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Lithium And Lamictal Combo For Depression? (Am I Really Bp2?)

Lithium Lamictal

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#1 SpruceMoose

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Posted 16 August 2012 - 09:31 AM

Hello. I've been battling depression this year after being really stable on Lexapro for about 7 years.

I've gone through augmenting the Lex with Risperidone, switching to Viibryd, going back to Lex, switching P-Docs, getting on Effexor, getting off Effexor, ending up in a partial hospital program, getting put on Lithium, Lamictal and Prozac, discontiuing the Prozac after 2 weeks because I thought it was making me edgy...since then I've gone back to my P-Doc. I tried Zoloft, but I thought it made me irritable.

I've been at 200mg of Lamictal for more than a month now as well as the LIthuim. I thought something was making me mentally slow and/or stupid (memory, concentration, ummm). My P-Doc said she hasn't had any of those symptoms with Lamictal and Lithium was likely the culprit. We talked about adding Wellbutrin. Then I wanted to decrease the Lithium and it seemed to help but now I'm depressed and agitated. I called her and she said to go back up on the Lithium.

I just feel really scared. I am a single father with an eight year old son and I just started a new job at Starbucks that pays alot less than my career in video editing used to (that fizzled out). I guess some things that scare me about working at Starbucks is (1) the info retention of sooo much new stuff (2) remembering cutomer's names and drinks.

I felt like crying when I went through some of the training content because I felt like I could not remember anything.

I feel restless, scared, irritable and frustrated. I don't know if I trust my P-Doc anymore- Ideally, I would just like to go back on Lexapro and/or get a second opinion from a doctor and not deal with any of this shit anymore. I feel stupid that I've run down a long list of medications and I just want to feel stable like I used to.

Really sorry for the long rant, I guess the short of it is that I really don't understand why I'm on two mood stablizers for a BiPolar type 2 diagnosis, when I thought I had Major Depressive Disorder for so long. Am I crazy for wanting to be put on an SSRI again, even though I thought I couldn't tolerate some and my P-Doc says they weren't helping?
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#2 Velthir

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Posted 16 August 2012 - 09:52 AM

What were your reactions to Effexor/Viibryd? Might help to know/I'm curious.

As for the lithium/Lamictal, both can affect memory. If you've established it's mainly the lithium that's causing it, it might be worth seeing if your pdoc will let you go to a higher dose of Lamictal before moving the lithium down again. It has taken 250mg for me to be 'mostly' stable since it destabilised me/gave me horrible mixed states at lower doses despite me only being 'maybe' bipolar. Pretty sure I still need more.

Also you might find that the Wellbutrin you're taking helps destabilise you and that you might tolerate lower lithium levels if you stop it, might be worth bringing up with your pdoc as well.

As to why you're now bipolar, I think (not 100% sure and someone might correct me) that essentially you can be bipolar but only ever show depressive symptoms to start with which respond to ADs, then over time it gets worse and you might find that ADs start destabilising you or they don't work.

In my case I've been just depressed for 10+ years varying between dysthymia and major depression. Only started getting treatment a couple of years ago and basically every AD causes some major problem with me (irritability, completely screwed up sleep cycles, hypomania, mixed states, etc) even though I look unipolar without meds.

You've tried the majority of SSRIs and said they don't work or cause you problems, so I wouldn't have thought it would be worthwhile to try the one or two you have left. If you want to try another antidepressant, it might be worth looking at mirtazapine (Remeron).

Was Lexapro doing anything for you at when it was being augmented with risperidone? If it was helping a little it might be worth trying to augment that with the lithium or Lamictal, or Seroquel/Abilify which are both more antidepressant antipsychotics than risperidone
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Dx: Dysthymia, recurrent treatment resistant depression, Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), 600 mg of bupropion SR (Wellbutrin)
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: duloxetine (Cymbalta), nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine

#3 SpruceMoose

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Posted 16 August 2012 - 02:51 PM

Lexapro was helping when augmented with risperidone. I had to be on a really low dose (0.5 cut in half if I remember) but I guess my issue was that it felt like my brain turned into mush at around 8pm.

It wasn't tolerable then, but it sounds tolerable now.

Thanks for your response.
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#4 thewaytoneptune

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Posted 17 August 2012 - 06:51 PM

I can personally say that both cause cognitive dulling. It does get better with time, but it is very noticeable at first. Hang in there and give it a good go.
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#5 martasi2

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Posted 17 August 2012 - 09:36 PM

Am I crazy for wanting to be put on an SSRI again, even though I thought I couldn't tolerate some and my P-Doc says they weren't helping?


It's not wrong to want to know your PDoc's treatment strategy and if she's diagnosed you w/BP2. It's only fair to know why you're on these particular meds. I'm not criticizing your meds or the PDoc, just saying that you're entitled to know why they've been prescribed. You always have the right to seek other treatment if you don't have confidence in your doctor. But I think you need more information from your PDoc.
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#6 Molari

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Posted 20 August 2012 - 12:15 PM

I don't know if this applies to your situation, but here are things I've tried around avoiding mental dullness and memory problems.

1. I've been taking a folic acid supplement since I started lamictal. I don't know what the research is on this (I imagine it's weak) but my experience with methotrexate (another folic-acid antagonist) has led me to believe that there's an effect the research isn't capturing. There's that vitamin D thing too. http://www.crazymeds...ideEffects#toc6

2. I titrated down my clonopin. I was having a lot of trouble getting my thoughts organized at work, so I skipped it for a day. Then my brain worked normally! I started back on a lower dose and after a few days it built up again, same routine. Now I'm on a quarter of what my pdoc first prescribed with a prn for breakthrough and I'm not dropping nearly as many balls.

I don't know if your clonopin is daily or prn, but even a prn clonopin will stick around in your system for a while. It's possible that with starting new medications your body could be responding to it differently so even if you've been on it for a long time, that's what I'd play around with first. Also you get to find out pretty quickly if that's the problem.
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#7 SpruceMoose

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Posted 21 August 2012 - 08:24 AM

Thanks for the feedback.

I also been taking a folic acid supplement, but I was still getting the stupids. I looked into how the supplement might have been absorbed and looking into getting foods rich in folic acid, but...I didn't go that far. I was too drowsy/lethargic/depressed.

I have been cutting down my lithium after starting a job at Starbucks. Unfortunately, I have a lot of opening shifts, where I have to be there at 430am and need to be alert for the 7am to 9am rush. I got stuck on stupid to a point where it felt like my brain crashed

I decided to skip my morning dose of Lith and did better today (Monday). I don't want the depression to creep back in, fingers crossed.

The agitation, irritability, anxiety from Wellbutrin subsided after a little bit more than 2 weeks to my suprise. I wonder if I'm going to go up to 300mg...

I am definitely looking into a 2nd opinion on the meds (and was really obsessing about getting someone to properly take me off he mood stabilizers), but thankfully it doesn't seem as urgent anymore...for now....or perhaps there's something to be said about me forgetting my depressive episodes on Friday and Saturday.

Velthir- I meant to respond to your inquiry about Effexor/Vybriid.

Vybriid - I honestly don't remember too many of the specifics of my Vybriid experience- it just didn't seem like it was helping, or perhaps it was that my old pdoc took me off Lexapro in 2 days and then the Vybriid. Some SSRI discontinuation definitely happened there. I don't remember exactly why I stopped Vybriid- it might have been side effects...I was very skeptical about being on something so new at the time. I didn't trust my pdoc anymore as well. 40mg dose and talking to my pdoc.

Effexor was awful for me. I'm sure it does wonderful things for some people but I remember telling my pdoc I felt like I was going crazy and she kept saying to stick it out. After 6-7 weeks I said I didn't want to be on it anymore and then the dosage reduction began. Luckily, my pdoc was familiar with the method of cutting back slowly, but I ran into trouble stopping the 37.5mg dose. I felt like I went into an fatigued black hole for a number of days when I tried to stop. My pdoc was thankfully open minded about the issue. I believe I got some Wellbutrin 20mg SR tablets that I took for a week. The following week I took 10mg SR tablets and got off of it.
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#8 Urania60

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Posted 22 August 2012 - 02:24 PM

I really empathize with you memory issues. It has taken several months, but my memory on lamictal and lithium has improved. But several months is hard to imagine when you have to go to work every day.

Changing your lithium dosage, even if it is just when you take it, is kind of dangerous. The effectiveness of lithium is based completed on the level in your blood. There is a *very* small range in which it is effective; too low a level and it is ineffective, too high a level and you are toxic. My doc checks my blood every 3 months to make sure I'm in the sweet spot. My thyroid medicine and high blood pressure medicine affect the lithium level.
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#9 Nurse Ratched

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Posted 24 August 2012 - 08:47 AM

More than any other med, lithium gave me the stupids. Much improved after the first few weeks, but it was really terrible. I expect that more time or higher dose of wellbutrin might be the answer.
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Current Meds: Topamax 200 mgs, Seroquel XR 300 mgs, Wellbutrin 300 mgs, Vistaril 50 mgs x4, Klonopin .5 mgs, Ambien CR 12.5 mgs

Former meds: Paxil, Zoloft, Effexor, Remeron, Elavil, Abilify, Lamictal, Geodon, Zyprexa, BuSpar, Xanax, Depakote, Trazodone, Ambien, Lithium, Risperdal, Doxepin,  Cogentin, Haldol, Saphris, Latuda, Neurontin, Lexapro.


#10 thegron

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Posted 25 August 2012 - 08:20 AM

I took 25mg of Lamictal for 2 weeks and then bumped it up to 50mg. 6 days into my 50mg week (was about to increase to 75mg the next day) the cognitive dulling (the stupids!) sank in over the course of that day. It was very noticeable because of how suddenly it came over me. I eliminated all possible causes and I know it was the Lamictal. About 5 days later I stopped the Lamictal all together (with authorization of course). Today is my 11th day off of it completely and I still don't feel normal. The brain fog is still pretty bad. Now, it was definitely a lot worse last week so I think it is gradually improving, but it is odd that it is lingering. I have talked to a lot of people who have experienced the same problem. Some said it took a few weeks, some said a month, some said three months, some even said six months, but the point is, eventually they all felt better. Anyway, I hope that my memory continues to improve but it seems to have pleatued a bit (of course that doesn't mean it won't continue to gradually get better).

Btw SpruceMoose, adding wellbutrin probably won't help much... I have been taking Provigil for a couple days and it seems to be giving me some slight relief from the brain fog but the memory is still pretty bad. Could be worth a try.

Anyone else experience this lingering nonsense?
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#11 Rane

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Posted 26 August 2012 - 02:06 PM

What's your Lithium blood serum level?

What's the feeling about folic acid and Vitamin D? Does it work for any of you? I'm starting to take stupid for granted.....
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Lithium (0.9 @ 750mg/day), Lamotrigine (400mg/day), Levoxyl (88 mcg), Lorazapam (prn).

Fails: amitriptyline, zoloft, prozac, wellbutrin, depakote

#12 thegron

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Posted 26 August 2012 - 08:16 PM

What's your Lithium blood serum level?

What's the feeling about folic acid and Vitamin D? Does it work for any of you? I'm starting to take stupid for granted.....


I think it mainly depends on what the cause of your cognitive impairment is. Both Lithium and Lamictal can lower folic acid levels when they are used long-term. If that is the case, then folic acid supplementation could be very helpful. Keep in mind that if you are planning on using an ancillary dose larger than 1mg/d, you need to be taking some vitamin B12 as well.

I doubt the Vitamin D would help, unless you were deficient (and a lot of people are). But I wouldn't recommend taking more than 2000 IU's a day. It can be dangerous.

All in all, these drugs tend to cause some level of neurodegeneration. I'll post a link to a study below that explains this in greater detail.

http://www.medical-r...rics-papers/261
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#13 Rane

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Posted 27 August 2012 - 08:45 AM

All in all, these drugs tend to cause some level of neurodegeneration. I'll post a link to a study below that explains this in greater detail.

http://www.medical-r...rics-papers/261



Thanks, thegron. I appreciate the article. I didn't realize that Lamotrigine caused so much neurodegeneration.

Question: If Lithium is neuroprotective, does it balance some of Lamotrigine's neurodegeneration?

The article emphasized an "enriched environment" that counteracts (?) neurodegeneration. I wish they described that more clearly -- like in a detailed, bulleted list! I imagine it's some of the things my therapist advises: nutrition, activity, intellectual engagement, exercise and mindfulness (not that the poor rats practiced mindfulness).

I've been on Lithium over ten years and Lamictal around eight. My brain is much slower than it was, and that's been a good thing, but I think I have to think about supplements and an "enriched environment."
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Lithium (0.9 @ 750mg/day), Lamotrigine (400mg/day), Levoxyl (88 mcg), Lorazapam (prn).

Fails: amitriptyline, zoloft, prozac, wellbutrin, depakote

#14 Velthir

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Posted 27 August 2012 - 08:59 AM

The linked article says "While new AEDs such as topiramate (40㎎/㎏) and lamotrigine (80㎎/㎏) caused apoptotic neurodegeneration and decreased expression of BDNF and NT-3 only at high dose levels. Neurogenesis increased in the rats treated with valproate (50㎎/㎏, 212±43, t=3.39 P<0.01) and lamotrigine (20㎎/㎏, 195±18, t=4.23 P0.05)." I'm not sure in practice how that relates to humans since lamotrigine isn't normally dosed per weight, but it's going to be a lot less than 50mg/kg. Nerogensis is one of the theories as to how lamotrigine works for depression, along with the glutamate thing.

If you search for lamotrigine and neurogenesis there's a few articles, along with a few saying it actually prevents neurodegeneration due to other factors.

Folic acid is possibly worth trying though.

Edited by Velthir, 27 August 2012 - 09:02 AM.

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Dx: Dysthymia, recurrent treatment resistant depression, Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), 600 mg of bupropion SR (Wellbutrin)
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: duloxetine (Cymbalta), nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine

#15 martasi2

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Posted 27 August 2012 - 10:12 AM

All in all, these drugs tend to cause some level of neurodegeneration. I'll post a link to a study below that explains this in greater detail.

http://www.medical-r...rics-papers/261


thegron,

This links to a site called "Medical Research Papers" with someone's article about a rat study. I didn't find any authors, clinics, citations or references that would authenticate it. Can you provide more info about this study?
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#16 VAL

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Posted 27 August 2012 - 12:18 PM

Veltair,

Neurogenesis increased in the rats treated with valproate (50㎎/㎏, 212±43, t=3.39 P<0.01) and lamotrigine (20㎎/㎏, 195±18, t=4.23 P0.05)."


Although it does indicate neurogenesis it also had this to say :

Interestingly, VPA and LTG cause increased neurogenesis in dentate gyrus with an absence of mossy fiber sprouting. These findings present one possible mechanism to explain cognitive impairment associated with exposure of humans to antiepileptic therapy.

which would seem to indicate that it's a problem in some areas of the brain.

My own experience with lamictal has not been consistent with the finding of this study as the cognitive impairment I experienced in the beginning eventually abated and I'm pretty well back where I was pre lamictal except that some things, such as short term memory, have actually improved...perhaps the AAP's or Wellbutrin or from the neurogenesis described in lamictal use.
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Current Meds: Lamictal 300mg, Wellbutrin XL 450mg, Neurontin 900mg, Klonopin 1.5mg,  Trazodone up to 300mg and Inderal 20mg PRN
Past Meds: Siniquan, Elavil, Imipramine, Zoloft, Seroquel, Abilify, Nardil, Emsam, Rozerem, Celexa and Ambien
Current Non-psych: Soma 350mg PRN, Norco 10mg/325 PRN, Percocet 10mg/325 PRN, Advair, Nasonex, Ventolin PRN, Allegra, Benicar, Dexilant, Levothroxine, Pravachol and Nexium. 


#17 Velthir

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Posted 27 August 2012 - 03:23 PM

Yeah, I had transient cognitive impairment at dose increases and such and have probably actually had marginally better memory at times (when I've actually been sleeping).
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Dx: Dysthymia, recurrent treatment resistant depression, Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), 600 mg of bupropion SR (Wellbutrin)
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: duloxetine (Cymbalta), nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine

#18 thegron

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Posted 27 August 2012 - 06:39 PM


All in all, these drugs tend to cause some level of neurodegeneration. I'll post a link to a study below that explains this in greater detail.

http://www.medical-r...rics-papers/261



Thanks, thegron. I appreciate the article. I didn't realize that Lamotrigine caused so much neurodegeneration.

Question: If Lithium is neuroprotective, does it balance some of Lamotrigine's neurodegeneration?

The article emphasized an "enriched environment" that counteracts (?) neurodegeneration. I wish they described that more clearly -- like in a detailed, bulleted list! I imagine it's some of the things my therapist advises: nutrition, activity, intellectual engagement, exercise and mindfulness (not that the poor rats practiced mindfulness).

I've been on Lithium over ten years and Lamictal around eight. My brain is much slower than it was, and that's been a good thing, but I think I have to think about supplements and an "enriched environment."


Hmm... probably not because just because one is neuroprotective and one is neurodegenerative doesn't mean they act in the same location in the brain.

Yeah I found it a little irritating that they did not explain the enriched environement in greater detail. I looked it up online. It is pretty difficult to create an enriched environment imo but I think for now, you can try and consistently challenge your mind and stimulate it with interesting intellectual material that you enjoy.

You could try certain nootropic substances such as Piracetam (always take it with a choline supplement as well), Sulbutiamine, Meclofenoxate, Ginkgo Biloba, Lion's Mane, etc. All in all though, these supplements will only help so much imo. For neurogenesis specifically, the Piracetam (with choline!) and Lion's Mane are your best options.

The linked article says "While new AEDs such as topiramate (40㎎/㎏) and lamotrigine (80㎎/㎏) caused apoptotic neurodegeneration and decreased expression of BDNF and NT-3 only at high dose levels. Neurogenesis increased in the rats treated with valproate (50㎎/㎏, 212±43, t=3.39 P<0.01) and lamotrigine (20㎎/㎏, 195±18, t=4.23 P0.05)." I'm not sure in practice how that relates to humans since lamotrigine isn't normally dosed per weight, but it's going to be a lot less than 50mg/kg. Nerogensis is one of the theories as to how lamotrigine works for depression, along with the glutamate thing.

If you search for lamotrigine and neurogenesis there's a few articles, along with a few saying it actually prevents neurodegeneration due to other factors.

Folic acid is possibly worth trying though.

Keep in mind that just because it has neuroprotective properties in one part of the brain doesn't mean it isn't neurodegenerative in another.

All in all, these drugs tend to cause some level of neurodegeneration. I'll post a link to a study below that explains this in greater detail.

http://www.medical-r...rics-papers/261


thegron,

This links to a site called "Medical Research Papers" with someone's article about a rat study. I didn't find any authors, clinics, citations or references that would authenticate it. Can you provide more info about this study?

I wish I could... I don't even remember how I found this study (damn lamictal stupids... Either I found it or someone on another forum showed it to me. I would try copying the name of it and pasting it in google or google scholar.

Veltair,

Neurogenesis increased in the rats treated with valproate (50㎎/㎏, 212±43, t=3.39 P<0.01) and lamotrigine (20㎎/㎏, 195±18, t=4.23 P0.05)."


Although it does indicate neurogenesis it also had this to say :

Interestingly, VPA and LTG cause increased neurogenesis in dentate gyrus with an absence of mossy fiber sprouting. These findings present one possible mechanism to explain cognitive impairment associated with exposure of humans to antiepileptic therapy.

which would seem to indicate that it's a problem in some areas of the brain.

My own experience with lamictal has not been consistent with the finding of this study as the cognitive impairment I experienced in the beginning eventually abated and I'm pretty well back where I was pre lamictal except that some things, such as short term memory, have actually improved...perhaps the AAP's or Wellbutrin or from the neurogenesis described in lamictal use.


I'm jealous VAL. Tomorrow will be 12 days off Lamictal completely and my memory is still f'ed... Every day it sticks around makes me more afraid that it is permanent... :(

Edited by thegron, 27 August 2012 - 06:43 PM.

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