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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by lepus on November 24, 2003, at 19:47:55
My pdoc has me starting on Lamictal for monotherapy for BPII (or at least that was the last dx I remember). He has me starting out at 12.5 for two weeks, then 25 for two weeks, and so on. Isn't this a little slow? I really don't trust this pdoc to be honest and am searching for another one. He seems to be in the pockets of the pharm reps and rather uneducated.
Also, how long does it take for the side effects to go away and to notice some improvement? I thought I was noticing some improvement but now (at a week and 3 days into therapy at 12.5) I am feeling depressed and anxious. Will this go away or do I need to stop the medication? Honestly, right now I feel worse than when I started it. I am tired, anxious, feeling down having difficulty concentrating, etc. Any thoughts?
Thank you and I find this board to be wonderful. I am glad I found it.
-Lep
Posted by Emme on November 24, 2003, at 21:57:22
In reply to Lamictal dosage increase intervals, posted by lepus on November 24, 2003, at 19:47:55
> My pdoc has me starting on Lamictal for monotherapy for BPII (or at least that was the last dx I remember). He has me starting out at 12.5 for two weeks, then 25 for two weeks, and so on. Isn't this a little slow?
That's not unreasonable. 12.5 mg per week is a common rate of increase. Your doctor's just being a bit cautious. Better that than the reverse. You might ask him what he thinks about a faster increase.
>I really don't trust this pdoc to be honest and am searching for another one. He seems to be in the pockets of the pharm reps and rather uneducated.
Is this your first pdoc? How does he seem to be in the pockets of the pharm reps (more so than other doctors)? How does he seem uneducated? Does he not answer your questions or give you enough information? Good luck with your search.
> Also, how long does it take for the side effects to go away and to notice some improvement? I thought I was noticing some improvement but now (at a week and 3 days into therapy at 12.5) I am feeling depressed and anxious. Will this go away or do I need to stop the medication? Honestly, right now I feel worse than when I started it. I am tired, anxious, feeling down having difficulty concentrating, etc. Any thoughts?Way way too soon and much too low a dose to tell anything about whether it's going to help your depression. The therapeutic dose is highly variable. For some, 75 mg will do it, others need to go into the hundreds. Monotherapy would be great, but don't be bummed if you should end up needing to augment it.
I found it activating at first and was jittery, but that wore off with time. I also felt fluish and generally unwell when increasing the dose, but that also wore off within a few weeks and hasn't been a problem at higher doses. It didn't hinder my concentration, but if you are experienceing that, it may wear off. Keep contact with your doctor and try to stick it out for a longer trial before ditching it unless you start to feel really bizarre or intolerable side effects.
Emme
Posted by lepus on November 25, 2003, at 11:31:40
In reply to Re: Lamictal dosage increase intervals » lepus, posted by Emme on November 24, 2003, at 21:57:22
Thanks for your reply. Basically, I felt he was uneducated because he told me nothing of the rash! He didn't tell me to look out for it or that it was dangerous! When I asked about increasing the dose so slowly he said that it was not because of the danger of the rash but just "how they do it". Also, the few times I have seen him there has always been a pharm rep there and I have had to wait to see him until he sees the pharm rep even if he is already late for my appointment. Rather annoying. I just don't get a good feeling that he is very knowledgeable or even cares. Phone calls haven't been returned even when I have stated it was an emergency, etc.
But thanks for the info on my titration schedule.
Posted by Emme on November 25, 2003, at 14:39:14
In reply to Re: Lamictal dosage increase intervals, posted by lepus on November 25, 2003, at 11:31:40
> Thanks for your reply. Basically, I felt he was uneducated because he told me nothing of the rash!
Bad news. Either he's ignorant or irresponsible about giving patients approrpiate information. Given how much the rash risk is talked about, I'm betting the latter.
> He didn't tell me to look out for it or that it was dangerous! When I asked about increasing the dose so slowly he said that it was not because of the danger of the rash but just "how they do it".
Bad news. Get another pdoc. Maybe he was trying not to scare you or something, but everyone else's doctors tell them to be on the lookout for a rash. Most of the time the rash is harmless, but it needs to be taken seriously just in case.
> Phone calls haven't been returned even when I have stated it was an emergency, etc.
That's very bad. Good luck finding someone new. You need someone more on top of things to guide you with a tricky drug.
> But thanks for the info on my titration schedule.
You're welcome.
Posted by delna on November 25, 2003, at 17:49:17
In reply to Lamictal dosage increase intervals, posted by lepus on November 24, 2003, at 19:47:55
Your pdoc may be incompetant and by all means find a new one. Especially since he gave you no warnings about the serious side effects.
I just wanted to add that my pdoc started me out so slowly too-just to see if i could tolerate the drug at all.
After around 50mg a day ,he accelerated the dose at a better rate. 25mg every 2-4 days- till I was on 200 daily. I really didnt believe the drug would help but by the time i reached full dosage I was really well.
As for side effects-I was throwing up after every dose increase - my pdoc had to give me anti-nausea pills. I was also anxious,agitated and tired. I felt so discouraged and cried daily, thinkng that I was a hopeless case. I must add that having had bipolar since I was a child, I have never been funtional before.
I held on and it paid off in the end. My pdoc just encouraged me so much to hang in there and give the drug a full try.
For me that really helped. It is so important to have a pdoc that is willing to be there for you
Lamictal really changed my life despite the initial problems. Today I am a new person.
As for the side effects, these went away in a few days as by body became more tolerant.
Now I dont have any side effects- no tiredness and infact increased concentration and no anxiety.
I so hope it helps you.
Lots of love and luck
D
sorry for babbling so much
This is the end of the thread.
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