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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on November 15, 2011, at 7:32:36
In reply to Re: Other options besides AAP for depression?, posted by psychobot5000 on November 14, 2011, at 17:56:12
>Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.
Posted by SLS on November 15, 2011, at 8:14:54
In reply to Re: Other options besides AAP for depression? » psychobot5000, posted by ed_uk2010 on November 15, 2011, at 7:32:36
> >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
>
> That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.
- Scott
Posted by creepy on November 15, 2011, at 8:31:37
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
The AAPs all do some serotonin receptor antagonism. Not much different than trazodone / nefazodone I think.
If thats not doing it, you might want to try TCA's next.
Posted by psychobot5000 on November 15, 2011, at 10:39:21
In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 8:14:54
> > >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
> >
> > That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.
>
> Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.
>
>
> - ScottI agree, of course, about the rapid improvements the drug can offer, and also that they disappear. However, I think any partial response is an illusion--based largely on the fact that, when the drug is withdrawn, you temporarily do worse (until your body readjusts to the new baseline). This is based, in part, on anecdotal watching of people on message boards over the years ("It doesn't seem to help, but then I get worse if I stop, so I guess I'll keep taking it."), part on a relatively recent trial against that prozac-zyprexa combination, the only decent numbers the drug has gotten, uh...ever, in a study designed to be extra short, so that Lamictal would still be titrating and thus wouldn't work as well as the other drug...missing the point that Lamictal ONLY works when it's still being titrated upward. And of course there's my own experience. There's a danger, of course, in extrapolating too much from one experience, and I usually try to avoid that, constantly qualifying, (i.e. "as with other drugs, mileage varies, so you'll just have to try it and see if it's helpful for you.")...but, consider this:
I get a response to EVERY antidepressant and augmentor I've ever taken. MAOis, every one I've ever taken (high dose selegiline, tranylcipromine (sp?) phenelzine), tricyclics, SSRIs, all the modern atypical antidepressants, as well as atypical antipsychotics, and even stimulants in a way (though their effect is different)...the list goes on for days. Also vagal nerve stimulation and cranial electrotherapy stimulation, St John's Wort (a little). They all make my depression recede (though stimulants only in proportion to your blood-levels of the drug at any given time). If you can name it and call it an antidepressant, it works for me. Here, in contrast, is the list of every antidepressant drug EVER that offered me no net benefit:
Lamictal.I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work. I very much doubt it works as an augmentor (for what it's worth, I've tried that, too). It does, however, offer many a transient (though very substantial!) benefit during upward titration, juxtaposed against a corresponding transient lowering of mood when the drug is discontinued or titrated downward. I think that's the entire story. Obviously, I don't know enough to be certain about that (no one does), but it all fits together pretty neatly and matches all the available evidence.
Posted by SLS on November 15, 2011, at 15:09:59
In reply to Re: Other options besides AAP for depression? » SLS, posted by psychobot5000 on November 15, 2011, at 10:39:21
> I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
- Scott
Posted by psychobot5000 on November 15, 2011, at 16:03:12
In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 15:09:59
> > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
>
> My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
>
> - ScottYou say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
Posted by SLS on November 15, 2011, at 18:32:42
In reply to Re: Other options besides AAP for depression? » SLS, posted by psychobot5000 on November 15, 2011, at 16:03:12
> > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
> > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
> You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
No.I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
- Scott
Posted by Phidippus on November 15, 2011, at 20:34:37
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
Lots of options. You can try augmenting with a different class of AD, such as Wellbutrin, an NDRI or perhaps a TCA, like Clomipramine (the risk of seratonin syndrome is exaggerated).
You can try stimulants, like Methylphenidate, Dextroamphetamine or Nuvigil.
You can try Tramadol, a pain drug which has been found useful in the treatment of depression. It is an opiate, so there is some risk of dependence. Tramdol is also an SNRI and NMDA antagonist.
You can try regular opiates, but they are tricky.
The last I can think of is Memantine, an NMDA antagonist. Originally created as an Alzheimer's treatment, it has been studied for the treatment of depression, anxiety, OCD, etc.
Eric
Posted by Bob on November 15, 2011, at 20:42:40
In reply to Re: Other options besides AAP for depression? » psychobot5000, posted by SLS on November 15, 2011, at 18:32:42
> > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
> > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
> > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
>
>
> No.
>
> I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
>
>
> - Scott
Scott, do you still have Abilify on board?Bob
Posted by psychobot5000 on November 15, 2011, at 20:54:12
In reply to Re: Other options besides AAP for depression? » psychobot5000, posted by SLS on November 15, 2011, at 18:32:42
> > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
> > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
> > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
>
>
> No.
>
> I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
>
>
> - ScottI suppose there's no reason there couldn't be a niche where the med is useful. Best of luck in maintaining a regimen that works for you.
-PB
Posted by SLS on November 15, 2011, at 20:55:48
In reply to Re: Other options besides AAP for depression? » SLS, posted by Bob on November 15, 2011, at 20:42:40
Hi Bob.
> Scott, do you still have Abilify on board?
Yes. I'm still at 10 mg.
Currently:
Pristiq 100 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
- Scott
Posted by SLS on November 15, 2011, at 20:56:47
In reply to Re: Other options besides AAP for depression? » SLS, posted by psychobot5000 on November 15, 2011, at 20:54:12
> > > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
> >
> > > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
> >
> > > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
> >
> >
> > No.
> >
> > I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
> >
> >
> > - Scott
>
> I suppose there's no reason there couldn't be a niche where the med is useful. Best of luck in maintaining a regimen that works for you.I gotta find one that works first.
:-(
- Scott
Posted by Zyprexa on November 16, 2011, at 6:26:01
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
Usualy they use SSRIs for depression. Thats about all they do, even though sometimes they think it can help with anxiety but they don't for me. I would suggest Celexa for depression, it worked realy well when I started taking it. I brought me out of sad wanting to cry all the time. I'm not sure but the brand celexa might work better. Currently I take zoloft. Not sure if I need an AD anymore.
Posted by Phillipa on November 16, 2011, at 18:26:58
In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 20:56:47
Scott any improvement from pristiq? Phillipa
Posted by sleepygirl2 on November 16, 2011, at 21:14:56
In reply to Re: Other options besides AAP for depression? » Phillipa, posted by gadchik on November 14, 2011, at 10:13:32
Hey,
If you don't mind, can you describe some of the psychotic symptoms that went with your depression? It would be helpful to me.
Thanks,
sleepy
Posted by gadchik on November 17, 2011, at 9:32:57
In reply to Re: Other options besides AAP for depression? » gadchik, posted by sleepygirl2 on November 16, 2011, at 21:14:56
The psychotic symptoms came after I stopped sleeping & eating.I thought I had an x in my tongue and i would look at it in the mirror,and think I was marked by the devil,also thought the mirror moved everytime i looked in it. I thought my stomach was disconnected from my intestines and kept going to the er wanting xrays.I was sure that if i ate or took any pills i would die.I got obsessed w/owls.Thought if I looked one in the eye,whether real or in a picture,I would die.I had loud music blaring in my head all night long,and felt as if bugs were crawling up & down my legs.I really felt doomed and often thought of walking into the dead of night,laying down in the woods and dying by freezing to death.I was pretty bad off.I would hear some evil voice saying bad things to me.I was afraid of water too,I thought I would die if I took a bath.Didnt wash my hair for 4 months,now I think,yuk.I almost got put into the psych ward.I came back from all that,cant believe it and I am so grateful to feel good again.
Posted by ed_uk2010 on November 17, 2011, at 11:46:22
In reply to Re: Other options besides AAP for depression? » sleepygirl2, posted by gadchik on November 17, 2011, at 9:32:57
> The psychotic symptoms came after I stopped sleeping & eating.I thought I had an x in my tongue and i would look at it in the mirror,and think I was marked by the devil,also thought the mirror moved everytime i looked in it. I thought my stomach was disconnected from my intestines and kept going to the er wanting xrays.I was sure that if i ate or took any pills i would die.I got obsessed w/owls.Thought if I looked one in the eye,whether real or in a picture,I would die.I had loud music blaring in my head all night long,and felt as if bugs were crawling up & down my legs.I really felt doomed and often thought of walking into the dead of night,laying down in the woods and dying by freezing to death.I was pretty bad off.I would hear some evil voice saying bad things to me.I was afraid of water too,I thought I would die if I took a bath.Didnt wash my hair for 4 months,now I think,yuk.I almost got put into the psych ward.I came back from all that,cant believe it and I am so grateful to feel good again.
Gadchik, thanks for posting your experience. What brought you out of this awful psychotic depression?
Posted by sleepygirl2 on November 17, 2011, at 12:11:37
In reply to Re: Other options besides AAP for depression? » sleepygirl2, posted by gadchik on November 17, 2011, at 9:32:57
Thanks for sharing that. Were you on any meds at the time?
Posted by gadchik on November 17, 2011, at 12:13:45
In reply to Re: Other options besides AAP for depression? » gadchik, posted by ed_uk2010 on November 17, 2011, at 11:46:22
It was a slow process.I felt like a half crushed insect,left to suffer.My husband kept telling me that when spring came,I would heal.I held onto his statement.It was after a pdoc was summoned to er room,and she told my husband i would die w/o treatment,and he was crying for me to take meds,they gave me an ativan injection.I slept,hadnt slept in a month.I went home,started to sleep,took crumbs of ativan,saw that i wouldnt die,so i tasted a strawberry.I relished the flavor,noticed the deep color.I prayed for sanity.I dreamed in brilliant colors,beautiful sunny days,green grass.In my dream I would run up to people and tell them i was well.I decided to start walking again,outside in the sun.Spring was arriving,and i came alive,ate very healthy,started to see a pdoc and therapist.I took the zoloft,remeron,and klonopin.Very gradually,my mind came back to me.At the beginning,when I knew I was headed for a breakdown,I had a dream.It was a hummingbird w/its wings glued to a white plate,and its eyes were the saddest ive seen.this was this last dream i had for months.After that dream,I seemed to give in to the downward spiral,and just let myself fall.Never again.
Posted by ed_uk2010 on November 17, 2011, at 12:31:09
In reply to Re: Other options besides AAP for depression? » ed_uk2010, posted by gadchik on November 17, 2011, at 12:13:45
Gadchik, do you think that not being able to sleep was what brought on the psychotic symptoms?
Posted by gadchik on November 17, 2011, at 12:59:58
In reply to Re: Other options besides AAP for depression? » gadchik, posted by ed_uk2010 on November 17, 2011, at 12:31:09
It was no sleep to the extreme,and no food.I think combined w/extreme anxiety,all that contributed to me losing it.When they torture people by keeping them from sleeping,the person will get psychotic.I was my torturer,my brain was.
Posted by ed_uk2010 on November 17, 2011, at 14:17:43
In reply to Re: Other options besides AAP for depression? » ed_uk2010, posted by gadchik on November 17, 2011, at 12:59:58
> It was no sleep to the extreme,and no food.I think combined w/extreme anxiety,all that contributed to me losing it.When they torture people by keeping them from sleeping,the person will get psychotic.I was my torturer,my brain was.
I see, so you didn't need an antipsychotic to get better, you needed to sleep?
Posted by gadchik on November 17, 2011, at 16:55:28
In reply to Re: Other options besides AAP for depression? » gadchik, posted by ed_uk2010 on November 17, 2011, at 14:17:43
No one every suggested an antipsychotic,because i just kept going to ers and telling them I had physical things wrong w/me,I suppose I did need an antipsychotic,but Id never heard of them.When I finally did see a pdoc,that i trusted,I was on my way out of it.What did people do before antipsychotics?
Posted by ed_uk2010 on November 17, 2011, at 17:31:13
In reply to Re: Other options besides AAP for depression? » ed_uk2010, posted by gadchik on November 17, 2011, at 16:55:28
>What did people do before antipsychotics?
Well, they either got better or they didn't, just like now... but now we have more options. Before antipsychotics, only sedative medications were available, and ECT.
During your crisis, a sedating antpsychotic such as Zyprexa or Seroquel could have been useful but it doesn't sound like you would have needed it long term. You would probably have started sleeping much more and your delusions would have been reduced. The problem with antipsychotics is that once they get started then don't always get stopped. They can lead to pronounced weight gain and other problems. Some people may need them long term, but not others. It's not always easy to tell the difference.
Posted by psychobot5000 on November 17, 2011, at 17:51:50
In reply to Re: Other options besides AAP for depression? » gadchik, posted by ed_uk2010 on November 17, 2011, at 17:31:13
> >What did people do before antipsychotics?
>
> Well, they either got better or they didn't, just like now... but now we have more options. Before antipsychotics, only sedative medications were available, and ECT.
>>
The man treatment before effective medications were available was a retiring trip to the sea or the country or to a mineral bath--which treatment still shows the same efficacy as antipsychotics, I'm told. Presumably this was because of the reduction in stress and stimulation.However, obviously that treatment was only available to a small socioeconomic class, and even then was often impractical.
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