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Lamictal, Refractory Depression/BPII, & Hair Loss


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Hi. This is my 1st time posting.

I've been dealing with lifelong depression -- yes, truly as far back as I can remember; it's not normal for a 4 yr old to be obsessing about death, is it? ;) Refractory, somewhat leaning toward BPII. Been on everything, and a lot of combos. Was even a patient in one of the 1st Venlafaxine (Effexor) studies in the early 90s. For a few years it worked well (had to take 450 mg. day). Then it pooped out.

Earlier this year, I titrated off Effexor and on to Cymbalta. Nothing. Might as well have been water. Since I think late Aug/early Sept, I've been titrating off Cymbalta and on to Lamictal. Fortunately, I have a wonderful internist. He's also been very conservative, only upping it 12.5 mg. at a time. (Going to ask him Friday if we can go to 25 mg. increase.) I'm now on 100 mg, and I think as of this week I can finally say I am over the KILLER headaches and muscle pain. (thank god!!!) Still no antidepressant effect, but I don't expect that yet.

Reading the messages at this site has given me encouragement and hope to hang on with this process. I do have a couple questions I haven't seen answered yet here, for those of you who have longer experience dealing with Lamictal (sorry about the long ramp-up to get to these!):

1. Anyone out there with my particular "flavor" of depression (very treatment-resistant, with some thought towards it being BPII) who's had experience with Lamictal? Has it been successful? What dose did you need for it to work? Did it stay effective at that level, or did you need to increase it? Given my background, I'm wondering if it's likely I'm going to need a super high dose -- I know no one can tell me this, and it's obviously going to be trial and error. On the other hand, maybe someone in my situation, similar condition, might have some light to shed. (I'm getting antsy and am probably particularly sensitive to this possibility -- that I'm going to need a high dose and it'll take a long time for me to get there -- because my finances are in such rotten shape and I desparately need to be able to make a living, which is not really possible now in my current state.)

2. Does the hair loss stop? Does it grow back? I've seen many times people mentioning the other side effects do stop when you hit a therapeutic level, but I've seen no mention about the hair loss. 

Thanks for bearing with this lengthy message.

Susan

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Anyone out there with my particular "flavor" of depression (very treatment-resistant, with some thought towards it being BPII) who's had experience with Lamictal?

<{POST_SNAPBACK}>

I was that flavor, but that was so last year (for me). Now, I just play for the Bipolar (NOS) team.

Has it been successful?

<{POST_SNAPBACK}>

Yes, but not by itself. The Lamictal mostly knocks out the depression component of my flavor of Bipolar, but I need add-ons to make the whole package work.

What dose did you need for it to work?

<{POST_SNAPBACK}>

I slowly titrated up to 200mg. I went up to 225mg. Better. I went up to 250mg. Not better. I went back down to 225mg. Better.

Butter.

Did it stay effective at that level, or did you need to increase it?

<{POST_SNAPBACK}>

So far, so good, with no increases once the correct dose was established. Lamictal and I are coming up on our one year anniversary, for which I think paper is the proper gift. I am thinking of going with a paper prescription and paying with cash. Not sure what Lamictal is thinking.

As you noted, this is me. It will so very likely be different for you. I have not had any hair loss problems that I have noticed, so I cannot really comment on that.

Todd.

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Heya,

hahaha, I like that, Todd, happy anniversary.

I'm on the NOS team too.  Apparently since grade 6.  As I just finished grade 24, that's a long membership.

Revlow:  SSRIs were also like water for me.  So far (3 months) Lamictal is helping.  I'm hoping to try a higher dose though.  And thinking of augmenting with Wellbutrin.

Good luck.  I also don't know much about the hair loss.  Most med-related hair loss is temporary as your hormones adjust to the meds, but YMMV (your mileage may vary.  Guess I should say kilometrage.  But mileage sounds better.).

--ncc--

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1. Anyone out there with my particular "flavor" of depression (very treatment-resistant, with some thought towards it being BPII) who's had experience with Lamictal? Has it been successful? What dose did you need for it to work? Did it stay effective at that level, or did you need to increase it?

I have the treatment-resistant depression, no BP of any variety, and Lamictal has been good for me. I'm on 300mg/day, and have been there for a long time. The effectiveness doesn't seem to have dropped off any.

2. Does the hair loss stop? Does it grow back?

<{POST_SNAPBACK}>

I didn't have any hair loss from Lamictal. However, whenever you start losing hair it's a good idea to have your thyroid checked and a thyroid imbalance can also contribute to a number of mental health issues.

Fiona

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Thanks to you all for the feedback. I guess I too play for the NOS team. I kind of see it as a continuum, and I'm probably somewhere on the spectrum. Even if that particular place on the spectrum hasn't quite yet been identified. So "atypical, refractory depression" or BPII, or somewhere in between -- or even elsewhere -- who cares? So long as I can get something that helps.

Thanks again!

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Another newbie to Lamictal here, as of 3 days ago.

25mg for 3 days so far and no side effects I can think of... does seem to accentuate the benzo high from Klonopin, though, and I am not complaining. Reasonable improvement in depressive phase of BPII already (could be placebo effect, though).  Titrating to 50mg next week and 75mg the week after.  And then to 100mg for 3 weeks, and then maintenance at 200mg.  So far, none of the popular side effects, especially headaches and body aches.  Really hoping I avoid The Rash .  Hopefully it all goes well, in theory it should since I have such a high tolerance to the head meds (it generally takes the highest dose for my scanty 130 lb. self before anything starts working and/or any major side effects appear.  Same with the head med known as 40% w/v ethanol. ;-)).

Also, the department I used to work in has expressed interest in helping me launch an internal case of grievous professional faculty misconduct against my previous boss.  This also makes me feel better.  ;)

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revlow -

Alcohol is classified as a depressant officially, but that's only because that's the closest category it goes into.  It's most popularly known for its GABA receptor agonism (which is why benzos are useful for treating its withdrawal), but it's also got a moderate effect as a dopamine agonist (part of the reason it shouldn't be taken in high doses with buproprion/Wellbutrin, at the risk of having seizures.)

That's why alcohol can cause a range of emotions from apathy, depression, giddiness, anxiety, anger, and sometimes pure psychosis (once had a roommate who'd get that way despite having no other visible MI!).  Ever try to convince a friend that he in fact, wasn't a pomegranate?? This all depends on your personal brain chemistry, the environment you're in, the rate of alcohol consumption/other metabolic factors, the phase of the moon, the alignment of the rings around Uranus, and the current ranking of Duke University on the BCS.  For me personally, the alkie tends to dull away the constant emotional torment from the voices in my head (well, thoughts, not literally voices!) and lift the spirits (no pun intended) a little.

In case you're wondering, I don't drink on a daily basis or anything.  I do tend to binge on extremely stressful occasions (like the past couple of weeks, when I've done it a few times).  My naturally high tolerance makes the binges that much larger.  Maybe I should work on that part (or have emergency PRN benzos on hand - same effect but safer on the liver!).  It's odd, since otherwise I have a very normal relationship with my two-carbon hydroxyl friend... A glass or two of wine with dinner has (so far) never sent me into a bender the following night, and I've gone whole months without even touching the stuff (such as during an MS attack, which is when I found out, the hard way, that a single alcoholic beverage would leave me passed out on the floor... no fun.)

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herrfous:

My apologies. I knew it was a "Mom" thing to say. You obviously know much more about it on a chemical level than I, and of course you know what works for you.

Not directed toward you, but my concern with us MI folks is that it is soooooo easy to self-medicate with it to the point where it in itself becomes yet another problem -- yeah, like we need more, eh?

Ever try to convince a friend that he in fact, wasn't a pomegranate??

<{POST_SNAPBACK}>

Gosh, no! LOL.
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revlow -

Don't worry, no hate mail... hehehe.  Well unless you personally verbally abuse me, accuse me of fabricating my resume, accuse me of bribing my references to say nice things, and compare me to a high schooler in terms of lab skills, and then fire me with much prejudice (more details on that upon request!).  I'm an easy-going, nice and sweet guy and I don't stick it to people unless they really, really deserve it.  And then I stick it to them so hard that I've pierced their sternum as well as the space between the T3 and T4 vertebrae.  And such people also tend to be stuck to the wall with the same long rapier, until they bleed into a slow, horrible death in absolute writhing agony.  Then I start turning the rapier so that every internal organ gets hemorrhaged in the most painful way you could imagine.  Then after the person finally dies days later, I sell their organs as commodity offal for livestock feed.  And I laugh, and so does everybody else within sight.  hehehehhe.

But yeah really, us MIs tend to self-medicate too often.  I thank God that in addition to having an addictive personality, I also have an extreme desire for self-control, which balances out the former.  Once I realize "no alcohol, bad, bad!!!!" it immediately stops.  Especially if I can convince myself it'll somehow make me less attractive to the opposite sex.  I think if I were female, I'd probably be anorexic (but as a male, I'm more of a compulsive exerciser). 

And lastly, I am not offended by your "mom" attitude.  I don't know how old you are (I'm 22, for reference), but my own mother (who's 42) will never find out that I enjoy drinking (i.e., getting plastered) when stressed.  Her

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herrfous...

LOL! All I can say is you're hysterical...and I mean that in the good way!

<{POST_SNAPBACK}>

In addition to being hysterical, I'm also cute as a button.  And very drunk at this particular time.  I'm-a go sleep now okie? byebye... hehehehehe

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Hi, to all...

Here's an update. First of all, I'd especially like to thank Fiona for mentioning:

I didn't have any hair loss from Lamictal. However, whenever you start losing hair it's a good idea to have your thyroid checked and a thyroid imbalance can also contribute to a number of mental health issues.

<{POST_SNAPBACK}>

I can second that! I have hypothyroidism; however, I don't think it's causing my hair loss at the moment (I get my thyroid checked on a regular basis, and have been successfully treated for years). But, Fiona is right...it is important to mention whenever hair loss is an issue, as well as for MI issues in general.

At another thread, NARS mentioned zinc and aimees said her pdoc recommended a multivitamin. Which all got me thinking re: what I'd read over the years about vitamin deficiencies and hair loss, particularly in some of the old Adelle Davis books. Unfortunately, I can't just look it up in one of my copies. A few years back, 4 teenagers broke in to my house, set a match and burned it to the ground -- including 1000s of books. (Yup, and I was already depressed!) So, I've been searching online to see what I can find.

For whatever it's worth, I did find this list. I don't vouch for it (it was at a forum about raw food diets), but it doesn't seem unreasonable either:

-----------------------------------------------------------------------------------------------

B-Vitamins

B vitamins are important for the health and growth of the hair. Foods rich in B vitamins include beans, peas, carrots, cauliflower, soy beans, nutritional yeast, bran, nuts and eggs. Take a vitamin B-complex and supplement it with the following additional B-vitamins for best results.

Vitamin B3 (niacin) - 50 mg 3 times daily.

Pantothenic acid (vitamin B5) -100 mg 3 times daily.

Pyridoxine (vitamin B6) -50 mg 3 times daily.

Biotin - Dosage: 50 mg 3 times daily.

Biotin is very important for hair health. It is needed for healthy hair and skin, and may even prevent hair loss in some men. Eat plenty of foods high in biotin and/ or take it in supplemental form. Good food sources of biotin include brewer's yeast, brown rice, bulgur, green peas, lentils, oats, soybeans, sunflower seeds, and walnuts. You can also use hair care products containing biotin.

Inositol - Dosage: 100 mg twice daily.

Inositol is vital for hair growth.

Vitamin C - Dosage: 3,000-10,000 mg daily.

Vitamin C aids in improving scalp circulation. It is important to maintain capillaries that carry blood to the follicles.

Vitamin E - Dosage: Start with 400 IU daily and slowly increase to 800-1,000 IU daily.

Vitamin E increases oxygen uptake, which improves circulation to the scalp. It improves health and growth of hair. Since hair health is tied to the immune health, vitamin E is believed to stimulate hair growth by enhancing the immune function.

Zinc - Dosage: 50-100 mg daily. Do not exceed this amount.

Zinc stimulates hair growth by enhancing immune function.

Other Nutrients That May Help Hair Health

Coenzyme Q10

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I really need to start on a B12+B-complex soon.  Might help my generalized alopecia that I've had since starting Paxil 2 years ago (by generalized I mean not in an androgenetic pattern and not patchy, either.  I mean everywhere, including occasional loss of bodily hair).  Also would help counter one of the effects of my other meds (13.5g 40% v/v ethanol PRN), hehe.

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revlow - My hairdresser told me about taking Biotin & Zinc when I was taking Topamax.  But I didn't have anymore than the normal hairloss with that.  It wasn't until Lamictal that I really noticed a difference.  I have been taking it for about 2 months now.  My sister takes Biotin for her hairloss due to birth control pills and it's working for her, but she has been taking it longer.

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