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Lamictal for non-bipolar depression?


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Long story short, been on loads of antidepressants over the years and my depression is worse than ever.  Only one AD has ever worked (Celexa) but I can't tolerate the side effects.

Some here have suggested other options, like Lamictal.  I talked to my Dr. and he said that wouldn't be his first choice for me because Lamictal is normally indicated in those who are bipolar, and as far as he can tell, I am not. 

So...my question is this.  Could Lamictal potentially help depression in someone who isn't bipolar?  Also, my father WAS bipolar, so could this mean that my depression has a "bipolar element" even if I'm not truly bipolar?  My doc isn't against my trying the drug, but doesn't seem that confident that it will help.  However, I feel that I'm at the end of my rope here and if I don't find something that helps my whole life is going to go down the tubes.

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i think so, yes. at the very least it will make an AD more potent so you have to take less of it, meaning fewer side effects. if you can take lamictal, and some people have a hard time and others like it (i like it), then i'd give it a go.

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Yes, mood stabilizers like Lamictal, Lithium and others are appropriate for use with depression. They often used as an adjunct to an antidepressant.

Research has shown that often what has been labelled "refractory depression" that fails to respond to multiple AD's often turns out to be unrecognized Bipolar Disorder.

Why?  Bipolar Disorder when not exhibiting wild manic symptoms is notoriously difficult to diagnose. Again, research shows that BP'ers spend as much as 53% of the time depressed, with obvious manic or hypomania occuring at a much smaller percentage of the time.

Check out what Dr. Jim Phelps has on his Bipolar website about this:

http://www.psycheducation.org/depression/0...gnosis_app.html

Does your doctor know this?  I don't know. It can take years for the latest knowledge and treatment protocols to filter down to the Pdoc in the field.

Good luck.

A.M.

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Hi, devon00...

I'm like a broken record where this is concerned. AirMarshall gave you a great link. If you want to read the rest of Dr. Jim Phelps' info on this, go to: http://www.psycheducation.org/start/BPIntro.htm -- this is about both BPII and unipolar refractory depression. I like Dr. Phelps because he writes in a way that is generally understandable to the lay person, even as he writes for the physician.

Be sure to read through the list of "Soft signs" of bipolarity on the "Diagnosis" page. By the "Diagnosis" page I mean the one you'll get to by going the the link I gave you; this is where you'll see the soft signs list. AirMarshall gave you a direct link to the "Diagnosis Details" page. They are both topics at the website you'll get to by going through the above link. (I hope this makes sense.)

Obviously, having a first-degree relative (like your father) with a diagnosis of bipolar disorder is on the list. But there are other, more subtle indicators. You might want to read through it and see what else fits.

The Home Page for his entire site is here: http://www.psycheducation.org/index.html

Two articles published at the The Canadian Journal of Psychiatry, geared more towards docs, scientists and researchers are:

http://www.cpa-apc.org/Publications/Archiv...ry/angst-ID.asp

http://www.cpa-apc.org/Publications/Archiv...adesDisease.asp

All of the above address the idea of bipolar spectrum disorder. This includes the possibility that treatment-resistant unipolar depression might fit within this, at one end of the spectrum.

I can definitely tell you that for my predominate symtom of severe refractory depression, Lamictal has made a huge difference.

I don't know if any of this helps. Maybe you'll want to print some part of Dr. Phelps' website or the other articles to bring to your doc?

Best,

revlow

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Heya devon,

Definitely read Jim Phelps' info, and bring at least the link to your doctor.  As a doc and a patient I really found it helpful.

*Especially* with a family history of bipolar, this treatment-resistant depression of yours is more likely to respond to mood stabilizers, alone or with antidepressants.

People with bipolar are likely to have a relative with bipolar.  People with unipolar are less likely to have a relative with bipolar.

And if antidepressants don't cut it, trying a mood stabilizer is a very reasonable choice.

Here's another up-to-date (though more aimed at docs ... print out and bring in isn't a bad thought) site you can look at:

http://www.cfpc.ca/cfp/2002/may/_pdf/vol48-may-cme-1.pdf

http://www.cfpc.ca/cfp/2004/mar/_pdf/vol50-mar-cme-2.pdf

Canadian Family Physician is a good journal.  These articles above are aimed at helping us catch and treat bipolar.

Even if you're not clearly bipolar, hey, what you've tried isn't working and it's worth branching out, safely.

Good luck.

--ncc--

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I've been prescribed Lamictal for what appears to be treatment-resistant unipolar depression (though my father too is bipolar, and it is suspected that my illness has a bipolar element).

I was a little disturbed to read something on the Lamictal website:

"LAMICTAL does not take away the initial feelings of depression or mania you may be experiencing. LAMICTAL helps keep mood episodes from coming back for an extended period of time."[ http://www.lamictal.com/bipolar/patients/about_lamictal.html ]

Presumably that's because it's only licensed as a preventative treatment for bipolar episodes? I hope it does take away feelings of depression, as it's kind of my last hope after trials of multiple medications and combinations over the past year. Can anyone give me any encouragement about this?

cheers,

Andrew

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Lamictal has a known AD effect. I can swear on that from personal experience. I was in a deep bone-sucking depression when I started taking it. (Of course, YMMV.)

I think what they are saying there is that it may take time..."LAMICTAL does not take away the initial feelings of depression or mania you may be experiencing." Meaning that, for example, if you are in a full-blown mania it will not stop it in its track.

Some people do feel an AD effect fairly soon, even in the 25-50 mg range. I think I've read (and my doctor definitely told me) that it usually occurs around 100 mg. For me, it happened when I hit somewhere between 125-150. And when it happened, it was fairly dramatic. For other people it takes a higher dose.

What generally happens is that the AD effect occurs first; mood stabilization comes later. As you can see in my signature, I'm now taking 400 mg. That is because I'm on hormones; they increase the clearance of Lamictal. So, don't fret...as you are not a woman, this doesn't apply to you.

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Lamictal is used for people with unipolar depression, generally together with an AD. Although as someone noted, it does have something of an AD effect itself.

I take it with my other meds -- an anti-depressant and anti-psychotic -- to help them them along. And also to help smooth out my moods. I'm definately not bipolar, but I've found that most ADs alone haven't provided the smooth even mood I need. I think now that I'm stable and not much depressed on my AD, I could get by with less Lamictal. My pdoc has suggested that this summer I might be able to step down some of the meds.

Fiona

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Yeah, to what everyone else said.

I'm not sure if I like Lamictal or not, but I did well on it last summer before my "real" manias came. I was probably bipolar II then, but mostly depressed. So that worked for me. But now that my bipolar problems are more pronounced, it doesn't work that well, at least not on its own.

I definately think it can help with "ordinary" depression.

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