Posted by PeterMartin on January 28, 2015, at 8:03:35
In reply to Re: Blood levels: Marplan + Lamictal vs Lamictal alone, posted by ed_uk2010 on January 28, 2015, at 4:10:25
> > Hey.
> >
> > After 5yrs of taking Marplan & Lamictal for Bipolar I/TRD I had to taper off and stop taking Marplan due insurance no longer covering it.
>
> Do they cover any other MAOIs? If so, do you plan to switch?
>
> >I know Lamictal levels are affected by most other medications....
>
> By several, but not by most... by any means.
>
> >Is it more likely that ceasing Marplan would lead to a raise in Lamictal blood levels or a lowering?
>
> I couldn't find any evidence that this has been studied. Regarding the related Nardil, I found some evidence to suggest that Nardil does *not* inhibit the metabolism of Lamictal.
>
> >I'm just wondering if some of my depression this week could be due to changes in my Lamictal levels and not only the return of MAO.
>
> It's possible, but to be honest, I think the return of uninhibited MAO is far more likely to be the reason for depressive symptoms appearing.
>
> Take care.Ed,
Thanks a lot for the reply. I think an old writeup about Lamictal clearance from Crazymeds (now found here: http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/LamictalPharmacokinetics ) is what I've been ruminating over. It mentions how the half life/levels can vary greatly/etc due to interactions. Had I only gotten down and not gotten so itchy I probably wouldn't be questioning it but the itching has been noticable.
My insurance (CVS caremark) dropped Marplan Jan 1st and they don't cover any others in the class. I couldn't tolerate Parnate (spiked BP each dose). Nardil would be expensive but potentially doable out of pocket. The other alt would be having my doctor write a letter of medical necessity and see if I get continued coverage.
It's been a fairly good ~5yrs run on Marplan but since my living situation has improved (living w a longtime GF vs. parents / etc) I'm optimistic about trying to see where I'm at without. I did take Lamictal prior to adding Marplan and it generally did a good job of keeping me from getting too low even when my life was pretty lonely.
I haven't added anything for depression per say but my doc did OK a trial of the 5ht2c agonist Lorcaserin (Belviq). It's recently trialed & approved for weight loss in the US but may also have some positive affects of mood. Reviews on some forums for the med seem to support this. Even if not losing some of the weight I've put on from meds will prob help me feel better about myself overall, stick to eating better, and find exercise more rewarding. Down ~10lbs in 3wks (229 to 219 - 6' male 37y) - some loss could be from stopping Marplan too although the my weight gain has been about 10lbs per year since I've taken it.
So yea again so if this reads jumbled (typing on my phone) but appreciate the reply. It may be a bumpy couple months but yesterday was much better than the few days before......probably just need to give my body a few weeks to adjust / get consistent levels to see if Lamictal is sufficient on it's own at this point.
poster:PeterMartin
thread:1075628
URL: http://www.dr-bob.org/babble/20150102/msgs/1075664.html