![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SLS on April 9, 2004, at 9:32:30
Hi.
Just an idea.
I am currently investigating how I respond to memantine (Namenda). I am trying to treat a severe depression that most likely fits somewhere along the bipolar spectrum. I had thought to do this for several reasons, one of which is that I maintain a partial antidepressant response to lamotrigine (Lamictal). Both lamotrigine and memantine possess properties that facilitate the reduction in the activity of glutamatergic neurons, albeit through different mechanisms. It is far too early for me to pronounce the addition of memantine to my drug regime a success, but I am encouraged with how I have been feeling over the last few weeks. I will continue to post of my progress.
It might be that for some of those people treating depression with lamotrigine who maintain a partial response to it, there might be a benefit from the addition of memantine or using memantine as a substitute for lamotrigine.
Crossing my fingers...
- Scott
Posted by f l y on April 9, 2004, at 20:45:35
In reply to Partial response to Lamictal - memantine?, posted by SLS on April 9, 2004, at 9:32:30
does lamictal cause sedation about an hour after taking dose? what made you go to 300mg? are evenings uncomfortable?
best to ya,
fly
Posted by SLS on April 10, 2004, at 10:02:05
In reply to Re: Partial response to Lamictal » SLS, posted by f l y on April 9, 2004, at 20:45:35
Hi Fly.
> does lamictal cause sedation about an hour after taking dose?
No. I don't think I have ever experienced this.
> what made you go to 300mg?
200mg gave me some relief from depression initially, but it faded. 300mg seemed to recapture the improvement.
> are evenings uncomfortable?
No. My worst time of day is between 1:00pm and 3:00pm. That is a bit unusual for a depressive diurnal variation. Usually, people are either at their worst in the morning (endogenous melancholic unipolar depression) or in the evening (atypical unipolar and bipolar depression)
> best to ya,
Back at ya'.
- Scott
Posted by Emme on April 10, 2004, at 11:57:45
In reply to Partial response to Lamictal - memantine?, posted by SLS on April 9, 2004, at 9:32:30
Hi Scott,
How ya doin'? I am finally trying memantine now. How long has it taken you to notice any improvement? Do you find it very activating? If so, has that faded?
2.5 mg made me jittery. 1.25 still a bit much. I took a break for a few days and now I'm trying 1.25 mg every other day and I've been doing that for about a week. I don't notice any benefit yet. Like you, I have partial response to Lamictal for severe depression in the bipolar spectrum.
I hope your progress continues!
Emme
> Hi.
>
> Just an idea.
>
> I am currently investigating how I respond to memantine (Namenda). I am trying to treat a severe depression that most likely fits somewhere along the bipolar spectrum. I had thought to do this for several reasons, one of which is that I maintain a partial antidepressant response to lamotrigine (Lamictal). Both lamotrigine and memantine possess properties that facilitate the reduction in the activity of glutamatergic neurons, albeit through different mechanisms. It is far too early for me to pronounce the addition of memantine to my drug regime a success, but I am encouraged with how I have been feeling over the last few weeks. I will continue to post of my progress.
>
> It might be that for some of those people treating depression with lamotrigine who maintain a partial response to it, there might be a benefit from the addition of memantine or using memantine as a substitute for lamotrigine.
>
> Crossing my fingers...
>
>
> - Scott
Posted by Emme on April 10, 2004, at 12:10:33
In reply to Partial response to Lamictal - memantine?, posted by SLS on April 9, 2004, at 9:32:30
Oh, one other question. Do you think memantine is having any effect on your level of motivation?
I'm dismayed when I realize how much of my edge I've lost. I used to get a lot of things done, and pursued work, play, etc. more agressively. Not that I've ever been *super* high energy, but I was more actively involved in life in general. Now, well, a lot of that is gone. And I'm not sure if it's an issue for medicine, or just a cumulative fatigue from being beaten up by depression - in which case it might resolve if life ever gets straightened out. And I'd like to be able to concentrate and think again. But I ramble.
Thanks,
Emme
Posted by Emme on April 12, 2004, at 8:31:07
In reply to Re: Partial response to Lamictal - memantine? » SLS, posted by Emme on April 10, 2004, at 11:57:45
Hi Scott,
How ya doin'? I am finally trying memantine now. How long has it taken you to notice any improvement? Do you find it very activating? If so, has that faded?
2.5 mg made me jittery. 1.25 still a bit much. I took a break for a few days and now I'm trying 1.25 mg every other day and I've been doing that for about a week. I don't notice any benefit yet. Like you, I have partial response to Lamictal for severe depression in the bipolar spectrum.Also, do you notice any improvement in motivation with the memantine?
I hope your progress continues!
Emme
> > Hi.
> >
> > Just an idea.
> >
> > I am currently investigating how I respond to memantine (Namenda). I am trying to treat a severe depression that most likely fits somewhere along the bipolar spectrum. I had thought to do this for several reasons, one of which is that I maintain a partial antidepressant response to lamotrigine (Lamictal). Both lamotrigine and memantine possess properties that facilitate the reduction in the activity of glutamatergic neurons, albeit through different mechanisms. It is far too early for me to pronounce the addition of memantine to my drug regime a success, but I am encouraged with how I have been feeling over the last few weeks. I will continue to post of my progress.
> >
> > It might be that for some of those people treating depression with lamotrigine who maintain a partial response to it, there might be a benefit from the addition of memantine or using memantine as a substitute for lamotrigine.
> >
> > Crossing my fingers...
> >
> >
> > - Scott
>
>
Posted by SLS on April 12, 2004, at 8:48:38
In reply to To Scott - memantine...., posted by Emme on April 12, 2004, at 8:31:07
Hi Emme.
> 2.5 mg made me jittery. 1.25 still a bit much. I took a break for a few days and now I'm trying 1.25 mg every other day and I've been doing that for about a week.
Wow. You certainly are sensitive to this med. I experienced nothing like that. I started with 5mg and raised the dosage by 5mg each week. I am currently taking 20mg.
> I don't notice any benefit yet.
I experienced a "blip" response over the first few days at 5mg. This phenomenon sometimes prognosticates a good latent response. I had to wait another 3 before I felt any improvement again.
Current meds:
imipramine 300mg
Lamictal 300mg
Zoloft 200mg
Abilify 10mg
memantine 20mgI'm not doing so well right now. I tried to discontinue Zoloft in order to test whether it was a necessary component of my positive response. Apparently, it is. I raised the dosage back up to 200mg yesterday, and I am beginning to feel a bit better. I was hoping to avoid the sexual side-effect of reduced libido that Zoloft is responsible for.
> Also, do you notice any improvement in motivation with the memantine?
Yes. I would say that I experienced a global improvement of all my symptoms of depression. Hopefully, I'll be able to recapture the antidepressant response and watch it grow.
> I hope your progress continues!Thanks.
- Scott
Posted by Emme on April 12, 2004, at 20:28:33
In reply to Re: To Scott - memantine...., posted by SLS on April 12, 2004, at 8:48:38
Hi Scott,
> Wow. You certainly are sensitive to this med. I experienced nothing like that. I started with 5mg and raised the dosage by 5mg each week. I am currently taking 20mg.
I'm sensitive to just about everything. And on top of that, sometimes my energy levels shift enough (jittery/anxious vs. sluggish) that something may make me jumpy one time but less so another time. It must be part of whatever subtle bipolar tendencies I have.
> I experienced a "blip" response over the first few days at 5mg. This phenomenon sometimes prognosticates a good latent response. I had to wait another 3 before I felt any improvement again.
Hmmm...so you did feel *something* within a week or so. I think I'm going scootch up the dose a bit and see if my body is adjusting. BTW, great use of an SAT word! Prognosticate. I like it. :)
> Current meds:
>
> imipramine 300mg
> Lamictal 300mg
> Zoloft 200mg
> Abilify 10mg
> memantine 20mgQuite the witches' brew. I think that if any of us ever gets a combo that works, we ought to name it, as they did with CA Rocket Fuel! I see you have both a TCA and an SSRI. You've found it helpful to use them together?
> I'm not doing so well right now.
I'm really sorry to hear that.
> I tried to discontinue Zoloft in order to test whether it was a necessary component of my positive response. Apparently, it is. I raised the dosage back up to 200mg yesterday, and I am beginning to feel a bit better.
I hope you continue to do better. I see a lot of people mentioning combining Lamictal and Zoloft. I'm sorely tempted to try it. But we're not sure about me and SSRIs. Paxil was fabulous as the first drug I ever used. But in a couple of subsequent trials, I either had outbursts of rage, or turned into a zombie, even with Lamictal and clonazepam on board. Celexa helped, then my mood slipped and got a bit erratic a few weeks later, and I was so cold it was intolerable. Zoloft - tried it once (solo) and it did nothing but make me jittery. But....the desperate part of me always thinks "Gee, maybe this or that combined with an SSRI would be exactly right...." But mebbe not.
> Yes. I would say that I experienced a global improvement of all my symptoms of depression. Hopefully, I'll be able to recapture the antidepressant response and watch it grow.
That's encouraging. I desperately need my mood to be less hopeless. I'll plod along a bit more with the memantine and see if I can take a higher dose. Too many more days like today and there won't be much left of me.
Hang tight, and I hope the upward trend continues.Emme
Posted by SLS on April 13, 2004, at 8:03:42
In reply to Re: To Scott - memantine.... » SLS, posted by Emme on April 12, 2004, at 20:28:33
Hi Emme.
> Hmmm...so you did feel *something* within a week or so. I think I'm going scootch up the dose a bit and see if my body is adjusting.
Based on my experience with memantine so far, I would say that it is worth pursuing.
> I see you have both a TCA and an SSRI. You've found it helpful to use them together?
Not helpful enough, obviously, but it is certainly a reasonabe thing to try. One must be aware that Paxil (paroxetine) can cause the blood level of TCA to increase dramatically, requiring a reduction in the dosage of the TCA.
What is it about your condition that indicates bipolarity?
> Hang tight, and I hope the upward trend continues.
Thanks for the encouragement! :-)
I hope things turn around for you soon. It is hard to be patient with these lengthy drug trials when you are feeling so miserable. <grimace>
Did I mention in one of my previous posts that the NIMH is conducting a trial of memantine for depression?
http://www.clinicaltrials.gov/show/NCT00040261
Best wishes.
- Scott
Posted by Emme on April 13, 2004, at 12:21:13
In reply to Re: To Scott - memantine...., posted by SLS on April 13, 2004, at 8:03:42
Hi Scott,
> Based on my experience with memantine so far, I would say that it is worth pursuing.
I'll keep at it a bit. I don't think I've been at it long enough at a high enough dosage to be a fair trial yet.
> What is it about your condition that indicates bipolarity?
Ready? Here goes. :)
My pdoc feels there are several subtle signs that, taken together, point to some bipolar component. Profound anxiety and lots of sleep problems. Multiple poop-outs and inconsistent responses on ADs. I've had the best relief from ADs, but they seem to go south on me.
I've had mood cycling that doesn't actually involve going hypomanic per se. My therapist and I realized I seem to have two modes. In one mode I'm very sluggish, profoundly depressed. In the other mode, I'm keyed up, anxious, stressed, hypersentitive to noise, but still depressed. In my more agitated states, I've left orange smears on the office carpet by hurling carrots out into the hall.
My thoughts don't normally "race", though I have often been driven to distraction by worried, negative thoughts swooshing around in my head.
I did have a wee hypomanic time for about four days that had something to do with a mall.... There have been a few other times when I felt like the world was going too slowly. If I think the traffic where I live is too slow, then something's wrong. I've nipped it in the bud with a dash of seroquel. Several weeks ago I think I was flat out manic for an evening, with some wicked agitation in the days before and after. Hard to say how much of it was due to med changes....
So anyway, I'm nowhere near BP1, and don't have as pronounced hypomanic features as many BP2 people, but my depression isn't entirely straightforward either.
> I hope things turn around for you soon. It is hard to be patient with these lengthy drug trials when you are feeling so miserable. <grimace>Agreed. sigh.
> Did I mention in one of my previous posts that the NIMH is conducting a trial of memantine for depression?
Thanks. I'll be interested to see how the it turns out...
Whoa. Thunder.. Gotta split and unplug my computer.
Keep haning in there!
Emme
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.