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Lamictal still no controlling depression


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I'm at 250 mg. of Lamictal and am still having bouts of depression.  Not the can't get out of bed depression, but the extreme sensitivity, tears, negative stuff.

Has it been your experience that it is better to increase Lamictal or to add an A/D? I've not taken SSRIs successfully in the past, but have never tried one with an A/C.

I'll ask my pdoc, of course, when I see her, but that's almost a month from now and I'm trying to gather some ideas.

Thanks, everyone.

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I'm at 250 mg. of Lamictal and am still having bouts of depression.  Not the can't get out of bed depression, but the extreme sensitivity, tears, negative stuff.

Has it been your experience that it is better to increase Lamictal or to add an A/D? I've not taken SSRIs successfully in the past, but have never tried one with an A/C.

<{POST_SNAPBACK}>

Are you bipolar? Or some other reason not to take an AD directly?

Since it has helped so far, increasing the Lamictal might be a good answer. Adding an AD could be helpful if you're not worried about becoming manic. Since you haven't had good experience with SSRIs maybe you could try something else? Effexor? Wellbutrin? Or even a tricyclic like nortriptyline or amitriptyline.

I hope things do improve for you over the next month.

Fiona

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Three possibilities:

- Increase lamictal

- Add anohter mood stabilizer, especially Lithium

- add AD's

Most docs are reluctant to add AD's untill theyve tried other things.

Lithium is shown to be even more effective wtih depression than Lamictal.  One advantage to using lithium is that it is not handled by the liver like lamictal and the other stabizers, but by the kidney.

Good luck.

a.m.

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lamictal at 250mg worked well for some time for me and then i got stuck in a nasty mixed state for a while.  we decided to up to 300mg.  being there, it knocked me on my asssssss...so i went down to 275mg and what a lifesaver!

i feel great.

maybe im med sensitive, i dont know. but the extra 25mg REALLY helped me.

tal

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I'm BPII, sorry forgot to say.

I've taken Wellbutrin before, but not with an A/C.  I liked it for its energy and weight-reducing properties, but it was too agtivating then.

I've been on lithium in the past, not in concert with the Lamictal, and had a hard time with it.  The pdoc said it was too harsh for my kidneys.

I took tricyclics years ago before they knew I was BP and of course they didn't work then. 

I've never tried Effexor.

Wonder what is the best way to go with this.  I'd like to do my homework a bit before I get in there for my monthly 15 minutes.

I do have serious anxiety and PTSD so wondered about Lexapro.  Isn't it supposed to be good for anxiety, given with Lamictal?

It would be great not to add another drug....just increase the Lamictal.

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I know this is all-too-obvious, but perhaps you should try a mild, clean SSRI (ex: Lexapro or Fluoxetine) at a low dose with your Lamictal.  I'm on 200mg Lamictal QD and still get those episodes of "fvck life" and crying a few times a month.  And society at large has told me that I'm a defective individual for crying while also possessing a Y chromosome.  I'm also tapering off Cymbalta (60 mg to 30 mg), so that may not be helping.  I might be adding an NRI (ex: Strattera) or mild SSRI (ex: Fluoxetine) at a low dose if the lovely depression comes back hardcore.  Well, as long as it's not suicidal.  That's no fun.

Your other option, as said before, is to increase Lamictal.  Although most people observe max AD effects at 200-250mg and solely mood stabilization therebeyond, it takes up to 400mg for many to experience the whole AD.  Have your lamotrigine plasma level checked to see if your blood is at the right level of Lamictal.  Drug-resistant folks such as myself need one hell of a dose of anything to see any effect; I don't know if you're in this category as well.  I'm getting my lamotrigine plasma level checked tomorrow; and if it's not high enough for my 200mg current dose, I'm going to be seeing a bit of an adjustment (which would be welcomed).

Overall, I'm a bit annoyed that I'm going to be on a GABA-agonist such as Lamictal and little to no serotonin or NE action (pdoc is trying to minimize my dose of even Trazodone).  I might convince her to keep me on a permanent low (20mg Q2D?) dose of Cymbalta just to keep the sanity running.  I've been on the SSRI circuit since 2003, and when I went off of them totally for 3 months, I went utterly berserk with akasthisia, though that may have also been due to the dopamine antagonism caused by the big Z.  I warn you of the same if you've had issues with that.

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Well, duh, I didn't even know there was a test for that.

So herrfous, you think there is some value in the balance of adding something like Trazodone or maybe Provigil.  Those are two drugs I have on hand and I'm not using. I switched to Ambien CR for sleep and only take the Provigil if I wake up tired in the morning.

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hello,

i'm taking lamictal now and was hoping it would satisfy both as a mood stabilizer and AD. it didn't work out that way. so, now i'm back on nortriptyline, but at a low dosage, 25 mg. just being on the lamictal alone made me feel numb and dull. sort of depressed, but functional. but with the nortriptyline, i feel a lot better. hope you find what your looking for. matt

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Well, duh, I didn't even know there was a test for that.

So herrfous, you think there is some value in the balance of adding something like Trazodone or maybe Provigil.  Those are two drugs I have on hand and I'm not using. I switched to Ambien CR for sleep and only take the Provigil if I wake up tired in the morning.

<{POST_SNAPBACK}>

crazyethel-

I'm at a loss for specific suggestions here, since all I know is that you're still getting depressive episodes.  Provigil helps some (Jerod swears by it), and it helped me, though only ancillary to the fact that I was narcoleptic (it's since pretty much cured me and I no longer consider it an active Dx of mine, well so long as I take it semi-regularly!).  Since you said you suffered serious anxiety problems, it doesn't seem like a choice for you.  Your current PRN use is probably just fine, but possibly Provigil is the problem here?

You're right that Lexapro is often recommended for anxiety... in fact, I believe it and Paxil/paroxetine are the only two SSRIs approved for GAD and PanicD.  It might not hurt, since it looks like you've got no serotonin action going on.  Since avolition doesn't seem to be an issue, you might not be so interested in the more activating antidepressants (SSNRI's like Cymbalta tend to be mildly activating, and DRI's like Wellbutrin... extremely activating - that's the point!).

Trazodone often works wonders for sleep.  Maybe your pdoc would like to start you at 50mg before bedtime.  A warning though, for most people (unless you're a drug-resistant freak like me), it kicks in very rapidly and will leave you on the floor if you can't make it to bed in time.  It also has a terrible habit of giving one a bit of a fatiguing hangover (my ex-girlfriend was put on it for chronic insomnia and she couldn't even stand the hangover at 25mg).  Then again, some freaks like me, have taken 150mg, feel the need to sleep within 1-2 hours, and awaken as refreshed as they did before starting the med.

Oh yeah, for sleep, have you considered Lunesta or Rozerem?  Although Ambien CR makes sense (longer molar half-life = less addictive potential and longer action, generally), Lunesta is considered nonaddictive despite hitting the same receptors the benzos do.  Of course, I don't take the stuff, as it leaves my tastebuds feeling like I'd been sucking on a nickel all night (I believe that symptom was reported in up to 30% of all people taking it in clinical trials).  Rozerem is also an interesting fellow, it doesn't hit anything even vaguely GABA-related, only the MT-family receptors, whose endogenous biological ligand... umm, I mean natural activator in the human body, is melatonin.  From what I know, though, Rozerem is more effective at regulating your sleep-wake regularity than it is in knocking you out.

On a semi-OT/miscellany note (and I will NOT officially recommend this to you), after having my sleep break down the past few weeks into pure REM (that's 7-8 hours a night of successive 30 minute REM periods, no stage 3/4 sleep whatsoever, following by waking up and occasionally changing clothes and bedsheets soaked in sweat), I did get significant results with a "nutritional supplement" mixture containing actual GABA as well as a few misc. amino acids. I started last night, taking a moderately high dose (they suggest 2-7 'scoops', and I took 5), and within an hour, I felt quite like the first day I took 150mg Trazodone... as in, more out of it than Howard Dean in the 2004 DNC primaries.  Slept better than my mom did after I gave her DayQuil, telling her it was NyQuil instead.

Come to think of it, I can't actually officially recommend anything to you, given as I'm not a medical professional (though sadly, I generally play that part in most doctors' offices I find myself in).

Where were we again? Wait, was this a sleep-related post or a bipolar depression post? Oh hell.  Now's a good time for cookies, I think. 

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Thanks, herr.  Your post brings up several interesting points.  BTW, your writing vocabulary is pretty impressive. 

Thanks, everyone, for your ideas.

I guess I won't know if an increase in lamictal would bring me better results than my current dose plus an a/d until I try it.  In a perfect world, it would be nice to take just one pill. (Can you even imagine???)

I'm not interested in paxil (took it before and gained tons of weight), but I have friends who take lexapro for anxiety and think it does a good job.

Much to talk to pdoc about.

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Thanks, herr.  Your post brings up several interesting points.  BTW, your writing vocabulary is pretty impressive. 

Thanks, everyone, for your ideas.

I guess I won't know if an increase in lamictal would bring me better results than my current dose plus an a/d until I try it.  In a perfect world, it would be nice to take just one pill. (Can you even imagine???)

I'm not interested in paxil (took it before and gained tons of weight), but I have friends who take lexapro for anxiety and think it does a good job.

Much to talk to pdoc about.

<{POST_SNAPBACK}>

Writin vocabulary? I ain't spent no 4 years 'n fitty thousand dollars on college an' not git dat!  (Believe it or not... if for any God-forsaken reason you happen to meet me... unless I try otherwise, I will speak closer to that than I will how I write... having lived 90% of my life in the deep South and Midwestern US, where speaking otherwise would have gotten me labelled a n*gger [or at very minimum, a sand n*gger, if the ignorant population were sufficiently edumacated].  I'm just used to it as a defense mechanism, and it's now just a habit, and really it gets me labeled as a "good ole' boy" instead of "one 'dem dirty terrist A-rabs".  It was so bad that I got made fun of while in college in Cleveland for sounding like a total hick.  A hick of Indian descent, no less.)

And... HAHAHA... just one pill... I can't imagine that for even the more "physical" disorders out there!! (yes, I do believe that much MI is mostly neurotransmitter/brain malfunction and is helped by both medication AND psychological mindset, just like all other illness... hey your diabetes or heart disease ain't gonna get too much better unless you can eat something besides skillet bread 'n chit'lins 'n lard grits 'n get off yer butt and walk around a bit!).  Oh God, there comes out my living in Georgia and Indiana for most of my life, again.

And yeah, Paxil/paroxetine? Known far and wide for being one of the less "clean" of the SSRIs.  If not the "dirtiest", and by far the nastiest pure SSRI/non NE drug to get off of.  That said, my mom's been on it for almost 2 years (dx'ed MDD/GAD at my encouragement of visiting a tdoc and pdoc, likely Dx BPII in the near future), she's struggled with being overweight, prediabetic, and hypertensive all at once, and Paxil caused her to lose a (per her opinion, though I think she's healthy) much-needed loss of 10 lbs., as she managed to curb her carb and fat intake somewhat since her appetite went major downhill with it.  And she's quite thankful for it.  This despite the fact that my rather normal body weight and low body fat content still makes me prediabetic and hypertensive, at the age of 22!  The woman is impossible to convince, I tell you.  Just like me.  AGH.

P.S.  AirMarshall - Is Lithium really that much more effective against depression than Lamictal?  Despite its risks to me personally (I'm hypothyroid and hypertensive as it is), I'd really like to know more about that.  Especially given... well................. the fact I'm basically a 22 year old recovering alcoholic with potential liver problems.  Let me know if there are any studies I should look at... thanks!

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As far as your clinical options of

1. increasing Lamictal

2. adding another mood stabilizer

3. adding an AD

I had a great pdoc before I got fired. She liked the combo of a rather high dose of Lamictal with a low atypical and a flexible dose of AD. Wellbutrin is the least likely to cause mood issues and makes me feel like I have my innocence back!  ;)

No, really, since I got my new pdoc to go back to this formula I've felt a lot better. I take Lamictal, Abilify, and WB. We're not sure about the AB, it may go or be prn, but for right now in my depressed state we need all teh help we can get.

Lamictal is a wonder drug for some. But sometimes you need high doses, especially if you are a female on hormonal contraception, as it halves the effective dose you are taking. My gyn has me take my pills continuously rather than play with blood levels of Lamictal. This may be worth asking about.

-----melinda the loon--------

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