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ideas for the next AD


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um, no good at keeping a long story short, but here goes. i went off meds (lamotrigine and citalopram) in the fall (for stupid reasons that are hard to remember now, like that the citalopram was making me agitated or something and i didn't think either of the meds were really doing anything to keep me sane - HAH).

i recently (less than two weeks ago) crashed like hell, went to ER because my pdoc is away, got put back on the re-start version of what i was on before (starting at 100mg lamotrigine, 20 mg citalopram) plus 25mg of seroquel for sleep, also clonazepam PRN which i already had been using to poorly manage what seems like some kind of mixed state.

so, i see my real pdoc when he returns friday. last time i saw him he knew i was off meds, didn't want to go back on them, and let me try omega-3. well that worked out spectacularly, so we're back to where we were. and i am feeling pretty desperate in terms of needing to see new options, because i am thoroughly done with going through the same old class of meds with sucky results.

ditching the lamotrigine was a bad, bad idea. it's been the only medication that i know stops me from getting far enough down to be suicidal. but it doesn't make a big enough dent in the depression for me to be really functional, either. so there has to be something else added. whatever, right now i don't care how many meds it takes as long as it freakin works.

in the past, all my "mixed states" or whatever have occured when i was on SSRIs or SNRIs, so i was sure that it was always med-induced. this time, it happened in the absence of meds. so i'm thinking maybe the lamotrigine was preventing that from happening as well as helping the depression and i just didn't know it. so i'm pretty sure i'll be hanging on to that one.

the antidepressant is where i'm stuck.

like i said earlier, the SSRI class is just a miserable failure with awful side effects every time. the only combination i've ever taken that worked like a charm was lamotrigine and the original GSK wellbutrin XL together - and that's no longer possible, as the other manufacturer's version is unfortunately not the same at ALL for me.

i know WB is supposed to be activating and stuff but for me it was the opposite - i had almost no anxiety ever, just a mood lift and actual motivation without feeling agitated for once.

so if you were me, where would you look next? i know there are other classes of ADs left. my preference would be for one that also helps with neuropathic pain, since i have issues with that too, and i know there are drugs that work for both. i tried reading up on them, and honestly, i need a dumber version of my options because i'm too depressed to make sense of it (how embarrassing is that).

thanks if you read all that, and have any ideas or experience to share. i know there are people out there that have tried even more meds than i have before something worked. anyone who wants to share their happy ending med story and give me some hope here, i'd really appreciate that too. i really need some.

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citalopram put me into mixed states too. Id get really irritable depending on the dose. If it was very low or high Id be ok. 20mg is right about where I had issues.

You could try a lower or higher dose and see if it helps. For me a lower dose did nothing and a higher dose made me apathetic. Or you could try some other SSRI or raise lamictal.

If wellbutrin worked, you could try different manufacturers of XL generic, or try the SR version. I didnt have a very different reaction to name brand versus generic.. maybe a tiny bit more effect with less side effect. What I do experience with wellbutrin every time I try it is that it poops out on me in no time flat.

I was on desipramine for awhile, its an old TCA NRI. It seemed to do a lot of what wellbutrin did without the anxiety. You might give that a shot.

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Hi. Sorry you are in a sucky place and that the no meds trial didn't work. Wouldn't that have been sweet. Sigh.

Lamictal and Lithium works wonderfully for me. With a little Risperdal, I was totally depression free this winter. I have to go back to childhood to remember that happening. Talk to your doc. Lithium isn't a scary drug if it is properly managed.

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The other AD's are SNRI's which you say you've tried, and TCA's. However, you may need to consider not taking a standard AD since it triggered a mixed state. I would agree that Lamictal probably provided help in this area.

As for the depression, Abilify tends to help as well as Lithium (however that med can cause Thyroid problems, so that may result in not being able to take it). As for neuropathic pain, Neurontin is often used.

These are just ideas that you can bring up at your appointment. It is up to your pdoc as to the direction you should go.

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thanks creepy.

i've tried every dose from 10-50 of the citalopram, it's not a keeper.

i've gone up as high as 250 of the lamotrigine and didn't notice any extra AD effects past 200, just a lot of cognitive issues, so i think i was back down to 200 or 225 when i quit.

i've also tried every combination and dose of the generic WB XL and SR to no avail.

and i think six SSRIs plus effexor.

desipramine, however, i have never tried, and will write down on my list of "ask pdoc about this"...

Stacia i am so glad to hear you have had a depression free winter - that is so awesome.

i'm scared of lithium because i dread the maintenance involved, but i'll also put that on my "ask pdoc" list. who knows, it might force me to pay better attention to my physical well-being.

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thanks Cetkat - i've never tried Abilify, or Neurotonin, so those are going on the list, too. my thyroid is already fried (radioactive iodine),and that's something i wasn't thinking about with the lithium, thanks.

i'm also seeing a neurologist tomorrow for a nerve conduction test, i'll ask questions there too if i can manage to keep any wits about me.

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You could also try more Seroquel - I don't know if the potential for weight gain is a dealbreaker for you. I tend to lean towards the more sedating meds because SSRIs and co give me terrible agitation along with my depression, and it seems like you have some of the same.

Valproic acid is so far being okay to me also.

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thanks tryp - really glad to hear the valproic acid is so far so good.

seroquel has helped me get out of this horrible mixed crap many times before, but i never thought about if it helps my depression. actually i think it's the med that's kicking down my racing thoughts right now, as i feel SO MUCH better after i take it (but then go to bed an hour later). maybe a decent dose if it would work on the depression too. i'd have to learn to deal with the weight thing like it or not i suppose. better alive than thin i guess.

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Dont know if it would work for you, or if you've already tried it, but I am a big fan of Remeron. It is the only antidepressant that has worked for me other than Wellbutrin XL. Like you, I have had absolutely no luck with SSRIs, they make me climb the walls with anxiety.

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thanks Moody. unfortunately remeron didn't go well either... no agitation, but massive lethargy and some anxiety. and no help with the depression. i'm really glad it works for you though!

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thank god for reminder calls... the appointment is this afternoon, not friday...

i want to add one more to the "ask" list... strattera. i'm looking for something as close to the old wellbutrin as i can get, and strattera is an NRI if i'm understanding right? i know it's not first-line for depression/BP, but i'm wondering if anyone has had success with it. i don't want to take something that pushes my anxiety through the roof, but wellbutrin was supposed to do that and worked the other way around. anyone have any good/bad experiences with strattera plus an AC?

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strattera might work out, certainly worth a try.

wellbutrin always made me anxious but some people with anxiety respond paradoxically and do well on it. Its weird like that.

The only thing you can do if wellbutrin was promising, is investigate NRIs, and then stimulants (which dont last you become tolerant) and DRI's like methylphenidate and then dopamine agonists like mirapex, etc. I did so well on wellbutrin that I asked my doc about this but she refused.. Im guessing she wasnt familiar using with them on other patients. Heck, she took me off desipramine and it was working! Im imagining the reason was the same, no experience with it.

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that sucks that you got taken off a drug that was working!

i'm keeping all these ideas on board. i saw pdoc today, and we decided getting the agitation under control was first priority before fooling around with something new... so i'll be throwing the citalopram away (yay), and taking more lamotrigine, seroquel, and clonazepam. after a week of that, we're going to review.

thanks everyone for your help... pdoc really is interested in my suggestions, and your knowledge/experience helps so much.

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i thought i should come back and update the saga if for no other reason than i'll forget why we made the med changes we did, and i'll find this post someday and go "oh yeah, duh".

we talked about med options for a long time and pdoc left LOTS AND LOTS of options open to me. that makes me happy that he really wants me to be that involved in my treatment. however, it was also confusing as hell.

it came down to either a TCA or strattera. he was pretty sure the strattera would work for me, but concerned that it may poop out pretty quickly, and that maybe my insurance won't pay for it since i don't have ADHD.

so we went with imipramine. started at 25 and will have increased to 75 by the end of the week. increased the lamotrigine again as planned, kept the clonazepam on board, and 50mg seroquel at night for sleep.

i wish i knew how long it would take before i know if this is going to work (or make things worse, god forbid)! this is my first TCA... i'm a little nervous.

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thanks Kodos (i love that name btw). i did give both versions of the generics a try, played with all kinds of dosing options with them, and no luck. for some people, the generic just does NOT work, and unfortunately i'm one of them :(

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thanks mcj and chimp,

i can't remember every med i've been on this morning... i've tried at least prozac, paxil, zoloft, effexor, remeron, celexa, wellbutrin... there's a few more in there but it was so long ago. prozac and paxil made me behave (in retrospect) like i was hypomanic then completely quit working. effexor made me incredibly sick for years and still wasn't all that great - just didn't poop out as fast as the others did. others totally sedated me. GSK wellbutrin was great while it lasted.

i've been on doxepin for TMJ pain, didn't work for pain nor depression, trazadone for sleep which works in the short term but no AD effect. tried lyrica, got a rash but it was doing something. tried seroquel, zyprexa, risperdal, all great for agitation but no AD effect (and hormonal issues on risperdal).

i'm up to 150 mg of lamotrigine and 75mg of imipramine now. no AD effect yet. agitation is coming down slowly, could be the AC or the seroquel i'm taking for sleep.

seeing pdoc today... i suspect we'll just do another bump up on the AC and the AD.

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