# Lamictal May Be Helping



## Guest (Dec 5, 2009)

I was put on Lamictal about 10 days ago and in the first few days it REALLY helped. By day 5 I was feeling really happy and hopeful. My dp has gone back to where it was before (because of environmental factors and probably the fact that the medication has started to level out in my system and I need to increase the dose). I have noticed in the past couple of days that some major changes are occuring. The first being that my vision is normal (pre dp vision). With dp my vision is usually flat and 2-d. That is gone. I also have started to remember a lot about my life before dp and feel the emotions connected to those memories. This is something that was impossible before. With dp I could remember very little of my life before dp and what I did remember felt like I was recalling something out of a book I once read. None of it seemed like it really happened to me. I would have maybe one or two memories here and there. In the past couple of days it has been like the flood gates have opened and I have reconnected to my old life. I remember more things than I could list, I can feel emotions connected with those events, and I know that those events did happen to me. They don't seem unreal anymore.

Right now I am on 25mg of lamictal daily. Because of the type of medication it is, you have to increase your dose slowly at 14 day intervals. The therapudic dose is 200 mg a day so I have a lot of room to move up before I will be at the therapudic dose. I initally had only one side effect, akathisia, which has since gone away. I am about 4 days away from being able to increase my dose and fully plan on doing so. I also read an article last night by dp researches in the UK who have found the Lamictal is a very good drug for treating dp and seems to be even more effective when used in combination with an ssri. http://apt.rcpsych.org/cgi/content/full/11/2/92

Anyways, like I said, I am having pretty bad dp/dr right now but I am also am having positive effects from the medication and feel like any small step toward recovery is reason for hope and to celebrate. There are far too few success stories on here and it leaves the rest of us without hope. So if I can give a little hope, I will.


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## guest123 (Dec 2, 2009)

There are a lot of success stories, just none that involve a 'magic' answer ( because there isn't one)

I read that paper a while back, I also took it in to my local psychotherapy unit and to my doctor and psychiatrist, however it was pretty inconclusive in terms of scientific studies, it is meant more as a summary to guide the medical profession in diagnosis, I think as the below states...



> Recognising and diagnosing the condition may in itself have therapeutic benefits. Many patients express the sense that their problems are baffling and perhaps even unique ? a recurring theme among patients attending our specialist depersonalisation clinic is the relief of discovering, first, that their problem is recognised and described by psychiatry and, second, that they are not the only individuals to suffer from the condition. For this reason alone, patients may benefit from referral to a specialist clinic. B*ut we also hope that dissemination of information on depersonalisation through articles such as this will enable general psychiatrists to feel more confident about diagnosing and treating the condition.*


Lamotrigine is an interesting one but unfortunately, the only placebo-controlled study showed no significant benefit as compared to the placebo. The previous study which showed some improvement wasn't controlled, I believe. This is as regards Lamotrigine on its own, however - I don't think it has been fully tested with an SSRI, at least not officially, although that paper is about 4 years old so it probably has since then.

The theory behind lamotrigine is that it inhibits the release of glutamate (an excitatory neurotransmitter in the brain) - the reason being that ketamine, which is a dissociative anaesthetic, increases release of glutamate by antagonising NMDA receptors - therefore if lamotrigine has the reverse effect, perhaps it can reduce dissociation. However this is highly theoretical and in reality, the mechanisms are rarely that simple in terms of reversing effects.

I would be more inclined to get excited about naloxone myself. Here's a quote from a study that looked at its effects on DP and it is much more promising than the lamotrigine study:


> In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization.


(Naloxone is an anti-opioid drug and it is thought that increased activity of the opioid system contributes to dissociative symptoms)


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## arxiloxos (Nov 16, 2009)

The naloxone study was also open-trial, not placebo-controlled. There hasn't been a placebo-controlled study to date on naloxone or naltrexone for dp.

tinyfairypeople, I also just started lamictal nearly two weeks ago. I haven't noticed anything yet, but I'll be increasing my does to 50 mg in a few days. I definitely want to hear how you do on it!


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## guest123 (Dec 2, 2009)

arxiloxos said:


> The naloxone study was also open-trial, not placebo-controlled. There hasn't been a placebo-controlled study to date on naloxone or naltrexone for dp.
> 
> tinyfairypeople, I also just started lamictal nearly two weeks ago. I haven't noticed anything yet, but I'll be increasing my does to 50 mg in a few days. I definitely want to hear how you do on it!


Yeah, that was my point, there HAS been one for lamictal which basically said it had no more effect than a placebo.


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## arxiloxos (Nov 16, 2009)

True, although the lamotrigine study only had 9 subjects, so it's hard to say definitively that it can't be helpful. And a 2006 study with 32 subjects found that it had an effect as an add-on to an SSRI, so it seems like it's worth a shot. Although personally, SSRIs made things far worse and blunted my emotions far more than the DPD alone, so I'm just trying the lamotrigine alone.


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## guest123 (Dec 2, 2009)

arxiloxos said:


> True, although the lamotrigine study only had 9 subjects, so it's hard to say definitively that it can't be helpful. And a 2006 study with 32 subjects found that it had an effect as an add-on to an SSRI, so it seems like it's worth a shot. Although personally, SSRIs made things far worse and blunted my emotions far more than the DPD alone, so I'm just trying the lamotrigine alone.


I hadn't read that paper, been away and had a look, the trouble is that even 32 is still a tiny pool to test.

I'm still of the belief that most people don't need medication unless they have a co-existing disorder such as GAD or depression, personally. This is kind of proven by the fact that medicine rarely has much effect. The few cases where it does, well, perhaps the sufferer had an underlying conditon that the medicine helped? In the case of lamotrigine, maybe mild temporal lobe epilepsy (it can go undetected, I believe) or even bipolar. It also is thought to fix neurotransmitter imbalance, which is interesting as regards the fact that people have had some success with supplementing neurotransmitter precursors.

"One cognitive behavioral conceptualization is that misinterpreting normally transient dissociative symptoms as an indication of severe mental illness or neurological impairment leads to the development of the chronic disorder. This leads to a vicious cycle of heightened anxiety and symptoms of depersonalization and derealization"

For me, I think the above is true. I had a out of the blue grand mal seizure following years of drug abuse, just over 4 years ago now. It's only since I properly understood DP and could start to retrain myself not to be scared or impressed by it that it has started to go away. I see people on here day after day stressing about one symptom or the other, listing all the things they've felt that day etc, and it doesn't suprise me that they don't improve to be honest. I'm not saying it's their fault, just that it seems to be a highly self-obsessive disorder. It's easy to forget there's a world out there beyond the computer if you don't make yourself get out and experience it, no matter how hard it is. Many are the days I have spent more time hiding in the toilet than actually working, but gradually those days reduced and now I can't even remember the last time I had a day off cos of DP.....maybe last February? Which is good considering the first year of work I had like 34 sick days :roll: 
Firmly believe that unless you get out there and show your brain you're not scared/there's nothing to fear, then you won't improve.

Sorry about the mini rant haha 

Normally there is a balance kept between the sympathetic and parasympathetic nervous systems, but in long term chronic stress this balance can be disturbed and either one of the sympathetic or parasympathetic nervous systems can predominate over the other leading to stress related health problems.

Bit of blurb about fight or flight:



> THE FIGHT OR FLIGHT RESPONSE
> 
> When we perceive a real or imagined threatening stressor, the brain initiates the stress response by triggering a series of chemical chain-reactions that prepare the body for fight or flight. This reaction is a healthy, vital defense mechanism and triggers the release of hormones that affect every organ and system of the body. The hypothalamus, a collection of tissues in the brain, which then stimulates the pituatary gland in the brain which then stimulates the adrenal gland on top of each kidney to release its stress hormones. The stress response is the biological equivalent of a super charger on an engine.
> 
> ...


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## arxiloxos (Nov 16, 2009)

Don't apologize for the 'rant'  This website is about people exchanging information and support, after all. I appreciate being able to hear your views and experiences.

I agree that DPD typically appears to involve a lot of obsessive thinking about the condition itself. But I don't think everyone experiences this. In my case, I was severely depressed before I had DP, and although it's not clear when the DP started, there was a period when most of the "positive" symptoms of depression had resolved but I was still experiencing DP. I didn't obsess about the symptoms then; because the intense sadness and hopelessness were gone, I thought I had gotten better and simply set about trying to live my life. I had severe anhedonia, my concentration and memory were impaired, and the world seemed strangely flat and irrelevant. Still, I told myself (and others) that everything was fine now, and I dismissed those symptoms as being external "facts" about the world, not internally generated states. My depression started in adolescence, and it was only around age 20 (concurrent with my use of SSRIs) that the sadness and hopelessness started to ebb. So when I emerged into this new world that was strange and empty but not positively painful, I thought, "this must just be what the grown up world is like. Children feel intense joy and pleasure, and adults don't. Adults just get through the day. It isn't painful, it just doesn't feel like anything." I didn't obsess about the feelings because I didn't think of them as pathological. I thought of them as a part of life. I sometimes longed for childhood, when things had seemed vibrant and important and real, but since I was functioning quite well I didn't focus on it too much.

It was only later that I realized that anhedonia was not a part of life but a symptom of disorder. And it was later still that I realized that DP was a condition in itself and that life wasn't meant to be this strange and disorienting. That realization came after another bout of severe depression in which the feelings of unreality got even stronger, and the sense that I had a coherent self, or any self at all, got correspondingly weaker. This time, when the sadness had gone, I didn't think everything was suddenly okay, because it clearly wasn't. I still had all these symptoms that I recognized as symptoms. I had never heard of DPD though, so I thought I just had some form of atypical depression, or maybe brain damage of some kind. One night in desperation I googled 'world doesn't feel real' and came across this condition. And I was practically shaking as I read these accounts of DPD which unified so many aspects of my experience and explained so many symptoms that I hadn't even necessarily thought were related. I realized that nearly everything that was wrong was part of this disorder.

All that is just to say that at least in my case, I don't think DPD is fueled by obsessive thinking about it. I'm not saying that obsessing doesn't make things worse, but I had clear symptoms of DPD which I didn't spend much thought on at first because I didn't think they were symptoms. Coming to that realization was a gradual process that started with me eventually questioning, "Is this _really_ what life is like? Is it really this alien and emotionless?"

A lot of people on this board talk about doing the things you love in spite of DP, which sort of confuses me. I function well enough on a day to day basis, and I participate in activities I _used to_ enjoy, but I don't enjoy them now. Simeon (in Feeling Unreal) says that "hypoemotionality appears to be one of the core features of this disorder" (p. 122), but it's not totally clear whether that includes anhedonia. I'm really curious to know what proportion of people are still able to enjoy things, even if it feels like they aren't the ones enjoying it. (Although that sounds kind of paradoxical...) Or does the ability to enjoy things always fluctuate inversely with respect to how DP-ed they are?

What's your experience?


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## arxiloxos (Nov 16, 2009)

There, there's a rant of my own


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## guest123 (Dec 2, 2009)

Obsessive thinking definitely keeps DP alive, in my experience. However it tends to be when it is linked with anxiety/fear as this sends the message to the brain that there is something wrong/a threat.

Regarding the things you love, I think that is more about keeping busy and not letting DP stop you doing stuff, yeah not feeling love for things is part of the numbing, it can also be part of depression so perhaps there is still a bit of that lingering?


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## arxiloxos (Nov 16, 2009)

Could be, yeah. That's one of the things I'm trying to figure out. I mean, it's not important in and of itself, but it might guide me toward one treatment option or another. Is that not the case for you? You're still able to feel things even when DP-ed?


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## guest123 (Dec 2, 2009)

Well no, that's the very nature of it - as a process, it's designed to separate you emotionally so that you can be objective in the face of a threat - unfortunately it's an outdated system, but hey, nature ain't perfect - look at the spine, you'd NEVER design it that way, but because we evolved from species that were quadrupeds, it's had to adapt from that design as best it can.


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## Sleepwalker (Dec 4, 2008)

[quote name="tinyfairypeople"]I was put on Lamictal about 10 days ago and in the first few days it REALLY helped. By day 5 I was feeling really happy and hopeful. My dp has gone back to where it was before my vision is normal (pre dp vision). With dp my vision is usually flat and 2-d. That is gone. I also have started to remember a lot about my life before dp and feel the emotions connected to those memories. This is something that was impossible before. With dp I could remember very little of my life before dp and what I did remember felt like I was recalling something out of a book I once read. None of it seemed like it really happened to me. I would have maybe one or two memories here and there. In the past couple of days it has been like the flood gates have opened and I have reconnected to my old life. I remember more things than I could list, I can feel emotions connected with those events, and I know that those events did happen to me. They don't seem unreal anymore.

I can empathise with you completely, tinyfaifypeople.
In a nutshell, Lamictal has been my savior (with some help from Clonazepam)--maybe from even suicide; resurrected me from a life in bed; of exhaustion, anxiety, memory blurrring, non-existent concentration, working memory.....
It kicked in, after tiny incremental increases, at 200mg/day. That was in 2004 and after 28 yrs or so of dp. Since then, I have been functional--albeit ,barely. I'm still not satisfied and continue searching.
I hope it works (or worked) for you. I'm just too tired right now to search your follow-up
Cheers.


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## Guest (Dec 31, 2009)

I only took it for 3 weeks because of the side effects. I am now completely dp free and still have dr but its only about 10 to 50 as intense as it was before. I really believe that the lamictal corrected the chemical imbalance enough for me to start to recover. A month ago I couldnt get out of bed and now im driving and starting college classes in a few days. I have all my emotions and memories back. I only have slight brain fog. I feel like 75 % better.


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## guest123 (Dec 2, 2009)

that could well be the case, TFP. one of it's hypothesised methods of action is that it rebalances neurotransmitters in the brain


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