Lamictal or Topomaz

[crazymama30]

Well, I think I have to give a mood stabilizer one more try. difficult child is so irritable, he is at times unbearable. He will not quit arguing, listen, and is just unreasonable. We are down to Topomax or Lamictal. What has anyone's experience with either of these medications, and what did they improve? I realize that everyone reacts to medications differently, but I just different input than psychiatrist,webmd, and pharmicist can give me. I get so worried about medications, we have had so many problems. :surprise:

Thanks

 

[smallworld]

I have two kids on Lamictal. It helped with their irritability, which was tied to depression. Because you must start low and go slow (to avoid the serious rash side effect that is associated with Lamictal), it can take a while to see any benefit from the medication. In our case, it has been well worth the time it took to reach therapeutic levels.

Topamax is not considered a first-line mood stabilizer, but there are some on this board who have had luck with it. It can cause cognitive dulling (hence its nickname Dopamax).

 

[crazymama30]

I read about Lamictal, and was concerned about the rash. I don't like the nickname dopamax. I am just not sure where to go next. difficult child can't tolerate Lithium or Depakote. Thanks for your input.

 

[givnmegryhr]

Both my son and I are on Lamictal. It was the first ms to be of help to him. I am 4 weeks into it and still waiting for results. It is very slow titrating up but thats to avoid the rash. My sons psychiatrist talked about adding Topomax because I don't feel the Trileptal is helping him. I even asked my psychiatrist about it. She isn't counting it out, just waiting to see how the lamictal works. There are more side effects from Topomax though and it has been referred to as Dopomax for its cognitive dulling. That does scare me a bit, so if it were me, I would probably say try the lamictal first.

 

[smallworld]

The rash is a rare side effect. It is much less likely to appear if the dose is started low and titrated up very slowly (difficult child 2 started at 12.5 mg and went up 12.5 mg every two weeks).

 

[crazymama30]

How much do your difficult children take of Lamictal,if I am not out of place in asking? I do not want to be too nosey.

 

[Sara PA]

Both drugs, like all anticonvulsants, have a higher than normal risk of "the bad rash", aka Stevens-Johnson Syndrome. Lamictal has an ever so slightly higher risk than Topamax. There is also a benign rash fairly common to Lamictal which tends to get people upset when it occurs.

Lamictal is approved by the FDA as a mood stabilizer (or, as they call it, for the maintenance treatment of bipolar disorder). Topamax is not.

Topamax is so notorious for causing cognitive dulling that it is called "Dopamax" in some circles. A lot of people find it to be a very unpleasant drug to take. Lamictal is the anticonvulsant which causes the least amount of cognitive dulling.

Any mood stabilizers will take time until you notice results because their purpose is to stop cycling in the long run, not to address they symptoms of the current phase of cycling. For Lamictal and the need to titrate slowly it may take months. Mood stabilizers are not quick fixes.

Lamictal is thought to be more appropriate than the other approved mood stabilizers for people with more depressive phases than other mood stabilizers. There is no information on whether Topamax is effective on either mania or depression.

My son wishes Lamictal had been the only drug he had ever taken.

ETA: I must have typed really slow because none of those other replies were there when I started, LOL. I wasn't repeating what the others said, just saying the same thing at the same time.

 

[smallworld]

difficult child 1 (who weighs 120 pounds) takes 200 mg (100 mg BID). difficult child 2 (who weighs 55 pounds) takes 125 mg (75 mg morning and 50 mg evening). In both their cases, Lamictal evened out and lifted their moods, but they were still depressed. So our psychiatrists added low doses of antidpressants once they were at therapeutic levels of Lamictal.

 

[crazymama30]

Thanks guys, I do not mind waiting to see if they will help as long as they do not cause more problems than they are worth. I think we will try Lamictal. Is it always given as a BID medication?

 

[pepperidge]

My son is on both. Topamax seemed to really help even things out, while Lamictal seemed to reduce the depression and irritability. He was on Lamictal once a day. We have not noticed any real side effects with Topamax on him (but he is on a pretty low dose, 100 mg). We may try to slowly reduce the Topamax.

I guess if I were in your shoes and had to start with one, Iwould start with Lamictal.

But I would go real real slow.

We saw some improvements on my son at even a dose of 25 mg.

good luck.

 

[Sara PA]

My son and a friend of mine who takes Lamictal for seizure control both told me that is can cause some sleeplessness for a few hours after taking it. My friend had to take it BID so he took it about 3 hours before he wanted to go to sleep. My son discovered that he didn't need to take it twice a day and took his entire dose -- as much as 400 mg at one point -- when he woke up in the morning. He said it not only prevented the sleeplessness at night, it gave him a little needed kick awake in the morning.

 

[DammitJanet]

I started first with topamax. I started very low and very slowly and didnt have side effects really. Then we added lamictal after a year or two...now Im on both. I take 300 of lamictal and 600 of topamax. I like both and wouldnt be without either of them.

 

[Wiped Out]

My difficult child was on Lamictal but it didn't really help him-however-I'm not sure he ever reached a theraputic dose.

He is currently on Topomax and it has helped far more than any other mood stabilizer-and he's tried a bunch. It isn't a magic cure but his violent outbursts are fewer and don't last as long when they do happen. Also he is a little more even keeled than without it.

 

[kris]

<span style="color: #660000">no first hand experience but have known folks on both. i've seen more success with-the lamictal. the cognitive dulling with-the topomax can be really difficult & heaven knows they don't need that re: school.

if it were my child i go with-the lamictal over the topomax.

kris </span>

 

[crazymama30]

Thanks so much for your input. I e-mailed psychiatrist and told him we are stopping the focalin, and would like to try Lamictal. I will probably hear back from him sometime today.

You guys are all great