# Yet another Lamotrigine success



## TDX (Jul 12, 2014)

Look at this:

https://www.researchgate.net/profile/Argyris_Stringaris/publication/299339558_Emotional_experience_and_awareness_of_self_functional_MRI_studies_of_depersonalization_disorder/links/56fd023208aeb723f15d2c1d.pdf

They used Lamotrigine and 6/11 patients who tolerated Lamotrigine responded to it.


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## luctor et emergo (May 22, 2015)

Great news, so we most use it minimally for 6 months and apperenty 400mg/d seems to be sufficient.

My lamotrigine serum concentration was measured last week and it was on the low end of the spectrum,

while fluoxetine 40mg was on the high end.

I was planning to up my dose to 700mg/d, but it doesn't seem neccesary.

Are there any adverse effects with such a high dose (on dp, dr?).


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## Billy D.P. (Apr 12, 2016)

Lamotrigine alone made my symptoms worse. But I guess you're supposed to take in along with another medication as well to precipitate these positive effects, right?


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## TDX (Jul 12, 2014)

> Great news, so we most use it minimally for 6 months and apperenty 400mg/d seems to be sufficient.


I don't think you have to use it for 6 months. The effects should come immediately if the dosage high enough.



> My lamotrigine serum concentration was measured last week and it was on the low end of the spectrum,
> 
> while fluoxetine 40mg was on the high end.
> 
> I was planning to up my dose to 700mg/d, but it doesn't seem neccesary.


If it's on the low end a higher dosage might be necessary. I read in epilepsy forums that someone take 1000 mg/day.


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## luctor et emergo (May 22, 2015)

As you are reading the epilepsy fora and a whole lot of studies, 1000mg seems credible. You mentioned this dose earlier.

700mg is currently my psychatrists limit, but she is very willing to help.

TDX, when taking doses of >700mg/d after how many weeks / months should one notice a positive effect? Or any effect... as a mood stabilizer it doesn't do anything.

Actually my mood is going to depression again. 
This is with 600mg lamotrigine, 40mg fluoxetine and 300mg bupropion! :-(


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## TDX (Jul 12, 2014)

> TDX, when taking doses of >700mg/d after how many weeks / months should one notice a positive effect? Or any effect... as a mood stabilizer it doesn't do anything.


I think it should work almost immediately if the dosage is reached. I never read in the depersonalization literature that the effect of Lamotrigine is supposed to have a delayed onset. So I think if you're on the target dose for a few weeks and it doesn't work it might never work.


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## hopefuluk2 (Aug 20, 2015)

TDX said:


> Look at this:
> 
> https://www.researchgate.net/profile/Argyris_Stringaris/publication/299339558_Emotional_experience_and_awareness_of_self_functional_MRI_studies_of_depersonalization_disorder/links/56fd023208aeb723f15d2c1d.pdf
> 
> They used Lamotrigine and 6/11 patients who tolerated Lamotrigine responded to it.


Was their DP triggered by weed or cannabis?


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## TDX (Jul 12, 2014)

> Was their DP triggered by weed or cannabis?


In 3 people it was induced by Cannabis and in one person by MDMA. The bad thing: They do not say in which people it was drug-induced. They referre to table 1, but it doesn't contain any information about who abused which drug and who did not.

This is sad, because it could have answered the question if people with Cannabis-induced DPD can respond to Lamotrigine.


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## luctor et emergo (May 22, 2015)

TDX said:


> This is sad, because it could have answered the question if people with Cannabis-induced DPD can respond to Lamotrigine.


Sigh, so we are left with maybe unnecessary trial and error. 700mg/d is the target for this week.


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## hopefuluk2 (Aug 20, 2015)

TDX said:


> In 3 people it was induced by Cannabis and in one person by MDMA. The bad thing: They do not say in which people it was drug-induced. They referre to table 1, but it doesn't contain any information about who abused which drug and who did not.
> 
> This is sad, because it could have answered the question if people with Cannabis-induced DPD can respond to Lamotrigine.


I have a feeling that a drug (cannabis) DP is different from all other forms of DP...


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## luctor et emergo (May 22, 2015)

hopefuluk2 said:


> I have a feeling that a drug (cannabis) DP is different from all other forms of DP...


It's starting to look like this... and documentation where cannabis is the sole trigger / onset is practically nihil.

edit: where do we go from here as rimonabant is out of the question?

A PM from Elliott gives some hope...

"Rimonabant is a write-off. It was hard to acquire before everyone decided to stop selling it.

I do believe in the mechanism of action though. Or at least I believe it's certainly worth a shot. I'm currently looking into other cannabinoid antagonists/inverse agonists that hopefully have less aggressive side-effect profiles. I know there are several in development. I'll let you know what I find. It's going to end up on my master list anyway!"


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## TDX (Jul 12, 2014)

https://en.wikipedia.org/wiki/Hemopressin


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## hopefuluk2 (Aug 20, 2015)

TDX said:


> https://en.wikipedia.org/wiki/Hemopressin


Do you agree TDX that DP triggered by cannibas seems different from other DPs?


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## TDX (Jul 12, 2014)

At least regarding symptoms and course there do not seem to be significant differences. But maybe there are differences in the underlying neurobiology that might determine which treatment is effective and which not.


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## curiousmind (Oct 31, 2019)

hopefuluk2 said:


> Do you agree TDX that DP triggered by cannibas seems different from other DPs?


A study from Daphne et. al. published in 2009 "strongly suggests a uniform syndrome regardless of precipitant" [study].


"The study strongly supports a uniform syndrome for chronic depersonalization/derealization regardless of precipitant."
"The 2 most common precipitating drugs were cannabis and hallucinogens, followed by ecstasy."
"The D group [drug induced group] showed significantly greater improvement over time than the ND [not drug induced] group (P = .002), although the groups did not differ in reported psychotherapy or pharmacotherapy effectiveness."

Currently no evidence exists to suggest that "drug-induced DPD" is any different from the "non drug-induced version". Neural underpinnings of the disorder are most probably the exact same.

A recent study (to be published in the upcoming months) examining the efficacy of rTMS on the right Angular Gyrus is bound to give new insight into the disorder as it is the largest DPD trial to date (102 recruited patients). If the response rate is high, it is likely that the characteristics of the responders will be discussed (including the type of onset of the disorder), which may further indicate whether or not drug-induced DPD is any different from non drug-induced DPD from a neurophysiological point of view. Such specifications couldn't have been discussed previously in the significantly smaller pharmacological trials.


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## Aridity (Jun 12, 2011)

curiousmind said:


> A study from Daphne et. al. published in 2009 "strongly suggests a uniform syndrome regardless of precipitant" [study]
> 
> 
> "The study strongly supports a uniform syndrome for chronic depersonalization/derealization regardless of precipitant."
> ...


How do we know this study has even been conducted? Last updated in 2017, and it has not even been formally posted on their website. I do hope so though.


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## curiousmind (Oct 31, 2019)

Scroll down on the website, the study has been completed in September 2019. I'm assuming that since then they have been dealing the formalities such as conducting the peer-review. Besides it being the first DPD study to have a large sample size, the fact that it is a randomized, double-blind, placebo-controlled study makes it that much more legitimate, exciting and promising.


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## 35467 (Dec 31, 2010)

The study is done by Marion PLAZE, Saint-Antoine Hospital in Paris that is a research hospital.The study is paid by the hospital. A publication on their site from 2017 says that the study in ongoing.

http://www.ch-sainte-anne.fr

The study here in this pdf. file in french from the hospital on page 28.La Recherche au Centre Hospitalier Sainte-Annewww.ch-sainte-anne.fr › file › Plaquette-2016-recherche_

"Trouble de déPERsonnalisation : efficacité thérapeutique de la Stimulation magnétique transcrânienne répétée Neuronaviguée du gyrus Angulaire droit"


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## 35467 (Dec 31, 2010)

Here the recruitment for the trail in french,http://www.ghu-paris.fr/fr/recherche-et-epidemiologie/appels-a-volontaires/


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