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I saw my pdoc yesterday and just NEED to rant a bit.  Sure, I'm a little edgy, because I just reduced my tegretol, which is an effective bump in lamictal, but I need to vent.

I've been at 200 lamictal, 400 tegretol and 450 wellbutrin for a month.  I really really want to get off the tegretol, because it did nothing but make me sleep and drove me into a crushing depression last summer (despite the 450 wellbutrin) that didn't get better until started taking lamictal.  Even 25 mg of lamictal made life a teensy bit more possible than tegretol/AD therapy. 

The past month has been really good.  Still foggy, but my mood has been level, and I've been able to work, sometimes for long hours.  The depression is gone, no mania.  Just a touch of cycling of energy levels, never hitting a real mood, but still there.  I think the tegretol is still dragging me down, and that I need a tiny bit more lamictal to level out the bumps.  So I asked the pdoc if I could drop the tegretol.  I meant to ask if I could raise the lamictal a touch at the same time, but forgot to because when I asked to taper further off the tegretol he became very very resistant. ;) I spent about 5 minutes talking him into letting me drop it to 200 a day.  For some crazy reason he thinks tegretol prevents depression.  But it dropped me like a bomb last summer!

I know I'm overreacting, but I really think he doesn't know much about lamictal.  He's admitted he doesn't use it that much, that his office partner is the lamictal guru.  He doesn't seem to like the idea of lamictal monotherapy; he insists that I will be taking wellbutrin forever, too.  Sure, if I need a cocktail, I'll use a cocktail.  I don't mind the wellbutrin, if it's helping.  But all tegretol has done for me is screw me up. :)

Sigh.  Does anyone have a link to any of those studies touting lamictal monotherapy?  I figure I'll just email it to him before my next appointment, along with some choice exerpts from the PI sheet.

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hi NARS,

i don't have any links but i just wanted to slip in an opinion that your pdoc is wrong and quite peculiar. my pdoc for example won't let me anywhere near an antidepressant--. i was on lamictal monotherapy for a good while--and it was a most excellent time. i still look fondly back on those days. my pdoc takes a very conservative approach--minimal dosages and minimal numbers of meds.

7

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Thanks for the feedback.  After another (very restful, thank you) night's sleep, I think I was just irritable in general yesterday.  After all, I did stop my morning dose of tegretol, so by afternoon I was feeling the initial weirdness of the med change.  Today I'm much, much better.

Anyhow, I do think he's a little inexperienced with lamictal and overcautious about tegretol, but in the past he's proved to be trainable if I come up with studies and articles.  I do so much research and am so proactive (and polite) that I often end up educating my doctors a bit. 

I'd love to be able to make all the changes right now, but there are a lot of reasons to take my time.  First of all, I really am doing quite well on the current regime so anything more is gravy.  And I've got a very busy fall hearing schedule so I don't want any wild side-effect ride.  And when I see him in 6 weeks, I'll have a better feel for whether my seasonal shift requires that I need a boost in something.

So I'll sit down, shut up, and wait for the new dosages to settle down.  My pdoc's conservatism is part of why I do well with him--he calms my impulsivity.  It'll work out.  It's not like he's taken away my beloved lamictal or anything.

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