View Full Version : Lamictal Protects Against Bipolar Symptoms


Andrew
05-28-03, 03:15 PM
LAMICTAL PROTECTS AGAINST BIPOLAR SYMPTOMS
GlaxoSmithKline's anticonvulsant Lamictal (lamotrigine) was shown in a study to protect against the depressive symptoms of bipolar 1 disorder. The 18-month study was one of the longest and largest ever conducted for bipolar 1 disorder treatment. The drug significantly delayed the time to intervention for a mood episode in patients who were recently manic or depressed. Lamictal is under review by the FDA for treating bipolar 1 disorder.

*Source: FDA

fasttalkingmom
07-27-03, 06:41 PM
My husband has been on this drug for the past 5 days...... First time for him to be on any meds for bipolar....

The past couple days he's been very calm. He's been complaining about being very tired at the end of the day and he says kinda dizzy like....

Not sure what I'm looking for in the way of change in his behavor. His bipolar behavor has been going on sooooooooo long, years ! I never reconized it as bipolar...... I just thought I married a mean, nasty, depressed, human being.....Some info. I saw on this board is how I started to realize what was going on with him. I had to force him(with the help of his Dr.) to go with me to get help....


Any other infor. on this drug would be so great !

Paula

joanrdtobe
07-27-03, 06:48 PM
Paula: In general the goal for bipolar disorder is mood stabilization....not up and not down...but somewhere in the middle...not manias and not depressions...or at least less time between either of the two....and it IS a challenge...as many treatments for this disease have been shown to illicit depression..and so doctors have to add an antidepressant...but that's great about the Lamictal findings:)

Andrew
07-27-03, 09:22 PM
More Lamictal info...

Lamictal (mfg's website) (http://www.lamictal.com/)
FAQ: Psychiatric Uses of Lamotrigine (http://www.psycom.net/depression.central.lamotrigine.html)
Epilepsy Drug Lamictal Appears Effective For Bipolar Depression (http://www.pslgroup.com/dg/eb8ea.htm)

fasttalkingmom
07-28-03, 12:45 PM
Thank you ! found so heplful and very useful info.

Lafnalot
07-29-03, 10:57 PM
Most of the issue isnt the inducement of depression. Its the inducement of mania. Antidepressants induce mania in bp people, hence the use of mood stabilizers, many of which are anticonvulsants like Lamictal.

joanrdtobe
07-30-03, 07:01 PM
That may be true Crissy, in theory, but not the experiences I have had at the several inpatient hospitals I've been priviledged to spend time in during the darkest times of my life. At one such hospital: the medical director (who obviously was a psychiatrist) diagnosed a fair amount of patients with bipolar disorder (myself included). So he would put us on lithium or depakoate or tegratol WITH an antidepressant, as we were told that our bipolar meds, with its mood stabilizing properties, may induce depression, not mania. Most of us did find that to be the case. Again, I'm a true believer that people will respond to meds in different ways....

Lafnalot
07-30-03, 08:40 PM
In unipolar area of bipolar disorder, that would be correct.
In traditional bipolar disorder which includes hypomania or traditonal mania, it is not.

http://www.psychguides.com/bphe.html
"Although mood stabilizers by themselves, especially lithium, can sometimes pull you out of a depression, you may also need to take a specific antidepressant medication to treat the depressive episode. However, if given alone, antidepressants can sometimes cause a major problem in bipolar disorder by pushing your mood up too high (causing hypomania, mania, or even rapid cycling). Therefore, in bipolar disorder, antidepressants are given together with a mood stabilizer to prevent an "overshoot."


http://www.bpso.org/ads.htm :
"Use of Antidepressants in Treating Bipolar Disorder
Patients with bipolar disorder, particularly those who are undiagnosed or in the early phases of their illness, often first seek medical help complaining of depression. Inexperienced or inadequately informed medical personnel often take these complaints at face value and prescribe an antidepressant, which frequently induces an episode of mania in the patient. It is crucial that physicians, in addition to looking for physical causes of depression (such as thyroid conditions), also explore the patient's personal and family medical history for signs of bipolar disorder. Consultation with the patient's nearest loved ones can be critical, as some early signs of the disorder may not seem to be worth mentioning to the depressed patient.

The conservative approach is first to establish a mood stabilizing medication prior to beginning the antidepressant. The mood stabilizer has the effect of moderating or opposing the mania-inducing effects of the antidepressant. (Antidepressants taken without a mood stabilizer are known as "unopposed antidepressants.") There are situations where unopposed antidepressants may be acceptable, as when suicide is an imminent treat, but in any case the important fact is that antidepressants should be prescribed to persons with bipolar disorder with extreme caution, and only by skilled psychiatrists or psychopharmacologists."



http://www.psycheducation.com/bipolar/controversy.htm
Antidepressants in Bipolar Disorder: The Controversy
(revised July 2003)

There is strong consensus that antidepressants carry risk if used alone near the Bipolar end of the spectrum below:



However, there are two controversies in Psychiatry regarding antidepressants in bipolar disorder. First, can one safely use antidepressants alone nearer the "unipolar" end of this spectrum? And secondly, can one combine an antidepressant with a mood stabilizer and continue it?

Controversy 1



Is the "transition point" -- the point at which antidepressants begin to carry some risk of inducing hypomania -- better indicated by the yellow, or the green arrow below?



This is the heart of the first controversy about using antidepressants in patients within the bipolar spectrum: where is the arrow? However, obviously we have no criteria for "mapping" a patient's position on this spectrum, even if we did know whether the yellow or the green arrow was more accurate. Still, almost all psychiatrists agree on the principle: watch out, if your patient is to the right of the arrow. We just disagree on where the arrow is!

Thus even mood experts disagree about how much caution to use when considering antidepressants for a patient with mild, or subtle, or vague hypomanic signs such as:

severe insomnia (as opposed to decreased need for sleep, a more accepted sign)

moderate irritability (as opposed to profound, irrational, impulsive acts of anger)

anxiety or agitation (possibly the most important risk factor for suicide in mixed depressed states)

a patient who endorses "racing thoughts", but does not volunteer this complaint

For patients like this with depression, choosing an antidepressant alone is still a more common choice than choosing a mood stabilizer. I think that will change, but for now, you can use either medication with lots of good company.

Controversy 2: Your patient is better; should you continue or taper the antidepressant?

Report in preparation. This got a lot more complicated as of July 2003 when Dr. Altshuler and colleaguesAltshuler published a study showing antidepressants, when continued along with a mood stabilizer, were associated with a substantially better outcome than when they were tapered early.

Was this due in some way to patient selection? or to the lack of additional means of preventing depressive relapse (e.g. lithium or lamotrigine?) Since there are other really smart psychiatrists (e.g. Sachs, Ghaemi) who have argued strongly for tapering the antidepressant in this circumstance, I wonder if somehow these different groups are describing "different parts of the elephant"? Clearly some patients will start cycling if given an antidepressant; and clearly one of the best ways to handle rapid cycling is to taper the antidepressant. So how is it that Altshuler et al's patients did so well?

IN SUM:

1. Do not use antidepressants if hypomania is already clearly present.

2. If a patient becomes hypomanic when given an antidepressant, strongly consider a mood stabilizer (see guidelines on their use in primary care) as opposed to another antidepressant.

3. If in doubt, refer for a diagnostic consultation (if no psychiatrist is available, use a therapist whose diagnostic skills you trust) before proceeding. At minimum, use the 1-page screening tool to "rule out bipolar", and/or have the patient read about bipolar II to enlist her/his efforts re: accurate diagnosis and understanding of risk.

joanrdtobe
07-30-03, 08:49 PM
Thanks for the information....Again, just my experience....

Andi
12-28-03, 11:45 PM
I'm a classic example to this debate...I began on a low dosage of Lexapro and it did little for what was thought to be deep depression. By the time I began to seek psychiatric help I was already on 20mg Lexapro, 15 mg of Buspar, and 1 mg of Xanax to stop my "anxiety/panic" attacks and severe depression. Since it was clear I was depressed and suicidal and that the meds weren't working the Psych doubled my Lexapro. In full bipolarII rapid cycling style, I went off the charts. The antidepressant caused a non-stop manic phase. I was quickly switched to Lithobid and Zyprexa. We are still working for a complete solution, but through my research and understanding through my doctor, SSRI's cause manic phases...the only reasoning I can give is that perhaps a temporary small dose of an antidepressant will bring a bipolar patient into a manageable manic phase which can be viewed as better than the severe depressive low.

Andi
03-09-04, 03:39 PM
Lmbo...Guess who is on Lamictal now. Initially I called it my wonder drug. After being a Lithobid zombie for several months the primary doses appeared to be lifting the haze...chasing away the clouds but now, on 125mgs I'm cycling again. I may attribute it to the revelations and repressed memories that have decided to surface and my doctor informs me that I should consider what it would be like if I were Lamictal free, but we shall see. So, I'm fast approaching increased doses...shooting for 300mg and let's hope no more.

damddrew
04-23-04, 01:41 AM
i thank all who posted... more info is what we all need.

to start, im labeled bpII w/ severe dep. was started out on celexa/lexapro ... for 5+ yrs was on 20mg

now that has stopp'd. i recently started lami(lamictal), and got up to 100mg dose now ... i still stay depressed most of the time, and i rarely hit any "high's" ....

this all started in relation to a car accident i was passenger in, that left me with a TBI

got a neuro phych that 'thinks', that ive never completely come to, after the coma? how odd i thought.

mayb he's right, probly hes wrong. but im 'forced' to test with him. :nono:
---------------------------

now i get most of the S.E's of the lami, including the groggy feeling in the mornings. now this is bad for me, as i tend to b accident prone in most i do. as far as the 'rash' .... i started to get these little bumps, not in a rash formation. just scattered about on my body ... looks similar to a pimple only a small whitehead to top'em.

now i can hardly tell the differance, if ANY ... from my titration of the lami ... now i dont have an' anti-dep to keep me happy. altho i didn't like how lexapro kept me happy, even when i knew i should of b pis-E. but i stay so low now i want sumthing. ive discussed this with my pdoc, but he seems to not hear me, or just ignoring me. well theres my word, accept it, deny it ... thats my experience, i was never to b thought of as ADD/ADHD with my complaints of personal thoughts
X da drubster X

Wish
05-02-07, 12:45 PM
Lamictal was a great drug for the first 10 days I took it. Unfortunately, I'm one of the rare adults who got the dreaded lamictal rash. It was the most horrible thing I've ever experienced as far as skin problems go.

I'm hoping I can find something else that helps for bipolar ii and that doesn't cause a rash or significant weight gain.

Andi
05-02-07, 10:22 PM
Just a question...while you were beginning your treatment, were you slowly increasing the dosage, which has been known to lessen the incident of rash, AND have you by chance been going to the suntanning bed or suntanning outside? If so, please let your pdoc know and see what they say.

Wish
05-02-07, 10:59 PM
Andi, I started on 10 mg once a day. I hadn't been tanning at all. In fact, I haven't been outdoors much these past few months. I'm actually allergic to the drug. So, even starting slowly won't help. I went to bed feeling fine and woke up with a red bull's eye looking spots all over my body.