Depression - Lamictal

[flutterby]

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 meds, 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

So, now I don't know what to do. I really don't want to add another AD - BTDT 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 tdoc appointment last week was a disaster. I couldn't get in this week. I was going to take PC's appt for today, but it was at 3pm and I was at the sleep study until 4:30. I don't see tdoc until Tuesday.

[MidwestMom]

I can't really give advice on meds, 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 meds 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."

[crazymama30]

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.

[flutterby]

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.

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 pdoc, 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.

[totoro]

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.

BTW:I never feel a huge difference with my increases, it is very gradual and happens over time.

[smallworld]

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.

[emotionallybankrupt]

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.

[flutterby]

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 meds, it gets very scary, very fast.

[smallworld]

Heather, my daughter A is on Lamictal (250 mg) and Lexapro (7.5 mg). When we recently increased her by 25 mg, her pdoc 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 pdoc 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 med-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.

[emotionallybankrupt]

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

[smallworld]

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.

[crazymama30]

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 gfg) took it and it was great for her.

Maybe seeing a pdoc would be a good idea, if you can find a good one.

[Dammit Janet]

I do think seeing a pdoc 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.

[totoro]

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.

[emotionallybankrupt]

I'd definitely go with a pdoc. 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 pdoc'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.