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Can You Combine Lamictal with SSRIs?


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#1 Guest_shigg_*

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Posted 22 October 2005 - 03:58 PM

I was initially thinking about switching my AD from Zoloft to Lamictal; my doc told me to keep the Zoloft on and add the Lamictal, because he said they work on difffernt parts of the brain. I have major depresssion & he wants to keep the Zoloft on for my GAD

I was just wondering if folks commonly or here have combined an SSRI and Lamictal. I am sure I once read somewhere in a published article that an MD was quoted as saying Lamictal kind of "has an SSRI built into it." I'm sure I could dig it up if I googled long enough...
& from what I've gathered on the info sheets, Lamictal does hit up serotonin receptors somewhere along the lines.

I've also read that Lamictal could in theory increase the blood level content of Zoloft...so I'm all perplexed.

I guess the bottom line question is are people effectively combining SSRIs with Lamictal?
tanx


#2 gretl

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Posted 23 October 2005 - 08:50 AM

Yep, lots of people combine them.  I've been on Trileptal and Lexapro for a long time but I'm in the process of switching the Trileptal to Lamictal, so right now technically I'm on Lamictal+SSRI.  However I'm curious to see if I can ditch the Lexapro once I'm just on a therapeutic dose of Lamictal. 

You can take advantage of other people's Googling and read through this old thread; basic inconclusive conclusion was:

"Current American Psychiatric Association guidelines state that an antidepressant should NOT be added to a mood stabilizer (such as Lamictal) to treat bipolar disorder. But, there is now contradictory research evidence on this recommendation."
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#3 NARS

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Posted 23 October 2005 - 03:05 PM

But, there is now contradictory research evidence on this recommendation.


I'd add the caveat "with caution."  I've been taking wellbutrin for years (a multiple reuptake inhibitor, so it's not just seratonin I get loaded with).  I increased the dose to 450, the maximum recommended, when I got depressed last summer while changing meds.  I started lamictal a few months ago, and got mania this past month or so (not clear when exactly it started to get bad).  I've reduced the wellbutrin to 300 and changed to sustained release, and at the same time increased the wellbutrin.  I'm much better, but pdoc and I agree that if possible I should get off the AD because the lamictal's AD effect may be strong enough.

But if it's not, I'll keep the wellbutrin in the mix.  It's safer for BP than most ADs, including any of the SSRIs.  If you start getting too activated with zoloft, you might suggest switching to something more friendly to BPs like wellbutrin.
Dx: BP II; Psychmeds: lamictal 300mg, wellbutrin xl 300mg, ambien CR (5mg), provigil 100.


You don't have to believe everything you think

#4 MoparGuy1991

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Posted 23 October 2005 - 10:51 PM

I think, for me, Lamictal's AD effect is pretty weak at best. I'm on 400mg.
I may need some SSRI. My baseline mood is still fairly/moderately depressed, and my general outlook is still kinda negative/pessimistic in general. People tell me I'm down a bit. I feel sad to music that's supposed to uplift me. ;)

But Lamictal and Topamax (250mg) are actually working fine as mood stabilizers. No more mixed states, irritability, excitation/agitation, impulsiveness. Also, less anxiety, little reduction in OCD symptoms, less bizarre behaviors, don't take things as hard, less ruminations. I'm more stable than ever on those two meds.
Ultra-Rapid/Ultradian Cycling, OCD, Aspergers Syndrome
Current Cocktail:
Lamictal - 300mg (200mg AM, 100mg PM)
Topamax - 150mg (50mg TID)
Omega 3 Mood 1000mg EPA QAM

#5 Elwood

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Posted 24 October 2005 - 02:21 PM

I'm on Paxil while titrating up to a theropeutic does of Lamictal.  New p-doc doesn't seem all that interested in messing with the Paxil since I've already been taking it for some time, but to tell the truth I'd just as soon not have Paxil at its' current dose.  He say that while Paxil would never be a first choice for anyone with any type of BP, 40mgs is far from a maximum does and that I'll be fine.  OTOH, previous p-doc, who prescribed it in the first place, was trying to talk me down to 20mgs (from 30).  PCP is the one that raised it to 40mg, which I've generally regarded as a bad move. I guess I'll just have to trust the new p-doc on this one for now. 
No job. No car. No Life. No worries.

Dx: BP II
Rx: Paxil 40mg, Lamictal 150, Trazadone 150.

#6 tigrre

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Posted 24 October 2005 - 02:29 PM

I just added lexapro to the lamictal I've already been taking because the lamictal wasn't doing much for my depression.  It isn't giving me any problems (but not working too great either at the moment... I'll talk to the pdoc about the dosage) 

But yeah, lamictal and an SSRI could work.
Dx: Depression and anxiety, oh and there's some ADHD too...
Rx: Adderall 30 mg XR, Adderall 20 mg PRN, Rozerem 16 mg, Seroquel 150 mg, Valium 15 mg
Other stuff to keep me sane: rTMS, Vitamin D (supplements and sunshine... or errr... 4 minutes in a tanning bed a couple times a week, because there's no real sunshine where I live), Melatonin, and Omega-3s.

#7 seven

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Posted 24 October 2005 - 05:37 PM

Not only can you combine them. Lamictal potentiates antidepressants. Sometimes Lamictal is added to an SSRI for treatment resistant depression—the same way Lithium is sometimes used for its antidepressant-potentiating properties. By itself, Lamictal usually does not work for unipolars.

All your posters thus far are bipolar...so I find all the cautionary asides about mania very amusing given that you have MDD. For more info about how Lamictal is used for depression, go to the crazymeds.us page for Lamictal and follow the link in the Off-Label uses category:

Depression (The only studies I could find were using it to augment antidepressants.  Here's one with just unipolar participants.)


And a little googling research will garner you even more info. Try e.g. lamictal and unipolar

Good Luck! Sometimes it's the Lamictal that makes all the difference between a lame SSRI and a great one.

7

Edited by seven, 24 October 2005 - 05:55 PM.


#8 MoparGuy1991

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Posted 24 October 2005 - 09:58 PM

I just added lexapro to the lamictal I've already been taking because the lamictal wasn't doing much for my depression.  It isn't giving me any problems (but not working too great either at the moment... I'll talk to the pdoc about the dosage) 

But yeah, lamictal and an SSRI could work.

<{POST_SNAPBACK}>


I'm in same boat as you.
I take 400mg Lamictal and 250mg of Topamax. They work well as mood stabilizers, each in different ways. Lamictal (the MS with the touted AD properties) doesn't do much at all for my depression either.

So, at my doctor's appt. today, we decided to add a little Lexapro in. He told me not to escalate right to 10mg but to start at 5mg instead because it's a potent SSRI. My system would need to adjust.

From reading here, it seems like Lamictal and an SSRI go well together for TRD. Studies have been showing this.

Now, on the other hand, my experience has been DO NOT ever mix Geodon with Lexapro, or any other SSRI.
Ultra-Rapid/Ultradian Cycling, OCD, Aspergers Syndrome
Current Cocktail:
Lamictal - 300mg (200mg AM, 100mg PM)
Topamax - 150mg (50mg TID)
Omega 3 Mood 1000mg EPA QAM

#9 Dweii

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Posted 25 October 2005 - 05:29 AM

I was on Lamictal and Lexapro for a while, and that kept me stable and happy.

Waaaaiiit a minute... I knew it.






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