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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by NKP on November 15, 2022, at 9:00:20
Do you think that lamotrigine, along with a low dose of Fluanxol, could be used as an antidepressant, without an SSRI?
Posted by jay2112 on November 15, 2022, at 12:12:09
In reply to Mood stabiliser + antipsychotic for depression, posted by NKP on November 15, 2022, at 9:00:20
> Do you think that lamotrigine, along with a low dose of Fluanxol, could be used as an antidepressant, without an SSRI?
Certainly possible, but your mood won't benefit from a boost from an SRI/SNRI. The a.d. is actually a mood stabilizer in itself. Careful with the lamictal. There is a lot of talk of the "lamictal rage" on social media these days.
Jay
Posted by SLS on November 15, 2022, at 17:54:10
In reply to Re: Mood stabiliser + antipsychotic for depression » NKP, posted by jay2112 on November 15, 2022, at 12:12:09
> Careful with the lamictal. There is a lot of talk of the "lamictal rage" on social media these days.
What the hell are you talking about?! I take it, and I don't get no friggin' rage attacks.
- Scott
Posted by Phillipa on November 16, 2022, at 19:52:11
In reply to Re: Mood stabiliser + antipsychotic for depression » jay2112, posted by SLS on November 15, 2022, at 17:54:10
There is the lamictal rash though?
Posted by rjlockhart37 on November 18, 2022, at 13:55:48
In reply to Re: Mood stabiliser + antipsychotic for depression » SLS, posted by Phillipa on November 16, 2022, at 19:52:11
i take lamictal with latuda, lamictal has some antidepressant properties but it doenst feel like an antidepressant fully. Seems to bring nuero's back to baseline. But everyone is diffrent. I've taken lamictal for 11 years. When i first started it, i didnt like it, felt too stablized and a bit blunted. But after time i started noticing small antidepressant effect. I used to take zyprexa with lamictal, it seemed to work ok.
Go ahead and try it, lamictal does seem to have blunting effects, at first. I take 400mg, high dose, but 200mg standard dose should be a good target.
Posted by rjlockhart37 on November 18, 2022, at 13:58:40
In reply to Re: Mood stabiliser + antipsychotic for depression, posted by rjlockhart37 on November 18, 2022, at 13:55:48
It has some antidepressant effect, but everyone is diffrent. Some people can take lamictal and hate it, and get off it. It blunted me at first, and caused some cognkive change. But as my nuero's got used to it, it seemed to go away. I don't want to tell you to try it, but just go ahead and give it a shot. Just be aware it can have blunting effects at first, but it does have antidepressant effects in some people
Posted by jay2112 on November 19, 2022, at 14:27:19
In reply to Re: Mood stabiliser + antipsychotic for depression » jay2112, posted by SLS on November 15, 2022, at 17:54:10
> > Careful with the lamictal. There is a lot of talk of the "lamictal rage" on social media these days.
>
> What the hell are you talking about?! I take it, and I don't get no friggin' rage attacks.
>
>
> - Scott
>Scott,
Just because you don't experience those side effects, doesn't mean others won't or haven't.
Jay :)
Posted by SLS on November 19, 2022, at 19:10:21
In reply to Re: Mood stabiliser + antipsychotic for depression » SLS, posted by jay2112 on November 19, 2022, at 14:27:19
> > > Careful with the lamictal. There is a lot of talk of the "lamictal rage" on social media these days.
> >
> > What the hell are you talking about?! I take it, and I don't get no friggin' rage attacks.
> >
> >
> > - Scott
> >
>
> Scott,
>
> Just because you don't experience those side effects, doesn't mean others won't or haven't.
>
> Jay :)
>
>
That was poorly-executed satire.:-)
- Scott
Posted by NKP on December 3, 2022, at 4:47:39
In reply to Re: Mood stabiliser + antipsychotic for depression, posted by SLS on November 19, 2022, at 19:10:21
Currently I'm on venlafaxine 225 mg/day and lamotrigine 200 mg/day. This combination works well except for the following side-effects: (i) excessive sweating; (ii) no sexual desire; (iii) apathy and lack of motivation. I think that venlafaxine is the culprit.
I'm seeing my psychiatrist on Wednesday. I want to propose a few alternative combinations to him. Any ideas will be appreciated.
(i) sertraline 50 mg/day + flupentixol 0.5 mg/day
(ii) sertraline 50 mg/day + lamotrigine 200 mg/day
(iii) flupentixol 0.5 mg/day + lamotrigine 200 mg/day
(iv) duloxetine 20 mg/day + flupentixol 0.5 mg/day
(v) duloxetine 20 mg/day + lamotrigine 200 mg/day
Posted by SLS on January 4, 2023, at 20:30:57
In reply to Re: Mood stabiliser + antipsychotic for depression, posted by NKP on December 3, 2022, at 4:47:39
> Currently I'm on venlafaxine 225 mg/day and lamotrigine 200 mg/day. This combination works well except for the following side-effects: (i) excessive sweating; (ii) no sexual desire; (iii) apathy and lack of motivation. I think that venlafaxine is the culprit.
>
> I'm seeing my psychiatrist on Wednesday. I want to propose a few alternative combinations to him. Any ideas will be appreciated.
>
> (i) sertraline 50 mg/day + flupentixol 0.5 mg/day
>
> (ii) sertraline 50 mg/day + lamotrigine 200 mg/day
>
> (iii) flupentixol 0.5 mg/day + lamotrigine 200 mg/day
>
> (iv) duloxetine 20 mg/day + flupentixol 0.5 mg/day
>
> (v) duloxetine 20 mg/day + lamotrigine 200 mg/day
The side effects you are concerned about certainly sound like those of a serotonin reuptake inhibitor. I know nothing about flupentixol. Is it capable of producing the side effects you are experiencing?
A few hopefully helpful comments:1. I do not respond to Effexor at 225 mg/day. 300 mg/day gives me a partial improvement. Drug companies look for that sweet spot and chooses as its maximum dosage one that produces robust efficacy, but with a minimum in the number or magnitude of side effects. They try to minimize the number of drop-outs. Sometimes, they become their own worst enemies. I don't have statistics to cite, but they are out there. I think that there are too many people who fail to respond to 225 mg/day and go on to respond to 300 mg/day not to make 300 mg/day the maximum dosage recommended by the drug company. I would be surprised if someone who tolerates 225 mg/day could not tolerate 300 mg/day. I see recent papers reporting the use of 300-375 mg/day of Effexor for treatment-resistant or severe cases. During the dosage finding phase of their R & D of Effexor, I think 600 mg/day was one of the dosages evaluated. Some doctors are not afraid to use 600 mg/day.
2. Many people need 300 mg/day of lamortrigine to get the most antidepressant effect from it. In my experience, lamotrigine does *not* produce an all-or-nothing drug response. In other words, one can experience a partial improvement at 200 mg/day, and a much greater improvement at 300 mg/day.
3. Sertraline can be given at a maximum dosage of 200 mg/day. Why would you limit yourself to 50 mg/day?
4. Duloxetine can be given at a maxiumum dosage of 120 mg/day. Why would you limit yourself to 20 mg/day?
5. Do you place a limit on the number of drugs you take at the same time?
* If you have developed a hypersensitivity to the side effects of SRIs at low dosages, that doesn't imply that you need low dosages to respond.
Good luck.
- Scott
Posted by undopaminergic on January 5, 2023, at 9:02:37
In reply to Re: Mood stabiliser + antipsychotic for depression » NKP, posted by SLS on January 4, 2023, at 20:30:57
> > Currently I'm on venlafaxine 225 mg/day and lamotrigine 200 mg/day. This combination works well except for the following side-effects: (i) excessive sweating; (ii) no sexual desire; (iii) apathy and lack of motivation. I think that venlafaxine is the culprit.
> >
> > I'm seeing my psychiatrist on Wednesday. I want to propose a few alternative combinations to him. Any ideas will be appreciated.
> >
> > (i) sertraline 50 mg/day + flupentixol 0.5 mg/day
> >
> > (ii) sertraline 50 mg/day + lamotrigine 200 mg/day
> >
> > (iii) flupentixol 0.5 mg/day + lamotrigine 200 mg/day
> >
> > (iv) duloxetine 20 mg/day + flupentixol 0.5 mg/day
> >
> > (v) duloxetine 20 mg/day + lamotrigine 200 mg/day
>
>
> The side effects you are concerned about certainly sound like those of a serotonin reuptake inhibitor. I know nothing about flupentixol. Is it capable of producing the side effects you are experiencing?
>Flupenthixol is an older (atypical) antipsychotic with antidepressant effects starting at very low doses, but I don't know if it is more effective as an antidepressant at higher doses (typically used for psychosis). In my experience, it is capable of inducing anorgasmia -- this happened for me at a dose of several milligrams. But to reduce sexual desire? Possibly, but not as far as I know. Reduce motivation? As a dopamine antagonist, you might expect the possibility at high doses. Induce sweating? Probably not.
-undopaminergic
Posted by SLS on January 15, 2023, at 21:49:36
In reply to Re: Mood stabiliser + antipsychotic for depression » SLS, posted by undopaminergic on January 5, 2023, at 9:02:37
Hi, UD.
> > The side effects you are concerned about certainly sound like those of a serotonin reuptake inhibitor. I know nothing about flupentixol. Is it capable of producing the side effects you are experiencing?
> Flupenthixol is an older (atypical) antipsychotic with antidepressant effects starting at very low doses, but I don't know if it is more effective as an antidepressant at higher doses (typically used for psychosis). In my experience, it is capable of inducing anorgasmia -- this happened for me at a dose of several milligrams. But to reduce sexual desire? Possibly, but not as far as I know. Reduce motivation? As a dopamine antagonist, you might expect the possibility at high doses. Induce sweating? Probably not.
>
> -undopaminergicThanks. Good info.
- Scott
Posted by undopaminergic on January 17, 2023, at 11:00:15
In reply to Re: Mood stabiliser + antipsychotic for depression » undopaminergic, posted by SLS on January 15, 2023, at 21:49:36
> Hi, UD.
>
> > > The side effects you are concerned about certainly sound like those of a serotonin reuptake inhibitor. I know nothing about flupentixol. Is it capable of producing the side effects you are experiencing?
>
> > Flupenthixol is an older (atypical) antipsychotic with antidepressant effects starting at very low doses, but I don't know if it is more effective as an antidepressant at higher doses (typically used for psychosis). In my experience, it is capable of inducing anorgasmia -- this happened for me at a dose of several milligrams. But to reduce sexual desire? Possibly, but not as far as I know. Reduce motivation? As a dopamine antagonist, you might expect the possibility at high doses. Induce sweating? Probably not.
> >
> > -undopaminergic
>
> Thanks. Good info.
>
>
> - Scott
>
>I just noticed that I wrote "atypical" when I meant "typical".
-undopaminergic
Posted by SLS on January 17, 2023, at 17:45:44
In reply to Re: Mood stabiliser + antipsychotic for depression » SLS, posted by undopaminergic on January 17, 2023, at 11:00:15
> > Hi, UD.
> >
> > > > The side effects you are concerned about certainly sound like those of a serotonin reuptake inhibitor. I know nothing about flupentixol. Is it capable of producing the side effects you are experiencing?
> >
> > > Flupenthixol is an older (atypical) antipsychotic with antidepressant effects starting at very low doses, but I don't know if it is more effective as an antidepressant at higher doses (typically used for psychosis). In my experience, it is capable of inducing anorgasmia -- this happened for me at a dose of several milligrams. But to reduce sexual desire? Possibly, but not as far as I know. Reduce motivation? As a dopamine antagonist, you might expect the possibility at high doses. Induce sweating? Probably not.
> > >
> > > -undopaminergic
> >
> > Thanks. Good info.
> >
> >
> > - Scott
> >
> >
>
> I just noticed that I wrote "atypical" when I meant "typical".
>
> -undopaminergic
That happens to me all the time here. Perhaps I think faster than I can type. I also don't do a very good job of proofreading.
- Scott
This is the end of the thread.
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