Posted by SLS on April 16, 2002, at 21:35:18
In reply to Re: lamictal and provigil? » SLS, posted by jazzdog on April 16, 2002, at 11:24:42
Hi Jane.
> I'm considering combining my lamictal (currently 300 mg) with provigil, to improve my sluggish cognition. It appears, however, that they have an opposite effect on glutamate levels.
I was concerned about exactly the same thing when I added Provigil to the 300mg of Lamictal that I was taking two years ago.
> Do you know if that's true,
It is true that various experiments have demonstrated that Provigil increases, while Lamictal decreases, the amount of glutamate that accumulates in between neurons. Glutamate is the most pervasive excitatory neurotransmitter in the brain, and increasing glutamate activity in certain structures can produce increased wakefulness and motivation. However, without more information, one cannot draw any definite conclusions as to how these experimental observations are to be interpreted.
Example: It might be that Lamictal reduces the release of glutamate only when neurons are stimulated repetitively at high frequencies. It could thus be acting as a sort of squelch filter to prevent runaway excitation. Perhaps Provigil raises the baseline amount of glutamate that remains during the period in between nerve impulses. It could thus decrease the amount of glutamate needed to be released to transmit any one excitatory message. These two actions are not necessarily antagonistic.
> and if so, what it means? Thanks for your help -
Hmmm.
I really don't know what it means. The brain is so complex, that I am usually reluctant to forecast what the result of any treatment will be based upon simplistic models that use so little of the limited and incomplete information available. I am probably too conservative in this regard, but I would rather plead ignorance than exclude possibly effective treatment options without empirical justification.
Now...
Unfortunately, I was impatient enought to make two changes at the same time. I added the Provigil within a week of beginning sulpiride, a neuroleptic antipsychotic with antidepressant properties. I experienced what I like to call a "blip" mood-lift immediately after taking my first dose of 100mg Provigil. It faded by the end of the day, but I was optimistic just the same. However, by the third day I began to experience a mind-numbing, foggy-brained cognitive disruption that led me to discontinue both Provigil and sulpiride simultaneously. For the next two weeks, my depressive state was very much worse than it had been before I started the two drugs. Because I changed two variables at the same time, I can't determine which of them was responsible for this deterioration in my condition. I have suffered similar cognitive side-effects from neuroleptic antipsychotics other than sulpiride, so it is possible that it was the sulpiride rather than a Lamictal + Provigil interaction that produced the negative effect.
I wish I could give you some guidence as to whether or not Lamictal and Provigil interact with one another antagonistically in such a way as to prevent a positive therapeutic effect or cause harmful side-effects. Since the consequences of guessing wrong could be substantial, I would be inclined to wait and see if anyone else has tried this combination, and use such empirical evidence to aid you in making a decision.
I am currently taking Lamictal 300mg and imipramine (a tricyclic antidepressant). I will most likely add Nardil (an MAOI) to these.
I write too much. I hope you can make heads or tails of this. If it makes no sense to you - and I'm not sure it does to me - my best answer to your questions is simply that I don't know. I just used a fancy way of saying it. :-)
For what it's worth, I am again considering adding Provigil to Lamictal. I might try adding S-AMe first, though.
- Scott
poster:SLS
thread:100086
URL: http://www.dr-bob.org/babble/20020416/msgs/103286.html