Psycho-Babble Medication Thread 57666

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Can one start lamictal while on geodon and zoloft?

Posted by katrina on March 27, 2001, at 9:32:39

Should lamictal really be started on it's own and the above added on later? What is lamictal like?

 

Re: Can one start lamictal while on geodon and zoloft?

Posted by SLS on March 27, 2001, at 19:03:16

In reply to Can one start lamictal while on geodon and zoloft?, posted by katrina on March 27, 2001, at 9:32:39

> Should lamictal really be started on it's own and the above added on later? What is lamictal like?

Hi Katrina,

Where did you see this?

Although I am not all-knowing, I can't think of any reason why you could not add Lamictal to any ongoing drug treatment. It is important to note, however, that when adding Lamictal to Depakote, the dosage of Lamictal must be cut in half, and the rate of dosage increased more gradually.

Lamictal is a drug originally developed for epilepsy, but has shown itself to be of benefit in bipolar disorder and depression. Lamictal acts as both a mood-stabilizer and an antidepressant. It works well for many people.

One must follow the prescribed schedule for the gradual increases in the dosage of Lamictal when treatment is first started. The body needs time to get used to it. This is true of many other drugs. With Lamictal, increasing the dosage too fast will occasionally produce a serious reaction that shows itself as a skin rash.


- Scott

 

Re: Can one start lamictal while on geodon and zoloft?

Posted by SalArmy4me on March 29, 2001, at 5:00:20

In reply to Can one start lamictal while on geodon and zoloft?, posted by katrina on March 27, 2001, at 9:32:39

Lamictal is probably the drug with the least side-effects known to mankind. But everyone who hasn't taken it is afraid of it due to a possible "rash"--so they suffer with a medication that has more side-effects. I have a one-man mission to prove that the fears over Lamictal (lamotrigine) rashes are unfounded. The chance of having a mild to moderate rash are 3%--according to clinical trials. But clinical trials done years ago do not necessarily predict the incidence of side-effects now. Besides, most of these rashes were due to taking a combination of Valproate and Lamictal, and they resolve without hospital stays. I believe that the chance of a seizure from Wellbutrin is much higher, and the chance of a hypertensive crisis with phenelzine is a little higher.

The chance of having a severe rash leading to hospitalization is reported as 0.3%. With those odds, it is easier to get hit by
lightening than it is to have a Lamictal rash. Point in case: You never hear in the paper about someone severely harmed
by Lamictal.

I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects. I believe that Lamictal will replace Lithium as the drug of choice in bipolar disorder in 10 years, due to its prominent antidepressant effect and benign side-effect profile.

 

not the rash issue

Posted by katrina on March 29, 2001, at 9:31:10

In reply to Re: Can one start lamictal while on geodon and zoloft?, posted by SalArmy4me on March 29, 2001, at 5:00:20

I'm not worried about the rash. Just wondering about starting it cuz I am not sure it's necessary as the AP's may be helpful for me. The SSRI's really aren't. I have had major depressive episodes, then agitated ones, then ups, flat, etc.

 

Re: not the rash issue

Posted by SalArmy4me on March 31, 2001, at 10:03:50

In reply to not the rash issue, posted by katrina on March 29, 2001, at 9:31:10

I'm tired right now, and I can't think straight. But one should think of Lamictal as an ANTIDEPRESSANT--which most people have not heard--and I will prove why when I'm awake.

> I'm not worried about the rash. Just wondering about starting it cuz I am not sure it's necessary as the AP's may be helpful for me. The SSRI's really aren't. I have had major depressive episodes, then agitated ones, then ups, flat, etc.

 

Re: Can one start lamictal while on geodon and zoloft? SalArmy4me

Posted by phillybob on April 1, 2001, at 23:26:58

In reply to Re: Can one start lamictal while on geodon and zoloft?, posted by SalArmy4me on March 29, 2001, at 5:00:20

> > I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects.

Sal, are you taking Lamictal as monotherapy? How much are you taking? You said "moderate" benefit ... what exactly does that mean?

I've been very slowly titrating Lamictal (up to 50 mg/day since starting at 12.5 mg/day on 3/5). I have been very sensitive to all meds I've ever taken, but thus far, do not even notice the Lamictal and don't even feel like I'm taking anything. Health improvement-wise, for me, has been only mild at best, and my patience is a tad thin, so I've just recently added Adderal for hopefully a little jumpstart. [Let's see if the initial positive reaction to this new input holds ... such never did last whenever I've had Ritalin in my system and now just practically "reject" such.]

P.S. I've read the term NEUROMODULATORY (on Medscape) used to describe Lamictal, Topamax and Neurontin. I kind of like that.

 

Re: Can one start lamictal while on geodon and zoloft?

Posted by SalArmy4me on April 3, 2001, at 2:44:54

In reply to Re: Can one start lamictal while on geodon and zoloft? SalArmy4me, posted by phillybob on April 1, 2001, at 23:26:58

I take 400 mg of Lamictal per day. It gets rid of anxiety, a tiny bit of depression, and OCD >

You have not taken the Lamictal for long enough to notice a difference: Steady-state blood concentrations of lamotrigine are achieved in 2 weeks or something.

Stick with it, and I promise you an improvement. I have a hunch about this thing.

 

Re: Can one start lamictal while on geodon and zoloft? SalArmy4me

Posted by Daky on June 2, 2001, at 11:20:46

In reply to Re: Can one start lamictal while on geodon and zoloft?, posted by SalArmy4me on April 3, 2001, at 2:44:54

> I take 400 mg of Lamictal per day. It gets rid of anxiety, a tiny bit of depression, and OCD >
>
I am so glad to hear that Lamictal has significant AD properties. My 20 year old daughter was put on Lamictal 2 weeks ago after having manic responses to first Celexa, then Zoloft. Her initial diagosis was GAD with OCD. She is ready to throw out all the medications because she believes they have caused her more problems than any benefits derived from them. I am encouraging her to stick it out and see how the Lamictal does. She is noticing some slight weight gain and breast enlargement and that is upsetting to her. I just read here that Lamictal can cause that. However, if the benefits are as great for her as they have been for you then she will have hope and right now she really needs that. Does anyone else have positive things to say about Lamictal?

 

Lamictal and SAMe

Posted by Miriamne on June 12, 2001, at 18:59:11

In reply to Re: Can one start lamictal while on geodon and zoloft? SalArmy4me, posted by Daky on June 2, 2001, at 11:20:46

All this info about Lamictal is very helpful. I posted a few weeks ago, mentioning my serious depression that we think is part of Bipolar II (I'm 90% convinced, anyway..).

I have been trying out SAMe (have been through a range of SSRIs and a couple of other drugs, but couldn't deal with the side effects) and am about to increase the dosage from 800mg to 1600mg. So far, it has done nothing for my mood, but has seemed to "activate" me so that I can at least do some rudimentary activities; I still feel hopeless and sad, though. My doctor wants me to see if the increase helps at all, with the possibility of adding Lamictal if I'm still feeling bad in 2-4 weeks.

Has anyone heard of combining these two meds? Should I be concerned about it? The descriptions I've heard about Lamictal so far make it sound almost perfect for me, but I don't know how it might be affected by the SAMe, if at all.
Thanks for any help--!
Miriamne

 

Re: Lamictal and SAMe Miriamne

Posted by Sulpicia on June 12, 2001, at 21:01:02

In reply to Lamictal and SAMe, posted by Miriamne on June 12, 2001, at 18:59:11

> All this info about Lamictal is very helpful. I posted a few weeks ago, mentioning my serious depression that we think is part of Bipolar II (I'm 90% convinced, anyway..).
>
> I have been trying out SAMe (have been through a range of SSRIs and a couple of other drugs, but couldn't deal with the side effects) and am about to increase the dosage from 800mg to 1600mg. So far, it has done nothing for my mood, but has seemed to "activate" me so that I can at least do some rudimentary activities; I still feel hopeless and sad, though. My doctor wants me to see if the increase helps at all, with the possibility of adding Lamictal if I'm still feeling bad in 2-4 weeks.
>
> Has anyone heard of combining these two meds? Should I be concerned about it? The descriptions I've heard about Lamictal so far make it sound almost perfect for me, but I don't know how it might be affected by the SAMe, if at all.
> Thanks for any help--!
> Miriamne


Hi -- just to be upfront here, my daughter takes lamictal for bipolar and it saved her life.
And she had *the rash*.
SAMe can cause mania or hypomania: lamictal is energizing and the combo might land you in orbit.
My real worry would be if SAMe might act to trigger a reaction to the lamictal-- see below:
http://www.mhsource.com/bp/meet0614.html

Question: Do you rechallenge lamotrigine if rash occurs the first time? (This was a difficulty with photosensivity.)

Dr. Ketter: This is the major deficit of Lamictal, the thing you have to be most careful about. I kind of view Neurontin as an
easy to use add-on and can help insomnia, pain, anxiety, but may not really hit the core of bipolar disorder. Lamictal in some
patients is a silver bullet, and you can get excellent responses. But these rashes are serious, and they occur in one in ten
patients, benign; and one in a thousand, serious. (Tegretol is one in ten, benign; and one 100,000, serious.) So the risk is
potentially greater than the risk with Tegretol, and the practice in the past with rashes was to increase the dose, add a little
antihistamine, and wait to desensitize people. We're still doing that in very-carefully selected cases in concert with very careful
dermatologic follow-up. Any patient that gets a rash on Lamictal that has a fever, any sort of systemic illness, any eye-mouth
involvement, pain on urination, that's a medical emergency. You want those people to go to the emergency room, and you
probably never want to do that again. The NIH study had a somewhat more rapid introduction of Lamictal than is in the
package insert. And in the response confirmation stage, the patient was given blind Lamictal and then blindly given it again, they
had one case of toxic epidermal necrolysis. The patient was in the burn unit for three weeks. So, potentially, it's an extreme
problem, yet a drug that can literally change people's lives.

We address it. We tell people not to start eating any new foods, don't start any new drugs, no new cosmetics, don't go out and
get poison oak on them, don't start within a week of having a viral syndrome, don't go out and get a sunburn. Anything that
could activate the immune system, we try to discourage people from getting into. Our prevalence of rash is about 3%.

Dr. Cutler: Yes, that's been my experience, too; 10% overall is probably high, some of that data came from out of the
epilepsy studies, too. So we've learned now that if you start lower and go more slowly, you do seem to decrease this incidence
of rash, but I absolutely agree that it is potentially a very serious problem. It should not be taken lightly.

I can tell you that I have rechallenged people successfully with Lamictal, although hopefully we are both giving you the flavor
that you should be careful in doing that. Again, the rashes Dr. Ketter mentioned, with any whiff of systemic illness, fever, any
mucosal membrane pathology, you should probably not rechallenge those people. But all rashes are not the same, most likely,
with this medication. Again, the only reason I would consider doing that is because this medicine has been so impressive, at
least to me. There are times when I would want to try to re-challenge the person, if I can, at either a lower dose with a very
slow titration, or go to a lower dose than they were on previously. I counsel patients very carefully about how to avoid other
potential rash inducers, like the sun, illnesses, plants, bees and other insects.
Question: Do you rechallenge lamotrigine if rash occurs the first time? (This was a difficulty with photosensivity.)

Dr. Ketter: This is the major deficit of Lamictal, the thing you have to be most careful about. I kind of view Neurontin as an
easy to use add-on and can help insomnia, pain, anxiety, but may not really hit the core of bipolar disorder. Lamictal in some
patients is a silver bullet, and you can get excellent responses. But these rashes are serious, and they occur in one in ten
patients, benign; and one in a thousand, serious. (Tegretol is one in ten, benign; and one 100,000, serious.) So the risk is
potentially greater than the risk with Tegretol, and the practice in the past with rashes was to increase the dose, add a little
antihistamine, and wait to desensitize people. We're still doing that in very-carefully selected cases in concert with very careful
dermatologic follow-up. Any patient that gets a rash on Lamictal that has a fever, any sort of systemic illness, any eye-mouth
involvement, pain on urination, that's a medical emergency. You want those people to go to the emergency room, and you
probably never want to do that again. The NIH study had a somewhat more rapid introduction of Lamictal than is in the
package insert. And in the response confirmation stage, the patient was given blind Lamictal and then blindly given it again, they
had one case of toxic epidermal necrolysis. The patient was in the burn unit for three weeks. So, potentially, it's an extreme
problem, yet a drug that can literally change people's lives.

We address it. We tell people not to start eating any new foods, don't start any new drugs, no new cosmetics, don't go out and
get poison oak on them, don't start within a week of having a viral syndrome, don't go out and get a sunburn. Anything that
could activate the immune system, we try to discourage people from getting into. Our prevalence of rash is about 3%.

Dr. Cutler: Yes, that's been my experience, too; 10% overall is probably high, some of that data came from out of the
epilepsy studies, too. So we've learned now that if you start lower and go more slowly, you do seem to decrease this incidence
of rash, but I absolutely agree that it is potentially a very serious problem. It should not be taken lightly.

I can tell you that I have rechallenged people successfully with Lamictal, although hopefully we are both giving you the flavor
that you should be careful in doing that. Again, the rashes Dr. Ketter mentioned, with any whiff of systemic illness, fever, any
mucosal membrane pathology, you should probably not rechallenge those people. But all rashes are not the same, most likely,
with this medication. Again, the only reason I would consider doing that is because this medicine has been so impressive, at
least to me. There are times when I would want to try to re-challenge the person, if I can, at either a lower dose with a very
slow titration, or go to a lower dose than they were on previously. I counsel patients very carefully about how to avoid other
potential rash inducers, like the sun, illnesses, plants, bees and other insects.


Might be worth the time to get the SAMe out of your system before you try.
Best,
S.

 

Re: Lamictal and SAMe

Posted by Bill L on June 13, 2001, at 8:11:12

In reply to Lamictal and SAMe, posted by Miriamne on June 12, 2001, at 18:59:11

I use SAM-e along with Celexa with very good results. SAM-e is not supposed to be used by bipolar people. But since you are already trying it under your doctor's supervision, I would go ahead and try 1600 mg to see what happens. If it is going to work for your depression, it should only take a week or so to see some improvement.

If you see some improvement but not enough, maybe it would be ok to add Lamictal. But be careful and closely monitor your feelings and start with low doses since you are combining drugs.

SAM-e alone activated me also but did not give enough relief from anxiety or depression. That's why I addded Celexa. But I never went as high as 1600 mg of SAM-e when I took it alone. So maybe that would have helped.

> All this info about Lamictal is very helpful. I posted a few weeks ago, mentioning my serious depression that we think is part of Bipolar II (I'm 90% convinced, anyway..).
>
> I have been trying out SAMe (have been through a range of SSRIs and a couple of other drugs, but couldn't deal with the side effects) and am about to increase the dosage from 800mg to 1600mg. So far, it has done nothing for my mood, but has seemed to "activate" me so that I can at least do some rudimentary activities; I still feel hopeless and sad, though. My doctor wants me to see if the increase helps at all, with the possibility of adding Lamictal if I'm still feeling bad in 2-4 weeks.
>
> Has anyone heard of combining these two meds? Should I be concerned about it? The descriptions I've heard about Lamictal so far make it sound almost perfect for me, but I don't know how it might be affected by the SAMe, if at all.
> Thanks for any help--!
> Miriamne

 

Re: Lamictal and SAMe -- Thanks

Posted by Miriamne on June 13, 2001, at 9:04:05

In reply to Re: Lamictal and SAMe, posted by Bill L on June 13, 2001, at 8:11:12

Thanks for the information, Sulpicia and Bill. I'm quite interested to hear that Lamictal is activating... actually, I'm sick and tired of being activated (makes it sound like I'm a robot getting my batteries recharged!) What I would like is to feel like there's a point to getting up in the morning and some relief from the self-hatred.

I'm concerned about the possible effects the SAMe could have in combination with the Lamictal if I do decide to add it . One reason my doctor suggested Lamictal was that I am an artist and am trying to avoid the "flattening" that seems to come with other mood-stabilizers. But it may just have to be endured... along with everything else.

I plan to keep reading and see where my next 2 weeks on SAMe takes me.
Thanks again,
Miriamne

 

Re: Lamictal and SAMe --Miriamne

Posted by Roo on June 13, 2001, at 12:33:07

In reply to Re: Lamictal and SAMe -- Thanks, posted by Miriamne on June 13, 2001, at 9:04:05

Miriamne--

I'd be curious to hear a little more about your
symptoms since they seem similar to mine. (I too
am an artist). I take neurotin, and it's not activating
for me (nor sedating), although it was a little activating
at first--had some trouble sleeping, but now it seems
to help me sleep. I don't feel flat on it. I'm not
bipolar (at least I don't think), just cyclothymic.
I take prozac too, for depression. Just got done
with a trial of sam-e--I only went as high as 600 mg's--
it didn't do much for my depression. It did help my
sore, arthritic feet though :-)
The neurotin helped some, I believe, in combination
with an AD, to cut back on the self hatred and ruminating
thoughts. My body seems to adjust to the neurotin
too quickly though, and I seem to need higher and higher
doses to keep that effect. I started gaining weight
at 1800 mg's, and I'm still getting an "ok" effect
from it (feel like it could be better), but I'm not
willing to go any higher b/c of the weight gain.
Mindfulness Meditation helps some with the self hatred and
negative thoughts, but that's a slower path than the
meds...hard work, but very gratifying....
Anyway, I'm rambling--tell me more about your symptoms
if you're up for it, and also keep me updated about
the lamactical--I've been curious about trying that one
too--

Take Care, Ruth

 

Re: Lamictal and SAMe --Miriamne

Posted by Miriamne on June 13, 2001, at 15:58:36

In reply to Re: Lamictal and SAMe --Miriamne, posted by Roo on June 13, 2001, at 12:33:07

Ruth:

Actually, my doctor suggested Neurontin first before he mentioned the Lamictal-- maybe I'll end up trying that, depending on where the next few weeks take me... I was interested to hear that it does not seem to "dull" your feelings. I will keep this in mind in the seemingly endless search for the right drug for me.

I'm not sure what level of detail you would like re my symptoms, but the short description would be that I am mostly depressed, alternating with periods of agitation (guess I got shortchanged in the euphoria department when they were handing out Bipolar II symptoms!). The depression is made up of overwhelming sadness, hopelessness, tiredness,a sense of being cut off from everything because it is either too emotionally painful or too much effort; the agitation is made up of anger (at myself and others), lack of focus, racing thoughts, restlessness, inability to concentrate or complete anything but the most basic tasks, and anything requiring decision-making is so difficult that I end up either crying or raging about it.

I suspect I will end up going back to some form of antidepressant plus a mood-stabilizer, and simply having to live with the side effects. It would be great if the SAMe helped, but I don't see any results yet with the "feeling" part of this-- it does get me moving, but that's not the whole story, of course, and if it moves me into agitation, that's not going to work for the long run, obviously. I hate the waiting, but we'll see.

I do appreciate your comments-- all of this is a big help. What kind of art do you make?
Sincerely,
Miriamne

 

Re: Lamictal and SAMe

Posted by PaulB on June 13, 2001, at 17:03:30

In reply to Lamictal and SAMe, posted by Miriamne on June 12, 2001, at 18:59:11

> All this info about Lamictal is very helpful. I posted a few weeks ago, mentioning my serious depression that we think is part of Bipolar II (I'm 90% convinced, anyway..).
>
> I have been trying out SAMe (have been through a range of SSRIs and a couple of other drugs, but couldn't deal with the side effects) and am about to increase the dosage from 800mg to 1600mg. So far, it has done nothing for my mood, but has seemed to "activate" me so that I can at least do some rudimentary activities; I still feel hopeless and sad, though. My doctor wants me to see if the increase helps at all, with the possibility of adding Lamictal if I'm still feeling bad in 2-4 weeks.
>
> Has anyone heard of combining these two meds? Should I be concerned about it? The descriptions I've heard about Lamictal so far make it sound almost perfect for me, but I don't know how it might be affected by the SAMe, if at all.
> Thanks for any help--!
> Miriamne

If SAM-E isnt doing much for you I shouldnt think adding Lamictal would cause any drug-drug or supplement-drug interaction in this case. Ive been on both together, having known beforehand SAM-E wasnt for me and there was not problem. I think youll find Lamictal helpful though. Its a damn fine mood stabiliser and possibily antidepressant too in and by itself.

 

Re: Lamictal and SAMe --Miriamne

Posted by chloe on June 13, 2001, at 17:43:17

In reply to Re: Lamictal and SAMe --Miriamne, posted by Miriamne on June 13, 2001, at 15:58:36

Miriamne
I have never tried Sam-E but I just tried Lamictal for two weeks. It was the worst experience I have had in a long time. I felt like I was plugged into a live outlet. I never got tired (insomnia!), never got hungry, I just needed to be moving ALL THE TIME. But when I would do things, like work or garden, I often found myself getting agrevated and annoyed. FYI, I am not bipolar, but have many of the things that you describe, a lot of emotional pain, agitation and instability.

I do not like activating drugs, and this one was for me. However, I have heard many people who do get good result from this drug. If you try it, I hope it works for you. But watch out if you like the sun, I got ithcy sun rashes after 5 minutes in the sun. I would have to live in a cave if I stayed on Lamictal!

Oh, lastly, I was put on Neurontin to counteract some of the agitation associated with Lamictal. Now, Neurontin I do like and I have continued with it. I sleep well, and am MUCH calmer and quieter inside. I also don't feel impaired. That's my experience anyway...

Best of luck,
chloe

 

Re: Lamictal and SAMe --Miriamne

Posted by Roo on June 14, 2001, at 13:55:30

In reply to Re: Lamictal and SAMe --Miriamne, posted by Miriamne on June 13, 2001, at 15:58:36


> Miriamne,

I do big colorful paintings...most of them contain
animals. The one I'm working on now has a bride cat
and a groom cat, a cat playing guitar and a bass player
cat. Basically a wedding scene, only it's cat's. The
bride and groom are dancing. So obviously, I don't
do realistic art.

I hope you find something that works for you. The
neurotin would be a good bet.

 

Re: Lamictal and SAMe --Miriamne

Posted by AMenz on June 15, 2001, at 13:11:32

In reply to Re: Lamictal and SAMe --Miriamne, posted by Miriamne on June 13, 2001, at 15:58:36

I am no expert because besides having a bipolar II spectrum almost identical to yours, with very rapid cycles (sometimes diurnal) I am also menopausical and therefore have estrogen involvement.

But let me tell you what I have found out by experience. Virtually every antidepressant no matter in what dosage leads to that ugly hyper mood state. Stabilizing on a mood stabilizer and taking out the anti-depressants or lowering them substantially will eventually stop you from cycling and of course both the highs and the lows will ameliorate.

I have just gone through 6 months of horrible cycling between a euthymic state followed by the same length of mixed mania (irritable, etc. as you described), I finally after research on my own initiative cut down on Zoloft from 100mg to 50mg and saw a huge amelioration in the cycling. I plan to go down to 25 mg as soon as I get the courage up for withdrawal symptoms.

However, let me say I'm chagrined because Zoloft does do wonders for anxiety and depression, and I've never felt better than on SSRI's. SAM-e seems to have the same cycling activation effect.

Do some research on the internet on bipolar depression. See what you come up with. But you cannot go by what the unipolars say about depression on this or any other forum, because they do not experience activation of manic or mixed states when they take AD's

I hope this helps.
> Ruth:
>
> Actually, my doctor suggested Neurontin first before he mentioned the Lamictal-- maybe I'll end up trying that, depending on where the next few weeks take me... I was interested to hear that it does not seem to "dull" your feelings. I will keep this in mind in the seemingly endless search for the right drug for me.
>
> I'm not sure what level of detail you would like re my symptoms, but the short description would be that I am mostly depressed, alternating with periods of agitation (guess I got shortchanged in the euphoria department when they were handing out Bipolar II symptoms!). The depression is made up of overwhelming sadness, hopelessness, tiredness,a sense of being cut off from everything because it is either too emotionally painful or too much effort; the agitation is made up of anger (at myself and others), lack of focus, racing thoughts, restlessness, inability to concentrate or complete anything but the most basic tasks, and anything requiring decision-making is so difficult that I end up either crying or raging about it.
>
> I suspect I will end up going back to some form of antidepressant plus a mood-stabilizer, and simply having to live with the side effects. It would be great if the SAMe helped, but I don't see any results yet with the "feeling" part of this-- it does get me moving, but that's not the whole story, of course, and if it moves me into agitation, that's not going to work for the long run, obviously. I hate the waiting, but we'll see.
>
> I do appreciate your comments-- all of this is a big help. What kind of art do you make?
> Sincerely,
> Miriamne


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