Posted by BarbaraCat on September 22, 2003, at 14:38:22
In reply to How does lamictal feel and how much does it help??, posted by DayByDay on September 22, 2003, at 8:08:11
Hello Day,
I have BP-2 with severe mixed states depression, and it may possibly be BP-1 but who'se counting. Was on SSRI's and other major depression meds for over 20 years thinking it was major unipolar depression. Had the standard SSRI poop out then aggravation with periodic hellish psychotic depressions even on large doses of SSRI's (all of 'em) before realizing it was classic BP mixed states.Went on Lithium and it didn't provide the AD relief, although it did relieve the psychotic nature of the depressions. Added Lam and it was great, no depression, no agitation. I'm hypothyroid and lithium aggravates that condition so I stopped lithium hoping, as you are, that Lamictal would provide adequate monotherapy. Within a short time I started experiencing the agitation and dread that heralds a mixed states coming on, along with frazzled disorganization. Lamictal was not enough to overcome the agitatation that lithium was keeping at bay, however the depression I eventually slid into was not as violently despairing as when I was on SSRI's.
The combo that has worked well for me was going back on Lithium and Lamictal. I'm currently on 600mg and 125mg respectively. It's taken care of the mixed states hell, although I still get depressed from time to time, but mildly and not despairingly or hopelessly so. Lithium 600mg is below my therapeutic window but anything above is deadening. Lamictal at 125mg is also somewhat low for the typical AD response. In my own experience and from I've read of others', both appear to potentiate each other. I don't know if this is true for other mood stabilizers along with Lam, but I've read numerous reports that it is so with Lithium.
How Lamictal feels (when combined with lithium). Going very slowly say 12.5mg a week I noticed a brightening effect within 1 week. Colors seemed brighter, more energy, more enthusiasm, almost speedy. When I wasn't on Lithium that effect quickly turned into driving hypomanic disorganization but on Lithium it was pleasantly buzzy but in control. I had to experiment until finding the right dose. I went up to 150mg at one point and felt absolutely on top of the freakin' world, wonderfully hypomanic but without the 'due paying' part. I also got severe itching - not the rash, but scary enough. Went down to 125mg, the itching subsided and I calmed down. The zingy sparkly effect has worn off but that's fine. I feel normal.
Bottom line, I don't believe that Lamictal is going to provide monotherapy for your depression, especially if it's the mixed states variety. I believe that mixed states is a particularly virulent and violent form of the disorder that needs stabilization on both polar ends - Lamictal being the more activating but destabilizing pole. If you were on other mood stabilizers unsuccessfully in the past but not with Lamictal, you might try the combo this time. You'll probably find, as I did, that combining the two will provide an entirely different med that is greater than the sum of it's parts. My thyroid aggravation notwithstanding, I like lithium very much as long as I'm just below the therapeutic blood serum level. If you are definitely BP, avoid SSRI type meds completely, with or without mood stabilizers. You might want to read "Why your depression isn't getting better" by M. Bartos. Very helpful in understanding the SSRI's vs. BP dynamic. - Barbara
>
> My question to Henry or anyone else is: How well does Lamictal monotherapy work with treating depression (I know you can use is as maintanence to prevent the recurrence of depression) I´m a
> BPIII meaning I can´t take SSRI´s only (at least the one´s I´ve tried) and adding
> moodstablisers to them doesn´t seem to help me from having mixed mania symptoms.
> - tried combining with depakote(which by the way made me psychotic, hallucinating and confused-really scary) zyprexa and lithium.
>
> When does the effect become noticable, when does it peak and how does it feel. Can Lamictal only
> help with anxiety and OCD as well???
poster:BarbaraCat
thread:261445
URL: http://www.dr-bob.org/babble/20030917/msgs/262432.html