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FluffyDinosaur
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Default Mar 24, 2021 at 11:26 AM
  #1
What are some good PRN meds to augment monotherapy with lamotrigine in times of extra stress, such as when traveling? I know from past experience that stress is a major trigger for my episodes, especially when combined with sleep disturbances. My main goal is to prevent relapsing into depression in times when I can't avoid stress or sleep disturbances. I'm not yet certain whether the lamotrigine alone will be enough in those cases.

I'm definitely thinking something like lorazepam to counteract jetlag when I have to travel, but what else? Seroquel has been a relatively effective mood stabilizer for me in the past, and I suppose I could temporarily start it up again when I anticipate a time of stress, but if possible I would prefer something with fewer side-effects. Any recommendations? This thread is about meds but I do plan to use psychotherapy and non-medicinal coping methods as well, and of course to minimize stress in the first place.
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Default Mar 24, 2021 at 03:16 PM
  #2
The only type of med I can think of that truly works best for stress prn are the benzos. I think they're fine prn. The trick, of course, is not becoming dependent upon them by using them too frequently (like I did).

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Default Mar 25, 2021 at 03:44 AM
  #3
Thanks, I thought as much. The reason I mentioned Seroquel as well is as a sort-of extra "anti-depressant," but I don't know if it's really necessary if I already have lamotrigine. I would rather not take something like Seroquel again unless absolutely necessary, but I also don't want to risk relapsing because of something stupid like traveling for work. I've only ever taken benzos for sleep, so I don't know how quickly I would become dependent if I took them during the day also.
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Default Mar 25, 2021 at 09:00 AM
  #4
i don't have much to add but i Hope and Pray that you will be able to find what you're looking for. Do not give up though. Sending many safe, warm hugs to ALL of you guys and girls, @FluffyDinosaur, your Families, your Friends and ALL of your Loved Ones! Keep fighting and keep rocking NO MATTER WHAT HAPPENS, OK?!
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Default Mar 25, 2021 at 12:02 PM
  #5
Quote:
Originally Posted by FluffyDinosaur View Post
Thanks, I thought as much. The reason I mentioned Seroquel as well is as a sort-of extra "anti-depressant," but I don't know if it's really necessary if I already have lamotrigine. I would rather not take something like Seroquel again unless absolutely necessary, but I also don't want to risk relapsing because of something stupid like traveling for work. I've only ever taken benzos for sleep, so I don't know how quickly I would become dependent if I took them during the day also.

In my experience, and from what I've heard from others, it takes about a month to become dependent upon a benzo. Of course, Seroquel isn't without its dependency issues, too. At my pdoc's request I started using 12.5mg of Seroquel for sleep. That was in the fall. Now here I am, stuck with not being able to sleep without the Seroquel.

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Default Mar 25, 2021 at 02:47 PM
  #6
The two medications you mentioned serve me well. I have Ativan as a prn, but it's one I rarely take, nowadays. But it does indeed help with situational anxiety! For longer-lasting stress/anxiety, some extra Seroquel prn (or an increase in my base Seroquel XR) has worked great.

I take 600 mg of Seroquel XR (generic) daily, at night with 600 mg Tegretol XR (generic). Each morning, I take 100 mg generic Lamictal. When I mention Seroquel prn above, I refer to my supplies of the instant release (iR). As a prn, I might take between 25 or 50 mg a shot, up to 150 mg total in a day (beyond my base XR dose), but that's only when mixed states, or similar symptoms, are brewing...or sometimes even for anxiety, which it does help curb.

Insomnia:
If I can't sleep on the 600 mg XR, generally the extra iR small doses do relatively little to help. I confess I then might add a 1 mg Ativan as a booster. Maybe being a totally different med makes the extra difference? I know small doses of Seroquel iR help many people sleep, though.

Low Energy Depressed:
If I'm purely depressed, prn iR may or may not help during the daytime. Often lowering my base Seroquel XR does more good for that, taking me closer to the recommended 300 mg for depression control vs. higher doses for mania control. If anxious during the day, I tend to choose Ativan for anxiety since unlike at night, it doesn't sedate me during the daytime.

Mixed Mania or pure Hypo or Mania:
If I am high energy in any way, the Seroquel iR prn is the best choice. That or an increase in my base XR. The added amount won't usually make me tired. Just "Coooooooooool Jaaaaaazz", at the most. Or stabilization. Ativan does little for my mania, unless I take a huge enough dose, which I wouldn't. It has been administered in larger doses in injection form, in the psych hospital. That's for the nurse/doctor to do. Not me. At high doses, Ativan will knock me out during the day,

Really, it's something you'll have to feel out for yourself.

Last edited by Soupe du jour; Mar 25, 2021 at 03:01 PM..
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Default Mar 26, 2021 at 12:09 AM
  #7
Okay, thanks all, sounds like I wasn't too far off with my first thoughts!
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