Studies Of Lamotrigine In Bipolar Disorder
Findings of such broad spectrum activity and therapeutic magnitude have more recently been reported by a retrospective chart review of 587 bipolar disorder outpatients, comprising all subtypes and in various illness phases, in a private practice setting . Despite obvious methodological limitations, this study had the benefit of a large sample size. Using the Clinical Global Impression-Improvement scale as outcome measure, 59.5% of patients were rated as either very much improved or much improved on lamotrigine, and a further 20.4% were deemed to have minimally improved. Response rates were comparable across bipolar disorder subtypes and index mood episode for the bipolar I subset. The median time from lamotrigine initiation to observed response was 95 days, with a mean of 205 days.
There have been a number of published studies of higher-order design for lamotrigine in bipolar disorder. These have specifically examined the effects of lamotrigine on mania, bipolar depression, rapid cycling illness and bipolar disorder maintenance. These are sequentially discussed below.
Can Lamictal Be Prescribed For Depression Or Anxiety
Lamictal may also be used off-label to treat borderline personality disorder .
If you have questions about off-label uses of Lamictal, we suggest that you talk with your medical professional.
Rated For Bipolar I Disorder Report
continuing updates I have moved to 100 mg/day and have found basically I have flat lined no deep despair, no joy in life either. I have been battling depression since as long as I can remember, parents died early as did my brother. I divorced after a twelve year marriage, I also suffer from chronic pain from a fall some eight years ago. This is an update to earlier posts, I am unsure how to connect my posts to my previous ones. One thing is certain, I am more aware of my aloneness than I have ever felt…
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How Long Does Lamictal Stay In Your System
Healthcare professionals measure the time it takes to eliminate a drug from the body using a metric called a half-life this is the time it takes the body to get rid of half the amount of drug currently in your system.
The half-life of lamotrigine depends on several factors such as a patients age, kidney and liver function, how often lamotrigine is taken, and other medications that may interact with lamotrigine. When taken by itself, the half-life of lamotrigine is roughly 25 hours, and it takes five half-lives to eliminate most drugs. So, while the levels of lamotrigine may not be high enough to have noticeable effects, lamotrigine can remain in your system longer than five days after a dose.
When taken with valproate, the half-life of lamotrigine increases to 70 hours. This would increase the time it takes to fully eliminate it from the body to roughly two weeks. Other antiepileptic drugs such as carbamazepine or phenytoin can reduce the half-life of lamotrigine to fourteen hours. In this case, the time to eliminate lamotrigine would be approximately three days.
Lamictal Dosage For Bipolar I Disorder
Lamotrigine is a first-line treatment for acute depressive episodes in bipolar I disorder due to its effectiveness for acute depressive episodes. Lamotrigine delays the time to relapse of mood episodes as well as the onset of new depressive episodes. It is believed that lamotrigines effects stem from its ability to reduce the effects of a neurotransmitter called glutamate while increasing the release of another neurotransmitter called gamma-aminobutyric acid .
Lamotrigine can be used by itself or in combination with other medications for the treatment of bipolar I disorder. When used by itself , lamotrigine is started at 25 mg daily for two weeks, then increased to 50 mg for another two weeks, then increased again to 100 mg daily during week five. The target dose is 200 mg daily . When taken with other medications, this regimen may need to be decreased or increased, depending on the medicines. For example, when taking lamotrigine with valproate, the dose is reduced by half. When taken with certain mood stabilizers such as carbamazepine, the dose is doubled.
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Frequently Asked Questions About Taking Lamictal
Below are answers to frequently asked questions about taking Lamictal.
- How long does Lamictal take to work? Lamictal begins working as soon as you take a dose. But it may take a few weeks before you notice its effects on your condition.
- Are there any symptoms of missing a dose of Lamictal? It depends on the condition youre taking Lamictal to treat. If you take the drug to treat a type of epilepsy, missing Lamictal doses could increase your risk of a seizure.
- What should I do if I miss a dose of Lamictal? If you miss a dose of Lamictal, its advised that you take it as soon as you remember. But if its almost time for your next dose, its recommended that you skip the missed dose. You can take your next dose at the scheduled time. Its important to not take two doses at the same time because this can increase your risk of side effects from Lamictal.
- Is Lamictal meant for long-term use? If you and your medical professional agree Lamictal is working to treat your condition, youll likely take it long term.
- Should you take Lamictal with food? You may take Lamictal with or without food.
Lamictal is a prescription drug. The costs of prescription medications may depend on several factors, such as your insurance coverage and the pharmacy you use.
If youre wondering how to pay for Lamictal, check out the Medicine Assistance Tool website.
How Long Until Lamictal Works
Question posted by P77 on 31 March 2017
I was diagnosed with BP2 and PTSD a couple of years ago, have a strong family history and typically only seek treatment when depressed, sound familiar??? The depression started three years ago, I tried Lexapro which helped somewhat but it’s seem to really escalate the mania about seven months later so I came off of it. Ive also tried Wellbutrin but couldn’t handle the headache/side effects. I was started on Lamictal 25mg a week and a half ago to be taken every night and the only side effect of experience been so far is some insomnia, however I feel more tired and depressed and don’t increase my dosage to 50mg until next week. I’ve been reading some older posts on here but just wondering if anyone had any perspective for me. It is really scary to be reading how familiar are all of the stories sounds when people compare themselves to guinea pigs and medical experiments especially after watching my family member go through this and now experiencing myself, I’m terrified and so discouraged. I agreed to try this because obviously I feel so lousy, but also I’m hoping that it keeps me from having distractive behavior that know in hindsight looking back I can admit to, but when I’m going through it I cannot. I have a great life and wonderful people around me and really don’t want to jeopardize it or burden anyone with what I’m going through. Thanks for listening
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Dosage Forms & Strengths
With enzyme-inducing AED and no valproic acid
- Initial: 0.6 mg/kg/day PO divided q12hr for 2 weeks, THEN
- 1.2 mg/kg/day PO divided q12hr for 2 weeks
- At 5 weeks increase by 1.2 mg/kg q1-2Week to maintenance dose of 5-15 mg/kg/day PO divided q12hr
- Not to exceed 400 mg/day PO divided q12hr
With valproic acid
- Safety and efficacy has not been established
With valproic acid
- Initial: 0.15 mg/kg/day PO qDay or divided q12hr for 2 weeks, THEN
- 0.3 mg/kg/day PO qDay or divided q12hr for 2 weeks
- At 5 weeks increase by 0.3 mg/kg q1-2Week to maintenance dose of 1-5 mg/kg/day PO qDay or divided q12hr not to exceed 200 mg/day
- Alternatively, 1-3 mg/kg/day PO with valproic acid only
With valproic acid
- Initial: 25 mg PO qOD for 2 weeks, THEN
- 25 mg PO qDay for 2 weeks
- At 5 weeks may increase by 25-50 mg/day q1-2Week to 100-400 mg/day PO qDay or divided q12hr
- 100-200 mg/day PO with valproate alone
- Lamotrigine XR: Start 25 mg PO qODay for 2 weeks, THEN 25 mg PO qDay for 2 weeks, THEN 50 mg qDay , 100 mg qDay , 150 mg qDay THEREAFTER 200-250 mg PO qDay
Without valproic acid or AED
- Safety and efficacy not established
Without valproic acid or AED
- Initial: 0.3 mg/kg/day PO qDay or divided q12hr for 2 weeks, THEN
- 0.6 mg/kg/day PO qDay or divided q12hr for 2 weeks, THEN
- At 5 weeks increase by 0.6 mg/kg q1-2Week to maintenance dose of 4.5-7.5 mg/kg/day PO qDay or divided q12hr not to exceed 300 mg/day
Without valproic acid or AED
What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to lamotrigine.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking lamotrigine.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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Lamictal Taken Alone For Epilepsy
Lamictal is used alone to treat epilepsy in certain people who have partial-onset seizures. The drug is for use in adults, as well as children ages 16 years and older.
For this purpose, Lamictal is prescribed while youre still taking another epilepsy drug but plan to stop the treatment with the other drug. Your medical professional will slowly decrease the other drugs dosage while slowly increasing your Lamictal dosage. These other epilepsy drugs include:
- seizures caused by Lennox-Gastaut syndrome
Rated For Bipolar Ii Disorder Report
better at 300 mg from 200 looking forward to 500! I have been taking lamictal for 9 months and have absolutely no side effects. I am only taking 300 mg. and i am disappointed because I feel as if I am taking a placebo. The depression is slightly better in that I don’t spend most of the day in bed sleeping or watching tv. I like the weight neutral and no bloating and I was able to get off the prosac. I was rapid cycling within the hour on prosac. I also take Topamax and neurontin along with my lamictal. These were prescribed by a neurologist for chronic neuropathic pain and seem to work well with lamictal in controlling the mixed state rapid cycling.
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How Does Lamictal Work On Depression
Depression is characterized by feelings of being overwhelmed that make it difficult to live a normal life. Because the disorder affects each person differently, medical professionals tailor the treatment based upon the individuals unique situation and condition. People dealing with depression are usually encouraged to adopt lifestyle changes that help lower stress levels and improve sleep. The regimen will also include recommendations for creating a supportive social network, exercising on a regular basis and eating a nutritious diet. While these changes are beneficial, some patients also need the help of prescription medications, such as a mood stabilizer or an antidepressant.
Lamictal Dosage For Epilepsy
Lamotrigine is FDA-approved to treat epilepsy, specifically simple and complex partial seizures, generalized seizures of Lennox-Gastaut syndromes , and primary generalized tonic-clonic seizures in adults. It is only approved as monotherapy for partial seizures after carbamazepine, phenytoin, phenobarbital, primidone, or valproate has been used as monotherapy previously.
Lamotrigine is not approved for initial monotherapy for partial seizures. It is only approved for use alongside valproate or other antiepileptic drugs for tonic-clonic seizures and LGS. When used with valproate, the starting dose is 25 mg by mouth every other day for two weeks, then 25 mg daily for two weeks, then 50 mg daily for one week, then increased by 25-50 mg daily every one to two weeks. The target dose is 100-400 mg daily of the immediate-release tablets or 200-250 mg daily of the extended-release tablets. The starting dose, target dose, and maximum dose differ when taking lamotrigine with AEDs other than valproic acid.
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Which Conditions Are Treated With Lamotrigine
Although lamotrigine is not considered an antidepressant, it is used as a maintenance treatment for in patients 18 and older to help stabilize mood changes by delaying the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy. ¹²
It is considered second-line therapy. The drug manufacturers original studies of lamotrigine in bipolar depression found that improvements were stronger in bipolar 1 than bipolar II disorder, Dr. Goldberg recalls. Newer research suggests, however, that lamotrigine may be even more effective as a mood stabilizer in preventing relapses in treating bipolar II disorder.²
There are also conditions lamotrigine treats off-label including , schizoaffective disorder, and obsessive-compulsive disorder , Dr. Aiken says.
How Does Lamictal Work And Whats Its Half
How Lamictal works isnt fully understood. The drugs half-life is about 25 hours.
Its thought that Lamictal works by stabilizing levels of certain compounds called amino acids. This affects how some messages are sent in your brain. When used to treat bipolar I disorder, the drug reduces the number of mood episodes. And when used to treat seizures, the drug decreases the number of seizures.
A drugs half-life describes how long it takes your body to get rid of half a dose. With a half-life of about 25 hours, Lamictal takes about 100 to 125 hours to leave your system. Thats about 4 to 5 days.
Your medical professional can help answer other questions about how Lamictal works or how long it stays in your body.
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Can You Overdose On Lamictal
Taking too much lamotrigine can cause serious and life-threatening adverse effects. Commonly described toxic effects include seizures, movement disorders, reduced consciousness, and cardiovascular symptoms. Call poison control at 1-800-222-1222 if you have taken more than your prescribed dose of lamotrigine and are experiencing rapid, uncontrollable eye movements , increased muscular activity, tremors, poor balance or coordination , a noticeable change in heart rate or heart rhythm, or you are feeling faint. Call 911 if you have experienced a seizure, or if you are a witness to someone who has stopped breathing, collapsed, or has had a seizure.
Four Myths About Lamotrigine
A deep dive into the history, side effects, and efficacy of a controversial drug.
Transcript edited for clarity. – Ed
KELLIE NEWSOME: Lamotrigine was launched for bipolar disorder in 2003, but it was a quiet launch, and since then a few myths have gathered around it as if to fill that vacuum. Today, we will address 4 of them.
Welcome to PsychPearls podcast with Psychiatric TimesTM, the voice of psychiatry. With thoughtful insights into the world of mental health, this podcast provides timely clinical commentary and practical cutting-edge pearls for you and your practice. We hope you enjoy it.
I am Chris Aiken, the Mood Disorders Section Editor for Psychiatric TimesTM and the editor-in-chief of the Carlat Psychiatry Report, and I am Kellie Newsome, a psychiatric NP and the cohost of the Carlat Psychiatry Podcast.
A Quiet Launch
But bipolar disorder is a chronic condition, and that is where the medication succeeded: in the maintenance phase.
The 2 positive studies looked at lamotrigine in the long term, over 1 and a half years. There, lamotrigine helped patients stay well about twice as long as a placebo.1 Katz knew that long-term studies like this were expensive and hard to come by, but for patients who have to stay on a mood stabilizer year after year it is this kind of data that matters most. So he gave it an indication for delaying new episodes of depression, hypomania, and mania in BD.
Myth #1: Lamotrigine does not help mania
Can I Drive While Taking Lamotrigine
Do not drive a car or ride a bike just after you start taking lamotrigine.
Taking lamotrigine may make you feel dizzy and may affect your eyesight when you start taking it .
This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you.
Do not worry – most people do these things as normal while taking lamotrigine.
Your Doctor Should Know
You need to talk to your doctor or pharmacist before starting treatment with lamotrigine if any of the following apply to you:
- you have kidney problems
- you develop rashes after taking lamotrigine or any other medicines for bipolar disorder or depression
- you have or develop a blood condition called HLH. It produces symptoms like fever, headache, feeling or being sick, stiff neck or your eyes being sensitive to bright light. It is also a very rare side effect of taking lamotrigine
Lamotrigine tablets have lactose in them which may not suit people who have a problem drinking milk or eating certain sugars. Talk to your doctor or pharmacist about this if you think it could be a problem for you.
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