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So one of my care team at the hospital has mentioned lamotrigine may be an option for me as I have had limited success on SSRIs and bupropion and these meds have all lead to additional problems that I can't tolerate. 

I am kind of freaked out about it though. Steven Johnson syndrome looks horrible. 

Does lamotrigine work for depression? Reading up on it, all I can see is that it is used for anxiety. But there heaps of reviews on drugs.com by people using it for depression and having success. 

I'm an anxious person in general, especially when it comes to health issues and side effects, so I might be blowing the risks out of proportion in my head? 

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27 minutes ago, Melancholya said:

So one of my care team at the hospital has mentioned lamotrigine may be an option for me as I have had limited success on SSRIs and bupropion and these meds have all lead to additional problems that I can't tolerate. 

I am kind of freaked out about it though. Steven Johnson syndrome looks horrible. 

Does lamotrigine work for depression? Reading up on it, all I can see is that it is used for anxiety. But there heaps of reviews on drugs.com by people using it for depression and having success. 

I'm an anxious person in general, especially when it comes to health issues and side effects, so I might be blowing the risks out of proportion in my head? 

1) yes it’s used for depression. It is a first line for bipolar depression, but is sometimes used in stubborn unipolar depression too- I am not sure what the success rates for that are tho. 

2) while a rash is not uncommon, SJS is very rare, and the majority of people don’t have the issue as long as your doc titrates you up slow. Usually (if no med interactions) it’s something like- 

25 mg for 2 weeks, 50 for 2 weeks than 100 - from there some go to 200 or even more... but I don’t think that would be the case for unipolar depression. At least not right away. taking it slow most people avoid the sjs 

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I have MDD, maybe. Something like that.

Well anyways, it works wonders for me. It goes beyond just mood stabilization and actually provides an antidepressant effect. My baseline is mildly depressed and it takes care of that.

helps quite a bit with irritation and anxiety in my experience.

I had two rash scares and i'd to it all over again if i had to.

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3 hours ago, Iceberg said:

1) yes it’s used for depression. It is a first line for bipolar depression, but is sometimes used in stubborn unipolar depression too- I am not sure what the success rates for that are tho. 

2) while a rash is not uncommon, SJS is very rare, and the majority of people don’t have the issue as long as your doc titrates you up slow. Usually (if no med interactions) it’s something like- 

25 mg for 2 weeks, 50 for 2 weeks than 100 - from there some go to 200 or even more... but I don’t think that would be the case for unipolar depression. At least not right away. taking it slow most people avoid the sjs 

Thanks. Omg I'm still so anxious about it. 

1 hour ago, argh said:

I have MDD, maybe. Something like that.

Well anyways, it works wonders for me. It goes beyond just mood stabilization and actually provides an antidepressant effect. My baseline is mildly depressed and it takes care of that.

helps quite a bit with irritation and anxiety in my experience.

I had two rash scares and i'd to it all over again if i had to.

Do you take it alone or with other meds for MDD? 

What was the rash like? Was it uncomfortable? :(

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39 minutes ago, Melancholya said:

Thanks. Omg I'm still so anxious about it. 

Do you take it alone or with other meds for MDD? 

What was the rash like? Was it uncomfortable? :(

Your obviously aware and attentive, which means that even in the uncommon case that something starts to go bad I’m sure you’ll be totally on top of it... new meds can be scary but I think you’ll be ok 

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7 hours ago, Melancholya said:

Thanks. Omg I'm still so anxious about it. 

Do you take it alone or with other meds for MDD? 

What was the rash like? Was it uncomfortable? :(

With Wellbutrin and gabapentin.

The rash came on as single hives that sort of came on my arms, chest, back. That went away in a few days. Otherwise, disperse patches of itchy redness. All my rashes had, in common, that they did start fading in less than a day. None of mine were SJS, so itchiness was the only thing I noticed. No pain, no fever.

FWIW, the wellbutrin, now that i've been on this combo for a while, while it definitely helps, has the smallest order of magnitude for helping, vs the gabapentin and lamotrigine.

Also, sleep. I can't stress that enough. I get 6 or less and i'm a mess.

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13 hours ago, argh said:

With Wellbutrin and gabapentin.

The rash came on as single hives that sort of came on my arms, chest, back. That went away in a few days. Otherwise, disperse patches of itchy redness. All my rashes had, in common, that they did start fading in less than a day. None of mine were SJS, so itchiness was the only thing I noticed. No pain, no fever.

FWIW, the wellbutrin, now that i've been on this combo for a while, while it definitely helps, has the smallest order of magnitude for helping, vs the gabapentin and lamotrigine.

Also, sleep. I can't stress that enough. I get 6 or less and i'm a mess.

Yes, I am an utter disaster when I am lacking sleep too. 

What is gabapentin? And is lamotrigine ever used on its own for MDD? Have decided to discontinue wellbutrin because it's making me feel kinda crazy and tense in my body, but I'm still tired in my mind if that makes sense. 

21 hours ago, Iceberg said:

Your obviously aware and attentive, which means that even in the uncommon case that something starts to go bad I’m sure you’ll be totally on top of it... new meds can be scary but I think you’ll be ok 

Lol, that's one way of looking at it I guess. Another way is that I'm a hypochondriac. 😛

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6 minutes ago, Melancholya said:

Yes, I am an utter disaster when I am lacking sleep too. 

What is gabapentin? And is lamotrigine ever used on its own for MDD? Have decided to discontinue wellbutrin because it's making me feel kinda crazy and tense in my body, but I'm still tired in my mind if that makes sense. 

It's another anticonvulsant, similar to lamotrigine but works on the calcium channels instead of the sodium channels. It works on the gaba system which is the other side of the coin to the glutamate system where lamotrigine works with. If it helps there's significantly less chance you'll get SJS on it.

It's not actually FDA approved (IIRC you're in NZ or Aus, but 'MERICA FUCK YEAH, etc), for any mood disorder, but it's known to help sleep quality, anxiety and act as a weak/questionable mood stabilizer. If you don't have mood elevation or notable cycling, I'd recommend that first. It obliterated my depression, decreased my anxiety by quite a bit, stopped mixed episodes, but didn't deal with pure elevated moods. That would have been fine, prefect actually, except I'd get the case of the stupids after the crash.

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Posted (edited)
24 minutes ago, argh said:

It's another anticonvulsant, similar to lamotrigine but works on the calcium channels instead of the sodium channels. It works on the gaba system which is the other side of the coin to the glutamate system where lamotrigine works with. If it helps there's significantly less chance you'll get SJS on it.

It's not actually FDA approved (IIRC you're in NZ or Aus, but 'MERICA FUCK YEAH, etc), for any mood disorder, but it's known to help sleep quality, anxiety and act as a weak/questionable mood stabilizer. If you don't have mood elevation or notable cycling, I'd recommend that first. It obliterated my depression, decreased my anxiety by quite a bit, stopped mixed episodes, but didn't deal with pure elevated moods. That would have been fine, prefect actually, except I'd get the case of the stupids after the crash.

Man, I wish I understood more about all this stuff and of course about my brain. 

Yep I'm in NZ :) good memory. And I see that gabapentin is available here. 

Are you diagnosed bipolar? Is that why you take both gabapentin and lamotrigine - the gabapentin helps with lows and lamotrigine helps with highs? Is gabapentin alone likely to help me? 

I think I am feeling a bit skeptical because for the most part I've never treated my depression with a drug not actually labelled an antidepressant. I'm reading up on these and thinking really? But lately I have a pretty hard-to-shake belief that nothing will help me. 

Oh and absolutely no mood elevation here, lol. I'm either average or depressed. 

Edited by Melancholya

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59 minutes ago, Melancholya said:

Man, I wish I understood more about all this stuff and of course about my brain. 

Yep I'm in NZ :) good memory. And I see that gabapentin is available here. 

Are you diagnosed bipolar? Is that why you take both gabapentin and lamotrigine - the gabapentin helps with lows and lamotrigine helps with highs? Is gabapentin alone likely to help me? 

I think I am feeling a bit skeptical because for the most part I've never treated my depression with a drug not actually labelled an antidepressant. I'm reading up on these and thinking really? But lately I have a pretty hard-to-shake belief that nothing will help me. 

Oh and absolutely no mood elevation here, lol. I'm either average or depressed. 

Funny that. My DX is an unspecified mood disorder, but to call a spade a spade, it's some form of bipolar disorder, as in i'm on the bipolar spectrum. Perhaps my symptoms are subsyndromal or too short in length, is why it doesn't qualify for a bipolar dx proper.  There is a section in the DSM 5, for further study which is "MDD with short duration hypomania". That's probably where I am at. My response to ADs, with the exception of wellbutrin have been dismal, though admittedly i haven't tried quite a few of them.

The gabapentin was originally for sleep. Found it marginal for sleep, but I did notice that my mood got significantly better. I suppose wellbutrin alone took my mood from depressed to my baseline which was mildly depressed. I had to stop gabapentin due to a harmless rash (hives). We then tried remeron, but that made me super depressed, which i've come to learn that it was actually a mixed episode. fun. I restarted the gabapentin on my own accord and reviewed it with my pdoc at the time. She put me back on it and i take a zyrtec to deal with the rash. Still breaks through every so often but much better.

The plot thickened from there, as it does. So I had periods of elevated moods, which i thought was just me not being depressed. But i'd crash from there and have cognitive issues. My least favourite of the issues was the inability to write cohesive sentences. It just so happened that I lost my shit, sort of..an elevatedish mood, that wasn't fully pleasurable, around the time of a visit/check in with the pdoc. He lamotrigined my ass that appt and have been on it since then, rash scares and 1 rechallenge aside.

Hell of a way to get here, but to be honest, this combination is the best I've been on by far. My moods are stable thus far. Head is clear.

Back on topic. I'd say the gabapentin has a decent chance help you out. It seems you have a lot of anxiety thrown into the mix, which if nothing else, should help. If you've had bad experiences with other meds or a partial response to a good # of ADs, then it's time to start thinking out of the box. Not a doc, but it sounds like you at least have TRD.

This is probably, buspar aside, one of the more innocuous medications. YMMV of course.

 

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Posted (edited)

I've been on & off Lamictal for years. I don't think it's usually used for anxiety (mainly Bipolar and depression maintenance) I love that it's had the least amount of adverse effects than any med I've been on.

It does cause some wierd skin issues in the beginning for many people (or when increasing the dose) It was just like an itchy hives like reaction, nothing serious. I think the chance of SJS is extremely low (I don't have the exact number in front of me). The titration is somewhat of a pain, but you should notice effect by 100mg (I felt effect at 75mg)

It is really more ideal as a maintenance medication - meaning it will not work as well for acute episodes but works well for general stabilization. I have usually had to add on an antidepressant if my mood gets particularly bad.

Edited by Blahblah

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3 hours ago, argh said:

If you've had bad experiences with other meds or a partial response to a good # of ADs, then it's time to start thinking out of the box. Not a doc, but it sounds like you at least have TRD

Yup, I was diagnosed treatment resistant last year. I've tried most of the SSRIs, venlafaxine and bupropion as well as aripiprazole. The aripiprazole did almost nothing! I was really surprised by that. 

Ideally I want to only be on one medication, but it sounds like I might need to pair lamotrigine or gabapentin with something? I am trying to avoid sexual dysfunction and being turned into a zombie, which so far all the meds have done (aside from bupropion). 

I guess one of my worries with trying a mood stabilizer is that I'm not bipolar so will it stop me from feeling everything? Admittedly I really like the emotional blunting that SSRIs give me because I feel more in control, my emotions are extremely overwhelming when I'm not medicated. But I do still want to be able to feel. 

1 hour ago, Blahblah said:

I've been on & off Lamictal for years. I don't think it's usually used for anxiety (mainly Bipolar and depression maintenance) I love that it's had the least amount of adverse effects than any med I've been on.

It does cause some wierd skin issues in the beginning for many people (or when increasing the dose) It was just like an itchy hives like reaction, nothing serious. I think the chance of SJS is extremely low (I don't have the exact number in front of me). The titration is somewhat of a pain, but you should notice effect by 100mg (I felt effect at 75mg)

It is really more ideal as a maintenance medication - meaning it will not work as well for acute episodes but works well for general stabilization. I have usually had to add on an antidepressant if my mood gets particularly bad.

I think general stabilisation is what I'm after, I have ongoing chronic depressed feelings and anxiety. Great that it's had very few adverse effects for you :)

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10 hours ago, Melancholya said:

Yup, I was diagnosed treatment resistant last year. I've tried most of the SSRIs, venlafaxine and bupropion as well as aripiprazole. The aripiprazole did almost nothing! I was really surprised by that. 

Ideally I want to only be on one medication, but it sounds like I might need to pair lamotrigine or gabapentin with something? I am trying to avoid sexual dysfunction and being turned into a zombie, which so far all the meds have done (aside from bupropion). 

I guess one of my worries with trying a mood stabilizer is that I'm not bipolar so will it stop me from feeling everything? Admittedly I really like the emotional blunting that SSRIs give me because I feel more in control, my emotions are extremely overwhelming when I'm not medicated. But I do still want to be able to feel. 

I think general stabilisation is what I'm after, I have ongoing chronic depressed feelings and anxiety. Great that it's had very few adverse effects for you :)

What about the rima that is available to you. Your doc might have said it isnt very good, but different people have different head chemistry.

mood stabilizers attenuate cycling. Lamotrigine is said to stabilize from the bottom, meaning that it works on depression while other mood stabilizers work from the top to control mania. The thought behind it is if you don’t have an episode of depression then you wont swing up to mania in bipolar and vice versa. Since you don’t have mania, it in theory would keep your lows at bay or lessen the degree and length.

the goal for me is mono therapy with Lamotrigine. We would only start peeling back the meds once ive been stable for a year.

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1 hour ago, argh said:

What about the rima that is available to you. Your doc might have said it isnt very good, but different people have different head chemistry.

mood stabilizers attenuate cycling. Lamotrigine is said to stabilize from the bottom, meaning that it works on depression while other mood stabilizers work from the top to control mania. The thought behind it is if you don’t have an episode of depression then you wont swing up to mania in bipolar and vice versa. Since you don’t have mania, it in theory would keep your lows at bay or lessen the degree and length.

the goal for me is mono therapy with Lamotrigine. We would only start peeling back the meds once ive been stable for a year.

Thanks so much for the helpful info about how these meds work! 

I've requested a new psychiatrist and my next appt is on 2nd July, and yeah I've been thinking about discussing moclobemide with him. I'm just not sure which would be best to try first, moclobemide or lamotrigine/gabapentin. I suppose I should base it on which is easier to come off if it doesn't work. 

Good luck to you!! How far through the year are you? 

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1 hour ago, Melancholya said:

Thanks so much for the helpful info about how these meds work! 

 I've requested a new psychiatrist and my next appt is on 2nd July, and yeah I've been thinking about discussing moclobemide with him. I'm just not sure which would be best to try first, moclobemide or lamotrigine/gabapentin. I suppose I should base it on which is easier to come off if it doesn't work. 

Good luck to you!! How far through the year are you?  

if you'll be replacing the AD, of course leave it to your doc as to how,  @browri  and @mikl_pls  would be the two best resources here on understanding the nuances of cross titration.

It might be easier to just do an add on via the lamotrigine, but of course your doc should lead the way there too. It would probably be easier to drop the lamotrigine, as you'll know pretty quick if it works or not, despite the long titration period. Both Blah and myself saw results at even low doses.

I think i'm about 2 months into the year. Original start date was last Nov, but things happened, lol.

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1 hour ago, argh said:

if you'll be replacing the AD, of course leave it to your doc as to how,  @browri  and @mikl_pls  would be the two best resources here on understanding the nuances of cross titration.

It might be easier to just do an add on via the lamotrigine, but of course your doc should lead the way there too. It would probably be easier to drop the lamotrigine, as you'll know pretty quick if it works or not, despite the long titration period. Both Blah and myself saw results at even low doses.

I think i'm about 2 months into the year. Original start date was last Nov, but things happened, lol.

I want off SSRIs really. Even if I add lamotrigine won't I still have the sexual dysfunction and tiredness from sertraline? Bupropion wasn't even strong enough to mitigate those problems from only 50mg sertraline. 

2 months is awesome, though! 

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1 minute ago, Melancholya said:

I want off SSRIs really. Even if I add lamotrigine won't I still have the sexual dysfunction and tiredness from sertraline? Bupropion wasn't even strong enough to mitigate those problems from only 50mg sertraline. 

2 months is awesome, though! 

Yeah, Lamotrigine is not known to alleviate sexual dysfunction that comes with SSRIs. In the USA, bupropion or mirtazapine is added to help. If those don’t work then you might be out of luck in terms of SSRIs. You might have to try tricyclics if you want to stay on the antidepressant train. If i were you, given sexual dysfunction is a big problem, id start with going on the rima and evaluate from there. 

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13 minutes ago, argh said:

Yeah, Lamotrigine is not known to alleviate sexual dysfunction that comes with SSRIs. In the USA, bupropion or mirtazapine is added to help. If those don’t work then you might be out of luck in terms of SSRIs. You might have to try tricyclics if you want to stay on the antidepressant train. If i were you, given sexual dysfunction is a big problem, id start with going on the rima and evaluate from there. 

Yeah, that's why I was wondering if lamotrigine alone can alleviate depression, because I'm tired of SSRIs. Mirtazapine was too sedating. I'm not very keen on trying TCAs because I figure I'll just have the same problems plus more. 

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17 minutes ago, Melancholya said:

Yeah, that's why I was wondering if lamotrigine alone can alleviate depression, because I'm tired of SSRIs. Mirtazapine was too sedating. I'm not very keen on trying TCAs because I figure I'll just have the same problems plus more. 

makes sense. i think Blah is a prime example of being able to get away with lamotrigine monotherapy for a good long while.

Lamotrigine can actually improve dysfunction..at least in those with epilepsy..which would entail larger doses. 

https://www.ncbi.nlm.nih.gov/pubmed/16434217

will not cause dysfunction in those with mood disorders

https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20509

Here's a decent article about psychotropics and sexual dysfunction

https://www.mdedge.com/psychiatry/article/59789/prescribing-preserve-or-restore-sexual-function

Now that i think about it, the gabapentin does cause a bit, more in line of ED, but not desire or pleasure. You're a chick so i guess that's not an issue for you, lol.

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3 hours ago, argh said:

makes sense. i think Blah is a prime example of being able to get away with lamotrigine monotherapy for a good long while.

Lamotrigine can actually improve dysfunction..at least in those with epilepsy..which would entail larger doses. 

https://www.ncbi.nlm.nih.gov/pubmed/16434217

will not cause dysfunction in those with mood disorders

https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20509

Here's a decent article about psychotropics and sexual dysfunction

https://www.mdedge.com/psychiatry/article/59789/prescribing-preserve-or-restore-sexual-function

Now that i think about it, the gabapentin does cause a bit, more in line of ED, but not desire or pleasure. You're a chick so i guess that's not an issue for you, lol.

Thank you for the links. Unfortunately I couldn't read the mdedge one because I'm not subscribed. 

I think I'll ask about moclobemide first. 

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