Posted by colin wallace on June 15, 2003, at 17:16:56
In reply to Re: Lamictal: Ron Hill, Ritch 'Q' and 'A' » fluffy, posted by Ron Hill on June 15, 2003, at 15:54:40
> Katy Fluff,
>
> > If I augement, would a pinch of Lithium do the trick? I know there are *many* meds to try. I just don't want to slip again.
>
> After rereading my initial response to this post of yours, I feel I should have shown a little more enthusiasm regarding your idea of adding some lithium to your current Lamictal.
>
> For some time I've thought that this might make a good combination for many bipolar patients, particularly those patients who struggle significantly with bipolar depression. Lithium would provide the bulk of the moodstabilization and Lamictal would provide the antidepressant contribution.
>
> This might be worth a trial after the conclusion of your study. On the other hand, Colin Wallace added some Lithobid to his Lamictal/Prozac combo a few days ago and, the last I heard, it's not working out very well. Perhaps you've seen Colin's post on this subject in a thread further down on the PB page. There was a time when I wished I could try a Lithobid/Lamictal combination because, although Lithobid does a real good job controlling my hypomania, it does little or nothing for my atypical depression. So I wanted to add Lamictal to treat my depression. However, Lamictal give me a nasty rash over a significant portion of my body. Now, however, it is a moot point since I have my depression problem (and my irritability problem) solved using nutritional supplements.
>
> It is my opinion, however, that you will need more than just a pinch of lithium. If I were you, initially I’d shoot for a blood level of about 0.4 mEq/l and increase, if needed to fully control your hypomania, to 0.6 mEq/l. But all of this is just my opinion.
>
Hi there Katy,Sorry, I seem to have missed this thread somehow.As you probably know(if you've scoured the dusty archives)I've been taking Lamictal for a year, with superb results.
It has been the only med., after of a multitude of treatment failures, to have any significant impact on my depression.In fact, I would say that Lamictal monotherapy did actually allow mw to achieve complete 'remission' after 3 or 4 months at 200mg.
However, in common with the experiences of quite a few others, I found that I needed to chase the dose to maintain the effects and prevent breakthrough depression.
I had decided early on that, if I reached 300mg and still felt the need to titrate, then at this stage I'd begin plans to augment with an AD, another moodstabilizer, or both.
In short, I gave it until 400mg before bringing in reinforcements in the form of Prozac, which allowed me to recapture the Lamictal effect with some consistency, and also to lower the dose back down to a manageable 250mg.
Insofar as augmentation is concerned, you do at least have plenty of options if called for;
lithium in concert with a low dose tricyclic AD is considered by some to be very effective(look for Maximus' posts in the archives).
Personally, I like the principle of this option, although lithium and I didn't hit it off.But it works like a charm for some.
A couple of us here have had success with adding a small dose of Prozac -interestingly,I was never able to tolerate it pre-Lamictal, yet now they seem to provide complementary effects.
To my mind, the biggest advantage offered by Lamictal is the relative freedom to try different augmentation strategies, without undermining your previous AD gains/stability.
I'd go with monotherapy for as long as is feasible,and plan ahead as necessary, should you find yourself running into high-end doses to achieve results.Best,
Col.
poster:colin wallace
thread:99976
URL: http://www.dr-bob.org/babble/20030614/msgs/234161.html