was all just while titrating up. Since 200mg, my mood has stabilized to the point that I have hardly any days where I feel depressed - and those days are nowhere near as intense as in the past. I had only very minor acne issues (which may have been totally unrelated, I'm not sure) that have completely went away. No headaches, muscle aches, wooziness or anything else. Maaayybe some slight memory issues, but I've always been kind of spacey when it comes to names and such, so that might be just me. I'm actually considering upping to 250mg to see if there are any extra benefits as the side effects have been almost non-existent. Of course, ymmv.
posted by flamk at 6:04 PM on June 22, 2014

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