# Just started Lamictal, now what?



## sydneyarnce (Dec 2, 2015)

So, I was on Prozac for about 10 months and it did wonders for my constant panic and I think it sort of helped with some OCD. But now my anxiety is just about completely gone, all I am is numb all the time. There's no thoughts in my head so I don't even have the ability to really fear anything if that makes sense. I'll take my anxiety back, just take this numbness away!!

So with that, I stopped Prozac about a week and a half ago and got on Lamictal (which I'm very excited about, so please no negativity) about 4 days ago.

I'm feeling irritable coming off the Prozac (I've been on SSRIs for 7 years straight, and it's going to take a bit for my body to adjust)

I have seen sooooo many doctors and therapists and no one in my area (Oregon) knows anything about DPDR...
So I'm coming to you guys. My fellow suffering beautiful gumdrops. 
Once I get to 100mg, depending on the effects of the Lamictal alone, I'll want to add an ssri because everyone says that's what works the best. I don't want to risk an ssri numbing me out more than I already am,
SO I need advise. Any SSRIs that work particularly well with Lamictal? SSRIs that aren't super numbing? Possibly a dumb question...

You guys are my doctors. I trust you people more than anyone I've seen, so any feedback is appreciated. 
K love you, bye


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## sydneyarnce (Dec 2, 2015)

^^^^


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## luctor et emergo (May 22, 2015)

*Glutamatergic Drugs & NMDA Agonists*
A completely different approach to DP treatment involves using drugs that have an inhibitory effect on the glutamate neurotransmitter system. This system has long been thought to play a role in DP. The most commonly used glutamatergic drug for DP has its primary use elsewhere in medicine as an anti-convulsant (also known as an anti-seizure or anti-epilepsy drug).

*Glutamatergic Anti-convulsants (Anti-seizure Drugs)*
examples: *lamotrigine* (Lamictal)*, topiramate* (Topamax) and *levetiracetam* (Keppra)

Lamotrigine is the major player in this group. I'm unaware of any real evidence for the use of anti-convulsants other than lamotrigine. That's not to say the others definitely won't work but I'm going to focus on lamotrigine because it has been the subject of high quality research. Despite a promising early case series in which 4 patients responded to lamotrigine on its own, the only clinical trial of lamotrigine as a standalone treatment was very negative (0 out of 9 responded). Based on this early evidence, it appears that lamotrigine on its own might not be enough for many people.

Lamotrigine seems to come into its own when used in combination with an SSRI (usually citalopram). You don't have to feel any effect from the SSRI before taking lamotrigine. To benefit from the combination, you just need to be taking an SSRI at a reasonable dose for a reasonable amount of time. When you combine a therapeutic dose of citalopram with lamotrigine, the effects appear to be synergistic for reasons that are currently unknown. The two trials of the anti-depressant/lamotrigine combination found that 50-70% of people experienced a reduction in the severity of their DP symptoms. These numbers are amongst the best and the combination is now prescribed as standard procedure by the King's College DP research unit (so frequent was this practice that at one point the combination of lamotrigine and citalopram was referred to as the "U of London combo" on this forum).

We can't draw conclusions about the efficacy of lamotrigine as a standalone treatment just yet but it certainly seems like lamotrigine is significantly more effective when taken in conjunction with an SSRI. If you can tolerate an SSRI, there's no reason not to use the combination. If you can't tolerate an SSRI, lamotrigine may still be worth trying even without one (a single negative result in a small-scale trial is not conclusive). As a sodium channel blocker, lamotrigine has a broad range of effects (and potential side-effects) that you should be aware of. Of all the medications on this list, lamotrigine is probably one of the least well-tolerated. If you can't tolerate SSRIs and have other options, you might wish to explore those before trying lamotrigine as a standalone medication.

+ watch out for TDX's topic, he is going to try and record his Lamotrigine trial in about 30 days.


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## Fatoush (Jan 15, 2016)

Lamictal really stabilized me but I'm happy so I don't need a ssri


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## Fatoush (Jan 15, 2016)

It takes a couple months to actually kick in, you feel the affects but you don't feel the actual stability until later down the road


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## nfishe0882 (Feb 5, 2016)

I'm currently starting Prozac after withdrawing from Paxil, so I can definitely relate to the withdrawal feelings. Paxil is by far the worst drug to withdrawal from. As far as your post, I can only speak from my experience. Lamotrigine made me extremely anxious and gave me severe migraines, so I couldn't keep taking it. Best of wishes. Many people swear by that drug.


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