What next?

[buckeye74]

Hello all, 

I’m at a loss so I’m turning to this community for some new perspective. I suffer from generalized anxiety and depression. I have run the gamut of meds including SSRI, SNRI and tricyclics. Most SSRI and SNRIs I could not tolerate due to side effects. I’ve even tried off label uses for meds. I’ve been on Lamictal 200 mg for 2 years now. Initially it was great! I had more energy than I had felt in years! However, it has never helped my anxiety so I’ve tried multiple combos with the Lamictal. Lexapro, effexor, Paxil, Abilify, Pristiq. All had intolerable side effects. My mood has been so down for several months and my anxiety has been through the roof off & on since starting Lamictal. So now I’m beginning to wonder if the Lamictal is even working anymore??? I’m  currently on Lyrica 50mg 3X daily (off label for anxiety) in addition to the 200mg Lamictal. The Lyrica helps a little. It got me out of my depressed mood but I think only because it’s used for pain so I almost get a high. But it really does not help my anxiety. I’ve switched psychiatrists and my new one is not crazy about me being on Lyrica & refuses to jump through the hoops that are required for the preauthorization with the insurance company. So I’d rather not even mess with it since it’s not working all that great anyways. So now I’m back to square one. I’ve had genetic testing done to see which drugs I might tolerate better but there are several on the list that I’ve already tried. My doctor is a DO so he looks at a more holistic approach. He’s had me try a few supplements. But I have a condition called mast cell activation syndrome so I get allergic reaction flare ups and since I’m on so much it’s hard to tell what’s causing it. I’ve discontinued all the supplements for now. I have an appt with my psychiatrist on Weds and I really need to sit down with him and come up with a new game plan. Does anyone have any experience with Lamictal? Did it stop working on you? Did you still suffer with anxiety? Do you think I should cut back on Lamictal to lesson the side effects to other meds or just discontinue all together? Suggestions for different meds? Am I a lost cause????? ?

[jt07]

Hello buckeye74, I wish I could add something that would be helpful, but without knowing your exact cocktails, I really can't say much. As far as Lamictal goes, I found that it has a sweet spot and that if you get too far away from that sweet spot (either higher or lower) then it stops working. You could effectively change your dose if you gained or lost a low of weight recently.Other than that, I've never heard of Lamictal "pooping out" like the SSRIs are known to do. We are not competent to tell you to cut back or discontinue your Lamictal since we are not doctors here. That question should be between you and your doctor.

[thunder]

I have bipolar disorder and am on Lamictal and Zoloft. For me, higher doses of Lamictal have actually helped compensate for the increase in anxiety I experienced when we lowered my zoloft since it was pushing me hypomanic. I went from 200mg to 300mg gradually, which definitely helps. I don't recall really what effect Lamictal had on my anxiety before 200mg. I've also done years of therapy (and am still going to therapy), which helps the anxiety. I don't think meds alone would come close to addressing my anxiety. I really need the combination of meds and therapy to manage. 

[mikl_pls]

Hi there. I personally did have a problem with Lamictal stopping working. I switched to Zonegran and it worked pretty well for a few years, but wound up switching to Trileptal and Topamax. Trileptal helps immensely with my anxiety, and Topamax I think helps with my anxiety a little too and my depression a little as well.

Have you tried an MAOI before? Emsam is generally pdocs' favorite first MAOI to start with because the lowest dose (6 mg patch) doesn't require you to obey the dietary restrictions, but it's still good to do so in case you have to go up to the 9 mg or 12 mg patch. It is a transdermal medicine unlike any of the other antidepressants on the market. The other MAOIs are Nardil, Parnate, and Marplan. One of them for sure may work for you. Maybe you could ask your pdoc about one of them?

[buckeye74]

mikl_pls

I have been on Lamictal 200 mg for 2 years and now I’m wondering if it’s even working for me anymore. I still have depression and I still have anxiety. It really helped for depression in the beginning but has never helped with anxiety. I’ve tried it in combination (at different times) with Effexor, Pristiq, Seroquel, Gabapentin, Lyrica, celexa, Vibryd, Trintellix- all have intolerable side effects. Now I’m wondering if it’s because of the Lamictal interaction. Maybe I should just start coming off of it all together & starting from scratch? 

Thank you for your response! I will have to look at the meds you mentioned. Topomax I tried for migraine prevention but it made me like a zombie & I couldn’t function. I haven’t tried the others.

Edited January 30, 2018 by buckeye74

[buckeye74]

On 1/27/2018 at 3:50 PM, jt07 said:

Hello buckeye74, I wish I could add something that would be helpful, but without knowing your exact cocktails, I really can't say much. As far as Lamictal goes, I found that it has a sweet spot and that if you get too far away from that sweet spot (either higher or lower) then it stops working. You could effectively change your dose if you gained or lost a low of weight recently.Other than that, I've never heard of Lamictal "pooping out" like the SSRIs are known to do. We are not competent to tell you to cut back or discontinue your Lamictal since we are not doctors here. That question should be between you and your doctor.

I am currently on 200 mg of Lamictal and am weaning off of the Lyrica due to it being a nightmare to get it approved through insurance. That’s it. Other than a very low dose (.5 mg)  of Clonazepam for sleep or really bad anxiety. 

I tried going over 200 mg but the side affects were no bueno. I have an appt with my pshychiatrist tomorrow so I’m going to see if Lamictal is worth staying on. 

[mikl_pls]

40 minutes ago, buckeye74 said:

Now I’m wondering if it’s because of the Lamictal interaction. Maybe I should just start coming off of it all together & starting from scratch? 

Thank you for your response! I will have to look at the meds you mentioned. Topomax I tried for migraine prevention but it made me like a zombie & I couldn’t function. I haven’t tried the others.

 

Make sure that if you do this, that you do it under your pdoc's supervision.

If you didn't like Topamax, Zonegran might have similar side effects for you, but personally, I didn't have any side effects from Zonegran. It's just commonly mentioned that Zonegran has similar side effects as Topamax.

Best of luck to you in finding something you can tolerate and that works for you!

[Blahblah]

I've been on Lamictal (100mg) for over a year now. This is my 2nd trial of it, because after running the gamut of everything else, this was the one med that seemed to at least stabilize me and take the edge off with the least side effects.

By itself, I don't feel like it is enough for depression monotherapy. I've been adding different SSRIs, SNRIs, stimulants, A/P's etc without huge improvement to my depression (and more side effect, of course). My anxiety has never been a main issue, but my chronic low-level depression is. I'm also not sure whether the Lamictal is doing alot for me. I currently take Effexor and Ritalin with it, with some improvement (maybe it's just placebo though) I feel for the most part, functioning, OK and stable, but still have pretty bad dips into depression every month, but it has definitely lessened. It's always really tough to know (when you are on a combo of meds) assessing whether they are all effect or if you should drop one....

Anyone else know how to assess which are working, when rotating around with different combos?

Edited January 30, 2018 by Blahblah

[buckeye74]

21 hours ago, Blahblah said:

I've been on Lamictal (100mg) for over a year now. This is my 2nd trial of it, because after running the gamut of everything else, this was the one med that seemed to at least stabilize me and take the edge off with the least side effects.

By itself, I don't feel like it is enough for depression monotherapy. I've been adding different SSRIs, SNRIs, stimulants, A/P's etc without huge improvement to my depression (and more side effect, of course). My anxiety has never been a main issue, but my chronic low-level depression is. I'm also not sure whether the Lamictal is doing alot for me. I currently take Effexor and Ritalin with it, with some improvement (maybe it's just placebo though) I feel for the most part, functioning, OK and stable, but still have pretty bad dips into depression every month, but it has definitely lessened. It's always really tough to know (when you are on a combo of meds) assessing whether they are all effect or if you should drop one....

Anyone else know how to assess which are working, when rotating around with different combos?

I met with my doc today. Since I’m just taking the Lamictal now (I have weaned off the Lyrica) I will start lowering my dose of Lamictal to 150 mg (down from 200) for 4 weeks to see how that goes. After writing down all the issues I have (heart palpitations, feeling heavy in chest, feeling like I can’t breathe, feel like I’m all wound up all the time-so much so that I literally feel like I’m vibrating! Feels like I have a knot in my stomach) I’m starting to think Lamictal is the culprit. I do have depression & the med seemed to work at first but now I’m still having bouts of depression-I think partly it’s circumstances (I’m the caregiver to my 79 year old mother who has cancer) and because I’m so anxious all the time! My doc is a DO so he has recommended some natural supplements (corticare & cortisolv-both are to help with the cortisol levels & fight or flight instinct) and relax max (which has magnesium). I’m also vitamin D deficient and B12 deficient so we are upping those as well. I pray that it helps! I’m so tired of struggling with this! 

[Blahblah]

@buckeye74 Keep us posted here on how the lowering of the Lamictal goes. I'm always afraid with any med that I've been on for over a year, about the withdrawals. i know if you wean slowly, it is somewhat minimized. I haven't heard too much about people here withdrawing from Lamictal - and I wonder if it's very de-stabilising.

Anyhow, let us know how it goes! Magnesium, Vitamin D and B12 should help with your anxiety/stress a bit - especially if you are deficient.

[mikl_pls]

4 hours ago, Blahblah said:

Magnesium, Vitamin D and B12 should help with your anxiety/stress a bit - especially if you are deficient.

I'd just like to add that many people are magnesium and vitamin D deficient, and many people with mental illnesses like MDD and bipolar disorder usually have vitamin B12 deficiencies as well as folic acid deficiencies too (the latter most likely due to inability to metabolize folic acid to L-methylfolate due to genetic mutations in some MTHFR genes). Hope everything goes well for you @buckeye74!

[browri]

250mg-500mg of magnesium citrate per day is definitely a good suggestion for anxiety. It blocks NMDA receptors to reduce glutamate activity which should work synergistically with the lamotrigine. Worth pointing out that lamotrigine does weakly block 5HT₃ receptors which inhibits GABA neurotransmission. This is why some people still feel anxiety on lamotrigine even when other things have leveled out.

Valproate inhibits the breakdown of GABA and increases the synthesis of more GABA in the brain which may counteract this. I find that Depakote really helps to offset the activation from the 5HT₃ antagonism that Trintellix causes. I'm much calmer.