medication guru's

[flutterbee]

I'm going to see my GP Monday afternoon and discuss this with her - and I may very well just end up with a referral to a psychiatrist. But, I wanted to get some lay-opinions from those in the trenches.

As I posted on another thread, I'm wanting to add lamictal to my SSRI because the Lexapro just isn't holding me on it's own. I've tried many, many other AD's and they either didn't work or the side effects were too bad. She's wanting to add an SNRI (I think they are) and I've had horrible side effects from Effexor and Wellbutrin (Wellbutrin made me want to come out of my skin...OMG). Once my depression gets to a point, it becomes treatment-resistant and I'm trying to avoid getting there.

So, I was researching and came across this:

The second situation would be using it as an adjunctive treatment for other agents. My own algorithm for treating resistant unipolar depression does include using Lamictal, but only after I have tried combinations such as SSRI and Wellbutrin, or Cymbalta and Wellbutrin. The exception here would be someone who is getting some improvement with a standard antidepressant, but has some moodiness that might lend itself to improvement with a little mood stabilization. Even then, I often turn to Lithium to boost the effectiveness of the antidepressant. At low doses, there is minimal side effects for most people and there is limited risk. Blood work does not need to be done as rigorously when low doses are used.

I've taken both lithium and lamictal in the past - together - although I didn't get up to the therapeutic dose before discontinuing. That wasn't due to the medications, it was a bad psychiatrist experience. Anyway, I didn't have any problems while taking the two medications. In fact, I'm convinced that they are what pulled me out of my treatment-resistant depression in spite of not getting to therapeutic dose and discontinuing. It was enough to get the process started.

So, my question is: In your layman's opinion, if it were you, would you rather add low dose lithium or standard dose lamictal?

 

[smallworld]

I'd vote for Lamictal.

I've read that it's being used more and more for treatment-resistant depression with positive results. Plus it has a good side-effect profile as long as it's started low and titrated slowly.

My own daughter has been taking a combo of Lamictal and Lexapro for nearly two years. Except for some break-through symptoms last spring that were addressed with a 50 mg Lamictal increase, you wouldn't even know this kid was taking medications. She is very much behaving as a typical 13-year-old.

I hope you get some relief soon. Hugs.

 

[Hound dog]

Heather

I also vote to try the Lamictal first. Lithium makes me nervous. I know it works well for many, but you have to keep such a close watch on the blood levels or it can make things worse instead of better. You could always ask to keep the lithium in mind so that you have a back up in case the Lamictal doesn't work well enough.

Hugs

 

[Sara PA]

That SNRI category.....

There is a class of drugs which are SNRIs -- selective norepinephrine reuptake inhibitors. While a number are approved for use as antidepressants in other countries, the only one approved in the US is Strattera and that's for treatment of ADHD.

At some point the manufacturers of Effexor coopted the name SNRI to mean "serotonin norepinephrine reuptake inhibitors". Cymbalta followed. This name change happened about the time the SSRIs got the black box warning label. Prior to that, Effexor was known as an SSRI/SNRI combination medication. I suspect that the change was an attempt to distance Effexor from the SSRI category which was getting so much negative attention at the time.

As for your question -- I would add the Lamictal with the initial goal of going to a standard dose. But I would add it slowly and stop if the desired effects were achieved before reaching the standard dose.

 

[SaraT]

I too would start with the Lamictil. My daughter has been on it for years(started at 25mg, now at 150mg a day). Granted she is 12 and more bipolarish then depressed, but it had no side effects on her. The side effects of other medication for moods scare me.

 

[Nomad]

I can only speak generally.
However, I certainly have known lots of folks who have taken the medications you have mentioned and difficult child has been on Lamictal for over a year now.
I know many folks worry about that potential rash associated with Lamictal, but I don't think it is very common and of course as an adult one can keep an eye out for it and rush to the Dr. (or hospital) if there is a concern.
But I have seen many helped by Lamictal with actually NO side effects. On the other hand. other medications seem to cause many side effects, their effectiveness is debatable AND there are problems with withdrawal. So, Lamictal seems like a really good one to try.

 

[susiestar]

I also vote for the lamictal. You can try lithium if it doesn't work, but I would be nervous about it.

lamictal can be very very useful for treatment resistant depression. the first psychiatrist I saw spoke very highly of it.

I am sorry youare so miserable. I hope the GP will start the medications with the caveat that you have to see a psychiatrist ASAP.

PLEASE dont do the effexor, cymbalta or welbutrin. They really don't do good things for those of us with problems similar to yours. been there done that myself. Effexor made me crazy - first time I was psychotic and afraid of EVERYTHING. Cymbalta was similar.

Sending more gentle hugs.

 

[flutterbee]

Thank you for the advice.

My GP had mentioned Pristiq in the past and I told her that I didn't want to do it because there was only a 2 point difference on the depression scale between Pristiq and the placebo. Effexor is losing it's patent in 2010 so the company had to come out with another drug, you know. That's all it is.

So, I have a prescription for lamictal. My GP said it's the only mood stabilizer she's comfortable prescribing because it doesn't require the blood draws and has a good side effect profile. She's starting me on the starter pack, so I'll start at 25mg and titrate slowly to 100mg and then she wants to see me again. Ultimately, she said she'll probably get me to 200 mg.

So, I will start this in the morning. Wish me luck. I didn't get to sleep until 9am today and was up by 1pm and have all of this restless energy, but at the same time am so tired I'm miserable.

 

[Hound dog]

Glad you got the Lamictal! Keeping fingers crossed it works well for you too.

Hugs