[Odee]

So, anyone who has ever read me say anything on these forums likely knows I've been on Lamictal for almost a year.

The addition seemed to be so promising at first that I dropped the antidepressants I was on at the time to focus primarily on the mood stabilizer. My Pdoc warned me that Lamictal was often not enough, especially for someone with Bipolar 2 symptoms that matched mine. I have avoided adding anything else to what I take for several months, insisting that I wanted to maximize the effectiveness of lamotrigine and simply to increase the dose. I have been on Lamotrigine monotherapy since last July, the only variance being the past two months where I tried to add Trazodone for sleep.

It has become obvious to me now that the monotherapy isn't working. I have dipped into low depressions lately and high anxiety. I believe that I've just begun to feel as bad as I did before the lamictal. I've accepted that I need something else, and I will be talking to my psychiatrist next week. She does not want to increase Lamictal at all anymore. She has been insisting on adding buproprion.

I would just like to know what other people's thoughts and experiences are on adding to lamictal and what made the med truly effective. Where do I go when Lamictal alone is not enough?

I am BP2 with predominately depressive and anxious symptoms. I experience symptoms much like generalized anxiety, ADHD/ADD, and panic disorder.

[Victoria'smom]

My husband takes 20 mg celexa. I tried that eventually settled on viibryd.

[BlueInanna]

I took Welbutrin/Buproprion for awhile with some success... but that's not likely going to work forever either, even if it helps. Do you have a t, have you tried different types of therapy? I feel like, for me, the therapy I've had, talk therapy on here, and calm home/work (ha, not always possible) environments are the best medicine.

[vjdragonfly]

Lamictal was added to my med concoction a while back. I have noticed a significant difference in how I feel. The thing is, with bipolar, everything is touch and go. I was diagnosed back in `07 and within the last year gotten to a place where I feel good. You never know if you don't try. I hope you are able to find a concoction that works well for you.

[Confusedinomicon]

I think that a therapist would be the way to go. Therapist will help you understand the anxiety and teach you ways to counteract it.

Adding buproprion could help, but it wouldn't be instant.

[Odee]

I guess the consensus is that I need to be focusing on therapy as well. I am living with my parents over the summer this year, namely to be closer to the psychiatrist and my mom insists that I need to stick around with the goal to become stable. I will have to talk about getting a therapist this summer if possible, though I have never experienced any good results from therapy in the past.

The anxiety especially I feel is very psychological but I feel like the depression seems out of my control.

Yes, I understand, Odee. I hope your relationship with your parents is good, because if problems exist they could trigger your depression.

I took Lamictal, too, but gradually developed an intolerance to it so that even 15 mg would
push me into mild hypomanic state. One was enough. I dropped it, and because
I had made recommended changes in my diet, my pschiatrist recommended just
taking an aspirin.

I feel sure you've heard this before, but these are the things I was told by my
pschiatrist to do (and if you're sensitive to any of them, you should remove them from your diet completely.)

1. Do not eat or drink anything containing caffeine; it makes bipolar illness worse.
That would include coffee, tea, chocolate (which has theobromine, a first cousin to
caffeine, and reacts more negatively with me than caffeine), and anything else that has caffeine in it.

2. Do not drink alcohol; it makes bipolar illness worse. It's a depressant that you
need to avoid completely. Your brain will appreciate it, and so will your feeling tone.

3. Take your meds.

4. Maintain a regular sleep schedule if at all possible.

Over the years some other things have proved helpful for me; they might work for you, too.

1. The use of the "lemon thing" when tension is high. Squeeze two fresh lemons into 8 oz of water; drink it. If you aren't better in 4 hours, repeat the process; that should relieve the acid symptoms that build from meds and a diet that has too many acid-digesting foods in it. (There are websites that list alkaline and acid foods which you might wish to refer to.)

2. Keep a slightly more alkaline state of fluids and tissues, cutting back on red meats, sausages, anything that is beef, pork, liver, etc. Avoid wheat, milk products, including
cheese, cream, sour cream, milk, ice cream, etc. Ice cream is particularly bad for us.

3. Eat more green vegetables and salads. (Have a large salad daily.)

4. Do not drink sodas. They are extremely acid and aspartame (an artificial sweetener is extremely acid-reacting in the system, not to mention the negative
effects of caffeine in some of them.)

5. Add Omega 3's to your diet. Research now has proven that Omega 3's are helpful for improving symptoms in bipolar illness. I use Nordic Omega 3's, but there are many others out there that are equally as effective. About 2 or 3 capsules per day alleviates several problems in bipolar illness. (It was probably the most effective thing I did in a pro-active effort to correct the symptoms of the illness.)

6. Insist on having a regularly scheduled sleep schedule. Loss of sleep is as harmful as anything that can happen to us, in my view, in relation to bipolar symptoms. If
you have problems with that, please ask your psychiatrist for help until your system settles back into a calm modus operandi. Clonazepam (Klonopin) is very helpful for
me only on occasion.

7. Be gentle with yourself and avoid negativism as much as possible.

You should begin to see benefits in very short order, particularly if you start the Omega 3 fatty acids very soon.

Take good care of yourself, and you'll be fine.

(I take now only 10 mg. Prozac once a day and a food medication called Deplin., 15 mg. You might want to check that website and learn what it does for the system.)

I have BPII as well and recently added Wellbutrin to my Lamictal. I was taking only Lamictal for a couple of years and decided I needed something for the ongoing depression/ anxiety. I had hesitated about adding a AD to the mix because of past experience with it causing hypomania. It's only been a few weeks but I am feeling better with no side effects.

[Odee]

Roxie: I am happy that the buproprion seems to be helping you right now. Also; cute puppy in your sig! I'd love to have a Rottie.

Genetic: Thanks for all the advice. I have a habit of drinking lemon water at work, so maybe I'll keep at it.

Everyone: I just talked to my mom about regular psychiatric visits over the summer plus likely every other week visits with a therapist, potentially in the same building that my psychiatrist is in. Actually, I will be switching psychiatrists soon as well, but in the same building and my mom insists there is a guy who "gets it." (She worked for a clinical trial in this department, she's a neuroscientist so she is very understanding though with high expectations for me.)

[thebelljar12]

Originally Posted by Odee

So, anyone who has ever read me say anything on these forums likely knows I've been on Lamictal for almost a year.

The addition seemed to be so promising at first that I dropped the antidepressants I was on at the time to focus primarily on the mood stabilizer. My Pdoc warned me that Lamictal was often not enough, especially for someone with Bipolar 2 symptoms that matched mine. I have avoided adding anything else to what I take for several months, insisting that I wanted to maximize the effectiveness of lamotrigine and simply to increase the dose. I have been on Lamotrigine monotherapy since last July, the only variance being the past two months where I tried to add Trazodone for sleep.

It has become obvious to me now that the monotherapy isn't working. I have dipped into low depressions lately and high anxiety. I believe that I've just begun to feel as bad as I did before the lamictal. I've accepted that I need something else, and I will be talking to my psychiatrist next week. She does not want to increase Lamictal at all anymore. She has been insisting on adding buproprion.

I would just like to know what other people's thoughts and experiences are on adding to lamictal and what made the med truly effective. Where do I go when Lamictal alone is not enough?

I am BP2 with predominately depressive and anxious symptoms. I experience symptoms much like generalized anxiety, ADHD/ADD, and panic disorder.

Hi Odee,

I think we have very similar symptoms, except I started with too many meds. For a period of time I was just having the rapid thoughts, so I was taking ONLY lamictal for a year (maybe less), it helped so much with easing my thoughts, I actually had time to RELAX!

How many mgs of Lamictal are you on? I've heard that after a while, your body gets used to it, and that there may be a "maximum effective dose"..?

I would be careful with the wellbutrin because (unlike what one comment said) it can work FAST. I mean like within a few days.

I was taking my original antidepressant, Venlafaxine (effexor), for years. I was taking the maximum dose but it still wore off. I was also taking lamictal as a mood stabilizer. When I added on the wellbutrin, it flung me into a hypomanic episode that lasted months. It was absolute hell. I've heard that effexor can be dangerous for people with bipolar.

I am taking celexa now too, a low dose, but im still a little hypomanic.

Basically my point that Im trying to make is, please be careful with wellbutrin. It worked very fast on me, and got me to do some bad things, including vandalizing a car, to the point where i could have gotten arrested, when I was in a manic rage. It made me insane.

[Odee]

I am currently on 250mg of Lamictal. We went from 200mg to 250mg about two months ago. There hasn't been an increase in effectiveness. I don't know if 150-200mg had much of an increase either. I began Lamotrigine last summer and the titration was very slow primarily because I didn't schedule regular visits.

I have actually taken Wellbutrin for the better part of a year, when I was originally experiencing depression problems before I was diagnosed bipolar 2. I had never been on Wellbutrin and a mood stabilzer at the same time.

I feel as though I have a different expression of hypomania than others. If you want to read it, I wrote a description of it in this thread: http://forums.psychcentral.com/bipol...nce-poles.html

During the time I took Wellbutrin, it is very difficult to decide whether or not I had "manic" symptoms at the time. I could barely sleep and I was very anxious. However, and I'm not sure why anymore, my psychiatrist thought that this med was the most helpful for me, particularly because I talked about how it improved my focus which was very important education wise. Lately somnolence, lack of motivation, etc have been symptoms I have been dealing with, so she also asserts that Wellbutrin will be effective in the right way now that I am on a mood stabilizer.

However, anxiety has also been a big factor in how I feel, and Wellbutrin is supposedly not good for that.

The plan now is to just wait for next Monday's appointment, where I am sure that I will be receiving buproprion. Because that psychiatrist is moving, I will be finding a new one, that is step two. Step three is therapy. At least I have a plan now!

[Secretum]

I was on wellbutrin for about a year. It helped with my depressive symptoms a little. (And I mean just a little. I was still pretty depressed, even on wellbutrin). Your pdoc will probably be more apt to try wellbutrin over an SSRI because it is supposedly less likely to cause mania in people with bipolar. However, you already know that it makes you incredibly anxious. You should let your doctor know this. You have other options.

I am on a medication called "symbyax". It is a combination of two different drugs, zyprexa and prozac. Zyprexa is an AP with AD properties; prozac, of course, is an AD. It has really worked for me. So perhaps you could try adding an antipsychotic with AD properties, like zyprexa (or seroquel or abilify). Or, if you are really brave, you could try a really low dose of an SSRI. Be careful with this; SSRIs can cause weird reactions in bipolar patients, and I'm not just talking about mania. Lexapro increased my hallucinations and sui thoughts; I had to quit cold turkey.

Therapy is, of course, a great idea. Having social support is so important for people prone to depression.

Good luck and take care.