Anyone take Lamictal for UNIPOLAR depression?

[tek]

Sorry if I'm bombarding this forum with too much Lamictal crap. I'm just trying to do some of my own research or whatever, and since the drug is so mysterious and strange, reading personal accounts have been the most helpful for me. Bear with me...I'm still trying to get a handle on this drug and what to expect.

I wonder if anyone else with unipolar depression is currently on Lamictal? If so, what is your dose (goal dose if titrating) and do you take anything else for depression (i.e. any kind of AD, or "AD augmentor")?

My story: as of right this minute, I'm Dx'd with recurrent unipolar depression (each episode increases in severity). There was but one instance of hypomanic symptoms clinically observed in my entire life. Risperdal kicked it's butt and the loveliness was gone in about 2 days. But, I didn't earn an offical bipolar Dx. The episode coincided with a med cocktail including Effexor XR and Adderal XR, and I had hyperthyroid lab results 2 months following the episode. Of course, Pdoc is wary that the hypomanic symptoms were driven by meds or thyroid stuff.

Regardless, the pdoc is playing it safe and chose Lamictal as my sole antidepressant. I should note that I had negative reactions from other ADs, and a family history of BP so pdoc is aware that my Dx is still up in the air until something really obvious (read: mania) occurs. I'm not getting any straight answers about when/how we'll know to increase the dosage from my pdoc, as it seems to be something they play by ear. Well, I've been on my goal dose for 2 weeks and I'm not any less depressed than when I began titration 7 weeks ago. I've been on an 8-week short-term disability "too nuts to work" hiatus with a return in just one week. Needless to say, I'd hoped to be at least a little bit better than I am by now.

[Ophelia]

well, lamictal is a mood stabilizer with antidepressant qualities. does your pdoc have any plans on augmenting it with another med in the future?

i do know someone who was on it for just depression. i'm sorry to say that i am not positive of her experiences on it.

[tek]

well, lamictal is a mood stabilizer with antidepressant qualities. does your pdoc have any plans on augmenting it with another med in the future?

i do know someone who was on it for just depression. i'm sorry to say that i am not positive of her experiences on it.

She did mention maybe adding "just a tiny smidge" of something in the future if all remained stable. I'm assuming this was in the maybe category since I've had negative experiences with other ADs. I'm getting the impression that we're hoping Lamictal will be enough, but like I've said a hundred times...it seems like nobody really knows what it does at what dose for who and during what moon phase, etc. From her point of view, she probably thinks things aren't getting WORSE so just let me marinate in it a bit longer and see what happens. This is what we always do, probably from a lack of any other ideas that seem to have a high potential of success, and then I just eventually go back to hell. THEN we change everything around. At our next appointment, I'm going to bring it up again and ask her if we can just go for it and add that smidge she was talking about. Or up the dose. Fuck, do SOMETHING. Let's not repeat the same "wait and see" mistake for the third time in a row. I understand why she would be conservative but I've been in a bad enough place to warrant more aggressive treatment.

[Velvet Elvis]

According to The Last Psychiatrist:

The Conclusions seem to say Lamictal is good for preventing mood episodes, mania and depression-- is there any other way to interpret it? In fact, this study shows it is only good for preventing depression, not mania at all. Why is it written this way? Because the authors want to advance the idea that Lamictal is a "mood stabilizer" and not what it actually is: an antidepressant.

Depending on how much faith you put in what he says, it may not be that likely to do much of anything if it doesn't help with depression.

[tek]

Yeah, I've heard tons about it being good for "preventing depression" but does that apply to lifting current depression? Even my pdoc says Lamictal can't really be called an antidepressant since there's no beef on it other than studies showing less depressive episodes over a several year period.

[CER]

tek,

There's not a whole lot of real studies showing the effects of Lamictal as a monotherapy for depression. There's one here, but aside from that the success of it is mostly anecdotal. I saw a couple of people on the crazymeds site get good results, but most have gotten better results by combining Lamictal with another AD.

That's not to say you should give up yet.

[tek]

I got in for an appointment on Friday. I plan to ask to start on something to augment it. After 7.5 weeks (2.5 weeks at goal dose), I don't think I feel as good as I should if this monotherapy (at this dose) was going to do it for me. The only magic occured in the first 3 weeks or so, then leveled out to where I am now, which hasn't changed at all...but has the tinge of heading somewhere worse rather than better. I'm sure we won't go anywhere near SNRIs or NRIs, so it'll probably be another SSRI...something known to be less activating. I might even ask for Lexapro, since I only took it for about 6 weeks and asked to switch only because it made me so sedated (unless I took Adderall). Lexapro DID have a teeny affect and lifted me out of the suicidal phase at about 10mg, but like I said...I didn't stay on it long enough to know if it ever would've done more. Now I wonder... some response is better than nothing. Prozac was zero (unless you count extreme irritability and negativitiy!).

[meg]

hey tek,

just gonna add my experience here (even though I can't tell you how lamictal by itself affects me since I added it on top of three other meds)-- I am definitely unipolar though, and am taking it for it's antidepressant properties. sorry if this post is muddled but haven't been able to sleep in a while and am muddled myself :-P

I am also on:

• wellbutrin xl 450mg (max dose)
  • been about 1 1/2 years
    
    • not enough on it's own to sustain me or completely lift me out of my deep depression
      
    • 'poops out' and decreases affectiveness after a few months (bumping from 300 to 450 may have stopped that a bit tho, can't tell)
      

[*]zoloft 150mg

• been about 8 months
  
• wellbutrin's crutch originally, now it's wheelchair (it took going off of it and turning into a suicidal nutcase to figure out how vital it is to me)
  

[*]adderall 20-40mg

• figured I'd mention this, I usually take one in the morning, rarely get to 40mg
  

[*]now have lamictal (50mg, moving up to 100mg soon)

• I am SO GLAD that my pdoc was willing to try this. I've had some ups and downs (mostly due to me being so crappy at taking meds and remembering) but I really think that Lamical is the reason that I was able to feel GOOD.

seriously good. like in control of my life and mood and wanting to have a life again good. it was AMAZING. I had 4 days straight of this level, normal, wonderful mood that I hadn't seen in years. I've been up and down since then (pharmacy stuff, not taking meds, etc.) but now I have hope. I'm sticking with it and I really believe that it will be helpful to me and maybe I can finally stop messing with meds and just live for a while, you know? just be.

goodluck, hope I could be teeeensy bit helpful,

meg

ps- one BIG issue I have with lamictal is that I have to take it at the same time every day. I need it in the morning--days where I forget or sleep in aren't good days (moodtracker.com helped me find this pattern by the way) so it's definitely a med that is different for everyone and you should be aware of that if you can. I really suggest the mood/med tracking, I just made that page my home page and it has been helpful.

[tek]

[*]seriously good. like in control of my life and mood and wanting to have a life again good. it was AMAZING. I had 4 days straight of this level, normal, wonderful mood that I hadn't seen in years.

This is EXACTLY what I experienced during the 2nd and 3rd week of titration. The first week, I showed some signs that depression could be lifting but I was still down (way more social, intensly creative, interested in things). Then the "good times" (week 2 and 3) hit. I have NEVER felt so normal and such a zest for life. I've actually got another post in this forum written back when that was going on. Unfortunately, it lasted just barely over a week and then the unmotivated blahs came back. I was pretty down and shocked to feel so amazingly normal, then suddenly not. My pdoc's only explanation is that maybe the Lamictal activated me slightly, then I adjusted so the effects wore off. Well, jeez...activate me again. Something went on in there that hit the right spot, and I would kill to find out what that was and reproduce it. Meh!

I do plan to stick with Lamictal, since as I said above, my moods ARE more stable and that's a good start. I just wish there was a more defined protocol on how to know a dosage increase is warranted and when to do it, etc. I don't feel like I'm going to be able to talk my pdoc into upping my dosage, but since I've plateaued and Lamictal has had SOME positive effect you would think it might be worth a shot to add a bit more. She seems to be such a fan of "see what happens". This time I just want to actually change something and "see what happens" instead of wait around and "see what happens". Lady, I'll tell you what will happen.... /rant

[CER]

tek,

Have you ever tried Remeron? I take it with Lamictal and it kicked the shit out of my depression.

Just sayin...

[tek]

tek,

Have you ever tried Remeron? I take it with Lamictal and it kicked the shit out of my depression.

Just sayin...

Nope, I haven't. I swear my pdoc suggested trying it for initial insomnia back when I finally bitched enough to get some Ambien. Maybe I'm confusing it with something else. What type of drug is it?

[quiet storm]

Remeron is an antidepressant classified as a NaSSA(Noradrenergic and specific serotonergic antidepressant). Its not related to any other class of antidepressant. Its biggest side effects are somnolence and an extreme case of the munchies. So weight gain is common. Alot of people take a low dose as a sleep aid but its one of those that get less sedating as you increase the dose.

[tek]

Remeron is an antidepressant classified as a NaSSA(Noradrenergic and specific serotonergic antidepressant). Its not related to any other class of antidepressant. Its biggest side effects are somnolence and an extreme case of the munchies. So weight gain is common. Alot of people take a low dose as a sleep aid but its one of those that get less sedating as you increase the dose.

Hmmm, I just got off of Risperdal a few weeks ago...finally shed 7lbs of post-partum weight with little effort. So I don't think I'd immediately want to go for something that is likely to make me gain. I'm also not sure how well somnolence would work out for me, maybe not so bad since I also take a stimulant for ADD. I'll mention it to the pdoc, though.

[CER]

Remeron is an antidepressant classified as a NaSSA(Noradrenergic and specific serotonergic antidepressant). Its not related to any other class of antidepressant. Its biggest side effects are somnolence and an extreme case of the munchies. So weight gain is common. Alot of people take a low dose as a sleep aid but its one of those that get less sedating as you increase the dose.

Hmmm, I just got off of Risperdal a few weeks ago...finally shed 7lbs of post-partum weight with little effort. So I don't think I'd immediately want to go for something that is likely to make me gain. I'm also not sure how well somnolence would work out for me, maybe not so bad since I also take a stimulant for ADD. I'll mention it to the pdoc, though.

tek,

quite storm is right that at lower doses it can be more sedating (for some, but not all). At higher doses it's supposed to be more activating. As for the weight gain...unlike other meds where it's the pills that make you fat, with Remeron if you don't eat, you don't gain weight. It's that simple. Now it does make you crave a lot of sugary foods when you first start up on it, but that does subside after you get used to the med (at least it did for me). Remeron has an extremely low side-effect profile otherwise.

I take it now in a low dose, but even at higher doses (and mixed with Seroquel) I never gained weight on it, and I had great results.

But yeah...mention it to the pdoc and see what he says...

[tek]

Walked out with a few sample packs of Wellbutrin today. I'm pleased that pdoc got the message that it was time to be a bit more aggressive. I never expected that she would add Wellbutrin, but the decision has some logic and science behind it!

Obviously, I had a suspicion that my "week and a half of undepressed normalcy nirvana" wasn't just some random coincidence. The more I thought about what changes could've sparked the bliss, it dawned on me that I was still weaning off of Effexor XR right when I started Lamictal. So, I thought, maybe the residual Effexor neurotransmitter tweaking + Lamictal hit the right spot. But then the Effexor tweaking went away, and my good mood with it. I mentioned this to my pdoc and she reinforced my theory, stating that it was entirely possible and shouldn't be ignored. She re-evaluated my most troublesome symptoms (no motivation, lack of interest, limited pleasure or satisfaction in any activity, blah, couch potato, fatigue) and decided that Wellbutrin not only fit my current state of mind, but would also test the theory that leaving my seratonin alone and messing around with norepinephrine could be the magic my brain has been waiting for.

I'm also pleased that there is no titration, and it is known to begin working fairly quickly. I have prepared myself for the possible activating-type side effects...I take Ativan regularly, so hopefully that will ward off anxiety.

[meg]

Walked out with a few sample packs of Wellbutrin today. I'm pleased that pdoc got the message that it was time to be a bit more aggressive. I never expected that she would add Wellbutrin, but the decision has some logic and science behind it! /quote]

I'm so glad to hear that you managed to get through to your pdoc-- wellbutrin was the first thing to really help me and I really hope that it works for you. It really wasn't big on the side-effects (and trust me, I usually get SEs up the wazoo)-- lost my appetite for a while, drymouth (I get this with *everything* esp. the lamictal has made it worse) and my sex drive was crazy the first year or so, lol-- oh, the only other thing is a bit of increased sweating. Of course, you may not get any of these but I thought I'd mention it. For most people it's activating, so hopefully it'll go over well for you.

luck, keep us in the loop,

meg

[tek]

Thanks for the encouragement, Meg.

Yesterday was my first day on it, and I definitely felt some activation for awhile (just didn't feel like sitting down!) but was able to settle down just fine in the evening. I did notice being EXTREMELY argumentative and irritable, though. First tiff my husband and I have gotten into in about a month! I've heard this is a fairly common SE with Wellbutrin, especially when just starting out. I'm just going to try and keep my trap shut.

[Greenyflower]

A decades long friend has had recurrent depression for years. Antidepressants would work for several months to a year and then fail. Then she tried Cymbalta. It worked great. And then so good that the doc suspected hypomania. The dose was reduced and she fell into depression again. At that point her pdoc added lamictal.

In the couple of years since then, the descents into depression have been milder and milder. She has been mood stable and pretty much happy for about a year now.

She said that it took a good year for the combination to get her where she wanted to be. The changes were subtle, but all in the right direction. She began to sleep better, started to enjoy music again, then enjoy work, then was able to socialize. The bad depressions that routinely started in the spring have not happened for two years now.

[Cetkat]

Tek, I'm actually trying Lamictal for my MDD. I'm still titrating, so I don't yet know how well it will work.. but it has shown a slight improvement so far. (I'm up to 50mg) I doubt I'd use it as my primary med.. but it could be a strong second. I'm crossing my fingers.

[meg]

I did notice being EXTREMELY argumentative and irritable, though. First tiff my husband and I have gotten into in about a month! I've heard this is a fairly common SE with Wellbutrin, especially when just starting out. I'm just going to try and keep my trap shut.

Whoops, this is a SE that I forgot about completely (probably because it went completely away, thank goodness!).

I'm usually a very hard person to really ruffle-- I mean, I'll make the complaints and noise just like everyone else (ex: "OMG, did you hear what she just said to me, WTF?") but can stop at any time and not really be upset to the core at all, maybe mildly annoyed, but that's it. On Wellbutrin, that changed, whoaaa. Things that I didn't find irritating before that I could usually brush off (people complaining and whining for hours, noises, certain conversations, coworkers bickering, boyfriend teasing-- I could go on) really annoyed the HELL out of me. Sometimes all I could do was remove myself from the situation and remind myself that it was the medication, and nobody around me was irritated, I didn't need to be either.

Way easier said than done-- but I'm pretty sure it goes away for everybody. It seemed to come in waves with me, but a month or so it was gone. Only reappeared when I went up to 450mg from 300.

Goodluck, keep us posted I'm crossing my fingers that Lamictal is my final med change for a while!

meg

[tek]

Thankfully, it only lasted a couple of days. Though I can't totally blame it on WB since I was just beginning what you could call the "PMS phase". My periods are still messed up from Risperdal, but I'm definitely going to get it any day now. Any crankiness is easily written off to that!

Also, I just went up to 300mg yesterday. So far, I haven't noticed extra crankiness and I went to sleep just fine with 2 Ativan. I daresay that my mood was and is just a smidge better, too. In fact, it got a smidge better the first day I started 150. I hope this is actually a trend and not just coincidence. The most noticeable effect has been on motivation. I'm still not jumping for joy to do stuff, but I'm actually getting things done without an enormous struggle. That's progress!