Posted by Ritch on July 22, 2002, at 21:53:25
In reply to Depakote, Lamictal Prozac???, posted by Geezer on July 22, 2002, at 18:40:49
> Anyone had experience with this combo? I have been on Dep. 750mg for over a year - blood level OK. Started Lam. 4 months ago - titrated up slowly to 150mg (no depression relief from Lam. and pdoc did not want to go higher with Dep. on board). When I try to decrease the Dep., believe it or not, the depression gets worse. Added the Prozac 20mg only one week ago - now I am so damn dizzy I can't walk straight - still have atypical depression symptoms. Really wanted the Prozac to work because I had done so well on it in the past. My DX is still up in the air - 2 pdocs say Major Depression Recurrent and 2 say Bipolar II. I have been in this midranger depression for thirteen months. Any comments? Thanks
>
> Geezer
Hi Geezer,From what I understand (anybody please correct, add, or clarify), either the presence of lamotrigine tends to speed up metabolism/elimination of divalproex OR the presence of divalproex tends to *reduce* the rate of metabolism of lamotrigine. Given that, it is possible (everything else being equal), that a dose *reduction* of divalproex would tend to speed up elimination of lamotrigine, thereby *reducing* lamotrigine blood levels. That MIGHT explain your increased depression when you reduced divalproex. If that is true, then you would need to increase Lamictal when you decreased the Depakote. If that didn't happen, a reduced Depakote dosage could still trigger some Depakote withdrawal with increased agitation that might be interpreted as worsened depression. Is your depression tend to be agitative and mixed, with a lot of anxiety? The addition of the Prozac also might have tinkered with your blood levels of Depakote or Lamictal, making it difficult to tell what's helping or hurting due to hidden changes in their blood levels. Just some ideas.
Mitch
poster:Ritch
thread:113330
URL: http://www.dr-bob.org/babble/20020718/msgs/113362.html