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
poster:circusboy
thread:739722
URL: http://www.dr-bob.org/babble/20070308/msgs/740178.html