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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Cindylou on December 16, 2001, at 14:41:51
Hello,
I have had a hard time tolerating ADs in the past -- particularly the SSRIs and Effexor. I usually experience a large increase in depression and unmanageable fatigue for the first few weeks; then the depression lifts, but the fatigue remains.I am wondering if I may have a different (better) reaction to them now that I am on 100 mg of Lamictal.
Or, does anyone know of an antidepressant that does well in combo with Lamictal?
Thanks in advance for any info.
-cindy
Posted by ivoovi on December 16, 2001, at 16:09:12
In reply to Need to add an AD to Lamictal ... suggestions?, posted by Cindylou on December 16, 2001, at 14:41:51
Hey...have you tried wellbutrin? if SSRIs and Effexor have failed, and you suffer fatigue, wellbutrin might be the answer - it's activating, and for me, it's been a pretty good antidepressent (in combo with mood stabilizers -- Neurontin and Depakote), so it might be worth a try.
-Chris
Posted by Cindylou on December 16, 2001, at 19:05:14
In reply to Re: Need to add an AD to Lamictal ... suggestions?, posted by ivoovi on December 16, 2001, at 16:09:12
Thanks Chris ...
I have tried Wellbutrin in combination with SSRIs to help with the fatigue (it helped a LITTLE), and on its own, but it didn't help the depression much alone.I tried it also when I first started the Lamictal, and it was actually TOO activating for me then. But I was only on 25 mg of Lamictal, and perhaps I was too new on the Lamictal to try and add anything else at the time.
I'm thinking that maybe now that I'm up to 100 mg on the Lamictal my reaction to the Wellbutrin may be different this time ... worth a try!
Thanks for your input,
cindy> Hey...have you tried wellbutrin? if SSRIs and Effexor have failed, and you suffer fatigue, wellbutrin might be the answer - it's activating, and for me, it's been a pretty good antidepressent (in combo with mood stabilizers -- Neurontin and Depakote), so it might be worth a try.
>
> -Chris
Posted by Hattree on December 16, 2001, at 19:08:12
In reply to Re: Need to add an AD to Lamictal ... suggestions? » ivoovi, posted by Cindylou on December 16, 2001, at 19:05:14
I find Zoloft and Lamictal together more helpful than either alone.
> Thanks Chris ...
> I have tried Wellbutrin in combination with SSRIs to help with the fatigue (it helped a LITTLE), and on its own, but it didn't help the depression much alone.
>
> I tried it also when I first started the Lamictal, and it was actually TOO activating for me then. But I was only on 25 mg of Lamictal, and perhaps I was too new on the Lamictal to try and add anything else at the time.
>
> I'm thinking that maybe now that I'm up to 100 mg on the Lamictal my reaction to the Wellbutrin may be different this time ... worth a try!
>
> Thanks for your input,
> cindy
>
> > Hey...have you tried wellbutrin? if SSRIs and Effexor have failed, and you suffer fatigue, wellbutrin might be the answer - it's activating, and for me, it's been a pretty good antidepressent (in combo with mood stabilizers -- Neurontin and Depakote), so it might be worth a try.
> >
> > -Chris
Posted by dove on December 22, 2001, at 12:23:48
In reply to Need to add an AD to Lamictal ... suggestions?, posted by Cindylou on December 16, 2001, at 14:41:51
I have had a much better reaction to Prozac and Serzone (although it's not really considered a "SSRI") with the addition of Neurontin (gabapentin) which is labeled as an AED and used as a mood stabilizer and a mild anti-anxiety drug.
In the past, I took Prozac (and Wellbutrin for that matter) and had very negative reactions. I was suicidal, depressed, extremely tired yet aggravated and antsy, unable to communicate with family members or friends, and my depression did not lift one iota--although I was able to spend every minute of my day keeping my house all nice and clean (which made others think I was doing very well since I'm the worst housekeeper to ever walk the earth and everyone said that the depression would leave me once my household was in order.)
A little over a year later, after the addition and switch of a few meds, I'm taking 30-40 mgs of Prozac with much better results. The obsession with a clean house hasn't returned (is that good or bad?), the depression has lifted a bit, but I can still cry and feel joy. Whereas, the earlier attempt w/ prozac made me hopeless, tired and numb and on a smaller dosage.
Have you ever tried a TCA that is *not* recognized as sedating? Have all the SSRI's that you have tried been those that are, generally known to be more sedating (i.e. paroxetine, sertraline, or fluvoxamine)?
Do you have paradoxical reactions to the more stimulating meds? Maybe use a little reverse psychology, go with a calming AD and see what happens after a couple of weeks.
With the Lamictal still in place, you could even augment with a CNS stimulant (i.e. Ritalin, Adderall) and/or an anti-anxiety med that has AD effects but isn't a knock-out pill. Or even another certified mood-lifting mood-stabilizer? And there's the MAOIs, of which I don't have any extended knowledge and cannot add any comments to that genre of meds.
I hope you find something that works. Best Wishes!!!
dove
Posted by shellir on December 22, 2001, at 16:30:34
In reply to Need to add an AD to Lamictal ... suggestions?, posted by Cindylou on December 16, 2001, at 14:41:51
> Hello,
> I have had a hard time tolerating ADs in the past -- particularly the SSRIs and Effexor. I usually experience a large increase in depression and unmanageable fatigue for the first few weeks; then the depression lifts, but the fatigue remains.
>
> I am wondering if I may have a different (better) reaction to them now that I am on 100 mg of Lamictal.
>
> Or, does anyone know of an antidepressant that does well in combo with Lamictal?
>
> Thanks in advance for any info.
>
> -cindycindy,
my best results with any anti-depressants has been with lamictal and nardil together. Unfortunately I gained weight with the lamictal (not the nardil) so I went off and declined quickly.
shelli
Posted by Cindylou on December 23, 2001, at 19:44:21
In reply to Re: Need to add an AD to Lamictal ... suggestions? » Cindylou, posted by dove on December 22, 2001, at 12:23:48
Hi dove,
Thanks for the information and suggestions. I like your idea to try "reverse psychology" and go with a more sedating AD instead of the stimulating ones ... I do have paradoxical reactions to stimulating meds. Have tried several stimulants, which help a lot for a few days, but then I crash HARD. I feel sick and exhausted. It is very frustrating, since I felt so good for those few days -- I keep wanting to try again, but the same thing always happens (Ritilin, Adderall, Provigil, Prozac -- although I feel pretty good on Prozac for 2 months, then crash -- and even Wellbutrin.)I am currently taking Serzone with the Lamictal which really helps with anxiety -- but I cannot tolerate more than 100 mg, and I understand that you really need around 400 mg for an AD effect.
My pdoc suggested trying Paxil. So, I am tapering off the Serzone, then I'll try the Paxil. I am really nervous about it, but I guess I'll just have to see what happens.
Thanks again,
cindy
> I have had a much better reaction to Prozac and Serzone (although it's not really considered a "SSRI") with the addition of Neurontin (gabapentin) which is labeled as an AED and used as a mood stabilizer and a mild anti-anxiety drug.
>
> In the past, I took Prozac (and Wellbutrin for that matter) and had very negative reactions. I was suicidal, depressed, extremely tired yet aggravated and antsy, unable to communicate with family members or friends, and my depression did not lift one iota--although I was able to spend every minute of my day keeping my house all nice and clean (which made others think I was doing very well since I'm the worst housekeeper to ever walk the earth and everyone said that the depression would leave me once my household was in order.)
>
> A little over a year later, after the addition and switch of a few meds, I'm taking 30-40 mgs of Prozac with much better results. The obsession with a clean house hasn't returned (is that good or bad?), the depression has lifted a bit, but I can still cry and feel joy. Whereas, the earlier attempt w/ prozac made me hopeless, tired and numb and on a smaller dosage.
>
> Have you ever tried a TCA that is *not* recognized as sedating? Have all the SSRI's that you have tried been those that are, generally known to be more sedating (i.e. paroxetine, sertraline, or fluvoxamine)?
>
> Do you have paradoxical reactions to the more stimulating meds? Maybe use a little reverse psychology, go with a calming AD and see what happens after a couple of weeks.
>
> With the Lamictal still in place, you could even augment with a CNS stimulant (i.e. Ritalin, Adderall) and/or an anti-anxiety med that has AD effects but isn't a knock-out pill. Or even another certified mood-lifting mood-stabilizer? And there's the MAOIs, of which I don't have any extended knowledge and cannot add any comments to that genre of meds.
>
> I hope you find something that works. Best Wishes!!!
>
> dove
Posted by dove on December 26, 2001, at 14:15:37
In reply to Re: Need to add an AD to Lamictal ... suggestions? » dove, posted by Cindylou on December 23, 2001, at 19:44:21
> My pdoc suggested trying Paxil. So, I am tapering off the Serzone, then I'll try the Paxil. I am really nervous about it, but I guess I'll just have to see what happens.
>Well, going off the Serzone may prove a simple task as you're only taking 100 mgs. per day. I've had great difficulties when I took my Serzone a couple of hours late or accidentally run-out for a day. However, I'm taking 400 mgs. per day and in a med cocktail that needs the Serzone to mix-up properly.
One thing to keep in mind regarding the switch to Paxil is the fact that, in general, the SSRI's can cause some degree of anxiety from Day 1 and up to 5 weeks before they start doing their proper job at easing depression and anxiety symptoms.
So, if that's a significant issue for you, make sure and ask the Doc for something to help you through the transition. Some p-docs give out short-term and/or short-acting benzo's (i.e. Ativan or equivalent) or short-term, low dose, and long-acting benzo's (i.e. klonopin or equivalent). Some p-doc's don't use benzo's but use meds like amitriptyline and other sedating but short-term transitional meds.
However, there's always the chance that none of these side-effects will apply to your situation--we can hope! There are *always* exceptions to *every* rule :o)
dove
Posted by Cindylou on December 26, 2001, at 17:26:32
In reply to Re: Need to add an AD to Lamictal ... suggestions? » Cindylou, posted by dove on December 26, 2001, at 14:15:37
Hi Dove,
I decreased the Serzone by a measly 25 mg. and I felt very sick for a few days -- nauseous, exhausted, kind of flu-like. I didn't attribute it to the reduced Serzone, but could it have been?Also, thanks for the tip on the Paxil. I am getting more and more leary of trying it. I do take Klonapin to help offset the agitation I get from the Lamictal, so that could help me through the intial anxiety from the Paxil ... however, I thought Paxil was a more sedating med. Can it cause anxiety AND sedation? I have had that combo of symptoms many times -- would like to avoid it at all costs if I can! I am so med sensitive that if there is a side effect to be had, I'll have it.
SO, I'm still in a quandry over what to do. Might try increasing the Lamictal to 150 mg before I make any more changes. Then, maybe think about adding Celexa instead of Paxil. Any thoughts?
Thanks so much for your help! By the way, are you taking Lamictal (or have you tried it in the past?) Just curious. Is your current "cocktail"
working for you? I like and need to hear those success stories.take care,
cindy> Well, going off the Serzone may prove a simple task as you're only taking 100 mgs. per day. I've had great difficulties when I took my Serzone a couple of hours late or accidentally run-out for a day. However, I'm taking 400 mgs. per day and in a med cocktail that needs the Serzone to mix-up properly.
>
> One thing to keep in mind regarding the switch to Paxil is the fact that, in general, the SSRI's can cause some degree of anxiety from Day 1 and up to 5 weeks before they start doing their proper job at easing depression and anxiety symptoms.
>
> So, if that's a significant issue for you, make sure and ask the Doc for something to help you through the transition. Some p-docs give out short-term and/or short-acting benzo's (i.e. Ativan or equivalent) or short-term, low dose, and long-acting benzo's (i.e. klonopin or equivalent). Some p-doc's don't use benzo's but use meds like amitriptyline and other sedating but short-term transitional meds.
>
> However, there's always the chance that none of these side-effects will apply to your situation--we can hope! There are *always* exceptions to *every* rule :o)
>
> dove
Posted by dove on December 29, 2001, at 8:05:44
In reply to Re: Need to add an AD to Lamictal ... suggestions? » dove, posted by Cindylou on December 26, 2001, at 17:26:32
>
> I decreased the Serzone by a measly 25 mg. and I felt very sick for a few days -- nauseous, exhausted, kind of flu-like. I didn't attribute it to the reduced Serzone, but could it have been?
>
>Yes, and repeating the procedure will probably let you know for sure.
I wish I had more real-world knowledge regarding the Lamictal, it just leaves me hanging in the wind a bit. I know it's an AED with mood stabilizing and mood-elevating properties? I take Neurontin for these same desired effects, however, Neurontin doesn't "hype" me up, nor does it cause me to become agitated.
Paxil is *definitely* known as the "sleepy" SSRI, more so than any of the others; it is *the* anti-anxiety med of choice at my local clinic. So, my guess is that you would have the least amount of initial anxiety bridging over to it and it might work very well for your needs in the short and long term. Regarding the short-term, if you have klonopin on hand for any emergency break-through anxiety attacks, you are very well prepared.
Celexa has not been as successful for promoting a "soft" anti-anxiety effect from what I hear around me. I have never taken it and thusly, cannot give any personal experiences with the med, but words from many a horse's mouth have found it to be quite a let-down. And there goes the saying, YMMV and every person is unique; and it could be a back-up plan should the Paxil fail.
Regarding med-cocktails, mine hasn't done all that I, or my doctor had hoped it would do. It has stopped a considerable amount of suicidal ideation (my doc's word for thinking about suicide) and any planning, which is really quite good; yet, I still feel awash in the muck of things. I do have a lot on my plate (five kids from 4 to 11 yrs.), and am currently having some marriage problems (we just passed that ten year mark), and my mom was just given a temporary "all-clear" from aggressive Non-Hodgkin's Lymphoma discovered between Thanksgiving and Christmas of last year, yet I still feel like I'm wearing cement boots.
I started out on one med and the doc's kept changing and adding from there. The best combo I've been on is the current one, which includes the following:
Amitriptyline, Adderall, Klonopin, Serzone, Prozac, and Neurontin. Although, it does get complicated keeping track of them all :o)Best of luck to you and don't be afraid of the Paxil, many people find it truly helpful for anxiety! And keep everyone updated ;o)
dove
Posted by Cindylou on December 29, 2001, at 18:03:42
In reply to Re: Need to add an AD to Lamictal ... suggestions?, posted by dove on December 29, 2001, at 8:05:44
Hi dove,
Thanks so much for your informative and kind response. You HAVE been through a lot -- I'm glad your mom is doing better -- that must be such a difficult situation for you.AND 5 KIDS????????????? I have one 2-year-old and CANNOT IMAGINE even having two kids, much less five. I give you a ton of credit for hanging in there for them, and for you.
I'm glad to hear that your meds are helping a bit, and hope that they will give you more of a lift as time goes on.
As for me, I just added a mere 2.5 mg. Paxil to my 75 mg Serzone, 125 mg. Lamictal and ocassional Klonapin combo. I have felt pretty good for the past couple of days (but have learned that those "pretty good" feelings can be very fleeting.)
Thanks again for taking the time to help me out, when you have so much going on in your life.
Take care, and keep me posted on how you're doing too,
cindy
>
> Yes, and repeating the procedure will probably let you know for sure.
>
> I wish I had more real-world knowledge regarding the Lamictal, it just leaves me hanging in the wind a bit. I know it's an AED with mood stabilizing and mood-elevating properties? I take Neurontin for these same desired effects, however, Neurontin doesn't "hype" me up, nor does it cause me to become agitated.
>
> Paxil is *definitely* known as the "sleepy" SSRI, more so than any of the others; it is *the* anti-anxiety med of choice at my local clinic. So, my guess is that you would have the least amount of initial anxiety bridging over to it and it might work very well for your needs in the short and long term. Regarding the short-term, if you have klonopin on hand for any emergency break-through anxiety attacks, you are very well prepared.
>
> Celexa has not been as successful for promoting a "soft" anti-anxiety effect from what I hear around me. I have never taken it and thusly, cannot give any personal experiences with the med, but words from many a horse's mouth have found it to be quite a let-down. And there goes the saying, YMMV and every person is unique; and it could be a back-up plan should the Paxil fail.
>
> Regarding med-cocktails, mine hasn't done all that I, or my doctor had hoped it would do. It has stopped a considerable amount of suicidal ideation (my doc's word for thinking about suicide) and any planning, which is really quite good; yet, I still feel awash in the muck of things. I do have a lot on my plate (five kids from 4 to 11 yrs.), and am currently having some marriage problems (we just passed that ten year mark), and my mom was just given a temporary "all-clear" from aggressive Non-Hodgkin's Lymphoma discovered between Thanksgiving and Christmas of last year, yet I still feel like I'm wearing cement boots.
>
> I started out on one med and the doc's kept changing and adding from there. The best combo I've been on is the current one, which includes the following:
> Amitriptyline, Adderall, Klonopin, Serzone, Prozac, and Neurontin. Although, it does get complicated keeping track of them all :o)
>
> Best of luck to you and don't be afraid of the Paxil, many people find it truly helpful for anxiety! And keep everyone updated ;o)
>
> dove
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