Q: Lamictal, Physostigmine,
I'm a rapid cycler. My cycles seem to be from 3 weeks to a month in length with
the good times lasting for 2 to 3 weeks & the bad times lasting for a week to 10
days. My doctor is trying me on lamictal. So far no luck. I thought I was cured
until this week when I quite unexpectedly dropped into the abyss again. Three
1. I'm currently on 200mg of lamictal. Is it possible that a higher dose would
do the trick? I'm 6'3" & 250lb. if that makes any difference.
2. I read something about physostigmine which according to my interpretation of
the article, given by injection would bring a patient out of the depressive
phase. Do you know whether this might be true or not?
3. Does norepinephrine level play a role in manic depression? Do norepinephrine
reuptake inhibitors help to relieve the cycling?
Dear John --
Doctors who have used lamotrigine (Lamictal) up to the limit that the
neurologists usually use as a maximum, namely 400 mg per day, were reporting
verbally in a recent conference I attended that they saw additional benefit at
the higher doses and would not hesitate to go higher if getting less than a full
response. To my knowledge we have no data on this strategy, however. (Hint: the
200 mg pill costs about the same as a 100 mg pill; so definitely use bigger
pills and chop to keep costs down, but make sure you go up slowly according to
your doctor's directions, too).
#3 next: Norepinephrine reuptake inhibitors, like serotonin reuptake inhibitors
(or Effexor, which is both in one pill) are antidepressants and pose a risk of
inducing cycling. We have very few data suggesting that any antidepressant is
any less likely than the others to induce manic-side symptoms and cycling; some
people think Wellbutrin (buproprion) might be better that way but one study by
Gary Sachs did not show this difference (may have been too small for that
purpose), and many people think MAOI's might also be better in this way.
don't know about such a connection. A lit' search produced a couple of
interesting things, including physostigmine making depression mildly worse in
borderline "personality disorder"Steinberg;
and use of donepizil (Aricept), a medication for Alzheimer's dementia, showing
that it -- like physostigmine -- shortens the time to REM sleep. Basically it
looks like there is some research looking into the acetlycholine as a
neurotransmitter and its relationship to mood disorders, but there is nothing
conclusive there yet and no mention I saw about physostigmine as a treatment.
forget lithium has antidepressant as well as anticycling properties, if you're
hunting for something to add...
Published December, 2003