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Posted (edited)

Somebody not long back did one of these kinds of "help me with my cocktail" posts. I am in a similar situation here so I thought I would do one.

Check my signature below for my meds and dosing schedule. Well, I have a few options. Some way to perhaps get me moving again and not ruminate on something I did 14 years ago. The depression can be summed up in one word "anhedonia". The anxiety can get to the point of social withdrawal. I would describe it as a sense of of "jitteriness" and hypersensitivity, but when I am alone I go into hyper focus and can't really enjoy things. 

Needing less of prn Adderall and clonazepam would be nice too.

My doctor is giving me some wiggle room on where to raise them, but if I do have to without his immediate say so I can only do one of these changes at a time....

1. raise lamictal from 50 to 75 mg

2. raise risperidone from 1 to1.5 mg

3. go from buspirone 15 mg twice to three times daily

4. go from gabapentin 300mg twice to three times daily

 

Thanks.

 

 

Edited by Sephiroth999

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Posted (edited)

Not a doctor here...

As you said that depression, anxiety and sensitivity are issues, then raising Lamictal (as a "stabilize-from-below" kind of drug) may be a good idea.

Not sure about anhedonia, though making an educated guess I'd say that it is part of the depressive state.

Raising Buspirone also makes sense, but this is a tricky one because it can either lower or enhance Serotonergic activity by a rather unique mechanism. This may produce many different results.

Edit:
Thinking about it again more thoroughly, you are mentioning many symptoms of depression but you are not taking any antidepressant. They usually are the most "basic" meds for depression.
I can think of Buspirone as sort-of an antidepressant, but maybe a low-dose SSRI can help here. Or even replace it...

Edited by HydroCat

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29 minutes ago, HydroCat said:

Not a doctor here...

As you said that depression, anxiety and sensitivity are issues, then raising Lamictal (as a "stabilize-from-below" kind of drug) may be a good idea.

Not sure about anhedonia, though making an educated guess I'd say that it is part of the depressive state.

Raising Buspirone also makes sense, but this is a tricky one because it can either lower or enhance Serotonergic activity by a rather unique mechanism. This may produce many different results.

Edit:
Thinking about it again more thoroughly, you are mentioning many symptoms of depression but you are not taking any antidepressant. They usually are the most "basic" meds for depression.
I can think of Buspirone as sort-of an antidepressant, but maybe a low-dose SSRI can help here. Or even replace it...

FYI, I can not tolerate any of the SSRI's, SNRI's or Wellbutrin too many side effects and too emotionally numbing. I did like Remeron and nortriptyline and I might actually ask for one of those it next time.

Lamictal at my current dose doesn't really cause much mood elevation so much as it prevents the really bad lows. I really don't have any mania or hypomania either.

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14 minutes ago, Sephiroth999 said:

Lamictal at my current dose doesn't really cause much mood elevation so much as it prevents the really bad lows. I really don't have any mania or hypomania either.

What I meant by "stabilize-from-below" is that Lamictal is more of an anti-depression rather than anti-mania.

I understand that you don't have manic tendency, but even if you did have - Lamictal is also anti-manic.

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Posted (edited)
2 hours ago, HydroCat said:

What I meant by "stabilize-from-below" is that Lamictal is more of an anti-depression rather than anti-mania.

I understand that you don't have manic tendency, but even if you did have - Lamictal is also anti-manic.

Lamictal + SOMETHING seems to do the trick. One time it was lamictal+Remeron 30 mg, the other time was lamictal+nortriptyline 10 mg three times a day. I would describe my experience with nortriptyline as Remeron minus the sedation/sleep effect. Buspirone does have a mild antidepressant effect with no numbing. I actually like it.

Edited by Sephiroth999

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16 hours ago, Sephiroth999 said:

Lamictal + SOMETHING seems to do the trick. One time it was lamictal+Remeron 30 mg, the other time was lamictal+nortriptyline 10 mg three times a day. I would describe my experience with nortriptyline as Remeron minus the sedation/sleep effect. Buspirone does have a mild antidepressant effect with no numbing. I actually like it.

Out of those three options id be inclined to think lamictal too 

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Lamictal, yes raise it, 50 mg is low. Lamictal touches a lot of receptors just a little bit so I don't know what it does at such a small dose. Generally 100 mg at least is used for depression. Certainly you should titrate up 25 mg to 75 mg but keep in mind side effects will appear on dose changes with Lamictal that tend to go away. So you have to slowly increase the dose and give things time to shake out before you decide whatever side effect is too much to bear. It has a good likelihood of going away. I took 300 mg of Lamictal for years with nary a side effect but increasing or decreasing the dose brought on side effects like short lived insomnia. It lasted a week and never came back.

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Another for lamictal.

For me 25 to 50 wasn’t bad at all in terms of side effects. 50 to 100 and 100 to 150 caused a ton of side effects. Probably about 12 days into a dose increase, they would abate. This included the common harmless rash, which made the entire process nerve wracking.

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