Psycho-Babble Medication Thread 739722

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Lamictal as SSRI replacement?

Posted by Joe Bloe on March 10, 2007, at 1:50:39

I started Lamictal 3 weeks ago. I was prescribed 25 mgs a day to augment 20 mgs prozac and 20 mg adderall xr. After 4 or 5 days at 25 mgs, I was unable to function because of serious cognitive side effects. But I felt as if my depression was totally gone.

I decided to cut back to 12.5 mgs Lamictal a day and I now alternate days at 12.5 and 25 mgs. I also take it at night. I added 300 mgs supplementary choline to the regimen to mitigate cognitive SE's.

I also made the decision to end my 4 plus years with Prozac. It really wasn't doing much for me anymore and I am tired of feeling blunted, asexual, and I am also tired of the cognitive side effects which this gives me - such as poor memory. I just feel that this med has run its course. I plan to not mess with the Adderall for the time being. Something should be constant with this big change taking place.

I am now on week 4 of what I hope is a SSRI withdrawal. I am down to 5 mgs Prozac a day after reducing it to 15 mgs and then 10 mgs in weeks 1 through 3. I have some Benadryl ready in case I feel any withdrawal symptoms in the coming weeks and I am also ready to apply the "flex" plan advocated by SLS a few years ago - i.e. take a small dose of Prozac as necessary to aid withdrawal. I tried to withdraw from Prozac a couple of times before and failed. The withdrawal syndrome was too extreme. I feel determined this time to try to live without it.

This is where the Lamictal comes into play. With my current regimen, I am finding my memory return and the cognitive SEs seem to be diminishing for the most part. I almost feel as if the particular SE's caused by Prozac are diminishing. Also, the cognitive SE's caused by the SSRI and Lamictal appear to be an equal tradeoff, even though they have different manifestations.

Questions:

Can a small dose of Lamictal be used, not to augment, but to replace a SSRI in therapy for MDD/possible BP 2?

Also, does it seem possible that, because I am taking Lamictal, I might not experience the same unbearable withdrawal syndrome from Prozac that I did in the past?

 

Re: Lamictal as SSRI replacement? » Joe Bloe

Posted by Phillipa on March 10, 2007, at 11:51:51

In reply to Lamictal as SSRI replacement?, posted by Joe Bloe on March 10, 2007, at 1:50:39

What does your pdoc say? Run it by him first. Love Phillipa

 

Re: Biochemically feasible?

Posted by Joe Bloe on March 10, 2007, at 12:45:24

In reply to Re: Lamictal as SSRI replacement? » Joe Bloe, posted by Phillipa on March 10, 2007, at 11:51:51

I definitely will run it by him.

I am just wondering if anyone has had an experience like this with Lamictal or if it sounds feasible scientifically/biochemically?

 

Re: Lamictal as SSRI replacement?

Posted by circusboy on March 11, 2007, at 15:35:37

In reply to Lamictal as SSRI replacement?, posted by Joe Bloe on March 10, 2007, at 1:50:39

Hi Joe,

> I decided to cut back to 12.5 mgs Lamictal a day and I now alternate days at 12.5 and 25 mgs. I also take it at night. I added 300 mgs supplementary choline to the regimen to mitigate cognitive SE's.
>
Is the choline working? There's a good chance I could end up back on Lamictal, and I want to do everything I can to counter/minimize those cognitive SE's. (As an aside, I'd also check out acetyl l-carnitine. I've recently added it to my supp regimen, and it's been helpful... but perhaps that's a topic for the alternative board).

Anyway, I imagine it's hard to say, since you've changed a couple of things at the same time.

> I also made the decision to end my 4 plus years with Prozac. It really wasn't doing much for me anymore and I am tired of feeling blunted, asexual, and I am also tired of the cognitive side effects which this gives me - such as poor memory. I just feel that this med has run its course. I plan to not mess with the Adderall for the time being. Something should be constant with this big change taking place.
>
Prozac was my staple for many years as well, but quitting it was one of the best recent decisions I've made. While I've had somewhat less energy, been somewhat less socially motivated, and had a somewhat darker mood since quitting it a year+ ago, I've been much more *sane*. I don't make such erratic decisions; my personal relationships are much more stable; I'm not Woody Allen anxious all the time; my head doesn't buzz constantly with noisy, unhelpful thoughts; I can concentrate better and feel generally smarter. Also, I only have take 5-15mg of Ritalin a day instead of 30-50mg, which virtually eliminates the terrible crash I'd have at the end of every day.

Prozac is funny with the cognitive SE's. At first it seems an intelligence booster, after a few months it's much harder to concentrate on it. I think it has something to do with chronically elevating serotonin levels decreasing "dopaminergic tone" over time.

On the other hand, Prozac is the most noradrenergic of the SSRIs. I'm not sure how this fits in to the cognitive SE's game (you would think this would mitigate the cognitive SE's, but our experience is solid evidence against that idea) but I'm pretty sure that's the reason why it was the only SSRI that really worked for me.

> Questions:
>
> Can a small dose of Lamictal be used, not to augment, but to replace a SSRI in therapy for MDD/possible BP 2?
>
The "real" evidence that Lamictal works as an antidepressant in monotherapy is weak. The anecdotal evidence (at least in BP spectrum types) seems to be strong. My pdoc, for instance, really believes in the stuff. So I don't know. I'm not sure they've even sussed out any mechanisms by which Lamictal might make people happier.

For the short time I was on it, it certainly worked as an AD for me. It sort of laid bare my dysthymic tendencies, which I'd grown completely accustomed to. People around me noticed before I did.

-cb

 

Re: Lamictal as SSRI replacement?

Posted by Sandra62 on March 11, 2007, at 20:52:50

In reply to Re: Lamictal as SSRI replacement?, posted by circusboy on March 11, 2007, at 15:35:37

I am now on a med cocktail that includes 100 mg of Lamictal. But using it alone in the beginning, along with a benzo, gave me an incredible lift, I was completely lifted from my depression quickly and was creative, writing songs night and day. Unfortunately it made me go completely manic so had to augment with Zyprexa to calm me down. Ever since I've been unable to pick up my guitar or keyboard, I miss those days of creativity so much. Need to do a med makeover soon. But anyways in answer to your question, I consider it a fine antidepressant.

 

Re: Lamictal as SSRI replacement?

Posted by Joe Bloe on March 11, 2007, at 23:39:23

In reply to Re: Lamictal as SSRI replacement?, posted by circusboy on March 11, 2007, at 15:35:37

> Is the choline working? There's a good chance I could end up back on Lamictal, and I want to do everything I can to counter/minimize those cognitive SE's. (As an aside, I'd also check out acetyl l-carnitine. I've recently added it to my supp regimen, and it's been helpful... but perhaps that's a topic for the alternative board).

Not sure about the choline. I think it's doing something. The first few days I felt something for sure. It gave me a little anxiety so I cut down to 300 mgs from 600 mgs. I would add it to the regimen. My concern with the choline was that Lamictal's AD property was derived from its anticholinergic tendency, but so far it appears that it's not. Unless of course the supplement is not altering this tendency enough. But I'm on such a low dose of Lamictal and I feel so much better than I have in probably 2 years that I do not think it's negatively impacting the results of the Lamictal so far. In fact, it could be the opposite, i.e. choline improves the action of Lamictal further once the dopey anti-cholinergic effect of Lamictal is decreased. Just a premature hypothesis.

> Prozac was my staple for many years as well, but quitting it was one of the best recent decisions I've made. While I've had somewhat less energy, been somewhat less socially motivated, and had a somewhat darker mood since quitting it a year+ ago, I've been much more *sane*. I don't make such erratic decisions; my personal relationships are much more stable; I'm not Woody Allen anxious all the time;

It's weird because since starting my descent down mount prozac, I have been more social than usual and have felt what I think is increased energy. I think I feel much friendlier, socially stable as you said. I've certainly been posting more on here.

> my head doesn't buzz constantly with noisy, unhelpful thoughts; I can concentrate better and feel generally smarter.

I am noticing this as well. I think I am definitely feeling sharper. Concentration seems to be better.

> Also, I only have take 5-15mg of Ritalin a day instead of 30-50mg, which virtually eliminates the terrible crash I'd have at the end of every day.

I also think the Lamictal itself eliminates the CNS stim crash. I take my dose right as the Adderall XR wears off and I have zero crash.


> Prozac is funny with the cognitive SE's. At first it seems an intelligence booster, after a few months it's much harder to concentrate on it. I think it has something to do with chronically elevating serotonin levels decreasing "dopaminergic tone" over time.

That sounds like my experience indeed. As time has gone on, I have felt less and less intelligent on Prozac.

> For the short time I was on it, it certainly worked as an AD for me. It sort of laid bare my dysthymic tendencies, which I'd grown completely accustomed to. People around me noticed before I did.

If you do try it again, maybe you could stay at whatever dose you begin to feel positive changes from? If it continues to work so well at 25 mgs, I may not seek to increase it.


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