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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by fiftylager on February 4, 2007, at 6:14:22
In reply to Lamictal... is it truly effective at anything?, posted by River1924 on February 3, 2007, at 23:55:28
I am on lamictal and it is not working; however it seems that I am one of the few. It really depresses me further that this hasn't worked because for most who take it, it is a wonder drug. If you go look at remedyfind or many other different forums (bipolar mainly) this med is a wonder drug and doesn't have many side effects. I wish it worked for me. I'm at 200 mg, and I'm in a mixed state. I've been on this med for 9 months.
Crissi
Posted by Quintal on February 4, 2007, at 6:40:46
In reply to Lamictal... is it truly effective at anything?, posted by River1924 on February 3, 2007, at 23:55:28
Lamictal seemed to work for me at 200mg with 4mg Klonopin. That was the only regimen that kept my mood rock solid and bright for two years.
Q
Posted by ClearSkies on February 4, 2007, at 8:21:58
In reply to Lamictal... is it truly effective at anything?, posted by River1924 on February 3, 2007, at 23:55:28
> I read an article which said lamictal had failed (for bipolar depression)in six of seven studies larger than 200 people. Of course the company only published the the one with good spin in 1999.
>
> Is that true?
>
> River.Well, I can tell you that it's effective at removing hair from my head, and suppressing my sense of taste and smell.
I just gave up after more than a year on Lamictal, after having several hypomanic episodes that weren't the least bit slowed down by it.CS
Posted by Phillipa on February 4, 2007, at 11:49:57
In reply to Re: Lamictal... is it truly effective at anything? » River1924, posted by ClearSkies on February 4, 2007, at 8:21:58
Supposed to boost my antidepressant all I got was excess salivation. But I lost my sense of taste and smell about 2 and ahalf years ago before the lamictal wonder what other meds cause that? Love Phillipa
Posted by rina on February 4, 2007, at 16:02:26
In reply to Lamictal... is it truly effective at anything?, posted by River1924 on February 3, 2007, at 23:55:28
> I read an article which said lamictal had failed (for bipolar depression)in six of seven studies larger than 200 people. Of course the company only published the the one with good spin in 1999.
>
> Is that true?
>
> River.River, very true. I read a similar article. It said if the recommended maximum dose of lamictal is not taking effect within 2 to 3 weeks, it's not the best for that particular person. That dose is 300mg.
Posted by rina on February 4, 2007, at 21:33:16
In reply to Re: Lamictal... is it truly effective at anything? » River1924, posted by ClearSkies on February 4, 2007, at 8:21:58
> > I read an article which said lamictal had failed (for bipolar depression)in six of seven studies larger than 200 people. Of course the company only published the the one with good spin in 1999.
> >
> > Is that true?
> >
> > River.
>
> Well, I can tell you that it's effective at removing hair from my head, and suppressing my sense of taste and smell.
> I just gave up after more than a year on Lamictal, after having several hypomanic episodes that weren't the least bit slowed down by it.
>
> CS
> Wow!! I was wondering why I started to get two big plugs out of hair.
>
Posted by psychobot5000 on February 5, 2007, at 0:05:48
In reply to Lamictal... is it truly effective at anything?, posted by River1924 on February 3, 2007, at 23:55:28
My impression from this board and docs' opinions is that it seems pretty effective for bipolars with primarily negative symptoms. As for depression, it has an immediate mood-brightening effect in some people (like me), unlike most antidepressants, but that initial effect often disappears, and it can even make things worse.
I think the best dose for those disorders tends to be around 100-200mg? I've read a study or two that seemed to show positive and stabilizing effects on mood, but it wasn't useful to me in the long run.
Pbot
Posted by River1924 on February 5, 2007, at 0:15:56
In reply to Re: Lamictal... is it truly effective at anything?, posted by psychobot5000 on February 5, 2007, at 0:05:48
From what I read, it does not work as an anti-depressant but it will extend stable periods by a few months before the bottoms drops out compared to those who don't take it. R.
Posted by SLS on February 5, 2007, at 7:08:58
In reply to Re: Lamictal... is it truly effective at anything? » psychobot5000, posted by River1924 on February 5, 2007, at 0:15:56
McMan's Depression and Bipolar Report
Research and News
Jan 20, 2007 Vol 9 No 3
Lead Story
The answer is Lamictal. The question is why?
Also in This Issue
New Orleans, Quiz, The internet, rTMS, BP relapse risk, Omega-3, DSM, BP meds use, Brain science, Wellbutrin in Europe, Zyprexa settlement, Seroquel misstatements, Art Buchwald, William Styron, Final Word, About McMan's Report, About McMan, My Book, McMan's Web, My Blog, McMan Interviewed, My Upcoming San Diego Talk, Donations.
The Bipolar Depression Indication That Isn’t
Report 9#1 reported on seven unpublished phase II and III clinical trials that found that Lamictal (lamotrigine), failed to outperform the placebo in each of the studies. The trials in question tested Lamictal across a spectrum of depressions in the acute (initial) phase of treatment, including two for recurrent depression and four for bipolar depression. All but one of the seven trials involved at least two hundred patients.
All of these studies were conducted by GSK, makers of Lamictal, with a view to an FDA indication. Not surprisingly, GSK never sought approval for bipolar depression. Despite this, GSK is running advertisements that say: "Have you taken more than one antidepressant and still feel depressed?" The ads conclude with, "Say something to your healthcare provider."
With seven failed studies? What is GSK basing this on?
In 2003, the FDA granted Lamictal an indication for bipolar maintenance, based on two (published) trials that found the drug delayed relapses into bipolar depression over 18 months. In other words, Lamictal may help keep you well, but get you well? Surely, the psychiatric profession would see through this. Um, well, read on …
What the Treatment Guidelines Say
This Report reviewed six major bipolar treatment guidelines, all prepared by leading psychiatrists, with input from many more leading psychiatrists. All but one of the guidelines purports to be "evidence-based." The other relies on "expert consensus." In practice, most, if not all, are hybrid documents.
The four North American guidelines give Lamictal an overwhelming thumbs-up for acute (initial) phase bipolar depression. The American Psychiatric Association’s (APA) Practice Guideline published in 2002 advises: "The first-line pharmacological treatment for bipolar depression is the initiation of either lithium or lamotrigine."
The latest edition of the Texas Implementation of Medication Algorithms (TIMA, formerly TMAP), put out by the state of Texas in 2005 goes one better. For treating acute bipolar depression, the algorithm recommends Lamictal (either alone or with an antimanic agent) as its ONLY first choice.
The Canadian Network of Mood and Anxiety Treatment (CANMAT) Guidelines, issued around the same time as TIMA’s latest version, also recommends Lamictal as a first option for treating acute bipolar depression, but includes other choices, as well.
The 2004 Expert Consensus Guidelines, in its Patients and Families Guide, advises that Lamictal is "sometimes considered an antidepressant agent" and that "antidepressants treat symptoms of depression."
Exhibit A in the evidence line-up for these guidelines is the one GSK Lamictal study that produced an encouraging result. The reason everyone knows about this study is because this is the one that GSK published (in 1999). All four of the guidelines above site this study as evidence of Lamictal’s apparent efficacy, though there are two important caveats:
The APA did note that the study only succeeded using the MADRS scale as a measure (which happened to be the secondary endpoint) rather than the primary one (the HAM-D). In other words, the FDA probably would have thrown this study out.
The editors of the Expert Consensus Guideline did note that enthusiasm for the drug among the 47 psychiatrists it surveyed was rather surprising in light of only one published study.
What about all those failed studies? Nary a mention. Almost. The APA did manage to put a positive spin on one of the failed studies by way of an indirect citation from a review article. In addition, the APA (and TIMA and CANMAT) turned to Exhibit B in the form of a small study comparing Lamictal to Neurontin. The APA also cited an open label study in which most of the patients were on other meds.Time to hear from the English.
The British Association for Psychopharmacology (BAP), in its 2003 Guidelines, citing "limited evidence," recommends Lamictal as a first choice in the acute phase only for "less severe" depression.
The National Institute of Health and Clinical Excellence (NICE) is far less charitable. Its 2006 Guideline states: "The following treatments should not be routinely used for acute depressive episodes in people with bipolar disorder: lamotrigine …"
NICE cites GSK’s 1999 published study as "inconclusive" for efficacy and "unclear" for risk-benefit. The slow dosing schedule for Lamictal (six weeks to get up to full strength) is also an issue with NICE.
In another section, NICE explains its skepticism for industry-sponsored studies: "Such studies are more likely to report results that favor the sponsor’s product than are independent studies. This may reflect publication bias or design bias."
Publication bias? Talk about understatement.
Conclusion
In science, the object of an experiment is to prove one’s hypothesis wrong. In eight clinical trials – seven failures and one partial success - GSK admirably succeeded beyond its wildest expectations.
As expected, GSK was far too modest to broadcast the results. That, of course, is the job of psychiatry.
Which leads to the crunch question: With my illness, a serious depression is not a matter of if, but when. When that time comes, I expect my psychiatrist to recommend the best treatment to meet my needs. This will probably involve a medication of some sort. I do not expect to be handed what amounts to a placebo with side effects. My life may be riding on the outcome and one wrong choice may prove fatal. The problem is, with the best minds in psychiatry getting it wrong, with the APA itself getting it wrong, how on earth can I trust my psychiatrist to get it right?
Reminder
Lamictal is FDA-approved for bipolar maintenance, with demonstrated efficacy for delaying relapses into bipolar depression. As a mood stabilizer, there is also evidence that it helps against rapid-cycling. There may be occasion for your psychiatrist to recommend Lamictal for other uses, including ones that run counter to study evidence. But once again, the problem remains: How well do you trust your psychiatrist?
Posted by psychobot5000 on February 5, 2007, at 12:12:02
In reply to Re: Lamictal... is it truly effective at anything?, posted by SLS on February 5, 2007, at 7:08:58
The selective reporting the article (convincingly) alleges seems to me to be crossing a line--irresponsible, beyond just enthusiastic promotion of a product and into concealment of a large body of evidence against efficacy. How can you conduct six studies with more than two-hundred patients each, and not publish any of them?
Thanks for posting it. Makes me feel better about my own annoyance with the drug.
Posted by Phillipa on February 5, 2007, at 17:54:45
In reply to Re: Lamictal... efficacy...damn. » SLS, posted by psychobot5000 on February 5, 2007, at 12:12:02
Scott me too as it didn't work as an augmentor for depression for me. And now she wants triletal any better or the same for unipolar depression as I don't understand mood stabalizers if not bipolar. Love Phillipa
Posted by rina on February 5, 2007, at 18:10:52
In reply to Re: Lamictal... is it truly effective at anything? » psychobot5000, posted by River1924 on February 5, 2007, at 0:15:56
> From what I read, it does not work as an anti-depressant but it will extend stable periods by a few months before the bottoms drops out compared to those who don't take it. R.
Yep, after taking it for a year, the bottom drops out after the first 5 months. To bad because it worked wonders for me in the beginning.
Posted by River1924 on February 6, 2007, at 0:39:14
In reply to Re: Lamictal... is it truly effective at anything?, posted by SLS on February 5, 2007, at 7:08:58
Yep, that's where I read it. Thanks for the reminder. River.
Posted by ed_uk on February 6, 2007, at 17:04:17
In reply to Re: Lamictal... is it truly effective at anything?, posted by SLS on February 5, 2007, at 7:08:58
Scott,
After reading the article you posted, what is your opinion of using lamotrigine as a treatment for bipolar disorder?
Ed
PS. Is the Nardil helping?
Posted by SLS on February 6, 2007, at 18:31:40
In reply to Re: Lamictal... is it truly effective at anything? » SLS, posted by ed_uk on February 6, 2007, at 17:04:17
> After reading the article you posted, what is your opinion of using lamotrigine as a treatment for bipolar disorder?
I think lamotrigine can be effective. However, it has been my experience that it works better as an augmenter rather than monotherapy. There is definitely a pattern with many people of responding early in treatment with diminishing returns.
> PS. Is the Nardil helping?Yes. Thanks. I haven't yet decided what is the optimal dosage of nortriptyline. Micturition continues to be a problem. I'm sure everything will work out fine.
:-)
- Scott
Posted by ed_uk on February 7, 2007, at 14:42:54
In reply to Re: Lamictal... is it truly effective at anything? » ed_uk, posted by SLS on February 6, 2007, at 18:31:40
Hi Scott
It's really good to hear you sounding so much better :)
Ed
Posted by linkadge on October 21, 2007, at 0:30:16
In reply to Re: Lamictal... is it truly effective at anything? » SLS, posted by ed_uk on February 7, 2007, at 14:42:54
I hated lamotrigine. It is just a bunch of hype IMHO. Too much agitation, too much insomnia. It was like swallowing a benzo and a caffiene pill at once. I wouldn't call it a mood stabilizer either.
Linkadge
Posted by mogger on October 25, 2007, at 2:18:36
In reply to Re: Lamictal... is it truly effective at anything?, posted by rina on February 4, 2007, at 16:02:26
Lamictal has saved my life, I would pop some for breakfast, lunch and dinner if I could. I spent 8 years trying med after med without success and lamictal has been the one for me. It is what has made me change my thoughts (positive) on science and medication.
Posted by river1924 on October 25, 2007, at 14:38:50
In reply to Re: Lamictal... is it truly effective at anything?, posted by mogger on October 25, 2007, at 2:18:36
It didn't do anything for me but elevate my liver enzymes but I'm glad you found something. At least, it didn't make me feel worse. I'm lucky in the sense I can find lots of things that kinda work.
Congrats. Peace, River.
Posted by msanjelpie on October 26, 2007, at 3:53:06
In reply to Re: Lamictal... is it truly effective at anything? » mogger, posted by river1924 on October 25, 2007, at 14:38:50
I've been on Lamictal for 8 years. Only went off of it during last 4 months of pregnancy. When I am off of it and only on an AD, the AD just doesn't have enough punch. The lamictal increases the AD, but stops it from going through the roof. It's a stabilizer, not an AD. Sure I've had to increase and change ADs through the years, but Lamictal has remained constant. Klonopin is necessary to sleep and it completes the trifecta of anti-depressant / mood stabilizer / sleeping pill. Now if they could come out with one pill that does all 3, I'll be happy...
Jeannie
Posted by Bonnie_CA on October 27, 2007, at 14:42:52
In reply to Re: Lamictal... is it truly effective at anything?, posted by msanjelpie on October 26, 2007, at 3:53:06
It seems to work pretty well for me, but I don't think it will work alone. My doctor wants to get me off of SSRIs, but all it's doing is causing me to use more benzos. Trading one possible evil for another. It had some agitation and an energizing effect for awhile, but that seems to have subsided as of late. It does keep my mood more stable without making me flat. I'm on 200 mg. I was better on the full dose of the SSRI, so I think I'm going to go back to that. It's just the aches and pains after exercise. I need to find a way around that. Do some experimenting to see how I can avoid that. I still think that's being caused by the lamictal and not the lexapro.
-Bonnie
Posted by rina on October 31, 2007, at 17:38:53
In reply to Re: Lamictal... is it truly effective at anything?, posted by Bonnie_CA on October 27, 2007, at 14:42:52
Lamictal like always works in the beginning for me and then quickly pops out within the first 5-6 months and back to the drawing board. I also think the Lexapro and Topamax have had their life span as well.
Posted by rina on October 31, 2007, at 17:39:05
In reply to Re: Lamictal... is it truly effective at anything?, posted by Bonnie_CA on October 27, 2007, at 14:42:52
Lamictal like always works in the beginning for me and then quickly pops out within the first 5-6 months and back to the drawing board. I also think the Lexapro and Topamax have had their life span as well.
Posted by fjc9 on November 1, 2007, at 4:59:46
In reply to Re: Lamictal... is it truly effective at anything?, posted by msanjelpie on October 26, 2007, at 3:53:06
> I've been on Lamictal for 8 years. Only went off of it during last 4 months of pregnancy. When I am off of it and only on an AD, the AD just doesn't have enough punch. The lamictal increases the AD, but stops it from going through the roof. It's a stabilizer, not an AD.
I have been on Lamictal for three years but only coupled with Depakote. I'm currently on 100mg Lamictal and 1000mg Depakote ER. I was only given Lamictal after my pdoc had given some to a few of his bi-polars that were "stuck" and it helped them get "unstuck". Anyway, I was also kinda "stuck" but he wouldn't let me just have Lamictal w/o Depakote because he was using Depakote as the mood stabilizer to prevent Lamictal from amp'ing me up too much. Too bad Lamictal has that fatal rash complication --- or that it sucked in seven trials out of eight.
I just got EMSAM Tuesday night but I didn't put on the 6mg patch until tonight --- but only after GOOGLE'ing to see if it was swimming pool/shower proof. I thought it would be a thick patch sort of akin to a tea bag with adhesive but was surprised to see it was a transparent plastic film with adhesive. Sad. Wikipedia didn't say anything about it being shower-proof! I read the enclosed pamphlet too and it didn't seem to mention "Don't get wet" anywhere in bold relief!(>_<) Yeah, I did kinda forget to ask my doc about the water thingy...but I have been having a lot of (allegedly Depakote-related) "mental cobwebs" lately.
[Thanks go to Robert for his "First Day" thread in 2006 that GOOGLE seemingly latched onto... (http://www.dr-bob.org/babble/20060408/msgs/630549.html)]
Posted by Phillipa on November 1, 2007, at 20:24:51
In reply to Re: Lamictal... is it truly effective feat. EMSAM » msanjelpie, posted by fjc9 on November 1, 2007, at 4:59:46
No soaking in hot tubs though. And he's now taking it a few days a week for energy when feels the need for it. And down to l.5mg of klonopin. We still stay in touch and he's doing very well. Phillipa
This is the end of the thread.
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