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new research on Lamictal + anti-depressant


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My pdoc last week said that there is new research showing that long term, Lamictal all alone is better than Lamictal plus an antidepressant at treating bipolars.

Has anyone else seen or heard of such research?

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My pdoc last week said that there is new research showing that long term, Lamictal all alone is better than Lamictal plus an antidepressant at treating bipolars.

Has anyone else seen or heard of such research?

<{POST_SNAPBACK}>

Really?  Strung Out, have you seen that?

Not when I first read that post. I looked for studies, but then got distracted and forgot about it. Sorry.

Here's a study linked at remedyfind where it was good for long-term managment of bipolar depression.

And here is a link to a page about the 6th International Conference on Bipolar Disorder; one of the presentations was about a recently launched study comparing adjunctive Lamictal to adjunctive antidepressants.

And A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. from 1999. There was no "antidepressant + lamotrigine" group.

Here is a report on a study comparing Lamictal and Lamictal + antidepressants that found the combination to be effective for depression in Bipolar I. I'm surprised at how few hits the lead investigator's name got.

cj, could you ask your doctor where he read that and when?

  The last time I looked all the research had Lamictal working best as an add-on for depression.  But all the anecdotal evidence (i.e. the experiences of actual people) was following what you posted - depending on the nature of the bipolar 2, Lamictal often is better alone.  For classic bipolar 1 you really don't want an antidepressant in the mix anyway. 

I'd certainly go along with what your doctor is reporting.

<{POST_SNAPBACK}>

It's probably here. I haven't been searching that long.

Edited for clarity.

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I would love to hear everyone's "anecdotal evidence" regarding their mood experiences with and without an AD added to Lamictal

I started Lamictal and Prozac at the same time.  For the first few weeks I was just mildly depressed.  At least mild for me.  About a week after I bumped the Lamictal to 50mg and the Prozac to 20mg, I started cycling every couple of days.  Anxiety was heightened and I started having anxiety attacks, which very rarely happened before.  Been in the same pattern since.  About three weeks now.  I am hoping once I get to the theraputic dose of Lamictal and stop taking the Prozac, I will even out.

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I take Lamictal with 2 ADs: Effexor XR and Zoloft. I only take 100mg of Lamictal, however, so maybe if I took a higher dose of Lamictal I wouldn't need the ADs. I'm not going to screw with it, though, because 95% of the time it works- and that's the highest percentage I've ever achieved.

I am bipolar II which presents mainly as depression. I rarely get hypomanic and when I do I just get anxious & irritable- only very rarely do I have a stay-up-all-night-and-paint the-living-room phase.

And that's my anecdote...

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Hi All,

Newbie here. This is my very first post here even though I've been a member for a while, mostly due to my social phobia. Any way, just wanted to add my 2 cents here.

For many years, at least the last 3 or 4, I felt that I was dysthimic after doing some research on the subject, Up until about a year and a half when I had a major depressive melt down for no good reseason at ALL! I finally went to see the Pdoc and she said that I was clinicly depressed and started me on Effexor. All the up to 225mg before I returned from the deepest depths of HELL! But on a scale of 1 to 10, Iwas only at about a 6.5; we played around with some other meds to try an get me a better rating. Didn"t have any luck until she added Lamictal. When I reached  the 50mg mark, I was feeling pretty good, now i'm up to 150mg but still only about 7.5-8. being that i was doing so well she decided to wein me off the effexor. BOY was that a MIS QUE. When I got down to 75mg, my irritability and anger and rage came back sump'n feirce. So we went back up on the effexor (225mg). After a couple of weeks i was back to a 7.5 and after telling the Pdoc about what had happened (Iwont borther with the details) she used the word manic for the first time, which made me belive that she was changing my dx to Bipolar II. At this she adds Abilify 10mg and after a few weeks I'm feeling like a 9-9.5!!! I don't know wether or not I'm MDD or Bp II, but this is what I am currently taking and it works for me!

Effexor = 225mg

Lamictal = 150mg

Abilify = 10mg

Oh I'm also OCPD, GAD, and Social Phobic

Thanks for letting me rant.

Hope this helps,

Ska-Tay

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...after a few weeks I'm feeling like a 9-9.5!!! I don't know wether or not I'm MDD or Bp II, but this is what I am currently taking and it works for me!

Effexor = 225mg

Lamictal = 150mg

Abilify = 10mg

Oh I'm also OCPD, GAD, and Social Phobic

Thanks for letting me rant.

Hope this helps,

Ska-Tay

<{POST_SNAPBACK}>

Hello. Welcome.

Not a rant at all. Really glad to hear that you are doing so well!

Todd.

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Thanks everybody for your help.  Jerod and Strungoutonlife are especially amazing. I LOVE this site.  Sorry it took me a while to respond.  I have been unable to drag myself out of bed because I can barely stay awake more than a few hours at a time.    I thought adding a new anti-depressant would help perk me up, as long as I didn't go back to hypomania.  (I am currently taking protriptyline, Lexapro for ADs, and Prazosin, temazepam, and Lamictal. I have been on at least 35 different medications for bipolar disorder in the last  15 years.) Instead, she told me about the study and told me to increase my Lamictal.

I have an appointment with her next week and I will certainly ask her for the reference for her research.  Or maybe I just misunderstood what she said. (cognitive challenges

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sorry to be disappointing, but I asked my psychiatrist yesterday where she had read about the Lamictal solo, being better for bipolar II, than Lamictal plus an antidepressant. she said she read it in a summary of journal articles about two weeks ago, but she didn't remember the exact source. (sigh)  she did say there was a huge ongoing debate in the psychiatric community about this topic, and more recently the Lamictal alone seems to be winning.

let me troll the Web, and see what type of journals summaries are typically read by psychiatrists, and backtrack from there.

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I had my Lamictal dose increased to 300mg several weeks ago because 200mg wasn't doing the job. I started taking Abilify again as well but only at 2.5mg/day since I had side effects at higher doses. Also, my doctor added 100mg of Luvox because I have bad OCD with the bipolar. So, I'm on the following med cocktail now:

Lamictal 200mg night, 100mg morning

Luvox 100mg night

Abilify 2.5mg night

My ultradian cycling now seems to be getting somewhat better since these changes were made. My obsessive thinking has improved some as well. I'd rate my overall mood as content for the last week, but something really bad happened this morning. However, I handled it better than I would have before this change in my cocktail was made.

Any other experiences with a cocktail (Lamictal + SSRI + low-dose AP) like that?

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sorry to be disappointing, but I asked my psychiatrist yesterday where she had read about the Lamictal solo, being better for bipolar II, than Lamictal plus an antidepressant. she said she read it in a summary of journal articles about two weeks ago, but she didn't remember the exact source. (sigh)  she did say there was a huge ongoing debate in the psychiatric community about this topic, and more recently the Lamictal alone seems to be winning.

let me troll the Web, and see what type of journals summaries are typically read by psychiatrists, and backtrack from there.

<{POST_SNAPBACK}>

Here's the American Journal of Psychiatry and the Journals of American Psychiatric Publishing, Inc, if that helps.

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Guess what? Everybody was right.  Maybe.

Quick summary:

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. So a study is now being conducted to specifically test whether or not an antidepressant should be added to Lamictal in the long-term management of bipolar disorder.

More details:

There are two articles reviewing recent research, concluding that antidepressants DO help bipolar disorder, without potentiating manic episodes.  However, it is not clear exactly which mood stabilizers, were used in the summarized results.

Article 1: Am J Psychiatry 162:1546-1547, August 2005

Antidepressants for bipolar disorder

Article 2: Am J Psychiatry 161:1537-1547, September 2004

Antidepressants for bipolar depression: a systematic review of randomized, controlled trials

A third paper completely disagrees with the use of antidepressants in bipolar disorder. Their argument is that the studies cited above, did not look at long-term outcomes. These authors point out that bipolar illness is chronic, and needs to be measured at at least one to two years duration.  They show at least six studies where antidepressant exposure DOES makes bipolar illness worse.  (Again, it is not clear which mood stabilizers ended up in the meta-analysis):

Am J Psychiatry 162:1546, August 2005

Antidepressants for bipolar depression

Finally, just when it was getting really muddy, all of the researchers agreed that the current studies are inconclusive. So, there is a study underway now to at least answer the question more specifically using a trial of Lamictal alone, vs. adding an antidepressant.

Am J Psychiatry 162:1547-1548, August 2005

Dr. Gijsman and Colleagues Reply

It looks like they are still recruiting subjects for this experiment. Right now participation is limited to patients in Oxford, but they say it will expand and

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My updates/corrections based on further reading:

Everybody was right.  Maybe.
Still true.

So a study is now being conducted to specifically test whether or not an antidepressant should be added to Lamictal in the long-term management of bipolar disorder.

It is unclear whether there is any research currently underway to study this specific question.

There are two articles reviewing recent research, concluding that antidepressants DO help bipolar disorder, without potentiating manic episodes.  However, it is not clear exactly which mood stabilizers, were used in the summarized results.
For what it is worth, the first two articles I cite were written by the "top" research experts in affective disorders. Goodwin wrote the most comprehensive book on bipolar illness and is the senior author of the American Psychiatric Association's guidelines on treatment.

A third paper completely disagrees with the use of antidepressants in bipolar disorder. Their argument is that the studies cited above, did not look at long-term outcomes.

This is still a valid argument (my opinion).

Finally, just when it was getting really muddy, all of the researchers agreed that the current studies are inconclusive.
"All" of the researchers did not necessarily agree that current studies are inconclusive. it is unclear who agrees with what. The dates on the most recent articles are August, 2005, so I expect additional opinions will be coming out soon.

So, there is a study underway now to at least answer the question more specifically using a trial of Lamictal alone, vs. adding an antidepressant.

The abstract for this study was very misleading.  At least according to the protocol on its web site, the Oxford study is looking at two separate groups: one group on Lamictal and another on an antidepressant.  There are numerous research design problems with the way it appears to be structured.  It is not double-blind, antipsychotics can be added to the mix, the doctors treating the patients can decide which medication would be better for which subject, etc. So I think we'll have to wait and see if the design is updated, or if new studies are better able to answer the question.

Sorry for this rather geeky answer and the length of time it took me to write about it.  And of course all the above is just my opinion, which might be totally wrong.  My brain is not at its finest.

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I was on Prozac (80 mg) when I first was diagnosed as BPII instead Depression and started Lamictal.  After about three months on Lamictal I titrated off of the Prozac.  It made such a positive difference that a friend that keeps an eye out for the level of my depression asked me what I was doing differently because I was so much more stable.

However this was after I'd been on Prozac for about 5 years and it had stopped working.  I don't know if taking Lamictal first and then adding Prozac would have had a different effect.  However, I like having a labido so I will never go back on Prozac anyway.

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