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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by never2late on February 16, 2012, at 22:22:32
Hey everyone,
I have been taking Effexor 150 for about a little over a month in addition to concerta 54, two 10 mg boosters, and klonopin .5 2x daily (one to induce sleep).
My doc just added lamictal at 25 mg at night to startup. I was having unstable moods, or mood swings throughout the day. I dont have bipolar, I have MDD SAD GAD and ADD.
I have read alot of posts of lamictal for bipolar, bipolar II, soft bipolar and I wanted to know about peoples experiences more closely related to my own.
How long did it take to work? Did you feel a boost in your antidepressants effect when adding it? What antidpressant were you taking along with it? How high of a dose did you find you needed to take for best results?
Hope someone is out there like me. I really appreciate your advice and comments.
Posted by Phillipa on February 16, 2012, at 23:46:09
In reply to lamicital with AD starting up, posted by never2late on February 16, 2012, at 22:22:32
I was prescribed it for a boost for an antidepressant also on benzos for anxiety no add though. I didn't have side effects at 25mg but at 50mg still no mental side effects but started producing so much saliva was constantly spitting and had to stop the med. I took at night. It didn't effect my moods although in retrospect I became angry at times and that's new. Phillipa
Posted by SLS on February 17, 2012, at 7:40:49
In reply to lamicital with AD starting up, posted by never2late on February 16, 2012, at 22:22:32
> Hey everyone,
Hi.
> I have been taking Effexor 150 for about a little over a month in addition to concerta 54, two 10 mg boosters, and klonopin .5 2x daily (one to induce sleep).
Why are you not taking 300 mg of Effexor?
> My doc just added lamictal at 25 mg at night to startup. I was having unstable moods, or mood swings throughout the day. I dont have bipolar, I have MDD SAD GAD and ADD.I find that low-dosage lithium smooths out my depression during the day. I take 300 mg. If Lamictal is of no help, I would consider using lithium as an augmenter to Effexor.
I would also consider adding guanfacine. It treats both ADD and anxiety.
Lamictal can produce an antidepressant effect within two weeks of reaching 50 mg. However, it more often than not stops working at this dosage. You may even experience a short-lived improvements upon dosage increases. However, an antidepressant response is more likely to "stick" without poop-out once you reach 200 mg.
- Scott
Posted by never2late on February 17, 2012, at 23:25:28
In reply to Re: lamicital with AD starting up » never2late, posted by SLS on February 17, 2012, at 7:40:49
SLS,
I am not taking 300 because my doc only wants me to change one thing at a time in order to gauge my response. I mentioned to him that I was feeling better once starting the 150 for 14 days then felt depression creeping back in the next 14 days with uneven moods throughout the day.
He told me the next two things he would like me to try were lamictil, to help control the mood swings, and Intuniv ( you were right on the mark). I chose to start the lamictal first, as I have my sisters wedding coming up at the end of March and wanted to not be a sad sack on her special day. Intuniv might be down the road if the restlessness did not dissipate on its own. He said that the NE stimulation that might have positive effects on my brain might effect my body in negative ways. Thus the intuniv would counter that. This is my own words but I think thats what he was getting at.
The other reason he was satisfied with the 150 effexor was because I had been feeling restless during the day, wired but tired at some points. He said that due to the fact that I was taking Concerta and Ritalin that my NE stimulation was sufficient at this time and wanted to see if my body adjusted to the effexor in the next 4 weeks and what the impact of the lamictal would be as an adjunct.
He did say that after reaching 50 mg it would be very easy to determine if it was a good fit for me. He said he has used in a couple of patients and it was the missing piece of the puzzle in treating the depression and mood instability.
Posted by SLS on February 18, 2012, at 7:16:37
In reply to Re: lamicital with AD starting up, posted by never2late on February 17, 2012, at 23:25:28
> I am not taking 300 because my doc only wants me to change one thing at a time in order to gauge my response. I mentioned to him that I was feeling better once starting the 150 for 14 days then felt depression creeping back in the next 14 days with uneven moods throughout the day.
>
> He told me the next two things he would like me to try were lamictil, to help control the mood swings, and Intuniv ( you were right on the mark). I chose to start the lamictal first, as I have my sisters wedding coming up at the end of March and wanted to not be a sad sack on her special day. Intuniv might be down the road if the restlessness did not dissipate on its own. He said that the NE stimulation that might have positive effects on my brain might effect my body in negative ways. Thus the intuniv would counter that. This is my own words but I think thats what he was getting at.
>
> The other reason he was satisfied with the 150 effexor was because I had been feeling restless during the day, wired but tired at some points. He said that due to the fact that I was taking Concerta and Ritalin that my NE stimulation was sufficient at this time and wanted to see if my body adjusted to the effexor in the next 4 weeks and what the impact of the lamictal would be as an adjunct.That sounds reasonable. As a caveat, it is still premature in the study of psychopharmacology to be able to conclude what dosage of a certain drug will ultimately be the most effective. In the first place, how does Effexor work? I don't know, but I do know that 300 mg has been observed to be the "sweet-spot" for this drug when treating more severe depressions.
Here is a theory of mine: Lamictal produces an antidepressant effect by increasing dopaminergic activity in the nucleus accumbens region of the brain. It would do this by inhibiting glutamatergic neurons from releasing glutamate in the thalamus. These glutamate neurons normally inhibit dopamine release in the nucleus accumbens. The net effect is that Lamictal produces its pro-dopaminergic effects via disinhibition. I could be wrong about this, of course. I have not yet come across a similar explanation in the medical literature. At any rate, if the Lamictal helps at all, you might consider adding Wellbutrin or Abilify to further increase dopamine activity.
Theories are fun, but not always clinically applicable.
Enjoy the wedding.
- Scott
Posted by polarbear206 on February 18, 2012, at 12:45:28
In reply to Re: lamicital with AD starting up, posted by never2late on February 17, 2012, at 23:25:28
> SLS,
>
> I am not taking 300 because my doc only wants me to change one thing at a time in order to gauge my response. I mentioned to him that I was feeling better once starting the 150 for 14 days then felt depression creeping back in the next 14 days with uneven moods throughout the day.
> huLu
> He told me the next two things he would like bme to try were lamictil, to help control the mood swings, and Intuniv ( you were right on the mark). I chose to start the lamictal first, as I have my sisters wedding coming up at the end of March and wanted to not be a sad sack on her special day. Intuniv might be down the road if the restlessness did not dissipate on its own. He said that the NE stimulation that might have positive effects on my brain might effect my body in negative ways. Thus the intuniv would counter that. This is my own words but I think thats what he was getting at.
>
> The other reason he was satisfied with the 150 effexor was because I had been feeling restless during the day, wired but tired at some points. He said that due to the fact that I was taking Concerta and Ritalin that my NE stimulation was sufficient at this time and wanted to see if my body adjusted to the effexor in the next 4 weeks and what the impact of the lamictal would be as an adjunct.
>
> He did say that after reaching 50 mg it would be very easy to determine if it was a good fit for me. He said he has used in a couple of patients and it was the missing piece of the puzzle in treating the depression and mood instability.
>
> Hi. Check out psycheducation.org....top left link for soft bipolar. Be very patient with titrating the lamictal...it's been, worth the wait for me...12 years of success on lamictal.....caution....mixing stimulants with ad's and mood stabilizers can counteract and set you up for failure thus caexacerbate moods My sweet spot is 200mg Lamictal and 300mg of effexor.
Posted by polarbear206 on February 18, 2012, at 12:52:35
In reply to Re: lamicital with AD starting up, posted by polarbear206 on February 18, 2012, at 12:45:28
Forgot to mention......it appears to me that you have a good pdoc...good luck :)
Posted by never2late on February 18, 2012, at 15:30:13
In reply to lamicital with AD starting up, posted by never2late on February 16, 2012, at 22:22:32
Thanks for the input everyone!
I checked the "soft bipolar" signs. Copying and pasting them here:
The patient has had repeated episodes of major depression (four or more; seasonal shifts in mood are also common).
The first episode of major depression occurred before age 25 (some experts say before age 20, a few before age 18; most likely, the younger you were at the first episode, the more it is that bipolar disorder, not "unipolar", was the basis for that episode).
A first-degree relative (mother/father, brother/sister, daughter/son) has a diagnosis of bipolar disorder.
When not depressed, mood and energy are a bit higher than average, all the time ("hyperthymic personality").When depressed, symptoms are "atypical": extremely low energy and activity; excessive sleep (e.g. more than 10 hours a day); mood is highly reactive to the actions and reactions of others; and (the weakest such sign) appetite is more likely to be increased than decreased. Some experts think that carbohydrate craving and night eating are variants of this appetite effect.
Episodes of major depression are brief, e.g. less than 3 months.
The patient has had psychosis (loss of contact with reality) during an episode of depression.
The patient has had severe depression after giving birth to a child ("postpartum depression").The patient has had hypomania or mania while taking an antidepressant (remember, severe irritability, difficulty sleeping, and agitation may -- but do not always -- qualify for "hypomania").
The patient has had loss of response to an antidepressant (sometimes called "Prozac Poop-out"): it worked well for a while then the depression symptoms came back, usually within a few months.
Three or more antidepressants have been tried, and none worked.
The only criterium that hit are the first two items and the last.
AD tried Prozac, Lexapro, Zoloft, Wellbutrin.
Now I am on effexor. My doc said that Prozac, lexapro, and Zoloft were all in the same family (SSRI) and wellbutrin is atypical basically just poor mans stimulant). I feel like the fact that I was prescribed the SSRIS by my GP and then the wellbutrin by my former quack PDoc is not really a good indicator that I have tried 3 or more and failed. So the last item is questionable.
Also the 9th point regarding symptoms of hypomania severe irrability difficulty sleeping, and agitation occured when I was using Cocaine in my early twenties and was unmedicated and when I placed on Welbutrin in combo with adderall.
There have been no real other signs of Mania in my life aside from the ones described above.
Most of my mood shifts revolve around depression and anxiety. I sink into depression at points during the day and get very nervous that my life decisions are all wrong and I am just going to repeat past patterns of behavior that caused me to fail which makes me hate myself.
That is the issue that the lamictal is trying to minimize, making the low points not as low. When I feel good, it is not a top of the world I am God feeling that I assume a manic episode would be like. Mine are more of just an at peace feeling that I am ok, and what I doing is the right thing to do, and that I am a good person. I feel content.
I hope the lamictal does the trick.
Curiously some of you mentioned 300 mg effexor being the "sweet spot" my doc actually said he might considered lowering the effexor dosage contingent with a positive response to lamictal.
It is an interesting hypothesis aboUt lamictals effects on DA. My doc did not mention this to me at all. I hope that it does because I feel like my part of my restless feelings are due to some kind of faulty reward mechanism in my psyche. I can complete a task or get an A on an exam, have a positive interpersonal interaction with someone and still feel unfufilled. I dont know if this is a chemical problem or something to be adressed with CBT, but it is a concern. It helps that I have a busy schedule and have lots to do because never feeling like anything is good enough keeps me really busy trying to fill that void that never seems to be filled.
I apologize for the lengthy post. I know no one likes to read a whole page. Thank you also for the reassurance that I have a good Pdoc, the last one took me for a ride.
Thanks again for everyones input. Again any questions or thoughts are much appreciated.
This is the end of the thread.
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