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Hi,

I have chronic/recurrent/treatment-resistant depression (depends on the shrink). I'm currently on four medications. I feel like we just keep adding meds and never take any away. I kind of feel overmedicated (sluggish, tired), and also philosophically opposed to so many drugs. I have a full time job and manage all expectations at work and home, though I tend to "break down" every 18-24 months. I have two questions:

1) Has anyone ever been on this combo: lithium, lamictal, effexor, remeron? If so, have you had any problems? If not, any thoughts about any permutation of the four?

2) I have a newish shrink (only 2 months). I have decided I don't like him, and if he's not willing to work with me on reducing my meds, I'm getting another one. Which I might do anyway, since I don't like him. Any tips on the best way to either a) convince the doc to reduce my meds or b) fire a psychiatrist?

Thanks!

Melanie

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That's not a bad combination of meds. I take Lamictal and Lithium too. And if you don't have any problems for 18-24 months, you're doing better than most people!

Just tell your doctor you want to try lowering doses. If he doesn't want to help you do that, get another doctor. I would just say, I need a doctor who can help me lower doses, if you're not willing to do that, I need to find a doctor who can.

Good luck!

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The sluggishness and tiredness could just as easily be caused by your depression, as by your meds. Philosophical opposition to taking meds to treat a biologically based disorder is foolish. The real question is if your meds are working?

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agreed sasha, but do think adjusting could be a good idea. i too also feel sluggish sometimes. i adjusted my meds, now i feel a lot better.

i think when you basically rule out or are not open to changes, that can be a good thing and a bad thing. it's good if you have lots of experience in what your'e dealing with 15 years, and you got you're regimen down to science. but when you're not open to points of view. that can be hard especially for people with thought blocking to begin with. that are basically cognitively flat from their meds. but bipolar people would suggest otherwise.

it seems that you're taking antidepressants, so it could very well be depression as sasha mentioned.

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Quitting a pdoc just because you want to take fewer meds is foolish. Wanting to take fewer meds just to take fewer meds is foolish, too. I've felt that way, though. Then I got other kinds of sick and now take something like 14 meds plus vitamins and a couple supplements. So, bam, perspective for me.

Talk to your doc about the sluggishness. It could be a med or it could be your depression.

If you really can't communicate with your pdoc, that's reason to get a new one. Just wanting fewer meds is not one.

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I agree with the others. You're meds are quite reasonable and work on different things. You're not being overloaded.

If you really are treatment resistant, you should be grateful that you have a combo that actually does work. Many people, including myself, can't find that.

Ultimately I know that you're going to do what you want to do. I hope you change your mind because you really do need to be on some meds to treat your disorder - it's not just going to go away. You're stable because of the meds, not inspite of them. However, if you do go off at least do yourself the favor of noticing when/if you start to slip back down and revisit the idea of staying on these four. It would be in your best interest.

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Lithium and Lamictal together strikes me as possibly redundant, since both are mood stabilizers. Remeron is known for causing sedation, and Lamictal can make you feel drugged. I'm not sure what Lithium feels like.

I don't think four meds is necessarily too many, as long as each one needs to be there. You can try reducing or eliminating each drug one by one to see what it is doing to you. Obviously, if you start having some terrible symptom, you should resume taking that drug. You shouldn't be afraid to make reasonable changes without your doctor's permission. Just keep in mind that it's better to reduce a med slowly rather than stop suddenly. If your doctor scolds you for making a change, or has some passive-aggressive reaction due to being a control freak, then dump him or her. I can't stand pdocs that are control freaks.

Edit: This is only one person's opinion and does not reflect the opinion of a licensed psychiatrist. So follow this advice at your own risk. Sorry if this was not clear.

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Lithium and Lamictal together strikes me as possibly redundant, since both are mood stabilizers. Remeron is known for causing sedation, and Lamictal can make you feel drugged. I'm not sure what Lithium feels like.

I don't think four meds is necessarily too many, as long as each one needs to be there. You can try reducing or eliminating each drug one by one to see what it is doing to you. Obviously, if you start having some terrible symptom, you should resume taking that drug. You shouldn't be afraid to make reasonable changes without your doctor's permission. Just keep in mind that it's better to reduce a med slowly rather than stop suddenly. If your doctor scolds you for making a change, or has some passive-aggressive reaction due to being a control freak, then dump him or her. I can't stand pdocs that are control freaks.

Lithium and lamictal work very differently. They are pretty frequently taken together.

You should indeed be afraid to make changes without your doctor's permission. Not being a doctor, you have really no idea what constitutes a, "reasonable change," without your doctor's input.

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I don't see the point in paying a medical professional for his/her expertise, and then disregarding what is prescribed, or making your own decisions about how to take them. This is dangerous and not a good idea at all.

olga

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If your doctor scolds you for making a change, or has some passive-aggressive reaction due to being a control freak, then dump him or her. I can't stand pdocs that are control freaks.

In other words, you'd have us believe that when a psychiatrist speaks from his professional experience to tell you that you did something stupid, we should label him as a control freak and fire him? Rather than think, hmm, this guy has had eight years of training in medical school and seen hundreds if not thousands of patients, so he probably has a really good idea of how this shit works, has probably seen a lot of patients do exactly what I did, and seen the results?

You would tell us that we should treat our psychiatrists as highly-paid pill pushers, rather than rely on their experience to guide our treatment? Very good.

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Lithium and Lamictal together strikes me as possibly redundant, since both are mood stabilizers. Remeron is known for causing sedation, and Lamictal can make you feel drugged. I'm not sure what Lithium feels like.

Lamictal tends to be the anticonvulsant with the lowest side effect profile. Most don't feel drugged on it to my knowledge.

Lithium and Lamictal are often prescribed together as a depression focused mood stabilizing cocktail for lots of reasons. Adding an AD or two isn't so uncommon, either.

I don't think four meds is necessarily too many, as long as each one needs to be there. You can try reducing or eliminating each drug one by one to see what it is doing to you. Obviously, if you start having some terrible symptom, you should resume taking that drug. You shouldn't be afraid to make reasonable changes without your doctor's permission. Just keep in mind that it's better to reduce a med slowly rather than stop suddenly. If your doctor scolds you for making a change, or has some passive-aggressive reaction due to being a control freak, then dump him or her. I can't stand pdocs that are control freaks.

Sasha, Di, Olga, and Aurochs have pretty much covered what I have to say here.

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My opinion is the Lamictal and Lithium together are possibly, and only possibly, redundant. I would not say that they never make sense together.

And as alienite points out, the patient is the final arbiter of what meds to take, assuming a court has not ordered you to take them. You are free to take or not take the advice of random people on the internet, stuff you hear on TV, fortune cookies, or the voices in your head. I hope you have good judgment in that respect.

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It's your body. Your pdoc can give advice, but it's your choice at the end of the day. If you think that the downsides of 4 meds outweigh the benefits, it is 100% your right to choose another doctor.

Absolutely. But that's very different from messing around with your meds without talking to your doctor about it.

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It's your body. Your pdoc can give advice, but it's your choice at the end of the day. If you think that the downsides of 4 meds outweigh the benefits, it is 100% your right to choose another doctor.

Absolutely. But that's very different from messing around with your meds without talking to your doctor about it.

Well, we definitely agree then. Pdocs can't help if they don't know what a patient is taking.

That being said, I've heard of people switching pdocs for much more insignificant reasons on this site and on other sites.

Switching pdoc's can be a good or awful idea, depending. But changing up your own meds is only ever a bad idea.

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Thanks for all the responses, the feedback, and the perspective. I don't plan on going cold-turkey or anything, but I do plan to talk to my doctor about reducing my meds. And I think I will definitely seek out a new psychiatrist. I'm used to doctors that treat me as an intelligent partner in my care, not in some paternalistic manner like the one I'm currently seeing.

Be well.

Melanie

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