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Can You Combine Lamictal with SSRIs?

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Posted

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

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Posted

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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Posted

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.

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Posted

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.

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Posted

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. 

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Posted

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.

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Posted (edited)

Not only can you combine them. Lamictal potentiates antidepressants. Sometimes Lamictal is added to an SSRI for treatment resistant depression

Edited by seven

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Posted

I just added lexapro to the lamictal I've already been taking because the lamictal wasn't doing much for my depression.

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Posted

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

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