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Suggest Treatment For Manic Episodes While On Lamictal
Question: HYPOMANIA on Lamictal:
Please do not respond to me if you believe lamictal cannot cause manic episodes just because it is a treatment for bipolar depression. Otherwise, please read:
I have been taking solely Lamictal since february when a new doctor decided that my SSRI was making me unstable. Since being on generic lamotragine (150mgs) I have gradually lost interest in friends, exercising, hobbies, career, etc., however I have felt a nice stillness in my brain that I never had with antidepressants. Also I am very nervous and submissive in social interactions.
A new doctor said I am definitely having bipolar depression and need to increase my dose to 200mgs, and switch back to the blue brand name. Tuesday I began taking 150mgs all in the morning and within hours I was very motivated and excited, working on career applications, confident with coworkers, yet talking too much with clients, extremely irritable, hard to contain my hyperactive energy. I was up very late doing homework which had been largely ignored but also had to take a lot of klonopin and ambien to get to sleep.
This has been how Ive felt for 4 days. Extremely productive yet uncomfortable and full of anger. Every time I have moved back to the brand name formulation, I experience an overactivation and even heart palpitations. I don't know if I'm reacting to something else in the pill. I took about 25 mgs of the generic lamictal toward the end of the day and it returned me to the sense of calmness I was having before.
I don't have an official bipolar diagnosis, partly because I have a trauma background which can mimick bipolar symptoms.
I have very concerned about developing a serious or permanent problem, and my new doctor has not returned calls.
Please do not respond to me if you believe lamictal cannot cause manic episodes just because it is a treatment for bipolar depression. Otherwise, please read:
I have been taking solely Lamictal since february when a new doctor decided that my SSRI was making me unstable. Since being on generic lamotragine (150mgs) I have gradually lost interest in friends, exercising, hobbies, career, etc., however I have felt a nice stillness in my brain that I never had with antidepressants. Also I am very nervous and submissive in social interactions.
A new doctor said I am definitely having bipolar depression and need to increase my dose to 200mgs, and switch back to the blue brand name. Tuesday I began taking 150mgs all in the morning and within hours I was very motivated and excited, working on career applications, confident with coworkers, yet talking too much with clients, extremely irritable, hard to contain my hyperactive energy. I was up very late doing homework which had been largely ignored but also had to take a lot of klonopin and ambien to get to sleep.
This has been how Ive felt for 4 days. Extremely productive yet uncomfortable and full of anger. Every time I have moved back to the brand name formulation, I experience an overactivation and even heart palpitations. I don't know if I'm reacting to something else in the pill. I took about 25 mgs of the generic lamictal toward the end of the day and it returned me to the sense of calmness I was having before.
I don't have an official bipolar diagnosis, partly because I have a trauma background which can mimick bipolar symptoms.
I have very concerned about developing a serious or permanent problem, and my new doctor has not returned calls.
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
I do believe there can be a significant difference between brand name Lamictal and generic lamotrigine. The difference in quantity of active ingredient can be as high as 20%. So, the fact that you have emergence of symptoms on Lamictal but not with lamotrigine suggests to me a need to return to generic lamotrigine. If you are experiencing bipolar depression, I would suggest the addition of lithium or a weight-neutral atypical neuroleptic such as Abilify or Latuda.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
I do believe there can be a significant difference between brand name Lamictal and generic lamotrigine. The difference in quantity of active ingredient can be as high as 20%. So, the fact that you have emergence of symptoms on Lamictal but not with lamotrigine suggests to me a need to return to generic lamotrigine. If you are experiencing bipolar depression, I would suggest the addition of lithium or a weight-neutral atypical neuroleptic such as Abilify or Latuda.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Prasad
Thank you. I think we've discussed this before. Is there any way to determine if this is an agitation vs actual hypo mania or mixed state? Klonopin and prazosin haven't done much. Interestingly taking a small dose of the generic lamictal works to calm me down somewhat.
Switching back to the generic however would put me back at square one with no resolution to my demotivated depressed state.
I have lithium at home from a previous trial would that serve as a differential if it stops the agitation?
Could there be some other ingredient in the formulation that I could be reacting to?
My experience with Latuda is that it tends to dissociate me so I'm staying away.
Switching back to the generic however would put me back at square one with no resolution to my demotivated depressed state.
I have lithium at home from a previous trial would that serve as a differential if it stops the agitation?
Could there be some other ingredient in the formulation that I could be reacting to?
My experience with Latuda is that it tends to dissociate me so I'm staying away.
Brief Answer:
Followup
Detailed Answer:
There is really no way to determine if this is agitation versus hypomania, because they are largely describing the same thing in a bipolar patient. I would not take lithium unless prescribed by your doctor with a carefully monitored blood level. I would return to generic lamotrigine, which likely has a different dose compared to Lamictal rather than a different ingredient, and add Abilify to treat bipolar depression.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
There is really no way to determine if this is agitation versus hypomania, because they are largely describing the same thing in a bipolar patient. I would not take lithium unless prescribed by your doctor with a carefully monitored blood level. I would return to generic lamotrigine, which likely has a different dose compared to Lamictal rather than a different ingredient, and add Abilify to treat bipolar depression.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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