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How Quickly Can One Supplant an SSRI with Lamotrigine?


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so, my doctor  isn't quite sure if i should reduce escitalopram from 10mg/day to 5mg/day at the same time that i am to increase lamotrigine from 150mg/day to 200mg/day.

the decision to increase lamotrigine is largely up to me as i'm currently relatively stable and so i see no problem with the increase, although increasing lamotrigine would be contingent upon decreasing escitalopram for me.

i'm to wait the cursory two weeks to potentially increase from 150 to 200mg/day of the drug, but whether i can safely reduce escitalopram at the same time after two weeks have elapsed since i last reduced isn't known.

i would certainly do this if i weren't in the midst of moving to a new city to begin a graduate program at a renowned university on the 19th of september. on the other hand, there is no ideal time to make medication changes and i'm certainly not going to wait until next summer to touch the current cocktail.

i'm sort of confused with what i can expect both physiologically and psychologically when/if making this change. i can say that one week after increasing lamotrigine to 150mg/day and one and a half weeks after decreasing escitalopram from 12.5mg/day to 10mg/day i feel rather fine after a few days of feeling malaise and experiencing intense migraines. i haven't had any noticeable uptick in psychiatric symptoms (yet).

any advice?  i'm lost and my psychiatrist oddly doesn't have an appropriate timeline but is open to the change outlined above as long as my symptoms are okay. the worry is that symptoms related to the ssri reduction will pop up several weeks later, although i'm not sure if replacing the ssri with lamotrigine will mitigate some of this.

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53 minutes ago, basuraeuropea said:

i'm lost and my psychiatrist oddly doesn't have an appropriate timeline

I think this might be because No standard for this situation is universally accepted. Replacing an SSRI with lamictal is not a common approach, so maybe that’s why she’s going with the “feel it out” strategy. 
 

my advice would be don’t rush if you don’t have to. As long as there are no major side effects currently happening, I would give the lamictal time to optimize before further decrease. This might help reduce some unseen, down the road issues from decreasing SSRI 

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1 hour ago, basuraeuropea said:

so, my doctor  isn't quite sure if i should reduce escitalopram from 10mg/day to 5mg/day at the same time that i am to increase lamotrigine from 150mg/day to 200mg/day.

Maybe you could just go for a 2.5 mg decrease in escitalopram when you increase lamotrigine to 200mg.....In other words, maybe try reducing down to 7.5mg escitalopram instead of 5mg?....Ask pdoc what she thinks about that plan.

Another good option would be what @Iceberg indicated above--give some time after the lamotrigine increase before reducing escitalopram.

Edited by CrazyRedhead
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thanks to  you both! i think that if i were to reduce by 2.5mg/day then i'd want to go up by 25mg to 175mg/day of lamotrigine and only based on past experiences where, and perhaps irrationally, i've done better when something is replacing something else at the same time. so like, right now, even though i'm doing fine, i'd fear relapse if i were to remove more escitalopram.

yeah, and it makes sense to go as slowly as possible, but i really don't want to be dealing with ssri withdrawal during classes. also, lamotrigine increases have been pretty easy post 100mg/day compared to the hell that i went through getting to 100mg/day.

again, the psychiatrist's whole thing with the ssri is that regardless of the other disorders that i have, she *thinks* that they'd be well enough controlled on a lower amount of the ssri because the ssri is doing whatever flavor of bipolar disorder she has diagnosed me with more harm than good. honestly, i'm doing better on lamotrigine and on a lower dosage of escitalopram, so she's  onto something and that's amazing because the only medication that's helped in making me feel this 'normal' was mirtazapine.

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23 minutes ago, dancesintherain said:

I'm glad the lamictal worked out.  I don't have any thoughts on titration, but want to say that increases in lamictal for me also got much easier once I got past the first 100.  So that's a thing. 

thank you! i was SO skeptical and SO hopeless and it was a breath of fresh air that something finally was tolerable and has brought quite a bit of relief. i'm not perfect, but i'm in a much better position now that i was even a few months ago.

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