Combo of medication and boosting efficacy

Hi. Can anyone tell me if some combinations work perfect together and not at all as monotherapy? In the past i took lamictal and effexor for depression but without effexor lamictal was nothing. Now i take risperidone and recently added valproate which in the past i took it as monotherapy at low doses and nothing happens. Now i take max dose with optimal therapeutic levels with risperidone low dose. Is there a chance that things can change for the best? Also a couple days ago doc removed my antidepressant because i started having hypomania and valproate didnt do anything to protect from hypo or mania because i just started it. So i dont know if antidepressant made things worse or i should wait for valproate to kick in and take again the antidepressant. Im confused. So tell me opinions and advices. I hope valproate with an atypical antipsychotic like risperidone will make the difference. Thank you!

Welcome, GBigi95!

Truth is, finding the right medication(s) does usually involve trial and error, and what works for one may not work for another. Also, sometimes what works at one period of time may not work best at another, and vice versa. Waiting to find out does often require patience. That's why psychiatrists don't quickly change mixes before a fair shake.

I found Depakote to be a very good antimanic when taken with an antipsychotic. It wasn't, for me, that good with depression, but I've heard people say the opposite. I know some people who also need an antidepressant with a moodstabilizer (or antipsychotic) to fight depression. Any antidepressant, regardless of the medication cocktail, makes me unstable.

Keep being honest and sharing a lot with your psychiatrist, to let them make the decisions. That's what we have to do. Give the extra Depakote a bit more time before deeming your mix ineffective.

Add on: Sometimes what has worked fairly well for me was not side effect friendly. It's a shame that that can decide on a medication, too. Overall, Seroquel XR (quetiapine prolong) has been the lesser of the evils for me. It's been good as an anti-manic, antidepressant, anti-mixed states, anxiety control, and sleep aid.Unlike other APs, it's never given me akathisia, other EPS, hypoprolactinemia, nor other side effects. It hasn't been "weight friendly", but others were much worse. It is a bit sedating, but that's lessened a lot over time. As much as I've complained about it, all in all that was/is good for me, as I was always too hyper in the past, in a bad way.

You could be correct in both, GBigi95: it is possible the AD set you off, it is also possible the mood stabilizer (valp, depakote) has not reached peak levels in the blood stream.

You are doing the right thing, trying things with your doctor, being observant, you'll get there.

Just a note if you experience EPS: I would consider other antipsychotics. Although Risperidone is technically a second generation agent, it is most like first generation agents as second generation agents go in that it has a heightened propensity towards causing EPS.