Podcasts about lamotrigine

In honor of World Bipolar Day, host Nicholette Leanza sits down with psychiatrists Dr. Robert Herman and Dr. Joe Foundriest to explore the complexities of Bipolar disorder. Dr. Herman shares how personal experiences shaped his passion for the field, his research on Lamotrigine, and his work with the International Society for Bipolar Disorders. Dr. Foundriest provides insights into the psychodynamics of the disorder and the role of treatments like lithium and antipsychotics. This episode covers key topics such as the differences between bipolar I and II, early warning signs, the impact on sleep and daily life, and effective management strategies. Join us as we raise awareness, break stigma, and share valuable resources for those affected by bipolar disorder.

In this episode, we explore the safe use and monitoring of lamotrigine, focusing on cardiac risks and when EKG monitoring is necessary. Did you know that reducing lamotrigine dose doesn't actually mitigate cardiac risks but could increase the risk of psychiatric destabilization? Faculty: Scott Beach, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 0.5 CME: Lamotrigine: From Current Indications to Cardiac Side Effects Strategies for Safe Usage and Proper Monitoring of Lamotrigine

In this episode, we explore lamotrigine's cardiac side effects, focusing on QTc prolongation and QRS widening. How concerned should psychiatrists be about the FDA warning regarding lamotrigine's cardiac effects? We examine the evidence behind these concerns and discuss practical implications for clinical practice. Faculty: Scott Beach, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 0.5 CME: Lamotrigine: From Current Indications to Cardiac Side Effects Lamotrigine Effect on QTc Prolongation and QRS Widening

In this episode, we explore lamotrigine's side effects and special considerations, particularly focusing on identifying dangerous skin reactions, pregnancy considerations, and overdose risks. Did you know that Asian populations may require special genetic screening before starting lamotrigine due to increased skin reaction risks? Faculty: Scott Beach, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 0.5 CME: Lamotrigine: From Current Indications to Cardiac Side Effects Lamotrigine: Side Effects and Special Considerations

OCD, or Obsessive Compulsive Disorder, is a debilitating condition that involves intrusive thoughts and time-consuming, repetitive behaviors. It impacts 80 million worldwide, 2-4% of the US population or 1 in 100 people here in the US.It can be difficult to overstate the suffering caused by OCD, not only for those with this condition but also for their family members. In addition to the distress caused by the obsessional thoughts and compulsions, there can be shame and loss - loss of more meaningful, purposeful, or pleasant thoughts and behaviors. and loss of time connecting with others or engaging in purposeful or enjoyable activities.Other conditions associated with obsessive-compulsive disorder include:* Body dysmorphic disorder* Skin picking* Trichotillomania (hair pulling)* Hoarding* Hypochondria* Olfactory reference syndrome (an irrational feeling or belief that one emits a foul smell and often attempts to remove the odor).It´s not unusual for someone with OCD to have other conditions, such as:* Other forms of anxiety* Depression* ADHD* Autism spectrum disorder* Eating disorders* TourettesResearch suggests that having OCD raises one´s vulnerability to developing dementia. Many other brain conditions, however, also appear to increase this vulnerability similarly.Treatment ChallengesOCD is particularly challenging to treat. Of those with OCD, 60% do not respond to typical therapies (often medication in combination with psychotherapy involving gradual exposure to that which is being avoided). Typical medications include:* SSRI´s (Selective Serotonin Reuptake Inhibitors) -e.g., sertraline, fluoxetine, fluvoxamine, citalopram, paroxetine* Tricyclic antidepressant - clomipramine* SNRI - (Serotonin and Norepinephrine Reuptake Inhibitor) - venlafaxine* Atypical antipsychotic medications are sometimes addedMedication is combined with CBT (Cognitive Behavioral Therapy), which involves exposure and response prevention, or CBT is used alone.As you can see, most medication approaches aim to increase serotonin activity. Serotonin, however, is just one of the neurotransmitters involved. What has become increasingly clear from the research is that OCD involves abnormal activity at the NMDA receptor - a glutamate receptor.NMDA & GlutamateThe NMDA receptor is found throughout the brain. Glutamate, the primary excitatory neurotransmitter in the central nervous system, binds to the NMDA receptor. NMDA and glutamate are involved in synaptic plasticity (creating neuronal connections), learning, memory, and motor function.The synapse is the space between communicating neurons. Presynaptic neurons release glutamate, which binds to the NMDA receptor on postsynaptic neurons. This results in a cascade of signaling events that lead to “neuronal excitation.” The problem arises when this receptor has too much (or too little) activity. In the case of OCD, there is too much activity.Implications* Dysregulation at the NMDA receptor appears to play a role in OCD, depression, PTSD, schizophrenia, bipolar disorder, and substance use disorders.* Weak memory extinction can result from high activity at the NMDA receptor. While memory is a good thing, we can have problems with too much memory - or rather, problems putting our memories aside. This can look like thoughts getting stuck, for example:* Intrusive thoughts in OCD* Flashbacks in PTSD* Delusions in psychotic disorders* Cravings in addiction.* Neurodegenerative disorders, such as Alzheimer's, Parkinson's, and ALS, have also been linked to NMDA receptor malfunction.Methylation & NMDAThose who are undermethylated, especially those with OCD or addictions, have high activity at the NMDA receptor. To remind you, undermethylation is a biochemical process with many functions, including the breakdown of histamine, support of detoxification, and support of serotonin activity. When someone is undermethylated, they can tend to have allergies (from high histamine), be perfectionistic, competitive, strong-willed, have obsessive-compulsive tendencies, be ritualistic, have dietary inflexibility, and have high accomplishment or have family members with high accomplishment. Undermethylation can contribute to the low serotonin activity seen in OCD. Simply addressing undermethylation, like merely addressing serotonin, will only bring partial benefit. To address undermethylation, those of us trained by the Walsh Research Institute, use SAMe and/or methionine, B12, B6, magnesium, and antioxidants. We address this before starting methylation treatment for those with high homocysteine. But how can we also decrease activity at the NMDA receptor?Blocking NMDA & Normalizing Glutamate ActivityEsketamine or Ketamine, which has been getting much attention in recent years, can impact the brain in various ways; however, its primary mechanism is as an NMDA blocker or antagonist. For some, it can serve as a rapid-acting and highly effective antidepressant. It can also decrease OCD symptoms. Other NMDA-blocking drugs include memantine and dextromethorphan (combined with bupropion). Lamotrigine can decrease glutamate release and has been used as an adjunct medication for OCD.Nutrients, however, play an important role in the NMDA receptor. NAC or N-acetyl cysteine is a precursor to glutathione and, thus, an antioxidant. It is also anti-inflammatory and a binder for a particular toxin made by candida and mold. But, it is also a potent NMDA antagonist (decreases activity at NMDA) and has been shown to reduce obsessions and compulsions of OCD. It has also been studied in alcoholism, opiate addiction, cocaine abuse, gambling disorder, shopping disorder, cigarette addiction, and trichotillomania. It has been used by itself and as an adjunct to medication therapy. NAC has become part of the Walsh undermethylation nutrient protocols for those with OCD and/or addiction.Zinc also plays an important role in regulating functioning at the NMDA receptor. The Walsh Research Institute found that 90% of those with brain symptoms had relatively low zinc. Dosing of zinc is determined after testing plasma zinc levels using a narrow range (the Walsh/Pheiffer range differs from typical lab ranges). Zinc is checked in conjunction with copper. Zinc has been found to improve treatment response in those with OCD treated with SSRIs. Zinc can be depleted because of very high oxidative stress and/or high pyrroles, which also cause low B6. Because B6 is needed to make serotonin, pyrroles are also important to address if elevated.Inositol is a nutrient involved in the serotonin and glutamate signaling systems. It, too, is beneficial for OCD symptoms; however, it can require very high doses.The challenge of research, as you can see, is that these approaches are all looked at in isolation, as opposed to, for example, addressing undermethylation, optimizing zinc, decreasing activity at the NMDA and addressing sources of oxidative stress.Candida & MoldAside from undermethylation, low serotonin activity, and high activity at the NMDA receptor, those with OCD appear to have high oxidative stress, as is the case with most brain-related conditions. One of the more common sources of oxidative stress I see in my practice is candida overgrowth in the GI tract, which often follows antibiotic exposure and /or mold toxicity due to water damage causing seen or unseen toxic mold. Because mold and candida (yeast) thrive on sugar and a high-carb diet, symptoms can fluctuate with sugar or carb intake. How might candida and mold intersect with the NMDA receptor? Mold and yeast can contribute to high histamine states. Histamine can increase activity at the NMDA receptor. EstrogenFor women and teen girls that I see with OCD, there is often a fluctuation in their OCD symptoms with their cycle. Typically, their symptoms worsen during the times of the month when estrogen is the highest. This may be because estrogen can increase activity at the NMDA receptor.PANDAS & PANSWhen a child has an abrupt onset of OCD symptoms, PANDAS and PANS should be considered.* PANDAS = Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections* PANS = Pediatric Acute-Onset Neuropsychiatric SyndromePANDAS and PANS are autoimmune conditions, meaning the immune system is acting on the body, in this case, a part of the brain called the basal ganglia, that involves an acute onset of OCD symptoms. Other symptoms can include restricted eating, mood symptoms, regression in academic or social skills, and motor tics. While triggers are often viral, bacterial (strep in the case of PANDAS), candida,or other microbial source, what is underlying the dysregulated immune response to such microbes, in my experience, is mold toxicity. SummaryBecause OCD can be difficult to treat, my hope in sharing this information is to raise awareness that effective OCD treatments can require a multifaceted approach that includes:* addressing methylation (and high pyrroles if present) to improve serotonin activity* decreasing activity at the NMDA receptor* by optimizing zinc* using supplements or medication* addressing sources of inflammation and high histamine* address sources of oxidative stress - trauma, stress, toxins, inflammation If you find this information helpful and would like to help me get this out into the world, please consider sharing:As always, I welcome your comments, questions, and experience.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter and podcast episode is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, we explore the vital aspects of prescribing lamotrigine, from its mechanisms to titration schedules. Did you know that birth control pills can cut lamotrigine levels in half within just one week? Understanding these interactions is crucial for safe and effective treatment. Faculty: Scott Beach, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 0.5 CME: Lamotrigine: From Current Indications to Cardiac Side Effects Understanding Lamotrigine Mechanisms and Titration Schedule

In this episode, we explore the challenges and best practices for managing bipolar disorder during pregnancy. We discuss key medications, their risks and benefits, and the importance of individualized treatment plans. How do we balance maternal mental health with fetal safety when treating bipolar disorder in pregnant women? Faculty: Vivien Burt, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Perinatal Treatment of Bipolar Disorder Guiding Principles for Treating Bipolar Disorder During Pregnancy

Welcome to today's episode where we discuss another mood stabilizer, Lamotrigine (Lamictal). --- Support this podcast: https://podcasters.spotify.com/pod/show/psychrounds/support

Internationally renowned bipolar disorder expert Dr. Trisha Suppes unravels the latest science in bipolar disorder treatment by breaking down the proven and cutting-edge treatments available today - exploring traditional solutions such as Lithium and mood stabilizers alongside exciting new options like psilocybin, ketamine, and the Ketogenic diet. Dr. Suppes also navigates the complexities of mania and tackles the perennial question: is lifelong medication necessary to live well with bipolar disorder? (00:00) About Dr. Suppes Medication Treatments (03:00) Is Lithium the Gold Standard? (05:22) Atypical Antipsychotics (07:22) Dangers of Antidepressants? (09:17) Medications Lose Strength? Non-medication Treatments (10:47) Psychotherapy (12:54) Ketogenic Diet & Nutrition (13:28) Cannabis (14:20) Ketamine Brain Stimulation Therapies (15:18) rTMS (Transcranial Magnetic Stimulation) (16:01) VNS (Vagus Nerve Stimulation) (17:07) ECT (Electroconvulsive Therapy) Bipolar Disorder is Complex (18:52) Insight & Denying Bipolar Disorder (22:45) Bipolar I: Need Meds Forever? (23:44) Bipolar II: Need Meds Forever? (26:22) Hypomania Causes Misdiagnosis (28:16) Mixed States Psychedelics (29:28) Psilocybin & Magic Mushrooms (32:33) Microdosing & LSD (34:02) MDMA Closing (35:41) Keeping You "A Little Depressed" (37:55) Why Recovery Is Possible (39:06) Reflecting on Research Impact Dr. Trisha Suppes, M.D., Ph.D., is a distinguished expert on the biology and treatment of bipolar disorder, and mood disorders generally. Dr. Suppes is the Director of Exploratory Therapeutics and Professor at Stanford University in the School of Medicine. At the VA Palo Alto Health Care System, she is Director of the CSP NODES and is the Founder of the Bipolar and Depression Research Program. Her areas of expertise include long-term treatment strategies for bipolar disorder, identification and treatment of bipolar II disorder, treatment of those with bipolar disorders and co-morbid conditions and use of complementary medicine. She has recently launched a new initiative to explore the use of psychedelics for mood disorders and PTSD in Veterans. Dr. Suppes has been integrally involved in numerous initiatives to improve evidence-based treatment for bipolar disorders. Dr. Suppes participated as a member of the DSM-5 Mood Disorders committee on updating the APA DSM-5 criteria for Mood Disorders and was chair of the APA DSM-5 Bipolar Disorder subcommittee. She was the past President of the International Society of Bipolar Disorders (ISBD). Treatments Referenced

Lamotrigine is an antiseizure medication and also may be used for bipolar disorder. A rash is a major side effect to remember with this medication. Valganciclovir is an antiviral medication that can be used to prevent cytomegalovirus (CMV) in patients with a suppressed immune system. Fluconazole is an azole antifungal that can be used to treat candidiasis, blastomycosis, and tinea infections. Drug interactions, QTc prolongation, and hepatotoxicity are potential risks. Atenolol is a beta-blocker used to treat atrial fibrillation and hypertension. It is relatively selective for beta-1 receptors meaning that it doesn't affect the lungs as much as non-selective agents. Montelukast is a medication that blocks the actions of leukotrienes. This can be beneficial for the management of allergies and asthma.

Today I read two stories on the bipolar medication "Lamotrigine".

The Frontier Psychiatrist's newsletter? It is what you are reading. It's a health-themed publication written by Owen Scott Muir, M.D. This is a brief detour from my recent series on medications, many of which have a critical slant. Those include Risperidone, Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc. I write this all by myself every day. Consider subscribing. (the paywall starts 5 weeks back, and there are 360something articles back there). It makes a horrible or awesome gift, depending on your friend circle. I also get paid more money by Amazon if my readers buy stuff now, like, for example, my favorite book about mental illness—or this tea I drink daily. I also encourage you to send me this coffee maker— or, more realistically, to anyone else.Today, I address what happens when schizophrenia is not treated, even if it is. It has high morbidity and mortality, a problem that medications address. Effectively. Not without costs, but the best data suggests treatment is better than no treatment for most people.I'm going to cut to the chase briefly, and if you or a family member want to read a great book on treatment with antipsychotic medicine, I'd recommend this one. Jeff Leiberman, M.D., has been …controversial… of late. However, there is no denying his role in understanding schizophrenia and its treatment, and his book on the topic is worth a read or listen, called a Malady of the Mind.Psychotic. We use the word commonly in chit-chat to denote something is bad. Unreasonable. Wrong. Deranged. Nothing is beguiling about the word. It is a thing to deny in oneself— “I am not psychotic!”Understanding PsychosisSome people don't get that luxury. Some people are honest-to-goodness psychotic. Most of us do not know what that means. Some of us do, and some smaller portions are blessed with the ability to spend time on both sides of that psychotic equation. I will define the term:Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person's thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not. The most common illness we associate with psychosis is schizophrenia. Psychosis can occur with depression, bipolar disorder, and other maladies. Depression and mania are mood states; we refer to these mixed with psychotic symptoms as affective disorders in psychiatry. A brief grammar note, brought to you by Grammarly, a tool I use and—sadly—am not paid to promote:Is affective just another word for effective? Are the two words similar and entangled in the way the verbs affect and effect are? No, affective is not just another word for effective. And affective and effective are not derived from the verbs affect and effect. They come from the nouns affect and effect.There is a difference in the literature—and in the lives of patients—when it comes to illnesses that have affective psychosis and non-affective psychosis. Much of the anti-psychiatry crowd focuses on affective disorders and argues about the side effects of those treatments. Less attention is paid to non-affective psychosis because It's not as compelling an argument. These are challenging illnesses either way and are associated with significant morbidity—impairments in life—and mortality—early death.“Uncured of Worse”: 1937.As far back as 1937, authors noted the grim prospects in the long-term course of schizophrenia (in this context, I'm referring to largely “non-affective psychosis” —where the delusions or hallucinations are not tied to mood episodes):Of the 100 cases, 66% were uncured or worse after the lapse of 6-10 years, with persisting process symptoms or in a defective state after the course had run; 13% were improved, 4% were cured with defects, and 17% were completely cured. “The Prognosis is Poor”: 2010By 2010, with decades of more data, the conclusion was much the same—schizophrenia sucks, even compared to other admittedly bad illnesses:Our 26-year longitudinal study and other longitudinal studies confirm older views that outcome for schizophrenia, while showing some variation for different schizophrenia patients, is still significantly poorer than that for other psychiatric disorders.A large NIMH follow-up study with 2 to 10 years of time following patients from a first episode that required hospitalization demonstrated:The sample showed substantial functional impairment and levels of symptoms, with only about 20% of the sample demonstrating a good outcome…The “not-good” outcomes looked like this:78% of the sample suffered a relapse, 38% attempted suicide and 24% had episodes of major affective illness.Beyond Psychiatric Problems?We tend to focus on the role of bad psychiatric outcomes as psychiatrists. Still, the medical outcomes are similarly troubling, including high smoking rates, metabolic syndrome, heart disease, HIV, Hepatitis C, and other medical illnesses. Overall, this leads to an extremely disheartening finding: having schizophrenia is an illness that takes a tremendous toll on the individual and their family and leads to early death and disability at unacceptably high rates:Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Thus, the mortality gap not only persists but may actually have increased.Comparisons are useful, and if we look at HIV after the introduction of HAART (Highly Active Anti-Retroviral Therapy), we find:HIV-related mortality decreased from 6.5 to 1.3 per 100,000 population (80% decrease, p = 0.0115). New HIV diagnoses declined from 702 to 238 cases (66% decrease; p = 0.0004) with a consequent estimated decline in HIV incident cases from 632 to 368 cases per year (42% decrease; p = 0.0003).And if we compare that to schizophrenia, in the largest meta-analysis I could find, we find:The mortality risk for patients with schizophrenia was 1249 per 100 000 … (95% CI, 1029-1469)Psychosis is Bad Compared to Other Bad ThingsThe mortality from schizophrenia is 19,215% higher than from pre-HAART HIV infection and 96,076% higher than from HIV with HAART treatment. If you had to choose between HIV and schizophrenia, HIV is safer—with or without treatment.To make the point even more clearly, even having a car crash only has a 0.77% fatality rate, or 770/100,000.If you had to choose between a car crash and schizophrenia, the car crash is safer.Those outcomes are not good enough. Schizophrenia is impairing and dangerous to your life, especially if untreated. Other psychiatric illnesses are also. Psychiatric medications can modify this risk to your life in the right direction, even with those risks. Tapering them, as we saw in the RADAR trial (lead-authored by a critical psychiatrist, published in the Lancet just this week), doesn't make it better:At 2-year follow-up, a gradual, supported process of antipsychotic dose reduction had no effect on social functioning.And, further, made it worse:here were 93 serious adverse events in the reduction group affecting 49 individuals, mainly comprising admission for a mental health relapse, and 64 in the maintenance group, relating to 29 individuals.It includes twice as many deaths. In a research study, this is a huge deal. The way to look at this is the probability of relapsing is bad, and it's statistically more likely and with more than double likelihood if you were randomized to a taper protocol.Antipsychotic Medication Saves Lives. It has Burdens. These Choices are Difficult. We need to do better, but the haters are incorrect. We have done better than nothing, even with imperfect tools, even when examined by those who have an axe to grind with those very tools. Treatment of schizophrenia saves lives.Stay Humble,Faced with Suffering, and Carry On—Owen Scott Muir, M.D. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

My favorite opening line of an academic article (this week) follows:Mental illnesses are prevalent, cause great suffering, and are burdensome to society.Welcome to the Frontier Psychiatrists. It's a newsletter that I write all by myself. I'm doing a series on medications, largely (but not entirely) in psychiatry. I'm a child and adult psychiatrist, and I still see patients. I've also been a patient since I was 16 years old. Please consider subscribing and sharing widely.The first antipsychotic introduced after clozapine would be a big deal—especially if it didn't cause life-threatening side effects. Risperidone was first developed by the Johnson & Johnson subsidiary Janssen-Cilag between 1988 and 1992 and was first approved by the FDA in 1994. It's one of the very few drugs with data for bipolar disorder that I, personally, have never been prescribed.Risperidone—Risperdal as a trade name—was ready to be a huge hit.It was presented as very atypical—this was the post-clozapine branding of choice. The “second generation” label was added years later. I have a confession to make. After residency, when the attending doctors told me, as a trainee, what to prescribe, I never prescribed risperidone ever again. I think this compound—and paliperidone, the metabolite— still has an important role in managing schizophrenia and bipolar disorder. There are more formulations of long-acting injectable risperidone and related compounds than I can remember. I think those are going to be useful drugs for a long time. Oral risperidone? Nope.Clozapine was an exciting drug. No horrible motor side effects? (Plausibly) More effective? It was better than every drug that came before. It had this pesky adverse effect that could lead to death called agranulocytosis, which I addressed in my first research paper in 2011. We needed more drugs that were this atypical!We—the field of psychiatry, at least— needed things that were not gonna kill you abruptly, in a terrifying manner, like clozapine had the rare potential to do. But we didn't want more of the same old antipsychotics. After Psychiatry got a taste of not having to explain permanent tardive dyskinesia as a likely side effect of antipsychotic medication, we wanted to keep doing that. Editors note: It is still a side effect of all non-clozapine antipsychotics, and we should never have let our guard down.Risperidone was the first antipsychotic that came to market after clozapine rocked the world of psychiatry by being better. Risperidone is similar, and they even use the accidental branding of clozapine— “atypical”—for this medication. The Food and Drug Administration (FDA)-approved indications for oral risperidone (tablets, oral solution, and M-TABs) include the treatment of:* schizophrenia (in adults and children aged 13 and up), * bipolar I acute manic or mixed episodes as monotherapy (in adults and children aged 10 and up), * bipolar I acute manic or mixed episodes adjunctive with lithium or valproate (in adults)* autism-associated irritability (in children aged 5 and up). Also, the long-acting risperidone injection has been approved for the use of schizophrenia and maintenance of bipolar disorder (as monotherapy or adjunctive to valproate or lithium) in adults.The “mechanism of action” of all of the drugs that have efficacy in psychosis was presumed to be dopamine D2 receptor blockade, a mechanism shared with all of the prior medication from Thorazine (chlorpromazine) through Haldol (haloperidol). The assumption—which clozapine disproved—was motor side effects were required for the drug's efficacy in psychosis. This primacy of the D2 blockade as a mechanism of action has since been disproven. This is the mechanism that leads to gynecomastia, leading to a bevy of lawsuits from men who developed breasts. It also causes related side effects like galactorrhea—breast milk from breasts that can be on men or women who are not nursing— and erectile dysfunction. Dopamine—it does a lot of work in the brain, not just pleasure.This motor side effect profile was not true with clozapine. It had various additional receptors, particularly in the serotonergic family (5HT-2a, for example), and alpha-adrenergic, histaminic, and other receptor sites throughout the brain. This broad profile of different receptors explains the wide range of side effects. But more importantly, these are complex, “messy,” and hard-to-predict outcomes given the complexity of the brain. The complex pharmacology allowed psychiatrists like me to think—hard!—about which particular witches brew of receptors we would choose to tickle (agonize) or antagonize. It's very satisfying. I also suspect this is a story we tell ourselves that is not as closely moored to truth as we'd like. We enjoy thinking about science-ish stuff. Receptor binding profiles are seductive— because they are knowable. Our patient's heart, hope, dreams, and heartbreak? Less so.The most important feature of risperidone today—and its 1st order metabolite, paliperidone—is that is deliverable as pills, rapid-acting dissolvable tablets, and long-acting injectable formulations, lasting between 2 weeks and 6 months between doses. A psychiatric treatment that isn't an oral once-daily pill? One you have to take twice a year? Medicine that is intended for people who often—like many—feel conflicted about taking a daily pill? That is a big enough deal. That is a real innovation— it considers human frailty, ambivalence, and common failures of mind. Not because it's a magic drug. Rather, long-acting medicine that doesn't make crippling relapse easy —thanks to good design— is exactly the kind of medicine that works. My second research effort was on the acceptability of such medicines in youth. It's responsible for my presence at the academic conference where I met my now wife.Oral medicines were popular because they were easy to sell. Novel medicines and technologies will be easy to take. The story of my fascination with the risks and benefits of these medicines doesn't end there, though.I still research these medicines and their adverse effects— funded by NIMH— for identifying Tardive Dyskinesia with Machine Learning and closed-loop Internet of Things physical medication compliance tech with my team at iRxReminder and colleagues at Videra. We are enrolling in a study at Fermata in New York and other sites. Thanks for reading.This article is another in my series about one drug or another. Prior installments include Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.Sponsored Content!One way of supporting this publication is buying stuff from Amazon, like a nifty box from Apogee that I used to record the voice-over: the BOOM. In fairness, it's just the A/D. I am also using the API 512c mic pre, plugged into an AnaMod 660 500 series compressor, nestled in a reliable RND R6 Lunchbox, and all of that plugs into the Boom into my Mac. It's a Microtech Geffel mic. Most of the audio post-processing is done with Izotope RX 10. I get money if you purchase any of these things— not a trivial amount since they upped my affiliate rewards.In case anyone was wondering if I was an audio nerd… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

The Frontier Psychiatrists is a newsletter by noted medical content creator Owen Scott Muir, M.D. This series is on individual medicines. Data is presented and referenced, but it's a farewell to prescribing. I learned psychopharmacology, but it's not the focus of my career anymore. Other installments in this series include Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.I also take requests from subscribers—this whole series is by request from the inimitable Kari Groff. Thanks for reading, and please— support the work!By the 1960s, treatment had been medicalized. The first psychotropic drugs were discovered by serendipity and introduced into psychiatry. The symptom relief they brought was so startling and persuasive that there was a major shift from psychologic to pharmacological treatment.—Leon Eisenberg, M.D., the Stepfather of Laurence B. Guttmacher, M.D.Alprazolam is a benzodiazepine medication that has the brand name Xanax. It has an FDA label for “Panic Disorder, with or without agoraphobia.” In my Klonopin piece, and my prior general benzo review before that, I talked about lipophilicity—how fast a drug can get into the brain, based on how soluble it is in fat. A lipid bilayer protects our brain from drugs inviting themselves in, Willy Nilly.It gets into the brain fast. It has a short half-life—the liver breaks it down rapidly. Xanax is fast in and fast out. Was the drug concocted to be abused? With Xanax, You won't even remember you asked.The world would be better if nobody ever knew it existed. Those doctors who promoted it lied to themselves. One of the Xanax evangelicals told me so himself. Laurence Guttmacher, M.D., is his name. He was an older man when we met. He is very tall. My mother immediately remembered meeting him over a decade ago when I read this article to her on a first pass: “He thanked me for allowing us to train Owen as a psychiatrist,” she noted. He is an advisory dean at the University of Rochester School of Medicine and Dentistry. In the first week of medical school, the first lecture he gave me was about not allowing drug reps into the hospital. Only 15 years later, writing this, do I apprehend how haunted he was by the pharmacology he mid-wifed. He has written a medication guide and an older historical ECT manual, too. He spends time teaching now.Dr. Guttmacher is in the family business. He is a third-generation psychiatrist. His grandfather was the president of the American Eugenics Society—he took over from Margaret Sanger, the champion of the birth control pill. It kept undesirable people from having more children. Laurence Guttmacher is an American Jew. Eugenics was re-purposed from utopian, enlightened, Jewish, and intellectual ideals by Nazis. It was promptly used against the same Jews and other “feebleminded undesirables.” The subsequent rejection of medicalization of psychiatric distress is understandable, among largely Jewish analysts, given Nazis (again, from Drs. Guttmacher and Eisenberg):Psychoanalysis helped psychiatry preserve an abiding interest in the individuality of patients while other medical specialists were losing sight of the patient in their preoccupation with the biology of the disease. It connected the symptoms of mental illness to the psychopathology of everyday life. Psychiatrists learned to help patients by paying attention to their mental symptoms in an era when psychiatry had no procedures. …When [psychoanalysis] was banned from the Congress of Psychology at Munich as ‘a Jewish science' in October 1933, psychoanalysts in Berlin and Vienna began to migrate to the UK and the US. …some 100–200 European analysts and some 30–50 analytically orientated psychologists emigrated to America in the 1930s… the membership of the American Psychoanalytic Association was only 135 in 1936 and almost doubled to 249 by 1944 …[This] influx was as significant intellectually as it was numerically; many refugees … became leaders in the movement.This was Laurence Guttmacher's inheritance—idealism about mind or brain—gone, catastrophically, south. His father and mother were quixotic psychiatrists as well. Psychoanalysis was potent because it explains something. People love explanations— but don't often demand that they be correct. Before the age of oral medicines, psychoanalysis offered these:No other psychologic theory provided what was purported to be so comprehensive an account of the origins of psychopathology. The brain sciences were largely irrelevant to clinical practice. In the mid-century, descriptive psychiatrists were held in little esteem because the diagnosis was unreliable and made little difference in treatment. The psychiatric pharmacopeia was limited to hypnotics and sedatives. This changed with Thorazine. The push towards “biological” explanations continued with the advertising efforts of fellow psychiatrist Dr. Arthur Sackler. His advertising firms, which he purchased and disguised his control of, were behind campaigns for drugs like Valium, Thorazine, Serax, Miltown, and the rest. This was well before his feckless son, Dr. Richard Sackler, took his portion of a family business and murdered undesirables with Oxycodone.Physicians love to be scientific-ish. We love the sense of science. We love an explanation. Laurence Guttmacher loved explanations. Xanax worked—plus, safer than Miltown. As he would later write, doing some heavy editing for his late stepfather:The influence of the authority of one's teachers, the experience of seeing patients improve during psychotherapy (most non-psychotic patients did), the logic and malleability of psychodynamic explanations, and the readiness with which patients desperate for a way out of their dilemmas accepted those explanations combined to make believers of all but the most skeptical of trainees. Those who were non-believers were easily dismissed with ad hominem attacks on their unanalyzed resistance.In that week one lecture in medical school, Dr. Guttmacher was my authoritative teacher. The lesson? Be accountable, even for violations of good sense one has yet to commit.That class featured slides on the percentage of doctors who felt drug representatives had influenced them— according to themselves. A scant one percent admitted to any possibility of influence by industry. The same physicians' opinions about colleagues—99% of them above any influence, remember— were presented on the next slide.In my first week of medical school, Laurence Guttmacher highlighted our credulousness, 40% of the same physicians understood their colleagues would fall under the thrall of attractive drug reps. Physicians were justly suspicious of Pharma's influence on everyone—except ourselves. This, of course, was exactly the pitch Arthur Sackler was making—as far as I can tell, he was an astute psychiatrist.Physicians love to be helpful. What is the most addictive substance for physicians? Samples! We can give them to our patients. We loved it when our office staff were gifted treats. We are “jonesing” to be gracious. We get hooked when people listen to us! Industry paid for all this. Arthur Sackler's disciples were not high on their own supply, unlike individual physicians—intoxicated by how beyond reproach they were. They paid for us to talk to each other, and they paid more if the person being listened to said the right things about Xanax. Administrative staff? Lunch. The same devious machinations of Italian grandmothers—Mangia!— were deployed to influence physicians. There were attractive people to listen to us about how much we cared and our desire to be gracious—the Sacklers ensured it. Arthur was a psychiatrist, after all— someone to hear you out feels good.We had so much to teach. Dr. Laurence Guttmacher researched panic disorder at the National Institute of Mental Health earlier in his career. He was a compelling speaker for Xanax, given his panic disorder pedigree from NIMH.One morning, he awoke to a horrible realization: Xanax wears off after 3-4 hours. Everyone waking up (after 8 hours of sleep) was in Xanax withdrawal. That feels like a panic attack. The obvious cure, next to the bed, was the first of four Xanax tablets as prescribed and recommended—by Dr. Guttmacher in well-appointed dinners—throughout the day. The next day, this cycle of panic would begin again, but this time, worse. And the next day, a little worse still. This was a cycle of self-reinforcing madness. But it moved product.In one of the more demonic decisions ever made, Xanax was formed into a convenient “bar” with four subdivisions. This allowed someone to break 2 mg apart and take 0.5 mg four times a day.No one would ever think to take it all at once. Unless they were anyone, in which case, this is the most immediately obvious strategy.Xanax is a nightmare. It makes opiate—and other— overdoses endlessly more lethal. It's illegal in the UK and should be pulled from the market everywhere. This drug of abuse doesn't need to be an answer to an exam question on medical boards, ever again, unless it is under the “obviously unethical compounds” section.High lipophilicity, short half-life, high potency and poor cross-tolerance, frustrating attempts to switch to less harmful compounds. It is the most toxic in overdose of all the benzodiazepines. Xanax is present in 1 of 20 deaths by overdose.Once the genie is out of the bottle—Xanax will help you forget your woes—it does not stop. Fake bars are fueling death. Xanax is so addictive that counterfeit drug makers use its branding. Why is a prescription drug a better “abuse brand” than street drugs?In total, there were more than 54,000 overdose deaths, including 2,437 with evidence of counterfeit pill use. (CDC, 2019-2021)Xanax is a pox upon the house of medicine, and Laurence Guttmacher, M.D. was eager to blowtorch his very well-reimbursed speaking career when he understood the truth.Laurence Guttmacher, M.D., is an excellent teacher. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

This is the 27th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of Lamotrigine/Lamictal. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Irene Pastis, MD & Daniel Majarwitz, MD

This week we are discussing the importance of getting blood tests for medication, the issues with private health care in the uk, and the dangers of the hustle culture.  Follow me on Instagram: @thebipolardiaries_ TikTok: @thebipolardiaries Now live: www.thebipolardiaries.co.ukSee omnystudio.com/listener for privacy information.

In this episode, we discuss rapid cycling bipolar disorder and its treatment, focusing on the use of the combination of lamotrigine and lithium. We also highlight the importance of checking thyroid status and tapering antidepressants in patients with rapid cycling. Faculty: Jim Phelps, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 45 Lamotrigine and Lithium Combination for Treatment of Rapid Cycling Bipolar Disorder: Results From Meta-Analysis

Can you treat >95% of all patients with mood, anxiety, and psychotic disorders with just ten meds? Dr. H says YES.Here he posits his top ten, based on efficacy, safety, tolerability, and cost.BFTA on Instagram. @backfromtheabysspodcasthttps://www.instagram.com/backfromtheabysspodcast/BFTA/ Dr. Hhttps://www.craigheacockmd.com/podcast-page/

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 Things you need to know about the way antiepileptic drugs affect each other, all in one podcast. Take a few minutes here to familiarize yourself with these common and critical complications of seizure management. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was vetted and approved by Danielle Becker. REFERENCES Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology 2004;62(2):292-5. PMID 14745072 Pennell PB, Peng L, Newport DJ, et al. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology 2008;70(22 Pt 2):2130-6. PMID 18046009 Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol 2006;61(3):246-55. PMID 16487217 Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res 2005;65(3):185-8. PMID 16084694 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Would a slower lamotrigine titration rate decrease the likelihood of developing the dreaded lamotrigine-associated rash? This episode discusses the possible advantages of slower lamotrigine titration rates, tips for managing benign rashes, and when to rechallenge lamotrigine. Faculty: Jim Phelps, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: Quick Take Vol. 44 Impact of Selected Initial Titration Schedules on Safety and Long-Term Effectiveness of Lamotrigine for the Treatment of Mood Disorders

How to assess, treat, and when you can restart after a lamotrigine rash.CME: Podcast CME Post-Tests are available using this subscription. If you have already enrolled in that program, please log in.Published On: 10/24/22Duration: 17 minutes, 27 seconds

Dr. Alex Menze talks with Dr. Jacqueline French and Dr. David Auerbach about the updated research and science behind the neurological and cardiac "sudden death" risks of sodium channel blockers such as Lamotrigine. Dr. French will be joining us for our Fall Conference from Oct 28th-30th, 2022 to discuss other major findings in the Epilepsy community during her workshop "Curbside Consults; Epilepsy". Register today! This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/LamotrigineLamictalNursingConsiderations      Generic Name lamotrigine Trade Name Lamictal Indication seizures r/t epilepsy, bipolar Action Inhibits sodium transport in neurons Therapeutic Class anticonvulsant Nursing Considerations • may cause suicidal thoughts, dizziness, behavior changes, nausea, vomiting, photosensitivity, rash, Stevens-Johnson Syndrome • use caution with oral contraceptive use • assess mental status • assess for seizures • do not discontinue use abruptly

In this episode I'm joined by my own psychiatric nurse practitioner Cecelia Howard PMHNP to talk in detail about the tricky subject of mental health medications. It's an area that still carries a ton of stigma, and it's a serious matter to go down the road of taking antidepressants, mood stabilizers or other psychiatric meds. We use my own very positive experience of working with Cecelia and taking a couple of different drugs (A mood stabilizer called Lamotrigine and an SNRI antidepressant called Pristiq) to highlight her unique approach to working with patients. We talk about her lengthy intake process which includes using DNA testing to assess what medications a patient might need. We cover how to know when you might need meds, why you should avoid any practitioner who writes you a prescription after a 15min consultation, and how to get off meds in the right way at the right time. There are quite a lot of scientific terms used so here are some links if you are not familiar with some of the neuroscience behind this. Neurotransmitter Overview. GABA Glutamate Dopamine Seratonin Norepinepherine Calcium and Sodium ION channels NAC SAMe L-Tryptophan Folate Melatonin Lamotrigine (mood stabilizer) SSRI (antidepressant) SNRI (antidepressant) Benzodiazepine Genomind Pharmacogenetic Testing Book - Blame it on the Brain This Way Up - Digital Mental Health Tools.

Dr. Mark Keezer discusses the risk of sudden death and cardiac arrhythmia in patients utilizing lamotrigine to treat epilepsy.  Show references:https://n.neurology.org/content/early/2022/03/08/WNL.0000000000200164

Dr. Halley Alexander talks with Dr. Mark Keezer about the risk of sudden death and cardiac arrhythmia in patients utilizing lamotrigine to treat epilepsy. Read the full article in Neurology.

What does a holistic psychiatrist use to help resolve bipolar disorder and Lamictal/Lamotrigine withdrawal? Dr. Lee explains the core issue in bipolar illness from a holistic psychiatric perspective and goes over her favorite supplements for treating bipolar disorder and Lamictal/Lamotrigine withdrawal. Listen as she goes over each supplement and provides reasons why they are important for healing this difficult condition.For more about Dr. Lee, please visit:Website: www.holisticpsychiatrist.comYouTube: The Holistic PsychiatristClick on the Holistic Updates Sign up for weekly stories and insights: Holistic UpdatesTo schedule consultations or appointments, call her office at 240-437-7600The content provided by this podcast is for informational purposes only and has not been approved by the U.S. FDA. This podcast is not intended to provide personal medical advice, which should be obtained from a medical professional.

Although Jane never believed she had bipolar disorder, she was prescribed Lamotrigine/Lamictal for bipolar disorder in 1982. In 2018, after taking Lamictal for over 36 years, she wanted to get off of it safely. Is it possible to come off a medication after taking it for over three decades? What needed to happen in order for her to have a safe withdrawal? Jane and I revisit her healing journey: what needed to heal and how it was accomplished. What has life been like for Jane without a psychiatric diagnosis, chronic mental health symptoms, or a need for a prescription medication? Listen as Jane and I catch up on her ongoing adventures.For more about Dr. Lee, please visit: Website: www.holisticpsychiatrist.comYouTube: The Holistic PsychiatristClick on the Holistic Updates Sign up for weekly stories and insights: Holistic UpdatesTo schedule consultations or appointments, call her office at 240-437-7600 The content provided by this podcast is for informational purposes only and has not been approved by the U.S. FDA. This podcast is not intended to provide personal medical advice, which should be obtained from a medical professional.

Perhaps the most mysterious death of the 21st century is that of Elisa Lam. We share the tragic story of this young woman on this edition of Unpleasant Dreams. Cassandra Harold is your host. EM Hilker is our principal writer and researcher with additional writing by Cassandra Harold. Jim Harold is our Executive Producer. Unpleasant Dreams is a production of Jim Harold Media. SOURCES AND FURTHER READING: Anderson, Jake. Gone at Midnight: The Mysterious Death of Elisa Lam. Citadel, 2020.  Anon. “Questions Remain Three Years After…” LosAngeles.cbslocal.com. https://losangeles.cbslocal.com/2016/10/31/questions-remain-3-years-after-womans-body-was-found-inside-la-hotels-rooftop-water-tank/ Retrieved 16 February 2021.  Barrett, Christina. The Mysterious Death of Elisa Lam. CreateSpace, 2016. Brown, Jack. “Body Language Analysis No. 2313: Elisa Lam Video in Elevator at Cecil Hotel.” BodyLanguageSuccess.com. https://www.bodylanguagesuccess.com/2013/02/nonverbal-communication-analysis-2313.html Retrieved 16 February 2021.  Buzzfeed Unsolved. “The Bizarre Death of Elisa Lam.” Youtube. 18 March 2016. https://www.youtube.com/watch?v=48jBi86ih5Q Moncrieff, JH. “Whatever Happened to Elisa Lam?” JHMoncrieff.com. https://www.jhmoncrieff.com/whatever-happened-elisa-lam/ Retrieved 16 February 2021.  Peters, Lucia. Dangerous Games to Play in the Dark. Chronicle Books, 2019. Steel, Danielle. How Elisa Lam Got Disappeared. Sifox, 2017. Swann, Jennifer. “Elisa Lam Drowned in a Water Tank Three Years Ago, but the Obsession with her Death Lives On.” Vice.com. https://www.vice.com/en/article/3bkmg3/elisa-lam-drowned-in-a-water-tank-two-years-ago-but-the-obsession-with-her-death-lives-on-511. Retrieved 16 February 2021.  You can find EM Hilker's full article that this podcast was based upon HERE and a transcript of the podcast version below: PODCAST TRANSCRIPT It was early February of 2013 when some of the residents of the Stay on Main (formerly the Cecil Hotel) began to have problems with their tap water. The water pressure was inconsistent, and the water itself tasted peculiar and was oddly discoloured. In response to the residents' complaints, the hotel sent employee Santiago Lopez to investigate the issue. His investigation took him to the water towers on the roof of the hotel where, upon examination, he found the decomposing body of a solitary young woman, naked, floating in the cistern, her clothing and some personal effects in the water alongside her.  No one recognized by authorities knows precisely how Elisa Lam died. The known facts are that Elisa arrived in Los Angeles on January 26th 2013 and checked into the Stay on Main on January 28th. She was reported missing on February 1st, 2013, after she had fallen out of contact with her family; some time prior to that she displayed seemingly erratic behavior in the hotel elevator, which was caught on tape and has been much-analyzed by professionals and amateur sleuths alike. Her body and clothing were found in one of the rooftop water cisterns, which, in theory, should have been inaccessible by the hotel guests. For a period of time, the guests consumed the water that contained her body, which had been discoloured and had an unwholesome taste. Her clothes were in the cistern as well, covered with what appeared to be sand. It was noted that her cell phone and glasses were missing. Autopsy revealed that she had been dead for several days at a minimum, that there was water in neither her lungs nor her stomach, and that aside from a small abrasion on her knee that she could have gotten anywhere, she had no obvious external trauma that wasn't accounted for by decomposition.  Among the things that are unknown: how did Elisa get in that cistern, which was said to have been difficult to access? How did she get onto the roof, for that matter, where the cisterns are located, past the secured door? What was Elisa up to in that elevator? Was she alone? Before we delve into the details of this strange case, and the plentiful theories of what precisely happened, there is Elisa herself.  She was a young woman, only 21 years old at the time of her death, and at the beginning of her adult life. She had struggled with mental illness for many years, but despite her struggles she was kind, empathetic, dedicated, and passionate. She liked fashion, art, and literature, and found a great deal of solace on her blogs “Nouvelle/Nouveau” and “Ether Fields.” She was close to her parents, with whom she connected each day as she traveled. She called her trip “the West Coast Tour.” She had been very excited about it.   I think it's important to remember who Elisa was. That she was a real, warm, living person with hopes and goals and dreams and struggles. It's easy to forget Elisa herself in the twisting paths of this case, in all the weirdness of the circumstances and the copious amount of theories on what really happened to her. Elisa wasn't just a part of a mystery to be solved: she was a vibrant young woman, taken too soon from a life that she had only just begun. LAM-ELISA TB Test The circumstances surrounding Elisa's death, and her stay in Los Angeles in general, were strange, but little was as strange on the surface as the colossal coincidence of the LAM-ELISA tuberculosis test. The name LAM-ELISA seems like an improbable coincidence. The test was developed at the University of British Columbia, oddly enough, the university Elisa had attended more than four years before her last, fateful trip. LAM-ELISA is named for enzyme-linked immunosorbent assay, or ELISA, an enzyme used to detect lipoarabinomannan (Lie-poe-a-rab-in-o-min-in) (LAM) in samples of human sputum, in order to diagnose tuberculosis in the patient. There was, additionally, an outbreak of TB in the Skid Row section of Los Angeles at the time of Elisa's disappearance. Some conspiracy theories have cropped up around these coincidences, though none really fit the facts. The naming convention of the test is clear and logical, the test itself predates Elisa's stay in LA by literal years, and there was no sign of TB in Elisa's autopsy findings.  Dark Water Another strange coincidence comes in the form of two movies called ‘Dark Water' (a Japanese movie from 2002, and the American remake from 2005) as well as the short story by Koji Suzuki on which the two movies were based. As in Elisa's case, there were water supply issues caused by the body of a young girl in the building's water tower. Interestingly as well, the American remake names the lead character, Dahlia, which just so happens to be the press' nickname for murder victim Elizabeth Short.  The Elizabeth Short who was allegedly drinking at the then-Cecil hotel's bar shortly before her murder.  “The Suicide” The Stay on Main, formerly the Cecil Hotel but re-named in 2011, has a dark and violent history. There have been at least sixteen deaths (that we know of) at the Cecil hotel since the first recorded suicide in November 1931 (a selection of which include: self-poisoning, infanticide, and strangulation). Jake Anderson, author of, Gone At Midnight, the book on the case, believes the number to be higher.  Because of its reputation as a place frequented by death, it was popularly called “The Suicide.” In addition to the selection of murders and suicides in the hotel itself, it was also known for having housed both Richard “The Night Stalker” Ramirez during the period of his murder spree in the 1980s and Austrian serial killer Johann “Jack” Unterweger in the 1990s. Also, as previously mentioned, there is the fact that Elizabeth Short, “The Black Dahlia”, may or may not have had a drink at the Cecil in the last few days of her life. Inaccessible roof and sealed water tower? The roof should have been, many have said, inaccessible. The set of stairs leading to the roof from the fourteenth floor had a security alarm, which was not triggered the night of Elisa's disappearance. Indeed, Santiago Lopez had to disarm it before finding Elisa's body on the roof. There were, however, fire escapes that could be climbed to access the roof. Jake Anderson points out that there was graffiti on the roof, as well as reports of drinking up there; someone was accessing it. The cisterns have been said to be sealed in some sources, but elsewhere simply awkward and heavy. Somebody — Elisa or otherwise — got it open, after all. And then, perhaps most disturbing The Elevator Footage The footage of Elisa playing in an elevator on what was most likely the last day of her life, which the LAPD released to the public on February 15, has gotten a lot of attention online. The footage, as released, is certainly disquieting to watch, if only because of what would happen to her later that night. This footage has originated a number of the theories that we will discuss later. All is not as it seems on the surface, however. Often noted is that the elevator doors take an unusually long time to close in the video, though upon examination Kay Theng found that the doors to the elevator only close upon pressing the “close door” button or upon someone summoning the elevator from another floor. This may have been unusual behavior for elevators in general, but it was not unusual behavior for this particular elevator. Body language expert Dr. Jack Brown believes her body language to be playful rather than afraid, and speculates that there may be another person outside the elevator she's playing with.  However strange the circumstances surrounding her trip may be, the question remains, how did Elisa wind up in that water tower? The Paranormal Theory Well before Elisa's death, the hotel was thought to be haunted. The Ghost Adventures team has recorded a two-hour special in the former Cecil, noting that “it's undeniable that there are spirits inside this building.” Renowned psychic Joni Mayhan was asked to analyze the case for Anderson, and concluded that Elisa had been murdered, her murderer having been influenced by a malevolent force.  The Elevator Game The elevator game, which is said to have originated in Korea, has a very simple premise: you enter an elevator in a building that has a minimum of ten stories, alone, and after entering the elevator on the ground floor,  press the buttons in sequence, each after traveling to the last buttons' floor, without exiting the elevator. The order is 4, 2, 6, 2, 10, 5, 1. Certain things are said to happen along the way – a woman may enter the elevator at the fifth floor, to whom you must neither speak nor look at. It's not clear what happens to you if you do. In theory, if you've done all this correctly, when you press “one” to return to the ground floor, the elevator should instead ascend to the tenth floor, where you will find another world. You can either leave the elevator and explore this new world, an empty, dark world with a burning crucifix in the distance, or reverse the sequence of floors that you pressed to get here. The dark world is said to be hard to find your way back from (you need to use the same elevator that you used to get there). And, internet speculation has it, that Elisa Lam was playing that game in the elevator footage. I have a few problems with this theory: first, and perhaps most importantly: “Elisa had given virtually no attention to the paranormal. In all of her hundreds of pages of writings, not once did she ever reference ghosts, or hauntings, or possessions, or anything in the esoteric paranormal realm,” as Jake Anderson observes. There's no reason to believe that she would have played a relatively obscure game to go to another dimension, when she doesn't seem to have done so much as watched an episode of Ghost Hunters. Secondly, the infamous elevator footage took place on the fourteenth floor. The fourteenth floor isn't part of the elevator game, and the rules are very clear that you must begin on the ground floor. Thirdly, she's shown pressing what appears to be random buttons hurriedly, rather than traveling to each floor before pressing the next button in the sequence, and she doesn't appear to be pressing them in the order of the game. Finally, she leaves the elevator, which you're not to do until you reach the tenth floor. The Mental Health Aspect Elisa Lam was diagnosed and medicated for bipolar disorder, which she seems to have struggled with for most of her life and wrote about at length online. She had been taking medications to treat the disorder, but the toxicology results from her autopsy suggest that she hadn't been taking all of her medications at the time of her death. She appears to have been taking one of her antidepressants (Venlafaxine, ven·luh·fak·seen) regularly, but her other antidepressant (bupropion,byoo·prow·pee·aan) was in small enough amounts to indicate that it had been taken recently but certainly not that day. This was true of her mood stabilizing drug Lamotrigine (luh·mow·truh·jeen) as well. The antipsychotic she had been prescribed, quetiapine (kwuh·tai·uh·peen), was entirely absent from her system.  The autopsy report isn't the only reason to believe that something was amiss, however; Elisa had originally checked into her hotel room with two other women. Several days into Elisa's stay, the roommates complained to management that Elisa was acting in ways that made them uncomfortable, and Elisa was moved to her own room. Anderson had discovered one of the last people to see her alive, a man named Tosh Berman, who had encountered her in a bookstore. He described her behavior as erratic and unbalanced, and noted that he had been worried for her safety, not because of any immediate threat but simply because she was so unstable, and seemed so vulnerable. Skinny Dipping One theory on how Elisa wound up in that water tower is that she got in voluntarily. That perhaps in her manic state, she chose to go skinny dipping, alone, in a water reservoir on the roof of a 19 storey hotel that is — in theory, at least — hard to access, sometime in  February. The average daytime temperature in Los Angeles in February is 21 degrees celsius, or 69.8 degrees fahrenheit. That is, of course, assuming she had stolen away to do this during the day, when it's warmest but also presumably the easiest time to get caught). The interior of the water reservoir was completely smooth, lacking entirely in any way for her to climb back out. The theory is that she realized this too late, and the poor woman was left to tread water, hopelessly, knowing that no one knew she was there, knowing that rescue would never come, until she died.  The Murder/Manslaughter Hypothesis A very common theory is that Elisa was murdered, and that perhaps she was dead before her body entered the cistern. Dr. John Hiserolt believes that she may have been suffocated, and her body thrown in the water tower. He acknowledges the possibility of laryngospasm , sometimes called “dry drowning,” but finds it unusual that there was also no water in her stomach. Many have pointed out that a hotel employee could have accompanied her to the roof without setting off the alarm, and many others have pointed out that there were several registered sex offenders in the hotel at the time of Elisa's death. Jake Anderson himself suspects perhaps a date rape that became a murder. Mystery author JH Moncrieff agrees, writing at one point that “Personally, I think she was murdered, and not by a ghost, either.”  Ultimately, we may never know what happened to Elisa. But there's one more theory I'd like to share with you, which may be no more true than the others, but which accounts for at least most of the facts: It's possible that Elisa may have indeed gone skinny dipping in the water tower, perhaps in a manic state, with whoever she was playing with in the elevator footage. This person may also have helped her open the lid to the cistern. She took off her clothes, her watch, and her hotel key card, placing them in a pile on the floor of the roof, picking up the particulate matter that was found on them, and jumped in the water first. Quickly realizing that there was no way to get back out, her companion perhaps panicked (if this hadn't been the plan all along), and rather than getting help, threw her clothing and personal effects in after her, and left her to die. It's hard to hope for an answer to the mystery of Elisa Lam's death. At the time of this recording, it has been eight years. There is hope, however: recently, Netflix has released a documentary, and Jake Anderson has drummed up new interest with Gone At Midnight. With luck, this new spotlight on the case will lead to fresh information on Elisa, her last days, and perhaps finally an answer to the circumstances surrounding her tragic loss.    

Welcome to another episode of The PO3 Podcast (Episode 40). In this episode of the PO3 Podcast Marcus Marx talks about the nasty side effects that are occurring from the bipolar medication "lamictal" and the struggles that follow. We also discuss religion and where each of us stand on that topic. Follow the PO3 Podcast On Instagram @PO3_Podcast --- Support this podcast: https://anchor.fm/po3podcast/support

Lamotrigine was launched for bipolar disorder in 2003, but it was a quiet launch, and since then a few myths have gathered around it as if to fill that vacuum. Today, we will address 4 of them. 

A patient advocate for people living with epilepsy has called just-released coroners findings a "wasted opportunity". The chief coroner has this morning released her report into six deaths that occurred after a recent change in epilepsy medication. The report finds there was no clear links between the brand switch and the deaths. Arabella Gubay, whose daughter has epilepsy and who sat through the coronial inquest told reporter Emma Hatton she's shocked and heartbroken that because a link could not be found - the Coroner has not made any recommendations.

A patient advocate for people living with epilepsy has called just-released coroners findings a "wasted opportunity". The chief coroner has this morning released her report into six deaths that occurred after a recent change in epilepsy medication. The report finds there was no clear links between the brand switch and the deaths. Arabella Gubay, whose daughter has epilepsy and who sat through the coronial inquest told reporter Emma Hatton she's shocked and heartbroken that because a link could not be found - the Coroner has not made any recommendations.

Heartbroken, scared and angry. Just some of the reactions to the findings of the chief coroner who has ruled the deaths of six people were not linked to a recent epilepsy medication change. Judge Deborah Marshall couldn't rule it out for two of the people but in the end made no recommendations. Family members and patient advocates have called it a cop out and a wasted opportunity. Emma Hatton reports.

Heartbroken, scared and angry. Just some of the reactions to the findings of the chief coroner who has ruled the deaths of six people were not linked to a recent epilepsy medication change. Judge Deborah Marshall couldn't rule it out for two of the people but in the end made no recommendations. Family members and patient advocates have called it a cop out and a wasted opportunity. Emma Hatton reports.

Dr. Halley Alexander discusses the Neurology Today article, "Epileptologists Push Back on FDA's New Cardiac Warning for Lamotrigine". Show references: https://journals.lww.com/neurotodayonline/Fulltext/2021/04010/Epileptologists_Push_Back_on_FDA_s_New_Cardiac.6.aspx

Back to regular programming this week with a summary of the top news, which includes updated travel guidance; Six month efficacy data for the Moderna and Pfizer-BioNTech vaccines; Vial doses increased for Moderna; A new ADHD drug is approved; And the FDA has issued a safety communication regarding the potential increased risk of arrhythmias in patients taking lamotrigine.

Listen to an audio podcast of the March 31, 2021 FDA Drug Safety Communication that FDA review of studies show a potential increased risk of heart rhythm problems, in patients with heart disease taking lamotrigine (Lamictal). FDA requiring studies to evaluate heart risk across the drug class.

Pharmac's generic drug swap for epilepsy treatment saved $30 million over five years. But for some patients, the consequences were nightmarish.  

Richard Weisler tells the tale of science and serendipity that lead to his discovery of lamotrigine for bipolar depression 30 years ago. He shares a few dosing tips, and touches on how he works with patients and their families. Plus, the word of the day: Gramophone Syndrome. Published On: 1/25/21 Duration: 23 minutes, 30 seconds Got feedback? Take the podcast survey.

On this episode of the Real Life Pharmacology podcast, I discuss the ins and outs of lamotrigine pharmacology. Lamotrigine has a very slow dose titration schedule due to the risk of drug induced rash. Sedation, GI upset, and CNS changes are the most common adverse effects associated with lamotrigine. Lamotrigine concentrations can be increased by valproic acid, so we tend to use lower starting doses. Phenytoin and carbamazepine can lower concentrations of lamotrigine.

ANTI CONVULSANTS DRUGS (part 1) : 1. GABAPENTIN & PREGABALIN. 2. BARBITURATES (phenobarbital & primidone ). 3 . BENZODIAZEPINES ( CL+ AM) - clobazam , clonazepam, clorazepate ... “AM” - diazepam, midazolam , lorazepam : USED TO TREAT STATUS EPILEPSY 4. ETHOSUXIMIDE : treat ABSCENCE SEIZURE 5 . PHENYTOIN & FOSPHENYTOIN , purple glove syndrome . 6 . LAMOTRIGINE 7 . Lennox gastaut syndrome : RUFINAMIDE , VALPROATES , BENZODIAZEPINES, TOPIRAMATE

Drugs discussed in this topic : AMOXICILLIN, LAMOTRIGINE , OLANZAPINE , LITHIUM TOXICITY, CLAVULANIC ACID

Women with seizure disorders often have altered menstrual function, with or without anti-seizure medications. One anti-seizure medication has even been linked to the development of PCOS. Seizure disorders in reproductive age women can also influence contraceptive choice. Do you know what makes Lamotrigine unique? In this session, we will summarize the upcoming May 2020 ACOG committee opinion (806) focusing on gynecological care of reproductive age women with seizure disorders.

In this mini-episode Dr. H opens himself up for major audiophile shaming as he (reluctantly) reveals his three desert island albums. With this revelation complete, he then moves on to the challenge at hand-- which three psychiatric medications are at the top of the heap, combining efficacy, safety, and breadth of symptom coverage?A hint-- they all start with the same letter. And they are all generic. And psychiatry would be greatly hamstrung without them. Guesses?? Dr. Hhttps://www.craigheacockmd.com

Up to 70 million people worldwide have epilepsy and there are many Cochrane Reviews of ways to treat it. These include reviews that work with the original researchers to gather data on everyone who was in their studies, to perform individual participant data meta-analyses. In June 2018, Sarah Nevitt and colleagues from the University of Liverpool in the UK updated one of these reviews, comparing two commonly used drugs, lamotrigine and carbamazepine.

Up to 70 million people worldwide have epilepsy and there are many Cochrane Reviews of ways to treat it. These include reviews that work with the original researchers to gather data on everyone who was in their studies, to perform individual participant data meta-analyses. In June 2018, Sarah Nevitt and colleagues from the University of Liverpool in the UK updated one of these reviews, comparing two commonly used drugs, lamotrigine and carbamazepine.

Up to 70 million people worldwide have epilepsy and there are many Cochrane Reviews of ways to treat it. These include reviews that work with the original researchers to gather data on everyone who was in their studies, to perform individual participant data meta-analyses. In June 2018, Sarah Nevitt and colleagues from the University of Liverpool in the UK updated one of these reviews, comparing two commonly used drugs, lamotrigine and carbamazepine.

Tales of good and bad experiences with psychiatric medication, Lithium, Lamotrigine, Pregabalin, Abilify, Latuda, Risperidone,...

The post lamotrigine (Lamictal) Nursing Pharmacology Considerations appeared first on NURSING.com.

Unfortunately, many patients with epilepsy fail their first trial of an anti-seizure medication. A large proportion of these patients are put on a second agent...or a third. But is more necessarily better? Produced by James E. Siegler. Music by Justin Warren and Lee Rosevere. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61:246-255 Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004;62:292-295 Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res. 2005;65:185-188 Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130-2136

The Food and Drug Administration (FDA) is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder can cause a rare but very serious reaction that excessively activates the body's infection-fighting immune system. This can cause severe inflammation throughout the body and lead to hospitalization and death, especially if the reaction is not diagnosed and treated quickly. A link to the full communication detailing specific information for health care professionals and a list of FDA-approved GBCAs can be found at www.fda.gov/Drugs/DrugSafety Released 4/25/2018

The Food and Drug Administration (FDA) is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder can cause a rare but very serious reaction that excessively activates the body’s infection-fighting immune system. This can cause severe inflammation throughout the body and lead to hospitalization and death, especially if the reaction is not diagnosed and treated quickly. A link to the full communication detailing specific information for health care professionals and a list of FDA-approved GBCAs can be found at www.fda.gov/Drugs/DrugSafety Released 4/25/2018

The Food and Drug Administration (FDA) is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder can cause a rare but very serious reaction that excessively activates the body’s infection-fighting immune system. This can cause severe inflammation throughout the body and lead to hospitalization and death, especially if the reaction is not diagnosed and treated quickly. A link to the full communication detailing specific information for health care professionals and a list of FDA-approved GBCAs can be found at www.fda.gov/Drugs/DrugSafety Released 4/25/2018

FDA Drug Safety Podcast: FDA warns of serious immune system reaction with seizure and mental health medicine lamotrigine (Lamictal)

Things you need to know about the way anti-epileptic drugs affect each other, all in one podcast. Take a few minutes here to familiarize yourself with these common and critical complications of seizure management. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Danielle Becker. REFERENCES 1. Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61:246-255 2. Pennell PB, Newport DJ, Stowe ZN, Helmers SL, Montgomery JQ, Henry TR. The impact of pregnancy and childbirth on the metabolism of lamotrigine. Neurology. 2004;62:292-295 3. Petrenaite V, Sabers A, Hansen-Schwartz J. Individual changes in lamotrigine plasma concentrations during pregnancy. Epilepsy Res. 2005;65:185-188 4. Pennell PB, Peng L, Newport DJ, Ritchie JC, Koganti A, Holley DK, et al. Lamotrigine in pregnancy: Clearance, therapeutic drug monitoring, and seizure frequency. Neurology. 2008;70:2130-2136

1) Lamotrigine and aseptic meningitis and 2) Topic of the month: Recent book, Your medical mind: How to decide what is right for you. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Michaela Tegan Chatman interviews Drs. Simms, Kortepeter and Avigan about their paper on lamotrigine and aseptic meningitis. Dr. Stacey Clardy is reading our e-Pearl of the week about pregnancy on the course of neuromyelitis optica. In the next part of the podcast Dr. Ted Burns interviews Drs. Groopman and Hartzband about risk-benefit ratios. Next week, Dr. Burns will interview Drs Groopman and Hartzband about additional topics from their books and columns not previously discussed. The participants had nothing to disclose except Drs. Simms, Kortepeter, Avigan, Clardy, Burns, Groopman and Hartzband.Dr. Simms is employed at U.S. Food and Drug Administration. Dr. Kortepeter is employed at U.S. Food and Drug Administration. Dr. Avigan is employed at U.S. Food and Drug Administration. Dr. Clardy serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (30% effort); and has received research support from the Myasthenia Gravis Foundation of America and Knopp Neurosciences Inc..Dr. Groopman receives royalties from the publication of the book Your Medical Mind.Dr. Hartzband receives royalties from the publication of the book Your Medical Mind.

July highlights, including ultrasound to detect asymptomatic carotid stenosis in stroke prevention.

Borderline patients often display pathological aggression. We previously tested lamotrigine, an anti-convulsant, in therapy for aggression in women with borderline personality disorder (BPD) (J Psychopharmacol 2005; 19: 287–291), and found significant changes on most scales of the State-Trait Anger Expression Inventory (STAXI) after eight weeks. To assess the longerterm efficacy of lamotrigine in therapy for aggression in women with BPD, this 18-month follow-up observation was carried out, in which patients (treated with lamotrigine: n = 18; former placebo group: n = 9) were tested every six months. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the lamotrigine-treated subjects. All subjects tolerated lamotrigine relatively well. Lamotrigine appears to be an effective and relatively safe agent in the longer-term treatment of aggression in women with BPD.

This study was aimed at investigating the effects of lamotrigine (LTG) on electrically evoked field excitatory postsynaptic potentials (fEPSP) and population spikes in the CA1 hippocampal region of guinea pigs. The concentration response curves showed different actions of LTG on fEPSP and on population spikes. The data are in contrast to previous findings that suggest the drug acts primarily on presynaptic sites via a blockade of the release of excitatory amino acids, In the range of therapeutic plasma levels, synaptic transmission was not affected. Copyright (C) 2000 S. Karger AG, Basel.

Actions of the new antiepileptic drug lamotrigine (LTG) were characterized using extracellular and whole cell patch clamp recordings from rat CAI and CA3 pyramidal cells in vitro. The results suggest that LTG, beside its previously described effect on the fast sodium inward current, also modulates - presumably voltage-gated - calcium currents and the transient potassium outward current ID. These may be effective mechanisms to inhibit pathological excitation in epilepsy and may be of potential benefit in treating: underlying cellular disturbances in bipolar disorder.

The new anticonvulsant, lamotrigine, is becoming an important tool in the treatment of bipolar disorder, including bipolar depression. Its efficacy in bipolar depression might be linked to its inhibition of serotonin uptake. We present the case of a female schizoaffective patient successfully treated with 400 mg of lamotrigine developing considerable genital disorder, a side effect well known from the treatment with selective serotonin reuptake inhibitors (SSRIs). We suggest that female genital disorder induced by high doses of lamotrigine is a serotoninergic side effect.

There is accumulating evidence for the efficacy of lamotrigine in the treatment of bipolar disorder, including bipolar depression, both as monotherapy and in combination with sodium valproate. We present the cases of 3 female patients admitted to our hospital with the diagnosis of schizoaffective disorder who were treated with lamotrigine. While dosages up to 200 mg/day, resulting in serum concentrations of less than 5 mg/l, were only partially effective, 400 mg/day (with serum concentrations >10 mg/l) led to considerable mood stability, with complete remission from paranoid symptoms. We suggest that lamotrigine might be helpful in the treatment of schizoaffective disorder, probably with serum concentrations of more than 5 mg/l.