Lamictal dosing?

Hey, all!

My DD (18) has been on 100mg lamictal in the morning with 200mg lamictal and 5mg abilify at bedtime. She started tending hypomanic at the beginning of july, and i've seen rapid cycling recently, too. She saw her pdoc today and despite her claims that she's fine... (she's definitely not), he upped her meds so she's taking 150mg lamictal in the morning and 250mg lamictal (still 5mg abilify) at bedtime. And she reluctantly agreed to take it (phew!).

Anyway, her psychologist a few weeks ago thought her psychiatrist might increase the abilify and from what I'd seen, I thought she was already on kind of a high dose of lamictal (actually lamotrigine). So the increase in Lamictal surprised me a bit.... But maybe I was wrong in thinking the 300mg, now 400mg is high? Anybody else on doses this high?

Thanks!

Hi coaster mom : )

I remember talking to a woman who came here for help due to an unusually high dose of lamictal. I've never had that high a dosage of lamictal, but there is a delicate balance and once the dosage was too high, the effects were spooky. She was having a medical emergency and needed to seek help immediately. Seems like the abilify should increase, like your psychologist recommended. My pdoc said that my husband was the best gauge for how my meds were working, or not, because he/you can see the behaviors better than anyone. Report your concerns and ask the questions to her pdoc right away. The right blend and balance of dosage is half the battle so continue to advocate and question until you feel like she's stable.

having been in the guine-pig study to get FDA approval for abilify i can attest that it would be the preferred one to increase.

on the other hand, it sounds alot to me like the doc is prescribing what the drug company is promoting this week.

I guess I should've updated everyone on what happened! Less than a week after her psychiatrist upped her lamictal, my DD left home in the middle of the night to stay with an abusive boyfriend. She went off all meds. And I honestly forgot I'd posted that question here.... sorry... things were just kind of chaotic...

About a month later, she returned home and we started her meds back up, using a modified ramp-up schedule from her psychiatrist for the lamictal. She was actually doing very well, until right after she hit the full dose at which point we started seeing signs of hypomania again. It just happened that shortly after she hit that level, a book I was reading talked about lamictal and the possibility that it could actually push a patient into hypomania in spring or other times when depression wasn't as much of a problem, but hypomania might be. I contacted an old psychiatrist in another state where we'd previously lived and he agreed with my thought that her lamictal was probably too high and actually pushing her into hypomania. He suggested increasing abilify rather than lamictal for problems with hypomania. I immediately cut her lamictal back to a level where we'd seen stability a few months prior (300mg). We did see an improvement. At her next appt with her psychiatrist here a couple of weeks later, I brought him up to speed and he agreed to cut back the lamictal, although he seemed like he would've argued it at first and then said something about a "rare reaction." He indicated he wanted to use the lamictal because of it's antidepressant properties. DD has never had a major issue with depression, her hypomania is much more of an issue. But both her psychiatrists up to that point had talked about lamictal because it acts as an anti-depressant as well as a mood stabilizer. They are the doctors, right?

We recently began seeing a new psychiatrist (due to the old one starting to see people only on an inpatient basis) and the new psychiatrist looked at what we were saying -- that our dd doesn't deal with major depression and her hypomania hits every spring and is much harder to deal with -- and he began the process of weaning her off the lamictal, saying its use would be limited since the next few months we would be dealing with hypomania rather than depression (finally someone listened when I explained her cycles!). We had started seeing some hypomania right after Christmas (normal for her pattern). Since the new psychiatrist halved her lamictal (now 150mg/day) last week, though, we've seen an improvement.

So... yeah... lamictal is a balancing act... and personally I'd ask serious questions if a dr wants to go above the normal 300mg/day max -- especially if you have problems with hypomania. And... lamictal may need to be adjusted for the seasons if you cycle seasonally. I think our initial problem was because DD is usually naturally more stable during the summer, but we didn't reduce her lamictal... and so when she hit a normally "good" time for her with the lamictal so high... it pushed her into hypomania.

hmm, yea, my doc actually told me that 100 mg of lamictal was the most efficient dose before you start to see the efficacy slow down and eventually plateau. (200 mg of lamictal is not going to be twice as effective as 100 mg of lamictal.) The drug happens to work really well for me so he's okay with upping the dose when I need it, if I just need an extra boost. If your daughter goes well beyond a normal therapeutic dose of anything I would ask the doctor about whether or not it's the right drug for her. I don't like doctors that beat a dead horse, I know it's really really hard for bipolar people to change meds, and it's not to be taken lightly when a med change is required. However, if the drugs aren't causing the chemical correction that somebody needs, it's really healthy to question the doctor and see if you can try something else that may work in lower doses. I find that people don't like questioning doctors a lot, but they are only human too- the more information they have about your daughter, and the more questions and concerns you have, the better the outcome. (You can do this without trying to play MD- they have all the info in their minds and they can inform you about a variety of options- potential benefits vs. potential harm. That is what they are there for.) Educated patients and family members are never a bad thing!