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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I am fully off Nardil and would like to revisit

Answered by
Dr.
Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5171 Questions

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Posted on Thu, 28 Feb 2019 in General Health
Question: I am fully off Nardil and would like to revisit the role of Lamictal again in my current regimen.

Racing thoughts, cognition, anger, and hypervigilence regarding the thoughts/presence of others had been a problem during my withdrawal period. These problems seem less when I either held off taking my lamictal OR took the generic version of it.

Here are the specifics: I had been taking my tianeptine sulfate 25 mgs, 100 mgs brand name lamictal, 50 mgs modafinil, and 100mgs gabapentin (as needed) in the morning.

Friday I staggered the meds to minimize my racing thoughts. I took just the modafinil at first. It gave me mental clarity without the racing or impatience. at lunch I added the lamictal and my thoughts began racing and I would "hyperfocus" on classifying the people around my and my surroundings. Mood and motivation increased, as did the desire to smoke cigarettes.

Then I took tianeptine and I felt that it slowed me down some and impacted cognition a little.

Saturday I took both modafinil and lamictal in the morning. I was very quick to anger, judgmental, and very scared and ruminative around my roommate. When I ate food in the afternoon the symptoms abated.

Sunday: I choose to take the generic lamictal (in addition to the other meds) as it was alway less racy. I felt sad, empty, unmotivated, withdrawn, and socially anxious all day. I had no interest in my hobbies, which had motivated a lot of my behavior in the past 2 years.

I tried adding some ritalin and coffee, which made no difference.

Finally in the late afternoon I took 50 mgs of brand name lamictal, and these all qucikly reversed...I thought about making plans with people, my sex drive returned, but I suddenly wanted to drink and smoke again. The lift did not last very long and I returned to feeling empty and avoidant after a few hours.

Is it possible that the brand name lamictal is the only thing controlling my depression right now? I am having trouble determining if it is lifting my depression or puting me into a mixed, hypomanic state? I know this is rare but I have friends who suffered mixed states on lamictal.

I am waking up depressed every morning now until I take my medications, if that is useful information.

Thanks for your thoughts.
doctor
Answered by Dr. Seikhoo Bishnoi 13 hours later
Brief Answer:
Lamotrigine is safe if manic switch is considered

Detailed Answer:
Hello again, thanks for asking again

We can see slight difference in pharmacodynamic properties between Lamictal and Lamotrigine generic. But overall Lamotrigine is a good drug for bipolar depression. I don't think the drug can cause mania switch or could cause mixed mood states. In some individuals the drug is known to cause brain fog like symptoms but in high doses like 200 mg per day.

Slight worsening of symptoms can be dose related but this can't be drug related. You are taking these drugs regularly and if the worsening of mood is there in day time then this means that depression is still persisting.

In such case the dose adjustments should be done. The dose of Tianeptine in coming weeks can be increased. The increased doses would make better symptoms control and the racing thoughts will decrease. Lamotrigine too helps in controlling the racy thoughts so there is no need to get worried for that.

Lamotrigine is controlling depression but at the same time Tianeptine too is working in improvement of symptoms.

Remain relaxed, Lamotrigine will not put you in depressed mixed state. The drug is great drug for resistant depression and bipolar depression.

Please don't hesitate to ask again for more clarifications.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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