Depakote+Lamictal combo

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Does anyone have any experience specifically with the Depakote+Lamictal combo (with or without other medications). I've been on Depakote now since about November of last year but we're swapping out the Trintellix for Lamictal because my new insurance in July might give me a hard time about covering Trintellix. And we (my pdoc and I) figured that demonstrating an approved medication doesn't work (if it doesn't work that is) should be something we should try before submitting the step therapy paperwork for Trintellix. For this new insurance, they not only require that you try at least two other generics, but the "Restricted Access" meds also are only allowed to be used for FDA approved indications (i.e. Trintellix is approved for MDD but I'm BP2).

I started Lamictal on Thursday. 25mg every other day for 2 weeks. Then 25mg every day for two weeks. Then we'll decide if we want to increase it again to 50mg for another two weeks or if we want to increase the Depakote or Rexulti.

I don't recall Lamictal having such a difficult startup when it comes to GI discomfort. I remember the antsy almost anxious feeling, and I remember the headaches, but I'm also having nausea, some mild stomach cramping, diarrhea, but fortunately no vomitting. Has anyone else ever taken Depakote and started Lamictal and found they had a hard time. Better yet has anyone ever taken Lamictal both with AND without Depakote and found it less tolerable when taken with Depakote?

I am aware of the medication interaction between these two meds. So I know that Depakote is going to increase Lamictal blood levels and might amplify some of these side effects. It's just more difficult than I remembered from the last time I took it years ago when I wasn't on Depakote and I wasn't really expecting it to be this much worse. Granted, I've only taken two doses at this point. So I might be jumping the gun and might find that I feel better later this week. But I'm also supposed to be discontinuing the Trintellix on Thursday. And if I'm still having a hard time adjusting to the Lamictal, stopping Trintellix at the same time could make me miserable, and I know that.

Anyone have two cents? 

[confused]

I took lamictal and depakote together years ago.  It was not planned. I was titrating off depakote and on to lamictal, but i started to become unstable when the depakote went below therapeutic levels.  So, i stayed on both.  It was a good combo for me. I did not go over 200 mg lamictal because  of the increase from depakote. There was a lamictal starter pack for when you are on depakote,. It sounds like you are following that regimen. 

It us an unusual combo because of the interactions. I think the depakote decreases, too, but that may be wrong.

now, i am on lamictal alone as a mood stabilizer. I don't feel it is as effective as depakote for me.  A pdoc felt there are more side effects from depakote, that were not affecting me, so he switched it. I keep contemplating going back on depakote, but my pdoc now doesn't want to make a big change.  He does everything in little increments.

i hope it works well for you

i don't remember having issues with lamictal with depakote.  

Edited June 17, 2018 by confused

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1 hour ago, confused said:

I took lamictal and depakote together years ago.  It was not planned. I was titrating off depakote and on to lamictal, but i started to become unstable when the depakote went below therapeutic levels.  So, i stayed on both.  It was a good combo for me. I did not go over 200 mg lamictal because  of the increase from depakote. There was a lamictal starter pack for when you are on depakote,. It sounds like you are following that regimen. 

It us an unusual combo because of the interactions. I think the depakote decreases, too, but that may be wrong.

now, i am on lamictal alone as a mood stabilizer. I don't feel it is as effective as depakote for me.  A pdoc felt there are more side effects from depakote, that were not affecting me, so he switched it. I keep contemplating going back on depakote, but my pdoc now doesn't want to make a big change.  He does everything in little increments.

i hope it works well for you

i don't remember having issues with lamictal with depakote.  

Yeah it does seem like some pdocs are concerned about a lawsuit because of the POTENTIAL long-term effects of these medications. I do acknowledge they are very real. However, I started out on the "easier" stuff first and it just didn't provide a level of consistency that I required.

We did try lithium before we tried Depakote. Unfortunately, I could not tolerate it at all. I felt so sick and I only got up to maybe 600mg of the CR but I couldn't last longer than 10 days. Compared to that Depakote has been a DREAM. I feel so much more calm, and yeah I've had a fair bit of weight gain from the Depakote+Rexulti combo, but my mood has improved so much (both hypomanic and depressive symptoms) since starting the Depakote+Rexulti combo as a mood stabilizer that the weight gain doesn't bother me as much. Trinellix was supposed to be a permanent fixture in my cocktail until I found out about BCBS of NC's policy on antidepressants being used off-label. My pdoc could certify that I be kept on it because I've been clinically stable for a significant amount of time since starting it, and I'm already taking it going into a new benefit period on a new carrier.

That being said, I have been having some breakthrough hypomanic/mixed symptoms on the Depakote+Trintellix+Rexulti+Vyvanse combo. Honestly I've been out of a depressive episode now for some time, it's summer time, and we figured it was time to take a break from ADs to let my brain "reset" a bit. I asked to start on Lamictal as my previous experience with it showed me that it is quite effective at preventing episode onset. I might still get upset or depressed about something but I get over it quicker and move on with life. I didn't plan on really going higher than 50mg because Depakote doubles that to 100mg. I really wanted to keep the Lamictal minimal to moderate in dosing because I'm on other meds as well.

My goal is to see if I can get through a winter after stabilizing on Depakote+Lamictal+Rexulti+Vyvanse. Since I started seeing this pdoc in 2014 or so I haven't made it through a single winter without sinking into depression no matter what medication I was on. And if it wasn't a textbook 2-week long pure depressive episode, then it was rapidly cycling, anxious, mixed episodes. But usually just sobbing, call-out-of-work, borderline catatonic depression. Trintellix is the only antidepressant that hasn't had a major impact on my sexual function. Can't say if it's made me gain weight or not because I am taking Depakote and Rexulti, which will cause weight gain, but it also helped to improve my cognition. On the higher doses of Trintellix, I didn't need as much Vyvanse to get through the day. In fact they worked together synergistically. So I want to see if Lamictal can take it's place. If so, that's awesome. If not, then my pdoc can go back to the insurance company and explain to them that coming off of Trintellix and going back on Lamictal ultimately destabilized my condition. We'll have more ground to stand on really. Have to say though that after the decrease of Trintellix from 10mg to 5mg and then starting the Lamictal, I feel SUPER foggy right now.

I have felt a lot better as the day has progressed. But I still feel kinda tired/fatigued. I took Imodium this morning before work for diarrhea and it literally had NO effect, which I thought to be very strange. The GI cramping has continued a bit and I'm still having mild lower back ache. No headache at the moment though. So that's nice at least. And no rash to speak of. Didn't have that problem last time, but I acknowledged that this had the potential to be a totally different experience with the Depakote on-board.

Thank you very much for posting back @confused. It makes me feel better knowing that someone else tolerated it well enough and got benefit from it. Sorry to hear your pdoc won't let you go back on Depakote when you know it made you feel better.

[confused]

I forgot to say, i usually feel icky (flu like) going through med changes.  I hope what you are experencing is temporary.

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4 minutes ago, confused said:

I forgot to say, i usually feel icky (flu like) going through med changes.  I hope what you are experencing is temporary.

I'm sure it is. If this Lamictal is like the Lamictal I remember then this all eventually goes away, and I won't have any side effects from it at all. In fact the only side effect I recall having from Lamictal after I adjusted to it was word recall (no pun intended). I would have the tip-of-your-tongue sensation a few times a month. Nothing serious though. I experienced more confusion from Trileptal than from Lamictal and Depakote really hasn't caused me any cognitive issues that I can speak of.