Depression - Lamictal

Discussion in 'The Watercooler' started by flutterby, Dec 3, 2009.

  1. flutterby

    flutterby Fly away!

    I don't know if I've already posted about this - my brain has been more foggy than usual - and if I have, please ignore.

    I was taking 100mg Lamictal for depression, along with 20mg Lexapro. Depression was rearing it's head again and it was hitting hard, so I decided to increase my Lamictal.

    *Most* people go from 100mg to 200mg, but knowing how sensitive I am to medications, my GP and I decided to go up 50mg in 25mg intervals. I had planned to take the extra 25mg for 2 weeks, then go up the next step. However, the extra 25mg didn't seem to be working fast enough and I really needed more.

    So, after one week at 125mg, I went to 150mg. Within 3 or 4 days, the side effects started. I didn't put them together, my mom did. The increased ear ringing, the numbness/tingling in my lips and tongue, plus *very* spacey. It almost felt like I was dissociating, but I wasn't. I felt disconnected like you would if you were dissociating, but it was more disconnected to my surroundings than to myself/body. Plus, it was causing insomnia and I was taking it in the morning.

    I had a sleep study coming up (Wed night and Thursday), so I decided to back down to 100mg since the Lamictal was causing insomnia. Within 2 days, the ear ringing was better (still there, but almost back to normal) and the tingling/numbness in my lips was gone. Still feeling spacey, but not disconnected - and sometimes I get spacey feeling from fatigue and/or pain, so it could be that - and sometimes it just happens all by itself!. hehe :whiteflag:

    So, now I don't know what to do. I really don't want to add another AD - been there done that and it doesn't work. Me and SNRI's don't agree, and I would have to add an SNRI if I were to add another AD. I thought about trying again and staying at 125mg a bit longer before bumping up and seeing if that works.

    Any thoughts or other ideas?

    My therapist appointment last week was a disaster. I couldn't get in this week. I was going to take easy child's appointment for today, but it was at 3pm and I was at the sleep study until 4:30. I don't see therapist until Tuesday.
     
  2. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I can't really give advice on medications, since I'm just as sensitive as you are and get every side effect, even the ones in the small print. I wanted to send (((hugs))) and say I understand. I had that same awful disassociating feeling on Lithium and that scared me from mood stabilizers. Sometimes I really believe less is more. In my case, this is certainly true. Often, lessening doses or removing certain medications helped me a lot more than increasing...I know this isn't very helpful, but just wanted to send my empathy and to say "I care."
     
  3. crazymama30

    crazymama30 Active Member

    Maybe try the bump to 125, that sounds kinda safe. Could you increase the Lexapro any? I am not familiar with it's dosing.

    Hugs, I hope something helps soon. The waiting game is even harder when you are depressed.
     
  4. flutterby

    flutterby Fly away!

    Thank you, MWM and CM.

    After prodding by my mom, I looked up the side effects to Lamictal and the ones I was having were listed under infrequent and rare. Those are the ones I tend to get. :hammer:

    CM - 20mg is the highest therapeutic dose of Lexapro. You can go higher, but the data isn't there that it is any more effective above 20mg.

    I think at this point I'm going to have to see a psychiatrist, which I really don't want to do. I've never had one listen to me and I don't want to play the trial and error game.
     
  5. totoro

    totoro Mom? What's a GFG?

    I usually do the 25mg bumps every 2 weeks with lamictal. Between Topamax and Lamictal I have gotten the tingling and spaciness, they have always gone away.
    Even now I will once in awhile have a few moments of tingling in my hands or lips but it doesn't last long. I also get some of the spacy feelings at times but again it doesn't last.
    At this point I don't know which one is causing the issues, but because they are so infrequent it doesn't bother me.
    I hope you can figure it out, I really like Lamictal, I am on 200mg and I take it in the am.

    by the way:I never feel a huge difference with my increases, it is very gradual and happens over time.
     
  6. smallworld

    smallworld Moderator

    I wonder if splitting Lamictal into morning and evening doses would minimize side effects. We needed to do that for A recently when we increased her dose by 25 mg, and it helped a lot.
     
  7. emotionallybankrupt

    emotionallybankrupt New Member

    I'm wondering if any of your side effects could be from any interaction between the lexapro and the lamictal. I used to take lexapro, and it controlled my depression but also blocked any happy feelings. I was leveled to the point of being numb to life, and I didn't like it. That was at 10 mg. The 20 mg. strikes me as high for a medication sensitive person. Just makes me wonder if it might be bringing more side effects than help with depression--especially since your depression is so out of control.

    I take 200 mg. lamictal, and it's worked a lot better for what I needed, which was help with the waves of depression as well as the overwhelming need to cry at times I couldn't afford to--like at work. I think I'm remembering reading that 100 mg. is not an effective dose for depression, but not sure.

    I always question adding versus substituting when things aren't working right. I think it gets a lot harder to sort out what's going on and very easy to wind up on way too much stuff and no clue which ones to adjust and how.

    Regardless, due to your sensitivity issues (which I have too), I'm guessing the adjustments are going to be a long, gradual process, whether up or down. I wonder about some low dose benzo to help you through that process. I know that docs do that sometimes.
     
  8. flutterby

    flutterby Fly away!

    T - I'm going to try 125mg for 2 weeks, then go to 150mg and see what happens. If it's just intermittent, I can handle it. These were getting worse by the day, though, so I'm going to bump more slowly.

    SW - Would splitting it help with the insomnia caused by going to 150mg? I currently take my dose in the morning. I only mentioned it in passing, but it was becoming an issue, too. Is that one of those side effects that your body adjusts to after a couple of weeks?

    EB - I've been on Lexapro for several years. I started at 10mg and after about a year, increased to 20mg because I needed more. About 18 months ago, I added Lamictal because, again, I needed something more. I did the starter pack, and at 100mg it was working so I held there. Now, I need more again, which is why I'm bumping. I also have .5mg tabs of Klonopin.

    I have severe, treatment resistant depression. When not controlled by medications, it gets very scary, very fast.
     
  9. smallworld

    smallworld Moderator

    Heather, my daughter A is on Lamictal (250 mg) and Lexapro (7.5 mg). When we recently increased her by 25 mg, her psychiatrist added the extra in the morning so it wouldn't cause insomnia (at this point she was taking 150 mg am and 100 mg pm). But she experienced headaches, dizziness and nausea even by day 10 so we moved the 25 mg to the evening (125 mg am and pm) and the side effects disappeared. It was dramatic.

    I have to be honest with you, however. A has had a lot of trouble sleeping for a while, not necessarily from the Lamictal, but from the Lexapro. She would fall asleep fine, but wake up at 3 am and not be able to fall back to sleep. Benadryl worked for a while and then that petered out. Her psychiatrist finally resorted to a low dose of Seroquel (25 mg), which has worked like a charm for about a year.

    Like you, A is very medication-sensitive. You may need to play around with dosing and timing until you get it right. We've done that, and I'm always pleased when it all works out.

    Hang in there.
     
  10. emotionallybankrupt

    emotionallybankrupt New Member

    Does lexapro "wimp out" after a long time on it? I didn't take it long enough to find out.
     
  11. smallworld

    smallworld Moderator

    EB, ADs certainly have the potential to do that. But we don't think that's happened with my daughter A. When we tried to wean her from Lexapro a while back, she started to become depressed. So we think it's still working.
     
  12. crazymama30

    crazymama30 Active Member

    Flutter, this is for info only, I don't know how effective it is, but I know that small doses of abilify are supposed to be a good add on for treatement resistant depression. A gal I work worth (who has a major difficult child) took it and it was great for her.

    Maybe seeing a psychiatrist would be a good idea, if you can find a good one.
     
  13. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I do think seeing a psychiatrist is in order. I also think that medications can peter out after a time. Our chemicals can adjust to them and they stop working as well. My topamax/lamictal combo worked well for me for years but then suddenly I needed to add a very small dose of seroquel to it for some strange reason. I really wasnt happy about that but it has worked.
     
  14. totoro

    totoro Mom? What's a GFG?

    H-
    I forgot to add that I did have the side effects when I did the bumps but they went away after a a week of so. Now they happen just once in awhile.
    I haven't bumped up in a long time though.

    I was one of those that also had horrible stomach pains when I started Lamictal and was told that never happens! LOL
    Well it did with me! I was on the couch for almost 2 weeks but I made it through it and now no problem.
     
  15. emotionallybankrupt

    emotionallybankrupt New Member

    I'd definitely go with a psychiatrist. I've been too messed up before by the non-specialists. I hope you can find a good one, Heather. I've been lucky on that.

    I've heard the same thing about the abilify. Don't know personally anybody who's done it though.

    My thinking about the lexapro was just wondering if it's still helping you at all, since you are still having so much trouble at max dose after being on it for years. That would be hard for you to find out, though, without a trial reduction and risk of a harder fall that you're already feeling. I guess the good part, if you have to do that, is that lexapro is probably the one that would give you the quickest message among SSRI's.

    My psychiatrist's approach is to add on if getting some good results but just need more. Change if no positive results. I've talked to other people whose docs just add, add, add--and I actually think a lot of docs in my area do that. That's where the tangled mess comes in, and I can't figure out why they do that.

    I hope you can find some relief soon.
     
  16. smallworld

    smallworld Moderator

    One other thought: A's psychiatrist just started her on Deplin, a concentrated form of folate that augments the work of antidepressants (Lamictal can deplete folate). You can read about it here:

    www.deplin.com
     
  17. smallworld

    smallworld Moderator

    I have three children who take Lamictal so I have watched its effects since 2006. My sense about it is that it is not great at treating deep bone-crushing depression. It seems good for treating mood instability that lies on the depressive end, emotional reactivity and anxiety somewhat.
     
  18. flutterby

    flutterby Fly away!

    I really thinkg that if it wasn't for the extenuating circumstances, i.e., my physical health, Lexapro would be working fine for me. If it wasn't working, and only 100mg Lamictal, I'd be in very bad shape right now.

    Actually, it's the combination of Lexapro and Aygestin (synthetic progestin that I take for endometriosis) that really did the trick. There is such a hormonal aspect to my depression. After my heart attack and angioplasty, and me doped up on Dilaudid, I made sure to let my cardiologists know that whatever medications they give me better work with those two because I wasn't changing them.

    Lamictal has been used off label for years for treatment resistant depression. I can't remember for certain, but I think it's usually used in conjunction with an AD.

    100mg worked. Now it's not. I'm going to try the 25mg bump again - only do it at night this time.

    SW - thanks for the info on Deplin. I'm going to talk to my doctor about it.

    Thank you for the info and concern, ladies. I really just don't want to add another frimpin' doctor to my list. And from the way things are going with difficult child 2 and psychiatrists, I have no faith in the ones around here.
     
  19. smallworld

    smallworld Moderator

    Heather, one more thought (if you can stand it): The 25 mg Lamictal pill can easily be cut in half with a pill splitter. We have sometimes done dose increases in 12.5 mg increments. You could do that, too, to minimize side effects. Since A had such a difficult time with her last 25 mg increase, I'm going to suggest that to her psychiatrist the next time we need to increase her Lamictal.

    And you're right, Lamictal is used to augment ADs for treatment-resistant depression.

    Hugs.
     
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