Lamictal for depression?

October 2, 2007 7:14 PM

Is Lamictal effective for treating depression? I have a life-long history of depression with a 20 year history of SSRI use. They are effective. Recently I was diagnosed with bi-polar disorder and a new doctor, after one meeting has taken me off Zoloft saying it would make the mania aspect of bi-polar worse and Lamictal is the only treatment needed for depression. She actually said it was an anti-depressant. I know my depression is worse, getting even more so and, because of my HMO am having trouble finding a second opinion. Does anyone have experience with Lamictal as an effective anti-depressent?
posted by anonymous to health (16 comments total)

Lamictal is FDA approved for the treatment of bipolar disorder.

FDA approval means that the treatment underwent rigorous scrutiny, showing safety and effectiveness.

So yes, someone does have experience with Lamictal in the treatment of bipolar disorder. It's technically classed as a mood stabilizer, though, not an anti-depressant, because it is good against both depressive and manic symptoms.
posted by ikkyu2 at 7:33 PM on October 2, 2007 [1 favorite]

talk to your doctor and let her know that you are doing worse. part of it may be that you have to get acclimated to the drug, and so you might be withdrawing from the zoloft and acclimating to the new drug at the same time. and that may just be the unhappy part you have to get through.

BUT. i am not the person to tell you this--please talk to your doctor.
posted by thinkingwoman at 7:35 PM on October 2, 2007

My understanding is that if what you really have is a bipolar disorder with a lot of time spent in the depressive end, then Lamictal might be all you need— but that it's not an antidepressant, really. I know a couple people who've been prescribed Lamictal in roughly your situation, but it didn't work for all of them.

SSRIs can trigger manic episodes, that's true.

IANAD nor even particularly expert.
posted by hattifattener at 7:37 PM on October 2, 2007

Just as a somewhat random data point, I was treated for epilepsy (off-label) with Lamictal for a while, and though it is hard to speak of its effectiveness in your or even my situation, I didn't have any seizures with it and the side effects were virtually non-existent comparied with the stuff I was on beforehand (Dilantin).
posted by lackutrol at 7:37 PM on October 2, 2007

I was on Lamictal for about a year in 2003-2004. You have to start on a lower dose and move up slowly. Once I was on 150mg/day for a while, it worked really well. In fact it worked so well I remember standing in my kitchen one day and thought 'damn, I feel normal'. I had an excellent run with it. It turned down the mania significantly and although I felt low at times, I never got to the sluggish, despairing and numb lows either. I didn't have any side effects whatsoever.

I was also seeing a cognitive behavioral therapist at the time and I think the combination of those was very effective.
posted by pieoverdone at 7:37 PM on October 2, 2007

I was on Lamictal for a while, for many of your symptoms, and while it takes a bit to kick in, it worked well for me.
posted by 235w103 at 7:40 PM on October 2, 2007

I guess I'll find out, I'm about to do the same thing! Just filled a prescription today. I've taken antidepressants but they never really worked. Then was diagnosed with.. at least mood disorder, perhaps bipolar II.

Good luck and take care.
posted by citron at 7:56 PM on October 2, 2007

My wife has bipolar II and Lamictal is by far the most effective medication she's been on. She's used if in combination with Zoloft for about three years now and it's been the most stable period of her life.
posted by Pater Aletheias at 8:04 PM on October 2, 2007

There is a fair amount of latitude in Lamictal dosage. I had trouble with depression symptoms at 200 mg. I had no problems (except for post partum mood swings) at 300 mg. You can go up to 400 mg for bipolar dosage.
posted by crazycanuck at 8:29 PM on October 2, 2007

Lamictal has a moderate chance of causing an allergic reaction in people, especially if the initial dose is moderately high. If you break out in a skin rash about a week after you start taking it, contact your doctor immediately and stop taking it until you hear otherwise.

In extreme cases it can take steroids to get the rash under control.
posted by Steven C. Den Beste at 8:43 PM on October 2, 2007

Self disclosure: I am currently on 300mg lamotrigine (Lamictal), 1200 mg lithium, and 10 mg escitalopram (Lexapro).

Your SSRI was discontinued to prevent a manic/mixed episode from occuring. As your mood stabilizer of choice titrated to the proper dose, an antidepressant may be added back in to give your mood a "bump", so to speak.

Regarding your current treatment: Is the doctor prescribing/adjusting your medication your family doctor? Or a psychiatrist? Push for a psychiatrist if you aren't seeing one already. Better yet, if you ever get out of the HMO, push for a psychiatrist who is on the faculty of a teaching hospital, since they tend to be 1) more read up on current treatment protocol, and 2) more aware of clinical trials in the event that the common medications don't work for you.

Based on literature, anecdotal and personal experience, I can tell you that lamotrigine is a very effective as a mood stabilizer for most people. However, lamotrigine has to be slowly titrated up because certain individuals will develop Steven-Johnson Syndrome, which may be very serious. For example: When I was started on lamotrigine, I took 50mg/day for 2 weeks, then 100mg/day for 2 weeks, then 200mg/day. Seeing as how you were diagnosed "recently", is your physician still in the process of ramping up your lamotrigine levels? If so, perhaps you haven't reached a therapeutic dosage yet.

Of course, there's always the possibility that lamotrigine simply does not work for you, but fortunately there is good old lithium (patchin' up bipolar brains since 1970!). The down sides to lithium are:

1. The window between "therapeutic dose" and "toxic dose" is very narrow, so many, many blood tests and doctor's visits are needed initially to "tweak" the blood lithium level within that window, and an occasional blood test has to be performed every few months, to make sure the blood lithium levels are okay. Thus, many needle sticks are needed. Needle-phobic individuals aren't going to be a fan of this.
2. Has a chance of causing kidney problems over the years.
3. Research has shown that lithium is not as effective as lamotrigine in preventing mania/hypomania. However, since your problem is with the depression side of bipolarity, lithium might be a good alternative.

Some physicians (especially non psychiatrists) might intentionally avoid lithium, seeing as how it's such a finicky high maintenance (compared to lamotrigine, at least) drug, and stick with lamotrigine even when it's clearly not working sufficiently.

There are plenty of other bipolar treatment options, but lamotrigine and lithium are the two pillars around which pharmaceutical treatment options are built around.

And if nothing works, there's always electroconvulsive therapy (stigma aside, medical literature has shown that it's the most effective depressive episode treatment there is).

Sorry the post is so long, but I hope it is useful.
posted by jytsai at 8:45 PM on October 2, 2007 [1 favorite]

Is Lamictal effective for treating depression? I have a life-long history of depression with a 20 year history of SSRI use. They are effective. Recently I was diagnosed with bi-polar disorder and a new doctor, after one meeting has taken me off Zoloft saying it would make the mania aspect of bi-polar worse and Lamictal is the only treatment needed for depression.

She decided after one meeting that:

1) You were actually bipolar?
2) Lamictal is "the only treatment needed for depression"?

Do you think you are bipolar? Were you having manic episodes on Zoloft, and were they intrusive and debilitating? If the Zoloft was working, why change both the diagnosis and the treatment, as opposed to supplementing the Zoloft?

I understand that it's hard to get a second opinion right now, but your description of how the doctor approached diagnosis and treatment raises some red flags. Are you still in touch with your previous doc? Could he or she give you a referral to a different psychiatrist?

Does anyone have experience with Lamictal as an effective anti-depressent?

Lamictal is now used to treat people who have what's referred to as "Bipolar II" or atypical bipolar depression. They have mood fluctuations, rather than dramatic mood swings. Their only signs of "mania" may be an occasional ever-so-slight and subtle elevation of their mood; however, they are usually in a state of depression and are therefore often diagnosed and treated as depressed than as bipolar. Re-evaluating the diagnosis, and changing meds accordingly, can be very effective, since very often people with atypical bipolar disorder don't get any releif from conventional anti-depressants.

The two most worrisome side effects of Lamictal are:

1) The (unlikely but still possible) risk of Stevens-Jonson Syndrome (mentioned above). If you have any kind of rash, especially in a place like your mouth, nose, eyes, or genitalia, don't just call your doctor. Go to the ER. If it's SJS it can prove fatal if you don't get treatment ASAP.

2) Bone loss, aka osteoporosis/osteopenia. Many medications originally developed as anti-seizure drugs have this very unfortunate side effect. Take you calcium. Lift weights. Walk everywhere. Not sure how old you are, but regardless, if you plan to stay on Lamitctal get a bone scan soon (your psychiatrist or family doctor can give you a prescription) and get another one in a year. I don't mean to sound alarmist- this side effect, like every side effect, is potential rather than inevitable. But my stint on Lamictal ended when I finally got around to getting a bone scan and was diagnosed with osteoporosis at age 30.

Finally, to add t the "red flag" pile, I'm dismayed that your doctor didn't throughly review the ins and outs of the drug, including the side effects, with you before handing out a prescription. Not explaining why you need to increase the dose very slowly, alerting you to the risk of SJS and telling you to get medical help immediately if you noticed any rashes is irresponsible. And worrisome.

Good luck!
posted by foxy_hedgehog at 2:54 AM on October 3, 2007 [1 favorite]

First a caveat: After being in almost the same boat as you (diagnosed with depression, effective treatment with SSRIs, new doc switches diagnosis to "maybe" bi-polar and put me on Lamictal), about 12 months ago I got fed up, stopped trusting psych-docs, eased slowly off all medication, and promptly became really skeptical (and healthier, happier, etc. consistently). I'm going to temper that skepticism, but it may permeate my answer.

Second a question: You say your treatment with SSRI's was effective, which sounds to me like you have NOT had a manic episode triggered by SSRI use. Is this so? Note that while SSRI use may trigger a manic episode in someone bi-polar, it does not ALWAYS do so and there are some SSRIs that are FAR LESS likely than Zoloft to trigger the reaction. Luvox is one I remember a doctor mentioning to me, but don't quote me on that.

If you're truly bipolar and concerned about mania to the extent you feel you are likely to have it triggered by SSRI's, Lamictal is a reasonable choice - I'm sure you've already read crazymeds.org. Lamictal is used to treat the depressive aspects of bipolar, without triggering mania. Personally, all the junk did for me was make my hair fall out, and I became less depressed after (safely!) discontinuing the medication. Other doctors may feel that, assuming you personally have not had mania triggered by an SSRI, you're still a candidate to continue your effective symptom control with the class of medicines that has functioned well for you for years.

Psychiatry, even at its best, often unfortunately involves a lot of guesswork - medications affect everyone VERY differently and side-effect profiles can't always be predicted. But, if you personally are at all hesitant about the Dx switch and Rx substitution, I would get as many second opinions as you'd like. Ultimately, don't let doctors tell you how to feel about yourself - it's okay to disagree with them, and tell them so (but be open to listening to their advice as well). If second opinions aren'y feasible, go back to the doctor and tell he/she that you're uncomfortable switching 20 years of diagnosis and effective treatment after a single evaluation, and that you'd like to use more objective diagnostical measures and work through understanding why this doctor feels a change is needed. The doctor will respect and understand that, and should be happy to work with you in ensuring a safe, healthy, helpful and appropriate diagnosis is found.
posted by bunnycup at 5:02 AM on October 3, 2007

I've been on Lamictal for about three years, and it has done wonders for me. However, I am also taking Celexa and Wellbutrin. Lamictal reduced the frequency and intensity of my manic episodes, but taken alone it didn't significantly lessen my depression.

Personally, I have never known someone with bipolar disorder who could get by on a mood stabilizer alone. I would consider getting a second opinion, particulary given that she referred to Lamictal as an antidepressant, when it is technically an anti-convulsant.
posted by Evangeline at 7:43 AM on October 3, 2007

Lamictal is the bee's knees. IT WORKS.

I no longer need it but when I did it was a life saver.

You most likely will not need an additional antidepressant with it.

(It is an anticonvulsant but it is one that is PROVEN to be effective as an antidepressant for bipolars.)

It didn't make my hair fall out but if you are worried about that side effect simply take Centrum Silver with it. (My doc recommended that as it has certain minerals that ease or eliminate the hair loss.)

And you really do want to avoid SSRIs if you can as they do trigger more mood cycles. Been there done that, etc.

Also one other thing-along with everything else I recommend regular exercise too. It makes a huge difference. It won't eliminate your need for a med but your meds will work much better and you will feel much better.
posted by konolia at 8:59 AM on October 3, 2007

I won't attempt to re-diagnose you. I will "simply" answer your question.

Lamictal has been approved by the FDA for the treatment of Bipolar Disorder. This means that the manufacturer had reason to believe that it was effective for this condition and that they could make enough money to more than defray the costs of the research required by the FDA to obtain approval. FDA approval means that it met the FDA requirements for safety and efficacy (statistically significant effectiveness for a group of people with the indicated diagnosis). As others have noted, safety is a relative matter. However, in the hand of a competent medical serious adverse reactions should be avoidable, manageable, or extremely rare.

That said, none of this means that the use of the medication is limited to the FDA indications. In clinical practice, many patients with unipolar depression (i.e., not depression with Bipolar Disorder) respond well to Lamictal making it a reasonable alternative or added medication for depression. In fact, some practitioners have found it to be more effective for depression than for mood stabilization.

A recent confounding factor is the explosion of the diagnosis of Bipolar Disorder. It has likely been over-diagosed based on the speculation of some experts in the field about a "spectrum" of symptom patterns (syndromes) that they believe constitute bipolarity. I would consider any new diagnosis of Bipolar Disorder with caution. However, Lamictal helps many with depression regardless of its "polarity."
posted by beginner at 4:18 PM on October 14, 2007