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Re: Other options besides AAP for depression? SLS

Posted by psychobot5000 on November 15, 2011, at 10:39:21

In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 8:14:54

> > >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
> >
> > That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.
> Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.
> - Scott

I agree, of course, about the rapid improvements the drug can offer, and also that they disappear. However, I think any partial response is an illusion--based largely on the fact that, when the drug is withdrawn, you temporarily do worse (until your body readjusts to the new baseline). This is based, in part, on anecdotal watching of people on message boards over the years ("It doesn't seem to help, but then I get worse if I stop, so I guess I'll keep taking it."), part on a relatively recent trial against that prozac-zyprexa combination, the only decent numbers the drug has gotten, uh...ever, in a study designed to be extra short, so that Lamictal would still be titrating and thus wouldn't work as well as the other drug...missing the point that Lamictal ONLY works when it's still being titrated upward. And of course there's my own experience. There's a danger, of course, in extrapolating too much from one experience, and I usually try to avoid that, constantly qualifying, (i.e. "as with other drugs, mileage varies, so you'll just have to try it and see if it's helpful for you.")...but, consider this:

I get a response to EVERY antidepressant and augmentor I've ever taken. MAOis, every one I've ever taken (high dose selegiline, tranylcipromine (sp?) phenelzine), tricyclics, SSRIs, all the modern atypical antidepressants, as well as atypical antipsychotics, and even stimulants in a way (though their effect is different)...the list goes on for days. Also vagal nerve stimulation and cranial electrotherapy stimulation, St John's Wort (a little). They all make my depression recede (though stimulants only in proportion to your blood-levels of the drug at any given time). If you can name it and call it an antidepressant, it works for me. Here, in contrast, is the list of every antidepressant drug EVER that offered me no net benefit:

I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work. I very much doubt it works as an augmentor (for what it's worth, I've tried that, too). It does, however, offer many a transient (though very substantial!) benefit during upward titration, juxtaposed against a corresponding transient lowering of mood when the drug is discontinued or titrated downward. I think that's the entire story. Obviously, I don't know enough to be certain about that (no one does), but it all fits together pretty neatly and matches all the available evidence.




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